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COSTS AND ASSISTANCE WITH COSTS

Q 72: How much will plans offered through Maine’s Health Insurance Marketplace cost?

There will be a wide variety of plans intended to fit different budgets, both through Maine’s Health Insurance Marketplace and in the market outside the Marketplace. Also, many consumers will qualify for the new premium tax credits, which will pay for part of their premium and help lower the cost of coverage. To compare the specific costs of plans and an example of a family rate calculation, go to http://www.maine.gov/pfr/insurance/ACA_Index.html, call the Bureau at 1-800-300-5000, or talk to a navigator, certified application counselor, or insurance agent or broker.

Q 73: Will plans offered through Maine’s Health Insurance Marketplace have large out-of-pocket costs?

The available plans feature a wide variety of out-of-pocket costs, but all plans must limit consumers’ annual out-of-pocket costs to no more than roughly $6,350 for individuals and $12,750 for families in 2014. However, out-of-network services do not count toward these limits. These maximum out-of- pocket amounts will go up in future years.

There are separate out-of pocket maximums for stand-alone dental plans.

Plans also are required to cover certain preventive services without cost-sharing.  For  a list of these services, see http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm

Also, consumers whose incomes are below a certain amount may be able to buy a plan that features lower cost-sharing and lower out-of-pocket costs (copayments, coinsurance, and deductibles) without paying a higher premium. Check with Maine’s Health Insurance Marketplace at www.healthcare.gov. Navigators, certified application counselors, or agents or brokers should be able to help consumers learn if they qualify. Also, the Marketplace application will tell consumers whether they might be eligible for MaineCare, which has very limited out- of-pocket costs.

Q 74: Is there help for people who can’t afford coverage? Who’s eligible for subsidies?

New premium tax credits and cost-sharing reductions are available to help eligible consumers who buy a plan through Maine’s Health Insurance Marketplace. The amount of the tax credit or cost-sharing reduction depends on family size and income. Larger families and families with lower incomes get the most help. Tax credits and cost- sharing reductions aren’t available for individuals who are eligible for MaineCare, Medicare, or qualifying employer- sponsored coverage. More information about tax credits and cost-sharing reductions is available at www.healthcare.gov.

Q 75: Where can consumers go to learn if they’re eligible for help paying premiums or for Medicaid?

Maine’s Health Insurance Marketplace will determine eligibility for subsidies (also called, “advance payments of premium tax credits”) and cost-sharing reductions. They will also assess MaineCare eligibility and make a referral, if appropriate, to the Maine Department of Health and Human Services for a final determination.

Q 76: How do premium tax credits to buy coverage through Maine’s Health Insurance Marketplace work?

Consumers who qualify for the premium tax credits can use them at any time – they don’t have to wait until they file their taxes. The advance payment is sent directly to the insurance company the consumer chooses to reduce his or her monthly insurance premium. Consumers also have the choice to wait to use their tax credits until they file their taxes. They also can use just part of their estimated tax credit in advance.

Consumers who want to use their tax credit in advance need to be as accurate as possible in estimating the income they expect to have in the coming year. If they underestimate their income and the tax credit is overestimated, they may have to repay part of their tax credits at tax time.

Consumers need to update Maine’s Health Insurance Marketplace during the year about any changes in income, family size (like having a baby or adopting a child), or employment (like getting a job where health insurance coverage is offered). Maine’s Health Insurance Marketplace will change the tax credit amount to reflect the new information. A consumer who forgets to update the Marketplace might owe money at tax time or realize they could have been using a larger tax credit amount in advance.

Consumers who don’t use the tax credit in advance don’t have to tell Maine’s Health Insurance Marketplace about any changes to their income, or employment during the year. They can get the tax credit on their tax returns.

Consumers may go to Maine’s Health Insurance Marketplace website at www.healthcare.gov or 1-800-318-2596 for more information about tax credits. Navigators, certified application counselors, agents or brokers also are able to give consumers information about the tax credit.

Q 77: Are health insurance premiums and other health care costs tax deductible?

For taxpayers and their spouses younger than age 65, health care expenses and premiums greater than 10% of adjusted gross income (AGI) are currently deductible as an itemized deduction on Schedule A of the federal tax return. For taxpayers or their spouses older than age 65, the AGI percentage is currently 7.5%, but will increase to 10% in 2017. For more information, visit the IRS website at  www.irs.gov/Individuals/2013-changes-to-itemized-deduction-for-medical-expenses.

Last Updated: October 1, 2013