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Affordable Care Act (ACA or “Obamacare”) Eligibility Highlights

By: by the Pennsylvania Health Law Project

Pennsylvanians expecting to earn over 100% of federal poverty level (FPL) in 2014 are eligible for subsidized health insurance through the federal marketplace.

$11,490 is FPL for a single person BUT those making less than that but living with family members may be eligible under ACA’s expanded definition of “household.”

Premium subsidies are very generous for people at the low end of the income scale.

People between 100 and 250% of FPL ($11,490 - 28,725) also have their co-pays and deductibles subsidized.

Call the ACA navigator, Resources for Human Development, at 855-668-9536 for help with enrollment or to answer any questions. People can also go directly to the federal website, healthcare.gov.
People need to file a 2014 tax return to be eligible for subsidies for the cost of health insurance, deductibles, and/or co-pays.

If people miscalculate their projected income as over the poverty line but end up earning less than the FPL, they will not have to pay any money back. If people earn more than their estimate, they may have to pay some money back when they file their taxes.

People who earn under 100% of FPL are not eligible to buy subsidized insurance through the ACA marketplace. Unless they qualify for Medicaid, they are in a “coverage gap” and are in the same status as they were pre-ACA.

Medicaid has not been expanded in Pennsylvania, so the eligibility rules are the same as they always have been. The Corbett Administration has a proposal to expand Medicaid, but it has not yet been approved by the federal government. If approved, it would go into effect in 2015.

February 14, 2014