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Covered California Q&A

Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.


Premium Limits for Some

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Qiuestion: My husband and I are 60 and 58 years of age our income is $45,000 a year. When will we know how much will we have to pay for Obamacare per month?

Answer: I can tell you right now that your monthly premium will be no more than $356 for a silver level plan. I can tell you that because individuals and families whose income is less than 400% of the federal poverty level (yours is 300% 0f FPL) are protected by premium limits on the amount they will pay. Regardless of the final rates we’ll see in June, you will pay no more that $356 per month and your premium subsidy will make up the difference.

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On top of having a limit on your premium, you will also have a lower out of pocket limit. That is, the level an individual or family must pay before their insurance plan begins to cover all medical expenses. The baseline out-of-pocket limit on each exchange is equal to the out-of-pocket limit for Health Savings Accounts (currently $5,950 for individuals and %11,900 for families) and is lowered from that ceiling level according to where an income level falls in the range.

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