Affordable Care Act: Premium and Deductible Changes After Income Adjustments

Imagine you receive a health insurance plan through the Affordable Care Act (ACA) marketplace. Recently, you faced an income change that prompted you to update your ACA application. To your surprise, you noticed significant increases in your deductible and out-of-pocket maximum (OOPM) for the same plan you were enrolled in. This situation raises several questions about ACA health insurance and the impact of income on your coverage. We will dive into these important factors and provide clarity on this matter.

Deductible and OOPM Changes

The cost of your health insurance plan is determined by several factors, including your income. Your monthly premium may adjust based on changes in income to ensure that you receive the appropriate financial assistance from the government. However, it’s important to understand that ACA plans also consider cost-sharing subsidies that can affect your deductible and OOPM. These subsidies are available to individuals with incomes below 250% of the federal poverty level and are only applicable to silver-tier plans.

When you update your ACA application with a higher income, you may no longer qualify for cost-sharing subsidies. As a result, you will be responsible for the full cost of your deductible and OOPM. This can lead to a noticeable increase in these amounts, as you have observed in your situation.

Credit for Previous Payments

While the cost-sharing subsidies may change, it’s important to clarify that you should receive credit for any expenses you have already incurred towards your deductible and OOPM. In your case, since you have already met your $800 deductible under your previous plan, that amount should be applied towards the new $2,000 deductible. This means that you will only need to pay an additional $1,200 to reach your updated deductible.

Eligibility and Plan Selection

In some cases, an income adjustment may result in changes to your plan eligibility. It’s possible that the plan you were previously enrolled in is no longer available to you. If this is the case, you will need to select a new plan from the options provided in the marketplace. It’s important to carefully review the details of any new plan you choose to ensure that it meets your needs and budget.

Contacting the Marketplace

If you have any questions or concerns regarding your ACA coverage, it’s advisable to contact the Health Insurance Marketplace at HealthCare.gov. They can provide guidance and assist you in navigating any changes or selecting the most suitable plan for your situation. Licensed agents are also available to offer professional advice and help you understand your coverage options.