State-by-State Estimates of the Number of People Eligible for Premium Tax Credits Under the Affordable Care Act
Issue Brief
Recent legally residing immigrants with incomes below the poverty line are treated as if their income were at the poverty line, making them eligible for premium tax credits.
Health plans sold in the individual market in a state all have essentially the same benefits. Plans are organized into five tiers based on the amount of cost sharing (e.g., deductibles, copayments, coinsurance) they have. The five tiers are catastrophic, bronze, silver, gold and platinum. For more information, see https://www.kff.org/wp-content/uploads/2013/01/8303.pdf.
We did not remove current nongroup purchasers with an offer of employer-based coverage from the potential market total. These people have already made the decision not to take employer-provided coverage and to purchase nongroup coverage.
Methods
Because some states have chosen to take the optional Medicaid expansion under the ACA and others have not, people with incomes from 100 to 138 percent of poverty will have different forms of financial assistance dependent on the state’s decision. These people will be eligible for Medicaid in states taking the expansion but will potentially eligible for premium tax credits in states not expanding Medicaid.