10 Key Questions on Public Option Proposals
10 Key Questions on Public Option Proposals – Issue Brief – 9388
Under the ACA, individuals with an offer of employer-sponsored coverage can still be eligible for marketplace subsidies if the employer plan fails to meet standards of affordability or minimum value. An employer-sponsored plan is considered affordable if the worker’s premium contribution for self-only coverage does not exceed 9.78% of income. An employer-sponsored plan meets minimum value standards if it has an actuarial value of at least 60%.
In the marketplace in 2020, the federal poverty level is $12,490 for an individual and $21,330 for a family of three.
The ACA sets a benchmark for covered benefits under marketplace QHPs based on the most popular small group health insurance plan on a state, or based on similar benchmarks that states may choose, such as the largest state public employee health benefit plan. While most plans that are sponsored by larger employers are considered comprehensive, they are not required to cover the essential health benefit package applicable to QHPs.
Under the Medicare buy-in proposals, people buying Medicare would be able to use cost sharing reduction subsidies to lower deductibles and add annual-out-of-pocket limits on other cost sharing under traditional Medicare.