Sunday, December 8, 2013

Comment la subvention pour le Maximum de leur poche...

Erreur lors de la désérialisation du corps du message de réponse pour l’opération « Translate ». Dépassement du quota maximal pour la longueur du contenu de chaîne (8192) lors de la lecture de données XML. Ce quota peut être augmenté en modifiant la propriété MaxStringContentLength sur l’objet XmlDictionaryReaderQuotas utilisé pendant la création du lecteur XML. Ligne 1, position 9202.  Buying health insurance is expensive, and paying the monthly premium isn’t the only cost involved with health insurance. You also have to pay deductibles, copayments, and coinsurance when you use your health insurance. These additional out-of-pocket costs, known as cost sharing, can add up to thousands of dollars per year.The Affordable Care Act created health insurance subsidies to make buying and using health insurance more affordable for people with low and modest incomes. There are two types:Subsidies that pay monthly health insurance premiums so buying health insurance is more affordable. Learn more about this in, “How Does the Health Insurance Subsidy Work—Understanding the Premium Tax Credit.” Subsidies that help pay out-of-pocket costs like deductibles, copayments and coinsurance. These are known as reduced cost-sharing subsidies and come in two parts: Part one reduces the amount you pay for your deductible, copayments, and coinsurance each time you use your health insurance. Learn more about this subsidy in, “How the Cost-Sharing Health Insurance Subsidy Works.” Part two reduces your out-of-pocket maximum so you pay less when your health care expenses are high.The out-of-pocket maximum, or the out-of-pocket limit, is the worst-case-scenario maximum amount you’ll have to pay toward cost-sharing expenses like your deductible, copayments, and coinsurance each year. Once you’ve paid enough in deductible, copayments and coinsurance to have reached the out-of-pocket maximum, your health insurance pays all your covered healthcare expenses for the rest of the year.If you don’t use your health insurance much, your cost-sharing expenses aren’t likely to reach the out-of-pocket limit. However, if you have an expensive chronic health problem or even a single catastrophic illness or injury, you could easily pay enough in coinsurance and deductible costs to reach the out-of-pocket maximum.For example, if you fall off of a ladder and break your hip while trimming a tree, your share of the emergency room, surgery and hospitalization costs could exceed $10,000 if your health insurance policy doesn’t have an out-of-pocket limit.However, if your health insurance policy has an out-of-pocket limit of $6,000, you stop paying once you’ve paid $6,000 toward your health care bills. After that, your health insurance company pays 100 percent of your health care bills for the rest of the year. You would pay $6000 rather than $10,000. If you needed more care later in the year, your health plan would pay the entire cost.The out-of-pocket maximum doesn’t include your monthly health insurance premiums. It doesn’t include expenses for things that aren’t covered by health insurance or aren't essential health benefits. For example, if your health insurance doesn’t cover acupuncture services, your acupuncture expenses won’t count toward your out-of-pocket maximum. It doesn’t include the balance-billed portion of care you got from an out-of-network health care provider.All individual and family health insurance policies bought through the Affordable Care Act’s health insurance exchanges must have an out-of-pocket limit. The federal government regulates how high that limit can be, and the allowed amount changes each year.For 2014, the out-of-pocket maximum can’t be more than about $6,400 for an individual or $12,800 for a family. A health insurance policy can, however, have an out-of-pocket limit lower than that.How much the subsidy reduces your out-of-pocket limit depends on your income. The closer your income is to the federal poverty level, the more your out-of-pocket maximum will be reduced. FPL changes each year and varies depending on family size and where you live.The FPL used to determine your 2014 subsidy is $11,490 for an individual, $15,510 for a couple, and $19,530 for a family of three. You can find the FPL for other years and family sizes here.Since both FPL and the federal limit on out-of-pocket maximum amounts change each year, the dollar amount of your reduction will change each year.For 2014, if your income is: 100-200 percent of FPL, your out-of-pocket limit won’t be more than $2,250 for an individual. your out-of-pocket limit won’t be more than $4,500 for a family.200-250 percent of FPL, your out-of-pocket limit won’t be more than $5,200 for an individual. your out-of-pocket limit won’t be more than $10,400 for a family.A special reduction is available for Native American Indians with incomes below 300 percent of FPL. In their case, the health insurer will eliminate all cost sharing for any of the essential health benefits.The out-of-pocket maximum subsidy doesn't actually give you money. Instead, it potentially saves you money since you pay less before reaching your out-of-pocket maximum.If you reach that reduced out-of-pocket maximum and continue to use health care services, your health insurance company will end up paying more for your care than if you hadn’t received the subsidy. In that case, the federal government will reimburse your health insurance company for the extra money it spent because of your subsidy.To be eligible for this subsidy: Your income must be 100-250 percent of FPL. (This could vary from year to year but won't exceed 400 percent of FPL.) You must get your health insurance through your state’s health insurance exchange. You must choose a silver-tier health plan. If you’re married, your tax filing status must be married filing jointly. A status of married filing separately will disqualify you. You must reside in the United States legally. You can’t be incarcerated.Apply for the reduced out-of-pocket limit subsidy at your state’s health insurance exchange when you shop for health insurance. You can apply for the other health insurance subsidies at the same time. Be prepared to give the health insurance exchange information about your income, family size, and employer if you have a job. Find your state’s health insurance exchange.Except for special circumstances, you can only buy health insurance through the health insurance exchange during the yearly open enrollment period. The first-ever open enrollment period is October 1, 2013-March 31, 2014. Thereafter, open enrollment will be from October 15-December 7 every year.If you get the reduced out-of-pocket maximum subsidy, make sure to notify your health insurance exchange if your income changes during the year. If your income decreases, you may be eligible to have your subsidy adjusted to further reduce your out-of-pocket maximum.The Affordable Care Act stipulates the out-of-pocket limit be reduced by 2/3 for people with incomes from 100-200 percent of FPL. 1/2 for people with incomes from 200-300 percent of FPL. 1/3 for people with incomes from 300-400 percent of FPL.However, that’s not how it ended up working. The Department of Health and Human Services determined it would be impossible to discount the out-of-pocket maximum that much for people making more than 250 percent of FPL without violating other parts of the law or causing an increase in the deductible for some subsidy recipients. So, in the final rule fleshing out how the subsidy will work, HHS changed those figures to reduce the out-of-pocket maximum by about: 2/3 for people with incomes from 100-200 percent of FPL 1/5 for people with incomes from 200-250 percent of FPL No reduction for people with incomes above 250 percent of FPL.HHS can make adjustments to these amounts each year when it publishes its “Notice of Benefit and Payment Parameters” for the coming year.Sources:The Notice of Benefit and Payment Parameters for 2014, Department of Health and Human Services, Accessed September 10, 2013.Actuarial Value and Cost-Sharing Reductions Bulletin, Department of Health and Human Services, Patient Protection & Affordable Care Act, section 1402 (c). Accessed September 9, 2013.Jost, Timothy, “Implementing Health Reform: The Benefit and Payment Parameters Final Rule” accessed on, September 9, 2013.

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