What is the FFM?
- It is the Federally-Facilitated Marketplace and it has many roles:
- Certify Qualified Health Plans (QHPs)
- Provide consumer education on plans
- Establish a Navigator program to assist consumers
- Determine eligibility, tax credits/cost-sharing amounts
- Enroll consumers in private insurance and public programs
Who is eligible?
- Marketplace eligibility requires you to:
- live in the Marketplace's service area
- Be a U.S. citizen or national (or a non-citizen who is lawfully present for the entire enrollment period
- Not be incarcerated (can apply is pending disposition of charge)
- Eligibility for premium tax credits requires:
- Household income from 100%-400% of FPL (Federal Poverty Level)
- Ineligibility for other insurance through employer or other government program
Marketplace Affordability:
- Financial help available for working families includes:
- tax credits to lower the premiums qualified individuals pay (100%-400% FPL)
- premium tax credits
- advanced premium tax credits
- reduced cost-sharing to lower out-of-pocket spending for health care (250% FPL and below)
Premium Tax Credits
- Premium Tax Credit (APTC)
- the amount depends on:
- Actual household income as a percentage of FPL
- Family size
- Advanced Premium Tax Credit (APTC)
- You can reduce your premium amount up front by advancing payments directly to your insurer
- You choose the amount (up to the maximum)
- The amount is based on projected household income
- reconciled at tax time against the actual Premium Tax Credit amount you are eligible for
- Report income changed immediately to avoid an overpayment and balance due
Tax Credit Eligibility
- Household incomre from 100%-400% of FPL
- under the full Medicaid expansion anticipated by the ACA, all indivduals would be eligible up to 133% of FPL
- Household size:
- One
- 100%- $11, 490
- 200%- $22,980
- 300%- $34,470
- 400%- $ 45,960
- Two
- 100%- $15,510
- 200%- $31,020
- 300%- $46,530
- 400%- $62,040
- Three
- 100%- $19,530
- 200%- $39,060
- 300%- $58,590
- 400%- $78,120
- Four
- 100%- $23,550
- 200%- $47,100
- 300%- $70,650
- 400%- $94,200
Enrollment for Individual Market:
- Open enrollment periods:
- Intially: Oct. 1, 2013-Mar. 31,2014
- Annually (2014 & after): Oct 15-Dec. 7
Cost-sharing Reductions
- Eligibility for reduced cost-sharing is based on
- Incomes at or below 250% of the FPL (58,875 annually for a family of four in 2013)
- Receiving the new Premium Tax Credit
- Enrolling in a marketplace silver-level plan
Contact Information: