If they make $30,000? What if they make more, and smoke?
well, i did a simple search and the avg disability check per person in PA, is $1100 a month, so let's say her family fixed income is $26000 cuz both she and her husband receive full disability from SSI, so even less than the 30k i first estimated..... as far as whether she is a smoker or not, the exchange in Maine, which allows insurance companies to increase your premium if a smoker, has a non profit insurance co on the exchange that gives no penalty for smoking, while the other insurer on Maine's exchange does charge 30% more for the individual smoker's portion, if in a family plan....so it is possible, if she is a smoker, there are plans on PA's marketplace that do not increase premiums for smokers, just like Maine.
here is what the Kaiser calculator estimates for this couple on a $26,000 a year income
Results
Note that regardless of whether your state expands Medicaid, children at this income under the age of 19 are likely eligible for coverage under Medicaid or the Children's Health Insurance Program (CHIP), depending on your state's eligibility requirements.
If your state expands Medicaid
If your state chooses to expand Medicaid to everyone under 138% of the poverty level under the ACA, you will be eligible for coverage under the program. Medicaid coverage varies from state to state, but out-of-pocket costs are generally modest. Smoking status is not taken into account in Medicaid eligibility.
If your state does not expand Medicaid
If your state does not expand Medicaid, you will be eligible to purchase subsidized coverage through the exchanges.
The information below is about subsidized exchange coverage. Note that depending on your state's eligibility requirements, you may still be eligible for coverage through Medicaid.
Household income in 2014:133% of poverty levelUnsubsidized annual health insurance premium in 2014: $10,668 Maximum % of income you have to pay for the non-tobacco premium, if eligible for a subsidy: 3.01% Amount you pay for the premium: $782 per year
(which equals 3.01% of your household income and covers 7% of the overall premium) You could receive a government tax credit subsidy of up to: $9,886
(which covers 93% of the overall premium)
The premium and subsidy amounts above are based on a Silver plan. You have the option to apply the subsidy toward the purchase of other levels of coverage, such as a Gold plan (which would be more comprehensive) or a Bronze plan (which would be less comprehensive).
For example, you could enroll in a Bronze plan for about $0 per year (which is 0% of your household income). By enrolling in a Bronze plan, you would receive $8,801 in subsidies, which would cover the entire amount of your Bronze premium. For most people, the Bronze plan represents the minimum level of coverage required under health reform. Although you would pay less in premiums by enrolling in a Bronze plan, you will face higher out-of-pocket costs than if you enrolled in a Silver plan.
Out of Pocket Costs
Your out-of-pocket maximum for a Silver plan (not including the premium) can be no more than $4,500. Whether you reach this maximum level will depend on the amount of health care services you use. Currently, about one in four people use no health care services in any given year.
You are guaranteed access to a Silver plan with an actuarial value of 94%. This means that for all enrollees in a typical population, the plan will pay for 94% of expenses in total for covered benefits, with enrollees responsible for the rest. If you choose to enroll in a Bronze plan, the actuarial value will be 60%, meaning your out-of-pocket costs when you use services will likely be higher. Regardless of which level of coverage you choose, deductibles and copayments will vary from plan to plan, and out-of-pocket costs will depend on your health care expenses. Preventive services will be covered with no cost sharing required.
Other Coverage Options
Children and young adults under age 30 are eligible to purchase catastrophic coverage. With a catastrophic plan, you would pay out-of-pocket for most health services until you reach the annual limit on cost sharing ($12,700 in 2014). However, preventive services are covered with no cost sharing required.
Children under the age of 19 may also be eligible for coverage under Medicaid or the Children's Health Insurance Program (CHIP), depending on your state's eligibility requirements.
Oh the irony
