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How will health care reform help Jana and Tom?
Help is coming for Jana and Tom, but they’ll have to wait four years to get most of it.
In 2014 income-based subsidies to help pay for employer-based health insurance will be available based on a family’s income, with the federal poverty rate of $22,050 for a family of four as the guideline.
In Jana and Tom’s case their annual income of $36,000 as a family of two will guarantee that they pay no more than 8 percent of their earnings for employer-based health insurance. For Jana and Tom, that would be a maximum of $2,880 a year. The couple currently pays more than $11,000 a year in premiums. Even if their income climbs, they will still be eligible for some federal subsidies for employer-based coverage until their earnings exceed $58,280.
If Jana and Tom’s earnings fall to $19,378 or less they will be eligible for Medicaid coverage if employer-based coverage is no longer available. But again, this option won’t be available until 2014.
If Jana and Tom simply can’t wait that long for assistance, they could take a risk and go without coverage for six months, at which point Tom will be eligible for coverage through a high-risk insurance pool for people with pre-existing conditions, expected to be up and running by September 2010. His cost would be no more than $5,950 annually, though probably less because of subsidies to help low-income families.
New health insurance rules going into effect in 2014 will also help them out: Insurers will no longer be allowed to deny coverage based on pre-existing conditions. What’s more is they won’t be able to drop a customer once they get sick and will be barred from imposing lifetime payout limits.