Cost-sharing reductions limit the out-of-pocket costs for EHB (Essential Health Benefits) covered by QHPs (Qualified Health Plans) such as deductibles or coinsurance, an individual is responsible for as part of their coverage under a QHP.
To be eligible for cost-sharing reductions, individuals must:
There are several categories of cost-sharing reductions that are based on annual household income and family size. Each QHP issuer will implement these differently, based on their specific plan design. When an individual is determined eligible for a category of cost-sharing reduction, the plan comparison pages will reflect adjusted cost-sharing requirements of each plan. See the plan details for the cost sharing adjustments.
A consumer’s summary of benefits and coverage will summarize the health plan’s benefits that apply to the QHP before taking into account financial assistance the enrollee may receive in the form of cost-sharing reductions. If a consumer is eligible for cost-sharing reductions, the cost sharing (for example, deductibles, coinsurance, or copayments) may be lower than what the consumer sees on his or her summary of benefits and coverage. Consumers who are eligible for cost-sharing reductions can review the cost-sharing information available on the Federally-facilitated Marketplace website or in their health plan’s plan documents to see what their cost sharing might be.
Next Topic: Medicaid And CHIP
Agents and Brokers are required to be trained to assist consumers with the application and decision making process. Using an Agent to enroll in a ObamaCare Health Plan will be the primary choice of many americans. After all agents have the inside track on companies and their promptness to handle claims and pay benefits in atimely fashion.
Next Topic: Coverage Basics