2014 Federal Poverty Guidelines Released

Under ACA, eligibility for Medicaid and premium-reduction subsidies for exchange policies is governed by the poverty guidelines for the policy year.   The 2014 guidelines are now available and can be viewed at: http://familiesusa.org/product/federal-poverty-guidelines

In the Medicaid expansion states, individuals and families who fall under 133% of the  poverty line will receive coverage through Medicaid.   Those whose incomes are between 133% and 400% are eligible for subsidies and/or a tax credit when purchasing insurance through an exchange.

In states that have not expanded Medicaid,  individuals and families are eligible to purchase subsidized insurance from an exchange so long as their anticipated income is at or above the 100% poverty level.

If a taxpayer is approved to receive a subsidy by an exchange, but their total income for the year as reported on their 2014 return falls below the 100% level, their tax credit will be computed as the value that would apply if their income was exactly 100% of the FPL.  Continue reading

HealthSherpa Web site

Does navigating your government-created health exchange web site give you a headache?

Here’s a quick online tool to find the health care offerings in your area, including a tool to quickly estimate subsidies:


This is a free tool created  using public databases. No login required — all information can be quickly entered on the home page, with results appearing as the the data is entered.

(Created as a public service by three young and capable San Francisco-based computer technicians – see http://www.thehealthsherpa.com/about to learn more about them)


Today’s number: 17

17% of potentially eligible Americans visited Affordable Care Act marketplaces in October, according to a survey by the Commonwealth Fund.  Of those visitors,  20% were young people between the ages of 19-29, and 20% of those who visited actually enrolled in a plan.  60% of survey respondents were aware of aware of the purpose of the health care exchanges; of those that did not enroll,  37%  cited technical problems with the exchange web sites as the reason for not enrolling.

See:  http://www.commonwealthfund.org/Publications/Data-Briefs/2013/Nov/Americans-Experiences-Marketplaces.aspx

17 million individuals will qualify for insurance subsidies, according to an analysis by the Kaiser Family Foundation. This number represents nearly 6 in 10 Americans eligible to participate in the ACA health insurance marketplaces.   To receive a subsidy through the ACA, individuals must earn between 100-400% of the federal poverty line.  Most of the individuals qualifying for subsidies reside in Texas, California, and Florida.

See: http://kff.org/health-reform/issue-brief/state-by-state-estimates-of-the-number-of-people-eligible-for-premium-tax-credits-under-the-affordable-care-act/

Anthem California Provider Lists

Finding Anthem’s provider lists for California is something of a treasure hunt — you can’t do it from the home page. But, nonetheless, I found it (and no, I don’t know if these will be updated to include more providers or hospitals in the near future):

Select your plan network from the list below:
Pathway X and Pathway PPO – ON & OFF Individual Exchange – PPO Network 
Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Nevada, Plumas, Shasta, Sierra, Siskiyou, Sutter, Tehama, Trinity, Tuolumne, Yuba Counties
Marin, Napa, Solano, Sonoma Counties
El Dorado, Placer, Sacramento, Yolo Counties
Contra Costa County
Alameda County
Santa Clara County
San Mateo County
Monterey, San Benito, Santa Cruz Counties
Mariposa, Merced, San Joaquin, Stanislaus, Tulare Counties
Fresno, Kings, Madera Counties
San Luis Obispo, Santa Barbara, Ventura Counties
Imperial, Inyo, Mono Counties
Kern County
Riverside, San Bernardino Counties
Pathway X and Pathway Tiered – ON & OFF Individual Exchange – EPO Tiered Network 
Los Angeles County
Orange County
San Diego County
San Francisco County
Pathway X and Pathway HMO – ON & OFF Individual Exchange – HMO Network 
El Dorado, Placer, Sacramento, Yolo Counties
Fresno, Kings, Madera Counties
Los Angeles County
Orange County
Riverside, San Bernardino Counties
San Diego County
Santa Clara County