You qualify for helping paying your premium if your modified adjusted gross income (MAGI) is between 100% and 400% FPL of Federal Poverty Guidelines. In Georgia, 100% of poverty is $11,880 for a single person household, and $16,020, $20,160, and $24,300 for households of 2, 3, and 4 respectively. The rate goes up an addition $4,140 per each additional member of the household. 400% of the Federal Poverty Guidelines is $47,520 for a single person household, and $64,080, $80,640, $97,200 for households of 2, 3, and 4 respectively. The amount goes up $16,560 per additional member of the household. Those that have income below 100% of Federal Poverty Guidelines fall into the Medicaid Gap and are not eligible for a subsidy to help them purchase coverage through the healthcare.gov Marketplace.
As some of you may know, the scheduled vote in the United States House of Representatives on the American Healthcare Act was delayed by a day. During this time, two more amendment packages have been released that makes changes to the legislative text.
Delay of the Medicare Tax Increase
The repeal of Medicare payroll tax on high income employee wages has been postponed until 2023.
Patient and State Stability FundAs we have discussed previously, the AHCA establishes the Patient and State Stability Fund to be used by states to provide financial assistance to hi-risk consumers, stabilize and reduce individual market insurance premiums, promote participation in the individual insurance market, promote preventive care, or reduce out-of-pocket costs.
This amendment adds maternity and newborn care to the permissible ways states may use this funding. This amendment also increases funding for this fund by $15 billion and provides that this funding must be used by states for maternity coverage/newborn care and mental health/substance use disorders.
Essential Health BenefitsUnder the ACA, all plans must cover the same categories of medical treatment, called Essential Health Benefits. These categories are currently decided by the federal government and include the following:
- Ambulatory patient services
- Emergency services
- Pregnancy, maternity, and newborn care
- Mental health and substance abuse services
- Prescription drugs
- Rehabilitative and habilitative services
- Laboratory services
- Preventive and wellness services
- Pediatric services, including dental services