Newsroom > Press Releases > “Free” Obamacare Coverage Available in 2018 for Most Subsidy-Eligible Families Earning $51,000 or Less, But It’s More Unaffordable Than Ever for Families Who Don’t Get Subsidies, eHealth Report Shows

“Free” Obamacare Coverage Available in 2018 for Most Subsidy-Eligible Families Earning $51,000 or Less, But It’s More Unaffordable Than Ever for Families Who Don’t Get Subsidies, eHealth Report Shows

Average premiums for the lowest-cost health insurance plan available through Healthcare.gov in surveyed cities to increase 25% in 2018, making health insurance “unaffordable” for the average unsubsidized family of three

MOUNTAIN VIEW, CA – November 1, 2017 – Today eHealth, Inc. (NASDAQ: EHTH) (www.ehealth.com) published an analysis of recently released 2018 health insurance costs, including the cost of benchmark silver plans used to calculate the value of premium subsidies, for two-parent families of three (parents age 35 and child age 13) in 40 metropolitan areas served by Healthcare.gov.

eHealth’s analysis found that a subsidy-eligible family of three earning $51,050 per year (250 percent of the federal poverty level) in 2018 would qualify for a zero-premium bronze level health insurance plan, while a subsidy-eligible family earning $81,680 per year (400 percent of the federal poverty level) would only pay $300 per month for the average lowest-priced bronze level health insurance plan.

Without a subsidy, a family earning about two hundred dollars more ($81,884, or 401 percent of the federal poverty level) in 2018 would pay $864 per month for the average lowest-cost health plan, which comes with an average annual deductible of $13,437. Such a family would pay $23,805 out of pocket in combined premium and deductible costs (29% of their household income) before their insurer covers most medical expenses in 2018.  

“If you qualify for Obamacare subsidies, you may be happy with your health insurance premiums – but the fact is that, for some families, earning just a couple hundred dollars more per year can make you ineligible for subsidies and raise your health insurance costs by thousands of dollars,” said eHealth CEO Scott Flanders. “Unfortunately, that’s the reality that many middle-income Americans are facing as we approach the 2018 open enrollment period.”

“No middle-income family of three should have to pay the equivalent of a second mortgage just to get coverage for necessary medical care,” said eHealth Chief Data Officer, Ian Kalin. “The current system unfairly punishes families with a crippling loss of subsidies when they make $200 more than some government-engineered threshold.”

Highlights of eHealth’s analysis for a typical family of three in the surveyed markets include the following.

Rate increases:

  • Average premiums for the lowest-cost health insurance plan available will increase 25% in 2018 compared to 2017.

Zero-premium bronze coverage:

  • Most subsidy-eligible families earning $51,050 or less per year will have access to free major medical coverage should they choose to apply their subsidy dollars toward the lowest-cost bronze plan rather than the benchmark silver plan. (Although these individuals would pay no premium, they may still pay deductibles and other out-of-pocket costs.)

The subsidy cliff:

  • In 2018, the subsidy cliff is $6,771 for a typical family of three, which means earning an extra $204 in annual household income above the subsidy eligibility threshold could cost a family $6,771 in federal subsidies.
  • In other words, families whose income increases $204, taking them from 400 percent of the federal poverty level (FPL) to 401 percent ($81,680 to $81,884) will face an additional $6,771 in average health insurance premiums over the course of a year.
  • The average lowest-price bronze plan will cost $300 per month, ($3,600 per year) for families receiving the minimum subsidy (because they earn 400 percent of FPL). 
  • The average lowest-price bronze plan will cost $864 per month, ($10,368 per year) for families not receiving a subsidy (because they earn 401 percent of FPL). 

The affordability gap in surveyed markets:

The 2018 affordability gap for an “Obamacare” health insurance plan is nearly $47,000 per year in household income. This means the average family of three earning between $81,884 per year and $128,795 in household income will not be able to afford the lowest-priced health insurance plan in 2018.

  • On average, the lowest-cost bronze plan will cost $10,368 per year for a family of three not receiving a subsidy, making health insurance “unaffordable” (according to Affordable Care Act rules) if they earn less than $128,795 in household income in 2018.
  • Access to Obamacare subsidies ends when a family of three’s income goes from $81,680 per year to $81,884.

In preparing its analysis, eHealth reviewed data published on Healthcare.gov to find the lowest-cost plans available and the second-lowest-cost silver plans available in 2018 for a family of three where both adults are age 35 and their child is 13 years-old in 40 metropolitan areas.

Calculating Tax Credits and the ACA’s Affordability

According to the rules of the Affordable Care Act (the ACA or Obamacare) the second-lowest-cost silver plan available, known as the “benchmark” plan, is used in calculating the dollar value of advanced premium tax credits (premium subsidies). Persons earning up to 400% of the federal poverty level may be eligible for premium subsidies. Under ACA rules, health insurance is considered “unaffordable” when the lowest-priced plan available costs more than 8.05% of household income (MAGI) in 2018. See the methodology note below for more information.

Average Premiums for Individuals Earning $51,050 Annually (250% of FPL)

Age

Average lowest cost bronze plan

Average

“benchmark" silver plan

Affordable price
for benchmark plan (income $51,050 per year)

Subsidy amount
(benchmark price – affordable price)

Average

bronze price after subsidy
(bronze - subsidy)

Average

$864

$1,215

$344

$871

$0

Subsidy Cliff Analysis: Cost of Insurance for Individuals Earning 401% of FPL vs. 400%

Average Age

Average benchmark plan premium / month

(no subsidy at 401% of FPL)

Monthly subsidy amount at 400% FPL

Average benchmark premium after minimum subsidy (at 400% of FPL)

Average lowest-cost bronze premium / month

(full price)

Average lowest-cost bronze after minimum subsidy

Average total

$1,215

$564

$651

$864

$300

Affordability Gap: Income Level Where Bronze Plans Become “Affordable”

Average lowest-cost bronze premium monthly

Average lowest-cost bronze premium annually 2018

Income at which bronze becomes “affordable”

$864

$10,368

$128,795

Methodology

eHealth surveyed 2018 monthly premium rates for the lowest-cost bronze plan and the benchmark silver plan available in 40 cities/metropolitan areas for families where both adults were aged 35 and the child was 13. Rates were gathered through the 2018 plan preview feature on Healthcare.gov in October 2017.

Premium increases from 2017 to 2018 were calculated by dividing the monthly premium for the lowest cost plan in 2018 by the monthly premium for the lowest cost plan for 2017 in eHealth’s October 12, 2017 analysis of 2017 plan costs in 50 U.S. cities. The average premium increase from 2017 to 2018 was 25%.

Each plan in each market had its own rate increase for 2018.  Rates may vary from zip code to zip code within the same metropolitan area or state, and less-costly plans may be available in some cases to consumers who do not use Healthcare.gov. In determining the subsidy threshold – the point at which government subsidies are no longer available to people purchasing qualifying health plans – eHealth employed federal poverty-level guidelines for the contiguous United States for 2017.

The affordable price of a health insurance plan for persons not receiving subsidies is calculated as 8.05% percent of household income for 2018. Health insurance is considered unaffordable under the ACA for such persons when the lowest-priced available plan exceeds this amount. For persons receiving subsidies, the affordable price, and by extension the dollar value of subsidies, varies based on income. Subsidies may be available to people with a household income of up to 400 percent of the federal poverty level. In calculating affordability for the present report, eHealth used figures derived from IRS Rev. Proc 2017-36.

All dollar amounts in this report were rounded to the nearest full dollar.

Cities included in the 2018 analysis are: Charlotte, NC; Phoenix, AZ; Raleigh-Durham, NC; Lincoln, NE; Birmingham, AL; Oklahoma City; Helena, MT; New Orleans, LA; Carson City, NV; Montgomery, AL; Milwaukee, WI; Topeka, KS; Nashville TN; Jackson, MS; Louisville, KY; Philadelphia, PA; Trenton, NJ; Chesapeake, VA; Tampa, FL; Miami, FL; West Palm Beach, FL; Kansas City, MO; Chicago IL; Little Rock, AR; Indianapolis, IN; Austin, TX; Atlanta, GA; Columbus, OH; Houston, TX; St. Louis, MO; Dallas, TX; Portland, OR; Des Moines, IA; Salt Lake City, UT; Cleveland, OH; Las Vegas, NV; Grand Rapids, MI; Pittsburgh, PA; Albuquerque, NM; Detroit, MI.

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About eHealth

eHealth, Inc. (NASDAQ: EHTH) owns eHealth.com, a leading private online health insurance exchange where individuals, families and small businesses can compare health insurance products from brand-name insurers side by side and purchase and enroll in coverage online and over the phone. eHealth offers thousands of individual, family and small business health plans underwritten by many of the nation's leading health insurance companies. eHealth (through its subsidiaries) is licensed to sell health insurance in all 50 states and the District of Columbia. eHealth also offers educational resources, exceptional telephonic support, and powerful online and pharmacy-based tools to help Medicare beneficiaries navigate Medicare health insurance options, choose the right plan and enroll in select plans online or over the phone through Medicare.com (www.Medicare.com), eHealthMedicare.com (www.eHealthMedicare.com) and PlanPrescriber.com (www.PlanPrescriber.com).

For more health insurance news and information, visit eHealth's Consumer Resource Center.