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CPA Looks at How to Keeps Costs Low for Health Insurance Under ACA

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TWC News: CPA Looks at How to Keeps Costs Low for Health Insurance Under ACA
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With just six weeks left to sign up for health insurance under the Affordable Care Act, NY1 takes a look at some of the help that's available to lower the costs. Tara Lynn Wagner filed the following report.

By now, most people are probably familiar with the four metal tiers of coverage available on the health insurance marketplaces. Platinum is the most expensive, but also the most comprehensive, covering 90 percent of your healthcare costs. Bronze plans have the lowest premiums but only cover 60 percent of your costs, meaning you'll pay more out of pocket.

CPA Daniel Mazzola, who recently ran a seminar on the Affordable Care Act for the New York State Society of CPAs, says when selecting a plan, it's important to look at the whole picture and not just simply choose the cheapest option.

“If you are someone who uses a lot of medical services or uses a lot of prescription drugs or specialty drugs, then you would probably want one of the better metals plans, a gold or a platinum. If you're in reasonably good health then it probably makes more sense to use a bronze or silver plan,” said Mazzola.

Of course what's affordable to one person can break the bank of another, which is why the government is offering some help.

An individual making under $46,000 may qualify for a tax credit to lower their monthly premium. For a family of four, the cut off is $94,000. But premiums are only part of the picture. Out of pocket costs like deductibles and co-pays can add up quickly. Luckily Mazzola says there is a cap.

“The annual out of pocket limit for an individual, $6,350 and for a family that’s $12,700 dollars, but again that's only for in-network services,” said Mazzola.

That doesn't include out of network specialists, services considered non-essential, or the cost of your actual monthly premiums.

In addition to the tax credits, low-income consumers may also qualify for cost sharing reductions.

Available only for silver plans, where consumers cover 30 percent of their costs, in a CSR plan, consumers will be responsible for anywhere from 27 percent to as little as 6 percent for families making $35,000 or less.

“In essence the silver plan is almost becoming a gold or a platinum plan for people with very low income,” said Mazzola.

The out of pocket cap drops as well to as low as $2,250 for a single person and $4,500 for a family.

Open enrollment will come to a close on March 31st. For more information, go to Yahoo. ClientIP:,, UserAgent: CCBot/2.0 ( Profile: TWCSAMLSP