Cost and Coverage: The Impact of Implementing Various State Health Care Reform Proposals Nationally. Subsidies

06/01/2008

The amount of the subsidy can vary based on a variety of factors.  A subsidy may be a set dollar amount or it could be a percentage of a premium.  In addition, if a subsidy is going towards a premium payment for ESI coverage, the employer contribution may impact the subsidy amount.  Some states, particularly those that provide subsidies for individuals and families higher up the income scale, vary the subsidy based on income.  Called a sliding fee scale, individuals at the lowest end of the income scale receive the full amount, with the subsidy decreasing incrementally as you move up the income scale.  For example:

Income
(As a percent of FPL)
Premium Contribution
per Adult
In Massachusetts the premium subsidies vary according to income with the subsidy reduced as a result of the required individual/family contribution as follows:
Less than 100% FPL

None

100% - 150% FPL

None

150% - 200% FPL

$35

200% FPL – 250% FPL

$70

250% - 300% FPL

$105

 

In Vermont the subsidies are reduced as a result of the individual/family contribution as follows:
Income
(As a percent of FPL)
Monthly Premium
(Depending on Family Size)
150 - 175% FPL

$60

175% - 200% FPL

$60 - $65

200% - 225% FPL

$60 - $110

225% - 250% FPL

$65 - $135

250% - 275% FPL

$110 - $160

275% - 300% FPL

$135 - $185

While both Massachusetts and Vermont begin requiring premium payments at 150% FPL, Massachusetts increases the individual or family contribution based on 50% increments in FPL, while Vermont increases the individual or family contribution based on 25% increments in FPL.

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