Nearly 5 in 10 Uninsured Single Young Adults Eligible for the Health Insurance Marketplace Could Pay $50 or Less Per month for Coverage in 2014. Notes

10/28/2013

1 For household size, a “household” is based on an individual’s “health insurance unit” (HIU), which includes adults, their spouses, and their dependent children (ages 0-18, plus full time students under 23), using ASPE analysis of the ACS data. “Single” household status in this context does not necessarily imply single marital status or that an individual lives alone. See the Methodology section of this brief for additional details.

2 We define Marketplace-eligible individuals in this analysis as uninsured U.S. citizens and legal residents with incomes above 138 percent of the Federal Poverty Level in Medicaid expansion states or above 100 percent of the Federal Poverty Level in non-expansion states. The estimates contained in this brief do not take into account certain Exchange coverage and Medicaid/CHIP eligibility requirements, such as those relating to other minimum essential coverage or tax filing requirements, and thus the populations described in this brief should be construed as “potentially” eligible, subject to these other requirements. For more information about eligibility to purchase coverage in the Marketplace, see https://www.healthcare.gov/immigration-status-and-the-marketplace/. Also, the statutory threshold for Medicaid expansion set by the Affordable Care Act is 133 percent of the FPL, not 138 percent of the FPL. This brief refers throughout to 138 percent of the FPL, which is the effective threshold including the 5 percent statutory disregard.

3 Non-incarcerated U.S. citizens and legal residents are eligible to purchase coverage on the Marketplace.

4 This is the estimated number of citizens or legal residents between the ages of 18 and 34 who are uninsured and appear to be potentially eligible for coverage either in the Marketplace or through Medicaid, based on ASPE analysis of the 2011 American Community Survey Public Use Microdata Sample (ACS PUMS). Some of these individuals may have been eligible for Medicaid or Children’s Health Insurance Program (CHIP) coverage prior to 2014 but were not enrolled. These estimates do not take into account the eligibility requirements relating to other minimum essential coverage or tax filing requirements.

6 Our analysis includes only the 34 states that submitted data to HHS for a Federally Facilitated Marketplace or State Partnership Marketplace. In addition, this analysis is limited to single individuals. There are 10.8 million eligible uninsured single young adults in all 50 states and the District of Columbia.

7 We define Marketplace-eligible individuals in this analysis as uninsured U.S. citizens and legal residents with incomes above 138 percent of the Federal Poverty Level in Medicaid expansion states or above 100 percent of the Federal Poverty Level in non-expansion states. The estimates contained in this brief do not take into account certain Exchange coverage and Medicaid/CHIP eligibility requirements, such as those relating to other minimum essential coverage or tax filing requirements, and thus the populations described in this brief should be construed as “potentially” eligible, subject to these other requirements. For more information about eligibility to purchase coverage in the Marketplace, see https://www.healthcare.gov/immigration-status-and-the-marketplace/.

8 The Affordable Care Act generally requires that qualified health plans (QHPs) offered on the Marketplace must be one of four tiers, based on the QHP’s actuarial value. Bronze plans have an actuarial value of 60 percent and the lowest premiums. Silver plans have an actuarial value of 70 percent, gold plans an actuarial value of 80 percent, and platinum plans an actuarial value of 90 percent. The tax credit available to certain qualified individuals under the Affordable Care Act is tied to the cost of the second lowest-cost silver plan available on the Marketplace in the tax filer’s state.

9 A catastrophic plan is available only to individuals ages 30 and under and to those who have an affordability exemption. Catastrophic plans have a deductible of $6,350, an out-of-pocket maximum of $6,350, and must cover preventive services and three physician office visits before the deductible.

10 Our analysis assumes that among the 34 states analyzed in this brief, the following nine expand their Medicaid programs: Arizona, Arkansas, Delaware, Illinois, Iowa, Michigan, New Jersey, North Dakota, and West Virginia. This analysis was completed as of Friday, October 25 using information fromhttp://medicaid.gov/AffordableCareAct/Medicaid-Moving-Forward-2014/Downloads/Medicaid-and-CHIP-Eligibility-Levels-Table.pdf.

11 This includes only eligible uninsured adults ages 18-34 in single-person households.

12 ASPE tabulations have been adjusted to include only U.S. citizens and legal residents.

13 The U.S. total is the total for all 50 states and the District of Columbia.

14 Totals may not sum due to rounding.

15 We define Marketplace-eligible individuals in this analysis as uninsured U.S. citizens and legal residents with incomes above 138 percent of the Federal Poverty Level in Medicaid expansion states or above 100 percent of the Federal Poverty Level in non-expansion states. The estimates contained in this brief do not take into account certain Exchange coverage and Medicaid/CHIP eligibility requirements, such as those relating to other minimum essential coverage or tax filing requirements, and thus the populations described in this brief should be construed as “potentially” eligible, subject to these other requirements. For more information about eligibility to purchase coverage in the Marketplace, see https://www.healthcare.gov/immigration-status-and-the-marketplace/.

16 The total “Any Marketplace Plan for $100 or Less” is the sum of the “Silver or Bronze Plan for $100 or Less” and the “Catastrophic Plan for $100 or Less” rows. The “Bronze Plan for $50 or Less” category is a subset of the “Silver or Bronze Plan for $100 or Less” category.

17 Includes those who could pay $50 or less.

18 Only age-based catastrophic eligibility among those who cannot buy a silver or bronze Marketplace plan for less than $100 is included in this figure. Catastrophic plans are also available to those over the age of 30 who do not have an affordable coverage option, but that eligibility scenario is not included here.

19 Only single young adults in expansion states with incomes below 138 percent of the FPL are counted as Medicaid eligible. Some individuals ages 18 and older may be eligible for CHIP, but that eligibility is not modeled here.

20 We do not count Medicaid-eligible individuals as Marketplace-eligible in this analysis.

21 The adjustment methodology is based on imputations of immigrant legal status in ASPE’s TRIM3 microsimulation model (http://trim.urban.org), according to methods initially developed by Jeffrey Passel and Rebecca Clark.

22 In Medicaid expansion states, this income is associated with Medicaid eligibility.

23 Complete data on premiums in these 34 states is available at https://www.healthcare.gov/health-plan-information.

24 ACS respondents are directed by the questionnaire not to answer for “anyone who is living somewhere else for more than 2 months, such as a college student”; therefore, we are unable to link a child not living in the household to a parent’s HIU. The 2011 ACS questionnaire is available online athttp://www.census.gov/acs/www/Downloads/questionnaires/2011/Quest11.pdf

26 A county to rating area crosswalk is available at http://aspe.hhs.gov/health/reports/2013/MarketplacePremiums/datasheet_home.cfm.

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