Health care options for young, healthy and broke

CONSIDER MEDICAID

Right now, Medicaid mostly covers children and low-income adults who are disabled, pregnant or raising kids. But the health care law will push states to expand Medicaid to also cover other adults with incomes up to around $15,000, adjusted for inflation in 2014. That’s designed to account for about half of the 30 million people expected to gain insurance coverage under the overhaul.

It may fall short, however. The Supreme Court recently ruled that the federal government can’t coerce states into joining the Medicaid expansion. Some states may decline to add people to their rolls.

THERE’S OTHER HELP

Most people with incomes up to four times the poverty level _ which currently comes out to $44,680 for an individual or $92,200 for a family of four _ will qualify for some help paying for private insurance. Aid drops off sharply as income climbs, and younger people get smaller subsidies than older folks whose insurance rates are higher.

The lowest earners shouldn’t have to pay more than 2 percent of their incomes toward insurance premiums for mid-level plans; those at the high end would have to contribute 9.5 percent. These plans also have significant co-pays and deductibles, but some help is available there, too.

For example, a single 26-year-old earning $16,000 might pay $537 toward the annual premium for a mid-level “silver” plan, according to estimates from the Kaiser Family Foundation. The rest of the premium would be covered by a $2,853 tax credit. (Deductibles and co-pays could cost up to an additional $2,083, depending on how much care the person needs.)

A 26-year-old earning $35,000 would pay $3,325 in premiums _ $277 a month _ for the same plan, after only a $66 tax credit. (And that patient might be on the hook for another $4,167 in out-of-pocket costs.)

A CHEAPER BUT SKIMPY CHOICE

For those under 30 there’s a special option to buy “catastrophic” insurance with the lowest premiums but scant coverage until a deductible of about $6,250 is met. While it may be tempting, caution is advised.

“We really encourage folks to do their homework and look at the details of the plan,” said Smith, who’s organizing efforts to help young people learn about their choices. “It’s not just the premium. You have to look at what’s being covered, what the deductibles are.”

GO BARE?

People who would have to spend more than 8 percent of their income to buy basic insurance are exempt from paying a penalty if they go without.

For others who feel they can’t afford or just don’t want coverage, the penalties start off relatively low in 2014.

Private insurers have yet to set the prices for their 2014 plans, because coverage that will comply with the law is still being developed. The Congressional Budget Office has estimated that premiums for the bare-bones plan, called “bronze” level, might average between $4,500 and $5,000 per year. Family plans might cost $12,500 per year.

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