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Do single people really even have to worry about the subsidy "cliff"?

L
lindsay · · 9 replies

I have to admit I wasn't paying attention to what people without jobs did back when there used to be a subsidy cliff, so I don't really understand what people are talking about. Right now, at least in NH, it tapers off dollar by dollar in terms of subsidy, but I don't have a working grasp of what it used to do, or what people are expecting it to do going forward.

But even then, is it really worth worrying about for single people? I'm paying the full cost this year and it's about $500/month for my silver plan, so even if we were talking about dropping from a 100% subsidy down to a 0% subsidy, it's only a $6k problem, and only for one year, since I can fix it the next year. And 100% subsidies aren't available anyway.

I get wanting to plan for this, but I don't understand why people worry about it. Am I just not getting it because I'm single, whereas most people are looking at insuring a bunch more people at significantly higher cost and it hits them harder? Or is this really just not as big a deal as people make it sound?

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Replies (9)

lindsay

lindsay

6 months ago

Today I found out about another "gotcha" as I was preparing for ACA open enrollment: Apparently the actual subsidy cutoff is 11.76 times (1 / 8.5%) the price of the second-lowest cost silver plan, which is known as the "benchmark" plan. You only get subsidies if the premium price would be more than 8.5% of your income. So in New Hampshire, subsidies cut off at like $53k for a single person, even though 400% FPL is almost $10k higher than that, because there's a tiny little local insurance company that provides two low premium silver plans that don't actually cover much of anything, and the second-lowest one is the "benchmark," even though every silver plan that actually covers things costs $150 to $200 more per month in premiums than these plans. It should be really fun to see all hell break loose if Congress hasn't sorted this out by the time open enrollment starts. What a racket. Since I'm not actually terribly worried about the subsidy part of it (it's just not a lot if you're <40 and single), I think I might actually buy my insurance directly from the insurance company.

brub888

brub888

7 months ago

All costs are relative. Consider a single person making a W-2 income of $60K/yr pre-tax without company health insurance. Income is over the 400% FPL but about middle income in non-HCOL areas. $6K/yr for health insurance is 10% of pre-tax income (and a higher ratio of post-tax) and has zero tax benefits. If the income was 1099 instead of W-2, it would be tax deductible or if the health plan was via W-2 payroll, the cost would be pre-tax.

ACA plan premiums are highly variable and very local. The premiums for a 60+ single would be ~$8K/yr in MN (Twin Cities) for the least expensive HSA-compatible bronze plan with a limited network and >$8K deductible/OOP in-network and >$16K deductible/OOP out-of-network. It is essentially just catastrophic insurance. According to the local newspaper and gemini LLM, the average 2026 premium increase for individual ACA plans, purchased through MNsure or directly from insurers, is 22% (not taking into account any subsidies or loss thereof).

GoingFI

GoingFI

7 months ago

At a younger age, single person, the potential tax savings may be low. For 50/60+ and as a couple, perhaps with medical needs, the subsidies could add up to a $20,000 tax. With $6k per individual person it may not be worth it limiting yourself to a 4x PL limit. If your MAGI is near the 2x PL, then saving a chunk on the $6k may be attractive math.

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