How ACA Subsidy Changes Might Affect You
The Trump Administration上周尚未宣布，它将停止支付保险公司补贴，为许多人提供价格实惠的护理法案的计划。如果您在联邦市场购买健康保险，这就是对您意味着什么。
问：这些补贴如何工作？
一种。The Affordable Care Act set up two major categories of subsidies to help people buy health insurance. The first,高级税收抵免，帮助抵消溢价本身的成本，可供任何人在其州保险市场购买健康计划的任何家庭收入。这些补贴仍然存在，并按照惯例进行报酬。(See if you qualify for the savings.)
成本分摊减少（CSRS）是补贴第二类主要类别。他们减少了较低收入人口（今年，这意味着个人30,150美元，夫妇为40,600美元，四口为4亿美元）。值得注意的是，只有在购买银色计划时才能申请CSR - 它们不适用于黄金或青铜计划。
The savings can be considerable. For the lowest-income people in this category, the CSR can reduce the deductible for a Silver plan from a typical $2,400 per year to $500 or less, and a typical coinsurance from 30 percent to 20 percent or less. Nearly 6 in 10 people buying insurance through the exchanges get some degree of CSR subsidy.
保险费直接向消费者给出税收抵免s to apply to the plan of their choice, but CSRs work differently. If you have a CSR Silver plan, you never even see the extra cost-sharing; it simply never is charged to you. Insurance companies absorb the extra cost and then are (or were) reimbursed by the federal government, to the tune, so far, of about $7 billion a year.
问：那么政府刚做了什么？
一种。The legal fate of CSR payments has been in contention for several years, with several lawsuits making their way through the federal court system. Essentially, opponents of the ACA have said that unless Congress explicitly appropriates money for CSRs (it hasn’t for the past several years), the government doesn’t have to pay the insurance companies back.
虽然诉讼等待最终决议，但直到现在，政府一直在一个月的基础上向保险公司偿还保险公司。特朗普的新公告结束了这一点。一群国家律师将军提出了诉讼，以试图迫使支付继续。
问：开放注册的意思是什么？
一种。今年11月份的ACA公开注册开始于11月1日开始。保险公司的困境是，即使他们没有得到政府偿还，他们仍然必须向CSR支付给合格的消费者。
One option for insurers is to pull out of the exchanges entirely, though none have done so as of this writing.
One reason for this is that many state insurance departments looked ahead and told health insurers to add extra money to their 2018 premiums to cover the added CSR expense — just in case the government stopped paying reimbursements, as it has now done. That’s one reason that premiums have risen sharply for 2018 in many states.
此外，大多数国家指示保险公司只有“加载”所有额外的资金，他们只需要对银行计划的保费，因为这些计划必须向符合条件的低收入买家提供CSR。
“In some states there will actually be Silver plans that are more expensive than some of the Gold plans,” says Louise Norris, a Colorado broker who has been tracking the issue nationwide.
这对高级补贴以及CSR付款具有重大影响，因为高级补贴的规模是根据银计划的成本计算的。如果银色计划额外昂贵，则补贴将是超大的。
Q. What should I do if I’m eligible for a CSR?
一种。Surprisingly, nothing. When it’s time to shop for a 2018 coverage, you’ll be able to buy a Silver plan with cost-sharing reductions as usual. Even if the premium has gone up, it won’t matter to you because your premium subsidy will get bigger too.
问：如果我有资格获得高级税收抵免但不是CSR，该怎么办？
一种。这一切都取决于您的国家如何决定处理CSR截止的威胁。如果您居住在一个告诉保险公司将所有成本加载到银色计划上的状态，如果今年，您的补贴可能比过去的价格相当高。Norris建议您应该接受它并逛街到其他金属水平。
Healthcare.gov，运行36个州的交流的联邦平台尚未有2018年的汇率，但有些国营交易所所做的。
One is California, where a 40-year-old buyer in the Los Angeles area who makes 300 percent of the poverty level, or $36,180, would come out ahead by taking his $310 monthly premium subsidy and spending $354 a month on a Gold plan instead of a $292 Silver plan. By spending an extra $62 a month (or $744 a year), he can get a plan with no deductible instead of a $2,500 deductible.
或者你可以去另一种方式，并采取你的往往的高级补贴，购买古铜色计划以进行一次性。但如果您这样做，请确保如果您在2018年结束昂贵的医疗保健需求，请确保您可以处理更大的免赔额。
如果您所在国家的保险公司选择将CSRS的增加的成本汇总到所有金属水平，您将更好地粘在银色计划中。
问：如果我为高级税收抵免做过太多的情况怎么办？
一种。如果您居住在将CSR成本上的状态纳入银行计划，您可以通过购买黄金或青铜计划来躲避额外费用。在一些州，包括加利福尼亚州，运营商正在提供无需CSR附加费的交易所的银计划。因此，在进行最终选择之前，请咨询一个可信的代理商或经纪人，他们可以为您提供交换银行的价格。
(In case you hadn’t realized it, all along since the passage of the ACA, insurers have been allowed to sell policies outside of the exchange. They have to adhere to the same metal levels and coverage rules as on-exchange plans. In general, they’re only a good idea if you are 100 percent certain that your income for the coming year will be too great to qualify for a premium subsidy.)
Your choices are tougher if you live in one of the few states where insurers spread the CSR costs broadly, as the premiums will go up across the board. You’ll either have to bite the bullet and pay extra for a Silver or Gold plan, or drop back to a less costly Bronze plan.
但一旦开放的注册开始，务必经常购物，并且可以看到实际的2018个保费。这是因为一些国家可能允许保险公司在最后一分钟鉴于CSR报销的撤销来修改其利率。
