Calculating the Premium Cap

Last June, we published a post in which we explained how to calculate the premium cap for the benchmark plan (the second-lowest-priced plan in the silver level of the individual marketplace) for people with different household incomes. The ACA gives us the break points – the percentage of household income that families would pay at 133%, 150%, 200%, 250%, 300%, and 400% of the Federal Poverty Level (FPL).

But what about all of those incomes in-between these break-points? While there is a complicated formula to figure it out, the below chart, adapted from the instruction booklet for IRS Form 8962, shows the premium cap for each income level between 133 and 400% of the FPL.
 

FPL Cap   FPL Cap   FPL Cap   FPL Cap
<133 2.00% 175 5.15% 218 6.93% 261 8.37%
133 3.00% 176 5.20% 219 6.97% 262 8.40%
134 3.06% 177 5.24% 220 7.00% 263 8.43%
135 3.12% 178 5.29% 221 7.04% 264 8.46%
136 3.18% 179 5.33% 222 7.07% 265 8.49%
137 3.24% 180 5.38% 223 7.11% 266 8.51%
138 3.29% 181 5.43% 224 7.14% 267 8.54%
139 3.35% 182 5.47% 225 7.18% 268 8.57%
140 3.41% 183 5.52% 226 7.21% 269 8.60%
141 3.47% 184 5.56% 227 7.25% 270 8.63%
142 3.53% 185 5.61% 228 7.28% 271 8.66%
143 3.59% 186 5.66% 229 7.32% 272 8.69%
144 3.65% 187 5.70% 230 7.35% 273 8.72%
145 3.71% 188 5.75% 231 7.39% 274 8.75%
146 3.76% 189 5.79% 232 7.42% 275 8.78%
147 3.82% 190 5.84% 233 7.46% 276 8.80%
148 3.88% 191 5.89% 234 7.49% 277 8.83%
149 3.94% 192 5.93% 235 7.53% 278 8.86%
150 4.00% 193 5.98% 236 7.56% 279 8.89%
151 4.05% 194 6.02% 237 7.60% 280 8.92%
152 4.09% 195 6.07% 238 7.63% 281 8.95%
153 4.14% 196 6.12% 239 7.67% 282 8.98%
154 4.18% 197 6.16% 240 7.70% 283 9.01%
155 4.23% 198 6.21% 241 7.74% 284 9.04%
156 4.28% 199 6.25% 242 7.77% 285 9.07%
157 4.32% 200 6.30% 243 7.81% 286 9.09%
158 4.37% 201 6.34% 244 7.84% 287 9.12%
159 4.41% 202 6.37% 245 7.88% 288 9.15%
160 4.46% 203 6.41% 246 7.91% 289 9.18%
161 4.51% 204 6.44% 247 7.95% 290 9.21%
162 4.55% 205 6.48% 248 7.98% 291 9.24%
163 4.60% 206 6.51% 249 8.02% 292 9.27%
164 4.64% 207 6.55% 250 8.05% 293 9.30%
165 4.69% 208 6.58% 251 8.08% 294 9.33%
166 4.74% 209 6.62% 252 8.11% 295 9.36%
167 4.78% 210 6.65% 253 8.14% 296 9.38%
168 4.83% 211 6.69% 254 8.17% 297 9.41%
169 4.87% 212 6.72% 255 8.20% 298 9.44%
170 4.92% 213 6.76% 256 8.22% 299 9.47%
171 4.97% 214 6.79% 257 8.25% 300 thru 400 9.50%
172 5.01% 215 6.83% 258 8.28%
173 5.06% 216 6.86% 259 8.31%
174 5.10% 217 6.90% 260 8.34%

 

Of course, as an agent you don’t need to calculate your clients’ premium tax credit or the percentage of their income they would pay for the benchmark plan. That will be calculated automatically when they go to the exchange or, better, when they visit your private exchange website and talk with the call center representative. But if you’re doing a group meeting and want to get people’s attention, showing some examples of what families with different income levels and household sizes would pay isn’t a bad idea.

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