a silver plan offered through the Marketplace
that covers every single member of the
household who is eligible for premium credits
(for example, because of the relationships of
the individuals in the household), the
benchmark may be based on the second lowest
cost silver option for one or more policies.
The following example illustrates how the
Marketplace would determine the applicable
benchmark plan in some different situations:
Example 1: Single individual obtaining self-
only coverage. John is eligible for a
premium credit, with an expected
contribution of 6.3 percent of his income, or
$1,448 a year. The three lowest cost silver
plans providing self-only coverage in John’s
area are Plans A, B, and C, priced at
$4,800, $5,000, and $5,200, respectively.
Plan B, which is the second lowest cost
silver plan, will be used as the benchmark.
Example 2: Parents and two children
obtaining family coverage. Peter, Mary, and
their two children have income at 225
percent of the federal poverty line, qualifying
them for premium tax credits with an
expected contribution of 7.18 percent of
income, or $3,802. The benchmark plan in
this case is the second lowest cost silver
plan that covers the entire family. In the
area where the family lives, the three lowest
cost silver plans that cover the entire family
are Plans A, B, and C, which cost $14,800,
$15,000, and $15,200, respectively. Plan
B, which is the second lowest cost silver
plan, will be used as the benchmark.
Example 3: Parents and two children
obtaining coverage only for the parents.
The circumstances are the same as in
Example 2, except that the family now lives
in a state that has a higher income eligibility
level for CHIP coverage so that the two
children are ineligible for premium credits
because they qualify for CHIP. Peter and
Mary’s household income would be the
same at 225 percent of the poverty line,
and their expected annual contribution
would stay at $3,802. The applicable
benchmark in this case is the second lowest
silver plan that covers just Peter and Mary.
The three lowest cost silver plans that cover
Peter and Mary are Plans A, B, and C, which
cost $9,800, $10,000, and $10,200,
respectively. Plan B, which is the second
lowest cost silver plan, will be used as the
benchmark in calculating the premium tax
credit amount.
Example 4: Members of a tax household
residing in different locations. The
circumstances are the same as in Example
2, except that one child is attending college
in a different part of the state where
services are considered out of network and
would not be covered by Peter and Mary’s
plan. As a result, the family has to purchase
a separate plan where the child attends
college and resides for most of the year.
The three lowest cost silver plans that would
cover Peter, Mary, and the younger child are
Plans A, B, and C, which cost $12,300,
$12,500, and $12,700, respectively. The
three lowest cost silver plans that would
cover the child in college are Plans D, E, and
F, which cost $2,400, $2,500, and $2,600,