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View Poll Results: Will you try to get the ACA subsidy?
Yes, the thousands saved would be worth the reduced budget 80 42.55%
No, the threshold is too low for the planned budget 23 12.23%
Undecided, still looking for more info. on how the subsidies would work 43 22.87%
Don't plan to use ACA plan, have alternative health care 42 22.34%
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Old 04-05-2013, 01:55 PM   #121
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Of course, what they don't point out is that every insurance plan and hospital group in the country negotiates discounts and limits the provider network. This is pure speculation and flawed logic.
That's what I was thinking also when I read the article.

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but everything has a TRUE price.
Isn't that part of the problem, the consumer has no idea what it cost because every insurance negotiates a different price with every provider and it is all different than cash.
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Old 04-05-2013, 01:56 PM   #122
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The article outlines how the policies on the exchanges differ from Medicaid and how a proposed plan in Arkansas to allow Medicaid eligible individuals to go through the Arkansas exchange is being thwarted by HHS:

I see nothing in this article that supports your claim anyone getting subsidized insurance through an exchange will be placed in what is actually a Medicare network . To the contrary, the article points out there is a distinct difference between Medicare and what is offered on the exchanges - but gives no network information that I could see.

Now, back to the question I asked and you haven't yet answered:

medicaid -not medicare-to lower the cost of a network squeeze providers-i cannot offer any more than my own opinions based on mass-which i live,california-based on what they provided.

since i can't offer any more i will have to wait until more states issue more stuff.
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Old 04-05-2013, 01:58 PM   #123
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That's what I was thinking also when I read the article.



Isn't that part of the problem, the consumer has no idea what it cost because every insurance negotiates a different price with every provider and it is all different than cash.

and medicaid networks are the lowest cost providers currently. if blue cross wants to compete with a medicaid based provider they have to get their own plan down to the costs of a medicaid based provider.
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Old 04-05-2013, 02:02 PM   #124
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How is the subsidy supposed to work ? I would assume that it is either paid by the government or it is not paid at all. It certainly isn't going to be paid by the consumer and then reimbursed.
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Old 04-05-2013, 02:07 PM   #125
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How is the subsidy supposed to work ? I would assume that it is either paid by the government or it is not paid at all. It certainly isn't going to be paid by the consumer and then reimbursed.
See this http://www.kff.org/healthreform/upload/7962-02.pdf
Premium tax credits are advanced at the time of enrollment. They can also be part of a refund. Cost sharing subsidies for lower income people will be administered by moving people into higher AV policies. This probably explains the confusion with the California plans.
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Old 04-05-2013, 02:14 PM   #126
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How is the subsidy supposed to work ? I would assume that it is either paid by the government or it is not paid at all. It certainly isn't going to be paid by the consumer and then reimbursed.

the plans will be available at the exchange based on the cost of second lowest silver provider.

based on mass this will be a medicaid based provider.

the five lowest were medicaid based than the higher providers.

if you want to be subsidized you will have to pick among the plans approved for subsidies bay the exchange.

then you fill out an online form which should be linked to the irs and other govenmental agencies. based on what this system approves( i have no idea if this will work) it approves your subsidy and to what amount and pays it directly to the provider.
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Old 04-05-2013, 02:16 PM   #127
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See this http://www.kff.org/healthreform/upload/7962-02.pdf
Premium tax credits are advanced at the time of enrollment. They can also be part of a refund. Cost sharing subsidies for lower income people will be administered by moving people into higher AV policies. This probably explains the confusion with the California plans.
Michael, I am on the same page as you. However, I don't understand how this could be administered. If lower income people are moved into higher AV policies (clearly what they intend), then what if they turn out to have higher income when they do their taxes? Who is going to go back and figure they paid this for this procedure and should have paid that? Likewise, if someone is in the lower AV plan but when they file their taxes, turns out they should have been in higher AV plan, then it would seem excessive to try to correct this after the fact...charge by charge. Does this make sense to you?
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Old 04-05-2013, 02:25 PM   #128
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See this http://www.kff.org/healthreform/upload/7962-02.pdf
Premium tax credits are advanced at the time of enrollment. They can also be part of a refund. Cost sharing subsidies for lower income people will be administered by moving people into higher AV policies. This probably explains the confusion with the California plans.
Thanks for the link. Very informative.
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Old 04-05-2013, 02:32 PM   #129
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Thanks for the link. Very informative.

i link again to this chart upper left .


money to the insurance/state exchange is a subsidy from federal government.

how it's done by the purchaser is credits on tax forms.

california calls it federal subsidy. obamacare call it tax credits to get it processed


http://www.coveredca.com/media/10745...itsSummary.pdf
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Old 04-05-2013, 02:43 PM   #130
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Michael, I am on the same page as you. However, I don't understand how this could be administered. If lower income people are moved into higher AV policies (clearly what they intend), then what if they turn out to have higher income when they do their taxes? Who is going to go back and figure they paid this for this procedure and should have paid that? Likewise, if someone is in the lower AV plan but when they file their taxes, turns out they should have been in higher AV plan, then it would seem excessive to try to correct this after the fact...charge by charge. Does this make sense to you?
The insurance policy is the same no matter who has it nor how much it is used. A taxpayer in a low income bracket gets premium help. If later on, it turns out they didn't need the help, they have to pay pack that premium help. This is all about the cost and affordability of the policy, not how much it is used.
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Old 04-05-2013, 03:06 PM   #131
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Michael, I am on the same page as you. However, I don't understand how this could be administered. If lower income people are moved into higher AV policies (clearly what they intend), then what if they turn out to have higher income when they do their taxes? Who is going to go back and figure they paid this for this procedure and should have paid that? Likewise, if someone is in the lower AV plan but when they file their taxes, turns out they should have been in higher AV plan, then it would seem excessive to try to correct this after the fact...charge by charge. Does this make sense to you?

the premium will always be based on the approved silver plan. that is the subsidy you will get. if you pick the platinum approved plan you will still get the same amount to the exchange that you will be approved for but your monthly premiums will add in the difference between the silver and the platinum
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Old 04-05-2013, 03:53 PM   #132
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the premium will always be based on the approved silver plan. that is the subsidy you will get. if you pick the platinum approved plan you will still get the same amount to the exchange that you will be approved for but your monthly premiums will add in the difference between the silver and the platinum
IOW, the govt doesn't care which plan you pick or how much it costs, they aren't paying for it, they only pay the subsidy amount you qualify for depending on your income. So it shouldn't matter to them if the plan you choose uses a limited 'medicare network' or not.

Just sayin'...
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Old 04-05-2013, 04:04 PM   #133
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IOW, the govt doesn't care which plan you pick or how much it costs, they aren't paying for it, they only pay the subsidy amount you qualify for depending on your income. So it shouldn't matter to them if the plan you choose uses a limited 'medicare network' or not.

Just sayin'...

but they do. that is why they have approved for subsidy plans and not approved for subsidy plans.

we will have to wait until more states implement something. you have your opinion and i have mine.
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Old 04-05-2013, 04:05 PM   #134
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but they do.
I give up...
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Old 04-05-2013, 07:57 PM   #135
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My understanding is this. It's kind of backasswards.

Your estimated income for 2014 (typically based on your 2012 actual income) will determine a maximum percentage of income that your health insurance will cost. As an example, a 58 yo couple with $60,000 of income would be expected to pay up to 9.5% of their income for health insurance (as would a 58 yo couple with $62,000 of income). The subsidy will be based on any excess of the actual cost of your health insurance (or the actual cost of the silver plan if your chose a richer plan) and 9.5% of your income. This difference will be paid directly to the insurer each month and the insured will be responsible for paying the excess of the premium over the subsidy.

However, assuming they have the same insurance plan, the couple with $60,000 of income would get a higher subsidy that they couple with $62,000 of income because the subsidy is based on the excess of the premium over 9.5% of income.

In the process of doing this I noticed that the Berkeley calculator has been changed and is more refined with respect to the members of the family unit. For our hypothetical couples, each would have gross premium of $1,468 a month.

The couple with $60,000 of income would get a $993 subsidy ($993 = $1,468 - $60,000/12*9.5%) and would pay the insurer $475 a month (9.5% of their income).

The couple with $62,000 of income would get a $977 subsidy ($977 = $1,468 - $62,000/12*9.5%) and would pay the insurer $491 a month (9.5% of their income).

So while subsidies vary with income, the cost of the policy selected by the applicant also comes into play. In the examples above, if these couples picked a cheaper plan that had a premium of $1,000 a month, their subsidies would decline to $525 a month for the couple with $60,000 of income and $509 per month for the couple with $62,000 of income but in each case their net cost would be 9.5% of their income.

Same thing if they are younger so the premium is lower - given the same levels of income the subsidies would be lower because of the lower premium but the net cost of health insurance will be the same if their income is the same.
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Old 04-05-2013, 08:09 PM   #136
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Does anyone understand how the mechanics of the out of pocket subsidies would work based on CA tables?
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Old 04-05-2013, 08:11 PM   #137
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I'm not aware of any out-of-pocket subsidies, only health insurance subsidies but I haven't looked at the CA plans.
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Old 04-05-2013, 09:15 PM   #138
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Does anyone understand how the mechanics of the out of pocket subsidies would work based on CA tables?

the out of pocket subsidies apply to the lowest 2 catagories in California


read the 2 catagories to the left on the sheet

http://www.coveredca.com/media/10745...itsSummary.pdf
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Old 04-05-2013, 09:22 PM   #139
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I give up...

this is my last try. read this article . 6th or 7th paragraph down.

the head of Aetna telling about creating low cost restrictive networks for the exchanges.

AETNA CEO Warns Health Insurance Premiums Will Double Under ObamaCare | FrontPage Magazine

another article -pretty long touches on subject i several different parts.
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Old 04-05-2013, 09:45 PM   #140
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the out of pocket subsidies apply to the lowest 2 catagories in California


read the 2 catagories to the left on the sheet

http://www.coveredca.com/media/10745...itsSummary.pdf
The subsidies apply to premiums - "Consumer Portion of Monthly Premium For Silver Plans (Balance paid by Federal subsidy)" (emphasis added) - no mention of subsidies applying to out-of-pocket costs.
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