Poll: Who's going to try to get ACA subsidies by staying under the threshold?

[gerrym51]

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.

 

[CH]

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?

 

[Gatordoc50]

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.

 

[gerrym51]

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/CoveredCA_HealthPlanBenefitsSummary.pdf

 

[MichaelB]

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.

 

[gerrym51]

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

 

[REWahoo]

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'...

 

[gerrym51]

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.

 

[REWahoo]

but they do.

I give up...

 

[pb4uski]

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.

 

[CH]

Does anyone understand how the mechanics of the out of pocket subsidies would work based on CA tables?

 

[pb4uski]

I'm not aware of any out-of-pocket subsidies, only health insurance subsidies but I haven't looked at the CA plans.

 

[gerrym51]

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/CoveredCA_HealthPlanBenefitsSummary.pdf

 

[gerrym51]

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.

 

[pb4uski]

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/CoveredCA_HealthPlanBenefitsSummary.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.

 

[gerrym51]

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.

did you read the columns-NO DEDUCTIBLE-in the first 2 plans-lower out of pocket costs. you should read.this is supplied by california-has nothing to do with premiums

another-cost sharing 3/4 page down under part about tax credits

http://www.coveredca.com/getting-covered/individuals-and-families/#faq-11

 

[REWahoo]

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

Reading the article in the website you linked - and the full Forbe's article the website quoted - leaves me with the following conclusion: some insurers (Aetna) may try to lowball the coverage available through exchanges but others (Humana) don't think that strategy will work.

Bertolini also elaborated on the type of insurance that Aetna would provide on Obamacare’s exchanges. “It’s about having the right products at the right cost structure, [with] narrow networks, low-cost networks,” he said. That is to say, Aetna’s exchange products will aggressively steer patients to low-cost doctors and hospitals so as to keep premiums low.

The website failed to include other information from the Forbes article which is in sharp contrast to Aetna's plans:

...counterparts at Humana don’t think that insurers will be able to get away with ultra-low Medicaid rates on the exchanges. “If you go down to Nashville and you ask [hospital chain] HCA about that, they’ll laugh you out of the room,” said Humana executive Bruce Perkins at Humana’s November analyst meeting. “This idea that it’s going to be Medicaid rates—that’s a joke.”

Thanks for the link.

 

[samclem]

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

Here's the problem: You've pasted in many links like this. They say the exchanges will have to have low cost providers. We all get that. But you also said that somehow subsidized plans will be in a different category from unsubsidized plans. You haven't provided any links or your own thoughts (with or without capitals and punctuation) to substantiate this.
The reason you can't show it is because it isn't so. Any medical plan offered through the exchanges can be bought by people with and without subsidies. The "subsidized plans" are no different in content or quality from "unsubsidized plans."
I'm talking about all medical plans offered through the exchanges here. Medicaid is something different--it will continue to be entirely "subsidized" and it will still be substandard care.

 

[gerrym51]

Now I give up.

 

[gerrym51]

Here's the problem: You've pasted in many links like this. They say the exchanges will have to have low cost providers. We all get that. But you also said that somehow subsidized plans will be in a different category from unsubsidized plans. You haven't provided any links or your own thoughts (with or without capitals and punctuation) to substantiate this.
The reason you can't show it is because it isn't so. Any medical plan offered through the exchanges can be bought by people with and without subsidies. The "subsidized plans" are no different in content or quality from "unsubsidized plans."
I'm talking about all medical plans offered through the exchanges here. Medicaid is something different--it will continue to be entirely "subsidized" and it will still be substandard care.

there is no difference to insurance coverage-but there is a difference in number and location of providers-thats all i saying-the odds are you will have to change doctors

 

[pb4uski]

Here's the problem: You've pasted in many links like this. They say the exchanges will have to have low cost providers. We all get that. But you also said that somehow subsidized plans will be in a different category from unsubsidized plans. You haven't provided any links or your own thoughts (with or without capitals and punctuation) to substantiate this.
The reason you can't show it is because it isn't so. Any medical plan offered through the exchanges can be bought by people with and without subsidies. The "subsidized plans" are no different in content or quality from "unsubsidized plans."
I'm talking about all medical plans offered through the exchanges here. Medicaid is something different--it will continue to be entirely "subsidized" and it will still be substandard care.

+1

 

[pb4uski]

Now I give up.

Hallelujah

 

[skyline]

OK, I'll add one more wrinkle for folks to consider. My family is currently on a high deductible plan that qualifies for an HSA account. The plan (incl. out of pocket costs) currently costs me around $5K/yr. I plan to enroll in a qualified silver ACA plan, which will probably cost around $14K/yr, but expect to receive about $9K in subsidies.

Although the net cost will be lower with the ACA plan, there are some finer points that make this narrower than you might think:

- giving up the HSA will cause me to lose around $1K/yr in tax savings
- I also lose the ability to harvest capital gains at 0% since I will be trying to keep my income as low as possible. Last year, I was able to harvest almost $50K in capital gains at 0%, so to me, this could potentially cost me $50K x 15% = $7.5K in future years depending on what happens with capital gains taxes in the future.

Finally, the decision to use an ACA plan is solely based on the expected tax subsidy - if there was no subsidy, I am guaranteed to be better off staying on my HSA plan, even if I hit my max out of pocket. So it's not simply a matter of maximizing my credit for something I would have bought anyways - it's actually impacting what I should be buying ([-]expect[/-]except I won't know until after the fact!).

What a mess...

 

[samclem]

What a mess...

Yep. The loss of the 0% CG rate (to the top of the 15% bracket) will impact a lot of folks. And others will be avoiding 72T withdrawals or other 401K/IRA withdrawals prior to reaching Medicare age in order to reduce taxable income and qualify for subsidies--this will possibly add to their tax liabilities later. But with what appears to be a growing rate of "change" in the rules, people will bias toward getting the benefits they can right now rather than betting the rules will stay the same so they can benefit later.

It's a shame to see HDHPs go by the wayside, they were one of the proven ways to reduce medical expenditures. Oh, well, progress . . .

 

[skyline]

It's a shame to see HDHPs go by the wayside, they were one of the proven ways to reduce medical expenditures. Oh, well, progress . . .

I am a firm believer in HDHP - it has certainly changed how my family approaches health costs (I think in a good way). But I'm OK with a more traditional plan as long as it doesn't cost me more $$'s - of course, figuring that out is the whole problem here...

BTW, does anyone know if it's still an option to stay on a HDHP after ACA goes fully into effect? I've read some contradictory articles recently that makes me wonder if it's an option to just stay on my HSA qualified plan (and continue to grow my HSA and harvest capital gains while the 0% CG rate stays in effect).

The contradictory part (or rather, the confusing part for me) being that a HDHP does/does not result in me being considered inadequately covered and requires me to pay the equivalent 'uninsured' penalty...