ACA and retiree FEHB

[Richard8655]

Has anyone heard any information regarding retiree FEHB coordination with the Affordable Care Act? In particular, if a federal retiree is paying more than 9.5% (12% in my case) of their gross income for FEHB coverage, will OPM or ACA provide any adjustment or tax credit?

Or must you leave retiree FEHB coverage and join an exchange insurance plan to be eligible for subsidy or tax credit?

 

[donheff]

Based on everything I have read (i.e. what I remember from MichaelB's posts ) if your Federal policy was too expensive to be "affordable" you could apply on your exchange and theoretically get a subsidy if your income is low enough.

 

[Richard8655]

Yes, I think you're right, thanks. I'm a little surprised an adjustment isn't built into the federal employee program, without having to leave it.

 

[No_Such_Reality]

In general the same plan off the Exchange is less expensive than getting it through the exchange. Many exchanges are subsidized and require greater expense absorbing by the providers for a given level of plan. i.e. At 200% FPL, you can get an "Enhanced" silver plan, which really equates to 87% coverage which in reality is almost Platinum level plan. So if you go off exchange, you'll find the baseline silver equivalent is actually cheaper.

 

[donheff]

In general the same plan off the Exchange is less expensive than getting it through the exchange. Many exchanges are subsidized and require greater expense absorbing by the providers for a given level of plan. i.e. At 200% FPL, you can get an "Enhanced" silver plan, which really equates to 87% coverage which in reality is almost Platinum level plan. So if you go off exchange, you'll find the baseline silver equivalent is actually cheaper.

You need to expand on that statement. I don't understand it at all.

 

[MichaelB]

+1@ Donheff . If your cost is greater that 9.5% for your single coverage policy, you can go to the exchange and get a policy with premium assistance. Lots of detail here http://www.healthreformgps.org/wp-content/uploads/crs-exchanges-6-11.pdf

Yes, I think you're right, thanks. I'm a little surprised an adjustment isn't built into the federal employee program, without having to leave it.

I think they can't, at least the way the programs is currently set up. Because congressional employees will also be shopping on the exchange I'm hopeful there will be some policies offered that are similar to the one yu currently have.

In general the same plan off the Exchange is less expensive than getting it through the exchange.

My understanding is a policy can be offered on the exchange, on other exchanges and also directly by the insurer, but all must use the same exact price.

 

[Mulligan]

+1@ Donheff . If your cost is greater that 9.5% for your single coverage policy, you can go to the exchange and get a policy with premium assistance. Lots of detail here http://www.healthreformgps.org/wp-content/uploads/crs-exchanges-6-11.pdf

I think they can't, at least the way the programs is currently set up. Because congressional employees will also be shopping on the exchange I'm hopeful there will be some policies offered that are similar to the one yu currently have.

My understanding is a policy can be offered on the exchange, on other exchanges and also directly by the insurer, but all must use the same exact price.

Maybe No Such Reality was referring to what I understood could happen. Companies could offer a different plans off exchange than offered on exchange. Though it would have to be compliant with the regulations, it could be a different version and possibly cheaper. Though in reality you would think the cheapest version would be in the exchange since that is where the majority of people will be shopping at and comparison pricing will be at a premium there.

 

[donheff]

Maybe No Such Reality was referring to what I understood could happen. Companies could offer a different plans off exchange than offered on exchange. Though it would have to be compliant with the regulations, it could be a different version and possibly cheaper. Though in reality you would think the cheapest version would be in the exchange since that is where the majority of people will be shopping at and comparison pricing will be at a premium there.

This may be true for different plans but NSR's post indicated that the same exchange plans would be more expensive because the providers have to provide subsidies (specifically - "Many exchanges are subsidized and require greater expense absorbing by the providers for a given levelof plan). But I have no idea what he was talking about and want to hear a more detailed explanation. Subsidies are paid by the general population through tax credits, not by the providers so why would a given plan cost more on an exchange than off the exchange? In fact, for almost half of exchange users subsidies will result in lower costs than could be obtained outside.

 

[MichaelB]

Maybe No Such Reality was referring to what I understood could happen. Companies could offer a different plans off exchange than offered on exchange. Though it would have to be compliant with the regulations, it could be a different version and possibly cheaper. Though in reality you would think the cheapest version would be in the exchange since that is where the majority of people will be shopping at and comparison pricing will be at a premium there.

The same plan must be offered at the same price. Insurers can offer different plans, but they must meet PPACA standards and follow the same benefit level structure (the metals) and they are not eligible for premium assistance. The cost of administering multiple plans is high, as is the agent network, so it isn't obvious that insurers have an incentive to do this.

+1@ Donheff . If your cost is greater that 9.5% for your single coverage policy, you can go to the exchange and get a policy with premium assistance. Lots of detail here http://www.healthreformgps.org/wp-content/uploads/crs-exchanges-6-11.pdf .

Forgot to add that MAGI needs to be between 100%-400% of the FPL

 

[Mulligan]

The same plan must be offered at the same price. Insurers can offer different plans, but they must meet PPACA standards and follow the same benefit level structure (the metals) and they are not eligible for premium assistance. The cost of administering multiple plans is high, as is the agent network, so it isn't obvious that insurers have an incentive to do this.

Forgot to add that MAGI needs to be between 100%-400% of the FPL

I have read that trying to price and compare your premium costs by using "off exchange" could become the "wild west of insurance". There may be different offerings that make comparison shopping hard. I will look at them both when I finally have to join Jan. 2015, but unless I am missing something, the only reason I would purchase off exchange is if my state does not offer an exchange HSA plan, but off exchange does.

 

[Richard8655]

Difficult choice for those on retiree FEHB and also eligible to join ACA. Once you leave FEHB, you can never go back. At least that's OPM's latest rule. So if you join and dislike ACA, you may have regrets. It's still very much of an unknown.

 

[Turtle]

I have read that trying to price and compare your premium costs by using "off exchange" could become the "wild west of insurance". There may be different offerings that make comparison shopping hard. I will look at them both when I finally have to join Jan. 2015, but unless I am missing something, the only reason I would purchase off exchange is if my state does not offer an exchange HSA plan, but off exchange does.[/QU

"wild west of insurance" Since I was laid off in 2007 I have been living there....

On a side note ... private exchanges being developed and starting to be used by corporate america look promising for driving down cost of health care and increasing quality care and competition. Walgreen moves employees to private healthcare exchange | Reuters