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Old 10-24-2013, 04:35 PM   #581
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I can't find a source to link but have read that once any member meets the individual deductible that member is only responsible for co-pays until the family TOOP is reached. This is mentioned in some insurers literature but I'm pretty sure it is now subject to ACA regulation.
For case of an HSA-qualified Plan (Exchange or not), isn't the family deductible all that matters?
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Old 10-24-2013, 05:03 PM   #582
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Note I edited my previous response due to a brain fart momentary distraction.

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Originally Posted by ERhoosier View Post
For case of an HSA-qualified Plan (Exchange or not), isn't the family deductible all that matters?
It matters for the total family OOP. Each family member, however, still enjoys an individual deductible and TOOP.
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Old 10-24-2013, 05:17 PM   #583
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For those of you wondering about individual vs family deductible, here's what I learned from our current insurer last week when I called to ask about their Marketplace plans. There are 2 kinds of deductibles, embedded and aggregate (non-embedded ).

The HSA plans I was asking about have the aggregate deductible which means that if there is more than one person on the plan the entire deductible has to be met before any benefits are paid, for us that's 2 times the $6000 = 12000 for example. For a family of more than 2 it may be limited to 2. Not certain about that.

For the non-HSA plans the deductible is embedded and applies per person. If person A meets the deductible of $6000 then after that benefits are paid to person A even if person B had not met the deductible. Talking to my insurer their HDHP with HSAs are all aggregate and their non-HSA plans are all embedded deductible. I don't know if all insurers treat HDHPs with HSAs vs regular insurance the same way.

Something to consider when shopping for plans and none of it is explained very well at Healthcare.gov. Like that's a surprise.....
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Old 10-24-2013, 05:18 PM   #584
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Note I edited my previous response due to a brain fart momentary distraction.



It matters for the total family OOP. Each family member, however, still enjoys an individual deductible and TOOP.

I am in a HSA right now and each family member does not enjoy an individual deductible and total out of pocket amount. The only thing that matters is the family Deductible and family out of pocket amount.

The policy information is crystal clear that with an HSA plan the individual deductible and out of pocket only matters if you have an individual plan.

I just looked at the benefit information Megacorp and it says:
It is important to note that the family deductible in a qualified HDLP works differently than the deductible in standard plans. IRS guidelines specify that the full family deductible must be met before any claims can be paid for any individual covered as part of a family plan...

Does anyone know how ACA exchange policies work. That is, let's say it is a family plan with a $3000 individual deductible and $9000 family deductible. One member of the family incurs $5000 in expenses. Is there payment for the expenses above $3000 (subject to any co-pays or percentages) or is there no payment until total family expenses reach $9000?
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Old 10-24-2013, 06:07 PM   #585
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This is all specified by policy and is not exchange-wide or insurer-wide.

If the policy CoC assigns both individual and a family deductions, both apply. A policy that uses aggregate deductions has no individual deduction. This applies to HSA policies as well. An HSA family policy can definitely have individual (embedded) deductions.

How the deduction is managed must be reflected in the price, because the policy must still meet an specific actuarial level and MLR target. A plan with one single family deductible must be less expensive than a similar policy with individual deductibles.

A search shows ACA regulations do not define deductibles (as embedded or aggregate), they define how deductions, co-pays and other cost sharing must be carried out.
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Need clarification and guidance here
Old 10-25-2013, 09:04 AM   #586
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Need clarification and guidance here

We submitted the ACA application last week and got an "eligibility letter" which I downloaded and printed. It says my daughter (who the application is for) is "eligible to purchase health coverage through the Marketplace" and the next step is to purchase a plan. However:

1. On the website when we are logged in, there is a big horizontal RED BANNER that says we need top submit more information to complete the application process. This information is to verify that even though her employer provides coverage to some employees, she needs to prove she is not one of the covered ones (she works part time).

2. We have the employer's info that includes their ID number, plan administrator's contact information, etc. We found a form: Employee Coverage Tool, OMB No. 0938-1191, that appears to be the one we fill out and submit. (it was interesting finding this form since the ACA site has no instructions as tho where it is).

3. The page the Red Banner is on allows us to go to a small link to expand what they think is missing in the application and a "drop down" box appears with a list of suggested documents to possibly upload. One minor issue here is the list of documents is not formatted properly and extends to the right off my screen. Shrinking my view to where I can read the list makes the text way too small to read. Trying to select and copy the list doesn't work and if I try to print the page, the drop down box closes. There is is serious coding wrong on this page.

4. Never the less, I attempted to upload the form we filled out minus a letter ACA asked for from the employer that confirms coverage from my daughter is not available. Well, making a .pdf and getting it ready to upload was easy, but what's not working is the Upload Button does not capture the file once selected.

5. Since we can't get the upload to work, we are asking if anyone here has actually uploaded a document to the site and how you did it? File size issue? Is a pdf proper? Etc.

6. Since she is eligible to purchase healthcare, we managed to find a way into available plan information, but I am doubting the costs presented are with a subsidy (there is no way to tell?). Am I correct here? We saw the four plan lists, could open plans, etc, but cost info looks "retail". How do you know if a subsidy is included? She makes $25K per year and should easily qualify.

7. Without the ability to upload the form we filled out to hopefully satisfy the RED BANNER statement requiring additional employer health plan info, is there a way to get this information to them? I asked a chat rep about this and she was clueless on the RED BANNER issue. I asked about mailing stuff in and she said that is possible, but could not tell me how to do this. Has anybody here actually mailed anything into them successfully?

8. I asked about the upload error and the rep had no clue except that maybe I should try it on off hours. I explained it is now 2:00 am and we are chatting and wondered what she thought "off hours" should be....no response. We did request, about 5 days ago, a call back from a tech on the upload issue, but have not gotten any calls yet.

We are frustrated like many here. If anyone has any suggestions on mailing, uploading, etc., please let us know.

Thanks!
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Old 10-25-2013, 11:23 AM   #587
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From another thread "Federal Exchange - ACA subsidies in jeopardy" by shotgunner
Court could block Obamacare subsidies in 34 states - Diana Furchtgott-Roth - MarketWatch
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Old 10-25-2013, 02:03 PM   #588
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MRG,

Thanks! And you were right. My application eventually appeared.

Am still not seeing any mention of subsidies. I do however see a blurb that says "You're eligible for a plan with cost-sharing reduction. Select the box below to see plans with these savings."

Yet the box is not selectable and has a blurb that says "Health plans with cost-sharing reduction (0)".

I guess that means no subsidy for me
Zedd, I started seeing the same Health plans with cost-sharing reduction (0). According to the person I talked to 'that part of the system is not currently working'. She wasn't sure when it might be fixed, but was given a status of 'their working on it'. I qualify at 214% FPL, so I'm going to wait. Based on a couple of threads here the cost sharing deductions may be worth waiting for.

MRG
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Old 10-25-2013, 02:30 PM   #589
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Originally Posted by aja8888 View Post
We submitted the ACA application last week and got an "eligibility letter" which I downloaded and printed. It says my daughter (who the application is for) is "eligible to purchase health coverage through the Marketplace" and the next step is to purchase a plan. However:

1. On the website when we are logged in, there is a big horizontal RED BANNER
.......................
8. I asked about the upload error and the rep had no clue except that maybe I should try it on off hours. I explained it is now 2:00 am and we are chatting and wondered what she thought "off hours" should be....no response. We did request, about 5 days ago, a call back from a tech on the upload issue, but have not gotten any calls yet.

We are frustrated like many here. If anyone has any suggestions on mailing, uploading, etc., please let us know.

Thanks!
I see a red banner, but when I take the link it says the enrollment is completed, just need to enroll. In reference to your number 8. Go back in this thread to 10/28/2013 at maybe 9:45. There's a couple of posts by aja8888 and grasshopper, that may explain what uploading means. The ARC(advanced resolution center) did actually return my call, but 7 business days later, I had escalated it several times.
In reference to subsidy (cost sharing), there's info here that suggests the site healthcare.gov is not calculating it(I can't believe that ).


Edit to add 'Whoops, didn't realize I was sending you to re read what you wrote'

Good luck,

MRG
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Old 10-25-2013, 02:33 PM   #590
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In the last few days it actually feels like the site has taken several steps backward, especially in terms of seeing your applications.
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Old 10-25-2013, 02:49 PM   #591
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I decided to look at some prices where I currently have insurance since I want to decide if I go COBRA or not....

Heck, all of the plans are expensive....
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Old 10-25-2013, 03:59 PM   #592
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Zedd, I started seeing the same Health plans with cost-sharing reduction (0). According to the person I talked to 'that part of the system is not currently working'. She wasn't sure when it might be fixed, but was given a status of 'their working on it'. I qualify at 214% FPL, so I'm going to wait. Based on a couple of threads here the cost sharing deductions may be worth waiting for.

MRG
Thanks for sharing your findings.

Thought I was losing my mind ... well maybe I am but at least not about this
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Old 10-25-2013, 10:22 PM   #593
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You know, if they're asking you to download, print and complete forms and upload them again, why did they bother with a web site?

Sounds like a tax return, where you can have multiple Forms and Schedules that you need to complete, depending on various scenarios.

It might be better for Intuit and the other companies which have online tax return sites to develop sites and/or desktop software (or iPad apps) which guide you through entering the required data and then transmitting them in the required formats to the agencies and/or insurers.

Or maybe add them as additional forms to Turbo Tax, Tax Act, etc. and charge extra for submitting those forms.

That's assuming the backend systems are capable of processing the volume of data.
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Old 10-26-2013, 09:16 AM   #594
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It might be better for Intuit and the other companies which have online tax return sites to develop sites and/or desktop software (or iPad apps) which guide you through entering the required data and then transmitting them in the required formats to the agencies and/or insurers.
As I've been reading about the healtcare.gov software problems, I had this same idea...let the public sector do it. Actually, my idea was not to rope the public sector into anything (desktop, iOS, etc), but just define API's. As TurboTax and Block are 'licenced' to submit to the IRS, you would licence legitimate players to access the servers that have the API's. You could give them a small finder's fee (something along the lines of how the Sabre, the airline reservation system, works). The result is that you'd have multiple private companies working on various UI's. Of course this would simply remove one aspect of the job from the government (the UI). But instead of "glitches", the explanation by the UI providers could be much more transparent (API "X" does not work at all, API "Y" returns bad information, API "Z" take 15 minutes to return).

EDIT: Many of us are programmers or technically inclined, but for the record: API = Application Programming Interface (how programs talk to one and other).
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Old 10-26-2013, 09:27 AM   #595
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I think there is little doubt that ACA could have been more efficiently accomplished if it was crafted as a set of requirements imposed on the healthcare and insurance industries, and therefore all aspects of it except enforcement would have been private rather than governmental. However, I think it is clear that that would have been opposed strongly. The ACA is what it is because it had to be a compromise.
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Old 10-26-2013, 05:46 PM   #596
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I can't find any source on it either. Just has been stated on this forum and another on health care. That is why I was asking.
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Old 10-26-2013, 07:21 PM   #597
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I can't find any source on it either. Just has been stated on this forum and another on health care. That is why I was asking.
Are you referring to cost sharing reducing deductibles, etc? If so here is a credible source....

In Addition To Premium Credits, Health Law Offers Some Consumers Help Paying Deductibles And Co-Pays - Kaiser Health News

Quote follows:

"But the Affordable Care Act also established another type of financial assistance for people who buy plans on the marketplaces, also known as exchanges. Cost-sharing subsidies can substantially reduce the deductibles, copayments, coinsurance and total out-of-pocket spending limits for people with incomes up to 250 percent of the federal poverty level ($58,875 for a family of four in 2013). Those reductions could be an important consideration for lower-income consumers when choosing their coverage."

Hope that's what you were after.
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Old 10-26-2013, 10:54 PM   #598
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.... Among its lessons is that adding more bodies to a project just delays it. ....
How true. Some managers think that any problem can be solved by just throwing enough or more people at it, but in most cases it is an issue of insufficient team members with the right knowledge or expertise and not necessarily insufficient headcount.

Or as I use to tell our management when they got stupid on things like this - just because it takes a woman 9 months to make a baby doesn't mean that 9 women can make a baby in a month!

They could generally understand that.
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Old 11-05-2013, 09:50 AM   #599
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From another thread "Federal Exchange - ACA subsidies in jeopardy" by shotgunner
Court could block Obamacare subsidies in 34 states - Diana Furchtgott-Roth - MarketWatch
I find this development very alarming even though we don't qualify for the subsidy anyway. The fallout could be huge chaos.

Discussion of details probably needs its own thread - it could really bog this one down.
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Old 11-05-2013, 10:54 AM   #600
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From another thread "Federal Exchange - ACA subsidies in jeopardy" by shotgunner
Court could block Obamacare subsidies in 34 states - Diana Furchtgott-Roth - MarketWatch
Have been reading about this the last couple of weeks. Yes we might need another thread because there is also this that just came out last night. A push to allow people to keep their old plans. A lot of challenges still.

Lawmakers push to keep Obama's health care pledge
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