ACA Federal Marketplace updates

teejayevans said:
So if I already have a policy (and either it's grandfathered in or it will compliant starting next year), then I still qualify for the subsidy and can skip the exchange process, yes?
TJ
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Looks like you need a policy that is offered on the exchange to be eligible for tax credits. This is a recent CRS white paper on premium credits http://www.healthreformgps.org/wp-content/uploads/crs-premium-credit-7-18.pdf
Premium credits will only be available to individuals enrolled in a plan offered through an individual exchange; premium credits are not available through the small business exchanges. Individuals may enroll in a plan through their state’s exchange if they are (1) residing in a state in which an exchange was established; (2) not incarcerated, except individuals in custody pending the disposition of charges; and (3) lawful residents.14
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Yes, the law says that you must be enrolled thru the exchange process to receive the subsidy. So, even if you have a compliant plan, if you have direct individual coverage, you will be responsible for paying the full load. If you want subsidy, you'll need to drop your current plan and go thru the exchange to obtain new coverage.


I ER'd in 2010 and took COBRA at $910 per month for my DW and me. Due to her having had stage one breast cancer in 2003 (no recurrence) and me having arthritis of the neck and medication for that, when COBRA expired, I ended up with private coverage running $1,962 per month (thru Golden Rule....it was the least expensive option).

Thru the new Health law, even without subsidies, my premiums will drop significantly (for better coverage) and, with subsidies, I should be looking at total premiums under $400 per month.

I've never looked for a handout ..... And am willing to pay my fair share. But $1962 per month is unaffordable, completely, for me.

.....
 
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MichaelB said:
Looks like you need a policy that is offered on the exchange to be eligible for tax credits. This is a recent CRS white paper on premium credits http://www.healthreformgps.org/wp-content/uploads/crs-premium-credit-7-18.pdf
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So even if my current policy is cheaper than exchange rate, I will be better off going to the exchange, paying more to insurance company, but get getting help from uncle sam to more than make up the difference.

Hmmm, now I know why insurance companies like this law. And this is suppose to lower costs how:confused:
TJ
 
PPACA has several specified "channels" for an individual to learn about and enroll in exchange policies: the HHS web site, on-line brokers like ehealthinsurance.com, traditional insurance agents and brokers, etc.

One education channel is "navigators". States with their own exchanges can hire or authorize navigators. The feds are doing the hiring where the federal exchange is operating.

From the HHS web site:

Navigators have a vital role in helping consumers prepare electronic and paper applications to establish eligibility and enroll in coverage through the Marketplaces and potentially qualify for an insurance affordability program. They also provide outreach and education to raise awareness about the Marketplace, and refer consumers to health insurance ombudsman and consumer assistance programs when necessary. Navigators play a role in all types of Marketplaces, are funded through state and federal grant programs, and must complete comprehensive training.

On August 15, 2013, CMS awarded $67 million in Navigator Cooperative Agreements to 105 entities to serve in the 34 Federally-facilitated and State Partnership Marketplaces.
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Here's the list: http://www.cms.gov/CCIIO/Programs-a...places/Downloads/navigator-list-8-15-2013.pdf

I don't see much impact to our alert readers. The primary effort will be in the form of "Did you know there's a new way to buy insurance at a reduced cost?" pitches to those who don't presently have insurance.
 
I must be one of the unfortunate folks because in no instance will the exchanges cost me less then I was paying or expecting to pay as companies in Connecticut, including the one I had worked for, are starting to move retirees and part timers to the exchanges rather than supplement or provide the insurance directly. Since my income in retirement puts me just above the subsidy I will get to feel the full effect on day one.

Question comes back what happens to everyone else when the subsidies end? That along with the realization that there is such concern regarding the young invincibles not signing up Selling The Idea Of Health Insurance To 'Young Invincibles' - Kaiser Health News is cause for concern.
 
killingme said:
I must be one of the unfortunate folks because in no instance will the exchanges cost me less then I was paying or expecting to pay
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This often is the case when, previously, you were one of the fortunate folks who had more affordable access than so many others.

killingme said:
Question comes back what happens to everyone else when the subsidies end?
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What happens to everyone when Social Security ends? There are always new challenges to face.
 
bUU said:
This often is the case when, previously, you were one of the fortunate folks who had more affordable access than so many others.

What happens to everyone when Social Security ends? There are always new challenges to face.
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I'm not sure you want to go down that path on this thread. I had an immediate retort to your post, but out of respect for the community and MichaelB, I stuffed it back down. Please Do NOT minimize the affect of the cost on those of us who will not get subsidies. Most did not and do not have it in our net budgets to afford. No surprise there since most of us planned for years not knowing how drastic all the rules would change.

None of us really know what they will be as of yet....although we can take a good guess.
 
Thanks, sheehs1. This is a difficult topic and keeping the thread focused on implementation is helpful to all. While access to healthcare insurance has been a major issue for some, losing coverage that is heavily subsidized or underwritten can be a serious financial blow.

Edit to add: my personal planning for healthcare assumes that I will pay slightly more than the average large group plan, adjusted for age. Most large group plans have coverage that already meets the minimum essential benefits, so the only reason it would cost more would be the additional overhead for an individual policy, which is norma, and the age factor, which we knowl. The average large group cost for an individual policy in 2012 was $5615. This presentation by KFF has all the detail. http://kaiserfamilyfoundation.files...efits-chart-pack-private-insurance-091112.pdf
My suggestion to friends and family members is, if they are paying much more than that, they might see a reduction is costs, and if they are paying much less than that, they should expect to see their costs approach the average.
 
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sheehs1 said:
I'm not sure you want to go down that path on this thread. I had an immediate retort to your post, but out of respect for the community and MichaelB, I stuffed it back down. Please Do NOT minimize the affect of the cost on those of us who will not get subsidies. Most did not and do not have it in our net budgets to afford. No surprise there since most of us planned for years not knowing how drastic all the rules would change.

None of us really know what they will be as of yet....although we can take a good guess.
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+1... But when it's not coming out of your own pocket, or you stand to benefit from the process, it is easy to dismiss concerns from people who have the bullseye attached their wallet. ......It's amazing the lack of knowledge about the upcoming change. I have read the government is planning a campaign directed at seniors. Many of them are confused thinking they will get fined if they don't sign up for insurance even though they are on Medicaid already. The government is afraid (according to the newspaper today) that millions of seniors will clog up the system with calls or trying to sign up.
I just spent an hour yesterday trying to get one of my older friends convinced that the exchange will be cheaper than his current group plan he is on. He is confusing a bunch of factors and some incorrect assumptions: 1) current underwritten plan pricing 2) government subsidies 3) rate relief from his "high priced" group rate. 4) not knowing exchange pricing is specific age based versus his current group pricing. 5) believing the exchange premium will pay for everything.
I finally quit arguing with him and sent him exact pricing links for each age from a couple of states for him to digest. He was shocked to find out that it wasn't going to help in fact it made his current plan appear cheap! I know he still doesn't get it, but he gets the important thing, and that is he will be keeping his current group plan until he is on Medicare.
 
There is still one big push to stop the ACA, to "de-fund" it by tying it to the upcoming debt ceiling battle and the sequester.

So if Congress withholds funds ...
 
explanade said:
There is still one big push to stop the ACA, to "de-fund" it by tying it to the upcoming debt ceiling battle and the sequester.

So if Congress withholds funds ...
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then the law goes ahead
 
Keeping politics and political speculation out of the thread will benefit everyone.
 
Mulligan said:
+1... But when it's not coming out of your own pocket, or you stand to benefit from the process, it is easy to dismiss concerns from people who have the bullseye attached their wallet. ......It's amazing the lack of knowledge about the upcoming change. I have read the government is planning a campaign directed at seniors. Many of them are confused thinking they will get fined if they don't sign up for insurance even though they are on Medicaid already. The government is afraid (according to the newspaper today) that millions of seniors will clog up the system with calls or trying to sign up.
I just spent an hour yesterday trying to get one of my older friends convinced that the exchange will be cheaper than his current group plan he is on. He is confusing a bunch of factors and some incorrect assumptions: 1) current underwritten plan pricing 2) government subsidies 3) rate relief from his "high priced" group rate. 4) not knowing exchange pricing is specific age based versus his current group pricing. 5) believing the exchange premium will pay for everything.
I finally quit arguing with him and sent him exact pricing links for each age from a couple of states for him to digest. He was shocked to find out that it wasn't going to help in fact it made his current plan appear cheap! I know he still doesn't get it, but he gets the important thing, and that is he will be keeping his current group plan until he is on Medicare.
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I hear you Mulligan. The roll out of educating the consumer is still a huge mountain. I was talking about it yesterday with a couple of people who knew very little.
I was on ehealthinsurnce.com getting quotes. A little confusing since it prompted me to answer questions on things like maternity coverage. I thought all of those items were required to be ACA compliant. All I can deduce is the quotes were not for ACA compliant policies at this point in time. With that I still can't get a realistic feel for what my health insurance will cost me in 2014, after my private individual coverage expires. Still too many ifs ands and buts.
 
MichaelB said:
Keeping politics and political speculation out of the thread will benefit everyone.
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+1
This is an emotionally charged subject and best not "to bait" others. I know I don't appreciate those posts so can only assume others do not as well.

p.s. I'd hate to see this informative thread closed down.
 
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sheehs1 said:
I hear you Mulligan. The roll out of educating the consumer is still a huge mountain. I was talking about it yesterday with a couple of people who knew very little.
I was on ehealthinsurnce.com getting quotes. A little confusing since it prompted me to answer questions on things like maternity coverage. I thought all of those items were required to be ACA compliant. All I can deduce is the quotes were not for ACA compliant policies at this point in time. With that I still can't get a realistic feel for what my health insurance will cost me in 2014, after my private individual coverage expires. Still too many ifs ands and buts.
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That is why they are cheaper because they are not ACA compliant policies. Here are some thoughts for you to consider, Sheehs, if you find out exchange prices are higher than your current underwritten plan is. 1) call your existing company and find out if they are going to carry you through next year, or find out when your presently yearly policy ends. 2) find out if you can re-enroll in plan in late December if it expires earlier in the year. 3) If they won't re-enroll, or are dropping you into exchange, consider getting another underwritten plan from another company by December. This will keep you out of the exchanges for a year. 4) If you are currently using an HSA plan, consider enrolling in an underwritten plan to get the tax deduction next year if your states exchange does not offer an HSA eligible plan which many appear not to be doing. It is possible in some states that HSA plans will be available off exchange, but not on the exchange.
I am dropping my present carrier and enrolled in CoventryOne that will offer them, including the HSA through next December. This next part only applies to me, but based on present insurance costs being reported in relation to my present cost and possible loss of HSA deduction, I am assured now of avoiding almost a $5,000 increase in health next year. 2015.....well not so much. :)
 
sheehs1 said:
Please Do NOT minimize the affect of the cost on those of us who will not get subsidies.
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Myself among them. However, to be clear, please understand that that was not my intention. Rather, my intention was to ensure that the affect of the subsidies on those who will get them was not minimized.
 
Mulligan...my plan renews Sept 1 and I am already safe until next September although with an 11% increase from prior year. Come Oct 1st...or whenever the exchange opens here in Va I'll take a look at those to see if I can get a feel for the individual rates.- on the exchange.
For the sake of others who may have individual coverage, I will pay $434 a month in 2014 for my current policy and my husband pays close to $400 a month for his. We both have $3500 deductibles. I have dental, he does not. We are both 58 years old. Neither are ACA compliant. This totals a $10,008 net of tax yearly amount and it is pre ACA implementation.
 
sheehs1 said:
Mulligan...my plan renews Sept 1 and I am already safe until next September although with an 11% increase from prior year. Come Oct 1st...or whenever the exchange opens here in Va I'll take a look at those to see if I can get a feel for the individual rates.- on the exchange.
For the sake of others who may have individual coverage, I will pay $434 a month in 2014 for my current policy and my husband pays close to $400 a month for his. We both have $3500 deductibles. I have dental, he does not. We are both 58 years old. Neither are ACA compliant. This totals a $10,008 net of tax yearly amount and it is pre ACA implementation.
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I can see why you are concerned and interested in finding out, as your present rates seem high to me, but I am still barely on the short side of 50. I am sure you have been tracking some of the other released states premiums. Though impossible to accurately compare apples to apples on policies let alone state costs, but it appears you could possibly be in line for a $100-$200 monthly increase pp, backing out your dental costs. But that is just speculative guessing based on a couple states and your age. To be honest I am just as worried about the second foot dropping. That being when this pot of money the government is temporarily giving to insurance companies to cover possible losses of sick people joining their plans. The money will have to come from somewhere and I think I know where it will.
 
sheehs1 said:
Mulligan...my plan renews Sept 1 and I am already safe until next September although with an 11% increase from prior year. Come Oct 1st...or whenever the exchange opens here in Va I'll take a look at those to see if I can get a feel for the individual rates.- on the exchange.
For the sake of others who may have individual coverage, I will pay $434 a month in 2014 for my current policy and my husband pays close to $400 a month for his. We both have $3500 deductibles. I have dental, he does not. We are both 58 years old. Neither are ACA compliant. This totals a $10,008 net of tax yearly amount and it is pre ACA implementation.
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Renewing now makes sense, because if a better plan appears on the exchange you can change. You would lose the deductible, so you're probably better off scheduling anything medical before the renew date.

Your rates look in the same ballpark as Maryland and DC, FWIW.
 
Mulligan said:
I can see why you are concerned and interested in finding out, as your present rates seem high to me, but I am still barely on the short side of 50. I am sure you have been tracking some of the other released states premiums. Though impossible to accurately compare apples to apples on policies let alone state costs, but it appears you could possibly be in line for a $100-$200 monthly increase pp, backing out your dental costs. But that is just speculative guessing based on a couple states and your age. To be honest I am just as worried about the second foot dropping. That being when this pot of money the government is temporarily giving to insurance companies to cover possible losses of sick people joining their plans. The money will have to come from somewhere and I think I know where it will.
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Back when I was 50, my rates were not bad either! :)
Amazing rate increases once past 55!
Believe it or not...our rates are good compared to some I have heard!.
 
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MichaelB said:
Renewing now makes sense, because if a better plan appears on the exchange you can change. You would lose the deductible, so you're probably better off scheduling anything medical before the renew date.

Your rates look in the same ballpark as Maryland and DC, FWIW.
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Yes..need to consider a full work up and all preventive tests.

Are those rates in Maryland and DC, projected exchange rates for individual coverage.? Need to spend some time looking around. I feel I am on the internet hours a day as it is! LOL!
 
sheehs1 said:
Yes..need to consider a full work up and all preventive tests.

Are those rates in Maryland and DC, projected exchange rates for individual coverage.? Need to spend some time looking around. I feel I am on the internet hours a day as it is! LOL!
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Though not your next door neighbors, here are a couple more you can play with if you feel compelled to hang out on the 'net some more. :)

http://missoulian.com/montana-exchange-rates-pcs-v-pdf/pdf_b48b562e-08e4-11e3-bafb-0019bb2963f4.html

http://www.healthsourceri.com/wp-co...RI-Individual-Plans-by-Age-FINAL-08202013.pdf
 
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