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Old 04-01-2013, 08:41 PM   #41
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We lived under NY state guaranteed issue health care plans for quite some time. The best one could say is they are crappy. I suspect the state exchange PPACA based policies will differ in two ways: less expensive and substantially better coverage.

Edit to add: PPACA guidelines limit the maximum regional charge @ 1.5x avg. The max price for the best coverage is less than $30k for a family of 4.
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Old 04-01-2013, 09:00 PM   #42
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Was that a typo? Did you say your full freight health insurance premium in NY would be $60000 a year for a family of 3 unless you kept your income to $65000 a year?
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Old 04-01-2013, 09:21 PM   #43
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Was that a typo? Did you say your full freight health insurance premium in NY would be $60000 a year for a family of 3 unless you kept your income to $65000 a year?
A qualified Yes. Of course the whole point is that the $60K plan would not be available on the exchange (I assume or else Obamacare subsidies will crush the system if everyone signs up for the $60K plan and then pay only $6K) so I could not even get that via subsidies so I would have to pay 60K to get it. So my choices are

a) Pay $60K for a very good plan
b) Pay $24K for a ok plan if my MAGI is above $78K
c) Pay $6K for a ok plan if my MAGI is below $78K

So if I want a good plan for my family if I retire I have to pay $60K a year. Under Obamacare it is claimed that this number might go down 12% so I guess it would be around $54K. As I mentioned before, reason this is so messed up in NY is because of Community Rating and Guaranteed Issue which led to a death spiral. BTW, Obamacare is doing exactly that (Community Rating and Guaranteed Issue) plus a "tax" to make sure people have to get healthcare to stop the death spiral.

Look, I have enough assets so I should not really have to game the system to get Obamacare subsidies. But if even a ok insurance is going to cost $24K unless I get subsidies, I will do it and game my investments so my MAGI is below $78K.
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Old 04-01-2013, 09:30 PM   #44
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We lived under NY state guaranteed issue health care plans for quite some time. The best one could say is they are crappy. I suspect the state exchange PPACA based policies will differ in two ways: less expensive and substantially better coverage.

Edit to add: PPACA guidelines limit the maximum regional charge @ 1.5x avg. The max price for the best coverage is less than $30k for a family of 4.
That is nice to hear. But that makes it worse to some extent. I assume this just means NY state must cost only 50% more than the cheapest plan. There seems no rule to mean that number just be $30K. Also for insurance company to be able to charge so "little" is, as it was pointed out, they will have to pay the doctor less which makes the plan that much crappier. If anything this "rule" sounds like bad news because it might ensure that all plans on the exchange will not be that good and I will be forced to pay for the $60K plan which would be outside the exchange. This entire Obamacare is a disaster. Either it total disaster by pushing up costs for middle class or it goes bankrupt paying out all these subsidies with everyone trying to game the system, or both.
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Old 04-01-2013, 09:34 PM   #45
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If $60000 a year for health insurance premium is "affordable care" , I don't want to know what is defined as unaffordable.
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Old 04-01-2013, 09:45 PM   #46
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I have different philosophy, I fully intend to game ObamaCare and some years qualified for a health care subsidy, by shifting income from one year to another.

I am also getting an electric car, beside the silly $7,500 tax credit. I get several perks in Hawaii. All large private and all public parking are required to have charging stations, which are place right by handicap parking spaces.

Plus I don't have to pay for parking at any parking meters or public parking lots. Now I can make a tenuous case why charging stations are good public policy (why they have to be upfront I don't know). But I can't possibly make any case why me or my fellow wealthy electric car owners need free parking. So I will happily write a letter to the newspaper, post on Facebook, the forum. Suggesting that this perk that I receive is unneeded and should be eliminated.

I'll do the same thing about a multimillionaire getting a health insurance subsidy. Although in the case of ObamaCare I am pretty sure that additional cost of the insurance will more than make up for my small bi-annual subsidy.
It's not gaming the system, this new hi-faluting health care is FREE..........
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Old 04-01-2013, 09:59 PM   #47
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I have different philosophy, I fully intend to game ObamaCare and some years qualified for a health care subsidy, by shifting income from one year to another.

I am also getting an electric car, beside the silly $7,500 tax credit. I get several perks in Hawaii. All large private and all public parking are required to have charging stations, which are place right by handicap parking spaces.

Plus I don't have to pay for parking at any parking meters or public parking lots. Now I can make a tenuous case why charging stations are good public policy (why they have to be upfront I don't know). But I can't possibly make any case why me or my fellow wealthy electric car owners need free parking. So I will happily write a letter to the newspaper, post on Facebook, the forum. Suggesting that this perk that I receive is unneeded and should be eliminated.

I'll do the same thing about a multimillionaire getting a health insurance subsidy. Although in the case of ObamaCare I am pretty sure that additional cost of the insurance will more than make up for my small bi-annual subsidy.
You are in luck. I believe the federal poverty level is higher in HI than mainland USA. So that gives you even more room to game the system for subsidies.
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Old 04-02-2013, 06:14 AM   #48
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That is nice to hear. But that makes it worse to some extent. I assume this just means NY state must cost only 50% more than the cheapest plan. There seems no rule to mean that number just be $30K. Also for insurance company to be able to charge so "little" is, as it was pointed out, they will have to pay the doctor less which makes the plan that much crappier. If anything this "rule" sounds like bad news because it might ensure that all plans on the exchange will not be that good and I will be forced to pay for the $60K plan which would be outside the exchange. This entire Obamacare is a disaster. Either it total disaster by pushing up costs for middle class or it goes bankrupt paying out all these subsidies with everyone trying to game the system, or both.
It seems like you are committed to your view despite the evidence. The premium ceiling is a rule, period. The way cost regions break down across the states, you probably live in a medium cost area. High cost are rural and lower density areas along with the largest cities, such as NYC. Not your case.

Insurance companies do not pay doctors different fees for the same service across different plan or policy groups. Most state regulators might object to this. What they do is limit the service options, which describes the current NY state individual insurance market. This measure will do more to bring broad coverage to individuals and small groups in NY than all the previous efforts of the past 2 decades.

No comment on your last thoughts. A bit ironic, though, given your intro post.
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Old 04-02-2013, 07:44 AM   #49
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It seems like you are committed to your view despite the evidence. The premium ceiling is a rule, period. ....
+1 I had the same thought while reading the thread.
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Old 04-02-2013, 09:37 AM   #50
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Right now my wife and I use our doctors in the New York City but that will change once we retire.
Here are the questions I'm trying to get an answer on. What if you signed up with one state's exchange and move to another state that doesn't have one, or has a different one? Are these exchanges "portable"? Or must we choose the Federal Exchange for purposes of "taking it with you". I'll let y'all know what I find out.
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Old 04-02-2013, 09:51 AM   #51
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But is that not cheating in some sense : if one has millions sitting in a retirement account, but withdraws only $30000 a year so he qualifies for the low rate?
Is it cheating? Let's assume two people who made the same total amount of money over a 40 year period of working.

Suppose Mr. Spender spent most of his working life spending every penny he made on booze, fast cars, faster women, casino vacations, and sports tickets. As a result his retirement benefit is SS and a very small 401K account. He easily gets a subsidy.

OTOH, Ms. Saver has lived below her means, denied herself many of the better things in life, and shopped the sales only for things she really needed. She has accumulated fat IRA accounts and can easily withdraw $70,000 a year if she needed it. No subsidy for her.

So, now we reward Mr. Sender with a subsidy, but deny it to Ms. Saver?? Is that fair? I think not.
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Old 04-02-2013, 09:58 AM   #52
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Is it cheating? Let's assume two people who made the same total amount of money over a 40 year period of working.

Suppose Mr. Spender spent most of his working life spending every penny he made on booze, fast cars, faster women, casino vacations, and sports tickets. As a result his retirement benefit is SS and a very small 401K account. He easily gets a subsidy.

OTOH, Ms. Saver has lived below her means, denied herself many of the better things in life, and shopped the sales only for things she really needed. She has accumulated fat IRA accounts and can easily withdraw $70,000 a year if she needed it. No subsidy for her.

So, now we reward Mr. Sender with a subsidy, but deny it to Ms. Saver?? Is that fair? I think not.
+1 (Chuckanut, I can't believe that I actually agree with you on something!)
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Old 04-02-2013, 10:01 AM   #53
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Is it cheating? Let's assume two people who made the same total amount of money over a 40 year period of working.

Suppose Mr. Spender spent most of his working life spending every penny he made on booze, fast cars, faster women, casino vacations, and sports tickets. As a result his retirement benefit is SS and a very small 401K account. He easily gets a subsidy.

OTOH, Ms. Saver has lived below her means, denied herself many of the better things in life, and shopped the sales only for things she really needed. She has accumulated fat IRA accounts and can easily withdraw $70,000 a year if she needed it. No subsidy for her.

So, now we reward Mr. Sender with a subsidy, but deny it to Ms. Saver?? Is that fair? I think not.
While ms saver doesn't get the subsidy she does get access to insurance she would not get if she had a preexisting condition so it's not all bad
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Old 04-02-2013, 10:03 AM   #54
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While ms saver doesn't get the subsidy she does get access to insurance she would not get if she had a preexisting condition so it's not all bad
TJ
Mr. Spender does as well, so I don't see how that is a mitigating factor. The focus of the "fairness" discussion is on the subsidy, not the access to health insurance which is the same for both Mr. Spender and Ms. Saver.
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Old 04-02-2013, 10:06 AM   #55
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My opinion is adjusting withdrawals to get insurance subsidies is no worse/better than adjusting withdrawals to avoid taxes.
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Old 04-02-2013, 10:21 AM   #56
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since i live in massachusettes.


another glitch in subsidized coverage.

as i've said before only certain plans in subsidized coverage. I have also found out today that only certain hospitals are in the subsidized plans.

be sure to check both-if the doctor you want and the most likely hospitals in your area is covered
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Old 04-02-2013, 10:28 AM   #57
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as i've said before only certain plans in subsidized coverage. I have also found out today that only certain hospitals are in the subsidized plans.
Are you speaking of Mass. currently or how coverage will work after the ACA policies go into effect on 1/1/2014?

If the latter, can you provide a link to confirm?
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Old 04-02-2013, 10:41 AM   #58
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Are you speaking of Mass. currently or how coverage will work after the ACA policies go into effect on 1/1/2014?

If the latter, can you provide a link to confirm?
other than increasing the 4th tier 300-400 for eligibility mass is keeping its system

Obamcare lets a state run its own health exchange as LONG as they provide a minimim coverage to the plans it subsidizes.


the state will continue to offer the plans the way it does-it will increase eligibility

the subsidized plans use medicaid networks. i have searched the web and find many references to subsized plans and medicaid networks.

i think many of the people on this forum are going to be dissapointed if they get subsidized coverage and find provider problems.

the government is NOT givning silver plan. they are subsidizing silver plan value-as they perceive it
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Old 04-02-2013, 10:47 AM   #59
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As I said previously, there is a subtle but important difference in doing things (adjusting your withdrawal rate) so one can passively avoid something (more tax) and actively acquiring something (getting a subsidy that is not meant for that group). I understand both maneuvers are legal and that how the rules were set up. I should have never use the word cheating in discussing the situation and just stay with "to me it may be slightly unseemly"
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Old 04-02-2013, 10:50 AM   #60
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It seems like you are committed to your view despite the evidence. The premium ceiling is a rule, period. The way cost regions break down across the states, you probably live in a medium cost area. High cost are rural and lower density areas along with the largest cities, such as NYC. Not your case.

Insurance companies do not pay doctors different fees for the same service across different plan or policy groups. Most state regulators might object to this. What they do is limit the service options, which describes the current NY state individual insurance market. This measure will do more to bring broad coverage to individuals and small groups in NY than all the previous efforts of the past 2 decades.

No comment on your last thoughts. A bit ironic, though, given your intro post.
Thanks for you feedback. I guess you have to educate me on how this works. It seems to me that in NY where insurance is very expenseive each insurance company has a choice, to enter health exchanges or not. The entire premise of this thread which I accept as fact, is that to be part of the exchange the insurance carrier has constraints on how much it charges (3 to 1 ratios, 150% rule etc etc.) What is also pointed out in this thread is that for the insurance company to comply with these rules they will have to pay doctors less. This is not about paying doctors differently between different plans but paying doctors less than insurance plans that are not on the exchange who does not have to comply with these rules. Also for someone to qualify for Obamacare subsidies one has to buy it on the exchange. So my point is perhaps what will happen is all the very good health care plans as far as very good doctors that will take said insurance will likely not be on the exchange. Again this fact seems to be asserted in this thread as well. So my point is that in NY after the exchanges are set up, we might end up with a two tier system of mediocre plans on the exchange and very expensive plans outside the exchange. And that even mediocre plans on the exchange might be very expensive forceing everyone to go for subsidies through hook or crook.

I love to hear more feedback on any facts I have asserted/picked up are problematic. This is very new to me so I want to learn more on how this works.
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