all insurances NOT in ACA subsidized plans

[Chuckanut]

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.

 

[pb4uski]

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!)

 

[teejayevans]

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
TJ

 

[pb4uski]

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.

 

[gerrym51]

My opinion is adjusting withdrawals to get insurance subsidies is no worse/better than adjusting withdrawals to avoid taxes.

 

[gerrym51]

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

 

[REWahoo]

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?

 

[gerrym51]

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

 

[bondi688]

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"

 

[kmt1972]

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.

 

[kmt1972]

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.

My understanding is no. If I recall, part of the Obamcare debate was an idea that insurance companies can sell acorss state borders. The result was that this idea was shot down. My plan as soon as my child goes to college, is to move to FL or DE where taxes are low and healthcare insurance are lower than NY. Then, I might not even need the subsidies.

 

[pb4uski]

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 have never use the word cheating in discussing the situation. The strongly term I employed was "to me it may be slightly unseemly"

and the sense I get is that many of us disagree with your view that structuring your withdrawals to qualify for the subsidy is unseemly, but we respect your right to have a different view and express it.

 

[REWahoo]

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

You are much better at searching than me as I've not been successful at all in finding any reference specifically linking ACA "subsidized plans" to medicaid networks.

Please provide links to a few of those you found.

 

[gerrym51]

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.

i believe the subsidized plans will basicly be medicaid networks. however medicaid people get excellent coverage. what they don't get is a lot of providers.

you need to check if your doctor and most likley hospital is in the plan

 

[MichaelB]

i believe the subsidized plans will basicly be medicaid networks. however medicaid people get excellent coverage. what they don't get is a lot of providers.

you need to check if your doctor and most likley hospital is in the plan

Gerry, under the PPACA plans are not subsidized. Some users will receive tax credits. Not the same thing.

 

[pb4uski]

i believe the subsidized plans will basicly be medicaid networks. however medicaid people get excellent coverage. what they don't get is a lot of providers.

you need to check if your doctor and most likley hospital is in the plan

That may to true in Mass, I can't speak to that, but it is definitely not the case in the rest of the country to the best of my knowledge. In these cases, the doctor and other medical providers will have no idea whether or not the insured is receiving a subsidy or not, all they will know is that the insured has XYZ individual health insurance plan.

 

[gerrym51]

Gerry, under the PPACA plans are not subsidized. Some users will receive tax credits. Not the same thing.

i hope your correct-so i can get tax credits 2014 and 2015

 

[REWahoo]

Gerry, under the PPACA plans are not subsidized. Some users will receive tax credits. Not the same thing.

+1

At the time of application will there be any way for an applicant to know for sure if they qualify for a subsidy, much less the insurer? Doesn't all that happen during the 2014 tax filing process?

 

[gerrym51]

all i can say if you google obamacare and subsidies you get a lot of choices.

 

[MichaelB]

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.

Sorry, we all educate ourselves here with the information freely offered.

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.

I would only point out this is not fact, only an assertion, unsupported, challenged.

Also for someone to qualify for Obamacare subsidies one has to buy it on the exchange

As pointed out elsewhere, the plans are not subsidized, some users receive tax credits. The assistance is based on the user, not the plan.

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.

Well, NY already has a two tier system.(I was an unhappy subscriber for many years and remember it quite well.) Actually, NY has a three tier system. Doctors that are unhappy with insurance reimbursement don't change plans because reimbursement rates differ by insurer but not within the insurer (exception Medicaid). What doctors do is they stop accepting insurance. There are enough wealthy people to support some of this. So, there is every reason to expect NY state to migrate from it's current three tier system to a much better two tier one, where decent plans are finally available to individual consumers.

 

[REWahoo]

all i can say if you google obamacare and subsidies you get a lot of choices.

But nothing that supports your belief that "the subsidized plans will basicly be medicaid networks"

I think your experience has you believing every state's ACA exchange will mirror Mass. You could be correct, but both you and I have been unable to find anything to confirm this is the case.

Once again, only time will tell...

 

[gerrym51]

Heres how you will know if there are different plans for subsidized/tax credit plans.

if the website says go to this portal to apply for subsidized plans and to this portal for non-subsidized.

that will be the test thats how it done in mass.

 

[REWahoo]

Heres how you will know if there are different plans for subsidized/tax credit plans.

if the website says go to this portal for subsidized plans and to this portal for non-subsidized.

that will be the test thats how it done in mass.

Under the ACA there will be no "subsidized plans", only tax credits [-]at the end of 2014[/-] to help pay for HI premiums. There will be no way for an applicant to differentiate at the time of application in the fall of 2013 as qualification for a subsidy will depend on earnings in 2014.

I suspect Mass will have to make some changes to the exchange application process under the new ACA rules.

 

[pb4uski]

+1

At the time of application will there be any way for an applicant to know for sure if they qualify for a subsidy, much less the insurer? Doesn't all that happen during the 2014 tax filing process?

No and yes.

There will not be any way for an applicant or insurer to know for sure if they qualify for a subsidy based on their 2014 income since they will be applying for 2014 coverage in late 2013.

During 2014, the insurer will receive directly from the government "provisional" subsidies (or not) based on the applicant's 2012 O-MAGI computed from the applicant's 2012 tax return. When the applicant files their 2014 tax return in early 2015, they will determine the amount of subsidy that they were actually entitled to in 2014 based on their 2014 O-MAGI. If they received more provisional subsidy than they were entitled to, they will owe the difference with their federal return (or it will reduce their refund, or both). Conversely, if they were entitled to more subsidy that they actually received in 2014, the difference will add to their refund or reduce their taxes due.

 

[MichaelB]

Heres how you will know if there are different plans for subsidized/tax credit plans.

if the website says go to this portal to apply for subsidized plans and to this portal for non-subsidized.

that will be the test thats how it done in mass.

So, what you are saying is the current Massachusetts exchange has different policies portals for subsidized and unsubsidized policies, and you believe all other 49 states plus DC will do the exact same thing.

Interesting. We don't really know, because no state has shared any specifics on how it's exchange will work. It is something else to be on the lookout for, and to track here. Please anyone share any links on details of specific state exchange operation.