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Anyone Signed for ACA for 2016?
Old 11-25-2015, 02:45 PM   #1
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Anyone Signed for ACA for 2016?

This is my first year where I have had to buy my own Health Insurance, although I have been FIRED for about 5 years my wife always worked... for healthcare, she retired this year.

I think I got a pretty good plan here in Florida with Florida Blue. We are fortunate we can control out income in retirement.

$350pm for both of us Ages 62 and 57 respectively.
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Old 11-25-2015, 02:53 PM   #2
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I signed us up 15 minutes ago. Humana PPO in Florida.
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Old 11-25-2015, 03:03 PM   #3
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My current plan just automatically renews if I don't do anything... same as last year.
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Old 11-25-2015, 03:11 PM   #4
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Good price, are your docs, facilities and any meds covered? First year here the local carriers were having a hard time providing that information. This year it was much improved.
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Old 11-25-2015, 03:14 PM   #5
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Good price, are your docs, facilities and any meds covered? First year here the local carriers were having a hard time providing that information. This year it was much improved.
Yes you can check it out here:

http://www.google.com/url?sa=t&rct=j...08194040,d.dmo
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Old 11-25-2015, 06:47 PM   #6
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We've done all our research and comparisons. I was just waiting for a phone call from my doctor's office about which plans they would be accepting in 2016. They dropped the narrow network plan we've had (and loved!) in 2015. They will only accept the larger network version and another insurer.

For me to stay with my doctor would cost an additional $189/mo. That's just for me, not including my husband. I could change to the other insurer that they accept, who we had in 2014 but that would cost me $203/mo more than my 2015 plan cost.

So we've decided that we will try another insurer that has a more reasonable cost. I already talked to my doctor about this (I want to keep you as my doctor but it will cost me an extra $200/mo) and she was very understanding. I told her I'll try to come back when I get to Medicare in 2020.

We are very disappointed by our plan offerings this year. We prefer a Bronze HDHP with HSA and none of the HSA eliglble plans were close to our price range. The plan we have decided on is a Bronze HMO, not HSA eligible, with a deductible of $6650, and a PCP copay of $40. Our closest city has two major hospital systems and we've been with system A and now we will move to system B which is no big deal, they are comparable.

As for using the Healthcare.gov website it was easy with plenty of options and filters. I also used HealthSherpa and Valuepenguin. HealthSherpa gave us a different subsidy amount but I figure this is all going to get reconciled at tax filing time with the numbers used by HealthCare.gov so we just went with their subsidy amount.

All in all I'm still very glad to have the ACA. At least we had a subsidy and choices and could be insured despite pre-existing conditions. I think it's all still evolving. I've seen big improvements and then again the deductibles and full prices of some of these plans are unbelievable!

For us, the insurance is for the privilege of paying the reduced network price and then having the safety net in the case of an expensive hospitalization.
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Old 11-25-2015, 06:53 PM   #7
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I signed us up 15 minutes ago. Humana PPO in Florida.
Same here - this afternoon. Humana PPO in Texas, off exchange.
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Old 11-25-2015, 06:55 PM   #8
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I switched from an Empire BCBS (NY) plan to a Silver Plus plan offered by a company called Oscar (available only in a few states). I can keep all of my doctors and not have to deal with Express Script for mail-order drugs after my recent fiasco with them Labwork is free if I use Quest Labs, my other copays are low, and my expensive diabetes drug is covered with a reasonable copay. My local hospital is In-Network. All of this with a lower premium than BCBS.
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Old 11-25-2015, 08:13 PM   #9
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Last year was my first time signing up on an exchange. It was easier this year since I already knew the "features" that were broken on Covered California. I did have to call the help desk because I went too far when I was testing whether the "feature" was still broken. (Getting the subsidy up front when signing up for more than 1 insurer within a family. DH wants a different plan the myself and the boys.) We have enough savings to pre-pay the full amount during the year and get the tax credit at tax time.
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Old 11-25-2015, 08:53 PM   #10
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Last year was my first time signing up on an exchange. It was easier this year since I already knew the "features" that were broken on Covered California. I did have to call the help desk because I went too far when I was testing whether the "feature" was still broken. (Getting the subsidy up front when signing up for more than 1 insurer within a family. DH wants a different plan the myself and the boys.) We have enough savings to pre-pay the full amount during the year and get the tax credit at tax time.
When you signed up, did you have to estimate income?

When filling out the application, I'm trying the lazy way. The question about income was optional, so I skipped that. Then there was a choice about if I wanted to get asked more questions, I chose no. The in the eligibility result, I got "eligible to buy from marketplace" but the result didn't say anything about tax credits.

My preference is to just pre-pay, then get a credit at tax time but now am not sure if I entered correctly.
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Old 11-25-2015, 09:03 PM   #11
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My preference is to just pre-pay, then get a credit at tax time but now am not sure if I entered correctly.
That should work. Not applying for a premium credit up front does not preclude you from claiming it when you file your tax return, as long as you purchased it off the appropriate exchange.
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Old 11-25-2015, 09:10 PM   #12
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That should work. Not applying for a premium credit up front does not preclude you from claiming it when you file your tax return, as long as you purchased it off the appropriate exchange.
Thanks. The explanation on the application website on the "Do you want more questions?" is misleading stating that if you say "no" then you won't get help with payments. I guess it really just means you won't get premium credits up front.
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Old 11-25-2015, 09:25 PM   #13
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When you signed up, did you have to estimate income?

When filling out the application, I'm trying the lazy way. The question about income was optional, so I skipped that. Then there was a choice about if I wanted to get asked more questions, I chose no. The in the eligibility result, I got "eligible to buy from marketplace" but the result didn't say anything about tax credits.

My preference is to just pre-pay, then get a credit at tax time but now am not sure if I entered correctly.
I entered an income high enough to be above tax credit qualification. The problem with the California exchange is that if you qualify for a tax credit up front you CANNOT set up groups so you can have different insurance for different family members. But if you set your income above the tax credit qualification, it lets you set up groups. Last year, after quite a bit of time on hold and discussions with multiple CSRs, I was told they were going to fix this for last year's enrollment - but they missed the deadline. I assumed it would work correctly this year (allowing groups)... so I put in a better guess of my income (which would qualify for tax credits up front)... and the group option wasn't there. Unfortunately, to redo things you have to have a CSR delete your eligibility so you can redo it.

Healthcare.gov doesn't have this "feature"... you can get tax credits up front and still set up groups.

I read the IRS pages and it seems very clear that you can get the tax credits at tax filing time. So I'm not worried.
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Old 11-25-2015, 11:47 PM   #14
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I entered an income high enough to be above tax credit qualification. The problem with the California exchange is that if you qualify for a tax credit up front you CANNOT set up groups so you can have different insurance for different family members. But if you set your income above the tax credit qualification, it lets you set up groups. Last year, after quite a bit of time on hold and discussions with multiple CSRs, I was told they were going to fix this for last year's enrollment - but they missed the deadline. I assumed it would work correctly this year (allowing groups)... so I put in a better guess of my income (which would qualify for tax credits up front)... and the group option wasn't there. Unfortunately, to redo things you have to have a CSR delete your eligibility so you can redo it.

Healthcare.gov doesn't have this "feature"... you can get tax credits up front and still set up groups.

I read the IRS pages and it seems very clear that you can get the tax credits at tax filing time. So I'm not worried.
Thanks for the info.

Well, I enrolled and payed my first premium. Glad to get that out of the way. There were two HSA compatible plans which had my doc and hospital in-network. BCBS Slimmed Down Choice PPO and a Humana HMO. The BCBS seemed better for coverage and price, so I chose that which actually is the same plan off-market plan suggested by BCBS.

As for my eligibility, my income is borderline Medicaid territory. So during the year, I'll have to plan things right so my income is high enough for the credits come tax time. Okay, from all this effort, I need a shower .
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Old 11-26-2015, 12:51 AM   #15
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All in all I'm still very glad to have the ACA. At least we had a subsidy and choices and could be insured despite pre-existing conditions. I think it's all still evolving. I've seen big improvements and then again the deductibles and full prices of some of these plans are unbelievable!

For us, the insurance is for the privilege of paying the reduced network price and then having the safety net in the case of an expensive hospitalization.
+1 Well said Sue J!

Yep, we paid full price in 2015 since a few month's w*rk & bonus at the beginning of the year pushed us over the ACA cliff. The full price cost is sobering, and so are the big OOP and deductible.

True broad network PPO's are disappearing in this state and getting very expensive in any event. Also, the in network vs. out of network has become an issue as providers drop out of the narrow network PPO's. We also have had issues with excessively aggressive treatment on the broad network PPO, a real problem since the OOP and deductibles are so large. This has been quite an awakening after "enjoying" good broad network, low OOP and deductible health insurance through w*rk for decades.

For 2016, we are moving from a broad network PPO to an HMO in the interest of cost containment, although not without reservations because of the less than stellar reputation of HMO's in general. Still, DW and I have had major health issues resolved successfully by HMO's in the distant past. Keeping our fingers crossed and praying for the best...

We signed up on healthcare.gov last week, now just waiting to pay the first bill. We intentionally overestimated income and will collect the subsidy after the next tax return.

Although we have enough taxable savings to manage our MAGI and ACA level for a few years, we decided to target the subsidy but forego the cost sharing, at least for 2016. We chose the Bronze level for maximum savings up front, although the silver level with cost sharing was tempting. In the end, we decided on Bronze to save on premiums and to mentally acclimate to the high OOP and deductible realities. For us, high OOP and deductibles will probably be our ongoing reality, especially in a few years when the IRA drawdown will push us out of the cost sharing MAGI range. Seems like such a long way to Medicare...

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Old 11-26-2015, 10:17 AM   #16
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That should work. Not applying for a premium credit up front does not preclude you from claiming it when you file your tax return, as long as you purchased it off the appropriate exchange.
I am just under the top MAGI limit to be able to claim a subsidy, so it ends up being rather small. I use the subsidy to offset the federal income taxes due at tax time because I have no taxes withheld from my investment income (my only income source). I use the slight overpayment of HI premium as a backhanded withholding tax.

It also saves me the trouble of having to verify my income for the advanced premium subsidy because those attempts had always been rejected by the NY Marketplace. I would upload my 1099 statements to them and NY Marketplace could never seem to figure out what I was sending them because it didn't fall into any of their more typical categories of verifiable income. With my investment income subject to spikes due to irregular cap gain distributions, there was no point to trying to estimate my MAGI anyway.
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Old 11-26-2015, 11:23 AM   #17
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I am going to sign up soon, sometime in early December but I am dreading it after my dismal attempt to sign up at the start of November (days of being on hold).

I still don't know how I am going to explain that our $23,000 2016 MAGI comes from a bit of dividends, some interest income, a few 1099 deals from bank signup bonus, and a rollover of traditional IRA funds to Roth IRA to fill the remainder. This is going to blow their minds, which rate somewhere below a trainee in a call center in India.
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Old 11-26-2015, 05:57 PM   #18
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We signed up last week and paid the January bill. We went from a bronze plan to a silver plan because the additional cost was offset by various savings and reduces our risk. We aren't eligible for subsidies.

Remember that if you are eligible for cost sharing (under 250% of FPL) as well as premium support (under 400% of FPL), you can only get cost sharing up front, not as a tax refund.
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Old 11-27-2015, 10:47 AM   #19
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I still don't know how I am going to explain that our $23,000 2016 MAGI comes from a bit of dividends, some interest income, a few 1099 deals from bank signup bonus, and a rollover of traditional IRA funds to Roth IRA to fill the remainder. This is going to blow their minds, which rate somewhere below a trainee in a call center in India.
*shrug* I recently signed up with a 2016 reported income of $23k for two people and sent them an explanation letter with a copy of my 2014 return, saying that wages reported then are now zero since I retired at end of 2014 (I had a substantial severance this year and wasn't eligible for a subsidized plan so 2016 is my first exchange year). Also sent the separation notice from my former employer. So all I have is investment income plus a little from my wife's PT biz plus a very small pension. The math is very clear and I've seen posts from folks saying that those kinds of retirement-related explanations were accepted for 2015 so I can only hope that's true next year.

Silver plans with 94% of costs covered are pretty awesome btw, if you can afford to manage income below 150% of FPL. The only drawback I've seen with them is sky-high OOP maxes on out of network coverage, like $50k for a family. Makes it even more of an imperative to demand in-network providers for everything, assuming you're able to do so after accidents etc.
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Old 11-27-2015, 10:49 AM   #20
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Remember that if you are eligible for cost sharing (under 250% of FPL) as well as premium support (under 400% of FPL), you can only get cost sharing up front, not as a tax refund.
Absolutely - if you can get near enough to be under the 250% Silver cost sharing cap it can be well worth it to go for one of those plans, even if you subsequently make more income to put you over. The cost sharing does not go away if you go over the cap, only the subsidy is reduced.
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