Are we allowed to talk about it yet?

[ShokWaveRider]

I was wondering if an insurance company for some reason could "force" a lapse in coverage? For any reason, missing a payment?, Clerical Errors, etc.

But I think I answered my own question as a "non contiguous" coverage is defined by an extended gap. I seem to remember reading that somewhere, but do not know what the gap would be for coverage to be considered non contiguous. Or, whether different HI companies have different rules.

 

[scrabbler1]

To me, the repeal of the individual mandate (at least the penalties for not buying HI) will be the most harmful for the individual market. Younger, healthier people will drop insurance and that will do more to drive up rates than anything else.

Here in New York, where rates are already pretty high compared to the rest of the country, I saw rates rise a lot back in 2010-2011 during my first few years or ER. As they rose, the younger, healthier people dropped coverage and the remaining people in the individual market were older and sicker ("death spiral"). It became too much for me (I was healthier back then) and in 2011 I dropped coverage, too, opting for a bare-bones policy to hold me over until the end of 2013.

New York actually has one of the better-run exchanges. Someone here posted a link to an article about now well it is run and how competitive it is. But one reason it has worked well is the presence of the individual mandate.

 

[LARS]

I was wondering if an insurance company for some reason could "force" a lapse in coverage? For any reason, missing a payment?, Clerical Errors, etc.

But I think I answered my own question as a "non contiguous" coverage is defined by an extended gap. I seem to remember reading that somewhere, but do not know what the gap would be for coverage to be considered non contiguous. Or, whether different HI companies have different rules.

It seems to me the real risk here (on maintaining continuous coverage) is if the rates of policies increase and some people cannot afford to maintain coverage.

 

[MichaelB]

Next steps

So, just to summarize what would need to happen next.

The Senate votes on and passes a bill. If different,

The House and Senate form a conference committee to negotiate a compromise bill.

The Senate and the House vote on and pass the new compromise bill. If that occurs, the President signs it and it then becomes law.

Then, the details regarding how the new law will be implemented must be written.

If there are changes to insurance oversight or regulation, State Insurance Regulators may need to modify their own regulatations.

Then, once implementation details and regulation has been clarified, insurers need to adapt their policy offerings to ensure compliance.

In other words, there's still a lot of heavy lifting ahead.

 

[steadystate]

I for one am not going to let the uncertainty over this issue derail my ER plan for this year; although I am 60 and so could be adversely affected. Seems to me it's just one more risk factor among many that early retirement entails.

 

[LastOfTheBoomers]

I read through the KFF comparison quickly and found an interesting sticky point with the proposed plan.

You can get tax credits when paying Cobra premiums - but if the health plan provides abortion services - then you can't.

So would the IRS have to track all health plans and then audit that credit?

 

[Fedup]

To me, the repeal of the individual mandate (at least the penalties for not buying HI) will be the most harmful for the individual market. Younger, healthier people will drop insurance and that will do more to drive up rates than anything else.

Here in New York, where rates are already pretty high compared to the rest of the country, I saw rates rise a lot back in 2010-2011 during my first few years or ER. As they rose, the younger, healthier people dropped coverage and the remaining people in the individual market were older and sicker ("death spiral"). It became too much for me (I was healthier back then) and in 2011 I dropped coverage, too, opting for a bare-bones policy to hold me over until the end of 2013.

New York actually has one of the better-run exchanges. Someone here posted a link to an article about now well it is run and how competitive it is. But one reason it has worked well is the presence of the individual mandate.

The mandate has not stopped young people from not buying HI until now. There has been a surge of people enrolled in HI this year since the talk of maintaining continuous coverage is in the news.

 

[Fedup]

I read through the KFF comparison quickly and found an interesting sticky point with the proposed plan.

You can get tax credits when paying Cobra premiums - but if the health plan provides abortion services - then you can't.

So would the IRS have to track all health plans and then audit that credit?

I used the KFF tool and found out for most people in different income up till $100k from age 27 and 40, there will be a net credit of $2200. Only when I put in age 60, where I saw a premium increase of $250.

 

[imoldernu]

One part of this insurance web, is the EMTALA Act

https://www.cms.gov/regulations-and-guidance/legislation/emtala/

I believe that today, this is still unfunded, and may be one of the most important issues to affect healthcare legislation in the future.

n 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay. Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual's ability to pay. Hospitals are then required to provide stabilizing treatment for patients with EMCs. If a hospital is unable to stabilize a patient within its capability, or if the patient requests, an appropriate transfer should be implemented.

There have been recent changes 2016, 2017, that deal with care subsequent to initial admission, allowing for hospital/patient negotiation, but nothing that changes the costs to hospitals for admission.

Hospitals in rural or low income areas are concerned for the sustainability of this care.

The devil is always in the details.

 

[scrabbler1]

The mandate has not stopped young people from not buying HI until now. There has been a surge of people enrolled in HI this year since the talk of maintaining continuous coverage is in the news.

True, but the penalties for not buying HI have increased sharply since 2014, from $95 in 2014 to $695 in 2016.

ACA Individual Penalties: Many Will Pay More Than $95 | Affordable Care Act Review

Higher penalties surely played a role in decreasing the number of people who willingly went uninsured. Removing the penalty will only increase the number of uninsured, particularly the younger, healthier people who would choose to game the system and tilt the market toward older, sicker people, the same type of market which kept rates high before the ACA.

 

[daylatedollarshort]

Simple Girl, Pre-ACA we had to have Kaiser (California) for our insurance through DH's employer because they did not have a life time cap. Our household joke was that no one ever lives long enough under Kaiser for them to have to worry about lifetime caps, but the other plans had $1M life time caps which didn't seem to be enough in case a of Christopher Reeves type accident.

Pre-ACA there were various ways to get around the pre-existing condition clause - some states didn't allow it, some part-time jobs had group insurance, HIPAA laws allowed you to continue coverage post COBRA (no $ caps though) and many states had "group" insurance rates with no pre-existing condition screening for small businesses of 1 or 2. These might still be options if needed in a post-ACA world for early retirees.

 

[evilanne]

In other words, there's still a lot of heavy lifting ahead.

Love the School House Rocks video

 

[sheehs1]

Read the thread, the white paper and all I am able to say at the moment is "ugh"!. Not going to get to into it until or if it passes the Senate and see what form it all takes then.

 

[W2R]

Read the thread, the white paper and all I am able to say at the moment is "ugh"!. Not going to get to into it until or if it passes the Senate and see what form it all takes then.

I think that is a very smart approach. Honestly until it passes the Senate everything is up in the air. They could change it or not even pass it at all. I understand why it is so stressful, really I do, not being totally heartless. Still, members on this forum have become pretty close over the years. We have been through a lot together. It just kills me to think of forum members stressing out too much over something that isn't a "done deal" yet.

So, here's a fix. After taking a deep breath I'd suggest

(1) exercise.....gym, go for a walk, swim ...
(2) "smelling the roses", enjoying life.... grandkids, puppy, fresh air...
(3) beverage of your choice.... beer, wine, root beer...
(4) distracting entertainment.... video game, TV, youtube...

 

[AllDone]

I think that is a very smart approach. Honestly until it passes the Senate everything is up in the air. They could change it or not even pass it at all. I understand why it is so stressful, really I do, not being totally heartless. Still, members on this forum have become pretty close over the years. We have been through a lot together. It just kills me to think of forum members stressing out too much over something that isn't a "done deal" yet.

So, here's a fix. After taking a deep breath I'd suggest

(1) exercise.....gym, go for a walk, swim ...
(2) "smelling the roses", enjoying life.... grandkids, puppy, fresh air...
(3) beverage of your choice.... beer, wine, root beer...
(4) distracting entertainment.... video game, TV, youtube...

Good advice, however it's hard to understand why anything so cruel is even being considered. By this age, few of us do not have a "pre-existing condition".

 

[simple girl]

I'm feeling better since hearing that the Senate has decided they will write their own bill and that the margin for it passing is so narrow. That gives me hope that if they do pass something new eventually, it will be more friendly towards those who have pre-existing conditions than the current bill passed by the House.

It also has helped me to look even closer at our contingency plans should something be passed that would require underwriting again. The more well-thought out our plan for the worst case, the better prepared I feel. Just merely waiting to see what happens isn't reassuring enough to me.

Thankful for all of the input from everyone here and being able to talk about this and ask questions without the thread going haywire! This place is where I come for smart feedback about important financial issues, and you all never disappoint!

 

[papajones]

Read the thread, the white paper and all I am able to say at the moment is "ugh"!. Not going to get to into it until or if it passes the Senate and see what form it all takes then.

It is too late.

You can try to bury your head in a sand but uncertainty in insurance market is already driving expected 2018 price increases up as compared to relatively "modest" hikes in 2017.

 

[MichaelB]

It is too late.

You can try to bury your head in a sand but uncertainty in insurance market is already driving expected 2018 price increases up as compared to relatively "modest" hikes in 2017.

At this point 2018 price increases are pure speculation, and also not the thread topic.

papajones, why not tell us a little about yourself, here Hi, I am... - Early Retirement & Financial Independence Community

 

[littleb]

Good advice, however it's hard to understand why anything so cruel is even being considered. By this age, few of us do not have a "pre-existing condition".

In reading the documents obesity is listed as a preexisting condition so if 30% of the US is obese (all ages) they will also be thrown into the high risk pool. There is no way this will work if 40-50% are considered high risk due to preexisting.

This should come up many times during the discussions and I am confident the preexisting condition clause will be more lenient than evidence of insurability restrictions prior to the ACA.

 

[littleb]

I'm feeling better since hearing that the Senate has decided they will write their own bill and that the margin for it passing is so narrow. That gives me hope that if they do pass something new eventually, it will be more friendly towards those who have pre-existing conditions than the current bill passed by the House.

It also has helped me to look even closer at our contingency plans should something be passed that would require underwriting again. The more well-thought out our plan for the worst case, the better prepared I feel. Just merely waiting to see what happens isn't reassuring enough to me.

Thankful for all of the input from everyone here and being able to talk about this and ask questions without the thread going haywire! This place is where I come for smart feedback about important financial issues, and you all never disappoint!

Yes, all we can do is stay positive, look at all options and have plans in place in case Plan A does not work. Or Plan B, C...

We are actually talking about starting a small business so we can get a group plan through the insurance company. The group plans waive preexisting and in some cases the premiums maybe lower. Our goal is to make just enough money to fund our health insurance premium and cover most expenses.
No salary because we have enough money to retire.

 

[W2R]

I'm feeling better since hearing that the Senate has decided they will write their own bill and that the margin for it passing is so narrow. That gives me hope that if they do pass something new eventually, it will be more friendly towards those who have pre-existing conditions than the current bill passed by the House.

It also has helped me to look even closer at our contingency plans should something be passed that would require underwriting again. The more well-thought out our plan for the worst case, the better prepared I feel. Just merely waiting to see what happens isn't reassuring enough to me.

Thankful for all of the input from everyone here and being able to talk about this and ask questions without the thread going haywire! This place is where I come for smart feedback about important financial issues, and you all never disappoint!

Glad that you are feeling better about things, simplegirl. Waiting is tough when so much depends on the outcome. Everyone here is hoping for the best for you and other forum members, as we read the news every day and wonder what will happen next.

 

[simple girl]

Yes, all we can do is stay positive, look at all options and have plans in place in case Plan A does not work. Or Plan B, C...

We are actually talking about starting a small business so we can get a group plan through the insurance company. The group plans waive preexisting and in some cases the premiums maybe lower. Our goal is to make just enough money to fund our health insurance premium and cover most expenses.
No salary because we have enough money to retire.

I am looking into this as well. It is a whole new topic for me to research for feasibility.

 

[littleb]

I am looking into this as well. It is a whole new topic for me to research for feasibility.

In some states you only need 2 people for group insurance (husband and wife) and other states it requires 3 or more. We had a group plan in the past with our small business.

 

[ERD50]

Good advice, however it's hard to understand why anything so cruel is even being considered. By this age, few of us do not have a "pre-existing condition".

From what I've been able to gather, LARS has it about right in his earlier post (quoted below).

Relax a little, this does not appear to be some outright "cruel" denial of coverage to anyone with any pre-existing condition. That appears to be fear-mongering from opponents. As long as you have had coverage (and weren't we ALL supposed to be covered under ACA?), you are OK. If not, a 30% hike for one year doesn't seem unreasonable to me, those same people 'got away' w/o paying into my risk pool, time for them to chip in a bit.

What I have read is that PreExisting Conditions only comes into play if there is a lapse in coverage. And if there is a lapse, the policy pricing can only be impacted for one year, after that you are no longer considered to have a Pre Existing.

Moreover, PreExisting can only occur if state requests a waiver, which will only be granted if a high risk, subsidized, pool is put in place.

Caveat: That is what I've pieced together but there is a lot of conflicting info. And, of course, as others have stated, it will all most likely change with Senate involvement.

-ERD50

 

[Gumby]

You might look into the benefits available to members of any professional organizations to which you belong. This sometimes can include group health insurance.

https://www.thebalance.com/membership-organizations-and-health-insurance-2645660