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Old 10-30-2013, 02:10 PM   #41
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That's my understanding as well.

I saw this article earlier today saying those who have their current individual policy canceled and elect to take their insurer's offer to switch to a new ACA policy won't get a subsidy even if they qualify because they bypassed the exchange.
Yes, the letter I received said you had to go through the exchange if you wanted the subsidy.
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Old 10-30-2013, 02:17 PM   #42
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That's my understanding as well.

I saw this article earlier today saying those who have their current individual policy canceled and elect to take their insurer's offer to switch to a new ACA policy won't get a subsidy even if they qualify because they bypassed the exchange.
That's really a shame considering how difficult it is to enroll in the exchange system. It would have been nice to report your policy on the tax return and just get the subsidy in the way of a refund. I guess they are not set up for that.
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Old 10-30-2013, 02:22 PM   #43
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Well, technically, there is premium assistance and there is cost sharing subsidy. Premium assistance, in the form of tax credits, can be applied after the year is over when one files the tax return (edit: yes, but see below). If one desires advance premium assistance, where part of the premium is paid directly to the insurer, the exchange must verify eligibility. That can be accomplished on the exchange but also from the insurer's website, they connect with the subsidy verification part of the healthcare engine.

Cost sharing subsidy is limited to specific plans and only available via the exchange.

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But it's a path that could take a detour around some competitors who are offering plans: because of a little-known rule proposed by the administration in June, customers will be able to buy their subsidized Obamacare insurance directly from the insurer.

The rule allows a customer to be sent briefly to a special section of the federal or state-run marketplaces only to see if their income qualifies them for subsidized coverage, and then can go right back to the WellPoint or Blues site to buy their coverage. These customers may not necessarily see the other options for insurance available on the exchange, and the other plans may cost less or include a wider provider network.
Univision Obamacare Deal Could Put WellPoint, Blues Ahead Of Competitors - Kaiser Health News


Edit; From the IRS website The Premium Tax Credit
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To qualify for the credit, you must get insurance through the Marketplace.
Federal register announcement http://www.gpo.gov/fdsys/pkg/FR-2013-06-19/pdf/2013-14540.pdf

So, if one is eligible for subsidies but doesn't use the marketplace, one must make sure the agent being used (the insurer, e-health, Univision, etc) confirms eligibility using the healthcare.gov system.
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Old 10-30-2013, 02:52 PM   #44
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MichaelB - Is there some advantage of a Multi-State plan over the Texas plans? I'm not sure I understand the role/purpose of a Multi-State plan other than for employers with employees in multiple states?

I'm going to post this as a separate topic.
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Old 10-30-2013, 03:16 PM   #45
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Well, technically, there is premium assistance and there is cost sharing subsidy. Premium assistance, in the form of tax credits, can be applied after the year is over when one files the tax return (edit: yes, but see below). If one desires advance premium assistance, where part of the premium is paid directly to the insurer, the exchange must verify eligibility. That can be accomplished on the exchange but also from the insurer's website, they connect with the subsidy verification part of the healthcare engine.

Cost sharing subsidy is limited to specific plans and only available via the exchange.

Univision Obamacare Deal Could Put WellPoint, Blues Ahead Of Competitors - Kaiser Health News


Edit; From the IRS website The Premium Tax Credit
Federal register announcement http://www.gpo.gov/fdsys/pkg/FR-2013-06-19/pdf/2013-14540.pdf

So, if one is eligible for subsidies but doesn't use the marketplace, one must make sure the agent being used (the insurer, e-health, Univision, etc) confirms eligibility using the healthcare.gov system.
Re-reading the Federal Register, it's clear that other exchanges (not State or federal) are allowed to enroll people in policies and still be eligible for subsidies. Not clear that an insurer meets the qualifications. With this doubt it's best to assume they can't.

I'll need to go back and revisit a few threads.
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Old 10-30-2013, 03:32 PM   #46
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For Idaho there is a 193 page PDF with all the plans and costs. They are not as high as I expected. Plan Information Page | Your Health Idaho
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Old 11-01-2013, 12:49 PM   #47
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Thanks for all the great information so far! (As usual with this forum)

From what I'm seeing, it looks like we're also going to switch my husband to a new ACA compliant plan even though he can keep his old one if he wishes. Even with a lower deductible, he'll be paying lower premiums if he moves to a bronze plan.

And being able to open HSA accounts for each of us next year will provide some considerable tax savings, especially since I turn 55 next year and so both of us will be able to make the extra contribution.

We will still be in the same PPO network. We'll have to pay more out of pocket up front, because we won't have low copays for doctors visits when needed. But we'd rather set aside the money saved from lower premiums.
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Old 11-01-2013, 12:55 PM   #48
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Thanks for all the great information so far! (As usual with this forum)

From what I'm seeing, it looks like we're also going to switch my husband to a new ACA compliant plan even though he can keep his old one if he wishes. Even with a lower deductible, he'll be paying lower premiums if he moves to a bronze plan.

And being able to open HSA accounts for each of us next year will provide some considerable tax savings, especially since I turn 55 next year and so both of us will be able to make the extra contribution.

We will still be in the same PPO network. We'll have to pay more out of pocket up front, because we won't have low copays for doctors visits when needed. But we'd rather set aside the money saved from lower premiums.
Just curious - what deductible and total OOP are you choosing? If I'm being too nosy don't answer...
I've narrowed it to either $3500 or $6250 for us, still wavering. It is insurance, so we should probably go with the lowest premium / highest deductible.
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Old 11-01-2013, 12:57 PM   #49
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I just have a question on this....

Do you HAVE to sign up in the exchange to get a subsidy Or do you just need to do it to get a current subsidy? IOW, if you do not get a subsidy now, and you should have received one..... don't you get it back on your tax return
You need to go through the Exchange to be eligible. So in reality, if someone is expecting a very small subsidy, they may just decide it's not worth dealing with the healthcare.gov mess, paying a little more and buying direct from the insurer with much more ease. Then one could go to the Exchange in 2015, by which time the bugs should be pretty much all worked out.
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Old 11-01-2013, 12:59 PM   #50
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It is insurance, so we should probably go with the lowest premium / highest deductible.
Yes, insurance almost always works this way if you can afford to "self-insure" as much as possible. It's even easier to make that decision if you can use all of the premium difference to fund an HSA to cover the higher deductibles.
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Old 11-01-2013, 01:02 PM   #51
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Just curious - what deductible and total OOP are you choosing? If I'm being too nosy don't answer...
I've narrowed it to either $3500 or $6250 for us, still wavering. It is insurance, so we should probably go with the lowest premium / highest deductible.
I'm leaning toward the Bronze with a $5000 deductible and $6250 max OOP in network, 20% coinsurance.

There is no Bronze option available to us with a $3500 deductible. Two PPO choices - $6000/$6000 or $5000/$6250 everything else identical. The second is $3 more a month.

If I want a $3500 deductible PPO I have to go to a Silver plan and pay a significantly higher premium.

Considering you have been the font and champion of knowledge on this very topic, MichaelB, I am more than happy to contribute a few details.
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Old 11-01-2013, 01:09 PM   #52
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I'm leaning toward the Bronze with a $5000 deductible and $6250 max OOP in network, 20% coinsurance.

There is no Bronze option available to us with a $3500 deductible. Two PPO choices - $6000/$6000 or $5000/$6250 everything else identical. The second is $3 more a month.

If I want a $3500 deductible PPO I have to go to a Silver plan and pay a significantly higher premium.

Considering you have been the font and champion of knowledge on this very topic, MichaelB, I am more than happy to contribute a few details.
Thanks! Probably we'll end up with that similar Fl version.

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It's even easier to make that decision if you can use all of the premium difference to fund an HSA to cover the higher deductibles.
This is something I absolutely need to keep in mind. As our premium declines, the difference is not available for other spending. It's not "real" savings, it needs to be set aside to fund potential future health care expenses.
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Old 11-01-2013, 01:16 PM   #53
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I'm leaning toward the Bronze with a $5000 deductible and $6250 max OOP in network, 20% coinsurance.

There is no Bronze option available to us with a $3500 deductible. Two PPO choices - $6000/$6000 or $5000/$6250 everything else identical. The second is $3 more a month.
I'd probably lean that way as well. It doesn't speak of average-case situations but going with the $5000/$6250 plan, worst case it costs you an extra $286 (with over $10K in medical expenses) -- but best case it can save you $764 (with exactly $6K in expenses).
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Old 11-01-2013, 01:17 PM   #54
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This is something I absolutely need to keep in mind. As our premium declines, the difference is not available for other spending. It's not "real" savings, it needs to be set aside to fund potential future health care expenses.
Yep. It's always easier to save money when you treat it as "gone" before it ever hits your checking account for available spending!
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Old 11-01-2013, 01:43 PM   #55
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I'd probably lean that way as well. It doesn't speak of average-case situations but going with the $5000/$6250 plan, worst case it costs you an extra $286 (with over $10K in medical expenses) -- but best case it can save you $764 (with exactly $6K in expenses).
Right. And you have coinsurance jumping in at $5000, which can at least slow down the bleeding!

The amount that you save in premiums better go to the "pay for doctors visits" pile. Since routine health checks are already paid for by even the bronze premium, that money really goes for extra doctor visits. Then, if you don't spend it all - it's available for the next year!

We already have savings set aside for whatever - travel for example. If one of us gets ill enough to start paying a lot for health care due to our high deductible, we'll probably not be traveling during that period, so the money would just be diverted.
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Old 11-01-2013, 02:26 PM   #56
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I've narrowed it to either $3500 or $6250 for us, still wavering. It is insurance, so we should probably go with the lowest premium / highest deductible.
I found this article discussing why bronze may be the best choice. Essentially now your OOPM really is the max. it includes deductibles/co-pay/co-ins, whereas before they could stack all of those on top of each other.

Bronze May Be the Most Precious Metal Under Obamacare | Hull Financial Planning
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Old 11-01-2013, 02:37 PM   #57
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I found this article discussing why bronze may be the best choice. Essentially now your OOPM really is the max. it includes deductibles/co-pay/co-ins, whereas before they could stack all of those on top of each other.
It's usually true of any insurance. If you don't expect to have significant medical costs in any given year and you can afford to self-insure, higher deductibles are almost always financially advantageous. As I said before, though, that requires enough discipline to firewall or set aside enough of your income/assets as "in reserve" to pay the higher deductibles and OOP limits.

ACA did standardize the way these things are treated and made cost comparisons much easier, and the website fiasco notwithstanding that much is a good thing. It's a lot easier to compare apples to other apples than to oranges....
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Old 11-01-2013, 02:43 PM   #58
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You need to go through the Exchange to be eligible. So in reality, if someone is expecting a very small subsidy, they may just decide it's not worth dealing with the healthcare.gov mess, paying a little more and buying direct from the insurer with much more ease. Then one could go to the Exchange in 2015, by which time the bugs should be pretty much all worked out.


But what if after the fact your circumstances changed and you are eligible for a big subsidy

I am a perfect example.... last year at this time I would not have qualified for a subsidy or a small one.... but now that I do not work, when I file my tax return I would qualify for a bigger one.... With being able to claim a subsidy or a credit ONLY if you buy through the exchange means that it would not be smart to buy anyplace else except the exchange.... because if you do and circumstances change.... well, too bad for you....
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Old 11-01-2013, 02:47 PM   #59
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With being able to claim a subsidy or a credit ONLY if you buy through the exchange means that it would not be smart to buy anyplace else except the exchange.... because if you do and circumstances change.... well, too bad for you....
If you think your circumstances may significantly change during 2014, I think this is true. That said, if you're pretty confident your situation won't change in 2014 (i.e. no chance to qualify for tax credits or cost sharing) or you decide the headaches of the healthcare.gov mess aren't worth potentially saving a few bucks (a "few" being in the eyes of the beholder), then you can go off the exchange.

The rest of us (especially those in a state using the federal exchange) have to grit our teeth and hope the bugs get fixed. I'm in a situation where I really need to use the Exchange, so I sit and wait, hoping it's all fixed by December 15 or else I could be screwed. I don't so much mind losing the subsidy (only about $100 a month) but I can't lose the ability to buy the cheapest plan and have no cost sharing (that can mean up to $6000 a year).
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Old 11-01-2013, 02:57 PM   #60
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But what if after the fact your circumstances changed and you are eligible for a big subsidy

I am a perfect example.... last year at this time I would not have qualified for a subsidy or a small one.... but now that I do not work, when I file my tax return I would qualify for a bigger one.... With being able to claim a subsidy or a credit ONLY if you buy through the exchange means that it would not be smart to buy anyplace else except the exchange.... because if you do and circumstances change.... well, too bad for you....
There are qualifying events that allow for special enrollment periods so you could probably enroll at that time.
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