Healthcare.gov -Anyone enrolled with subsidy yet?

[bamsphd]

Looks like in the third example you are having both of you hit the deductible for the bronze case instead of just one of you.

That bronze plan has a "family medical deductible" of $11,000 but not a separate lower "individual medical deductible." So in essence, yes, we both hit the deductible in that case. The Silver HSA plan has a "family medical deductible" of only $5000.

Even more importantly they also tweak the OOP max which is $12,700 for all the family bronze plans, but $8,000 for the family Silver HSA plan, and $7,000 for the family Gold non-HSA plan. So if hitting the OOP max is a concern one would want to pay an extra $1,538 in premiums for the Silver HSA plan to drop the OOP max by $4,700.

As far as I can tell for us as a couple in my state, the pessimist's clear choice family plan is the Silver HSA plan with an $8,000 OOP max, plus $8,702 in unsubsidized premiums, minus whatever tax/subsidy advantage the HSA provides.

Based on reading on the ER forum, I've decided I also need to further explore getting two individual policies instead. My initial pass eliminated them because the unsubsidized premiums would be more than a thousand dollars greater than a family plan. However, I don't think I adequately allowed for the lower individual deductibles and OOP max values. The biggest other downside of individual plans is that then we would definitely need two separate HSA accounts which would be a bit of a hassle.

 

[ziggy29]

The out-of-pocket max can, just like the deductible, be substantially lower in a Silver plan, if MAGI is below 250% of FPL. And, if you can get it down to 150% of FPL, the cost-savings are incredible:

Yes, but if you are a little too aggressive and slip below 133%, then you lose that cost-sharing benefit, AND the Exchange subsidies, AND if your state didn't expand Medicaid you could be royally screwed. What you say works but it's playing with fire because of how close you are getting to 133%.

 

[audreyh1]

That bronze plan has a "family medical deductible" of $11,000 but not a separate lower "individual medical deductible." So in essence, yes, we both hit the deductible in that case. The Silver HSA plan has a "family medical deductible" of only $5000.

Even more importantly they also tweak the OOP max which is $12,700 for all the family bronze plans, but $8,000 for the family Silver HSA plan, and $7,000 for the family Gold non-HSA plan. So if hitting the OOP max is a concern one would want to pay an extra $1,538 in premiums for the Silver HSA plan to drop the OOP max by $4,700.

As far as I can tell for us as a couple in my state, the pessimist's clear choice family plan is the Silver HSA plan with an $8,000 OOP max, plus $8,702 in unsubsidized premiums, minus whatever tax/subsidy advantage the HSA provides.

Based on reading on the ER forum, I've decided I also need to further explore getting two individual policies instead. My initial pass eliminated them because the unsubsidized premiums would be more than a thousand dollars greater than a family plan. However, I don't think I adequately allowed for the lower individual deductibles and OOP max values. The biggest other downside of individual plans is that then we would definitely need two separate HSA accounts which would be a bit of a hassle.

I think you may have to have two separate HSA accounts anyway. Am I wrong about that?

 

[bamsphd]

I think you may have to have two separate HSA accounts anyway. Am I wrong about that?

I think the answer is sometimes. See my full post in the "Fire and Money: HSA Account" thread for more details:

if the husband and/or wife is covered by a "family" high deductible health plan, then if both the husband and wife agree, you could split the "family" HSA contribution anyway you wanted between their two HSA accounts. You could also withdraw money from either account to pay for "Qualified" medical expenses incurred by either person.

 

[GLM]

I also think that if both of you are over 55 and have seperate HSA's you can shelter and extra $1000. from the link below

"If both spouses are 55 and older, can both spouses make “catch-up” contributions?
Yes, if both spouses are eligible individuals and both spouses have established an HSA in their name. If only one spouse has an HSA in their name, only that spouse can make a “catch-up” contribution. "

HSA Ed - HSA Q & A

 

[audreyh1]

I also think that if both of you are over 55 and have seperate HSA's you can shelter and extra $1000. from the link below

"If both spouses are 55 and older, can both spouses make “catch-up” contributions?
Yes, if both spouses are eligible individuals and both spouses have established an HSA in their name. If only one spouse has an HSA in their name, only that spouse can make a “catch-up” contribution. "

HSA Ed - HSA Q & A

That's a major caveat!!!!!

 

[audreyh1]

I think the answer is sometimes. See my full post in the "Fire and Money: HSA Account" thread for more details:

I keep running across statements like this one in the HSA FAQ from HSA Bank:

May a husband and wife have a joint HSA?
No. Each spouse must open a separate HSA. You can, however, give your spouse access to your HSA by designating them as an authorized signer on the account.

And then there's the catch-up contribution issue.......

 

[GLM]

tried reading the IRS instructions for the HSA deduction ( 8889) too late tonight - not sinking in but I did find this on when both Spouses are HSA elligible that reinforces the extra $1000 deduction - - -

which in part says -

"The main disadvantages of this strategy come in two specific scenarios. First, if Keith reaches the age of 55 before Lora, he will forfeit the opportunity to make an additional $1,000 catch up contribution unless he has his own HSA. Second, if Keith’s employer makes contributions to its employees’ HSAs then Keith will miss out on those funds as well."

Rules and Best Practices When Spouses Are Both HSA Eligible | Tango Health

 

[bamsphd]

The answer seems to be sometimes.

I keep running across statements like this one in the HSA FAQ from HSA Bank:

Yes, earlier in the "HSA Account" thread I tripped over the same HSA Bank FAQ.

Thanks, I had missed that aspect, though it is mentioned in the HSA Bank FAQ.
...
Edit: See revised understanding in my post below.

And then there's the catch-up contribution issue.......

Yes, if both members of the couple are eligible for catch-up contributions two accounts make more sense. That does not apply to my family.

 

[Rpharmer]

Yes, but if you are a little too aggressive and slip below 133%, then you lose that cost-sharing benefit, AND the Exchange subsidies, AND if your state didn't expand Medicaid you could be royally screwed. What you say works but it's playing with fire because of how close you are getting to 133%.

Thanks for the caution. I guess I should have mentioned that Missouri is one of those states that is not expanding Medicaid. So for us, the threshold for qualifying for premium and cost-sharing subsidies is a MAGI of 101% of FPL, not 133%. That's why I felt that using 139% was pretty safe. But I appreciate your perspective.

 

[mf15]

Am I reading this right,you can only get a subsidy if you go through the government
market place web site, as opposed to say blue cross site.
My son has a real problem giving the govt all the info they want,even for a subsidy.
Why cant you just do this on your regular tax return.
Old Mike

 

[audreyh1]

Am I reading this right,you can only get a subsidy if you go through the government
market place web site, as opposed to say blue cross site.
My son has a real problem giving the govt all the info they want,even for a subsidy.
Why cant you just do this on your regular tax return.
Old Mike

Does your son pay taxes? Then the IRS already has a this info. They just don't know what medical insurance he has or what his income might be next year. But they will find that out soon enough anyway.

 

[samclem]

My son has a real problem giving the govt all the info they want,even for a subsidy.

Your son may have heard (correctly) that the government site has not passed it's full security assessment, but was granted a waiver and put into service anyway. Maybe he heard (correctly) that a user in North Carolina logged in and received the personal information of people in another state.

Anyway, if a user wants access to the subsidies, he/she must enter their personal info into the web site. The alternative would be to call and speak to someone or send in a form, but the personal info still gets entered in the same databases, just by somebody else. That person might not have passed a background check, and could be a felon (according the Secretary Sebelius). I'm sure most of the people who have been hired are trustworthy.

But, everything should be fixed in a few weeks according to the leader of the team charged with making things work well. So, maybe your son will be more comfortable waiting for more fixes to be implemented. There are security concerns about the system, but if it's any consolation, your son won't be exposed to any higher risk than everyone else.

 

[mf15]

Yes he has read site that not totally secure.
Glad I am on medicare don't have to deal with this.
Old Mike

 

[Katsmeow]

My son has a real problem giving the govt all the info they want,even for a subsidy.
Why cant you just do this on your regular tax return.

Well you won't file your tax return for 2014 until sometime in 2015. Most people want to get their subsidy for 2014 in 2014 not later. And, they can't rely only on people's past tax returns because incomes change over time.

In any event, isn't the information that he will give information that the government already has anyway (or will have in the future when he files a tax return)? What's the concern?

 

[John Galt III]

................... If you realized last year that 2012 1040's would be the "benchmark" and set your MAGI accordingly then, it appears that you're good to go.

I'm concerned about this 2012 "benchmarK" (latest tax return on file). My 2013 and 2014 income will be much lower than my 2012 "benchmark".

In a chat session on HC.gov, I was assured that any tax credit and subsidy would be based on 2014 estimated income. I don't have much faith in the chat session answer, though. Anyone else have the big drop in income from 2012 to 2014 ? What is your understanding of how it affects us?

Thanks, and good luck in your PPACA foray.

 

[rbmrtn]

Does your son pay taxes? Then the IRS already has a this info. They just don't know what medical insurance he has or what his income might be next year. But they will find that out soon enough anyway.

You give the same info to a Credit card app or a mortgage etc. I didn't enter anything that they didn't already have ( most of it probably public already ). They just verify who you claim to be.

 

[rbmrtn]

I'm concerned about this 2012 "benchmarK" (latest tax return on file). My 2013 and 2014 income will be much lower than my 2012 "benchmark".

In a chat session on HC.gov, I was assured that any tax credit and subsidy would be based on 2014 estimated income. I don't have much faith in the chat session answer, though. Anyone else have the big drop in income from 2012 to 2014 ? What is your understanding of how it affects us?

Thanks, and good luck in your PPACA foray.

2014 income is what was asked for when I signed up, I think it asked a question if 2014 had changed substantially from 2012.

ACA Subsidies: Determined by Projected 2014 Income? - Medicoverage.com

 

[mf15]

That is what I keep telling him, the govt already has just about any and all info.
But he believes the govt knows whey too much about everyone.
OM

 

[MichaelB]

In a chat session on HC.gov, I was assured that any tax credit and subsidy would be based on 2014 estimated income. I don't have much faith in the chat session answer, though. Anyone else have the big drop in income from 2012 to 2014 ? What is your understanding of how it affects us?

Here's what the CMS says http://www.healthreformgps.org/wp-content/uploads/income-verification-8-6.pdf

The applicant’s inputted projected annual household income is then compared with information available from the Internal Revenue Service (IRS) and Social Security Administration (SSA). If the data submitted as part of the application cannot be verified using IRS and SSA data, then the information is compared with wage information from employers provided by Equifax. If Equifax data does not substantiate the inputted information, the Marketplace will request an explanation or additional documentation to substantiate the applicant’s household income.

When documentation is requested, the Affordable Care Act and implementing regulations specify that if the applicant meets all other eligibility requirements, he or she will be provided with eligibility for advance payments of the premium tax credit and cost-sharing reductions based on the inputted projected annual household income for 90 days (which may be extended based on good faith), provided that the tax filer attests to the Marketplace that he or she understands that any advance payments of the premium tax credit paid on his or her behalf are subject to reconciliation. If documentation is requested and is not provided within the specified timeframe, regulations specify that the Marketplace will base its eligibility determination on IRS and SSA data, unless IRS data is unavailable, in which case the Marketplace will discontinue any advance payments of the premium tax credit and cost-sharing reductions.

If your projected 2014 income is lower than your current income you need to document why, and then revisit after 90 days to confirm. Seems to me the biggest potential issue would be if you say you are not working but the SSA reports differently.

 

[Cedar]

I'm concerned about this 2012 "benchmarK" (latest tax return on file). My 2013 and 2014 income will be much lower than my 2012 "benchmark".

I retired last year and my wife retired in June of this year. Our combined income is a forth of what it was working. I signed on last night and it accepted my estimates for 2014 without any verification. Everything went smooth as glass but then again it was 4:00am. It is a very good website format when it works.

 

[GLM]

I retired last year and my wife retired in June of this year. Our combined income is a forth of what it was working. I signed on last night and it accepted my estimates for 2014 without any verification. Everything went smooth as glass but then again it was 4:00am. It is a very good website format when it works.

Good to know - DH left full time employ in February and is now working part time as a consultant. (much lower stress) Our Magi in 2014 will be 20-25% of what it was in 2012. Hopefully our application will go through smoothly too , if I ever get our identity verified . I have two applications pending . One in DH name , I scanned his driver's licence for verification a month ago- status pending . The other, in my name I tried going through verbal verification with Experian . They had me thaw my credit then verified me over the phone about two weeks ago but the website still says application pending .

 

[rbmrtn]

I have two applications pending . One in DH name , I scanned his driver's licence for verification a month ago- status pending . The other, in my name I tried going through verbal verification with Experian . They had me thaw my credit then verified me over the phone about two weeks ago but the website still says application pending .

FWIW, I think they have made some improvements. I was there also pending verification since early Oct. I had to go through multiple accounts, 1st on created back in august when they first put the site up, it stopped working sometime after Oct 1. Next couple got stuck at different spots, then one got to upload ID docs and showed verification pending. That one sat ther for 3 weeks. Stated over with a new account/email this week and it went right through without a glitch. I am still looking and have not enrolled yet.

Start with a clean account, make sure clean your browser each time. It finally worked for me.

 

[Calico]

FWIW, I think they have made some improvements. I was there also pending verification since early Oct. I had to go through multiple accounts, 1st on created back in august when they first put the site up, it stopped working sometime after Oct 1. Next couple got stuck at different spots, then one got to upload ID docs and showed verification pending. That one sat ther for 3 weeks. Stated over with a new account/email this week and it went right through without a glitch. I am still looking and have not enrolled yet.

Start with a clean account, make sure clean your browser each time. It finally worked for me.

And applying at 4:00 am seems to work, according to another poster! For once my night owl tendencies will pay off!

 

[Cedar]

And applying at 4:00 am seems to work, according to another poster! For once my night owl tendencies will pay off!

Prior to this last run at the exchange, I had tried numerous times just to have the system fail. What surprised me this time was how fast and easy I was able to enter my information and get approval. For me the 3:30-4:00am worked great. The interesting part was when you go to the exchange at that time there is a post stating; "The Health Insurance Marketplace online application isn't available from approximately 1 a.m. to 5 a.m. EST daily while we make improvements".