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Old 12-20-2013, 09:18 AM   #21
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I wish they would expand the "hardship exemption" to include people who face getting pummeled with 3X premium increase like me and allow us to purchase this as a permanent option!
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Old 12-20-2013, 11:43 AM   #22
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I wish they would expand the "hardship exemption" to include people who face getting pummeled with 3X premium increase like me and allow us to purchase this as a permanent option!
IF the 3X increase causes the premium of the lowest bronze plan available to exceed 8% of your income then that would be a hardship (unaffordable coverage) and you would be eligible to buy catastrophic coverage.

But, if you've been getting an outstanding deal for health insurance and the 3X increase is just a shift to reality and the 3X increase is still less than 8% of your income then you're out of luck.
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Old 12-20-2013, 12:07 PM   #23
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pb4uski, I'm curious how/where you found catastrophic coverage plans. Did you go to the exchange and fudge your age? Or maybe you contacted the insurer directly?

Odd that the plan you looked at is not HSA-eligible? That complicates things for me as I was counting HSA contributions to lower my OMAGI thus increasing my premium subsidy.
Well, that's the rub zedd. We are clearly eligible for catastrophic coverage even though we are over 30 because the lowest cost bronze plan available in our state exceeds 8% of our income but our income is too high to get a subsidy. (I concede it is a bit contrived since our income is controllable but if I don't have HSA deductions and limit our TI to the top of the 15% tax bracket then our income will be at a level that the premiums of the lowest cost bronze plan would be 8.2% of our income).

The premium for the catastrophic plan is about 63% of the premium for the bronze plan. The min, expected and max costs of the catastrophic plan are $5k, $5k and $18k respectively and the min, expected and max costs of the bronze plan are $8k, $8k and $21k respectively. The min is just premiums only, the expected is premiums and a couple office visits (we are in good health) and the max is the maximum OOP. So we save $3k a year with catastrophic coverage compared to the lowest cost bronze plan.

However, the process for getting an exemption is not defined. My state is relying on the feds to verify that I am exempt from the penalty and once i get an exemption certificate from the feds then I can buy catastrophic coverage. However, the feds don't yet have a process in place to apply for or issue exemption certificates - it is allegedly coming along anytime now but it has been the same story for a month. So I'm getting the proverbial bureaucratic runaround.

Since it is clear that my prior coverage has been canceled (and the state knows it), I'm hopeful that they will now clear a path for me to buy a catastrophic coverage policy.

I did find the catastrophic plan on my insurer's website, but they can't sell it to me because all policy sales have to go through the state exchange.

The summary on my insurer's website indicates that the bronze plan is HSA eligible, and indicates that the catastrophic plan is not.
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Old 12-20-2013, 02:58 PM   #24
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A few details.

A letter from a group of Senators to HHS (here) asks if individuals with cancelled policies who have not yet found affordable replacements will be eligible for a hardship exemption, which also makes them eligible for catastrophic coverage. The response is a letter (here) that basically says yes.

This doesn't look like a change in policy. Catastrophic coverage has always been available for individuals over age 30 who qualified for a hardship exemption, as shown by this thread. There may be something else not included in the referenced letters.

It would be most helpful to members if we could keep the discussion focused on implementation.
I don't get the "hardship" thing here. Are we just speaking now of individuals or couples who are over the subsidy cut off amounts, now able to purchase a catastrophic plan? Are these the people who this provision has been created for? What are their guidelines for "hardship". Are there numbers associated with it?
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Old 12-20-2013, 03:42 PM   #25
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I don't get the "hardship" thing here. Are we just speaking now of individuals or couples who are over the subsidy cut off amounts, now able to purchase a catastrophic plan? Are these the people who this provision has been created for? What are their guidelines for "hardship". Are there numbers associated with it?
Can't say. The exchange of letters doesn't give details, neither do any of the media reports. I've looked for the HHS bulletin, which I'm sure has the detail we want, but haven't seen it yet. It may become available over the weekend. If so, someone will surely posr details here.
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Old 12-21-2013, 11:44 AM   #26
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Here is a good analysis by Time.

Obamacare: Mandate Delay Is The Biggest Change Yet | TIME.com

Looks like a 'hardship' can be just about anything if you have been cancelled.
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Old 12-21-2013, 12:17 PM   #27
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I wish they would expand the "hardship exemption" to include people who face getting pummeled with 3X premium increase like me and allow us to purchase this as a permanent option!
Agreed. I've never understood why "catastrophic coverage" Plans should not be an option for all. Functionally they are not far off low-end Bronze in benefits, particularly if HSA eligible, and the bureaucracy associated with tracking, processing, & enforcing hardship exemptions costs $$$$ that could be better spent elsewhere (e.g. increasing co-pay subsidy for lower income folks).
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Old 12-21-2013, 01:20 PM   #28
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Agreed. I've never understood why "catastrophic coverage" Plans should not be an option for all. Functionally they are not far off low-end Bronze in benefits, particularly if HSA eligible, and the bureaucracy associated with tracking, processing, & enforcing hardship exemptions costs $$$$ that could be better spent elsewhere (e.g. increasing co-pay subsidy for lower income folks).
If they would just be honest and admit it, I wouldn't be nearly as perturbed over it. Instead of them saying in essence "we know what is best for you and saving yourself from these worthless policy's". I wish they would stand up and say "we don't want you healthy people to try and save a buck on your premium because we want your money to spend on the other peoples claims". The contradiction is befuddling to me.. They constantly parroted how high deductible plans are worthless, then they turn around and award them to young people and anyone who got cancelled.
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Old 12-21-2013, 02:02 PM   #29
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For those over 30 looking to apply for and exemption certificate so you can buy catastrophic coverage I just received a link to the "Application for Exemption from the Shared Responsibility Payment for Individuals who are Unable to afford Coverage and are in Certain States with a State Based Marketplace"

http://marketplace.cms.gov/getoffici...-exemption.pdf
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Old 12-21-2013, 02:49 PM   #30
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If they would just be honest and admit it, I wouldn't be nearly as perturbed over it. Instead of them saying in essence "we know what is best for you and saving yourself from these worthless policy's". I wish they would stand up and say "we don't want you healthy people to try and save a buck on your premium because we want your money to spend on the other peoples claims". The contradiction is befuddling to me.. They constantly parroted how high deductible plans are worthless, then they turn around and award them to young people and anyone who got cancelled.
The reason is that no one wants to say "we want ______ (insert group of people) to pay more for _______ (insert beneficiary group of people)'s benefit", because it sounds too much like a negative statement that can be thrown back in their face at election time. No one wants to have to defend arguing for someone to have to pay more.

Rather, by trying to argue that "this healthplan is inferior", it indirectly gives them a reason for wanting to abolish the plan, as though they are somehow looking out for and saving you, and making you better off (even though it involves you paying substantially more money). It's more palatable to voters to live in lala land where no one has to pay more for anything, and everyone is better off and gets something in return.

If they made EVERYONE buy a minimum of a Bronze plan, then the 20-somethings would have to pay even more for coverage than the catastrophic plans (even though the catastrophic plans are worse than many older High Deductible plans that they call "inferior!). By at least offering the under-30 crowd and those who have truly huge insurance costs a catastrophic plan with the lowest possible premiums, they can avoid the 'worst' of the black eye in trying to defend the healthcare plan with minimum premiums that are even more than the catastrophic.
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Old 12-21-2013, 02:50 PM   #31
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Can't say. The exchange of letters doesn't give details, neither do any of the media reports. I've looked for the HHS bulletin, which I'm sure has the detail we want, but haven't seen it yet. It may become available over the weekend. If so, someone will surely posr details here.
Here's the bulletin, http://www.cms.gov/CCIIO/Resources/R...12-19-2013.pdf

Not sure if this really something new or just clarification as there has always been a hardship for unaffordability. And if you qualify for subsidy a bronze plan may be cheaper, catastrophic plan may not be available ( none in my area ).

Here's a USnews article comparing bronze/catastrophic, ACA Bronze Tier Health Insurance vs. Catastrophic Plans - US News and World Report
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Old 12-21-2013, 03:27 PM   #32
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Here's a USnews article comparing bronze/catastrophic, ACA Bronze Tier Health Insurance vs. Catastrophic Plans - US News and World Report
Nice, concise table. "Catastrophic" Plans are not eligible for subsidy, which is huge for those eligible but non-issue for others. The limit to 3 primary care visits for gov't-defined "preventative services" seems almost meaningless since one (maybe 2) visits suffice for almost all folks. The deductibles & OOP max ($6,350/12,700) are same.
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Old 12-21-2013, 03:46 PM   #33
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Here's the bulletin, http://www.cms.gov/CCIIO/Resources/R...12-19-2013.pdf

Not sure if this really something new or just clarification as there has always been a hardship for unaffordability. And if you qualify for subsidy a bronze plan may be cheaper, catastrophic plan may not be available ( none in my area ).

Here's a USnews article comparing bronze/catastrophic, ACA Bronze Tier Health Insurance vs. Catastrophic Plans - US News and World Report
Thanks! This is new, but still doesn't look like a change in policy.
Quote:
If you believe that the plan options available in the Marketplace in your area are more expensive than your cancelled health insurance policy, you will be eligible for catastrophic coverage if it is available in your area.
if your policy is cancelled you don't need to meet the actual hardship test.

This looks much more like a one time exception. Makes sense, given how hard it has been for some to get hard quotes and policy info. It'll go away when the enrollment process and system is working more smoothly.

There is way too much complexity in our healthcare provider and insurance marketplace, it leads to difficult or poor choices. A catastrophic option for all could be in interesting option, but to work healthcare providers need to have "cash prices" at or below "insurance prices". As it works now not having access to in network prices is too much of a risk.
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Old 12-21-2013, 04:03 PM   #34
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Nice, concise table. "Catastrophic" Plans are not eligible for subsidy, which is huge for those eligible but non-issue for others. The limit to 3 primary care visits for gov't-defined "preventative services" seems almost meaningless since one (maybe 2) visits suffice for almost all folks. The deductibles & OOP max ($6,350/12,700) are same.
For us, there isn't much difference between the HDHI plan we currently have and a bronze plan and a catastrophic plan since we are not eligible for subsidy. Carrier and networks are identical.

HDHI/Bronze/Catastrophic

Individual Deductible $5,950/$5,000/$6,350
Family Deductible $11,900/$10,000/$12,700
Individual MOOP $5,950/$6,250/$6,350
Family MOOP $11,900/$12,500/$12,700
Annual premium $7,548/$8,187/$5,128
"Expected" cost $7,848/$8,487/$5,128
Max cost $19,448/$20,687/$17,828

Since we're pretty healthy the catastrophic plan will save us $3,059 a year in premiums and the benefits are similar. What we give up is being able to make HSA contributions but for us HSA contributions are just shuffling money from taxable funds to tax-free funds and the premium savings exceed the that benefit IME.
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Old 12-21-2013, 04:48 PM   #35
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Interesting that pb4uski shows sl lower OOPmax for Bronze vs catastrophic. In my area, those OOPmax's are the same.
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Old 12-21-2013, 05:13 PM   #36
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A catastrophic option for all could be in interesting option, but to work healthcare providers need to have "cash prices" at or below "insurance prices". As it works now not having access to in network prices is too much of a risk.

It's the wealthy sheikh problem.
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"You don’t really want to change your charges if you have a Saudi sheikh come in with a suitcase full of cash who’s going to pay full charges.”

- Dr. Warren Browner, CEO, California Pacific Medical Center, a Sutter Health Company
If you charge everyone the insurance negotiated rates, you can't do the "your money or your life" thing when a really wealthy sickie falls into your lap. Cash prices need to remain high relative to the insurance negotiated rate to maximize efficiency.
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Old 12-21-2013, 05:46 PM   #37
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It's the wealthy sheikh problem.


If you charge everyone the insurance negotiated rates, you can't do the "your money or your life" thing when a really wealthy sickie falls into your lap. Cash prices need to remain high relative to the insurance negotiated rate to maximize efficiency.
Hospital rack rates are ridiculously high, but no one -- other than the occasional sheikh -- pays them. The hospitals typically discount what they charge the uninsured and write off the difference as "charity care" against taxes or to maintain their "non-profit" status. Pharmaceutical samples and patient assistance programs are also allowed to declare retail prices against their tax liabilities even though few people actually pay those prices.

Negotiated prices for drugs are aproximately 10 cents on the dollar compared to the retail list price paid by the uninsured. There are ways to get around the insanely high drug pricing without insurance, but it takes a lot of work.

The system is broken and the ACA is only a baby step in the right direction.
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Old 12-21-2013, 05:56 PM   #38
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Looks like it all comes back to the fact that healthcare reform should be aimed more at the hospitals rather than the insurance companies. The new law already limits how much profit insurers can make, and some people have not stopped beating them up.

I have had a high-deductible ($10K/yr) plan with my insurer, and for 6 or 7 years did not get any coverage from them nor were we expecting any, because we were healthy. Then, just this year and the last, they have paid out more than $120K for my son's and my serious illnesses that required hospitalization and surgeries. We were not declined any services that my doctors and specialists said we needed.

PS. The rack rate would have been perhaps close to $300K!

PPS. The law requires insurers to rebate any profit that exceeds the legal limit. A few months ago, I got a check for $43. That shows my insurer has not been gouging its clients.
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Old 12-21-2013, 06:07 PM   #39
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This looks much more like a one time exception. Makes sense, given how hard it has been for some to get hard quotes and policy info. It'll go away when the enrollment process and system is working more smoothly.
I believe HHS has said it will be good for one year. Many people believe the exemption will also be extended from only those who lost coverage to anyone without coverage. There's no tenable way for HHS or anyone else to argue that an individual who lost coverage and cannot find an "affordable" policy is somehow at greater hardship than someone who never had insurance and is in the same situation. If the individual mandate erodes, we will face the problems of adverse selection and concomitant higher required rates. Or maybe everything will work out great.
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Old 12-21-2013, 07:16 PM   #40
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Any idea why the "catastrophic" plans aren't HSA eligible?
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