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Old 02-14-2013, 11:19 PM   #61
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Originally Posted by jclarksnakes View Post
People who truly do not want to waste their time arguing usually do not start the next sentence with "Just remember one thing".
I have to disagree. Obgyn is not wanting to argue, but rather is making an extremely important point. Before ACA, the majority of personal bankruptcies in the U.S. was and is due to the lack of affordable health care. Every other advanced country in the world makes sure that doesn't happen to its own citizens.

So his point stands very well, and should be understood in this context. In my opinion, we're now starting to join the rest of the advanced world with universal care for our people regardless of income and affordability.
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Old 02-14-2013, 11:42 PM   #62
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+1

I think the big winners will be the insurance companies. While most of America waits to see how the details turn out the insurance guys are working feverishly figuring out how to make the most money possible from the ACA. Somebody will have to pay the extra money they will make.
I thought the insurance companies lobbied heavily against the ACA. Maybe I'm wrong? I didn't follow this too closely.

The ACA does limit the medical loss ratio. Basically insurers can't get more than 15-20% profit. I thought some posters here already reported that insurers had to give back some of their premiums.
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Old 02-15-2013, 12:01 AM   #63
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They put together a crude cost estimator, which will give a quote for a "Silver Plan" policy. A typical high deductible policy such as many of us use is more like a "Bronze Plan" policy. Costs look comparable to current Preferred Provider plans from Aetna, Blue Cross, etc for California residents. That is, ouch... But we're used to it. (They probably just loaded in the current prices of plans similar to the Silver Plan benefits.)

Health Insurance Calculator | Covered California
For curiousity I did this. There wasn't a way to tell it that the household size wasn't equal to the number of people being insured. That is, for example, in my house DH is already on medicare. If I were to put in a 2 person household size with my age (I'm youngest) it says that the insurance cost is $1723 a month (ouch). If I put in a 1 person household size it goes down to $635 a month. So basically it costs more to insure a 2 person household size than to have 2 people insured not in the same household. Also the premium stays at $1723 if I put in 3 or 4 members in the household.

I have kids at home and it also says to put in the age of the youngest adult from 19-64. I put in 19 for my son and then the premium goes down to $574. I think they are assuming that if the youngest adult is 19 that the oldest adult is probably close to that age. It doesn't seem to be considering the possibility of older parents with adult kids at home. Just like it doesn't seem to have a concept of someone under 65 being in a household with someone over 65....

Edit: Another thing I did my son at 19 as an individual and it would be $212 a month. So theoretically if my kids could do individual polices that would be $424 a month ($212 each) and I would do $635 as a in individual so the total would be $1059 a month. But if you put in a 3 person family with the youngest adult at 58 and with 2 children under 19 (what is actually the case right now) then it is $1723 a month. Again, that doesn't seem to make sense....

Edit2: Looking at this they are only quoting based upon single person or family of 2 to 8. So this really isn't that useful.

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After a quick look at the prices it seems they are in the same ballpark as Mass. Not a surprise.
Not for me. I look at the Mass premiums which for me and dependent children were about $750 a month for a bronze plan (which is most similar to what I have now) and a little more for a silver plan. The Mass. website allows for putting in coverage for one person and dependent kids. Of course that $750 a month is way more than I pay now (on DH's subsidized retiree plan).
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Old 02-15-2013, 05:55 AM   #64
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I thought the insurance companies lobbied heavily against the ACA. Maybe I'm wrong? I didn't follow this too closely.
Without getting too political, I think there's general agreement that they reached an agreement with the White House early in the process and lobbied hard for PPACA once they were guaranteed that every American below the age of 65 would be induced by the government to be their customer. Many opponents of PPACA as it was written felt the insurers had made an underhanded deal, and there was very little sympathy for them--from anyone--when they got cold feet very late in the process when "cost controls" were beefed up slightly.
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Old 02-15-2013, 07:56 AM   #65
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The ACA does limit the medical loss ratio. Basically insurers can't get more than 15-20% profit. I thought some posters here already reported that insurers had to give back some of their premiums.
My understanding is that this is how they intend to kill off HDHP w/ HSAs.

With traditional "medical coverage" you pay premiums and all your covered medical expenses are paid by the plan (minus copays in some cases).

In the HDHP/HSA setup, you pay for your medical expenses yourself until you hit the deductible. Its much more like medical insurance rather then a medical plan. Since this money isn't routed through the insurance company, it's not counted toward their ML-Ratio.

The PPACA now triggers a rebate in many cases where the high deductible hasn't been reached. Of course, the companies need this "outrageous high profit" from these cases to cover the expenses when the real insurance kicks in.

If we can get the law changed to include the money people pay for their own care as part of the ML-Ratio, we might be able to save HDHP/HSA plans.
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Old 02-15-2013, 08:49 AM   #66
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There are so many things wrong with the current health insurance situation that something had to be done. Is the solution ideal? No, the bill that passed certainly would not have been my first choice. But it is a big step forward from the disgraceful situation we have now where millions have no insurance, millions cannot get insurance, and a shockingly large number of others who need significant medical care have inadequate insurance and eventually are forced into bankruptcy.

Massachusetts has had several years of experience with their very similar plan. Most residents support it, and the level of support has increased since it first went into effect. Although I've never lived in Massachusetts, I worked for a Massachusetts-based company and my insurance was through Blue Cross of Massachusetts when their state law went into effect. The cost of my health insurance actually dropped.
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Old 02-15-2013, 01:40 PM   #67
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Thanks for that link. After a quick look at the prices it seems they are in the same ballpark as Mass. Not a surprise.
Officially, now that California has the benefits laid out for each of the four exchange plans, bidding starts for what will be in the exchange in October 2013. The current prices that the estimator comes up with don't have the (not yet filed) bids figured in yet. I think they are just using prices for current individual insurance plans that have benefits similar to the new Silver Plan.

Those of us not seeing the doctor all that often, and on relatively few prescriptions, might have better overall expenses (insurance + deductibles + copays) on a Bronze plan, which looks more like a high deductible plan. If our income is too high for subsidies, sticking with a current high deductible plan might be the best deal of all.
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Old 02-15-2013, 01:42 PM   #68
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Massachusetts has had several years of experience with their very similar plan. Most residents support it, and the level of support has increased since it first went into effect. Although I've never lived in Massachusetts, I worked for a Massachusetts-based company and my insurance was through Blue Cross of Massachusetts when their state law went into effect. The cost of my health insurance actually dropped.
I remain skeptical, but I do hope it works out. I hope to never be of the mindset where I want public policy to fail because it may not completely jibe with my own political/ideological preferences.
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Old 02-15-2013, 01:45 PM   #69
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Without getting too political, I think there's general agreement that they reached an agreement with the White House early in the process and lobbied hard for PPACA once they were guaranteed that every American below the age of 65 would be induced by the government to be their customer. Many opponents of PPACA as it was written felt the insurers had made an underhanded deal, and there was very little sympathy for them--from anyone--when they got cold feet very late in the process when "cost controls" were beefed up slightly.
My understanding is that the insurers made it very clear that they *supported* a guaranteed issue, zero-underwriting system with no preexisting condition exclusions as long as they were allowed to price their product profitably and there was a true universal mandate (to avoid adverse selection).

Many of the insurers don't like how cheaply people can "go naked" and pay the fines, only to buy in once they start developing health problems. In other words, the fines (or taxes based on the SCOTUS decision) are not sufficient to enforce a universal mandate, and thus there is still the potential for too much adverse selection with younger and healthier folks opting out and paying the fine/tax.
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Old 02-15-2013, 01:47 PM   #70
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My understanding is that this is how they intend to kill off HDHP w/ HSAs.

With traditional "medical coverage" you pay premiums and all your covered medical expenses are paid by the plan (minus copays in some cases).

In the HDHP/HSA setup, you pay for your medical expenses yourself until you hit the deductible. Its much more like medical insurance rather then a medical plan. Since this money isn't routed through the insurance company, it's not counted toward their ML-Ratio.

The PPACA now triggers a rebate in many cases where the high deductible hasn't been reached. Of course, the companies need this "outrageous high profit" from these cases to cover the expenses when the real insurance kicks in.

If we can get the law changed to include the money people pay for their own care as part of the ML-Ratio, we might be able to save HDHP/HSA plans.
The rebate only kicks in when the plan-wide spending, across all members of a plan, drops below 80% of revenue. The expenses for an individual or a family may be much farther below the amount that they pay for insurance in a particular period, but some other member might have expenses far higher than their premiums. That's the risk-sharing aspect of insurance.
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Old 02-15-2013, 01:53 PM   #71
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Officially, now that California has the benefits laid out for each of the four exchange plans, bidding starts for what will be in the exchange in October 2013. The current prices that the estimator comes up with don't have the (not yet filed) bids figured in yet. I think they are just using prices for current individual insurance plans that have benefits similar to the new Silver Plan.

Those of us not seeing the doctor all that often, and on relatively few prescriptions, might have better overall expenses (insurance + deductibles + copays) on a Bronze plan, which looks more like a high deductible plan. If our income is too high for subsidies, sticking with a current high deductible plan might be the best deal of all.
Based on the Covered California calculator, subsidies go away once our income goes over $60K, which is not very much for our high COL area. Does anyone know if there will be any regional adjustment to the subsidies based on COL? Otherwise, it would be better to retire on $60K or less in a low COL area.
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Old 02-15-2013, 02:47 PM   #72
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Originally Posted by mpeirce

My understanding is that this is how they intend to kill off HDHP w/ HSAs.

With traditional "medical coverage" you pay premiums and all your covered medical expenses are paid by the plan (minus copays in some cases).

In the HDHP/HSA setup, you pay for your medical expenses yourself until you hit the deductible. Its much more like medical insurance rather then a medical plan. Since this money isn't routed through the insurance company, it's not counted toward their ML-Ratio.

The PPACA now triggers a rebate in many cases where the high deductible hasn't been reached. Of course, the companies need this "outrageous high profit" from these cases to cover the expenses when the real insurance kicks in.

If we can get the law changed to include the money people pay for their own care as part of the ML-Ratio, we might be able to save HDHP/HSA plans.
Having a HD plan that is very cheap, I share your concern. Mine is under the legal $6k limit, so it can continue, but the loss ratio is a deep concern to me for its long term viability. HSA's are going to be around, but in what form.... I have searched and searched and have not found anything on internet that states the maximum HSA deduction for 2014. In years past, you always knew what the following years limit would be. I am afraid they are going to lower the limit to coincide with the new plan deductibles.
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Old 02-15-2013, 02:50 PM   #73
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I have searched and searched and have not found anything on internet that states the maximum HSA deduction for 2014. In years past, you always knew what the following years limit would be. I am afraid they are going to lower the limit to coincide with the new plan deductibles.
Last year, the 2013 limits weren't released by the IRS until April 27.
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Old 02-15-2013, 03:08 PM   #74
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Last year, the 2013 limits weren't released by the IRS until April 27.
Maybe I was just reading estimates on some HSA material websites then, as I have never looked on IRS for info. That makes me feel better that maybe it will continue to go up. But I can't seem to find any information on them concerning the actual impact the healthcare act will have on them, dollar wise.
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Old 02-15-2013, 03:11 PM   #75
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Maybe I was just reading estimates on some HSA material websites then, as I have never looked on IRS for info. That makes me feel better that maybe it will continue to go up. But I can't seem to find any information on them concerning the actual impact the healthcare act will have on them, dollar wise.
I suspect the folks who usually "jump the gun" with estimates have very little certainty about what the IRS will do with this starting in 2014 when PPACA takes (more or less) full effect, so they are hesitant to stick their necks out as in past years.
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Old 02-15-2013, 03:19 PM   #76
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I suspect the folks who usually "jump the gun" with estimates have very little certainty about what the IRS will do with this starting in 2014 when PPACA takes (more or less) full effect, so they are hesitant to stick their necks out as in past years.
Still, Ziggy, you have given me hope. I am down to my HSA and mortgage as my last deductions, going forward. I would hate to be down to one, as the HSA is about to be a bigger deduction than my mortgage is.
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Old 02-15-2013, 03:24 PM   #77
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My Megacorp has a "retirement insurance" option that pretty much prices the insurance as I see in these calculators. They argue to us today that the insurance is a good benefit because there are no pre-existing condition clauses. I agree. Although expensive, it sure is nice to not worry about going through the pre-existing condition gauntlet.

However, since the cost will be about the same, and the ACA doesn't rule out if pre-existing conditions exist, I wonder if my Megacorp will bother continuing to offer the plan?

My bet is that they won't. I'm not complaining, just observing and predicting.
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Old 02-15-2013, 03:54 PM   #78
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My understanding is that the insurers made it very clear that they *supported* a guaranteed issue, zero-underwriting system with no preexisting condition exclusions as long as they were allowed to price their product profitably and there was a true universal mandate (to avoid adverse selection).
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Old 02-15-2013, 04:01 PM   #79
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Based on the Covered California calculator, subsidies go away once our income goes over $60K, which is not very much for our high COL area. Does anyone know if there will be any regional adjustment to the subsidies based on COL? Otherwise, it would be better to retire on $60K or less in a low COL area.
You are expected to contribute 9.5% of modified AGI, once the premium exceeds that amount you get a subsidy. The % contribution is fixed across the country.
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Old 02-15-2013, 04:02 PM   #80
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My Megacorp has a "retirement insurance" option that pretty much prices the insurance as I see in these calculators. They argue to us today that the insurance is a good benefit because there are no pre-existing condition clauses. I agree. Although expensive, it sure is nice to not worry about going through the pre-existing condition gauntlet.

However, since the cost will be about the same, and the ACA doesn't rule out if pre-existing conditions exist, I wonder if my Megacorp will bother continuing to offer the plan?

My bet is that they won't. I'm not complaining, just observing and predicting.
I'm facing the same deal Joe. My big hang up to RE is waiting to see how this all shakes out. While my Megacorp dropping retiree coverage has always been in the back of my mind, the 400% caught me off guard. I'm one of those people who put every available dollar into 401k's, 403b's and any other deferred account available. Now I find that I'll get hit pretty hard if megacorp drops their plan and I need ACA coverage. I don't plan to live on $60k a year after saving my entire worklife. However, I'm struggling with the taxable savings cash flow to make it work. Just when you figure it out they change the rules.
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