Obamacare and me

[frank]

I am 66 and on medicare, my wife is 60 and has an individual health plan. Does anyone have an idea how this will work when obamacare comes into effect? will we be classified as a couple for income purposes or she as an individual? Will they take our gross income to figure the obamacare subsidy for her health insurance? Do they have different levels of risk, say smokers vs nonsmokers or obese vs not heavy?

 

[Richard4444]

Also, since pre-existing conditions are included ... can someone with a pre-exisitng situation not immediately purchase ObamaCare, but wait until s/he has a claim which makes it worthwhile, and then be immediately covered?

 

[bUU]

ACA does have a waiting period before pre-existing conditions are covered. Depending on the policy and your state’s insurance regulations, this exclusion period can range from six to 18 months.

 

[Sue J]

I am 66 and on medicare, my wife is 60 and has an individual health plan. Does anyone have an idea how this will work when obamacare comes into effect? will we be classified as a couple for income purposes or she as an individual? Will they take our gross income to figure the obamacare subsidy for her health insurance? Do they have different levels of risk, say smokers vs nonsmokers or obese vs not heavy?

I have been looking for an answer to your question about only one person in a couple needing insurance since this whole thing started. I have been unable to get any kind of answer. In my state of Ohio we have the Office Of Health Transformation and I emailed them with my question. The answer that came back was -

[FONT=&quot]"Sue – [/FONT]

[FONT=&quot]Thank you for reaching out to the Office of Health Transformation. I apologize for the delay in getting back to you. [/FONT]

[FONT=&quot]Currently, there is no way to answer your specific question. It will depend on rules that the federal government is developing about the operation of the exchange. You may want to reach out to your US Congressional representative who can help ask these questions to someone at the federal level.[/FONT]

[FONT=&quot]Sorry I do not have more information for you at this time.[/FONT]"

Makes it sound like they are making it up as they go along. It should get very interesting in the fall.

 

[heeyy_joe]

Monitor www.dol.gov

For possible updates on AAPCA.

 

[omni550]

frank,

John Greaney wrote this piece called "Don't get stabbed by the Obamacare Spike" In it, he mentions that smokers will be paying a 50% premium for partaking of that vice: Don't Get Stabbed by the Obamacare Spike.

omni

 

[Texas Proud]

ACA does have a waiting period before pre-existing conditions are covered. Depending on the policy and your state’s insurance regulations, this exclusion period can range from six to 18 months.

It does not affect me, but since you seem to know....

Does this start from the very beginning or only apply if you do not get insurance when required

 

[Texas Proud]

frank,

John Greaney wrote this piece called "Don't get stabbed by the Obamacare Spike" In it, he mentions that smokers will be paying a 50% premium for partaking of that vice: Don't Get Stabbed by the Obamacare Spike.

omni

I love this quote from the article...

"For example, in Texas someone living in Houston or Dallas with easy access to world class medical facilites currently pays about 40% more than someone living in a sparsely populated rural area in the Western part of the state."


SOOOO, I am paying 40% more just because I live in a location that has a lot of medical facilities Not because we are sicker....

 

[ziggy29]

frank,

John Greaney wrote this piece called "Don't get stabbed by the Obamacare Spike" In it, he mentions that smokers will be paying a 50% premium for partaking of that vice: Don't Get Stabbed by the Obamacare Spike.

omni

The subsidy mechanism is odd, too. Looking at it, it looks like we get no *initial* 2014 subsidy based on 2012 MAGI (about $95K for us), and won't get it until filing the 2014 tax return in early 2015. It's a good thing we have enough cash in savings to eat these "full price" policies for a year before getting most of the cost refunded.

And whatever I get back as a credit for 2014 will need to be set aside for 2015 premiums, as 2015 might be a redux of 2014 -- since it will be based on 2013 income which (for my partial year of work, plus DW's income and other lay-off related income) will still probably put us a little north of 400% for the year. It may not be until 2016 that we don't have to pay the full cost (i.e. $1000+ per month) in advance. That assumes I understand things correctly. In the *long* run 2014 and 2015 coverage will be much cheaper than I initially pay, but that could cause a lot of trouble for households in my situation but without much cash in the bank. And it won't be until January 2016 that I won't have to pay the unsubsidized rate up front.

 

[MichaelB]

Pre-existing conditions are allowed under specific and limited circumstances, but generally are no longer allowed beginning 1/2014.
See this brief for details http://www.kff.org/healthreform/upload/8356.pdf
From page 3

How does the ACA affect pre-existing condition exclusions?

Beginning January 1, 2014, the ACA prohibits insurersin the individual and group markets(with the exception of grandfathered individual plans) from imposing pre-existing condition exclusions. The ACA’s prohibition on pre-existing condition exclusions will enable consumers to access necessary benefits and services, beginning from their first day of coverage. Beginning in 2014, the ACA will also require insurance companies to guarantee issue health plans to any applicant regardless of his or her health status and impose rating restrictions limiting how much insurers can vary premiums based on
an individual’s health status.

 

[Malcolm2]

Be prepared to pay much more for coverage under the ACA/Obamacare than you anticipate. That said, some of the features will not be funded. Future Congress action will likely further weaken, or totally eliminate the provisions. Best is not to include it at all in planning - could/likely to be totally redone. Could be a good thing as nobody really understands it anyway.

 

[bUU]

It does not affect me, but since you seem to know.... Does this start from the very beginning or only apply if you do not get insurance when required

That was the HIPAA regulations (which are effectively overridden by ACA). I copied and pasted the wrong paragraph. Sorry for the confusion.

Anyway, it isn't me that's the expert on ACA; that's my spouse. When my spouse is with me, I know every last little bit of it. When my spouse is not with me, then I know as much as anyone in Massachusetts knows about Romneycare.

Be prepared to pay much more for coverage under the ACA/Obamacare than you anticipate.

Our plan is already ACA compliant - has been for years - so we won't be paying substantially more.

That said, some of the features will not be funded.

Requirements like the prohibition on exclusion periods don't require funding.

Future Congress action will likely further weaken, or totally eliminate the provisions.

Such efforts would have to have made it through the Senate, which generally doesn't happen with things like this.

 

[ziggy29]

Be prepared to pay much more for coverage under the ACA/Obamacare than you anticipate. That said, some of the features will not be funded. Future Congress action will likely further weaken, or totally eliminate the provisions. Best is not to include it at all in planning - could/likely to be totally redone. Could be a good thing as nobody really understands it anyway.

At best we can only look at the law as we know it now. Anything more than that is political speculation with the usual divisive political arguments we try to avoid here.

Sure, we may want to include a fudge factor for potential watering down in the future (I do that for SS and Medicare), but speculation about its future usually only leads to political arguments.

 

[Mulligan]

frank,

John Greaney wrote this piece called "Don't get stabbed by the Obamacare Spike" In it, he mentions that smokers will be paying a 50% premium for partaking of that vice: Don't Get Stabbed by the Obamacare Spike.

omni

Ya, that will really incentivize them to buy a policy or check the box "yes" won't it? I am not a smoker, but this one escapes me. They have no problem smacking a surcharge on them, but Two Ton Tessy gets a free pass, along with drug addicted people and all their ensuing problems from abuse get the "good rate" also? I guess smokers are the last legally persecuted people you can pick on.

 

[scrinch]

SOOOO, I am paying 40% more just because I live in a location that has a lot of medical facilities. Not because we are sicker....

You probably pay more for housing, food, auto insurance, etc in a more urban area too, based on free market prices. I guess that's the price we pay for choosing to live where we've got all the conveniences.

 

[MichaelB]

I am 66 and on medicare, my wife is 60 and has an individual health plan. Does anyone have an idea how this will work when obamacare comes into effect? will we be classified as a couple for income purposes or she as an individual? Will they take our gross income to figure the obamacare subsidy for her health insurance? Do they have different levels of risk, say smokers vs nonsmokers or obese vs not heavy?

I have been looking for an answer to your question about only one person in a couple needing insurance since this whole thing started. I have been unable to get any kind of answer. In my state of Ohio we have the Office Of Health Transformation and I emailed them with my question.

Eligibility for subsidy is determined using the total household income, specifically the MAGI. Each individual in the household is eligible for subsidy if the total household MAGI is between 133% and 400% of the FPL. This determines the total amount one will pay, regardless of the cost of the premium, which does vary based on location, age, and smoker or not.

 

[marko]

Ya, that will really incentivize them to buy a policy or check the box "yes" won't it? I am not a smoker, but this one escapes me. They have no problem smacking a surcharge on them, but Two Ton Tessy gets a free pass, along with drug addicted people and all their ensuing problems from abuse get the "good rate" also? I guess smokers are the last legally persecuted people you can pick on.

IMO, smokers should be encouraged. Statistically, they die faster and younger thus using less health care resources than a life-long healthy person who is strong enough to 'linger' through old age.

I forget the actual numbers but smokers use a lot of HC resource but for a shorter period vs a non-smoker who uses moderate resources for much, much longer including LTHC. In the end, the healthy person is more of a longer term drain to the HC system just by living much longer.

It should almost be our duty to take up smoking, exit the planet early and reduce the overall HC costs for everyone! And let's not forget the benefit of added tax revenue.

A little bit of sarcasm here, but something to think about, I think.

 

[frank]

what would they do if you signed that you were a non-smoker or had other vices but actually were and then became sick? would they deny payment?

 

[bUU]

Yes.

My spouse was informed that even chewing Nicorette, without declaring it as smoking, would result in denial of benefits.

 

[braumeister]

Blood testing for nicotine is beginning to become more common for job applicants at some companies (same as any other drug testing).

 

[eytonxav]

SOOOO, I am paying 40% more just because I live in a location that has a lot of medical facilities Not because we are sicker....

We've been getting hosed for years due to all the free loaders we end up subsidizing here in TX, which I suspect will not change anytime soon even with ACA.

My subsidized mega corp benefit costs me more than 2x what an equivalent retiree pays in the Northeast

 

[MichaelB]

I love this quote from the article...

"For example, in Texas someone living in Houston or Dallas with easy access to world class medical facilites currently pays about 40% more than someone living in a sparsely populated rural area in the Western part of the state."


SOOOO, I am paying 40% more just because I live in a location that has a lot of medical facilities Not because we are sicker....

I didn't see anything to support that statement, and what I have read elsewhere points to the opposite conclusion. Rural and sparsely populated areas are high health care cost while large metropolitan areas are lower cost. Exception to Hawaii and NYC.

 

[Mulligan]

Yes.

My spouse was informed that even chewing Nicorette, without declaring it as smoking, would result in denial of benefits.

I would think it is based on the terminology of application. Some specify specifically including nicotine, while others have specifically stated smoking. The FDA just came out and recently states that it is safe to be on nicotine replacement gums/lozenges long term. My guess is it isn't about the nicotine, but the fact you are more prone to relapse and start smoking again.

 

[Mulligan]

IMO, smokers should be encouraged. Statistically, they die faster and younger thus using less health care resources than a life-long healthy person who is strong enough to 'linger' through old age.

I forget the actual numbers but smokers use a lot of HC resource but for a shorter period vs a non-smoker who uses moderate resources for much, much longer including LTHC. In the end, the healthy person is more of a longer term drain to the HC system just by living much longer.

It should almost be our duty to take up smoking, exit the planet early and reduce the overall HC costs for everyone! And let's not forget the benefit of added tax revenue.

A little bit of sarcasm here, but something to think about, I think.

No, you are spot on. Many studies have concluded this and we have had a thread on it before. In the totality of healthcare costs from cradle to grave, fat people and smokers consume less. If we get more people fit and off the smokes, we will just have to build industrialized sized complex nursing homes for all the healthy people who eventually develop Alzheimer's and such. But the insurance companies know this, let the problems develop after 65 so it isn't their problem. Plus you figure in the 10 years savings of less Social Security due to early death, I do not know if our country can financially afford a society of healthy people.

 

[MichaelB]

Eligibility for subsidy is determined using the total household income, specifically the MAGI. Each individual in the household is eligible for subsidy if the total household MAGI is between 133% and 400% of the FPL. This determines the total amount one will pay, regardless of the cost of the premium, which does vary based on location, age, and smoker or not.

I stand corrected. Further research points to healthcare subsidies will not cover any smoking surcharge. Sarah Kliff has a good article here Big tobacco and anti-cancer activists agree: Health provision goes too far