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Old 08-02-2013, 07:09 PM   #21
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Just today, I received a letter from my insurer, saying that my existing plan will be continued. I need to study PPACA provided plans more when they are available for my state. It may be difficult to compare. One should not go for just low premium alone.

By the way, we also received $43 from the insurer as the premium rebate. I remember a poster said his/her rebate was about 10 times as much. My insurer is apparently not so greedy. For several years, we nowhere approached the $10K deductible, but having done so 2 years in a row, first for my son's freak infection and now for me, I have been happy with the coverage.
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Old 08-03-2013, 07:47 AM   #22
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...those policies will only be in force until Dec. 31

To further Michael's thought. You also had to have the individual policy by March of 2010. Prior to that if your policy meet all guidelines it could stay in force as long as insurance company was providing it. If you purchased after that date, you will be an automatic contestant for Obamacare.
I'm not sure what you mean...are you saying I'll be FORCE into the exchanges (as it turns out, this is what I want, I'm just trying to get insurance to cover me until the end of the year and which point I'll switch, but only because of the subsidies), I just want to clarify for others who might read this.
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Old 08-03-2013, 09:36 AM   #23
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I'm not sure what you mean...are you saying I'll be FORCE into the exchanges (as it turns out, this is what I want, I'm just trying to get insurance to cover me until the end of the year and which point I'll switch, but only because of the subsidies), I just want to clarify for others who might read this.
TJ
Yes, your policy will have to end, and then your next policy will have to be purchased on the exchange (or other approved site, though prices will be the same). Now to muddy the waters a bit, due to the wording of the law, an insurance company can extend your coverage on an existing policy this year, through the end of next year if it so chooses. So it is possible you could stay on a plan you purchase this year through the end of next year. The insurance company I am sure will provide you your options before the end of the year I would think. I am still waiting my options from my carrier as they haven't announced anything yet.
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Old 08-03-2013, 11:34 AM   #24
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Yes, your policy will have to end, and then your next policy will have to be purchased on the exchange (or other approved site, though prices will be the same). Now to muddy the waters a bit, due to the wording of the law, an insurance company can extend your coverage on an existing policy this year, through the end of next year if it so chooses. So it is possible you could stay on a plan you purchase this year through the end of next year. The insurance company I am sure will provide you your options before the end of the year I would think. I am still waiting my options from my carrier as they haven't announced anything yet.
This may be a stupid question, but do ALL insurance companies HAVE TO participate in the exchanges, or can they opt out? For example I didn't see UHC in the list of companies in the list.
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Old 08-03-2013, 11:58 AM   #25
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This may be a stupid question, but do ALL insurance companies HAVE TO participate in the exchanges, or can they opt out? For example I didn't see UHC in the list of companies in the list.
TJ
There have been news accounts stating that recognizable companies are choosing not to offer exchange accounts in some states, but typically a state where their market share is low.

An insurance company must first register and comply with state insurance laws to offer a policy in that state. (nothing new here.)

Subject to the exchange's confirmation that a proposed policy meets ACA requirements, an insurance company may choose to offer that exchange policy in one or all of that state's geographic service areas, as defined by the exchange. The premiums can vary geographically.

Taken to an extreme to illustrate, I believe the smallest offering for a NY insurer might be to offer a single "silver" policy for the NYC metro area, with no variation offered for deductibles, co-pays, etc.

For the exchanges and states that show HI rate application traffic at the state Insurance Department, it's typical to see a dozen insurers offering over a hundred policy variations. Four metal plans times perhaps 5 geographic areas equals 20 distinct policy offerings from one insurer, before taking into account the possible permutations for deductibles, etc.
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Old 08-03-2013, 12:02 PM   #26
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This may be a stupid question, but do ALL insurance companies HAVE TO participate in the exchanges, or can they opt out? For example I didn't see UHC in the list of companies in the list.
TJ
No they do not have to, and some are sitting out at least the first year. The question I can't resolve is, can they legally offer a product that does not conform to the ACA. If they did, say a 10k deductible and it was cheap enough, I would consider buying that and paying the mandatory fine. In other words, companies can sell their health insurance "off exchange", but can they sell anything off exchange and not compliant? I imagine the answer is no though.
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Old 08-03-2013, 12:05 PM   #27
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This may be a stupid question, but do ALL insurance companies HAVE TO participate in the exchanges, or can they opt out? For example I didn't see UHC in the list of companies in the list.
TJ
Insurance companies are not required to participate in the exchanges and are free to offer policies directly to the public or through distributors, as long as they comply with PPACA requirements.
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Old 08-03-2013, 12:10 PM   #28
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Insurance companies are not required to participate in the exchanges and are free to offer policies directly to the public or through distributors, as long as they comply with PPACA requirements.
So there will be no possibility for an off exchange non compliant policy where you can pay the fine, correct?
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Old 08-03-2013, 12:15 PM   #29
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Perhaps I'm being overly cynical, but I can imagine the following scenario playing out.

Since the exchange plans are subsidized, it seems to me that the insuree will look at them the same way that an investor looks at municipal bonds versus taxable bonds. That is, the insuree should only care about the subsidized price, all else equal, as an investor, all else equal, only cares about the after-tax return. This gives the insurance companies the ability to raise the premiums to the point at which, with the subsidy, the insuree pays a little less than he would if he bought the same policy outside of an exchange. Hence the insurance companies can be more aggressive the first year as a way to "drum up" business with the hope that more and more people will move to the exchange plans, and more businesses will stop providing insurance to their employees and move them to the exchanges. I suspect the end result will be that the policies (on average) with the subsidy will equilibrate to the same price as an equivalent non-exchange policy today. This means that the pre-subsidy price will likely be higher, resulting in a wealth transfer from those who don't get a subsidy and the taxpayer to those who do and the insurance companies.
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Old 08-03-2013, 02:15 PM   #30
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I suspect the end result will be that the policies (on average) with the subsidy will equilibrate to the same price as an equivalent non-exchange policy today. This means that the pre-subsidy price will likely be higher, resulting in a wealth transfer from those who don't get a subsidy and the taxpayer to those who do and the insurance companies.
Unless exchanges get different customers (higher risk) then non-exchange customers. The companies have to price exchange policies based on no prescreening correct?, but they will be able to prescreen non-exchange customers, so if a 25 yr old can get a policy outside the exchange for $95/mon, it still may be cheaper than a exchange policy ($400- $200 subsidy, for a total of $200).
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Old 08-03-2013, 02:21 PM   #31
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The companies have to price exchange policies based on no prescreening correct?, but they will be able to prescreen non-exchange customers, so if a 25 yr old can get a policy outside the exchange for $95/mon, it still may be cheaper than a exchange policy ($400- $200 subsidy, for a total of $200).
I believe they can't prescreen or underwrite for non-exchange policies, either. Which means that someone paying $95 per month at age 25 couldn't be forced to pay more than three times that amount, or $285 per month, at age 64 (since age can only be used insofar as the oldest can't pay more than three times as much as the young). With guaranteed issue. And that won't happen.
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Old 08-03-2013, 02:36 PM   #32
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The question I can't resolve is, can they legally offer a product that does not conform to the ACA. If they did, say a 10k deductible and it was cheap enough, I would consider buying that and paying the mandatory fine. In other words, companies can sell their health insurance "off exchange", but can they sell anything off exchange and not compliant? I imagine the answer is no though.
Frankly that's been my thought too. I'd much rather keep my very high deductible plan with the low premium and pay the penalty.
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Old 08-03-2013, 07:44 PM   #33
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So there will be no possibility for an off exchange non compliant policy where you can pay the fine, correct?
I know of no written provision in ACA specifically outlawing non-compliant plans, although buying one would apparently not excuse someone from having to pay the fine. So whether or not companies might offer such plans in '14 & beyond is open to question.
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Old 08-03-2013, 08:19 PM   #34
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I suspect the end result will be that the policies (on average) with the subsidy will equilibrate to the same price as an equivalent non-exchange policy today. This means that the pre-subsidy price will likely be higher, resulting in a wealth transfer from those who don't get a subsidy and the taxpayer to those who do and the insurance companies.
That seems very logical--every player is pursuing their own self-interests (except, maybe, the taxpayers, who don't have a clear agent in all of this as you've laid it out).

It's the same mechanism which has caused college costs to increase much more rapidly than the CPI (or even medical costs)--increased demand/reduced pressure on prices due to easy money being pumped into the system.

But--if insurers can offer "wildcat" plans outside the exchanges directly to consumers, that might constitute a mechanism for price competition. If the fines remain modest, it might be economical for those who are not receiving subsidies to jump out of the whole process, pay the fines, and get one of these non-PPACA-compliant policies (that they deem to best meet their needs). If there's enough of this going on, there would be pricing pressure to reduce the cost of the plans offered on the exchanges.
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Old 08-04-2013, 07:25 AM   #35
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Insurance companies cannot offer any new plans that are not compliant with PPACA regulations regarding essential minimum health benefits and no underwriting. They can continue with their current grandfathered plans, subject to some PPACA conditions, but only to policyholders that were enrolled in 2010.

Insurers are not required to use the exchanges. They're free to interact directly with consumers or use other interfaces. Consumers can only get premium assistance or subsidy on an exchange or approved platform.
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Old 08-04-2013, 07:55 AM   #36
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> Insurance companies cannot offer any new plans that are not compliant with PPACA regulations regarding essential minimum health benefits

And some people wonder why so many folks are exasperated with the PPACA...
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Old 08-12-2013, 08:51 AM   #37
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[Mod Edit]

If one is Poor, (this is the noun) one will be excluded from getting insurance unless they are above 137% of the poverty line.

So, for us lucky folk who can control our taxable income, with some planning, can get insurance from the Federal Exchange for ~$60pm (Silver) if their AGI is kept right at $21,500?

This may take a year to perfect but surely it can be optimized for each of our personal situations. Who here gets insurance for ~$60pm that is not Military or covered by company plans? So this ACA is a good deal right?

[Mod Edit]

Does anyone have a good breakdown of what ALL the metal plans will offer, deductibles, Copays, OOP costs etc.?
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Old 08-12-2013, 10:55 AM   #38
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[Mod Edit]

If one is Poor, (this is the noun) one will be excluded from getting insurance unless they are above 137% of the poverty line.
Is it 137% or 100%?
Last info I received 138% or under is Medicaid eligible if a the state participates.
Those above 100% will have an opportunity to buy into the exchange.
Those under 100% cannot buy into the exchange.
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Old 08-12-2013, 10:57 AM   #39
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[Mod Edit]

If one is Poor, (this is the noun) one will be excluded from getting insurance unless they are above 137% of the poverty line.

So, for us lucky folk who can control our taxable income, with some planning, can get insurance from the Federal Exchange for ~$60pm (Silver) if their AGI is kept right at $21,500?

This may take a year to perfect but surely it can be optimized for each of our personal situations. Who here gets insurance for ~$60pm that is not Military or covered by company plans? So this ACA is a good deal right?

[Mod Edit]

Does anyone have a good breakdown of what ALL the metal plans will offer, deductibles, Copays, OOP costs etc.?
Shok, if you go to the Covered California ..... thread in this health section,go to page 2 and look in Explanade's post. Hit his consumer guide link and their is a detailed explanations of California's. Page 5 has a nice comparison chart of coverages for the different metal plans.
I did not know this but if one's income is such that insurance premiums are above 8% of income, they are exempted form coverage. I could see at some point many people making too much money for subsidies, but not enough to stay under 8% threshold.
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Old 08-19-2013, 01:43 PM   #40
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> Insurance companies cannot offer any new plans that are not compliant with PPACA regulations regarding essential minimum health benefits

And some people wonder why so many folks are exasperated with the PPACA...
And, yet, it is easy to see why the PPACA has that requirement.

Without that requirement, insurers could make a mockery of the requirement to insure people without underwriting. That is, the insurers could simply provide that all of their policies wouldn't include hospital coverage or would have a maximum payout of $2500 or would require a deductible of $50,000, etc. Without a listing of minimum benefits insurers could make the policies so narrow and with so little coverage available that the policies become all but meaningless.

The other issue is the deductible issue. I am sympathetic to the argument in favor of high deductible. And, for most of the people on this forum a $10,000 deductible would be fine since most here could meet that deductible and it wouldn't be such a hardship that they wouldn't get care.

On the other hand, I could see someone with low income choosing a really high deductible plan because he or she was "healthy" because the plan had much lower premiums. Then, that healthy person has an accident or gets sick, needs care and is utterly unable to pay the deductible which either throws the cost back on the hospitals if the person goes to the ER or results in the person not being able to afford to get needed non-ER care because the person can't afford to meet the deductible.

I'm not saying all the lists of minimum coverage requirements are the ones I would choose, but I do see why the requirement is there.
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