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Personal experience: work ins. to ACA ins.
Old 03-31-2015, 10:57 AM   #1
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Personal experience: work ins. to ACA ins.

Last day of work was March 27 (yay FIRE'd)

Applied for WA state ACA plan online but had to engage in three phone calls when system stuck on something.

There was no good way to enter income...either you were working and had monthly income or you were not working and they wanted to shuttle you to Apple care (WA state version of Medicaid).

We finally decided for this year to click the box that we were not applying for a subsidy, which caused all of the income questions to go away. Note that we are still buying a silver plan through the state exchange and so can claim the tax credit when we do our 2015 taxes in 2016. Our MAGI income for 2015 is guesstimated at around $50,000 after IRA, 401K, and HSA deductions so we are not eligible for cost sharing this year.

Premium for a Premera Blue Cross 2500 silver PPO plan with a 2500/5000 deductible were $676 per month for the two of us (age 44, 46). Our Cobra option, also with Premera and a 3000/6000 deductible was going to be $985 per month. We have not had any significant charges so far this year. Both plans are HSA eligible.

We should have been eligible for around a $200 a month subsidy based on my estimates, which we should be able to claim back in 2016.

Policy is set to start May 1, 2015, so we will be uncovered for one month. If anything major happened, I assume we could default back to Cobra as per some discussions on this forum. Minor expenses we can pay out of pocket (if less than $676 then we come out ahead anyway)

All in all, not a bad experience. I assume it will be much worse next year when we need to prove an income level of $25,000 or so.
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Old 03-31-2015, 11:10 AM   #2
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IRS form 8962 is the one that is used to grant a premium tax credit (PTC) at the end of the year or to reconcile advanced premium tax credits (APTC) that you received along the way. You may want to take a look at the form and its instructions now and perhaps even better, prepare a return with your favorite tax software to verify the PTC you anticipate will be correctly processed (ie no denial for married filing separately (MFS) status).

You will have to create yourself an artificial form 1095-A that the exchange will send you next year. The first column will contain the actual premiums paid to the insurer on a month by month basis. The second column will contain the second lowest cost silver plan (SLCSP) premium as a benchmark to determine the premium credit. The 3rd column would contain the APTC that you received up front, but would be 0 in your case.

You can research these values based upon the tools available at the marketplace exchange that serves your state, or the independent tools at http://www.valuepenguin.com/ppaca/exchanges.

-gauss
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Old 03-31-2015, 11:15 AM   #3
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All in all, not a bad experience. I assume it will be much worse next year when we need to prove an income level of $25,000 or so.
Not sure about your state but it was extremely easy for us when I signed up through my state's exchange back in November for 2015 coverage. I submitted a letter detailing the breakdown of anticipated income for 2015 for both of us and asked if they needed any additional information. The letter was sufficient and we were enrolled in a silver plan with cost sharing.
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Old 03-31-2015, 11:27 AM   #4
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...snip...

All in all, not a bad experience. I assume it will be much worse next year when we need to prove an income level of $25,000 or so.
Congratulations.
For 2014 I was asked if I'd changed jobs or left.. Just a yes/no question. Our income went down 80%.

In '15 was asked the same question, but then was asked for proof. I sent a cover letter and a year end brokerage statement. Think it's been accepted.
I think it'll get easier as they figure out their processes.
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Old 03-31-2015, 12:35 PM   #5
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Congratulations.
For 2014 I was asked if I'd changed jobs or left.. Just a yes/no question. Our income went down 80%.

In '15 was asked the same question, but then was asked for proof. I sent a cover letter and a year end brokerage statement. Think it's been accepted.
I think it'll get easier as they figure out their processes.
If you sent it USPS, I hope that page they tell you to send with the docs had an actual bar code on it. I've sent things in before with that page missing the bar code but having the app id and state, and they went nowhere. Call ctr lady told me last year that they can't verify without the bar code, even though you'd think the app id would be unique enough to match it up.

BTW, has anyone verified successfully using last year's 1040? The accepted docs list does not include that but it seems it would be sufficient. Thanks
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Old 03-31-2015, 02:23 PM   #6
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Note that we are still buying a silver plan through the state exchange and so can claim the tax credit when we do our 2015 taxes in 2016. Our MAGI income for 2015 is guesstimated at around $50,000 after IRA, 401K, and HSA deductions so we are not eligible for cost sharing this year.

Premium for a Premera Blue Cross 2500 silver PPO plan with a 2500/5000 deductible were $676 per month for the two of us (age 44, 46). Our Cobra option, also with Premera and a 3000/6000 deductible was going to be $985 per month. We have not had any significant charges so far this year. Both plans are HSA eligible.
I just wanted to point out that the premium tax credit can also be used on Bronze plans since you are not eligible for Silver plan cost sharing subsidies.

Another thing to consider when comparing premiums is the size of the provider network. The same insurer can have different networks for different plans.
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Old 03-31-2015, 02:50 PM   #7
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Originally Posted by ernow View Post
If you sent it USPS, I hope that page they tell you to send with the docs had an actual bar code on it. I've sent things in before with that page missing the bar code but having the app id and state, and they went nowhere. Call ctr lady told me last year that they can't verify without the bar code, even though you'd think the app id would be unique enough to match it
Thanks I believe I did.

Actually the statement that they need the barcode makes sense. Brings back memories of helping increase efficiency in back offices.

They're handling a lot of paper, using the barcode allows them to read the code and index something about the documents. Part of the problem they have is the adhoc nature of what documentation is attached. The barcode has the highest level index, but humans have to review and decide on each case individually! Lots of error prone work that adds little value. Not very efficient.

Contrast that to modern industries that still handle lots of paper. They all have defined forms with data thay can be scraped from the form and processed without any human interaction. They attemt to procees most transactions without a human doing anything. There's always some stuff humans need to fix or when it gets to a knowledge worker. Much more efficient that way.
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Old 03-31-2015, 03:30 PM   #8
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I just wanted to point out that the premium tax credit can also be used on Bronze plans since you are not eligible for Silver plan cost sharing subsidies.

Another thing to consider when comparing premiums is the size of the provider network. The same insurer can have different networks for different plans.
Yes, but next year we will be eligible for cost sharing subsidies. I figured going with a silver plan for the remainder of this year would be the easiest transition from our work policy but perhaps a bronze plan could have worked. Silver is needed next year for certain.

The Premera blue cross plan was probably the largest network we could get until we move to Texas and get a Blue Cross Blue Options plan.
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Old 03-31-2015, 05:41 PM   #9
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BTW, has anyone verified successfully using last year's 1040?
Yes.
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Old 03-31-2015, 07:26 PM   #10
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I won't go into a rant, but Connect for Health Colorado for me has been closer to a nightmare. It has taken me six months to finally have my 2015 coverage straight. I started last fall with the subsidy process. Information was lost. Then I had problems with the update/denial for Medicaid. Every time I called I was assured that it would be corrected. The latest was somehow I was enrolled in two of the same policies. I was afraid that when they canceled one, both would be canceled. They finally got me back to one enrollment. As of today I have the premium tax credits that should be effective when I pay my premium for May.


I can't tell you how many hours I have spent on the phone. I hope that the 2016 enrollment is nothing like the mess that I have had. I am very much in favor of the ACA, but Colorado needs to get it together before I have any faith in their system.
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