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View Poll Results: For my health insurance now or in the future ...
I need an ACA subsidy to pay for health insurance 4 3.77%
I will try to manipulate my income in order to qualify and get an ACA subsidy 38 35.85%
I would use an ACA subsidy, but won't manipulate my income, and can still have health care 17 16.04%
I will not use an ACA subsidy for my health insurance 36 33.96%
Something else, but at least I answered the poll 11 10.38%
Voters: 106. You may not vote on this poll

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Old 11-09-2014, 07:42 AM   #41
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Originally Posted by jim584672 View Post
I think the word "manipulate" is a loaded word with a negative spin. Something like "arrange your income streams to maximize ACA subsidies" would be more neutral.
What is wrong with making arrangements to minimize taxes, maximize benefits?

I maxed out the 401k to save taxes. So I "manipulated" my income to save taxes. Should I not "manipulate" my income? The law allows one to take legal steps for maximization. Should one not "file and suspend" for SS? Should I not sign up for Medicare at 65?
Quote:
Originally Posted by pb4uski View Post
jim, I understand your point but you seem to be overreacting.
I think that a more neutral word is "pragmatic".

Disclaimer - fully intend to use the subsidy if available to me. Just as I used maximum 401 deduction, home mortgage, and yes, it looks like this year even the deduction for healthcare related expenses. Such is life.
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Old 11-09-2014, 08:10 AM   #42
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Originally Posted by aim-high View Post
I'll need to figure out how to increase taxable income to qualify for subsidy and not fall into under medicaid rules for a state that doesn't have the expansion.
Same here. I'm in Pa. I had originally planned to take a small distribution from an IRA to increase my 2014 income to qualify for ACA and avoid Medicaid. But lately have been hearing good things about Medicaid (and bad things). With Medicaid I would avoid all the sneaky gotchas like uncovered "facility fees", out-of-network person showing up uninvited, etc. But I can't find out how, in reality, to use Medicaid in Pa, and if it really is as horrible as some people say. Don't know anyone on Medicaid. Will call a local hospital that accepts Medicaid patients and ask to talk to someone about it.
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Old 11-09-2014, 08:49 AM   #43
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Originally Posted by Theseus View Post
I think that a more neutral word is "pragmatic".

Disclaimer - fully intend to use the subsidy if available to me. Just as I used maximum 401 deduction, home mortgage, and yes, it looks like this year even the deduction for healthcare related expenses. Such is life.
And I suspect more than a few here got healthcare provided to them tax free while others had to pay for their healthcare with after tax dollars. Fair is when you get, unfair is when they get.
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Old 11-09-2014, 09:40 AM   #44
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Originally Posted by sengsational View Post
When I researched it last year for BlueCross, the policies from the exchange were exactly the same as those bought right from BCBS...after purchase, one can not be distinguished from the other.


In researching our options for next year, this scenario seems to be the direction I think I want to go. I want a plan that is widely accepted and not immediately identifiable as from the exchange. (Just in case there is some discrimination against the plans.). And then within the plan, (Blue Advantage is what I am looking at, in this instance, I live in NC), I can choose the level Bronze, Silver or Gold within my level of risk tolerance and expected expenses.

Does anyone know of this thinking is correct? That if my circle of doctors all accept "Blue Advantage" from Blue Cross Blue Shield, that the level (bronze, silver, gold) doesn't cause further accept/do not accept decisions from the practitioners? The levels just determine the payment split between insurer and me? Am I thinking about this correctly?


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Old 11-09-2014, 10:03 AM   #45
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Originally Posted by LOL! View Post
My impression (could be wrong) is that some folks are trying to adjust their cost of living (i.e. expenses) to be lower in order to qualify for a subsidy. So instead of living on $100K a year, they forego nice cars, nice vacations, nice retirement locations and drive their expenses to cardboard box housing in order to qualify for a subsidy while have tons of money in their portfolio. Wait a minute, that does sound very negative, doesn't it?
That is a ridiculous and completely unfounded impression, I figured there was an agenda here. I can live on a $40k draw a year which may be less than $20k in ACA income, and I can assure you that I'm not sacrificing anything to do that in retirement because I'm living on that now before I retire.

You have no idea what anyone needs to spend to live anywhere, and as pointed out you can have siginficantly higher income and still get subsidies.
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Old 11-09-2014, 10:03 AM   #46
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Quote:
Originally Posted by Charlotte View Post
...
Does anyone know of this thinking is correct? That if my circle of doctors all accept "Blue Advantage" from Blue Cross Blue Shield, that the level (bronze, silver, gold) doesn't cause further accept/do not accept decisions from the practitioners? The levels just determine the payment split between insurer and me? Am I thinking about this correctly?
Concerning the network decision, you can look-up each doctor on the bcbsnc.com site and see what plans they take. I did this last year and found that for the handful of doctors that my family went to, if they took one, they took them all. As a result, for me, it was not worth going past "Blue Value" (the lower premium, smaller network) to "Blue Advantage" (higher premium, larger network). Even a bunch of unexpected random hospital-based doctors we used this year were in the "Value" network. This selection is what determines if your doctor is "in" or not. Metal levels just determine the split, like you said.

Concerning the metal level to select, I ignore what the average payout is calculated to be and work through how much I'd pay for expected services (based on personal historical useage). For instance, is it worth $2400/yr in premiums so you can pay $30 (instead of $130) for your doctor visits? It would depend on how many doctor visits you expect to have. 24 visits was way more than we expected, for instance.

One warning: never buy an HSA-eligible policy with more than one person on it unless you expect three people on the policy to exceed their individual deductible; the individual deductible is meaningless on HSA-eligible policies.
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Poll: Will you need/use an ACA subsidy for health insurance?
Old 11-09-2014, 11:17 AM   #47
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Poll: Will you need/use an ACA subsidy for health insurance?

We're receiving the tax credit because we're eligible. No "manipulation" required.

Boy oh boy, though, are Anthem and CoveredCA making me sorry we moved south 5 months ago. (Not really, but....)

I had no idea that our moving would cause them so much confusion and generate so much paperwork.

First, our premium supposedly dropped by $300/mo but the portion we pay increased 5 fold. New county, lower premium, much lower tax credit.

Those 2 groups still haven't got us sorted out.

A couple of weeks ago we received at our new address a letter from Anthem, telling us our 2015 premiums are going up 34%.

Three days ago I got a third refund check from Anthem for overpayment
on our 2014 premiums.

Two days ago I finally got from Anthem our new 2014 premium--so they finally got our info from CoveredCA after 5 months. They wouldn't take it from me and sent 3 total refund checks for the new premium amount we had to pay.

Yesterday I got 2 pieces of mail from Anthem: one, a bill from March onward; the other a notice they are canceling our insurance for nonpayment from March forward.

Yes, we paid.

What a mess. 😳
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Old 11-09-2014, 11:30 AM   #48
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Originally Posted by Charlotte View Post
In researching our options for next year, this scenario seems to be the direction I think I want to go. I want a plan that is widely accepted and not immediately identifiable as from the exchange. (Just in case there is some discrimination against the plans.)

Does anyone know of this thinking is correct? That if my circle of doctors all accept "Blue Advantage" from Blue Cross Blue Shield, that the level (bronze, silver, gold) doesn't cause further accept/do not accept decisions from the practitioners? The levels just determine the payment split between insurer and me? Am I thinking about this correctly?


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Before visiting a dermatologist in our new location, I checked the Anthem website for a name.

I got one, and I called to see if they took my Anthem bronze plan. Yes.

When I arrived and gave them my card, they said they did not take the Plan and said I should have specified it was a Covered CA Anthem Bronze plan.

I left and found another doctor.
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Old 11-09-2014, 12:43 PM   #49
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Voted "I will try to manipulate my income in order to qualify and get an ACA subsidy". I guess I would have needed to work longer to afford the full freight insurance costs plus save extra to cover unknown extent of future increases or adverse rating by insurers for pre-existing conditions that develop over time. So maybe "I need ACA to pay for my health insurance" is also true. It looks like we'll get $4000-5000 per year in subsidies plus access to free health insurance for our kids through the state's low and moderate income children's health insurance program.

I'm definitely aware of the % FPL I need my AGI to be to optimize ACA subsidies. I have different sources of income that can increase AGI or not, and plan to come in around 133-150% of FPL at least while I have 3 kids in the house.

Edit to add: I can, for example, sell $40,000 of slightly appreciated stock in my brokerage account and recognize a $4000 gain from that sale. That means I could live on the $40k I need to fund my desired lifestyle, and only have a $4,000 AGI. I can then convert $33,000 from my traditional IRA to Roth in order to arrive at a $37,000 AGI (just enough to pay almost nothing for a gold plated silver plan). I can shape my income stream to have almost any AGI I wanted. I could even "make too much" and get my kids off the state Children's Health Insurance Program if they needed "regular" health insurance.
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Old 11-09-2014, 12:51 PM   #50
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Ah, the old in/out of network doctor ploy. Yes, yes...

We've been through this song and dance a few times. I finally got wise when I found that buying a UHC plan from one broker, and supposedly the same plan from another broker, would get me DIFFERENT networks of doctors. Some poking around turned up that there were many sets of plans, with identical benefits, but different doctors, that were 'qualified' for sale by different insurance brokers and networks. One guy told me that top producers got the plans with the better networks.

As best as I can figure, the actuaries were looking at the risk pools not just by where the insured lived and the allowed lifestyle/medical history choices (smoker or not, type of work, surgery in last year, etc) under state regulation, but also by who was selling the coverage, which was not restricted by state regulation. I suspect that if a salesman tended to sell to higher risk folks in a particular pool, the policies were attached to doctors who had agreed to a lower negotiated rate.

This was back in 2008. It sounds like some of the same stuff is still going on.
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Old 11-09-2014, 07:04 PM   #51
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When I researched it last year for BlueCross, the policies from the exchange were exactly the same as those bought right from BCBS...after purchase, one can not be distinguished from the other.

This isn't true in my area of Texas where when looking up doctors on my current insurer. AETNA, they tell you who does not take the AETNA exchange plans.

I am trying to stick it out w*rking full time til 63.5 (5 months!), go on COBRA for 18 months and hop onto Medicare.

And no, I wouldn't manipulate my income to qualify for an ACA subside.


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Old 11-09-2014, 10:14 PM   #52
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Can you just imagine the number of people that will pile into States with State run exchanges by simply moving a few miles if SCOTUS rules against federal subsidies?

This alone is reason that it won't happen.
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Old 11-09-2014, 11:20 PM   #53
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Can you just imagine the number of people that will pile into States with State run exchanges by simply moving a few miles if SCOTUS rules against federal subsidies?

This alone is reason that it won't happen.
Heh. Tough problem to have, eh? Hearken back to days of old, in ancient aeons of 2007-2008, where this board had threads like:

Private Health Insurance - If I move to new State
How to get Health Insurance in another state?
Individual Health Insurance in Florida - A Case Study
Why does health insurance vary state to state

In which members would discuss what they could get in another state, IF they could get coverage, strategies for moving to another state to get coverage, and other such arcana. We don't see those threads any more...
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Old 11-10-2014, 07:45 AM   #54
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We have been using a healthcare subsidy for 20 odd years (employer provided insurance) so I do not have any reason to refuse a subsidy from ACA when we ER.
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