PPACA, Obamacare and General Comments

[bUU]

The same can be said for the system we had.

But there were unequivocal differences: Pre-existing conditions; lifetime caps; no means to keep insurers from making insurance prohibitively expensive; etc.

No need to have changed it - just tweak it to work.

In essence, that's all ACA is: Just those few tweaks: the assurance of insurability, the minimum standards for coverage, and the subsidy. The mandate, recall, was only part of a deal to make the changes acceptable to the insurance industry.

 

[Htown Harry]

One interesting thing, for some of us at least, is how the premium and subsidy numbers will change for a smoker.

In the Berkeley / Colorado calculator, the effect is a double whammy: the calculator assumes a whopping 50% tobacco use surcharge on the non-smoker premium. Then, in applying the subsidy calculation, per federal rules the subsidy only applies to the base rate.

So, for example, if the non-smoker base rate is $400 per month and the subsidy is 60%, the net premium would be $400 x 40% = $160.

If the same person is a smoker, his payment would be $160 + 0.5($400) tobacco surcharge = $360.

On another thread, there is a link to actual rate filings in Oregon.
http://www.early-retirement.org/for...th-exchange-now-online-66583.html#post1318085

I clicked on four of the company names I recognized, then scanned their filings to see what they propose for their actual tobacco surcharge. Three of four propose no tobacco surcharge. The fourth is at 20%.

Smoke 'em if you got 'em, I guess.

 

[Htown Harry]

The feds posted sample exchange application forms about three weeks ago, if anyone wants to get a head start on October 1

It is amazing how short they are, until you realize that under ACA they don't need any health information.

Found them here on the CMS site
Other Resources - Centers for Medicare & Medicaid Services
(about halfway down the page at Forms)

Use this application to see what coverage you qualify for

• Affordable private health insurance plans that offer comprehensive coverage to help you stay well
• A new tax credit that can immediately help pay your premiums for health coverage
• Free or low-cost insurance from Medicaid or the Children’s health insurance Program (ChiP)

Single application:
http://www.cms.gov/CCIIO/Resources/...er-Resources/Downloads/AttachmentB_042913.pdf

Family application:
http://www.cms.gov/CCIIO/Resources/...er-Resources/Downloads/AttachmentC_042913.pdf

Single or family application without financial assistance request:
http://www.cms.gov/CCIIO/Resources/...er-Resources/Downloads/AttachmentD_042913.pdf

 

[sheehs1]

From what I gather from your posts, you think the subsidy should continue for people making more than the 400%.... just have it less and less.... this is where I do not agree...

Yes, I think it should be a gentler slope BUT I also see where that can be problematic in driving up the cost.

On another note: Called Anthem today. No answers for any of my questions.

 

[sheehs1]

m.
There has been an enormous amount of speculation in this and other threads about the PPACA. After October 1, we should all have real numbers and other specific information to go by. I think that all of this speculation at this time is pointless.

I don't think this thread has been about speculation or is pointless. It certainly has me delving into the links and becoming more informed. Trying to do it prior to this for me was pointless, as I wasn't sure how much would change. Now we are within the 6 month mark. Hopefully there are others it has helped as well.
Thanks to all who posted links, calculators, etc.

 

[MichaelB]

The feds posted sample exchange application forms about three weeks ago, if anyone wants to get a head start on October 1

It is amazing how short they are, until you realize that under ACA they don't need any health information.

Found them here on the CMS site
Other Resources - Centers for Medicare & Medicaid Services
(about halfway down the page at Forms)

Single application:
http://www.cms.gov/CCIIO/Resources/...er-Resources/Downloads/AttachmentB_042913.pdf

Family application:
http://www.cms.gov/CCIIO/Resources/...er-Resources/Downloads/AttachmentC_042913.pdf

Single or family application without financial assistance request:
http://www.cms.gov/CCIIO/Resources/...er-Resources/Downloads/AttachmentD_042913.pdf

+1@ how simple the forms are. I'm still a little in the "it's never that easy, something must be missing" stage, but it'll get better.

Great links! Thanks for posting them.

Edit: looking over the second form, the family application for people expecting premium assistance, I didn't see any reference to adult children age 26 and under that do not live at home.

 

[Mulligan]

Yes, I think it should be a gentler slope BUT I also see where that can be problematic in driving up the cost.

On another note: Called Anthem today. No answers for any of my questions.

Glad to see somebody else got no farther with Anthem than I did. No matter what question I asked, or how it was worded I received the same answer. Something to the effect that information will be sent out concerning these matters at a later time in the year.

 

[sheehs1]

Am reading IRS rules and regulations link that was provided. The part about "determining affordability" (page 30388-30389) for employers could get confusing. Employers with employees near the cusp of the cutoff may have to be careful about bonuses and overtime hours. What may have started as "affordable at the beginning of the year may not be so during the year based on bonuses, overtime, etc. and may possibly throw the employee to non-subsidized status on the exchanges if his pay goes up. (if employee is on the exchange).

The difference between a single filer making $45K a year and one making $50K a year is a subsidy of $1,115 a year (Kaiser calculator). Also will have to factor affect of taxes. Wages are taxed and premium payments are net of tax.

Is it possible that for employees using the exchanges, employers might start hearing the words, "No don't give me that bonus or overtime, I will loose my subsidy status!!!

Wow...wow....wow...this is very complicated for employers and employees. In any event, there may have to be much more communication between employer and employee as to what "changes in pay" will do to the employee status thru out the year.

Just absorbing some of these details now so hoping I'm interpreting correctly.

 

[ziggy29]

Edit: looking over the second form, the family application for people expecting premium assistance, I didn't see any reference to adult children age 26 and under that do not live at home.

I also don't see any place where they are asking for income stated on your last tax return in the core application. I just see them asking about your current income. That would be good news for us personally as we'd not be eligible for any subsidy under our 2012 (or 2013) income -- just a tax credit well after the fact -- but a rather significant one under expected 2014 income.

 

[anethum]

There has been an enormous amount of speculation in this and other threads about the PPACA. After October 1, we should all have real numbers and other specific information to go by. I think that all of this speculation at this time is pointless.

I don't think this thread has been about speculation or is pointless. It certainly has me delving into the links and becoming more informed. Trying to do it prior to this for me was pointless, as I wasn't sure how much would change. Now we are within the 6 month mark. Hopefully there are others it has helped as well.
Thanks to all who posted links, calculators, etc.

You replied to something different from what I actually wrote. I did not say this thread is pointless or that it is solely contains speculation. However, there have been many, many posts in this thread and others about the PPACA which have, for example, speculated and/or made claims about insurance rates in 2014 and beyond. I am as curious as the next person about what my own premiums will actually be, but I will wait until my state plan choices and rates are finally published before I comment on them.

Also, the bulk of my post (which you didn't quote) explained why I believe it was not possible to simply "tweak" (as you put it) the existing system in order to fix the multitude of problems with the current system. The PPACA has many aspects I hope get improved upon in the future. However, it makes relatively few changes to the existing private insurance (often employer-based) framework while still addressing the very serious problems we have with the current system. Other solutions to fix all of the health insurance issues this country currently has would have been far closer to "massive social change", as you described the PPACA.

 

[FinanceDude]

You replied to something different from what I actually wrote. I did not say this thread is pointless or that it is solely contains speculation. However, there have been many, many posts in this thread and others about the PPACA which have, for example, speculated and/or made claims about insurance rates in 2014 and beyond. I am as curious as the next person about what my own premiums will actually be, but I will wait until my state plan choices and rates are finally published before I comment on them.

The private insurers that are "invited" to sell in the exchanges are not going to tip their hand as far as premiums. We simply do not know what rates will be once the federal exchanges are set up. We have seen rates increase substantially the last couple years leading up to now. That may be prepositioning by the insurers or a sign of things to come. The slashing of Medicare to help fund this new national health care plan could have ominous results in a couple years.........

 

[MichaelB]

The private insurers that are "invited" to sell in the exchanges are not going to tip their hand as far as premiums. We simply do not know what rates will be once the federal exchanges are set up. We have seen rates increase substantially the last couple years leading up to now. That may be prepositioning by the insurers or a sign of things to come. The slashing of Medicare to help fund this new national health care plan could have ominous results in a couple years.........

Private insurers are not invited, all are free to sell their policies. So far rates look pretty much unchanged from 2013. Insurers have been raising rates at a double digit pace for over a decade and long before the PPACA was even a thought. If anything, rates are steady for the first time. As for that last thought, well, lets not go there.

 

[sheehs1]

You replied to something different from what I actually wrote. I did not say this thread is pointless or that it is solely contains speculation. However, there have been many, many posts in this thread and others about the PPACA which have, for example, speculated and/or made claims about insurance rates in 2014 and beyond. I am as curious as the next person about what my own premiums will actually be, but I will wait until my state plan choices and rates are finally published before I comment on them.

Also, the bulk of my post (which you didn't quote) explained why I believe it was not possible to simply "tweak" (as you put it) the existing system in order to fix the multitude of problems with the current system. The PPACA has many aspects I hope get improved upon in the future. However, it makes relatively few changes to the existing private insurance (often employer-based) framework while still addressing the very serious problems we have with the current system. Other solutions to fix all of the health insurance issues this country currently has would have been far closer to "massive social change", as you described the PPACA.

That's because I chose not to get into a tit for tat or "going back and forth" on the "old" versus the "almost new" and to stay away from which political party is responsible for "what" or any political type statements or "who deserves what" based on gosh knows what.

 

[FinanceDude]

Private insurers are not invited, all are free to sell their policies. So far rates look pretty much unchanged from 2013. Insurers have been raising rates at a double digit pace for over a decade and long before the PPACA was even a thought. If anything, rates are steady for the first time. As for that last thought, well, lets not go there.

How are rates unchanged when they have not been released yet? I am talking about national exchange, not state..........

 

[MichaelB]

How are rates unchanged when they have not been released yet? I am talking about national exchange, not state..........

We have seen a few states release preliminary pricing data, and proposed premiums are generally holding at current levels. That's why I wrote "so far". California preliminary pricing is especially encouraging, the population size and diversity makes it more easily applicable to other locations.

No national exchanges. All are State exchanges. Some will be built and run by HHS, but will remain state specific, and will have policies designed and licensed for residents of that state. Each will also offer at least two policies that provide coverage in all states.

 

[Buckeye]

Glad to see somebody else got no farther with Anthem than I did. No matter what question I asked, or how it was worded I received the same answer. Something to the effect that information will be sent out concerning these matters at a later time in the year.

+1

I encountered the same treatment from Humana.

 

[sheehs1]

+1

I encountered the same treatment from Humana.

Not getting answers when this will roll out Jan 1, 2014 is disconcerting. I was able to "glean" the following. All subject to some change I suppose.

New rates will be out sometime in July. My renewal date is Sept. Anthems new plans matching the levels of the ACA will not be out until October. I can keep my "renewed old plan" until Dec (4 months) but then will have to move to one of the new plans Jan1, 2014. Some talk about the possibility of a grace period until March. When asked what happens between Dec and March, all Anthem would say is "you won't be without coverage".

Having read something about being able to keep your plan until the next renewal date (which would make it September 2014), I asked about it. He conceded that might be case.

Some talk about grandfathered policies. I am not grandfathered as the premiums for my policy that would have been were going up a huge amount.
Those grandfathered policies may also start to see huge premium prices that may lead to people jumping from them to the new ones, especially since there is no lifetime cap on the ACA compliant ones.

 

[Mulligan]

Not getting answers when this will roll out Jan 1, 2014 is disconcerting. I was able to "glean" the following. All subject to some change I suppose.

New rates will be out sometime in July. My renewal date is Sept. Anthems new plans matching the levels of the ACA will not be out until October. I can keep my "renewed old plan" until Dec (4 months) but then will have to move to one of the new plans Jan1, 2014. Some talk about the possibility of a grace period until March. When asked what happens between Dec and March, all Anthem would say is "you won't be without coverage".

Having read something about being able to keep your plan until the next renewal date (which would make it September 2014), I asked about it. He conceded that might be case.

Some talk about grandfathered policies. I am not grandfathered as the premiums for my policy that would have been were going up a huge amount.
Those grandfathered policies may also start to see huge premium prices that may lead to people jumping from them to the new ones, especially since there is no lifetime cap on the ACA compliant ones.

Interesting stuff, as I have Anthem, too. There also has been some scuttlebutt about some insurance companies renewing the plans again in December so you would not have to enter exchange until the following December. The Anthem BCBS are all kind of a "loose confederacy" if I understand correctly, so I wonder if they will be consistent state to state with their implementation plans.

 

[Mulligan]

Not getting answers when this will roll out Jan 1, 2014 is disconcerting. I was able to "glean" the following. All subject to some change I suppose.

New rates will be out sometime in July. My renewal date is Sept. Anthems new plans matching the levels of the ACA will not be out until October. I can keep my "renewed old plan" until Dec (4 months) but then will have to move to one of the new plans Jan1, 2014. Some talk about the possibility of a grace period until March. When asked what happens between Dec and March, all Anthem would say is "you won't be without coverage".

Having read something about being able to keep your plan until the next renewal date (which would make it September 2014), I asked about it. He conceded that might be case.

Some talk about grandfathered policies. I am not grandfathered as the premiums for my policy that would have been were going up a huge amount.
Those grandfathered policies may also start to see huge premium prices that may lead to people jumping from them to the new ones, especially since there is no lifetime cap on the ACA compliant ones.

So, I wonder Sheeshs, if the July rate will be a close estimate to what we will be paying for the new plans in January? July is when I get my annual increase, too.

I am glad for the people who have received a preliminary estimate on pricing for their states. Most are pleased that it has not gone up by a considerable amount. However this hasn't really lowered my angst (maybe having too much time on my hands is part of them problem, too ) because those numbers are still extremely high compared to what I am used to paying. The states I read that were speculated to get "rate shock" are states such as AZ, VA, MO, KY, ID, GA, OH, OK, and TN. Of course I am one of those and there has not been a peep coming out of any of those states what the pricing will be based on anything I have read.

 

[sheehs1]

So, I wonder Sheeshs, if the July rate will be a close estimate to what we will be paying for the new plans in January? July is when I get my annual increase, too.

I am glad for the people who have received a preliminary estimate on pricing for their states. Most are pleased that it has not gone up by a considerable amount. However this hasn't really lowered my angst (maybe having too much time on my hands is part of them problem, too ) because those numbers are still extremely high compared to what I am used to paying. The states I read that were speculated to get "rate shock" are states such as AZ, VA, MO, KY, ID, GA, OH, OK, and TN. Of course I am one of those and there has not been a peep coming out of any of those states what the pricing will be based on anything I have read.

Mulligan, I wondered the same thing about the July rates. But here is a thought. If Anthem or the private insurers want to keep their customers, do you think they will try their hardest to be below the exchange rates we have been seeing on the Kaiser calculator? Otherwise, their customers may flock to the exchanges. I think they will have to come up with some incentive of some type to keep the customers. What they do in subsequent years to keep them is anyones guess.

One additional thought. Insurers may look closely at what their neighboring states are doing. Otherwise people just might establish residency across state lines. For example: We are only a short 20 minutes from the North Carolina line. My husband's business is in North Carolina. Since his health care is thru his business he gets Anthem N.C. rates which I assure you have been cheaper than my Anthem Virginia rates. Virginia is where our home is.

Anthem is privately owned here in Virginia. I don't know about elsewhere but I'll assume they too are privately owned. Years ago and I can't remember who I called, I'm sure it was several phone calls, but I was able to find out that Anthem in Virginia made over 300 million in profit or some other astronomical number for it's owners and stakeholders. It was actually kind of mind boggling since it was just the one state and since premiums were skyrocketing.

As far as I know Virginia has opted for the Federal Exchange.

 

[pb4uski]

sheehs1, there is no federal exchange. For states that declined to operate an exchange, the feds will step into the void and operate an exchange for that state. So you exchange will be a Virginia exchange, but will be organized and operated by the federal government. BTW, good luck with that.

 

[sheehs1]

sheehs1, there is no federal exchange. For states that declined to operate an exchange, the feds will step into the void and operate an exchange for that state. So you exchange will be a Virginia exchange, but will be organized and operated by the federal government. BTW, good luck with that.

Yes I know. The way I worded it is how our governor has worded it in the papers.

 

[sheehs1]

sheehs1, there is no federal exchange. For states that declined to operate an exchange, the feds will step into the void and operate an exchange for that state. So you exchange will be a Virginia exchange, but will be organized and operated by the federal government. BTW, good luck with that.

pb4uski...I meant to add "thanks for the feedback". Was doing three things at one time while trying to respond. Tough day today!

 

[CH]

I'm in Florida and our governor and legislature have fought everything related to Obamacare

This is not a true statement. The Fl governor wanted to do the Medicaid expansion but the legislature would not go along.

 

[FIRE'd@51]

But here is a thought. If Anthem or the private insurers want to keep their customers, do you think they will try their hardest to be below the exchange rates we have been seeing on the Kaiser calculator? Otherwise, their customers may flock to the exchanges. I think they will have to come up with some incentive of some type to keep the customers.

You would think so. I assume you have a policy that required medical underwriting, so it seems likely that the risk pool you are in is probably more healthy than the one in the exchange will be. On the other hand, there is no subsidy for your policy, so Anthem may not be able to price it below the subsidized rate.

BTW, Anthem is part of Well Point (WLP).