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Old 05-25-2013, 08:47 AM   #161
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Originally Posted by M Paquette View Post
The rules require issuers to treat all of their non-grandfathered business in the individual market and the small group market, respectively, as a single risk pool.

PHS Act section 2701 only allows non-grandfathered health insurance issuers in the individual and small group markets to vary premiums based on the following factors beginning in 2014: (1) whether the plan or coverage applies to an individual or family; (2) geographic rating area; (3) age, limited to a variation of 3:1 for adults; and (4) tobacco use, limited to a variation of 1.5:1.
can anyone explain the no. 3 and 4 scenarios as how they would apply to premiums? sorry if I am in this is the wrong place for this question.
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Old 05-25-2013, 01:14 PM   #162
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Quote:
Originally Posted by M Paquette View Post
PHS Act section 2701 only allows non-grandfathered health insurance issuers in the individual and small group markets to vary premiums based on the following factors beginning in 2014: (1) whether the plan or coverage applies to an individual or family; (2) geographic rating area; (3) age, limited to a variation of 3:1 for adults; and (4) tobacco use, limited to a variation of 1.5:1.
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Originally Posted by frank View Post
can anyone explain the no. 3 and 4 scenarios as how they would apply to premiums? sorry if I am in this is the wrong place for this question.
Frank, see my post #127 for info on #4.

This is the rate age-adjustment table from one of the plans I referenced, showing both 33 and #4 for particular plan. For a given policy and benefit set in a geographic region, they will charge 3 times the premium rate to a 64 y.o. as compared to a 21-25 y.o.

Quote:
Age and Smoker Factors
Exhibit 12
Age Age Related Smoker
20 0.64 1.00
21 1.00 1.20
22 1.00 1.20
23 1.00 1.20
24 1.00 1.20
25 1.00 1.20
26 1.02 1.20
27 1.05 1.20
28 1.09 1.20
29 1.12 1.20
30 1.14 1.20
31 1.16 1.20
32 1.18 1.20
33 1.20 1.20
34 1.21 1.20
35 1.22 1.20
36 1.23 1.20
37 1.24 1.20
38 1.25 1.20
39 1.26 1.20
40 1.28 1.20
41 1.30 1.20
42 1.33 1.20
43 1.36 1.20
44 1.40 1.20
45 1.44 1.20
46 1.50 1.20
47 1.56 1.20
48 1.64 1.20
49 1.71 1.20
50 1.79 1.20
51 1.87 1.20
52 1.95 1.20
53 2.04 1.20
54 2.14 1.20
55 2.23 1.20
56 2.33 1.20
57 2.44 1.20
58 2.55 1.20
59 2.60 1.20
60 2.71 1.20
61 2.81 1.20
62 2.87 1.20
63 2.95 1.20
64+ 3.00 1.20
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Old 05-25-2013, 04:04 PM   #163
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We currently are on my wifes group plan from her former job but pay the full premium, $1200 a month. Would we still be able to purchase on the exchanges?

I see on the calculators that they ask if you have insurance thru work.
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Old 05-25-2013, 06:38 PM   #164
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We currently are on my wifes group plan from her former job but pay the full premium, $1200 a month. Would we still be able to purchase on the exchanges?

I see on the calculators that they ask if you have insurance thru work.
If you are speaking of COBRA benefits, I believe the answer is yes.

The DOL recently (May 8th) put out a new templates for employers to use when notifying employees of eligibilty for COBRA policy continuation benefits at a "qualifying event".

The Department of Labor (DOL) has released 3 model notices as a result of changes under Health Care Reform:


This is included in the last one:
Quote:
There may be other coverage options for you and your family. When key parts of the health care law take effect, you’ll be able to buy coverage through the Health Insurance Marketplace. In the Marketplace, you could be eligible for a new kind of tax credit that lowers your monthly premiums right away, and you can see what your premium, deductibles, and out-of-pocket costs will be before you make a decision to enroll. Being eligible for COBRA does not limit your eligibility for coverage for a tax credit through the Marketplace.
More here: http://www.dol.gov/ebsa/newsroom/tr13-02.html
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Old 05-25-2013, 07:07 PM   #165
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We are not on cobra. Just allowed to stay on the group plan as long as we pay the full amount of the policy.
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Old 05-25-2013, 09:25 PM   #166
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I noticed that California received their insurance quotes this past week. I ran the coveredca calculator two weeks ago and my premium was over 1600 month, now its under 1300 a month.
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Old 05-25-2013, 11:55 PM   #167
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In Michigan there is definitely an assets test. I'd check further for you state.
Apparently the ACA eliminated the asset tests for Medicaid.

"... the new federal health care law bars states from adding asset tests and despite prior experience in Colorado and elsewhere that such tests aren't worth the time or money."

Colorado Republicans want asset test for Medicaid - The Denver Post
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Old 05-25-2013, 11:59 PM   #168
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We are not on cobra. Just allowed to stay on the group plan as long as we pay the full amount of the policy.
This article may be helpful in your situation. It describes what a grandfathered plans is, and why it may be an apples-to-oranges comparison to an exchange policy.

Should you skip Obamacare and keep your old plan? | Reuters
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Old 05-26-2013, 12:12 AM   #169
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Careful on that assumption of business expenses, DLDS. The Modified Adjusted Gross Income calculation may trip you up.
We have a couple of actual businesses with expenses like insurance, equipment, and phone costs. Increasing business expenses is one way to lower our MAGI.
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Old 05-26-2013, 08:10 AM   #170
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In post #162, I quoted the age adjustment table in one of the Oregon exchange plans.

Using those numbers, I calculated a percentage change from year-to-year during ER years. It is eye-opening, at least for me.

Now I can see that a HI premium budget based on individual policies should start with an assumed annual premium increase just for the age-rating effects, at around 5% in your 50's. Then add in additional assumed increases for the general inflation in the cost of health care services.

It adds some perspective to the many "my premiums got jacked up 15%" posts I've seen.
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File Type: jpg age table.jpg (44.5 KB, 5 views)
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No doubt a continuous prosperity, though spendthrift, is preferable to an economy thriftily moral, though lean. Nevertheless, that prosperity would seem more soundly shored if, by a saving grace, more of us had the grace to save.

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Old 05-26-2013, 09:37 AM   #171
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This article may be helpful in your situation. It describes what a grandfathered plans is, and why it may be an apples-to-oranges comparison to an exchange policy.

Should you skip Obamacare and keep your old plan? | Reuters
eHealthCare analysis agrees with what some of the members on this board have been saying about the price of exchange purchased HI:

Quote:
Despite the enchancements, plenty of people will look at the new benefits under PPACA and think, "Thanks, but no thanks." Their current policy, grandfathered in, may satisfy their needs and include their doctors in its networks — at a manageable price.
Indeed, many will find it's cheaper to keep their current coverage. Looking at plans in effect today, the online insurance broker eHealthInsurance found that premiums were 47 percent higher and deductibles were 27 percent lower than for individual plans that will incorporate all of PPACA's new rules.
Carrie McLean, consumer health insurance specialist for eHealthInsurance, notes it is not a direct apples-to-apples comparison because many existing plans don't meet basic requirements that all plans will follow as of next January. Also, members who buy coverage through health exchanges may qualify for government subsidies to ease costs.
Nonetheless, average monthly premiums for individuals in plans without the newly required benefits — the closest equivalent to grandfathered plans — were $190 versus $279. Average deductibles for individuals were $2,257 versus $3,079.
Not quite apples to apples, but increase in price by nearly half for something close. Not "affordable" for everyone, but if you can get the subsidy, that pain can be avoided. I just don't envy the guys that get their grandfathered plans closed-out and so are forced into the marketplace and also have MAGI above 400% FPL. Sad day for those guys.
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Old 06-07-2013, 08:05 AM   #172
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I am trying to plan against an uncertain work / ER schedule in 2014 and beyond. I may or may not need to purchase insurance through my state exchange in 2014.

This line in an otherwise unremarkable article caught my eye.
Obama set to kick off enrollment blitz amid jitters over health plan - Health Exchange - MarketWatch
Quote:
As Obamacare’s main provision requiring all U.S. citizens to have health insurance takes effect Jan. 1, enrollment via exchanges is scheduled to start in October and run through March.
Does anybody know what the reporter means by enrollment "running through" March 2014? Then what?

Is the plan for the exchanges to have an annual enrollment period similar to employer plans, or Medicare? If so, what will be the qualifying events that allow one to sign up for an exchange policy outside that period?
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Old 06-07-2013, 08:39 AM   #173
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Not sure about the March date, first time I've seen it. Haven't seen any rules on how to buy a policy outside of the annual open enrollment period, but I suspect they will be similar to what the Massachusetts exchange uses today, where you can buy into any policy during the year if you satisfy any of a list of qualifying criteria. https://www.mahealthconnector.org/po...EFactSheet.pdf
Still, I'm guessing, and it may also be up to each state to determine the criteria.
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Old 06-07-2013, 10:12 AM   #174
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My understanding is that the first enrollment period is extended through March to increase the chances that people will enroll. After that it will run from the start of October through to early December.

The reason for having an enrollment period is to discourage people from not signing up until they have a heath problem.

Edit: the above applies to Covered California. Don't know if other states are different.
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Old 06-07-2013, 10:20 AM   #175
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I am trying to plan against an uncertain work / ER schedule in 2014 and beyond. I may or may not need to purchase insurance through my state exchange in 2014.

This line in an otherwise unremarkable article caught my eye.
Obama set to kick off enrollment blitz amid jitters over health plan - Health Exchange - MarketWatch
Does anybody know what the reporter means by enrollment "running through" March 2014? Then what?

Is the plan for the exchanges to have an annual enrollment period similar to employer plans, or Medicare? If so, what will be the qualifying events that allow one to sign up for an exchange policy outside that period?
I do not know the long term process for enrolling and accessing the exchange. But, I have read a few articles stating that the original enrolling process was extended to march to allow for people unfamiliar with the process to get signed up. We take for granted that people know what to do, but in reality they do not. A survey released last week showed that 42% of Americans did not know the Act was even law. Half of those 42% thought either the Congress repealed it or the Supreme Court denied it becoming law. Of course the other half of those just didn't even really know anything about it all.
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Old 06-07-2013, 10:44 AM   #176
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I haven't seen anything on this but my guess is that it would be similar to exceptions to open enrollment exceptions for group plans so that you could enroll outside the open enrollment period if you lost your job or changed jobs to an employer that did not offer health insurance, etc. IMO it would be silly to make someone is such a situation wait to the following January and be uninsured in the interim.
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Old 06-07-2013, 10:57 AM   #177
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I suspect they will be similar to what the Massachusetts exchange uses today, where you can buy into any policy during the year if you satisfy any of a list of qualifying criteria.
This is encouraging, although reading each condition carefully it appears that one has to check the wording closely to avoid a short sequence of no insurance if transitioning from employer coverage to an exchange, or from employer to COBRA to exchange.
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Old 06-07-2013, 11:03 AM   #178
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I've seen the date on a few sites

How will Enrollment in Health Insurance Exchanges Work? | The Bailey Group Blog

The initial open enrollment period is expected to run from Oct. 1, 2013, through March 31, 2014.

When does open erollment for 2014 health insurance start?

Not sure where they got the dates.
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Old 06-07-2013, 01:27 PM   #179
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...Not sure where they got the dates....
Seems like Sec HHS has huge discretion with ACA- like ignoring the law's prescribed start date of the small business exchange

I've actually read the entire PPACA (over time, of course!) & do not recall any provision (authority) for modification of the law's open enrollment dates... for public education or any other reason. However extension of the OE period should be a potential benefit to some folks who want/need to buy indiv HI, so I doubt anyone will challenge it.
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Old 06-07-2013, 02:44 PM   #180
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Seems like Sec HHS has huge discretion with ACA- like ignoring the law's prescribed start date of the small business exchange

I've actually read the entire PPACA (over time, of course!) & do not recall any provision (authority) for modification of the law's open enrollment dates... for public education or any other reason. However extension of the OE period should be a potential benefit to some folks who want/need to buy indiv HI, so I doubt anyone will challenge it.
They are charged with doing so by the law itself. The secretary is charged with establishing the enrollment periods ( section 1311 (6) Enrollments ). The specific dates aren't in the "law".
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