PPACA, Obamacare and General Comments

[Katsmeow]

Subsidy Calculator | The Henry J. Kaiser Family Foundation


Not sure if anyone has used or posted this link yet. This is a calculator that you can plug in your age income and how many family members. It gives an estimate of your cost and subsidy.

There is one situation that I'm not sure that calculator deals well with which is the household with more people in it than will be insured. For example, a household with someone 65 or older on medicare is treated by this calculator for both premium and subsidy purposes as if it had one fewer people than it has.

We have retiree insurance through DH's former employer which we hope will continue, but since we don't know yet I do look at the various calculators.

Anyway - we have 4 people in the household - DH, me and adolescents. DH is on medicare so we would need insurance for 3. However, in terms of our income I would think we should be treated like a 4 person household since there are actually 4 people in the household. This calculator, though, treats us like there are 3 people in the household.

 

[Mulligan]

Our TX Humana HD plan is $257/mo total. Insurance fellow says to expect a 20% increase next year. They've dropped rates this year to sign up as many as possible in anticipation of losing some next year.
DW is 48, me, 42...
We have an old HSA to pay our deductible if needed.
We'll visits we get "free".

I would jump for joy and do back handstands for a 20% increase. The calculators and estimates at least are slightly improving for me. Estimates have dropped from almost a 600% increase for me down to closer to 450%. Based on latest estimates, I practically feel like I am getting it for free now.

 

[pb4uski]

I "think" that the amount you pay is based on your household income so if in the calculator you pretend DH is 64 rather than older then the amount you pay will be right. Similarly, if you pretend DH isn't in the picture (don't think about that too much ) then the calculator will give you the premium before subsidy for you and the kids.

I "think" that you'll end up having two "policies" - one through the exchange for you and the adolescents and medicare for DH and your subsidy will be the excess of the premiums for the two policies (including medicare premiums) over the amount you should pay based on your household income.

 

[Buckeye]

There is one situation that I'm not sure that calculator deals well with which is the household with more people in it than will be insured. For example, a household with someone 65 or older on medicare is treated by this calculator for both premium and subsidy purposes as if it had one fewer people than it has.

We have retiree insurance through DH's former employer which we hope will continue, but since we don't know yet I do look at the various calculators.

Anyway - we have 4 people in the household - DH, me and adolescents. DH is on medicare so we would need insurance for 3. However, in terms of our income I would think we should be treated like a 4 person household since there are actually 4 people in the household. This calculator, though, treats us like there are 3 people in the household.

I think you are asking the same question I have which is whether our income will be divided and only half of it allocated to me when DH goes on Medicare in 2016. This question may have already been answered in another thread but I have missed it. It may also be on the Kaiser site which I haven't had a chance to review thoroughly.

 

[haha]

I note that once my age 60+ family of two has $60,000 of AGI, (up from $59,000), my net monthly insurance premium LEAPS from $450 to $1,600! We are not working, but we will have realized capital gains this year + my wife's IRA withdrawls + Dividends, almost certainly taking us over $60,000 AGI. So, for a few thousand of extra AGI, I will suffer $13,000 per year in additional premium cost out-of-pocket. I didn't know that $60,000 was "wealthy". Also, I note that my current insurance premium (in NC) is $1,000/month, not the $1,600 estimated in the model. Welcome to eating dog food under Obamacare!

Since when are you supposed to be wealthy to pay for your own health insurance?

How quickly perceptions morph.

Ha

 

[teejayevans]

I'm in Florida and our governor and legislature have fought everything related to Obamacare so I guess we won't have this type of information until the very last minute....or later!

Right, but the US Govt (who's here to help ) is suppose to have a federal exchange for those states that don't participate, but rumour has it they are behind schedule, heck it's only been 3 years
TJ

 

[scrabbler1]

Here in New York State, the individual market is pretty harsh, so I am looking forward to getting into one of the exchanges. Back in 2010-2011, I saw my premiums rise by 50% in 2 years so I got out of that and went into a cheaper, bare-bones policy, one I don't really want to be in. Starting next year I will be able to buy a broader (subsidized) policy but not pay through the nose like I was in 2011 - more than I am paying right now but less than I was paying even in 2009 before the pemiums skyrocketed.

 

[ERhoosier]

I'm in Florida and our governor and legislature have fought everything related to Obamacare so I guess we won't have this type of information until the very last minute....or later!

Not sure how FL govt's conduct affected timing of info availability. Like most states, FL gov't chose not to develop its own exchange but to let Fed's do it. So it's HHS that's responsible for releasing this info.

BTW- According to VT's web site, info on their 2014 rates is not final but still preliminary.
Home | Vermont Health Connect

 

[ERhoosier]

Over the past 5 years I have done many policy comparisons for the folks kind enough to extend policy access to me. It is impossible to do effective side-by-side cost analysis because of the different levels of coverage and cost sharing. Now, between actuarial value classification, essential items mandates and a few other new regulations, comparing policies should be much simpler, and choice easier. That's good.

As I understand it, the REAL out-of-pocket (OOP) max for annual HC costs would (could) be HI premiums plus $12,500 (hi-income couple). If that's the case, wouldn't the net cheapest HI for someone with ongoing costly medical issues be bronze plan (i.e. lowest HI prem)? In other words, if you're going to hit that max OOP every yr why not minimize your HI premiums?

 

[MichaelB]

As I understand it, the REAL out-of-pocket (OOP) max for annual HC costs would (could) be HI premiums plus $12,500 (hi-income couple). If that's the case, wouldn't the net cheapest HI for someone with ongoing costly medical issues be bronze plan (i.e. lowest HI prem)? In other words, if you're going to hit that max OOP every yr why not minimize your HI premiums?

Yes to the 'real" out of pocket, which is the total OOP plus the premium cost. Not sure what the least expensive option is, it would depend on the difference in premium between policy options. Still, it is easier to compare.

 

[MichaelB]

I think you are asking the same question I have which is whether our income will be divided and only half of it allocated to me when DH goes on Medicare in 2016. This question may have already been answered in another thread but I have missed it. It may also be on the Kaiser site which I haven't had a chance to review thoroughly.

Once other criteria have been met, eligibility for premium assistance is determined by total household income and total number of household members, and then applied to each individual requesting coverage in the state exchange.
[SIZE=-0]Internal Rev. Code §36B(b)(3)(A) [/SIZE]http://www.gpo.gov/fdsys/pkg/USCODE...leA-chap1-subchapA-partIV-subpartC-sec36B.pdf

Except as provided in clause (ii), the applicable percentage for any taxable year shall be the percentage such that the applicable percentage for any taxpayer whose household income is within an income tier specified in the following table shall increase, on a sliding scale in a linear manner, from the initial premium percentage to the final premium percentage specified in such table for such income tier:

and

(1) Family size

The family size involved with respect to any taxpayer shall be equal to the number of individuals for whom the taxpayer is allowed a deduction under section 151 (relating to allowance of deduction for personal exemptions) for the taxable year.

(2) Household income

(A) Household income

The term ‘‘household income’’ means, with respect to any taxpayer, an amount equal to the sum of—
(i) the modified adjusted gross income of the taxpayer, plus
(ii) the aggregate modified adjusted gross incomes of all other individuals who—
(I) were taken into account in determining the taxpayer’s family size under paragraph (1), and
(II) were required to file a return of tax impose

What we don't know is how the policies are priced when one goes from individual to family. One thing to keep in mind for parents with children at college is not all policies offer out of state coverage.

 

[Buckeye]

Once other criteria have been met, eligibility for premium assistance is determined by total household income and total number of household members, and then applied to each individual requesting coverage in the state exchange.
[SIZE=-0]Internal Rev. Code §36B(b)(3)(A) [/SIZE]http://www.gpo.gov/fdsys/pkg/USCODE...leA-chap1-subchapA-partIV-subpartC-sec36B.pdf
and


What we don't know is how the policies are priced when one goes from individual to family. One thing to keep in mind for parents with children at college is not all policies offer out of state coverage.

I started reading and came to understand what I believe you are demonstrating above that household income is household income no matter how many people are purchasing health insurance or whether they are paying individual, medicare, or medigap premiums.

Hmmm. Is it possible our net cost of healthcare after (one individual policy plus Medicare with a medigap policy) will be higher than a family of 2 policy because I will be eligible for a smaller subsidy when all household income is assigned to me?

The Kaiser calculator lets me choose 2 people in the household but it doesn't let me make one of them over 65. I guess the question isn't really how many people are in the household but rather how many people in the household who are not eligible for Medicare.

 

[MichaelB]

I started reading and came to understand what I believe you are demonstrating above that household income is household income no matter how many people are purchasing health insurance or whether they are paying individual, medicare, or medigap premiums.

Hmmm. Is it possible our net cost of healthcare after (one individual policy plus Medicare with a medigap policy) will be higher than a family of 2 policy because I will be eligible for a smaller subsidy when all household income is assigned to me?

The Kaiser calculator lets me choose 2 people in the household but it doesn't let me make one of them over 65. I guess the question isn't really how many people are in the household but rather how many people in the household who are not eligible for Medicare.

Have you tried the Berkeley calculator? It lets you specify the number of adults and children on the policy with age for each. National Health Care Calculator

 

[Buckeye]

Have you tried the Berkeley calculator? It lets you specify the number of adults and children on the policy with age for each. National Health Care Calculator

Using this calculator, the family cost is the same regardless of how many are purchasing insurance. This makes sense because the family outlay is determined by percentage of MAGI. This makes me conclude things will get more expensive when DH goes on Medicare/Medigap because those costs are not included in the subsidized amount and the premium for my coverage as an individual is already over the amount that is being subsidized.

For example, if I create a scenario using income of $45,000, our monthly subsidized premium is $346 for a Silver policy for both of us. When DH goes on Medicare, the subsidized premium for an individual policy for me is still $346 but now we are also paying for Medicare and some sort of Medigap policy. Our monthly costs go up by the cost of Medicare and Medigap premiums.

Interesting.

 

[Buckeye]

Right, but the US Govt (who's here to help ) is suppose to have a federal exchange for those states that don't participate, but rumour has it they are behind schedule, heck it's only been 3 years
TJ

Even FL could have probably done it faster than the federal government if we had started right away!

 

[MichaelB]

Using this calculator, the family cost is the same regardless of how many are purchasing insurance. This makes sense because the family outlay is determined by percentage of MAGI. This makes me conclude things will get more expensive when DH goes on Medicare/Medigap because those costs are not included in the subsidized amount and the premium for my coverage as an individual is already over the amount that is being subsidized.

For example, if I create a scenario using income of $45,000, our monthly subsidized premium is $346 for a Silver policy for both of us. When DH goes on Medicare, the subsidized premium for an individual policy for me is still $346 but now we are also paying for Medicare and some sort of Medigap policy. Our monthly costs go up by the cost of Medicare and Medigap premiums.

Interesting.

And painful. Your example is probably correct, family policies appear priced that way.

 

[ERhoosier]

Yes to the 'real" out of pocket, which is the total OOP plus the premium cost. Not sure what the least expensive option is, it would depend on the difference in premium between policy options. Still, it is easier to compare.

IIUC, the various "metal levels" to be offered in the Exchanges will differ mainly (only?) in the "actuarial value" of each plan's benefits. The "scope" of benefits for all plans would be set by a "benchmark" determined by each state & HHS.
http://www.healthcare.gov/news/factsheets/2012/11/ehb11202012a.html
My guess is that, at least initially, consumers will be picking plans based on low price for the given "metal level". Insurers, under this pricing pressure, will be offering little or no additional benefits beyond the benchmark to keep their respective "metal level" plans near the lowest prices in that state's Exchange.
From what we know now, is that a reasonable assessment or am I out in left field

 

[Buckeye]

And painful. Your example is probably correct, family policies appear priced that way.

I'm okay with the situation. Painful is when you are 30 years old making $25,000 a year with a pre-existing condition that is no fault of your own and no one will sell you health insurance.

 

[ShortInSeattle]

Since when are you supposed to be wealthy to pay for your own health insurance?

How quickly perceptions morph.

Ha

DH and I were out for a walk today and had the same thought talking this issue through. While it might be only human to feel a stab of annoyance when you are "somewhat" over the subsidy cutoff, the truth is that we (and most FIRE folks) are well off compared to most Americans. IMO, we have no right to feel entitled to subsidies for those who may truly NEED help.

I don't begrudge anyone for taking advantage of the subsidies if they qualify. But I hope that if DH and I don't qualify we can stifle that "human" reaction to gripe and instead feel pleased that we can provide for ourselves.

SIS

 

[pb4uski]

Using this calculator, the family cost is the same regardless of how many are purchasing insurance. This makes sense because the family outlay is determined by percentage of MAGI. This makes me conclude things will get more expensive when DH goes on Medicare/Medigap because those costs are not included in the subsidized amount and the premium for my coverage as an individual is already over the amount that is being subsidized.

For example, if I create a scenario using income of $45,000, our monthly subsidized premium is $346 for a Silver policy for both of us. When DH goes on Medicare, the subsidized premium for an individual policy for me is still $346 but now we are also paying for Medicare and some sort of Medigap policy. Our monthly costs go up by the cost of Medicare and Medigap premiums.

Interesting.

But at the end of the day if you are 400% FPL or below, your health insurance cost will be based on your income, not on the premiums before subsidy. So in the scenario that you created, I think your subsidy would go up to cover the Medicare premium so your net health insurance cost would stay the same since your income hasn't changed.

I'm not sure how the Medigap would work but if Medicare and Medigap was the equivalent of a Silver plan then it might cover the Medigap premium as well.

 

[MichaelB]

IIUC, the various "metal levels" to be offered in the Exchanges will differ mainly (only?) in the "actuarial value" of each plan's benefits. The "scope" of benefits for all plans would be set by a "benchmark" determined by each state & HHS.
Essential Health Benefits, Actuarial Value, and Accreditation Standards: Ensuring Meaningful, Affordable Coverage | HealthCare.gov
My guess is that, at least initially, consumers will be picking plans based on low price for the given "metal level". Insurers, under this pricing pressure, will be offering little or no additional benefits beyond the benchmark to keep their respective "metal level" plans near the lowest prices in that state's Exchange.
From what we know now, is that a reasonable assessment or am I out in left field

Excellent point, and you have a good view of what will probably happen (imho). The policies must all meet certain requirements and offer a list of essential health benefits, so while in theory they can all be different, in reality pricing pressures will likely drive them to all compete at the minimum.

 

[MichaelB]

But at the end of the day if you are 400% FPL or below, your health insurance cost will be based on your income, not on the premiums before subsidy. So in the scenario that you created, I think your subsidy would go up to cover the Medicare premium so your net health insurance cost would stay the same since your income hasn't changed.

I'm not sure how the Medigap would work but if Medicare and Medigap was the equivalent of a Silver plan then it might cover the Medigap premium as well.

I don't think so. The Medicare and Medigap policies are neither covered nor considered by the state exchange. In a family policy at the exchange the total cost might decline but the premium assistance falls as well and the net cost remains the same (Berkeley calculator), but the cost of Medicare plus supplemental is a net addition. The cost here definitely increases.

 

[bUU]

Right, but the US Govt (who's here to help ) is suppose to have a federal exchange for those states that don't participate, but rumour has it they are behind schedule, heck it's only been 3 years

The rumors are that the exchanges that are not quite ready to go live are such because the development and deployment efforts were underfunded. As with most other things in the government, politicians work to deliberately sabotage the efforts related to initiatives that they personal opposed but failed to prevail in their opposition.

It's kind-of how the Soviets won the Olympic gold medal in basketball in 1972.

 

[pb4uski]

I don't think so. The Medicare and Medigap policies are neither covered nor considered by the state exchange. In a family policy at the exchange the total cost might decline but the premium assistance falls as well and the net cost remains the same (Berkeley calculator), but the cost of Medicare plus supplemental is a net addition. The cost here definitely increases.

Ah ha. So the family unit with one person on the exchange and one person on Medicare pays more compared to two 64 year olds because the net cost of the exchange policy considers the income of both people in calculating the subsidy but ignores the Medicare premium? That's stoopid.

 

[travelover]

The rumors are that the exchanges that are not quite ready to go live are such because the development and deployment efforts were underfunded. As with most other things in the government, politicians work to deliberately sabotage the efforts related to initiatives that they personal opposed but failed to prevail in their opposition.

It's kind-of how the Soviets won the Olympic gold medal in basketball in 1972.

That's how it has worked here in Michissippi. First we had to wait for the Supreme court decision, then we had to wait for the election. Now I guess we are waiting for permission from wealthy puppeteers.