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Variation in amount of ACA subsidy & other questions
Old 01-26-2014, 06:42 PM   #1
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Variation in amount of ACA subsidy & other questions

It looks like I might be without employee provided heath care by the end of this year and maybe even before that. I went on healthcare.gov to to a bit of exploring today and was surprised to find quite a bit of variation of subsidy depending upon the state and even the county where you live. Can anyone give me an explanation why?

If I find myself without health care insurance mid year, can I apply at that time for ACA coverage or must I purchase high priced Cobra coverage until open enrollment towards the end of 2014 for coverage starting Jan. 1, 2015?

Starting 2015 I will have zero income from paycheck, and maybe $10k-$12k 1099 income. I plan to take TIRA to Roth conversions to get MAGI up to about $35K. If I apply for ACA coverage end of 2014 to start Jan. 1, 2015, is there a way to apply that disregards previous year income and only bases it upon expected 2015 MAGI? I would prefer to have the subsidies paid up front instead of a tax refund. If you can't get it based on expected 2015 MAGI do you lose out on the possibility of "reduced out of pocket expenses" for a Silver policy?

I like that you can "see plans now" on healthcare.gov without filling in all the personal information, but when I click on any one of the policies listed for more details, the screen just stays grayed out, you cannot scroll down to see details of any of the available policies. Is that just me or have others experienced this problem?

DW and I are in pretty good health but you never know what can happen. I am thinking maybe a Silver plan if there is the possibility of "reduced out of pocket expenses", but pay more for monthly premium for lower deductibles or pay lower monthly premium with higher deductibles? How in the world do you choose a policy that best fits?

Back to the "reduced out of pocket expenses", with the purchase of a Silver plan. What gets reduced, co-pays or deductibles? How do you find how much the reduction is?

All information & advise is greatly appreciated.
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Old 01-27-2014, 06:52 AM   #2
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Quote:
Originally Posted by Tom52 View Post
It looks like I might be without employee provided heath care by the end of this year and maybe even before that. I went on healthcare.gov to to a bit of exploring today and was surprised to find quite a bit of variation of subsidy depending upon the state and even the county where you live. Can anyone give me an explanation why?
The amount you are expected to pay is the same around the country but policy premiums are different across the country, so the subsidy also differs.

Quote:
Originally Posted by Tom52 View Post
If I find myself without health care insurance mid year, can I apply at that time for ACA coverage or must I purchase high priced Cobra coverage until open enrollment towards the end of 2014 for coverage starting Jan. 1, 2015?
No need to wait. Loss of current insurance coverage is a qualifying event and you can get coverage on the exchange then.

Quote:
Originally Posted by Tom52 View Post
Starting 2015 I will have zero income from paycheck, and maybe $10k-$12k 1099 income. I plan to take TIRA to Roth conversions to get MAGI up to about $35K. If I apply for ACA coverage end of 2014 to start Jan. 1, 2015, is there a way to apply that disregards previous year income and only bases it upon expected 2015 MAGI? I would prefer to have the subsidies paid up front instead of a tax refund. If you can't get it based on expected 2015 MAGI do you lose out on the possibility of "reduced out of pocket expenses" for a Silver policy?
Yes, you can inform the exchange that your projected income will be lower and they have a methodology and process for projecting your new expected income. If you don't get premium assistance upfront you are still eligible when you file, but you can only get reduced cost sharing by enrolling in a specific policy, so that has to be done when you sign up.

Quote:
Originally Posted by Tom52 View Post
I like that you can "see plans now" on healthcare.gov without filling in all the personal information, but when I click on any one of the policies listed for more details, the screen just stays grayed out, you cannot scroll down to see details of any of the available policies. Is that just me or have others experienced this problem?
Many of us have had similar issues. You can see lots of policy detail on the website of the insurer.

Quote:
Originally Posted by Tom52 View Post
DW and I are in pretty good health but you never know what can happen. I am thinking maybe a Silver plan if there is the possibility of "reduced out of pocket expenses", but pay more for monthly premium for lower deductibles or pay lower monthly premium with higher deductibles? How in the world do you choose a policy that best fits?
One of our members, Animorph, created an excel spreadsheet to compare prices that others have found to be very helpful. It is post 85 in this thread Bronze, Silver and Coinsurance/Copay

Quote:
Originally Posted by Tom52 View Post
Back to the "reduced out of pocket expenses", with the purchase of a Silver plan. What gets reduced, co-pays or deductibles? How do you find how much the reduction is?

All information & advise is greatly appreciated.
This paper by CMS describes premium assistance in great detail. Page 13 is about cost sharing subsidies. http://www.fas.org/sgp/crs/misc/R41137.pdf

You may find the FAQ helpful FAQ Archive on PPACA
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Old 01-27-2014, 01:49 PM   #3
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The subsidy is eligibility based on your premium not exceeding 9.5% of your income. Then the amount is based on what the second least expensive silver plan in your area is. The subsidy is basically the difference between that plan cost and 9.5% of your income. So it can vary wildly depending on location.

You should be able to see plans, I'm not getting anything grayed out. The details open in pop up window. Are popups blocked ? What browser are you using.
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Old 01-28-2014, 06:28 AM   #4
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Thanks MichaelB you are a wealth of information. I have some reading to do.

rbmrtn: I am using Explorer but not sure what version but probably old. I am still using WindowsXP. When I click the details button, it goes to a pop up window that seems to show the details with it's own scroll bar on the side. However, you can't grab the scroll bar to read the rest of the details. The window in inactive as it is sort of grayed out and fuzzy.
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Old 01-28-2014, 03:21 PM   #5
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rbmrtn: I am using Explorer but not sure what version but probably old. I am still using WindowsXP. When I click the details button, it goes to a pop up window that seems to show the details with it's own scroll bar on the side. However, you can't grab the scroll bar to read the rest of the details. The window in inactive as it is sort of grayed out and fuzzy.
That sounds like a browser issue. I checked with XP/IE8 and seems to work.

Check the version of IE or try firefox, chrome

If you see the plan, then as MichaelB said, go to the insurers site and check for plan details. I did that earlier on before the healthcare site had the info
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Old 01-29-2014, 06:28 AM   #6
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That sounds like a browser issue. I checked with XP/IE8 and seems to work.

Check the version of IE or try firefox, chrome

If you see the plan, then as MichaelB said, go to the insurers site and check for plan details. I did that earlier on before the healthcare site had the info
Thanks rbmrtn, it was the browser, I tried it with Google Chrome and it works! I love this site because you can always get an answer to any question...and most times a correct answer.
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