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Old 07-17-2012, 03:17 PM   #221
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Yes indeed and I do. I don't want my question to be lost in the shuffle and that is in 2012 and 2013 I will have an HSA deduction reducing my AGI. That means my subsidies in 2014 and 2015 will be based on a lower income than my actual income in those years due to the loss of the HSA deduction. How is that handled, does it all catch up with a big adjustment lowering my subsidy in 2016?

Maybe nobody knows yet, but if you have a HDHP w/HSA your 2012 income will be used for your 2014 subsidy but even if your income is stable your AGI will rise by as much as $4100 in 2014 due to losing the deduction for the HSA.

MichaelB, my understanding of my taxes is the HSA deduction reduces AGI. The amount of premiums over 7.5% of AGI are deductable if you itemize but that deduction does not lower AGI. The AGI appears to be what is used for calculating one's income for the amount of subsidy. So losing the deduction for the HSA has an effect on the amount of subsidy whereas losing the deduction for HI premium over 7.5% of AGI does not.
Yes, the HSA reduces AGI and medical expense deductions do not. AFAIK this continues in 2014 and beyond.

Here is a link to a PDF that details the MAGI (page 6). http://www.ncsl.org/documents/health...MedicdProv.pdf There is a possibility this formula may change before 01/14 so I would wait until we are closer to implementation before taking any actions and in the meantime keep my options open.
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Old 07-17-2012, 04:41 PM   #222
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Under the PPACA though, the kind of policies you'd be buying wouldn't be the high-deductible ones which are advantageous to the insurers, right?

You'd get policies more along the lines of comprehensive ones where you don't have to pay a high deductible in order to get payouts?


On a related note, I got a solicitation in the mail from CA Blue Shield (I'm currently covered by my employer) promising plans starting at $99*. The asterisk said it's for the "Shiled (sic) Saver 6000 plans" for individuals 19-24 in good health, residing in Alameda County, except zip codes 95377 and 95391. "Rates vary on age, location and health history."

So under the PPACA, we wouldn't have rates varying based on age or health history?

For that matter, presumably these are high deductible plans so those would become less popular as "better" policies become more available in the individual market?

I also didn't know that rates would vary depending on zip code. I thought red-lining was had dubious legal status even for car insurance.
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Old 07-17-2012, 05:18 PM   #223
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Under the PPACA though, the kind of policies you'd be buying wouldn't be the high-deductible ones which are advantageous to the insurers, right?

You'd get policies more along the lines of comprehensive ones where you don't have to pay a high deductible in order to get payouts?

Insurance companies current policies are "grandfathered", that is, they can continue being offered. The PPACA mandates are:

Quote:
Create four benefit categories of plans plus a separate catastrophic plan to be offered through the Exchange, and in the individual and small group markets:

– Bronze plan represents minimum creditable coverage and provides the essential health benefits, cover 60% of the benefit costs of the plan, with an out-of-pocket limit equal to the Health Savings Account (HSA) current law limit ($5,950 for individuals and $11,900 for families in 2010);

– Silver plan provides the essential health benefits, covers 70% of the benefit costs of the plan, with the HSA out-of-pocket limits;
– Gold plan provides the essential health benefits, covers 80% of the benefit costs of the plan, with the HSA out-of-pocket limits;

– Platinum plan provides the essential health benefits, covers 90% of the benefit costs of the plan, with the HSA out-of-pocket limits;

– Catastrophic plan available to those up to age 30 or to those who are exempt from the mandate to purchase coverage and provides catastrophic coverage only with the coverage level set at the HSA current law levels except that prevention benefits and coverage for three primary
These policy mandates all have high, HSA type deductibles.

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Originally Posted by explanade View Post
On a related note, I got a solicitation in the mail from CA Blue Shield (I'm currently covered by my employer) promising plans starting at $99*. The asterisk said it's for the "Shiled (sic) Saver 6000 plans" for individuals 19-24 in good health, residing in Alameda County, except zip codes 95377 and 95391. "Rates vary on age, location and health history."

So under the PPACA, we wouldn't have rates varying based on age or health history?

For that matter, presumably these are high deductible plans so those would become less popular as "better" policies become more available in the individual market?

I also didn't know that rates would vary depending on zip code. I thought red-lining was had dubious legal status even for car insurance.

Yes, they can charge based on age, location, family size and tocacco use.
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• Require guarantee issue and renewability and allow rating variation based only on age (limited to 3 to 1 ratio), premium rating area, family composition, and tobacco use (limited to 1.5. to 1 ratio) in the individual and the small group market and the Exchange.
There are 3 area rating levels, but I have not found a source that tells me by zip code how they break down.

You can see specifics of the PPACA at the KFF here
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Old 07-18-2012, 08:09 AM   #224
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Insurance companies current policies are "grandfathered", that is, they can continue being offered. The PPACA mandates are:

These policy mandates all have high, HSA type deductibles.
Thanks Michael. I think unless something medically catastrophic happens I will be better off under the Silver plan in the PPACA. IF......I understand it correctly.

Currently if I were to have a procedure done that costs $4000, with my current HDHP w/HSA $5K deductible I would pay $4000.

Under the Silver plan I would pay 30%, $1200. The annual deductible under the Silver plan for single person is estimated at $5950 but I would have to have something really major or a lot of Dr. and hospital visits to reach it with a 70% benefit (about $20,000 of medical bills).
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Old 07-18-2012, 08:54 AM   #225
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There is still a lot of the law that needs to be "fleshed out". The final format and rules and such will not be completed for a couple years or so. The 2700 pages was merely a basic infrastructure...........
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Old 07-18-2012, 09:05 AM   #226
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There is still a lot of the law that needs to be "fleshed out". The final format and rules and such will not be completed for a couple years or so. The 2700 pages was merely a basic infrastructure...........
I agree but they have got roughly 14.5 months to get it fleshed out. Open season for purchase of HI through exchanges starts on 10/1/13. Penalty for not having qualified HI plan in place starts 1/1/14.
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Old 07-18-2012, 11:28 AM   #227
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I'm been following the thread closely and visited most of the links provided - I know a lot more now than I did. Many thanks to those who have worked to keep it from derailing!

I do have a question about my situation, however. I'm ER'd and on my former employer's health insurance, for which I now pay $341/month which equals half the monthly premium. As HI goes these days, that's not bad, but it's more than 9.5% of my AGI. With what we currently know, would I be eligible for a subsidy while keeping this insurance - or would I have to give it up and buy through the exchange in order to get a better price/subsidy?

I haven't been able to find anything on this; hoping some folks on here are/will be in a similar situation and have run across the answer.
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Old 07-18-2012, 11:44 AM   #228
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I'm been following the thread closely and visited most of the links provided - I know a lot more now than I did. Many thanks to those who have worked to keep it from derailing!

I do have a question about my situation, however. I'm ER'd and on my former employer's health insurance, for which I now pay $341/month which equals half the monthly premium. As HI goes these days, that's not bad, but it's more than 9.5% of my AGI. With what we currently know, would I be eligible for a subsidy while keeping this insurance - or would I have to give it up and buy through the exchange in order to get a better price/subsidy?

I haven't been able to find anything on this; hoping some folks on here are/will be in a similar situation and have run across the answer.
From this KFF brief on the subsidy if your employers plan does not meet certain levels of coverage or it is unaffordable you would need to get a policy from the exchange, but your would be eligible for subsidies.

http://www.kff.org/healthreform/upload/7962-02.pdf
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Who is eligible for premium tax credits?

Citizens and legal residents in families with incomes between 100% and 400% of poverty who purchase coverage through a health insurance exchange1 are eligible for a tax credit to reduce the cost of coverage. People eligible for public coverage and people offered coverage through an employer are not eligible for premium tax credits unless the employer plan does not have an actuarial value of at least 60%2 or unless the person’s share of the premium for employer-sponsored insurance exceeds 9.5% of income. People who meet these thresholds for unaffordable employer-sponsored insurance are eligible to enroll in a health insurance exchange and may receive tax credits to reduce the cost of coverage purchased through the exchange.
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Old 07-18-2012, 01:38 PM   #229
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People who meet these thresholds for unaffordable employer-sponsored insurance are eligible to enroll in a health insurance exchange and may receive tax credits to reduce the cost of coverage purchased through the exchange.
One thing I heard is that it *might* be possible that if states choose not to set up exchanges, the people in those states may not be eligible for subsidies (that is, the federal fallback exchange couldn't give the credits, only the state exchanges could). Now this can get political and I'm not looking to go there, but has anyone seen anything *concrete* on whether or not this is the case? If it is true, it seems like the states who are refusing to implement exchanges are giving the middle finger to their own residents.
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Old 07-18-2012, 01:42 PM   #230
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There is still a lot of the law that needs to be "fleshed out". The final format and rules and such will not be completed for a couple years or so. The 2700 pages was merely a basic infrastructure...........

Actually that is not correct although it has been repeated a lot on certain news channels. The actual page count is 906 and that includes the reprint of many existing laws that are used in it. Here is a link to this info: Patient Protection and Affordable Care Act - Wikipedia, the free encyclopedia
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Old 07-18-2012, 02:28 PM   #231
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One thing I heard is that it *might* be possible that if states choose not to set up exchanges, the people in those states may not be eligible for subsidies (that is, the federal fallback exchange couldn't give the credits, only the state exchanges could). Now this can get political and I'm not looking to go there, but has anyone seen anything *concrete* on whether or not this is the case? If it is true, it seems like the states who are refusing to implement exchanges are giving the middle finger to their own residents.
There was a paper published hypothecating that the way one section of the PPACA was written that there could be no subsidy for the exchanges established for each state by a federal program. The paper appears to be constructed for a particular viewpoint, judging by the somewhat unusual semantic weighting for an academic publication (I'm trying to be polite here...):

http://papers.ssrn.com/sol3/papers.c...act_id=2106789

The paper focuses on Section 1321 of the PPACA, to construct the argument. It ignores Section 1311 which is pretty explicit but inconvenient to their argument. It is very likely that in the inevitable court challenge that the construction of Section 1321 will be declared to be a scriveners error, and the intent presented elsewhere in the law and in supporting arguments as to the intent of the law from Congressional testimony will be upheld.

If a state refuses or otherwise fails to set up an exchange, the federal program will construct an exchange for that state. It'll still be a state exchange, offering qualified policies for that states residences, and the credits will very likely be there.
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Old 07-18-2012, 02:34 PM   #232
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If a state refuses or otherwise fails to set up an exchange, the federal program will construct an exchange for that state. It'll still be a state exchange, offering qualified policies for that states residences, and the credits will very likely be there.
Hope you're right and this is just "full of sound and fury, signifying nothing" (to channel Shakespeare).
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