2015-16 Healthcare Premiums to be released Sunday

[rbmrtn]

Still not able to reconcile the subsidy shown on HealthCare.gov. Comparing our 8.10% of income vs the second lowest cost silver plan and the subsidy seems low by about $87/mo.

FWIW, I see the same thing with my hand calc vs their estimate. Backing out their multiplier it looks they used 9.9% instead of 9.56%

Here's the 2015 draft of the IRS table. It shows 8.1% for 250% and 9.56% 300% up.

https://www.irs.gov/pub/irs-dft/i8962--dft.pdf

 

[Sue J]

Yep, I'm testing this at a few different income levels, just to play with it and it looks to me like they are using 9.56% at 200% of FPL. At 250% of FPL they are using 10.69%.

I tried 150% of FPL and it's 8.33%

Well, somebody needs to correct this before the entire ACA population freaks out.

 

[RockyMtn]

Only one company in Maricopa County AZ with PPO plans. Everything else is HMO. Bleeecchhh! The alternative to BCBS here I was thinking was Healthnet but they've eliminated their PPO too. Looks like I'll be sticking with BCBS and adjusting my income to maximize my benefits.

Was looking at that as well. Looks like UHC is the only one left! Guess we'll take a look at BCBS and Cigna HMO's. On the other hand the prices for the Silver HMO's are about 30% cheaper at the same income level than the Silver PPO my GF has in Colorado.

 

[ziggy29]

Was looking at that as well. Looks like UHC is the only one left! Guess we'll take a look at BCBS and Cigna HMO's. On the other hand the prices for the Silver HMO's are about 30% cheaper at the same income level than the Silver PPO my GF has in Colorado.

When was had my insurance through the Exchange it was a PPO. Here everything is an HMO now, so if you want an out-of-network doctor or don't want to need a referral to see a specialist, you're hosed. There is one other thing, though; for this zip code, anyway, it's the first time there has been a second insurer in the mix (it had been all BCBSTX before).

I wouldn't be happy about being forced into an HMO if I were still getting my insurance there, but at least Blue Cross tends to have a significantly larger "in network" provider list than most others.

 

[homestead]

This site does seem to be working but I am having a hard time believing the subsidy amount, for couple 62 & 67 with one on medicare and income of 63k it says the tax credit is $693/mo. Does this sound right?

Had my healthcare insurance agent look at the website plugging my numbers in and she said healthcare.gov is not calculating the tax credit correctly. Having one spouse on Medicare should not give you double tax credits.

 

[ziggy29]

Had my healthcare insurance agent look at the website plugging my numbers in and she said healthcare.gov is not calculating the tax credit correctly. Having one spouse on Medicare should not give you double tax credits.

I've also been playing around with covering myself only compared to both DW and me, factoring in the same level of income (about what I'd expect if I quit tomorrow). It looks like the subsidies they calculate show we'd pay LESS to cover both us instead of just myself, and not by just a couple bucks. Right now we could choose a silver plan that costs $254 for just me ($142 subsidy), or $163 for both of us ($580 subsidy)! It's like they would be paying us $91/mo to also cover my wife in addition to just me...

 

[Texas Proud]

I just got a rude awakening....

If I make LESS money, then my credit goes DOWN... yep, if you go below a certain point then your kids qualify for CHIPS or something and they will not give you credit for them....

Not sure if that is only for the monthly subsidy or you lose it when you fill out your tax return... now I have to worry if I make too much or not enough... I have to be Goldilocks and get it juuuuust right.....

 

[pb4uski]

I just got a rude awakening....

If I make LESS money, then my credit goes DOWN... yep, if you go below a certain point then your kids qualify for CHIPS or something and they will not give you credit for them....

Not sure if that is only for the monthly subsidy or you lose it when you fill out your tax return... now I have to worry if I make too much or not enough... I have to be Goldilocks and get it juuuuust right.....

If you have room on your return for Roth conversions then between conversions and recharacterizations that is very easy to do... for 2014 my TI was exactly the top of the 15% tax bracket because I did our return and determined how much I needed to recharacterize to nail it on the head.

 

[GTFan]

Wow the plan we're on now (Humana Bronze National POS) is going up 23% next year (from $706 to $865/mo). And that's with a $12.9k family deductible/max OOP, they don't pay a dime until you hit that. Good thing we're going to be on their subsidized Silver POS plan next year - estimated premium is $138 a month for two people with $1k deductible and $1.5k max OOP (<150% FPL cost-shared plan). I think it also went up by the same percentage vs. this year, which is really excessive.

 

[utrecht]

Wow the plan we're on now (Humana Bronze National POS) is going up 23% next year (from $706 to $865/mo). And that's with a $12.9k family deductible/max OOP, they don't pay a dime until you hit that. Good thing we're going to be on their subsidized Silver POS plan next year - estimated premium is $138 a month for two people with $1k deductible and $1.5k max OOP (<150% FPL cost-shared plan). I think it also went up by the same percentage vs. this year, which is really excessive.

The plan Ive looked at a few times was $580. Its now $680. But dont worry, next year I will wish I could get it for $680.

 

[pb4uski]

Just a reminder to those who are getting huge increases that if the lowest cost bronze plan exceeds 8% of your income that you are eligible to buy catastrophic coverage even if you are over 30. In my state, the coverage isn't very different from a bronze plan but the premiums are about 43% lower (for 2016) but I've heard that in many parts of the country that the premiums are not all that much lower so YMMV.

 

[Ian S]

Was looking at that as well. Looks like UHC is the only one left! Guess we'll take a look at BCBS and Cigna HMO's. On the other hand the prices for the Silver HMO's are about 30% cheaper at the same income level than the Silver PPO my GF has in Colorado.

Looking at UHC and BCBS silver plans for the seven months until I go on Medicare. Neither has all my docs but we'll see. Both have my primary doc whom I've been with for 20 years. UHC is cheaper and has closest hospitals in network. Maybe I'll flip a coin.

 

[meierlde]

Just a side note: The retiree plan for those not on medicare next year at my ex employer went up 26% in 2016. (of course after being stable for 2 years ) Went up that much early in the decade for a couple of years.
Now the medicare supplement my ex-employer offers went down by 7%.

 

[Mulligan]

Just a reminder to those who are getting huge increases that if the lowest cost bronze plan exceeds 8% of your income that you are eligible to buy catastrophic coverage even if you are over 30. In my state, the coverage isn't very different from a bronze plan but the premiums are about 43% lower (for 2016) but I've heard that in many parts of the country that the premiums are not all that much lower so YMMV.

It really seems to me to be very hard to find any info on this. I know what you wrote is true, but it isnt like they want to broadcast it. From what I ever find it mentions them only for the 30 and under crowd. Is there a specific link on Healthcare.gov?
I have never accessed the site since I never enrolled there.


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[rbmrtn]

It really seems to me to be very hard to find any info on this. I know what you wrote is true, but it isnt like they want to broadcast it. From what I ever find it mentions them only for the 30 and under crowd. Is there a specific link on Healthcare.gov?
I have never accessed the site since I never enrolled there.


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This might be it, https://www.healthcare.gov/exemptions-tool/#/results/2015/details/marketplace-affordability

If you don't qualify for a subsidy and the lowest cost bronze plan is more than 8.05% of income you can get an exemption for a catastrophic plan.

A link from kaiser, http://kff.org/health-reform/faq/he...ons/#question-who-can-buy-a-catastrophic-plan

and from CMS, https://marketplace.cms.gov/technical-assistance-resources/exemptions-catastrophic-coverage.pdf

 

[Mulligan]

This might be it, https://www.healthcare.gov/exemptions-tool/#/results/2015/details/marketplace-affordability

If you don't qualify for a subsidy and the lowest cost bronze plan is more than 8.05% of income you can get an exemption for a catastrophic plan.

A link from kaiser, http://kff.org/health-reform/faq/he...ons/#question-who-can-buy-a-catastrophic-plan

and from CMS, https://marketplace.cms.gov/technical-assistance-resources/exemptions-catastrophic-coverage.pdf

Thanks, RB. But now its more confounding... The links provided expressed $6300 deductible as the catastrophic plan. Heck that is lower than my HSA Bronze. That doesn't make any sense to me. I certainly didn't see a 10k deductible mentioned. One thing is for sure from this....paperwork is required... Why would I ever not think that would happen?
I am nowhere near the 8% bar yet, but with 15% annual increases it sure wont take very long....


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[rbmrtn]

The links provided expressed $6300 deductible as the catastrophic plan. Heck that is lower than my HSA Bronze.


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Yep, the catastrophic plans are still subject to the maximum deductible allowed.

This is good summary of the differences
http://health.usnews.com/health-new...health-insurance-plans-bronze-vs-catastrophic

 

[Mulligan]

Yep, the catastrophic plans are still subject to the maximum deductible allowed.



This is good summary of the differences

http://health.usnews.com/health-new...health-insurance-plans-bronze-vs-catastrophic

Well RB, that article sealed the deal. Im thinking "distinction without a difference". In fact the catastrophic is a better plan than mine...3 office visits. No reason for me to ever consider it if I am ever eligible as it cant be any cheaper.



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[pb4uski]

It really seems to me to be very hard to find any info on this. I know what you wrote is true, but it isnt like they want to broadcast it. From what I ever find it mentions them only for the 30 and under crowd. Is there a specific link on Healthcare.gov?
I have never accessed the site since I never enrolled there.


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Yes, while the provision exists, it is very under the radar and it is hard to find much on it other than piecing things together that are poorly worded on the healthcare.gov website.

The first one is that you qualify for an exemption from the fee for not having health coverage, one of which is if

The lowest-priced coverage available to you, through either a Marketplace or job-based plan, would cost more than 8.05% of your household income

. Check .... and getting easier to check each year as bronze plan premium increase and income is stable (and in my case, manageable via Roth conversions).

The second one is

If you’re granted a hardship exemption, the notice includes information on catastrophic health plans. With a hardship exemption, you can buy a catastrophic plan no matter how old you are or what your income is.

A catastrophic plan offers lower-priced coverage that mainly protects you from high medical costs if you get seriously hurt or injured.

To buy catastrophic coverage with a hardship, you’ll provide your Exemption Certificate Number (ECN) to the insurance company selling the plan.

Note: If you get a hardship exemption, you don’t have to buy a catastrophic plan. It’s just an option available to you.

The thing that is confusing is that the website materials only refer to being eligible for catastrophic plans if you are over 30 and qualify for a "hardship" exemption but the % of income limitation is framed as an income-exemption but they then say

To qualify for a catastrophic plan, you must be under 30 years old OR get a "hardship exemption" because the Marketplace determined that you’re unable to afford health coverage.

(emphasis added).

Yet there are numerous references outside the healthcare.gov website that catastrophic plans

are only for adults up to age 30, and for older people who can’t find any other Marketplace policy that costs less than 8.13 percent of their income.

Note: I suspect the 8.05% is 2014 and 8.13% is 2015.

This nuance of income based exemption vs hardship exemption wasn't an issue when I bought mine because my plan had been cancelled so I was automatically eligible to by a catastrophic policy since my plan was cancelled and I believed that the individual marketplace options in my area were unaffordable (yes, believe it or not that is actually the language that they used)... but since I have it I just let it renew each year and make sure that I keep my income low enough that it continues to be unaffordable.

 

[MBSC]

Catastrophic plans are not HSA compatible by design. Their lower premium may not offset the tax savings of a Bronze HSA plan for some. YMMV.

Unfortunately, HSA Plans are barred from the Catastrophic category... because they must cover up to three doctor’s office visits free of charge, which is against HSA qualifications by law.

Source: http://www.hsacoalition.org/wp-cont...derally-Run-Exchange-Marketplaces-12-5-13.pdf

 

[Mulligan]

Catastrophic plans are not HSA compatible by design. Their lower premium may not offset the tax savings of a Bronze HSA plan for some. YMMV.

Source: http://www.hsacoalition.org/wp-cont...derally-Run-Exchange-Marketplaces-12-5-13.pdf

No and the "cat" plan for me would have to be considerably cheaper as I save $1,000 in taxes by accessing the HSA plan. I still cant grasp how they can call it a catastrophic plan when it is actually covers more than my HSA Bronze will. If they insist on calling it a "catastrophic" plan they need to rename my HSA Bronze as a "crap plan" to more clearly differentiate the products.
I could have sworn (maybe I am wrong), that PB4USKI had written a catastrophic plan he had was 10k deductible. That would make more sense to me what a true "cat" plan would be. But I have not seen one of those types posted as an option.


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[Running_Man]

I am fairly flexible on how much income I can receive in 2016, but if I hold income @ $30,000 my BCBS silver policy is $330 a month for couple and $3,300 out of pocket max. If I allowed my income to increase to just $34,000 the premium increases to $378/mo but the out of pocket max increases to $10,500 and deductible goes from $2,000 to $6,400 for an increase of $4,400 in deductible and $576 in premiums for a $4,000 increase in income. Basically a tax of 120% on the extra income, if I were to have a bad medical year and reach the out of pocket max the tax effect is 200% of income gained

 

[GTFan]

Yep, staying under the FPL % thresholds makes a big diff in Silver cost sharing. Basically you want to try and stay below 250% of FPL if at all possible, you get nothing other than subsidy above that (up to 400%).

http://kff.org/health-costs/issue-brief/cost-sharing-subsidies-in-federal-marketplace-plans/

 

[ziggy29]

I am fairly flexible on how much income I can receive in 2016, but if I hold income @ $30,000 my BCBS silver policy is $330 a month for couple and $3,300 out of pocket max. If I allowed my income to increase to just $34,000 the premium increases to $378/mo but the out of pocket max increases to $10,500 and deductible goes from $2,000 to $6,400 for an increase of $4,400 in deductible and $576 in premiums for a $4,000 increase in income. Basically a tax of 120% on the extra income, if I were to have a bad medical year and reach the out of pocket max the tax effect is 200% of income gained

The ACA is full of these "cliffs" based on income levels, where earning just one more dollar of taxable income can cost you hundreds, even thousands, of dollars in lost tax credits and cost sharing. Usually these are along multiples of 50% of the FPL, as in 150%, 200%, 250%, 300%, and 400%. Above 400% there is no tax credit and above 250% (except for American Indians up to 300% who have no deductibles or copays at all) there is no cost sharing of deductibles or OOP maximums.

I fully expect to see an emerging industry coming out of financial planners helping households to engineer specific incomes for ACA purposes.

 

[Sue J]

Yep, I'm testing this at a few different income levels, just to play with it and it looks to me like they are using 9.56% at 200% of FPL. At 250% of FPL they are using 10.69%.

I tried 150% of FPL and it's 8.33%

Well, somebody needs to correct this before the entire ACA population freaks out.

I've been in contact with Aaron Albright, Director, Media Relations Group, Centers for Medicare and Medicaid Services about the discrepancy in the percentages I'm finding for the subsidy calculation. After a few emails back and forth here's his response -

Sue—I got back some guidance from our folks. It’s complicated, but the short answer is that the estimate is correct.

The percentages you mention below apply to specifically to only the portion of the premium used for “essential health benefits”. In other words, 8.1% applies to the essential health benefits portion of the plan’s premium. Something else also comes into play—the cost of the second-lowest cost silver plan in your area has gone down from last year. That’s usually good news. However, it also means that tax credits for plans will also be lower for all plans in the area.

Now, I knew about the SLCSP in my area going down in cost and how that affects the subsidy, so no surprise there. The part about the essential health benefits portion is hard to quantify.

I was so hoping that the estimates were incorrect as the cost to keep our same plan as this year has increased by $254.

Oh, well. This cuts deep and we will look at other options. DH's doctor just retired and he's only seen the new guy once so he's not attached to him and would be willing to change providers. I've been with my doctor for many years and like her but I do I like her enough to stay with a plan that costs $200+ more a month?

DH and I were just talking about going with a different insurer, changing providers and keeping the costs more reasonable.

It's disappointing but we will deal with it.