Bronze, Silver and Coinsurance/Copay

[ziggy29]

Quote:

Originally Posted by rbmrtn There are qualifying events that allow for special enrollment periods so you could probably enroll at that time.

Agreed, if it is triggered by a loss of coverage, loss of spousal coverage, marriage, divorce, childbirth or a few other things. I don't think "significant income change" in and of itself would trigger such an event.

[MichaelB]

Quote:

Originally Posted by rbmrtn I found this article discussing why bronze may be the best choice. Essentially now your OOPM really is the max. it includes deductibles/co-pay/co-ins, whereas before they could stack all of those on top of each other. Bronze May Be the Most Precious Metal Under Obamacare | Hull Financial Planning

Thanks!

Quote:

Originally Posted by Texas Proud But what if after the fact your circumstances changed and you are eligible for a big subsidy I am a perfect example.... last year at this time I would not have qualified for a subsidy or a small one.... but now that I do not work, when I file my tax return I would qualify for a bigger one.... With being able to claim a subsidy or a credit ONLY if you buy through the exchange means that it would not be smart to buy anyplace else except the exchange.... because if you do and circumstances change.... well, too bad for you....

You don't need to buy a policy on the exchange itself. You can use another authorized source, which includes some agents and insurers. But you do need an ACA compliant policy.

If your circumstances change and you go from "not subsidy eligible" to "eligible", you apply for a subsidy as soon as it happens. If you are currently eligible and think that might change, you apply now for the subsidy, and when your situation changes you notify the exchange to adjust the subsidy based on your new circumstances.

You need a specific criteria to change policy outside of the special enrollment period, but the subsidy can (and should) be changed any time your projected income changes.

[ziggy29]

Quote:

Originally Posted by MichaelB Thanks! You don't need to buy a policy on the exchange itself. You can use another authorized source, which includes some agents and insurers. But you do need an ACA compliant policy.

Right. But you do need to apply on the Exchange, right? My understanding is that you have to at least apply for (and be approved by) the exchange before you can use these other sources and apply the subsidy.

[47]

Quote:

Originally Posted by MichaelB Thanks! You don't need to buy a policy on the exchange itself. You can use another authorized source, which includes some agents and insurers. But you do need an ACA compliant policy.

Aren't ALL policies issued after 2014 Jan going to be ACA compliant policies -- except for a very very small subset of grandfathered policies which will go away in under a year anyway?

Could you please site the reference? This is such an important issue it would be helpful for everyone to have the official source.

I always thought this would be the trojan horse which would pretty much force the insurance companies into playing nice in the exchange as all consumers would pretty much buy in the exchange to play it safe.

[MichaelB]

Quote:

Originally Posted by ziggy29 Right. But you do need to apply on the Exchange, right? My understanding is that you have to at least apply for (and be approved by) the exchange before you can use these other sources and apply the subsidy.

"The marketplace" I know,, like the MAGI discussion, there are multiple definitions that are confusing us. This one is murkier.

My understanding is you can use the exchange or one of the authorized agents, such as ehealthinsurance.com. They can open the account for you, they submit your info to the healthcare.gov subsidy verification process, get the approval, and issue the policy.

We have one report from a member saying the insurer can do it directly http://www.early-retirement.org/foru...ml#post1373565 . In this situation it's not clear if a marketplace account was opened by him or BCBS. On the other hand, if you know which policy you want, there's no harm in calling the insurer and asking if you can get the subsidy directly through them.

The IRS language is pretty clear, to be eligible for subsidy a policy must be obtained through the marketplace. A FAQ on this would be nice but I haven't found one yet, though not for lack of searching.

[MichaelB]

Quote:

Originally Posted by 47Percent Aren't ALL policies issued after 2014 Jan going to be ACA compliant policies -- except for a very very small subset of grandfathered policies which will go away in under a year anyway? Could you please site the reference? This is such an important issue it would be helpful for everyone to have the official source. I always thought this would be the trojan horse which would pretty much force the insurance companies into playing nice in the exchange as all consumers would pretty much buy in the exchange to play it safe.

New healthcare plans must be ACA compliant.

The source for my marketplace confusion / comment is the Federal Register, June 19 2013 http://www.gpo.gov/fdsys/pkg/FR-2013...2013-14540.pdf

Quote:

We propose that ‘‘Exchange’’ would mean a governmental agency or non-profit entity that meets the applicable standards of Part 155 and makes QHPs available to qualified individuals and/or qualified employers. Unless otherwise identified, under the proposed definition this term would include an Exchange serving the individual market for qualified individuals and a SHOP serving the small group market for qualified employers, regardless of whether the Exchange is established and operated by a State (including a regional Exchange or subsidiary Exchange) or by HHS.

KFF interpretation of this rule is Univision Obamacare Deal Could Put WellPoint, Blues Ahead Of Competitors - Kaiser Health News

Quote:

The rule allows a customer to be sent briefly to a special section of the federal or state-run marketplaces only to see if their income qualifies them for subsidized coverage, and then can go right back to the WellPoint or Blues site to buy their coverage.

It would appear that BCBS Florida is already engaged.

Good to know I'm not the only one confused, so I feel like I'm in good company.

[rbmrtn]

Quote:

Originally Posted by ziggy29 Agreed, if it is triggered by a loss of coverage, loss of spousal coverage, marriage, divorce, childbirth or a few other things. I don't think "significant income change" in and of itself would trigger such an event.

A change in income may qualify as it impact affordability

You are newly eligible or lose eligibility for advance payment of the premium tax credit, or you experience a change in eligibility for cost sharing reductions.


Taken from this

PPACA Qualifying Events Beginning in 2014 - KHI Agents

[47]

This Univision BCBS deal stinks to high heavens.

This is just swindling, plain and simple which bypasses the entire raison d'etre of an exchange -- head to head comparison shopping -- but still feeding on the public trough.

[mod edit]

[rbmrtn]

Quote:

Originally Posted by MichaelB My understanding is you can use the exchange or one of the authorized agents, such as ehealthinsurance.com. They can open the account for you, they submit your info to the healthcare.gov subsidy verification process, get the approval, and issue the policy.

I think that is the key. The agent/broker is essentially doing the signup for you through the exchange. You are getting an exchange plan but dealing with the broker/agent/insurance company. They have to be approved to work with the exchange.

Here's a HHS memo on the role of agents/brokers in the exchange

http://www.in.gov/idoi/files/agent-broker-5-1-2013.pdf

[audreyh1]

Quote:

Originally Posted by rbmrtn I found this article discussing why bronze may be the best choice. Essentially now your OOPM really is the max. it includes deductibles/co-pay/co-ins, whereas before they could stack all of those on top of each other. Bronze May Be the Most Precious Metal Under Obamacare | Hull Financial Planning

I think for us the availability of Bronze Plans is the true innovation of ACA (we already had deductibles included in max OOP). Before this, all that was available to us was more like a Silver plan, with the corresponding higher premium because it offered low copays for X doctors visits, prescription drugs, etc. These all look preferable on the surface, until you realize you're EACH paying an extra $1200 to $1500 a year in premiums for the privilege!

[MichaelB]

Quote:

Originally Posted by rbmrtn I think that is the key. The agent/broker is essentially doing the signup for you through the exchange. You are getting an exchange plan but dealing with the broker/agent/insurance company. They have to be approved to work with the exchange. Here's a HHS memo on the role of agents/brokers in the exchange http://www.in.gov/idoi/files/agent-broker-5-1-2013.pdf

Great find! Thanks for another excellent reference. At first glance it answers quite a few questions about the role of the other marketplace players. I'll put it in the FAQ and hopefully will be able to get through it over the weekend.

[audreyh1]

Quote:

Originally Posted by MichaelB New healthcare plans must be ACA compliant. The source for my marketplace confusion / comment is the Federal Register, June 19 2013 http://www.gpo.gov/fdsys/pkg/FR-2013...2013-14540.pdf KFF interpretation of this rule is Univision Obamacare Deal Could Put WellPoint, Blues Ahead Of Competitors - Kaiser Health News It would appear that BCBS Florida is already engaged. Good to know I'm not the only one confused, so I feel like I'm in good company.

BCBS TX website also has a link to go to the exchange to enroll and determine your subsidy, and then return to them to complete the enrollment.

[tinlizzy]

For individual plans HSA contributions are not going to be included when figuring a plan's AV. Would this mean, all things being equal with the minimum essential standard requirements (60% for bronze), that the high deductibles in an HSA plan would have to be offset by better benefits somewhere else to get to the 60% AV?

In other words, once you've met the high deductible, the HSA plan would pay out better than the other plans?

Side note - I read that the employer contribution (group plan) to an HSA is included in the AV.

Please correct me if I'm wrong - I'm not sure I have my head quite wrapped around the HSA implications to actuarial value.

http://www.cms.gov/CCIIO/Resources/F...r-bulletin.pdf

This implies also that cost sharing is even better because a plans AV can be +/- 2%, but the cost sharing must be +/- 1%.

[ziggy29]

Quote:

Originally Posted by tinlizzy In other words, once you've met the high deductible, the HSA plan would pay out better than the other plans?

I think you have to run the numbers yourself, as I don't think there's a definite answer to this.

One important thing to remember is that HSA contributions reduce your MAGI, so taking a high deductible HSA-eligible plan could not only get you a larger subsidy if you contribute to the HSA, but also potentially reduce your cost sharing requirements if you purchased an HSA-compatible Silver level plan (Bronze-level plans are eligible for a subsidy but not reduced cost-sharing in the general case).

[tinlizzy]

Quote:

Originally Posted by ziggy29 I think you have to run the numbers yourself, as I don't think there's a definite answer to this.

No number running - what I'm thinking is that this would be a given now because of the minimum essential standards.

[tinlizzy]

I also found the AV calculator that the insurers are using.

Centers for Medicare & Medicaid Services

1st link

[audreyh1]

Could they possibly not be considering an individual's tax savings into account in their models?

The actuarial models don't use the subsidized cases either from what I read.

I'm not sure this matters to me as a customer. The Bronze plans are HSA qualified period. I don't see an option for Bronze HSA versus Bronze non-HSA plan I can purchase.

[ziggy29]

Quote:

Originally Posted by tinlizzy No number running - what I'm thinking is that this would be a given now because of the minimum essential standards.

OK, let's try this again: once you've met the deductible, sure, anything that results in a lower premium AND lets you contribute to an HSA looks better.

But the problem is that few of know this will be the case going into any given year. And it ignores the concept that one deductible may be $2000 and the other may be $6000.

Am I missing something?

[ziggy29]

Quote:

Originally Posted by audreyh1 I'm not sure this matters to me as a customer. The Bronze plans are HSA qualified period. I don't see an option for Bronze HSA versus Bronze non-HSA plan I can purchase.

Audrey, when I look at the plans, the Bronze PPO plans are showing up as HSA-eligible but the bronze HMO plans are not. And maybe it's different in my county, but the only HSA-compatible plans I'm seeing are the two Bronze-level PPO plans offered by BCBS through the Exchange. I don't know if this is a bug or if there is something about the HMO plans that don't meet all the technical criteria for HSA eligibility.

[tinlizzy]

Quote:

Originally Posted by ziggy29 Am I missing something?

Yes, how they arrive at the actuarial value of a plan.

The deductible, co-pays, coinsurance all go into a formula that makes up the AV of a plan - correct?

A high deductible would subtract from the AV of a plan, correct?

So now we have the ACA requiring a minimum essential standard - so if the low deductible plan and the high deductible plan have the same AV (e.g.60%) then the AV would have to made up somewhere else in the pay-outs - yes?