Executive announcement to end cost sharing reductions

[ShokWaveRider]

She is a Florida Blue Rep. CSRs are NOT regular subsidies, they are Purely for Deductible and TOOP cost sharing.

 

[MichaelB]

Anyone know how it will affect us folk below 200% of PL in Florida?

CSRs were what allowed me and DW to have a $0 deductible for 2016 and 2017. TOOP was $2500 each for 2016 and $2000 each for 2017. My agent says as a result of this order a deductible (TBA) will apply and TOOP will Triple. But the overall monthly payment "Should" be comparable.

Look at some of the links earlier in this thread. They describe how insurers in Florida are reacting to this.

Florida BCBS has already released policies and premiums for 2018. You can see there exactly what you would get by insuring with them.

She is a Florida Blue Rep. CSRs are NOT regular subsidies, they are Purely for Deductible and TOOP cost sharing.

This is confusing. Florida Blue is offering Silver Policies with CSRs for 2018.

 

[Mulligan]

What many people forget is if an insurer offers aca plan in a state or county they have to offer it to everyone csr or not. The rules won’t let them charge more for a policy if they are csr eligible. The insurers have two choices to get back this seven billion
1. Charge every aca policy more premiums or
2. Stop offering Aca policies

The people hurt the most by this are those who need an aca policy but are over 400 percent of fpl. In essence they will have to pay the subsidy for those under 250 percent fpl.
The government will also end up paying more premium tax credits to those under 400 fpl.

I expect insurers to stop offering policies in counties that have a high proportion of policies that are csr eligible.

Yes, this has me in the cross hairs, just like everything has from inception. An option (besides the govt forcing me to get married and take cheap high quality employer subsidized insurance off long time GF) I will be exploring is the 11 month short term health policy. Then lining it up to its expiration date with ACA enrollment periods. That way if something goes wrong long term, I would flip into the other. If I stay healthy, I just keep enrolling in the short term policy. My brother is on one now while having VA hospital, as his backup...Very inexpensive because of underwriting being allowed.

 

[donheff]

It sounds like the net effect of the Federal refusal to pay CSRs is to shift $7-10B per year from taxpayers at large to the small group of ACA marketplace participants who don’t get substantial credits. No wonder premiums are jumping for those effected.

 

[Senator]

It sounds like the net effect of the Federal refusal to pay CSRs is to shift $7-10B per year from taxpayers at large to the small group of ACA marketplace participants who don’t get substantial credits. No wonder premiums are jumping for those effected.

I do not think that is the case at all. Any premium increase has to approved by regulators. It only affects silver plans.

From the Kaiser article, here is a quote.

Any systematic increase in premiums for silver marketplace plans (including the benchmark plan) would increase the size of premium tax credits. The increased tax credits would completely cover the increased premium for subsidized enrollees covered through the benchmark plan and cushion the effect for enrollees signed up for more expensive silver plans. Enrollees who apply their tax credits to other tiers of plans (i.e., bronze, gold, and platinum) would also receive increased premium tax credits even though they do not qualify for reduced cost-sharing and the underlying premiums in their plans might not increase at all.

 

[ivinsfan]

She is a Florida Blue Rep. CSRs are NOT regular subsidies, they are Purely for Deductible and TOOP cost sharing.

Yes, but they can't just add this to the cost of your policy..they have to add it to everyones costs and they have to continue to offer the cost sharing feature on sliver plans...

 

[Pilot2013]

It sounds like the net effect of the Federal refusal to pay CSRs is to shift $7-10B per year from taxpayers at large to the small group of ACA marketplace participants who don’t get substantial credits. No wonder premiums are jumping for those effected.

Weren't premiums already up over 100% over the last 4 years? Not sure the increases are from a couple of days ago.

 

[scrabbler1]

I can afford it but want to make sure I'm doing the most efficient thing. With this news, is anyone switching strategies? If so, what are you changing to and why?

I considered switching from my Silver plan to a Bronze plan (same insurer) at the start of 2017 but after comparing the two I saw that the Silver premium minus the small subsidy wasn't a lot more than the Bronze premium and the higher copays for the Bronze policy for just the known stuff I'd be using (i.e. drugs, doctors, services) made it not worthwhile to switch. So I stayed with my Silver plan even though the insurer changed a few things which did not work in my favor.

Even before the recent announcement, I was going to take another look at switching to the Bronze plan again for 2018. After the announcement, I am eagerly waiting until the start of November when my insurer will release their plan descriptions and premiums. All I have so far is a July letter from my insurer telling me what rate they filed for in 2018 for my existing plan.

A big unknown for 2018 is what the SLCSP (Second Lowest Cost Silver Plan) premium is for my county. I don't even know what it is for 2017, as I won't find out until early January, around the time it is officially released with the Form 1095-A form we use for our federal income tax form (8962). The SLCSP plays a big role in what my premium subsidy will be. It rose about 4% for2016 and 2017, but will it rise more, thereby increasing my ACA subsidy? Makes it tough to make a decision on if I should switch or not.

 

[donheff]

I do not think that is the case at all. Any premium increase has to approved by regulators. It only affects silver plans.

From the Kaiser article, here is a quote.

Yes Senator it does appear the government would still fund a lot of the missing money thru tax credits. So not big shift in burden.

 

[catotx]

Yes, this has me in the cross hairs, just like everything has from inception. An option (besides the govt forcing me to get married and take cheap high quality employer subsidized insurance off long time GF) I will be exploring is the 11 month short term health policy. Then lining it up to its expiration date with ACA enrollment periods. That way if something goes wrong long term, I would flip into the other. If I stay healthy, I just keep enrolling in the short term policy. My brother is on one now while having VA hospital, as his backup...Very inexpensive because of underwriting being allowed.

I am in my late 40s and FIRE'd earlier this year. My original plan was to forget about ACA subsidies and go for Roth conversion to the top of the 15% bracket.

But from what I'm reading, the rates in my state are expected to go up by more than 50% next year. This will be close to $20k for my family of 4. I think my strategy now is to get below 400% FPL next year. Maybe when all the dust settles in a few years, the premiums will become more reasonable. I will then revisit my plan to do Roth conversions. At least, I still have many years before I have to deal with RMDs.

 

[MichaelB]

I just looked over all the BCBS rates in Florida for '17 and '18, and it is confusing. There are no Silver CSR plans in '18 - yet. All the silver plans show normal metal level deductibles. The price increases for the bronze plans average 25% and tthe silver range between 40% - 70%. With increases of this magnitude one would expect some explanation, but nothing yet, except a notice from BCBS that their increase was approved as requested.

 

[ivinsfan]

I thought offering a sliver plan with CSR on the ACA exchange was mandated under ACA law?

 

[Mulligan]

I am in my late 40s and FIRE'd earlier this year. My original plan was to forget about ACA subsidies and go for Roth conversion to the top of the 15% bracket.



But from what I'm reading, the rates in my state are expected to go up by more than 50% next year. This will be close to $20k for my family of 4. I think my strategy now is to get below 400% FPL next year. Maybe when all the dust settles in a few years, the premiums will become more reasonable. I will then revisit my plan to do Roth conversions. At least, I still have many years before I have to deal with RMDs.

That is a closed door option for me. I am just a single and can afford for now what they throw at me until I say No Mas. But 20k for a family of 4 especially Joe worker just over the cliff? I suspect he will choose a roof and food over paying that. Unless present course changes outside of employer based insurance, only the wealthy and poor will be able to afford healthcare.

 

[MichaelB]

I thought offering a sliver plan with CSR on the ACA exchange was mandated under ACA law?

This is not an exchange plan, it is the direct offerings from BCBS. Like last year, they released their plans and premiums early.

It is confusing, though.

 

[SecondCor521]

I considered switching from my Silver plan to a Bronze plan (same insurer) at the start of 2017 but after comparing the two I saw that the Silver premium minus the small subsidy wasn't a lot more than the Bronze premium and the higher copays for the Bronze policy for just the known stuff I'd be using (i.e. drugs, doctors, services) made it not worthwhile to switch. So I stayed with my Silver plan even though the insurer changed a few things which did not work in my favor.

Even before the recent announcement, I was going to take another look at switching to the Bronze plan again for 2018. After the announcement, I am eagerly waiting until the start of November when my insurer will release their plan descriptions and premiums. All I have so far is a July letter from my insurer telling me what rate they filed for in 2018 for my existing plan.

A big unknown for 2018 is what the SLCSP (Second Lowest Cost Silver Plan) premium is for my county. I don't even know what it is for 2017, as I won't find out until early January, around the time it is officially released with the Form 1095-A form we use for our federal income tax form (8962). The SLCSP plays a big role in what my premium subsidy will be. It rose about 4% for2016 and 2017, but will it rise more, thereby increasing my ACA subsidy? Makes it tough to make a decision on if I should switch or not.

Thanks. I haven't taken a look at the Bronze plans yet but I will at some point soon.

You might take a look at Gold plans. In my case I can either spend $311 on a CSR Silver plan (with 87% AV) or $225 on a Gold plan (with 80% AV). Both are from the same insurer.

 

[ivinsfan]

This is not an exchange plan, it is the direct offerings from BCBS. Like last year, they released their plans and premiums early.

It is confusing, though.

I was confused because only the exchange would have the CR plans..

 

[scrabbler1]

Thanks. I haven't taken a look at the Bronze plans yet but I will at some point soon.

You might take a look at Gold plans. In my case I can either spend $311 on a CSR Silver plan (with 87% AV) or $225 on a Gold plan (with 80% AV). Both are from the same insurer.

I had looked at Gold plans for 2017, too, but the premiums relative to the Silver ones put them out of range. Might not be so far out of range this time, I will check them out again for 2018.

 

[MichaelB]

I was confused because only the exchange would have the CR plans..

Right. As I understood it, premium credits and CSR subsidies were only available on an exchange, not directly from the insurer. What I think is happening is Florida BCBS makes available the policy and premium info on their website, but then requires users to apply on the exchange.

 

[MichaelB]

Thanks. I haven't taken a look at the Bronze plans yet but I will at some point soon.

You might take a look at Gold plans. In my case I can either spend $311 on a CSR Silver plan (with 87% AV) or $225 on a Gold plan (with 80% AV). Both are from the same insurer.

I had looked at Gold plans for 2017, too, but the premiums relative to the Silver ones put them out of range. Might not be so far out of range this time, I will check them out again for 2018.

Just a reminder, Animorph posted a useful Excel spreadsheet that allows you to compare policies with different premiums, deductibles and co-pays, and see the total yearly cost of each based on different scenarios. It's here http://www.early-retirement.org/for...nd-coinsurance-copay-68965-3.html#post1374536

 

[Sue J]

A big unknown for 2018 is what the SLCSP (Second Lowest Cost Silver Plan) premium is for my county. I don't even know what it is for 2017, as I won't find out until early January, around the time it is officially released with the Form 1095-A form we use for our federal income tax form (8962). The SLCSP plays a big role in what my premium subsidy will be. It rose about 4% for2016 and 2017, but will it rise more, thereby increasing my ACA subsidy? Makes it tough to make a decision on if I should switch or not.

You can find your 2017 SLCSP at healthcare.gov
click on "Still need a '17 plan? See if you can enroll."

Use the "see if you can qualify" button. Answer one of the questions YES and then scroll down to "see plans before you apply".

Fill it all out like you did when applying (use your age as of 1/1/17) and then filter for just Silver plans. In my state it shows the full price without the subsidy along with the subsidized price. Or if your state doesn't show that you can make your income over 400% FPL and see the full prices.

Once you filter for Silver plans you can see the 2nd lowest cost.

I always write the SLCSP amount down when I apply during open enrollment. Also, once we get into tax filing time HC.gov posts a tax tool - https://www.healthcare.gov/tax-tool/

 

[scrabbler1]

You can find your 2017 SLCSP at healthcare.gov
click on "Still need a '17 plan? See if you can enroll."

Use the "see if you can qualify" button. Answer one of the questions YES and then scroll down to "see plans before you apply".

Fill it all out like you did when applying (use your age as of 1/1/17) and then filter for just Silver plans. In my state it shows the full price without the subsidy along with the subsidized price. Or if your state doesn't show that you can make your income over 400% FPL and see the full prices.

Once you filter for Silver plans you can see the 2nd lowest cost.

I always write the SLCSP amount down when I apply during open enrollment. Also, once we get into tax filing time HC.gov posts a tax tool - https://www.healthcare.gov/tax-tool/

Actually, I tried it for my state exchange's website so I could refresh my memory as to what were the key features of each metal's plan. Bronze lacks sufficient drug coverage, my costliest benefit, while Gold costs more for the same benefits while its lower deductible is still higher than what I would typically reach.

It looks like the SLCSP might rise by a lot more than 4% for 2017, based on my review of the comparable 2017 Silver plans and how my list of Silver plans in prior years compared to the final SLCSP. That means my 2017 subsidy will rise, too.

 

[RetiredGypsy]

What I think is happening is Florida BCBS makes available the policy and premium info on their website, but then requires users to apply on the exchange.

That's exactly it. If you click to Apply For Tax Credit (green button on the plan you choose), it takes you to the Marketplace site to apply for that plan there instead.

 

[pb4uski]

My company does not offer "health insurance", they provide insurance that is self funded. Do you propose to cut off all working peoples affordable "health insurance"?

Your company choses to self-insure and pay for administration.... they may also buy stop-loss coverage (many employers do). I would expect that employers would have the same reasons to assist employees with the cost of health insurance that they do today.... to attract good employees in a competitive workplace. Just because an employer plan is ASO doesn't mean it is cheap... in fact, between what employer's pay for claims, administration and stop-loss coverage the total cost to most employers would be about the same, or perhaps even less. You can get a pretty good idea of the employer's true cost by looking at the cost of COBRA.

 

[Montecfo]

I think there is also an expected consequence. The whole idea of health insurance outside of an employer plan is becoming increasingly uncertain. Since you cannot be sure what kinds of policies will be available for the next few years, whether they will be affordable or how pre-existing conditions will be covered or priced, people on the cusp of ER are forced into OMy until the situation is clarified.

I do not think I have heard any proposals to not cover pre-existing conditions. Quite the contrary. But if you maintain coverage, you are generally not being charged for having a health issue, to my knowledge.

Is there something i am missing here?

 

[Pilot2013]

Your company choses to self-insure and pay for administration.... they may also buy stop-loss coverage (many employers do). I would expect that employers would have the same reasons to assist employees with the cost of health insurance that they do today.... to attract good employees in a competitive workplace. Just because an employer plan is ASO doesn't mean it is cheap... in fact, between what employer's pay for claims, administration and stop-loss coverage the total cost to most employers would be about the same, or perhaps even less. You can get a pretty good idea of the employer's true cost by looking at the cost of COBRA.

I happen to be in a position to know 100% what our self insured costs are for the last 5 years. Our company does not have stop-loss, and cost shares at 1/3 employee, 2/3 employer. Also, almost all prescriptions (generic) are free, wiht highest cost $30. We have a few multi billion $ (over 100 billion) companies that I would stack up our employee costs against. It can be done.

Yes, this is to attract high performing employees.