Obamacare

[Katsmeow]

Individual policies begin at age 26 and end on the first day of 65th birthday.

Are you saying that someone under age 26 can't buy an individual policy? I know that they can be on the parent's policy, but is it required? That is, let's say that someone is 25 living on his/her own and that person's parent doesn't buy a family policy or any policy. Are you saying that person is unable to obtain health insurance because his/her parents don't buy it?

On another note - about the premium calculators we've seen here I know that they are largely guesses and aren't really accurate in terms of family size, etc.

They have some strange results. For example, for me as someone 58 it says I would pay $635 a month for an individual policy. That is not so bad. But make it a 2 person policy - such as me and one of my children and it goes up to the $1723 a month which just seems insane. For example with the calculator for my 19 year old son as individual it shows a premium just over $200 a month so the combined premium for both would be under $900 a month. But if it is a family policy it is suddenly over $1700 a month? That doesn't make sense.

I did at one point just for grins look at the Massachusetts health connector and to obtain a policy for me and kids was much more reasonable - DH is on medicare so he wouldn't be insured under it. For that, putting in me and 3 kids bronze plans were in the $800-900 range, Silver plans around an average of $1200-1300 a month which seems a lot more reasonable.

We are on DH's subsidized retiree plan. We had an over 250% premium increase this year since Megacorp only subisidizes a small part of the increase, but even so it is less than $500 a month. Like many, I worry that Megacorp will get rid of the retiree plan.

 

[meierlde]

I know in my case and the case of some friends, that we will be encouraging our young adults who do not have employer provided health insurance to enroll and take the subsidy. While we obviously have the welfare of our adult children in mind we are also cognizant that we also would not want to end up in a position of having an uninsured adult child have a serious illness that requires costly care and having to decide between paying for that care at the peril or our own plans for the future.

Of course in that case as in a number of others if the child is over 21 there is no legal requirement to pay for their care in general. If they have few assets then bankruptcy is a good route. (Note that 401ks and IRAs are not included in the assets to be seized in bankruptcy, so encourage that first, and in some states home equity is also exempt). So it would just be savings a fancy car and the like, that would be attached. (Basic cars are also exempt up to some worth)

 

[bUU]

The penalty to NOT enroll will be less than the cost of having insurance. They would rather take the chance the IRS chases them down for a couple grand than to enroll when they think they are immortal and invincible........

I firmly believe that the responsible ones will far outnumber the miscreants you're referring to.

 

[MichaelB]

Are you saying that someone under age 26 can't buy an individual policy? I know that they can be on the parent's policy, but is it required? That is, let's say that someone is 25 living on his/her own and that person's parent doesn't buy a family policy or any policy. Are you saying that person is unable to obtain health insurance because his/her parents don't buy it?

No. I can think of a number of legitimate reasons a 24 year old would need his or her own policy. The 26 through 65 comment I made was about the age pricing factor.

On another note - about the premium calculators we've seen here I know that they are largely guesses and aren't really accurate in terms of family size, etc.

I agree the calculators give funny results and stopped trying to make sense of them.

One thing I am sure of - your premium cost in the exchange - or better put, your eligibility for premium credits, depends on total household income regardless of whether one member is enrolled in Medicare. The other thing, the cost of a child in college, we can speculate that it should not add any additional cost to the policy, but with no calculator support its better to wait until we have some hard pricing available.

 

[pb4uski]

Of course in that case as in a number of others if the child is over 21 there is no legal requirement to pay for their care in general. If they have few assets then bankruptcy is a good route. (Note that 401ks and IRAs are not included in the assets to be seized in bankruptcy, so encourage that first, and in some states home equity is also exempt). So it would just be savings a fancy car and the like, that would be attached. (Basic cars are also exempt up to some worth)

If they are in an accident and end up in the ER with life-threatening injuries the uninsured young adult will get care, but if they have a curable illness I'm not so sure that the medical facility will provide care knowing that the patient can just later declare bankruptcy and avoid the bill.

 

[MichaelB]

If they are in an accident and end up in the ER with life-threatening injuries the uninsured young adult will get care, but if they have a curable illness I'm not so sure that the medical facility will provide care knowing that the patient can just later declare bankruptcy and avoid the bill.

Not even. ER treats and relocates. It is a good option for trauma and emergency treatment but not much else, and repayment will always be a concern for the provider. I think there is simply no room for "no insurance" as an option when trying to provide coverage for everyone.

 

[pb4uski]

Not even. ER treats and relocates. It is a good option for trauma and emergency treatment but not much else, and repayment will always be a concern for the provider. I think there is simply no room for "no insurance" as an option when trying to provide coverage for everyone.

So each of us has a vested interest in making sure that our kids have coverage.

 

[MichaelB]

So each of us has a vested interest in making sure that our kids have coverage.

Exactly. Ours and everyone else's.

 

[bUU]

If they are in an accident and end up in the ER with life-threatening injuries the uninsured young adult will get care, but if they have a curable illness I'm not so sure that the medical facility will provide care knowing that the patient can just later declare bankruptcy and avoid the bill.

As Michael indicated, the legal requirement of EMTALA is stabilization - essentially caring for the patient until they're healthy enough to be discharged, according to medical parameters. However, unlike many other operations within many industries in the economy, many emergency departments hold themselves to a higher standard than the bare minimum that EMTALA imposes.

Exactly. Ours and everyone else's.

Precisely: Ours, because of the limitations of EMTALA, and everyone else's because of the humane manner many emergency departments implement it and related provisions.

 

[gerrym51]

As Michael indicated, the legal requirement of EMTALA is stabilization - essentially caring for the patient until they're healthy enough to be discharged, according to medical parameters. However, unlike many other operations within many industries in the economy, many emergency departments hold themselves to a higher standard than the bare minimum that EMTALA imposes.

Precisely: Ours, because of the limitations of EMTALA, and everyone else's because of the humane manner many emergency departments implement it and related provisions.

since i used to deal with the aftermath of this being a pharmacist-an emergency room does stabilize the patient and does nto worry about getting paid-but a pharmacy is under no legal requirment to do so.

i have had customers have this happen to them-go to the emergency room-get prescriptions- then go nuts when they have to pay for the prescriptions because they have no insurance.

 

[Gatordoc50]

http://www.statisticbrain.com/uninsured-motorist-statistics/

Just out of curiosity, I looked up how many people elect to drive without buying auto insurance. On the one hand, car insurance is way more affordable than health insurance so these statistics are worrisome. On the other hand, many of the people who refuse to purchase auto insurance are going to be given free health insurance.

 

[ShokWaveRider]

I just tagged on to this thread, so sorry if I did not read EVERY post in it. But I read a lot. Here are some comments and questions.

Comments:

1) This does not seem half bad for those who are retired and not eligible for Medicare, or do not have Employer sponsored plans.

2) I agree with others here that it would be sad if there are only 2 options, Single and Family of 4.

Questions:

1) For those who, like DW and I, have 50% or more of their nest Egg in Post Tax Moneys, this seems like we can decide whether or not we are below the poverty line based on how much we take from our pre-Tax moneys. Does this sound rational?

2) If one is deemed below the poverty line, and qualifies for Medicaid. Will there be doctors available who take it? Where we live a lot of the doctors do NOT take Medicaid.

3) If you are below the poverty line, and the ACA is called Medicaid, what is it called if you are not, and will the doctors take it?

4) If the GOP (Ryan Plan) repeal the ACA as they seem to keep on about, what will happen then?

Thanks

SWR

 

[FinanceDude]

I firmly believe that the responsible ones will far outnumber the miscreants you're referring to.

Have you spent quality time with the young cherubic youth of today? It is more about Facebook friending, texting, and video games than unimportant pesky things like Obamacare.......

 

[MichaelB]

I just tagged on to this thread, so sorry if I did not read EVERY post in it. But I read a lot. Here are some comments and questions.

Comments:

1) This does not seem half bad for those who are retired and not eligible for Medicare, or do not have Employer sponsored plans.

2) I agree with others here that it would be sad if there are only 2 options, Single and Family of 4.

Questions:

1) For those who, like DW and I, have 50% or more of their nest Egg in Post Tax Moneys, this seems like we can decide whether or not we are below the poverty line based on how much we take from our pre-Tax moneys. Does this sound rational?

2) If one is deemed below the poverty line, and qualifies for Medicaid. Will there be doctors available who take it? Where we live a lot of the doctors do NOT take Medicaid.

3) If you are below the poverty line, and the ACA is called Medicaid, what is it called if you are not, and will the doctors take it?

4) If the GOP (Ryan Plan) repeal the ACA as they seem to keep on about, what will happen then?

Thanks

SWR

The answers to questions 1,2 and 3 can be found in this thread and a couple of others that are open. Try here as well http://www.early-retirement.org/for...-under-the-threshold-65954-2.html#post1305317

Q#4 will get us into political speculation and away from PPACA implementation, and we'd rather focus on implementation for now and things we need to do.

 

[REWahoo]

3) If you are below the poverty line, and the ACA is called Medicaid, what is it called if you are not, and will the doctors take it?

If you are above the poverty line it is simply called 'health insurance' and since it is offered by an insurance company that has a network of participating doctors an hospitals, those who participate will take it.

 

[samclem]

1) For those who, like DW and I, have 50% or more of their nest Egg in Post Tax Moneys, this seems like we can decide whether or not we are below the poverty line based on how much we take from our pre-Tax moneys. Does this sound rational?

Yes--but. That's a good way to assure you get the subsidy check or qualify for Medicaid, but it might also leave you with higher balances in your after-tax accounts in later years. That means higher RMDs and possible higher taxes, resultant loss of any "free" cap gains up tot he top of the 15% bracket, etc. Look out a few years and make some assumptions, and also look at what happens when one of you passes on--the single-payer brackets are low.

2) If one is deemed below the poverty line, and qualifies for Medicaid. Will there be doctors available who take it? Where we live a lot of the doctors do NOT take Medicaid.

First, the "poverty line" stays the same--and you need to be at an income less than 133% of it to qualify for the expanded Medicaid--IF your state has agreed to expand Medicaid. Some aren't. And regarding the availability of practitioners willing to accept Medicaid--this legislation gets a lot of people medical coverage, that's not at all the same as medical care. And not the same as quality medical care. As you point out, there are big questions about whether those on newly expanded Medicaid will be able to find providers in a timely manner, especially when its a problem for "unexpanded" Medicaid recipients today.

3) If you are below the poverty line, and the ACA is called Medicaid, what is it called if you are not, and will the doctors take it?

If you get insurance directly from your employer than you don't call it anything special. But small employers and individuals wll buy plans on the "exchanges" or "marketplaces". Folks above the Medicaid line but below 400% of that line get a subsidy from the government to help them buy a plan. There are supposed to be Platinum, Gold, Silver and Bronze level plans in every state offered by various private insurers. You take your money plus the voucher provided by taxpayers and you choose one. They vary in what they cover and how much you'll pay out of pocket for various things.

4) If the GOP (Ryan Plan) repeal the ACA as they seem to keep on about, what will happen then?

Let's take one "change" at a time. If/when the whole thing gets revamped, would it make any difference to your present planning? If not, don't worry about it.

 

[meierlde]

2) If one is deemed below the poverty line, and qualifies for Medicaid. Will there be doctors available who take it? Where we live a lot of the doctors do NOT take Medicaid.

3) If you are below the poverty line, and the ACA is called Medicaid, what is it called if you are not, and will the doctors take it?



Thanks

SWR

There are always clincs that take any funding either free clinics or clinics that are set up to take the load off emergency rooms. It may not be the traditional Dr patient relationship, but rather more like the old days at a college health service, and you may see a nurse practitioner rather than a physician.

 

[Brat]

Nothing wrong with Nurse Practitioners for routine health care. Many have specialties as well (obstetrics, cardiac re-hap, geriatrics). They are trained to listen.

 

[gerrym51]

Cover Oregon


cover oregon is up with their obamacare exchange some info

 

[Midpack]

I firmly believe that the responsible ones will far outnumber the miscreants you're referring to.

Uninsured Motorist Statistics | Statistic Brain

Just out of curiosity, I looked up how many people elect to drive without buying auto insurance. On the one hand, car insurance is way more affordable than health insurance so these statistics are worrisome. On the other hand, many of the people who refuse to purchase auto insurance are going to be given free health insurance.

Interesting indicator for comparison.

If 16.1% of drivers are uninsured, and (subsidized) health care will be more expensive, it's reasonable to assume more than 16.1% will be ACA "miscreants." "Outnumber" is probably correct, but over 16% is quite a drag on ACA if that's how it shakes out. Time will tell...

 

[Silver]

Nothing wrong with Nurse Practitioners for routine health care. Many have specialties as well (obstetrics, cardiac re-hap, geriatrics). They are trained to listen.

They are also licensed and capable of doing 75-85% of what a physician does. Surgery is one of the very few things NP's cannot perform.

 

[photoguy]

If 16.1% of drivers are uninsured, and (subsidized) health care will be more expensive, it's reasonable to assume more than 16.1% will be ACA "miscreants." "Outnumber" is probably correct, but over 16% is quite a drag on ACA if that's how it shakes out. Time will tell...

CBO published some estimates on how many people will decline health care and pay the tax.

Of the remaining 11 million to 12 million uninsured people, ... CBO and JCT now estimate that about 6 million people will pay a penalty because they are uninsured in 2016 (a figure that includes uninsured dependents who have the penalty paid on their behalf )

http://cbo.gov/sites/default/files/cbofiles/attachments/09-19-12-Indiv_Mandate_Penalty.pdf

Note there are another 20M people who won't get insurance but are not subject to the tax because they are say unauthorized immigrants (can't receive subsidy etc.) or have other issues.

They estimate 1.8M people who above the 400% FPL who will decline healthcare and pay tax. This seems surprising to me since I believe you don't have to pay the tax if healthcare would be > 8% of income and 400% FPL is quite a decent amount of income. I guess these are strategic defaulters?

 

[bUU]

but over 16% is quite a drag on ACA if that's how it shakes out. Time will tell...

There will always be non-compliance. Heck, I've made a career out of compliance assurance - no - two separate careers, built around compliance assurance. You wouldn't think compliance would be so difficult to arrange for, but as selfishness has increased, the need for compliance assurance has increased. However, that's a societal trend - not anything unique to health care or ACA. It appears in practically every aspect of society, financial and non-financial. It's the underlying drag on everything in society.

 

[gerrym51]

I found ct. new exchange page.

their calculator asks the persons in family who need coverage differently.

california does not ask how many people in family need coverage. ct. does

if there are 2 people in your family and one of them is on medicare then whole familys amount of money is used but just one person covered hard to get subsidy.

How to save | Access Health CT


compare to californias calculator and how questions phrased


http://www.coveredca.com/calculating_the_cost.html


this calculator mirrors california but not CT.


http://www.coveroregon.com/calculator.php

 

[FinanceDude]

They are also licensed and capable of doing 75-85% of what a physician does. Surgery is one of the very few things NP's cannot perform.

We also will see an increase in PA's (physician assistants)