PPACA, Obamacare and General Comments

[Buckeye]

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Originally Posted by Mulligan Glad to see somebody else got no farther with Anthem than I did. No matter what question I asked, or how it was worded I received the same answer. Something to the effect that information will be sent out concerning these matters at a later time in the year.

+1

I encountered the same treatment from Humana.

[sheehs1]

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Originally Posted by Buckeye +1 I encountered the same treatment from Humana.

Not getting answers when this will roll out Jan 1, 2014 is disconcerting. I was able to "glean" the following. All subject to some change I suppose.

New rates will be out sometime in July. My renewal date is Sept. Anthems new plans matching the levels of the ACA will not be out until October. I can keep my "renewed old plan" until Dec (4 months) but then will have to move to one of the new plans Jan1, 2014. Some talk about the possibility of a grace period until March. When asked what happens between Dec and March, all Anthem would say is "you won't be without coverage".

Having read something about being able to keep your plan until the next renewal date (which would make it September 2014), I asked about it. He conceded that might be case.

Some talk about grandfathered policies. I am not grandfathered as the premiums for my policy that would have been were going up a huge amount.
Those grandfathered policies may also start to see huge premium prices that may lead to people jumping from them to the new ones, especially since there is no lifetime cap on the ACA compliant ones.

[Mulligan]

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Originally Posted by sheehs1 Not getting answers when this will roll out Jan 1, 2014 is disconcerting. I was able to "glean" the following. All subject to some change I suppose. New rates will be out sometime in July. My renewal date is Sept. Anthems new plans matching the levels of the ACA will not be out until October. I can keep my "renewed old plan" until Dec (4 months) but then will have to move to one of the new plans Jan1, 2014. Some talk about the possibility of a grace period until March. When asked what happens between Dec and March, all Anthem would say is "you won't be without coverage". Having read something about being able to keep your plan until the next renewal date (which would make it September 2014), I asked about it. He conceded that might be case. Some talk about grandfathered policies. I am not grandfathered as the premiums for my policy that would have been were going up a huge amount. Those grandfathered policies may also start to see huge premium prices that may lead to people jumping from them to the new ones, especially since there is no lifetime cap on the ACA compliant ones.

Interesting stuff, as I have Anthem, too. There also has been some scuttlebutt about some insurance companies renewing the plans again in December so you would not have to enter exchange until the following December. The Anthem BCBS are all kind of a "loose confederacy" if I understand correctly, so I wonder if they will be consistent state to state with their implementation plans.

[Mulligan]

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Originally Posted by sheehs1 Not getting answers when this will roll out Jan 1, 2014 is disconcerting. I was able to "glean" the following. All subject to some change I suppose. New rates will be out sometime in July. My renewal date is Sept. Anthems new plans matching the levels of the ACA will not be out until October. I can keep my "renewed old plan" until Dec (4 months) but then will have to move to one of the new plans Jan1, 2014. Some talk about the possibility of a grace period until March. When asked what happens between Dec and March, all Anthem would say is "you won't be without coverage". Having read something about being able to keep your plan until the next renewal date (which would make it September 2014), I asked about it. He conceded that might be case. Some talk about grandfathered policies. I am not grandfathered as the premiums for my policy that would have been were going up a huge amount. Those grandfathered policies may also start to see huge premium prices that may lead to people jumping from them to the new ones, especially since there is no lifetime cap on the ACA compliant ones.

So, I wonder Sheeshs, if the July rate will be a close estimate to what we will be paying for the new plans in January? July is when I get my annual increase, too.

I am glad for the people who have received a preliminary estimate on pricing for their states. Most are pleased that it has not gone up by a considerable amount. However this hasn't really lowered my angst (maybe having too much time on my hands is part of them problem, too ) because those numbers are still extremely high compared to what I am used to paying. The states I read that were speculated to get "rate shock" are states such as AZ, VA, MO, KY, ID, GA, OH, OK, and TN. Of course I am one of those and there has not been a peep coming out of any of those states what the pricing will be based on anything I have read.

[sheehs1]

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Originally Posted by Mulligan So, I wonder Sheeshs, if the July rate will be a close estimate to what we will be paying for the new plans in January? July is when I get my annual increase, too. I am glad for the people who have received a preliminary estimate on pricing for their states. Most are pleased that it has not gone up by a considerable amount. However this hasn't really lowered my angst (maybe having too much time on my hands is part of them problem, too ) because those numbers are still extremely high compared to what I am used to paying. The states I read that were speculated to get "rate shock" are states such as AZ, VA, MO, KY, ID, GA, OH, OK, and TN. Of course I am one of those and there has not been a peep coming out of any of those states what the pricing will be based on anything I have read.

Mulligan, I wondered the same thing about the July rates. But here is a thought. If Anthem or the private insurers want to keep their customers, do you think they will try their hardest to be below the exchange rates we have been seeing on the Kaiser calculator? Otherwise, their customers may flock to the exchanges. I think they will have to come up with some incentive of some type to keep the customers. What they do in subsequent years to keep them is anyones guess.

One additional thought. Insurers may look closely at what their neighboring states are doing. Otherwise people just might establish residency across state lines. For example: We are only a short 20 minutes from the North Carolina line. My husband's business is in North Carolina. Since his health care is thru his business he gets Anthem N.C. rates which I assure you have been cheaper than my Anthem Virginia rates. Virginia is where our home is.

Anthem is privately owned here in Virginia. I don't know about elsewhere but I'll assume they too are privately owned. Years ago and I can't remember who I called, I'm sure it was several phone calls, but I was able to find out that Anthem in Virginia made over 300 million in profit or some other astronomical number for it's owners and stakeholders. It was actually kind of mind boggling since it was just the one state and since premiums were skyrocketing.

As far as I know Virginia has opted for the Federal Exchange.

[pb4uski]

sheehs1, there is no federal exchange. For states that declined to operate an exchange, the feds will step into the void and operate an exchange for that state. So you exchange will be a Virginia exchange, but will be organized and operated by the federal government. BTW, good luck with that.

[sheehs1]

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Originally Posted by pb4uski sheehs1, there is no federal exchange. For states that declined to operate an exchange, the feds will step into the void and operate an exchange for that state. So you exchange will be a Virginia exchange, but will be organized and operated by the federal government. BTW, good luck with that.

Yes I know. The way I worded it is how our governor has worded it in the papers.

[sheehs1]

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Originally Posted by pb4uski sheehs1, there is no federal exchange. For states that declined to operate an exchange, the feds will step into the void and operate an exchange for that state. So you exchange will be a Virginia exchange, but will be organized and operated by the federal government. BTW, good luck with that.

pb4uski...I meant to add "thanks for the feedback". Was doing three things at one time while trying to respond. Tough day today!

[CH]

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Originally Posted by Buckeye I'm in Florida and our governor and legislature have fought everything related to Obamacare

This is not a true statement. The Fl governor wanted to do the Medicaid expansion but the legislature would not go along.

[FIRE'd@51]

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Originally Posted by sheehs1 But here is a thought. If Anthem or the private insurers want to keep their customers, do you think they will try their hardest to be below the exchange rates we have been seeing on the Kaiser calculator? Otherwise, their customers may flock to the exchanges. I think they will have to come up with some incentive of some type to keep the customers.

You would think so. I assume you have a policy that required medical underwriting, so it seems likely that the risk pool you are in is probably more healthy than the one in the exchange will be. On the other hand, there is no subsidy for your policy, so Anthem may not be able to price it below the subsidized rate.

BTW, Anthem is part of Well Point (WLP).

[MichaelB]

Why don't we stick to PPACA, healthcare and how to deal with it, and leave that other stuff for another discussion.

[Buckeye]

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Originally Posted by MichaelB Why don't we stick to PPACA, healthcare and how to deal with it, and leave that other stuff for another discussion.

Ooops. Deleted. Thought it was informational, not political but definitely off topic.

[sheehs1]

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Originally Posted by FIRE'd@51 You would think so. I assume you have a policy that required medical underwriting, so it seems likely that the risk pool you are in is probably more healthy than the one in the exchange will be. On the other hand, there is no subsidy for your policy, so Anthem may not be able to price it below the subsidized rate. BTW, Anthem is part of Well Point (WLP).

Thanks FIRE'D. Yes, had to go thru underwriting. Keep in mind that since there will be no underwriting due to automatic acceptance for any of them, the health status of all the pools may change.

Heck, I don't even know if they will have "pools" within the levels. Anyone have any idea how the classifications will work within the levels or is everyone pooled together at the level they apply for?

We don't qualify for a subsidy, have no way to get below that cutoff so it's a non-event for us or perhaps I should say an expensive event.

Just tried this calculator from Covered California..and the rates are significantly lower than the other calculators. So now I'm a bit confused.

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

[Mulligan]

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Originally Posted by sheehs1 Thanks FIRE'D. Yes, had to go thru underwriting. Keep in mind that since there will be no underwriting due to automatic acceptance for any of them, the health status of all the pools may change. Heck, I don't even know if they will have "pools" within the levels. Anyone have any idea how the classifications will work within the levels or is everyone pooled together at the level they apply for? We don't qualify for a subsidy, have no way to get below that cutoff so it's a non-event for us or perhaps I should say an expensive event. Just tried this calculator from Covered California..and the rates are significantly lower than the other calculators. So now I'm a bit confused. http://www.coveredca.com/calculating_the_cost.html

Thanks for the link. Every calculator that comes out seems to be a little better. Mine pegged out at $393 for a 49 yr. old. My plan is more closer to a bronze so I would guess the premium to be closer to $300. About a 350% increase for me, but better than 600% a few months ago. I have to assume my state will be a little cheaper than California. Although our legislatures refused to take federal money and expand Medicare. Local paper speculated this could lead to higher premiums to help pay for all the hospital charge offs from Medicare not expanding.

[M Paquette]

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Originally Posted by sheehs1 Heck, I don't even know if they will have "pools" within the levels. Anyone have any idea how the classifications will work within the levels or is everyone pooled together at the level they apply for?

The rules require issuers to treat all of their non-grandfathered business in the individual market and the small group market, respectively, as a single risk pool.

PHS Act section 2701 only allows non-grandfathered health insurance issuers in the individual and small group markets to vary premiums based on the following factors beginning in 2014: (1) whether the plan or coverage applies to an individual or family; (2) geographic rating area; (3) age, limited to a variation of 3:1 for adults; and (4) tobacco use, limited to a variation of 1.5:1.

[daylatedollarshort]

So if we sell our house and live off the proceeds for a number of years, and we either stop our business income or what we earn gets dispersed between business expenses and retirement contributions, then our taxable income might be pretty low in future years.

The calculators show us on Medicaid under that scenario. That is pretty odd there is no asset test.

What is it like to be on Medicaid? Is that something most doctors and hospitals accept? Is it Medicaid or no subsidy at all for us if our taxable income is low enough?

[landover]

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Originally Posted by sheehs1 I'm not worried about loosing my health care at the moment. I am worried about the "cost of premiums" for what I consider low to high middle America. I don't see how a couple making $70,000 per household can easily afford an $18,000 net of tax expense on the exchanges if that is their only choice.

How are they getting the health insurance now, are they uninsured, or their current employer will drop health insurance without increase in compensation after Jan 2014?

[travelover]

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Originally Posted by daylatedollarshort ........... The calculators show us on Medicaid under that scenario. That is pretty odd there is no asset test...........

In Michigan there is definitely an assets test. I'd check further for you state.

[Htown Harry]

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Originally Posted by daylatedollarshort So if we sell our house and live off the proceeds for a number of years, and we either stop our business income or what we earn gets dispersed between business expenses and retirement contributions, then our taxable income might be pretty low in future years. The calculators show us on Medicaid under that scenario. That is pretty odd there is no asset test. What is it like to be on Medicaid? Is that something most doctors and hospitals accept? Is it Medicaid or no subsidy at all for us if our taxable income is low enough?

Careful on that assumption of business expenses, DLDS. The Modified Adjusted Gross Income calculation may trip you up.

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Internal Revenue Code, §36B(d)(2), ‘‘(d) TERMS RELATING TO INCOME AND FAMILIES.—For purposes of this section— ‘‘(2) HOUSEHOLD INCOME.— ‘‘(B) MODIFIED GROSS INCOME.—The term ‘modified gross income’ means gross income— ‘‘(i) decreased by the amount of any deduction allowable under paragraph (1), (3), (4), or (10) of section 62(a), ‘‘(ii) increased by the amount of interest received or accrued during the taxable year which is exempt from tax imposed by this chapter, and ‘‘(iii) determined without regard to sections 911, 931, and 933.

Section 62(a) is the IRS regulation describing the "above the line" deductions that are calculated before AGI is figured, i.e. those seen on the first page of form 1040. The full list is found here:
Above-the-line deduction - Wikipedia, the free encyclopedia

Paragraphs 1, 3, 4 and 10 are:

• (1) TRADE AND BUSINESS DEDUCTIONS.--The deductions allowed by this chapter (other than by part VII of this subchapter) which are attributable to a trade or business carried on by the taxpayer, if such trade or business does not consist of the performance of services by the taxpayer as an employee.
• Losses from sale or exchange of property
• Deductions attributable to rents and royalties
• Alimony

[sheehs1]

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Originally Posted by landover How are they getting the health insurance now, are they uninsured, or their current employer will drop health insurance without increase in compensation after Jan 2014?

I don't have an answer for this question. I've read about many families with this income level range that didn't have insurance to begin with due to all the other expenses of their families, i.e. the ones who don't have access to city, state, federal insurance policies which are exempt from ACA anyway.

I seriously doubt employers will increase compensation in addition to the expense they will have with ACA. Either way their cost are going up with (1) offering health care or (2) paying the penalty. Employers may try to make the employee "net neutral" but that is just speculation on my part.