Affordable Care Act -- NOT Affordable

[mommaduck]

DS has never had insurance and I only have catastrophic. I was hoping that for the first time I would be able to get him insured but it looks like they are requiring all the low income people to go through Medicaid. I can't do that.

 

Does anyone know if you are allowed to purchase insurance on your own for a child? Or how to go about doing that...

 

If you are low income, then why would you not be able to go through Medicaid?

[LizzyBee]

If you are low income, then why would you not be able to go through Medicaid?

 

In states that haven't expanded medicaid, most adults other than pregnant women are not eligible.

 

[Mom-ninja.]

How can you prepare for 2.8 million people? Any why would you? Overall there won't be a need for a computer infrastructure that would support that kind of web traffic on a daily basis. ehealthinsurance.com is not the same thing, and if 2.8 million people tried to get quotes on one day, they would have delays too.

 

Slow down there. I was not in any way implying that they should or could have been prepared for the overwhelming traffic. I simply wanted to say that the reason why there is a delay is due to the massive traffic. They could not predict the load that was placed on the system. I'm not saying someone is at fault or that it should have been avoided.

 

I didn't realize I came across sounding like the government should have been better prepared.

[HelenNotOfTroy]

DS has never had insurance and I only have catastrophic. I was hoping that for the first time I would be able to get him insured but it looks like they are requiring all the low income people to go through Medicaid. I can't do that.

 

Does anyone know if you are allowed to purchase insurance on your own for a child? Or how to go about doing that...

 

All states have a children's health insurance program through a federal program called Children's Health Insurance Program, or CHIP.

[mommaduck]

In states that haven't expanded medicaid, most adults other than pregnant women are not eligible.

 

 

Sorry, I didn't realize your DS was an adult.

[Trish]

Some people in Florida are starting to get calls from United Health Care that their doctors will no longer be accepted under their current plan.

 

We'll see how widespread this becomes.

 

[SwallowTail]

We just got a letter from BCBSFL that our plan is being cancelled at the end of tthe year.  We donot qualify for an exhange, subsidy, nor Medicaid. DH will most likely get something reasonable throughhsi work, as they pay most of the premium for mployees, but we won't be able to afford the plan for family.  (3 years ago it was over $800/month, with a 5K deductible.  I can't imagine what it would be up to now.  We were doing a low/no premium HSA plan w/ a 10k deductible the past 3 years, which stunk, but was more affordable for us than the other plan). 

[Mrs Mungo]

Some people in Florida are starting to get calls from United Health Care that their doctors will no longer be accepted under their current plan.

 

What does this mean? It makes no sense for them to kick doctors off the plan. 

 

Ah, actually reading news articles, I see that the *reverse* is the issue. Local hospitals and providers have decided to stop accepting United Healthcare *Medicare* supplemental plans (which isn't all of United Healthcare) for non-emergent care due to non-payments. Even then, it depends upon what type of plan you have. 

 

This sort of thing has happened in the past with our military insurance, doctors have stopped accepting it. The pediatric dentist that my kids saw in NC refused to accept the military's dental insurance as payment. So, I had to write them a check, they submitted the claim, then they wrote a check back to me for the covered portions. 

 

This is nothing new and has *nothing* to do with the ACA.

[TechWife]

Got this message at work today:

FYI: BCBS announced this morning that the Exchange is not going to be operational for “auto enroll†tomorrow and they are recommending waiting until things are working properly. BCBS and Coventry, the carriers on the Exchange, are scrambling!!

 

This is for NC.

 

There is no NC exchange. 

[LizzyBee]

Sorry, I didn't realize your DS was an adult.

 

I was responding to a question you had asked someone else.  I thought she was talking about getting insurance for herself as well as her son, but I might have misread her post.  I'm guessing her son is probably not an adult. Sorry for the confusion.

 

[LizzyBee]

Sorry, I didn't realize your DS was an adult.

 

duplicate

[LizzyBee]

Sorry, I didn't realize your DS was an adult.

 

duplicate

[LizzyBee]

There is no NC exchange. 

 

Every state has an exchange, although most of them (34, I think) are being run by the federal government.

[FairClaire]

FWIW, I have employer based insurance with BCBS of NC.  Our insurance has been going up about 15%/year unless we cut benefits.  For 2014, BCBS is telling us that our premiums are projected to increase 35-40%.

 

 

:huh:   

 

That would mean an increase from $600 to $840...might just be better to switch to something new off the exchange.  I'm still considering the Samaritan Ministries too.

[FairClaire]

We just got a letter from BCBSFL that our plan is being cancelled at the end of tthe year.  We donot qualify for an exhange, subsidy, nor Medicaid. DH will most likely get something reasonable throughhsi work, as they pay most of the premium for mployees, but we won't be able to afford the plan for family.  (3 years ago it was over $800/month, with a 5K deductible.  I can't imagine what it would be up to now.  We were doing a low/no premium HSA plan w/ a 10k deductible the past 3 years, which stunk, but was more affordable for us than the other plan). 

 

 

When did you get the letter?  Everyone here and on FB with similar plans to ours is saying they are being dropped, but I haven't heard anything from BCBS about our policy.

[QueenCat]

When did you get the letter?  Everyone here and on FB with similar plans to ours is saying they are being dropped, but I haven't heard anything from BCBS about our policy.

 

We have BCBS through dh's employer. Our plan is not changing much. No changes to premiums or out of pockets/deductibles. It's not a high deductible plan though ($5000 per person or family, whichever comes first). Definitely not being dropped.

[TXMary2]

For those qualifying for subsidies, the rates look pretty darn good.

 

Well lucky you. Too bad for everyone else.  :/

[StephanieZ]

We won't get a subsidy, but we will buy our plan off the exchange (in WV), and I have to tell you that the plans look awesome, the rates are lower than we've paid in years, and I am very happy! 

[creekland]

We won't get a subsidy, but we will buy our plan off the exchange (in WV), and I have to tell you that the plans look awesome, the rates are lower than we've paid in years, and I am very happy! 

I am glad to hear it works for some folks, and this is NOT sarcastic.  I'm genuinely glad.

 

I'd like to see everyone have access to health care and have affordable health insurance or be able to join a health sharing group.

 

I wish it would work for everyone who wanted/needed it.

[hsmamainva]

Our update:

 

Completed the application early yesterday morning ... about 24 hours ago....and it's still in the verification process. 

 

This was supposed to take less than 24 hours but I guess not! 

 

Spoke with someone via live chat and they said that, unfortunately, they don't know how long the verification process will take as it varies from application to application and that I should just keep checking.

 

*sigh*

 

So I haven't been able to shop for plans or anything yet.

 

 

[zimom]

For both of these programs, the health dept would have to open a case with child services to try to get bio-dad involved, supposedly to better our financial situation so we don't need those programs. But if he hasn't seen fit to get in touch with us in the 6 years he's been gone, I'd rather he stay gone...I like my drama-free life. So I'm trying to see if I can get insurance for DS some other way.

Wendy,

Honestly this is just a guess... Most insurance companies do not offer 'child only' plans at this point, or at least they did not when the law changed and children had to be covered without penalty even if they had a pre-existing condition (we were a family that were able to take advantage of this change). Maybe you will need to shop the exchanges for a family plan and just make sure your income is over the Medicaid guideline even if you have to fudge/raise your income some, so that he does not fall in that category. Since it sounds like you don't want the hassle of Medicaid, you could probably then end up with the cheapest plan possible. I don't remember if you mentioned you had coverage or not.

 

Edited to add: I'm sure it's illegal to say you make less, but I can't imagine it is illegal to say you make more. We would have qualified for Medicaid when I had my son 21+ years ago but chose not to go that route, the Medicaid police still haven't arrested me :)

 

I hope that makes sense.

[QueenCat]

Well lucky you. Too bad for everyone else.  :/

 

That is rude and uncalled for. And I don't qualify for subsidies. People making close to $90,000/year do though.............

[Susan in MO]

Well,  just to see how it worked and to figure out what we would have to pay if we didn't have insurance, I put in our information.  We qualify for a subsidy because of the number of children we have.  What really struck me though was how much the government was going to pay for our policy.  For a silver plan  the government would pay 12,000.00 per year and we would pay 6000.00 per year (an 18,000 dollar policy, btw.)  Considering we only pay around 13,000 in taxes, I am floored.  Where is the money coming from?  Am I missing something?  How on Earth can the country support paying so much for peoples insurance long term?   

[Lady Florida.]

Dh's company was sold in August, and while they kept everything the same until open enrollment, we're waiting to find out what insurance will look like with the new company. We'll still have Aetna but are unsure of what the cost and coverage will look like. I tried to see what we'd get from the exchange (I don't think we qualify for a subsidy but am not sure) but couldn't get in yesterday. The page got stuck where you have to choose a security question. I was going to try live chat, but the wait was long and I couldn't stay at the computer. I plan to try again. Maybe in a week or so, the system won't be so overloaded.

[HRAAB]

We won't get a subsidy, but we will buy our plan off the exchange (in WV), and I have to tell you that the plans look awesome, the rates are lower than we've paid in years, and I am very happy! 

 

I'm trying to remain optimistic.  I still can't get past the sign in page, but I keep hoping when I do, I see some reasonable premiums.

[jelbe5]

Well, just to see how it worked and figure out what we would have to pay if we didn't have insurance, I put in our information. We qualify for a subsidy because of the number of children we have. What really struck me though was how much the government was going to pay for our policy. For a silver plan the government would pay 12,000.00 per year and we would pay 6000.00 per year (an 18,000 dollar policy, btw.) Considering we only pay around 13,000 in taxes, I am floored. Where is the money coming from? Am I missing something? How on Earth can the country support paying so much for peoples insurance long term?

In my humble opinion, and from what I understand, this is the question no one wants to really answer. My understanding is almost 50% of the US population lives in households that receives government benefits. If this is accurate, none of this is sustainable . . . People were surprised Detroit has gone bankrupt. But that is what happens if you are paying out more than you are taking in. I am not sure what can be done since so many of our jobs have been outsourced. It seems as though things are really in a mess . . .

[NicksMama-Zack's Mama Too]

Well,  just to see how it worked and figure out what we would have to pay if we didn't have insurance, I put in our information.  We qualify for a subsidy because of the number of children we have.  What really struck me though was how much the government was going to pay for our policy.  For a silver plan  the government would pay 12,000.00 per year and we would pay 6000.00 per year (an 18,000 dollar policy, btw.)  Considering we only pay around 13,000 in taxes, I am floored.  Where is the money coming from?  Am I missing something?  How on Earth can the country support paying so much for peoples insurance long term?   

 

 

Well, I was hoping that the young and healthy forced to sign up for insurance would help.  But then I read the tale of 30-year old law student, Brendan Mahoney.  He went to sign up for insurance through the exchanges and found out that he qualifies for Medicaid.  So he will go from paying $39/month for his college-sponsored plan, to paying "0" and getting healthcare courtesy of the taxpayer.

 

http://www.discoverynews.org/2013/10/medicaid_is_the_out_for_young_077381.php

[LizzyBee]

Dh's company was sold in August, and while they kept everything the same until open enrollment, we're waiting to find out what insurance will look like with the new company. We'll still have Aetna but are unsure of what the cost and coverage will look like. I tried to see what we'd get from the exchange (I don't think we qualify for a subsidy but am not sure) but couldn't get in yesterday. The page got stuck where you have to choose a security question. I was going to try live chat, but the wait was long and I couldn't stay at the computer. I plan to try again. Maybe in a week or so, the system won't be so overloaded.

 

Because you have access to an employer-based plan, you won't qualify for subsidies.  "Access" means you can be enrolled; it doesn't matter whether the employer pays any of the premiums.

[QueenCat]

Because you have access to an employer-based plan, you won't qualify for subsidies.  "Access" means you can be enrolled; it doesn't matter whether the employer pays any of the premiums.

 

If the employer's plan's premiums are above a certain percentage of your income, then you can use the exchange instead, if you would like.

[duckabell]

So I haven't gone through the exchanges yet, but I was looking at ehealthinsurance.com to see what plans were offered in 2014.  The cheapest I found were $850 or so a month with a $12,000 deductible attached to an HSA.  So if I maxed out my HSA I would get some tax savings, but otherwise I would be paying $22,000.00 a year if I maxed out my health plan and then nothing after that.  So let's assume I max out my HSA and my tax burden is reduced $1,500.  I still pay around $20,000.00 a year before benefits kick in besides well doctor visits and probably vaccines.  Is it worth it?  Is there that great of a chance that I'll have health costs greater than $20,000 a year?

[LizzyBee]

I'm trying to remain optimistic.  I still can't get past the sign in page, but I keep hoping when I do, I see some reasonable premiums.

 

Let us know what the rates are like when you find out.  In NC, I would have to pay more for a silver plan on the exchange than I currently pay for a plan that pays 100% after we meet our deductible.  "They" are saying that the reason the rates for NC are so high is because we only have two companies offering plans on the exchange (BCBS and Coventry), and only one of them (BCBS) is providing plans in all 100 counties.

[LizzyBee]

If the employer's plan's premiums are above a certain percentage of your income, then you can use the exchange instead, if you would like.

 

Yes, except... the % is calculated using employee-only coverage, but it's the family premiums that will put most families over the limit.  Yet, if you can enroll your family, you have "access" to employer based insurance even if the employer pays zero toward the premiums.  It's a real kick in the teeth for people who were expecting to qualify for subsidies.

 

I pay well over 9.5% of my income for my family's insurance, I fall within 400% of the poverty federal level, and I am not eligible for a subsidy or tax credit because of this loophole.  I have friends in the same situation.

[QueenCat]

Yes, except... the % is calculated using employee-only coverage, but it's the family premiums that will put most families over the limit.  Yet, if you can enroll your family, you have "access" to employer based insurance even if the employer pays zero toward the premiums.  It's a real kick in the teeth for people who were expecting to qualify for subsidies.

 

I pay well over 9.5% of my income for my family's insurance, I fall within 400% of the poverty federal level, and I am not eligible for a subsidy or tax credit because of this loophole.  I have friends in the same situation.

 

Oh, I didn't know that.... I'm not seeing that info on the Kaiser site......... I won't be using the exchange so I hadn't looked at it to find answers to important questions. Hopefully, that will be something that changes once our lawmakers see what a real issue that is... I wonder if it's something they decide or if it's part of rules/regulations determined by the bureaucracy......... Double check with the navigators, they may be able to help you, or at least be able to see to the powers that be "we have a problem".

[LizzyBee]

Oh, I didn't know that.... I'm not seeing that info on the Kaiser site......... I won't be using the exchange so I hadn't looked at it to find answers to important questions. Hopefully, that will be something that changes once our lawmakers see what a real issue that is... I wonder if it's something they decide or if it's part of rules/regulations determined by the bureaucracy......... Double check with the navigators, they may be able to help you, or at least be able to see to the powers that be "we have a problem".

 

It's in the IRS regulation.  Congress writes the laws, other agencies interpret them.  The law is ambigous, the IRS wrote its regulation based on what they think the law means, and if they didn't accurately interpret it, Congress will have to pass legislation to fix it.  Or a court could re-interpret the law if someone wants to challenge it by claiming an exemption from the penalty based on total premiums as a % of income rather than employee only premiums.

 

[QueenCat]

It's in the IRS regulation.  Congress writes the laws, other agencies interpret them.  The law is ambigous, the IRS wrote its regulation based on what they think the law means, and if they didn't accurately interpret it, Congress will have to pass legislation to fix it.  Or a court could re-interpret the law if someone wants to challenge it by claiming an exemption from the penalty based on total premiums as a % of income rather than employee only premiums.

 

 

I do understand the process :)  I was just wondering in this specific instance, where it came from. It makes sense that the IRS made these specific "qualifiers".....

[StephanieZ]

I know healthcare.gov has been a mess.

 

This is the site I was able to use yesterday to check out the WV plans. It is very easy to navigate, and can give you an idea of your options while we wait for the .gov site to catch up to the demand and get straightened out.

 

http://www.valuepenguin.com/ppaca/exchanges/

 

I hope some of you find great plans for great prices!! 

[hsmamainva]

Update #3 --- Application still says "in process" so my hubby called the 1-800 number.

 

He was told that we would hear something in the mail *IN THREE WEEKS* if we have been "approved"!!!  :cursing:

 

So I guess we won't be able to look online and pick our plans and all that stuff for awhile!  This stinks!

 

 

[VaKim]

Were we supposed to get some kind of letter from employers by October 1 regarding this stuff? Or was that only for companies of a certain size, etc.? My dh still hasn't gotten anything from his employer. I told him to ask, but he is currently working night shift, and the office isn't open then. Might have him call today.

[Scarlett]

Were we supposed to get some kind of letter from employers by October 1 regarding this stuff? Or was that only for companies of a certain size, etc.? My dh still hasn't gotten anything from his employer. I told him to ask, but he is currently working night shift, and the office isn't open then. Might have him call today.

Dh got the letter at work. Very small company...under 20 employees.

[NicksMama-Zack's Mama Too]

Update #3 --- Application still says "in process" so my hubby called the 1-800 number.

 

He was told that we would hear something in the mail *IN THREE WEEKS* if we have been "approved"!!!  :cursing:

 

So I guess we won't be able to look online and pick our plans and all that stuff for awhile!  This stinks!

 

That's weird.  A friend of mine lives in Alexandria, VA and was able to talk with someone yesterday - she got quotes (not good ones, apparently).  Here's her Facebook post about it.

 

"Just for fun, i called a healthcare.gov representative to get some pricing on insurance. My family will be losing their healthcare coverage soon. After asking a few questions i receive outrageous pricing on a plan that doesn't even come close to what i have now. I told the representative i can't afford that and will have to go without insurance. She said "i'm so sorry. Have i answered all your questions today?"

 

 

Why are people receiving different information?

[NicksMama-Zack's Mama Too]

I know healthcare.gov has been a mess.

 

This is the site I was able to use yesterday to check out the WV plans. It is very easy to navigate, and can give you an idea of your options while we wait for the .gov site to catch up to the demand and get straightened out.

 

http://www.valuepenguin.com/ppaca/exchanges/

 

I hope some of you find great plans for great prices!! 

 

The Virginia link does not provide a details (deductibles, copays, out-of-pocket) about the plans.  It's funny, although my best friend's income is 25% higher than mine, she gets a subsidy and I don't!

[jelbe5]

Open enrollment at my husband's work will begin in two weeks - it is always at the end of October through mid November. HR sent an email with a link to a video that provided a simple explanation to ACA and basically said it will be better if we continue with the coverage through work. So the good news is the employer will offer coverage. The bad news is they are not providing any info right now on the cost or coverage. It is frustrating since I am sure they have already negotiated everything with the plans they will offer and have signed contracts with those insurance companies. So why not send us the info a little earlier this year? It makes me really nervous that we have not heard anything yet.

[HRAAB]

The Virginia link does not provide a details (deductibles, copays, out-of-pocket) about the plans.  It's funny, although my best friend's income is 25% higher than mine, she gets a subsidy and I don't!

 

Is it because you have employer based insured available?  That's the boat we're in.  Honestly, we could use a subsidy to pay for health insurance.  We're not desperate, but it's getting closer with each increase.  That's why I'm hoping for a comparable premium with what I'm paying now but with better coverage.  My coverage absolutely stinks.

[LizzyBee]

Were we supposed to get some kind of letter from employers by October 1 regarding this stuff? Or was that only for companies of a certain size, etc.? My dh still hasn't gotten anything from his employer. I told him to ask, but he is currently working night shift, and the office isn't open then. Might have him call today.

 

Most employers with annual revenue of more than $500,000 were required to distribute the Marketplace Coverage Notice by October 1. 

 

http://www.dol.gov/ebsa/pdf/FLSAwithplans.pdf

[LizzyBee]

I know healthcare.gov has been a mess.

 

This is the site I was able to use yesterday to check out the WV plans. It is very easy to navigate, and can give you an idea of your options while we wait for the .gov site to catch up to the demand and get straightened out.

 

http://www.valuepenguin.com/ppaca/exchanges/

 

I hope some of you find great plans for great prices!! 

 

According to this website, for $395.14/month more than I'm already paying, I can get a plan for my dh and kids comparable to keeping them on my employer based insurance.  Humph.

[Word Nerd]

I checked the site listed above. The premiums are several hundred more than I'm paying now, even after our recent rate increase for my employer-provided plan, and no information about the deductible or coinsurance was available. 

[HRAAB]

I know healthcare.gov has been a mess.

 

This is the site I was able to use yesterday to check out the WV plans. It is very easy to navigate, and can give you an idea of your options while we wait for the .gov site to catch up to the demand and get straightened out.

 

http://www.valuepenguin.com/ppaca/exchanges/

 

I hope some of you find great plans for great prices!! 

 

I can't get this calculator to work for me, but I also noticed that my state is one of those that is white?  Hmmmm.....  Patience is not one of my outstanding virtues.

[LizzyBee]

Here is another useful guide to healthcare law by Consumer Reports:

 

http://www.consumerreports.org/cro/magazine/2013/11/showtime-for-health-care-reform/index.htm

 

 

Some folks mentioned paying about $1400/month under new law. Our family paid that much over 7 years ago when we had to buy insurance on the individual market.

 

I'm the one that mentioned that based on current projections, I'll be paying about $1400/month, more or less, when our policy renews next August.  But that's just the portion to have my family on the policy.  My employer pays what it would cost for me to have self-only coverage, which is currently $563.12/month.  The total monthly cost is already over $1,400 when we add employee + family premiums together.  But my point wasn't how much I'm paying or will be paying, but the projected 35-40% increase next year.

[CupOCoffee]

I am one of the lucky ones in this big mess.  My (large) employer will continue to offer 3 different types of plans (HMO, PPO, CDHP) for which they pay part of the premiums.  My employer also offered a Wellness program this past year, and if you participated in it and earned a certain amount of points, you earned a 15% discount on 2014 premiums.  Kicker is that the premiums did go up by 13% -- so the work that I put into earning the points, netted me a 2% discount.  I will actually pay $10 less per month for medical in 2014 than 2013.  Co-pay and coverage stayed the same, thank God again.  With 2 ppl in the house that have chronic illness issues, I am so very, very thankful for what I have.

 

My heart is breaking for all of you!  Really it saddens me so much to hear all that is going on with this hot mess!!  I pray and pray that things actually start to change and look better in the future.

 

~coffee~

[yinne]

Any idea which of these scenarios is correct?

 

I have been told by one insurance company that they can sell me a plan that would begin 12/31/13 and it would not have to be an ACA plan and because it was issued in 2013 I would not be subject to the penalty. End of 2014 I would need to find an ACA plan.

 

I was told by another insurance company that I would still be charged the penalty even though I had insurance because the plan isn't ACA approved.

 

Of course it is affordable

 

Yvonne in NE