Affordable Care Act -- NOT Affordable

[LizzyBee]

My cousin just got her renewal statement. Here's what she posted about it on FB.

 

"I just got my renewal message from Group Health. My premiums are going up by about 85%, the deductible is increasing by 45%, and my out of pocket is increasing also. As far as I can see the only benefit that will increase, for me, will be that I get prescriptions covered, but only after I've paid the 4K deductible. I might just have to drop health insurance."

 

She lives in Washington State and is in her mid-forties. Single, no kids.

 

My facebook is blowing up with friends getting these letters. For some of them, the rates have more than doubled.

 

On the LLS forums, someone posted not to pay attention to the negativity because politicians are spreading false information.  That comment rubbed me the wrong way, because I don't know what the politicians are saying, but I do know that a lot of my friends can no longer afford their insurance.

 

[creekland]

In our state, it's illegal to charge people who don't have insurance less than you bill insurance companies.  

 

Glad this is not true in the two states we deal with!

[Snickerdoodle]

In our state, it's illegal to charge people who don't have insurance less than you bill insurance companies.

 

Back in the day, we called this insurance fraud.

Some doctors will code things differently for uninsured patients (Level III appt for the insured but Level I for uninsured)

 

Which is how I remember it too.

[ChocolateReignRemix]

We have BCBS Federal and I have been waiting for a letter since reading this thread and posts on Facebook. But I haven't gotten one yet. I did Google it, and found some articles saying that our rates are going up about 4%, really only a few dollars. Does anyone else have the same and hear/read something different?

 

Also, so, these exchanges.... They open on Tuesday? Where do you go to look at your options and pick a plan? My sister is low income and needs insurance. They don't have a computer, so I'd like to point her in the right direction. Is it some website, or something? I haven't paid attention to this stuff at all....

 

You should be able to find your rates on opm.gov, but that number for BCBS sounds about right.

[ChocolateReignRemix]

I take it you are under the FEHB (Federal Employees Health Benefit) system? Yes, I read that there will be a 4% increase for those under FEHB. A sweet deal if you ask me. I am speaking as a person who is currently under the FEHB, but was in the private industry for 20 years.

 

I wonder how much sympathy we will get when the government shut-down occurs if people consider what a nice deal we (Federal employees) get on health insurance.

 

FEHB covers a wide variety of plans, and the rate change varies by plan.  Some are going up much more than others, depending on what company and the type of coverage.  As far as the "nice deal" federal employees receive on health insurance, again it varies but is fairly consistent with the packages offered by many large corporations with a professional workforce.

[ChocolateReignRemix]

Yes, it's FEHB. Thanks, just wondering if anyone else had received one of those letters. Sometimes I just put stuff from BCBS straight into the shredder b/c it's just "explanation of benefits" junk. Was starting to worry that I shredded something important.

 

I'm hoping the government doesn't shut down. DH does national security stuff, so he would still have to go to work, but just not get paid. And we really need to get paid, lol!

 

Will our health insurance not work if the govt. shuts down?

 

I'm not sure what you mean about sympathy.

 

Your insurance will still work, so no worries there.

[NicksMama-Zack's Mama Too]

Yes, it's FEHB. Thanks, just wondering if anyone else had received one of those letters. Sometimes I just put stuff from BCBS straight into the shredder b/c it's just "explanation of benefits" junk. Was starting to worry that I shredded something important.

 

I'm hoping the government doesn't shut down. DH does national security stuff, so he would still have to go to work, but just not get paid. And we really need to get paid, lol!

 

I feel your pain. However, I was a federal employee back in the 80's and we had a few days off due to a government shut down. In the end, after the smoke cleared, we were paid. I'm not sure that will happen again, but it wouldn't surprise me.

 

Will our health insurance not work if the govt. shuts down?

Your health insurance will continue, even if there is a shutdown. Your premiums will continue to accrue and you will play catch when your paychecks continue. Keep in mind, I've never been through a shutdown that lasted more that 2 or 3 days. Like I said, we frequently end up being paid anyway.

 

I'm not sure what you mean about sympathy.

 

I have friends who have had similar policies and pay 100% of their premiums and have seen a huge increase in their premiums for 2014. Some own businesses and have been suffering through this bad economy on top of rising costs. They don't feel bad if federal workers get a taste of the bad economy for a few days.

[creekland]

Back in the day, we called this insurance fraud.

 

I don't know that it's fraud.  The offices we've dealt with have all given us a discount saying it costs them less to simply get paid for their services and not have to take the time to send anything through insurance.  They are merely passing on their savings to us - which we appreciate.  I'm sure it's not necessarily a 25 - 30% savings in time alone - they also are likely to know how much they are actually going to get from insurance.

 

FWIW, if we paid on a payment plan, we pay the full cost.

[*lifeoftheparty*]

.

 

[ChocolateReignRemix]

 

Yes, it's FEHB. Thanks, just wondering if anyone else had received one of those letters. Sometimes I just put stuff from BCBS straight into the shredder b/c it's just "explanation of benefits" junk. Was starting to worry that I shredded something important.

 

I'm hoping the government doesn't shut down. DH does national security stuff, so he would still have to go to work, but just not get paid. And we really need to get paid, lol!

 

I feel your pain. However, I was a federal employee back in the 80's and we had a few days off due to a government shut down. In the end, after the smoke cleared, we were paid. I'm not sure that will happen again, but it wouldn't surprise me.

 

Will our health insurance not work if the govt. shuts down?

Your health insurance will continue, even if there is a shutdown. Your premiums will continue to accrue and you will play catch when your paychecks continue. Keep in mind, I've never been through a shutdown that lasted more that 2 or 3 days. Like I said, we frequently end up being paid anyway.

 

I'm not sure what you mean about sympathy.

 

I have friends who have had similar policies and pay 100% of their premiums and have seen a huge increase in their premiums for 2014. Some own businesses and have been suffering through this bad economy on top of rising costs. They don't feel bad if federal workers get a taste of the bad economy for a few days.

 

 

lol Yeah federal workers are just rolling in the dough.

 

[ChrisOR]

We haven't gotten our group health/company plan info yet.  This is through a Fortune 500 company, a very well-known name.  My husband called and got this answer: "we don't have info to give to you."   He did find out that our open enrollment is November this year, but there was neither a letter sent about that nor any notice on their benefits website about the date.  I think that is bizarre, considering everything this year.  

 

Our insurance premiums have gone up about 400% in the past 15 years, so we're not getting our plan cheaply though I know now that it is just slightly less than the state marketplace will be offering.  

[Paige]

In our state, it's illegal to charge people who don't have insurance less than you bill insurance companies.  The difference is that insurance companies have negotiated rates so they pay less than the bill, but the uninsured patient has to pay the whole thing.

I think this is a significant factor to our whole insurance/health care/ rising costs problems. Insurance companies refuse to pay a normal rate- they want to pay less than they should. But most people have insurance...and most insurances don't want to pay- they want to negotiate a lower bill- so providers have had to respond. They respond by inflating the price to some insane rate and then let the insurance pay 10-20% of that. Anyone without insurance has to pay the inflated price. The providers would like to have them pay the same as insurance, but that's now insurance fraud? People see the insane bill and say "screw it all!" and don't pay whereas if the bill was more reasonable, they'd probably be more likely to pay. It should be illegal for the doctor to charge people more than what the insurance company is actually paying!

[ktgrok]

No wonder insurance companies were so on board with Obamacare, they can price gouge us now more than ever and we are legally required to purchase their crappy product!  What a racket.

 

Actually Obama care limits how much they can spend on overhead. If they don't spend at least 80% on actual medical costs they have to send you a refund. 

[HRAAB]

I feel like I have a 100 dumb questions about the ACA. Little by little I'm trying to figure it out, but no matter how man FAQs I read, I can't find all my anwers. I have an individual plan for me and the kids (dh has his through work - too expensive to put the family on), and I want to compare my current premium/benefits with what is available. However, my policy doesn't renew until June 2014. So I guess I can sit still and not do anything, but I'm afraid next June my premium will have taken a big increase, and then I'll be stuck with it until the next open enrollment.

 

Also, since I'm not employed I don't have employer provided insurance so I'm assuming I'm eligible to look on the exchange. Dh has employer insurance so he's not eligible for the exchange unless his premium exceeds a certain percentage of his income. Because I'm his spouse and his employer offers insurance, would I still be able to go to the exchange?

 

Like I said, dumb questions, but it's the dumb ones that just drive me over the edge.

[LizzyBee]

I feel like I have a 100 dumb questions about the ACA. Little by little I'm trying to figure it out, but no matter how man FAQs I read, I can't find all my anwers. I have an individual plan for me and the kids (dh has his through work - too expensive to put the family on), and I want to compare my current premium/benefits with what is available. However, my policy doesn't renew until June 2014. So I guess I can sit still and not do anything, but I'm afraid next June my premium will have taken a big increase, and then I'll be stuck with it until the next open enrollment.

 

Also, since I'm not employed I don't have employer provided insurance so I'm assuming I'm eligible to look on the exchange. Dh has employer insurance so he's not eligible for the exchange unless his premium exceeds a certain percentage of his income. Because I'm his spouse and his employer offers insurance, would I still be able to go to the exchange?

 

Like I said, dumb questions, but it's the dumb ones that just drive me over the edge.

 

Even though your insurance renewal date is June, you should be able to drop it any time.  So if you can get a better deal on the exchange, you should be able to drop your current policy with no penalty. 

 

My understanding is that your dh can buy insurance on the exchange, but would not be eligible for a subsidy.  But since his employer doesn't pay for dependents' premiums, you and the kids should be able to get the subsidy if you qualify based on income.

[Liberty]

Just got a call from my brother who lives in Michigan.  He is self employed (can't even afford employees) and was paying to self insure him and his wife for $500/month with a $5,000 deductible (not ideal, but they have many health issues as they are in their 50's, so was better than no insurance at all).  He got his letter stating that under the new law his rate will now be $1,050 per month with the same $5,000 deductible.  He is completely distraught.  He says he can't afford it and may just pay the $90 penalty and go without insurance and just pray they don't get cancer or something.

 

What were the politicians thinking?  Obviously it wasn't to reduce the cost of health care for normal everyday people.....

[Peach]

Here's what the Montana coop calculator gave me:

 

Family of 5. If we made around 35000, we qualify for subsidies. Insurance for hubby and I (kids are covered now) would be 58/month. Since we make much less, it shows no subsidies at all, monthly cost  $718. Since the Supreme Court made expanding Medicaid optional, Montana hasn't done it yet (there was a stupid voting snafu and now they are discussing special sessions and ballot initiatives), we don't qualify for Medicaid normally. We certainly can't afford this...it's more than our rent for on campus grad housing. 

[Mommy22alyns]

Here's what the Montana coop calculator gave me:

 

Family of 5. If we made around 35000, we qualify for subsidies. Insurance for hubby and I (kids are covered now) would be 58/month. Since we make much less, it shows no subsidies at all, monthly cost  $718. Since the Supreme Court made expanding Medicaid optional, Montana hasn't done it yet (there was a stupid voting snafu and now they are discussing special sessions and ballot initiatives), we don't qualify for Medicaid normally. We certainly can't afford this...it's more than our rent for on campus grad housing. 

 

 

Similar situation here, and it really sucks.  I thought this whole thing was to help people like us.

[Scrub Jay]

We have an excellent insurance plan through the Writer's Guild but DH decided, for fun, to figure out what we would pay through Obamacare.  It was 1/3 of what we were paying when I carried the insurance (HMO) a few years ago.  And that insurance wasn't anything to write home about.

 

So if I was still the insurance carrier then Obamacare would have saved us a few thousand a year.

[*lifeoftheparty*]

.

[Elfknitter.#]

Well, I live in a state that is extending Medicare to include more people. However, we're on the cusp of not being poor enough. With the new Medicare limits, our kids will be fully covered. Dh and I will need to purchase insurance on the exchange. If we want this coverage onto extend to the kids, we can opt to pay the full price and forego any subsidies. So we can pay full price and all be on the same insurance or we can just pay for dh and myself to get the subsidies and have the kids on Medicare. I personally find all of this to be extremely hair pulling.

[LizzyBee]

Even though your insurance renewal date is June, you should be able to drop it any time.  So if you can get a better deal on the exchange, you should be able to drop your current policy with no penalty. 

 

My understanding is that your dh can buy insurance on the exchange, but would not be eligible for a subsidy.  But since his employer doesn't pay for dependents' premiums, you and the kids should be able to get the subsidy if you qualify based on income.

 

I did some research and found out this isn't accurate.  If you have access to your dh's employer-based insurance, you can't get subsidies even if the employer doesn't pay one penny toward the premiums for you and your kids.  That just sucks.  A whole lotta people who thought they were going to be able to afford insurance in 2014 are going to be sorely disappointed.

 

[FeFe]

Our monthly premium went up and our ability to utilize saving in our Medical Savings (FSA) went down considerably - which costs us more. 

 

So frustrating and I don't see HOW this is helping anyone. There are several companies around here that are laying people off too.

[ChocolateReignRemix]

I did some research and found out this isn't accurate.  If you have access to your dh's employer-based insurance, you can't get subsidies even if the employer doesn't pay one penny toward the premiums for you and your kids.  That just sucks.  A whole lotta people who thought they were going to be able to afford insurance in 2014 are going to be sorely disappointed.

 

 

They would be eligible for subsidies if the premiums were above 9.5% of income, but otherwise you are correct.

[LizzyBee]

They would be eligible for subsidies if the premiums were above 9.5% of income, but otherwise you are correct.

 

But... 2 different websites I checked, including the federal Dept of Labor, say that the 9.5% limit is calculated using only the employee portion of the premium.  The cost of adding the family is not included. 

 

Here is the dilemma that creates.... I pay 14.5% of my income to have my dh and kids on my employer based policy.  But the employee only portion is nowhere close to 9.5%, and my employer pays all of it except $1/month.  So we are ineligible for any subsidies for the insurance premiums we pay for dh and the kids.

 

We can still shop the exchange but we won't get any subsidies.  The online estimator for the NC exchange says that we will pay over $1,000/mo for a silver plan.  I already pay a little over $1,000/mo for a much better plan, so based on the sketchy information that is available so far, there doesn't appear to be any reason for us to switch to the exchange.  But.... on August 1, 2014, BCBS has predicted that our premium increase will be about 40%.  That means premiums for my family will increase to about $1400-$1500, but the exchanges won't have open enrollment again until Oct 1.  And even on the exchange, if a get a plan that is comparable to the one my employer offers, I will probably be paying the same $1400-$1500/month, considering that the silver plan will be over $1,000/mo.  So do families use their money to have insurance while eating rice and beans daily and wrecking their health, or do they drop insurance and eat fresh produce and high quality meats and pray they don't get sick?

 

I said from the beginning that people are going to be disappointed when all the provisions of the AFA go into effect and they realize what the bill really is.  At this point, I feel sick inside because I think it's going to be even worse than I thought.  We live very frugally because health insurance is a high priority for us; I'm on medication that costs $9,611/month.  We never thought that would happen to me, and I don't want to take any chances on having it happen to a family member and being uninsured.  But a lot of people just can't afford insurance  no matter how frugally they live, and so many families are going to caught in situations where the AFA won't help them.  As for the employer-based insurance catch, I have other friends in real life who are in the same situation.  Our premiums are increasing or will increase because of AFA, yet we can't get any help from the AFA.

[yinne]

The "Free Preventive Services" complements of The unAffordable Care Act. Can you really call them "Free" when I would have to pay $1100/month (Bronze Plan) to get them? The government must use a different dictionary than I do! No wonder premiums are skyrocketing. Also notice how many of them are lifestyle choice decisions. (I did not make this list up or the wording --- came directly from the government's health care website.)

 

I have also been on the phone with BCBS the past couple of days and basically they told me there are winners or losers -- no one in the middle.   This law either benefits you or you are paying big time for it.

 

Yvonne

 

 

Free preventive services

All Marketplace plans and many other plans must cover the following list of preventive services without charging you a copayment or coinsurance. This is true even if you haven’t met your yearly deductible. This applies only when these services are delivered by a network provider.

1. Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
2. Alcohol Misuse screening and counseling
3. Aspirin use to prevent cardiovascular disease for men and women of certain ages
4. Blood Pressure screening for all adults
5. Cholesterol screening for adults of certain ages or at higher risk
6. Colorectal Cancer screening for adults over 50
7. Depression screening for adults
8. Diabetes (Type 2) screening for adults with high blood pressure
9. Diet counseling for adults at higher risk for chronic disease
10. HIV screening for everyone ages 15 to 65, and other ages at increased risk
11. Immunization vaccines for adults--doses, recommended ages, and recommended populations vary:
o Hepatitis A
o Hepatitis B
o Herpes Zoster
o Human Papillomavirus
o Influenza (Flu Shot)
o Measles, Mumps, Rubella
o Meningococcal
o Pneumococcal
o Tetanus, Diphtheria, Pertussis
o Varicella
12. Obesity screening and counseling for all adults
13. Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
14. Syphilis screening for all adults at higher risk
15. Tobacco Use screening for all adults and cessation interventions for tobacco users

Comprehensive coverage for women’s preventive care

All Marketplace health plans and many other plans must cover the following list of preventive services for women without charging you a copayment or coinsurance. This is true even if you haven’t met your yearly deductible. This applies only when these services are delivered by an in-network provider.
1. Anemia screening on a routine basis for pregnant women
2. Breast Cancer Genetic Test Counseling (BRCA) for women at higher risk for breast cancer
3. Breast Cancer Mammography screenings every 1 to 2 years for women over 40
4. Breast Cancer Chemoprevention counseling for women at higher risk
5. Breastfeeding comprehensive support and counseling from trained providers, and access to breastfeeding supplies, for pregnant and nursing women
6. Cervical Cancer screening for sexually active women
7. Chlamydia Infection screening for younger women and other women at higher risk
8. Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt “religious employers.â€
9. Domestic and interpersonal violence screening and counseling for all women
10. Folic Acid supplements for women who may become pregnant
11. Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes
12. Gonorrhea screening for all women at higher risk
13. Hepatitis B screening for pregnant women at their first prenatal visit
14. HIV screening and counseling for sexually active women
15. Human Papillomavirus (HPV) DNA Test every 3 years for women with normal cytology results who are 30 or older
16. Osteoporosis screening for women over age 60 depending on risk factors
17. Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
18. Sexually Transmitted Infections counseling for sexually active women
19. Syphilis screening for all pregnant women or other women at increased risk
20. Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users
21. Urinary tract or other infection screening for pregnant women
22. Well-woman visits to get recommended services for women under 65

Coverage for children’s preventive health services

All Marketplace health plans and many other plans must cover the following list of preventive services for children without charging you a copayment or coinsurance. This is true even if you haven’t met your yearly deductible.
1. Autism screening for children at 18 and 24 months
2. Behavioral assessments for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
3. Blood Pressure screening for children at the following ages: 0 to 11 months, 1 to 4 years , 5 to 10 years, 11 to 14 years, 15 to 17 years.
4. Cervical Dysplasia screening for sexually active females
5. Depression screening for adolescents
6. Developmental screening for children under age 3
7. Dyslipidemia screening for children at higher risk of lipid disorders at the following ages: 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
8. Fluoride Chemoprevention supplements for children without fluoride in their water source
9. Gonorrhea preventive medication for the eyes of all newborns
10. Hearing screening for all newborns
11. Height, Weight and Body Mass Index measurements for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
12. Hematocrit or Hemoglobin screening for children
13. Hemoglobinopathies or sickle cell screening for newborns
14. HIV screening for adolescents at higher risk
15. **Hypothyroidism screening for newborns
16. Immunization vaccines for children from birth to age 18 —doses, recommended ages, and recommended populations vary:
o Diphtheria, Tetanus, Pertussis
o Haemophilus influenzae type b
o Hepatitis A
o Hepatitis B
o Human Papillomavirus
o Inactivated Poliovirus
o Influenza (Flu Shot)
o Measles, Mumps, Rubella
o Meningococcal
o Pneumococcal
o Rotavirus
o Varicella
17. Iron supplements for children ages 6 to 12 months at risk for anemia
18. Lead screening for children at risk of exposure
19. Medical History for all children throughout development at the following ages: 0 to 11 months, 1 to 4 years , 5 to 10 years , 11 to 14 years , 15 to 17 years.
20. Obesity screening and counseling
21. Oral Health risk assessment for young children Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years.
22. Phenylketonuria (PKU) screening for this genetic disorder in newborns
23. Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents at higher risk
24. Tuberculin testing for children at higher risk of tuberculosis at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
25. Vision screening for all children.

[Susan in TX]

This is just depressing: Forbes Article

 

"The second problem that will become obvious as the program is fully implemented is the unfairness of the subsidies provided by Obamacare. If an employer offers its workers health insurance, but an employee turns it down because the cost is too high, that worker is not eligible for a government subsidy in the health care exchanges. Thus, two families with the same income could pay very different rates for their health insurance because one was offered insurance at their job and the other was not."

 

And this

 

"For months, we’ve heard about how Obamacare’s trillions in health care subsidies were going to save America from rate shock. It’s not true. If you shop for coverage on your own, you’re likely to see your rates go up, even after accounting for the impact of pre-existing conditions, even after accounting for the impact of subsidies."

 

Susan in TX

[NoPlaceLikeHome]

This NY Times article has useful info on the health care law:

 

http://www.nytimes.com/2013/09/28/your-money/health-insurance/a-guide-to-the-new-health-insurance-exchanges.html?hpw

[NoPlaceLikeHome]

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.

[Scarlett]

I have been looking at the http://kff.org/interactive/subsidy-calculator

 

Is the amount given for the family or per person?

[texasmama]

Is the income asked for in order to determine subsidies taxable or gross income?

 

We have no employer health insurance as an option. Our current individual policy will be going from $582 a month to over $1200 in January. Got the letter from the insurance company today.

[Scarlett]

Is the income asked for in order to determine subsidies taxable or gross income?

 

We have no employer health insurance as an option. Our current individual policy will be going from $582 a month to over $1200 in January. Got the letter from the insurance company today.

It is MAGI.

[HRAAB]

I did some research and found out this isn't accurate.  If you have access to your dh's employer-based insurance, you can't get subsidies even if the employer doesn't pay one penny toward the premiums for you and your kids.  That just sucks.  A whole lotta people who thought they were going to be able to afford insurance in 2014 are going to be sorely disappointed.

 

 

Could you provide a link to this information.  I've been searching and asking people, and you're the first one with an actual answer.

 

This is our exact situation.  Dh's employer pays part of his premium but none towards the children or me; that's why I had to opt for individual policy for the kids and me - high deductible with poor coverage (no lab costs, no office visits, no prescriptions etc.).  Plus, I got a letter from my insurer informing me that since my policy was grandfather, it would be exempt from some of the ACA requirements.  I read this to mean that it still wouldn't cover lab work and such.

 

I'm thinking though that if he had the entire family on his insurance, it would exceed 9% of his income so that would mean we would be eligible to go to the exchange.

 

I'm getting way too stressed over this.  It's just so frustrating.

[texasmama]

It is MAGI.

Thank you.

[HRAAB]

But... 2 different websites I checked, including the federal Dept of Labor, say that the 9.5% limit is calculated using only the employee portion of the premium.  The cost of adding the family is not included. 

 

Here is the dilemma that creates.... I pay 14.5% of my income to have my dh and kids on my employer based policy.  But the employee only portion is nowhere close to 9.5%, and my employer pays all of it except $1/month.  So we are ineligible for any subsidies for the insurance premiums we pay for dh and the kids.

 

We can still shop the exchange but we won't get any subsidies.  The online estimator for the NC exchange says that we will pay over $1,000/mo for a silver plan.  I already pay a little over $1,000/mo for a much better plan, so based on the sketchy information that is available so far, there doesn't appear to be any reason for us to switch to the exchange.  But.... on August 1, 2014, BCBS has predicted that our premium increase will be about 40%.  That means premiums for my family will increase to about $1400-$1500, but the exchanges won't have open enrollment again until Oct 1.  And even on the exchange, if a get a plan that is comparable to the one my employer offers, I will probably be paying the same $1400-$1500/month, considering that the silver plan will be over $1,000/mo.  So do families use their money to have insurance while eating rice and beans daily and wrecking their health, or do they drop insurance and eat fresh produce and high quality meats and pray they don't get sick?

 

I said from the beginning that people are going to be disappointed when all the provisions of the AFA go into effect and they realize what the bill really is.  At this point, I feel sick inside because I think it's going to be even worse than I thought.  We live very frugally because health insurance is a high priority for us; I'm on medication that costs $9,611/month.  We never thought that would happen to me, and I don't want to take any chances on having it happen to a family member and being uninsured.  But a lot of people just can't afford insurance  no matter how frugally they live, and so many families are going to caught in situations where the AFA won't help them.  As for the employer-based insurance catch, I have other friends in real life who are in the same situation.  Our premiums are increasing or will increase because of AFA, yet we can't get any help from the AFA.

 

This is my other concern.  I can keep my current individual policy, but my fear is the premium will increase will be so great, that we will be totally strapped paying it, and open enrollment won't happen until Oct 2014.  How did you find out what the potential premium increases are?  BCBS has not sent me any information regarding potential increases.  I don't know how we would handle a 40% increase on my policy plus no telling how much dh's premium might increase.  

[LizzyBee]

Could you provide a link to this information.  I've been searching and asking people, and you're the first one with an actual answer.

 

This is our exact situation.  Dh's employer pays part of his premium but none towards the children or me; that's why I had to opt for individual policy for the kids and me - high deductible with poor coverage (no lab costs, no office visits, no prescriptions etc.).  Plus, I got a letter from my insurer informing me that since my policy was grandfather, it would be exempt from some of the ACA requirements.  I read this to mean that it still wouldn't cover lab work and such.

 

I'm thinking though that if he had the entire family on his insurance, it would exceed 9% of his income so that would mean we would be eligible to go to the exchange.

 

I'm getting way too stressed over this.  It's just so frustrating.

 

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

 

Look near the bottom.  "If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income...."

 

http://www.aon.com/attachments/thought-leadership/IRS_Proposes_Rules_Federal_Subsidy_Health_Insurance.pdf

 

See page 3 of this document.

 

http://www.healthcareshopper.com/advice/

 

See the first question of the last link.

[LizzyBee]

This is my other concern.  I can keep my current individual policy, but my fear is the premium will increase will be so great, that we will be totally strapped paying it, and open enrollment won't happen until Oct 2014.  How did you find out what the potential premium increases are?  BCBS has not sent me any information regarding potential increases.  I don't know how we would handle a 40% increase on my policy plus no telling how much dh's premium might increase.  

 

When we renewed in August, we had a staff meeting with our health insurance agent.  Our premium increase this year would have been 16%, but the firm opted for an increased deductible instead.  The agent said that the projected increase for employer plans in 2014 is at least 35-40%.  It's just a guess at this point.

 

Basing affordability of an employer on the employee only premium when it's family coverage that is usually more expensive is just asinine.  It seems like they are trying to incentivize employees to request that their employers stop offering health insurance as a tactic to force more people into the exchange. 

[HRAAB]

I'll be interested to see what dh's company has to say.  Right now they pay 50% of the lowest premium for the employee; you can't opt for a better policy, but they still pay 50% based on the lowest premium.  A 35-40% increase on dh's policy might make it dang near unaffordable.

 

I hate to say it, but I'm beginning to wonder if we would be better off if his employer decides to quit offering health insurance.  

 

Thank you for the links - not that they've made me happy.  Quite the opposite.

[LizzyBee]

It is MAGI.

 

http://laborcenter.berkeley.edu/healthcare/MAGI_summary13.pdf

 

Here's a chart from UCBerkeley with more info.  However, I think there might be a mistake in it.  It says that the nontaxable portion of social security benefits has to be added back to AGI in the calculation of MAGI.  However, I think the IRS regulation says that the nontaxable portion of social security benefits doesn't have to be added back.  But the reg is 73 pages long written in lawyerese, so I'm not going to look it up again to see whether it's me or Berkeley that is in incorrect. :tongue_smilie:

[LizzyBee]

I'll be interested to see what dh's company has to say.  Right now they pay 50% of the lowest premium for the employee; you can't opt for a better policy, but they still pay 50% based on the lowest premium.  A 35-40% increase on dh's policy might make it dang near unaffordable.

 

I hate to say it, but I'm beginning to wonder if we would be better off if his employer decides to quit offering health insurance.  

 

Thank you for the links - not that they've made me happy.  Quite the opposite.

 

I was thinking today that we might be better off if my employer refused to enroll dependents.  But at least one of the partners has a family on the policy, and he won't be eligible for subsidies if he moves his family to the exchange because their income will be too high, so I'm sure they won't change firm policy to prevent families from enrolling.  There's another employee (single mom) who has her daughter on her policy and money is really tight for her.  I bet she'd be better off if she could shop the exchange and get a subsidy for her daughter's insurance, too.

 

Until today, I didn't realize how much we were paying for insurance as a percentage of our gross income, and how high that percentage could be next year.  No wonder we always feel broke even though I think I make a great salary.

 

You're welcome for the links.

[flyingiguana]

I've found this (in answer to the question about subsidies for families if one member of the family can cover the rest on his/her employer based plan):

https://www.healthcare.gov/what-if-i-have-job-based-health-insurance/

But I'm not sure what it means.

 

Kaiser has this: "In general, employees who are offered insurance through work are not eligible for subsidized exchange coverage, so long as their insurance meets specified requirements. You would only be eligible for subsidized exchange coverage if your income is between 1 and 4 times the federal poverty level and you would have to pay more than 9.5% of your household income for your own coverage through the insurance offered by your employer."

 

But the family isn't an employee, so it still seems vague to me.  What am I missing?

 

But then there's this article: http://medcitynews.com/2013/09/millions-of-americans-with-employer-provided-health-insurance-may-be-better-off-with-subsidized-aca-plans/

"Roughly "37 million people would be financially better off switching to the exchange" from employer-sponsored insurance, said Dr. Jay Bhattacharya of Stanford School of Medicine, who led the study.

"The reason is that these workers would qualify for substantial subsidies to buy exchange insurance," he said. As a result, the subsidized Obamacare premium will be less than what they pay for employer-based insurance. The cost to the federal treasury if all 37 million switch: $132 billion a year in subsidies, according to the study."

 

So you can dump the employer plan if you choose and then qualify for the subsidies?  But this seems contrary to what other sites are saying.  (Which is that you can dump the employer based plan, but you won't get subsidies.)

 

Or is there just a lot of misinformation out there?  Problem is knowing which one is right.

[NicksMama-Zack's Mama Too]

Basing affordability of an employer on the employee only premium when it's family coverage that is usually more expensive is just asinine.  It seems like they are trying to incentivize employees to request that their employers stop offering health insurance as a tactic to force more people into the exchange.

The "tin-foil-hat people" have been saying this for months.

[LizzyBee]

The "tin-foil-hat people" have been saying this for months.

 

Yep.  As my husband says about conspiracy theories, it's not paranoia if it's true.  I think it's a line or paraphrase from a movie.

 

[LizzyBee]

I've found this (in answer to the question about subsidies for families if one member of the family can cover the rest on his/her employer based plan):

https://www.healthcare.gov/what-if-i-have-job-based-health-insurance/

But I'm not sure what it means.

 

Kaiser has this: "In general, employees who are offered insurance through work are not eligible for subsidized exchange coverage, so long as their insurance meets specified requirements. You would only be eligible for subsidized exchange coverage if your income is between 1 and 4 times the federal poverty level and you would have to pay more than 9.5% of your household income for your own coverage through the insurance offered by your employer."

 

But the family isn't an employee, so it still seems vague to me.  What am I missing?

 

But then there's this article: http://medcitynews.com/2013/09/millions-of-americans-with-employer-provided-health-insurance-may-be-better-off-with-subsidized-aca-plans/

"Roughly "37 million people would be financially better off switching to the exchange" from employer-sponsored insurance, said Dr. Jay Bhattacharya of Stanford School of Medicine, who led the study.

"The reason is that these workers would qualify for substantial subsidies to buy exchange insurance," he said. As a result, the subsidized Obamacare premium will be less than what they pay for employer-based insurance. The cost to the federal treasury if all 37 million switch: $132 billion a year in subsidies, according to the study."

 

So you can dump the employer plan if you choose and then qualify for the subsidies?  But this seems contrary to what other sites are saying.  (Which is that you can dump the employer based plan, but you won't get subsidies.)

 

Or is there just a lot of misinformation out there?  Problem is knowing which one is right.

 

To answer the bolded question, an IRS ruling that "access" to employer-based insurance includes family coverage regardless of whether the employer pays a penny toward the family's coverage.  This, combined with the 9.5% of income limit being based on self-only coverage, is going to be devastating to families that would otherwise qualify for subsidies.  Assuming that the AFA stands and is not defunded, Congress needs to fix this.  But I think they're too busy arguing about the bill as a whole to stop and focus on this detail that pretty much derails the intent of the AFA for a large segment of the population.

 

ETA: IRS has to interpret the law because they are responsible for collecting the "shared-responsibility payments" from uninsured persons.  Congress is the entity that has to say, no, that wasn't our intent and fix the ambiguity in the law itself.

[NoPlaceLikeHome]

More and more employers have been offering fewer people health insurance by only offering part time jobs for years before the healthcare reform act. Or they have been offering skimpier and skimpier plans that have increased almost every year long before this law passed. These actions by employers are all due to the fact that health care insurance premiums have been rising every year by unreasonable amounts. Frankly, I am for universal healthcare and I see this healthcare law as a tiny step in the right direction. Health insurance needs to be separated from employment IMHO to benefit not only employers but also employees.

 

Here is a great article about the many people who were trapped in jobs due to the need for health insurance who will now be free to start their businesses. I have met many people like this and our family experienced this as well.

 

http://www.nbcnews.com/health/quitting-obamacare-trapped-workers-may-seek-relief-new-health-exchanges-8C11277058

[NicAnn]

We'll, I'm a little pissed. Just reworked the calculator to be more accurate and change the state. It looks like we make too much for Medicaid (or state isn't expanding) and too little (yes too LITTLE) for subsidies. SO we can either pay 49.5% of our income for insurance or apply for a hardship waiver. Looks like the ACA isn't helping my family at all. I was looking forward to going to a dr this year.

[Scarlett]

We'll, I'm a little pissed. Just reworked the calculator to be more accurate and change the state. It looks like we make too much for Medicaid (or state isn't expanding) and too little (yes too LITTLE) for subsidies. SO we can either pay 49.5% of our income for insurance or apply for a hardship waiver. Looks like the ACA isn't helping my family at all. I was looking forward to going to a dr this year.

 

 

I really don't think the information and calculators are accurate at this point.  So just hang on and see what it says when the exchange opens tomorrow.  Even then don't panic.  (that is what I keep telling myself....;))

[HRAAB]

Dh said he read somewhere that the 9.5% was the top limit based on income so someone making $35,000 (just pulling a figure out) would not have to be paying in excess of 9.5% of their income - the percentage would be less.  This made sense since 9.5% of $80,000 is quite a bit different than 9.5% of $40,000.  However, he can't find it now.

[LizzyBee]

Dh said he read somewhere that the 9.5% was the top limit based on income so someone making $35,000 (just pulling a figure out) would not have to be paying in excess of 9.5% of their income - the percentage would be less.  This made sense since 9.5% of $80,000 is quite a bit different than 9.5% of $40,000.  However, he can't find it now.

 

http://101.communitycatalyst.org/aca_provisions/subsidies

 

There's a chart at this link that shows the percentages at the various income levels. 

 

The kicker that's going to keep a lot of families from getting subsidies is that the percentage is calculated using the employee's contribution for self-only coverage.  For me, that's $1, yet the actual % I pay is 13%. I am annoyed for myself, but I am flat out mad, mad, mad on behalf of friends who make less money than us and really need the subsidies to offset the huge premium increases they are being hit with.  Some of them are going to lose their insurance because they flat out can't afford the increased premiums. 

 

[HRAAB]

Also, you need to include total household income for all dependents when calculating for the subsidy.  This would include working teens.