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I am so confused about this health care plan stuff...


Mynyel
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I've been hearing that around here - a concern that the exchange policies will not include a good selection of providers and facilities.  Has anyone been able to see a list of providers for the exchange plans?  I've heard that there are no lists available, but I haven't gone through the enrollment procedure to find out.

 

 

In NC you can but that's mainly due to only BCBS being the only provider in the exchange. I was able to check that DH's dr was taking the plan we wound up selecting.  There were notes as to 2013 and 2014 and the plans they accepted. Some were at a higher co-pay depending on the plan but it was like a $5 difference.

 

I had honestly given up all hope until I was put in touch with an agent. It's worth trying to find one to help you through this mess. If you're in NC  shoot me a PM and I'll send you the info on the one I know. He could make a referral if he couldn't help. 

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I've been hearing that around here - a concern that the exchange policies will not include a good selection of providers and facilities.  Has anyone been able to see a list of providers for the exchange plans?  I've heard that there are no lists available, but I haven't gone through the enrollment procedure to find out.

 

 

The plans vary so much by state but Blue Cross/Blue Shield holds many options in many states via the state exchanges and the federal exchange. The Blue Cross network tends to be very good.

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The plans vary so much by state but Blue Cross/Blue Shield holds many options in many states via the state exchanges and the federal exchange. The Blue Cross network tends to be very good.

In our state, Blue Cross is separate from Blue Shield.  Blue Shield covers the "good" hospitals.  Blue Cross does not (for the exchange compatible plans).  

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In NC you can but that's mainly due to only BCBS being the only provider in the exchange. I was able to check that DH's dr was taking the plan we wound up selecting.  There were notes as to 2013 and 2014 and the plans they accepted. Some were at a higher co-pay depending on the plan but it was like a $5 difference.

 

I had honestly given up all hope until I was put in touch with an agent. It's worth trying to find one to help you through this mess. If you're in NC  shoot me a PM and I'll send you the info on the one I know. He could make a referral if he couldn't help. 

 

So you can see the provider lists on the BCBS website for the plans that are sold on the exchange?

 

We are in NC and have a great BCBS policy through my employer.  We'd have to buy a platinum plan on the exchange to have comparable coverage, it would cost more than we are paying now, we've already met our deductible on our current policy, and we are not eligible for subsidies because of the so-called family glitch.  I am concerned about what will happen on August 1, but we're good until then. 

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So you can see the provider lists on the BCBS website for the plans that are sold on the exchange?

 

We are in NC and have a great BCBS policy through my employer.  We'd have to buy a platinum plan on the exchange to have comparable coverage, it would cost more than we are paying now, we've already met our deductible on our current policy, and we are not eligible for subsidies because of the so-called family glitch.  I am concerned about what will happen on August 1, but we're good until then. 

 

 

I can from the BCBS rate quote - https://www.bcbsnc.com/assets/shopper/public/quote/#/

 

Just enter your info and it will give you some plans. Once you select one on the left hand side it will say 'Find a Doctor'. I did a search from there.

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What I'd like to know is how long will the subsidies last?  I could "save" money now by signing up--my premium would double, but I'd get more than half back in subsidies.  But where does that leave my family in one year? three years? when the govt decides to lower the subsidies? No one's talking about this. There is no guarantee written into the law.

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Things like choices of hospitals, etc are entirely up to the private insurance companies and their decisions on what to offer, not something that is dictated by the ACA.

 

Unfortunately, NC chose to do a lot more to stick it to poorer residents (and other groups) than just not expand Medicaid.

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What I'd like to know is how long will the subsidies last? I could "save" money now by signing up--my premium would double, but I'd get more than half back in subsidies. But where does that leave my family in one year? three years? when the govt decides to lower the subsidies? No one's talking about this. There is no guarantee written into the law.

The subsidies and their calculated increases are written into the law. They are a part of the law, so it would have to be amended to get rid of them, reduce them, or otherwise change their scheduled calculation.

 

http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/121xx/doc12188/05-12-subsidies_in_exchanges.pdf

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What I'd like to know is how long will the subsidies last?  I could "save" money now by signing up--my premium would double, but I'd get more than half back in subsidies.  But where does that leave my family in one year? three years? when the govt decides to lower the subsidies? No one's talking about this. There is no guarantee written into the law.

 

There is no guarantee that current premiums will stay the same from year to year either.  It's a gamble either way.  It just is.

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The subsidy is a refundable tax credit, like the Earned Income Credit. It is not treated as income.

http://www.irs.gov/uac/Newsroom/Questions-and-Answers-on-the-Premium-Tax-Credit

 

Wait.  So that means that you have to pay the full premium amount each month and then you get a credit on your taxes???  How in the heck is that supposed to help people pay their premiums each month???

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No, you can elect to have the subsidy sent directly to your insurance carrier and that lowers your monthly premium or pay the higher premium and get a tax refund.

 

Questions and Answers on the Premium Tax Credit
The Basics

1. What is the premium tax credit?

The premium tax credit is an advanceable, refundable tax credit designed to help eligible individuals and families with low or moderate income afford health insurance purchased through the Health Insurance Marketplace, also known as the Exchange, beginning in 2014. You can choose to have the credit paid in advance to your insurance company to lower what you pay for your monthly premiums, or you can claim all of the credit when you file your tax return for the year. If you choose to have the credit paid in advance, you will reconcile the amount paid in advance with the actual credit you compute when you file your tax return.

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Wait.  So that means that you have to pay the full premium amount each month and then you get a credit on your taxes???  How in the heck is that supposed to help people pay their premiums each month???

 

No! It's paid directly to your private insurance carrier. You only pay the difference, to your insurance carrier, if you have a difference.

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