Sactoking's ACA Q&A Thread

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Dec 9, 1999
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"3 years after passage of the law, after a few years of (not fully predictable) progress in medicine and IT (and every other kind of technology that effects healthcare) and dealing with states' reactions, the plans get modified/altered. The federal government has had plans (long in advance, as you say) and could base estimates on those plans but it also fine tunes them and alters them all along (mostly with the intention of reducing overall costs and delivering the best service while following the law that was passed), hence the release of a new CBO report on how much it will cost in the long run earlier this year. Like everything else, it will always be evolving."

No, my Engrish is just fine...
 

Jadow

Diamond Member
Feb 12, 2003
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just found out my per paycheck premium for myself + son is going to go from 50 to 120 dollars next year. That's 1800 right out of my pocket. This is for an HSA too. ACA sure didn't help me.
 
Oct 12, 2009
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just found out my per paycheck premium for myself + son is going to go from 50 to 120 dollars next year. That's 1800 right out of my pocket. This is for an HSA too. ACA sure didn't help me.
My new premium is $492/mo, $10K deductible, ....and they're dropping coverage in SC 12/31/2013. Thanks assholes.
 

Patranus

Diamond Member
Apr 15, 2007
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Patranus

Diamond Member
Apr 15, 2007
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just found out my per paycheck premium for myself + son is going to go from 50 to 120 dollars next year. That's 1800 right out of my pocket. This is for an HSA too. ACA sure didn't help me.
Kaiser had to eliminate my health plan.
The plan I had before fit my lifestyle perfectly.

Extremely high deductible, extremely low premium.
No unnecessary services covered.

I was forced onto a plan that now covers a wide range of pointless services and costs twice as much.

Way to go ACA!

Then again, I am in the target demo ("young" and employed) that the ACA targets for redistribution.

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Anyways, Sactoking, I was told that if I liked my plan I could keep it. Why couldn't I keep my plan?
 

Patranus

Diamond Member
Apr 15, 2007
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And thus begins the government forcing the price of private insurance up until no one can afford it...
That is the entire point of the ACA.
Create an artificial crisis to pass their next agenda item.
 

sactoking

Diamond Member
Sep 24, 2007
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Anyways, Sactoking, I was told that if I liked my plan I could keep it. Why couldn't I keep my plan?
No offense, but I hesitate to answer questions like this because it seems like a rhetorical question. You (the community) put me in a tough place when you have a post that basically says "The ACA sucks! Tell me why they did this" and then follow it up with a legitimate question. It seems like I'm being baited. Maybe not your intent, but that's the perception.

At any rate, the President did say something to effect of "If you like your current plan you can keep it". As to why that didn't turn out to be the case for you in particular or other people in general, the answer is likely to be partisan, and there's not much of a middle ground for me to tread, so I'll give you both:

The "liberal" answer is that the President was correct, you could have kept your plan, but the insurance companies took that away from you. The ACA includes a "grandfather" provision that exempts plans in existence when the President made his statement from complying with pretty much all of the ACA's reforms. That your plan wasn't grandfathered was a conscious choice by your insurer.

The "conservative" answer is that the President spoke a half-truth. The ACA did include a grandfather clause but the provisions of the clause were so onerous that it was obvious few if any plans would qualify. To be considered grandfathered you had to be enrolled in the plan as of May 2010 and the plan design could not substantially change, ever. Grandfathered plans would not be subject to guaranteed availability, so the only new enrollees would be family members of grandfathered participants. Grandfathered participants would not be part of the single risk pool, so as the block of business shrank and got older the risk pool would deteriorate to the point that premiums would skyrocket, which would drive more people out and premiums even higher. Add that to the fact that the insurer would have an administrative burden administering a plan that had only a few thousand or hundred enrollees, and they quickly become uneconomical for both insurer and enrollee.
 
Dec 9, 1999
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You know, this is such an excellent thread lets try and keep the bashing out of it. If that means past post(s) of mine need to be deleted by the mods, so be it. sactoking is either a SME on this, or, knowledgable to such an extent that to us here on AT, he's close enough to a SME as we're likely to get. Lets have at least one thread that doesn't go to sh1t...

Chuck
 
Dec 21, 2005
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Question: if a family makes just over $200k total, and currently has an employer-provided PPO that costs around $420/mo out-of-pocket for medical, dental, AND vision coverage, are that family's annual insurance/healthcare expenses likely to increase under ACA? Or, will they stay roughly the same (iow, continue to follow the normal trend of 7-9% annual increases)? If they will likely increase substantially, what order of magnitude are we talking about here (a percentage range would work)?

Too many variables, maybe? I'm just trying to sift through all the rhetoric and get an idea ahead of time of how painful this is going to be. If I need to prepare myself to bend over and take it without lube, please let me know so I can start getting my picket signs, angry letters, and other supplies together.

EDIT: I'll say this right now: if this single government Act essentially wipes out the combined total of the last five years of my considerably small annual raises (only 2-3% per year), which I've worked my butt off to earn, I'm going to be very f'n bitter -- to say the least.
 
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sactoking

Diamond Member
Sep 24, 2007
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Question: if a family makes just over $200k total, and currently has an employer-provided PPO that costs around $420/mo out-of-pocket for medical, dental, AND vision coverage, are that family's annual insurance/healthcare expenses likely to increase under ACA? Or, will they stay roughly the same (iow, continue to follow the normal trend of 7-9% annual increases)? If they will likely increase substantially, what order of magnitude are we talking about here (a percentage range would work)?

Too many variables, maybe? I'm just trying to sift through all the rhetoric and get an idea ahead of time of how painful this is going to be. If I need to prepare myself to bend over and take it without lube, please let me know so I can start getting my picket signs, angry letters, and other supplies together.

EDIT: I'll say this right now: if this single government Act essentially wipes out the combined total of the last five years of my considerably small annual raises (only 2-3% per year), which I've worked my butt off to earn, I'm going to be very f'n bitter -- to say the least.
I'm sorry but there's really not any way I can honestly answer; the variables are too complex. What state are you in? How many people in your family? How many employees does your employer have? Is your employer self insured or fully insured? What are the general health and age of employees? How much is the total premium before your employer pays its share? What's your benefit package? Does your employer have a pay or play decision to make? Do you currently receive a "C-level" benefit package? Etc.
 
Dec 21, 2005
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I'm sorry but there's really not any way I can honestly answer; the variables are too complex. What state are you in? How many people in your family? How many employees does your employer have? Is your employer self insured or fully insured? What are the general health and age of employees? How much is the total premium before your employer pays its share? What's your benefit package? Does your employer have a pay or play decision to make? Do you currently receive a "C-level" benefit package? Etc.
I figured as much; and, I must say, it's not knowing what to expect that is bothering me the most. Based on the options I've seen in California's version, I'm expecting a 100% increase, or worse, if my employer elects to drop coverage -- and it's highly unlikely that we'll qualify for any substantial tax credit.

It's just so damn frustrating... :(
 

Smoblikat

Diamond Member
Nov 19, 2011
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I figured as much; and, I must say, it's not knowing what to expect that is bothering me the most. Based on the options I've seen in California's version, I'm expecting a 100% increase, or worse, if my employer elects to drop coverage -- and it's highly unlikely that we'll qualify for any substantial tax credit.

It's just so damn frustrating... :(
Thats why we need to pass the bill, so we can see whats in it.

Question: I am a contractor, my contracting agency offers a very basic health plan that I opted out of. Will I be forced to buy a subsidized health plan, or is the fact that my employer offers one that I decline to use good enough?
 

sactoking

Diamond Member
Sep 24, 2007
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Thats why we need to pass the bill, so we can see whats in it.

Question: I am a contractor, my contracting agency offers a very basic health plan that I opted out of. Will I be forced to buy a subsidized health plan, or is the fact that my employer offers one that I decline to use good enough?
I assume you're referring to the individual shared responsibility payment (individual mandate tax)?

If your employer offers a basic health plan and you opt out then you do not have minimum essential coverage and you do have to pay the penalty. Additionally, assuming that the plan you were offered by your employer is affordable, you will not be eligible for a tax credit on the individual market. In order to avoid the penalty you will have to buy the employer insurance, pay full freight for an individual policy, or prove that both the employer and individual policies were unaffordable.
 

nanette1985

Diamond Member
Oct 12, 2005
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Thank you, this has been an awesome thread. And you are awesome for putting up with us, and for trying to deal with this system.

My youngest son is 23, works as a waiter at IHOP they don't have health insurance. He's been trying to find something - obviously he's very interested in this ACA.

He went online to research NJ. The form to fill out for information asked for a LOT of the personal information that no sane person would ever put on a random internet form - bank info, SS number, and so on.

When I called my social worker (I'm disabled) she said this is the only way there is to find out anything about ACA - and that the info site won't be fully up and operational until next January.

This concerns me.

Also, does he have to use the exchange here in NJ or can he get insurance in a different state? We do live only a few miles from NY.

And how does this tax credit thing work? He's a low income guy, doesn't pay much in taxes. Is turbo-tax going to be the people who figure this out?

Thank you. You've been amazing.
 

sactoking

Diamond Member
Sep 24, 2007
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Thank you, this has been an awesome thread. And you are awesome for putting up with us, and for trying to deal with this system.

My youngest son is 23, works as a waiter at IHOP they don't have health insurance. He's been trying to find something - obviously he's very interested in this ACA.

He went online to research NJ. The form to fill out for information asked for a LOT of the personal information that no sane person would ever put on a random internet form - bank info, SS number, and so on.
DO NOT FILL OUT THE FORM! Can you give the website address? New Jersey is going to be using a federal exchange and their website is (AFAIK) not yet operational. Any website that purports to be distributing information in exchange for personally identifiable information is likely to be a scam.

When I called my social worker (I'm disabled) she said this is the only way there is to find out anything about ACA - and that the info site won't be fully up and operational until next January.

This concerns me.
It should; the social worker is wrong. All exchange web portals will be operational October 1 of this year. I would recommend, for the time being, that you use only www.healthcare.gov for your research. It is partisan (it's the White House's site) but it will not lead you to any scams. I'm not in New Jersey so I can't give you a list of trusted state-specific resources (I just don't know) and it's likely that the New Jersey Department of Banking and Insurance won't have information (since it will be a federal exchange).

Also, does he have to use the exchange here in NJ or can he get insurance in a different state? We do live only a few miles from NY.
You're supposed to be eligible for purchase based on your primary address. In order to buy in New York you'd have to establish residency there.

And how does this tax credit thing work? He's a low income guy, doesn't pay much in taxes. Is turbo-tax going to be the people who figure this out?

Thank you. You've been amazing.
The state exchange (in NJ, the federal exchange) will do the eligibility determination for the tax credit. You will need to input some basic information including family size, zip code, and modifed adjusted gross income (MAGI). The MAGI can be found on your tax return: line 4 on a 1040-EZ, line 21 on a 1040-A, or line 37 on a 1040. (Technically, it's the amount on that line plus the foreign income and foreign housing deductions, but I would venture to guess those don't apply in your case)

There are some tax preparers that advertise some form of "insurance tax eligibility determination", I think H&R Block is one, but be aware that whatever they tell you is only an estimate. Only your state's exchange can give you an official determination.
 
Sep 25, 2001
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i'm furloughed. my company health insurance runs out in sept.
i can elect cobra up to a year after health insurance ends, but must pay all the months.

ie: i elect cobra in dec 2013. i must pay oct + nov cobra.

i plan to go on obamacare in jan 2014.
if i'm healthly oct-dec, i want to skip cobra and save $ on the insurance premiums.

1) when obamacare kicks in Jan 2014, do i need 12months continuous coverage anymore?
(i live in VA)

2) if i go back to work at the same company/same position/same desk in jan 2014, any downside for not buying cobra oct-dec?
 

sactoking

Diamond Member
Sep 24, 2007
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IIRC you can only elect COBRA coverage within 90 days of termination of employment, and you do have to pay the back premiums, so conceivably you could only enroll in COBRA through December.

As of 1/1/14 you do not need to show continuous creditable coverage.
 
Jan 31, 2010
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londojowo.hypermart.net
I'll post this question here too.

Will those in the lower income brackets have subsidized deductible and copays as well? If not, they still may not be able to afford healthcare.
 

sactoking

Diamond Member
Sep 24, 2007
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There are cost sharing reductions available for people with lower incomes that reduce the deductibles and coats.
 

owensdj

Golden Member
Jul 14, 2000
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sactoking, thanks for posting that and all your other help. I do have a question about how the subsidies work in this situation. What if an adult child lives with his parents? Does he count just his own income or does he have to count the total "household" income? This could make a huge difference in the amount of subsidy he receives, if any. For example, if he makes $30K and his parents make $50K and $40K the household income would be $120K and nobody would receive a subsidy. Counting only his own income he would receive some help.
 

sactoking

Diamond Member
Sep 24, 2007
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Since the tax credit is an IRS item it follows the normal rules for dependency: if the adult child is claimed as a dependent by the parents then total household income is used.
 

owensdj

Golden Member
Jul 14, 2000
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Thanks. Another thing I noticed is that there appears to be a "hole" in the subsidy for some people. If they make under 133% of the FPL they receive a subsidy. If they make less than 100% of the FPL it looks like they receive zero subsidy and must depend on state Medicaid. Many states aren't expanding Medicaid coverage with the start of the ACA, so some people will be out of luck.
 
Sep 25, 2001
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question about reinsurance:

reinsurance protects the insurance companies participating in ACA exchanges. that way they don't lose their shirt when large #s of old and sick are expected to enroll.

but to prevent this as a net substidy for the industry, the fed govt puts a fee on ALL healthcare insurance companies.
so those insurance companies that wont do the aca exchanges are substidizing those who do.


now I don't understand how this fee hoses unions?

don't unions use major insurance companies? and aren't these major insurance companies also part of the ACA exchanges?? so the fees are zero net?
 

sactoking

Diamond Member
Sep 24, 2007
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question about reinsurance:

reinsurance protects the insurance companies participating in ACA exchanges. that way they don't lose their shirt when large #s of old and sick are expected to enroll.

but to prevent this as a net substidy for the industry, the fed govt puts a fee on ALL healthcare insurance companies.
so those insurance companies that wont do the aca exchanges are substidizing those who do.


now I don't understand how this fee hoses unions?

don't unions use major insurance companies? and aren't these major insurance companies also part of the ACA exchanges?? so the fees are zero net?
Most union plans are Taft-Hartley self-insured plans. They use commercial insurers as third-party administrators, but the risk is borne by the Trust.

The unions, then, complain that they're paying into the reinsurance program pool to help buoy insurer solvency without receiving any direct benefit.

This complaint, of course, ignores the reality that self-insured plans are allowed to discriminate in who they offer insurance to, so the bold ones will dump their worst risks onto the exchanges, threatening insurer solvency.

Therefore, they are complaining about propping up a system that they may have a part in jeopardizing.
 

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