ACA ObamaCare 2018 - Rules, Premiums, Info, Etc.

[russelltw]

I hope these people start complaining about it loud enough. It is getting out of hand if you make more than 400% of FPL.

For my clients with a subsidy, their premiums are going down across the board. With my personal book of business, 24% of them have a premium less than $10/month. Most of that 24% are $0/month...

 

[somarco]

getting out of hand if you make more than 400% of FPL.

Congress needs to raise the FPL so more people can get free insurance.

 

[TN_agent]

I hope these people start complaining about it loud enough. It is getting out of hand if you make more than 400% of FPL.

For my clients with a subsidy, their premiums are going down across the board. With my personal book of business, 24% of them have a premium less than $10/month. Most of that 24% are $0/month...

For my subsidized clients, 90% are seeing at least one zero premium plan available (most counties in TN have only one carrier option).

My unsubsidized people are taking it up the rear in a BIG way.

Married couple age 60 who makes $64,000 a year in McMinn county cheapest silver plan:$0 a year
Married Couple age 60 who make $69,000 a year in McMinn county cheapest silver plan:$31,728 a year

I had a 63 year old woman crying over the phone the other day, her husband is older and retired on Medicare and has a pension and forced withdrawals from his IRA that along with their Social Security puts them over the limit for a household of two. They don't have enough deductions to get them down under the limit according to her (I suggested HSA, but they are limited to $4450). They both have significant RX needs and they are looking at spending over $25,000 next year combined for her premiums on cheapest bronze, her MOOP (which she hits in month 2) and his Medicare/sup/rx premiums and OOP. They have it in savings obviously, but she was distraught at how much of their savings was going to be swallowed in the next 2 years.

They are not my clients, she was just calling looking for help.

 

[VolAgent]

Congress needs to raise the FPL so more people can get free insurance.

You joke, but unless something is done we will simply end up with more uncompensated care. I don't claim to know the solution, but I know this isn't it.

 

[russelltw]

Here are my two cents on this:

1. Carriers will drop gold plans and only offer cat, bronze and silver
2. Carriers will introduce some mini-med that looks similar to what UW coverage used to look like.
3. Bronze coverage will be "unaffordable" with future rate increases, so many (400%+) will qualify for a "hardship exemption."
4. Silver will become the high risk pool for the 100-400% of FPL.
5. Those over 400% will get exemption and buy mini med from Carriers

Back to where we were in 2009.

 

[junkman]

You joke, but unless something is done we will simply end up with more uncompensated care. I don't claim to know the solution, but I know this isn't it.

I'm holding those in Congress responsible. They are not ignorant, have access to information and have the nerve to sit with cheap insurance paid for by tax payers while letting our premiums go through the roof. Any of them could easily call up the president of one of the carriers or sit down with an actuary and have adverse selection and average claims cost of employer pools vs ACA explained.

We need to enroll all eligible. Have HDHP plan design with HSAs for those with incomes over $x. Extract copays from the lower income people and keep them out of the ER. Pay agents to hand hold and get people enrolled. Post provider rates and incentivise low cost provider selection in the plan design.

I talked with a COBRA eligible friend of mine today. Cobra is $500 and change for a Mercer administered self-funded plan with his former employer. Cheapest Oscar was upwards of $750 with a crappier network, higher OOP and Oscar's no-pay, no integrity claims paying process. This guy is slightly above the subsidy level and pays the full load.

I told him that paying me $200 would be a better deal than Oscar. I wouldn't pay claims either but at least he's get to keep some of his money.

 

[scagnt83]

Congress needs to raise the FPL so more people can get free insurance.

Like to $100k per year... LOL.

Seriously though, Ive never had so many high earners (as in $80k+) ask me about "what to do about their health insurance premiums" as I have this year.

 

[junkman]

Self employed $150K - federal taxes - house payment - property tax - HSA - SEP - IRA does not allow for another 20k in insurance premiums. People in the 100 to 200k income level spend $100,000 on the items above before they put gas in the car. One person said that every time his checking acct builds up, it's time for quarterly taxes.

Again, make those in Congress pay the full load of unsubsidized premiums ant this would be solved. Perhaps that's something to proliferate on social media.

 

[Ann H]

Yagents, correct me if I am wrong, but being offered MEC alone isn't enough for employee/dependents not to be eligible for subsidy, it has to be a plan with minimum essential coverage and minimum value at less than approx. 9.5% (I know it changes but just an average) household income for employee only coverage.

There are tons of those temp agencies offering those MEC policies that literally only cover preventive stuff (due to a loophole supposedly protects them from the fine for not offering coverage and protects the employee from the fine--at least according to the companies selling it), but in reality they are not major medical with prescriptions coverage, hospitalization coverage, etc. They wouldn't cover you if you got in a car accident or had appendicitis, etc. I don't believe those would be minimum value for subsidy eligibility determination.

Now, what I am not clear on is what happens to the employee's subsidy if those temp companies send a 1095 in saying their coverage was MEC and minimum value when in point of fact it was not. BEcause I read over the 1095C instructions, and in several places it refers to "minimum value" (as well as MEC). What happens if the employers just lie?? How would that be proved?

Who would complain at that point? Individuals complaining to the IRS when they get clawed back?

Those crappy MECs gets the employer out of the penalty.

CMS/HHS came out and said a couple years ago, people with these min value MEC's ARE eligible for APTC.

I'm not concerned with that as I don't have any clients in that situation.
I am more concerned for all those families where adding the family to the group plan was too expensive, and they applied for and were granted APTC with the help of HC.gov reps or agents. These families are NOT eligible for APTC, and just wondering when this will catch up with them. If ever................

For the EMPLOYER penalty, just offering MEC to 95% of full-time employees is enough to keep the employer out of one of the two penalties. For the Individual, you pay a penalty if you don't have MEC (unless you have an exemption).

To get a subsidy on the exchange if you are offered Employer-Sponsored insurance:
* If it is MEC, MV and affordable at the "9.56% of household MAGI for the employee premium" rule, then the whole family is out of luck for a subsidy.
* If it is MEC but not MV or affordable, but you made the mistake of ENROLLING IN IT, you are out of luck for a subsidy. Of course, you can unenroll during OEP and be okay.
* The only way to get a subsidy if you are offered employer-sponsored insurance is that it is MEC, and MV, and affordable for the employee, and you are not enrolled in it.

Someone correct me if I'm wrong. My memory is getting fuzzier the longer we march through this legal maze of a mess. This is the way that I remember it.

 

[somarco]

Frankly, we are at a point where I doubt carriers would ever return in numbers to the IFP market. DC killed that market with over-regulation in an attempt to set up single payer.

And I don't see SP coming on board any time soon.

What I do see is Medicaid expansion + national subsidized risk pool + some form of underwritten coverage although probably not as stringent as existed pre-2014.

Even if that happens, I would be very surprised if more than a handful of carriers decided to play.