California Exchange Comments on the Broker's Role

[Norwayguy]

Check out the link, and the 3 min video/audio of a woman with her sick child, who can't see a doctor because they don't have insurance. When asked why no coverage, she said she dropped her employer coverage because it was too expensive. Then she was told that Obamacare will give her subsidies for insurance. Wrong! Since she has employer offered coverage, as long as it's below 9.5% of her income, she is not eligible for subsidies.

She's in for a disappointment..........mis-information runs wild and just the beginning. Get ready to start pulling your hair out as you hear commercials and see incorrect news stories.

California bets big on marketing to spread the health care gospel | Marketplace.org

Yeah but yeah but yeah but. Don't forget this is being managed by CMS and take a look at seniors that choose a carrier during AEP and then decide they want out and have no Sep and low and behold CMS is providing a Sep. I am just wondering how much of the regulations will be reinterpreted on the fly by CMS whenever they want.

 

[Yagents]

See thread called obamacare glitch. Its in the law. Only congress can change it now

 

[Ann H]

True about CMS pulling SEPs out of the air. True about the Obamacare glitch being in the law. But all the woman has to do is quit her job, or go part-time. Instant SEP. Instant low income. Probably eligible for food stamps and other aid too.

 

[supersupps]

Ann,
In plain english, can you explain the obamaglitch and it's effects and way to counter? thanks

 

[Ann H]

Ann,
In plain english, can you explain the obamaglitch and it's effects and way to counter? thanks

This might be plain English, but it will never be plain logic (or horse-sense like Mama used to say). The PPACA law has a glitch that causes families to be ineligible for subsidies in the exchange when even ONE of the parents has "affordable" and "adequate" coverage from an employer.

"Adequate" means a health plan with minimum essential coverage. The definition of "Affordable" is the problem.

"Affordable" means the portion of the premium that the member pays for "self-only" coverage must be less than 9.5% of the family's Adjusted Gross Income. Remember the words "self-only". It doesn't matter how much it costs to add the spouse and kids. It is deemed "affordable" if the premium for just the employee's coverage alone costs the employee less than 9.5% of the family's AGI.

So what YAgents was saying about the case in this story is that the woman won't get subsidies because the story said she was ELIGIBLE FOR employer coverage. As YAgents said, if that employer coverage is "affordable" for her alone, she won't get a subsidy for her family. It doesn't even matter that she dropped that employer coverage due to the cost. If she is ELIGIBLE FOR it and if it is deemed "affordable" and "adequate", she will not get subsidies and neither will her family members.

As nuts as this glitch is, it has been confirmed by the CBO, the IRS and HHS as being written that way in the law. They can't change it by administrative rules.

(BTW, that 9.5% is technically a graded scale which is 9.5% at the highest end. Nonetheless, most people with family coverage would be at the 9.5% level.)

 

[supersupps]

In plain English Ann.. thanks. You are so smart you would make a great Navigator Manager.. lol.. just kidding.

What % of people going on the ACA would fall into this category? It is only for people that have coverage at work.

 

[Ann H]

In plain English Ann.. thanks. You are so smart you would make a great Navigator Manager.. lol.. just kidding.

What % of people going on the ACA would fall into this category? It is only for people that have coverage at work.

Thanks for the compliments. Smart is fine, but successful is better. Soon, we can put down the rule book and sell like crazy during open enrollment!

The number of people who will fall into this category is staggering. Nationally, most people have coverage through work. For groups of 50 or more full-time equivalent employees, the employer is penalized heavily if they do NOT make their coverage both adequate and affordable, using the definitions I described above. So most people who work for a firm with more than 50 employees will run into this problem. How many? Millions. Yeah. It's a major glitch.

 

[stuy119]

Thanks for the compliments. Smart is fine, but successful is better. Soon, we can put down the rule book and sell like crazy during open enrollment!

The number of people who will fall into this category is staggering. Nationally, most people have coverage through work. For groups of 50 or more full-time equivalent employees, the employer is penalized heavily if they do NOT make their coverage both adequate and affordable, using the definitions I described above. So most people who work for a firm with more than 50 employees will run into this problem. How many? Millions. Yeah. It's a major glitch.

Or again, opportunity, if viewed correctly.

 

[supersupps]

And if viewed correctly, what is th opportunity?

 

[stuy119]

And if viewed correctly, what is th opportunity?

That's what I've spent 2-3 years coming up with, and learning how to market. I'm not going to give it away on a forum to someone who just happened to show up recently, or just started coming up with their strategy once they realized that Obamacare is going to be implemented and they are in a panic to save their career.

Not saying that's you, but I'm far from willing to give away my R&D at this point.