Feds Say 7.5M Paid An Average Penalty Of $200 For Not Having Health Insurance

[somarco]

In the not too distant future, we'll be looking back at all this bullchit and shaking our heads in amazement at how complicated ObamaScrew was.

It's a feature, not a bug.

The idea is to encourage applicants to deal with the REAL experts at goodluck.gov.

 

[RayNY]

She had already met the $1,500 Silver CSR OOP. Suddenly she started getting bills again because the $1,500 OOP had become $6,300 OOP. There was no notification that this was going to, or had occurred.

Yikes, that sounds like a nightmare in the making.

Were those bills retroactive or only for new procedures?

 

[sman]

Yikes, that sounds like a nightmare in the making.

Were those bills retroactive or only for new procedures?

I never thought about it being retroactive. Now that's just plain scary.

 

[AllenChicago]

Yikes, that sounds like a nightmare in the making.

Were those bills retroactive or only for new procedures?

Sorry for the delay in responding, Ray. Had to check my written notes in the client's file.. (Yes, I'm old fashioned.)

The client got a hefty pay raise (new job) in July 2015..reported it to the marketplace on July 10th. Annual income increased from $32,000 to $110,000. The premium went from $340 to $1500 and the $1500 OOP to $6,300 OOP retroactive to July 1st.

Had to pay for maternity-related checkups retroactive to July 1st, and of course, ongoing checkups and the delivery until the wife's expenses reached $6300. Oh..and the baby was born January, under a new $6300 OOP.

 

[sman]

Sorry for the delay in responding, Ray. Had to check my written notes in the client's file.. (Yes, I'm old fashioned.)

The client got a hefty pay raise (new job) in July 2015..reported it to the marketplace on July 10th. Annual income increased from $32,000 to $110,000. The premium went from $340 to $1500 and the $1500 OOP to $6,300 OOP retroactive to July 1st.

Had to pay for maternity-related checkups retroactive to July 1st, and of course, ongoing checkups and the delivery until the wife's expenses reached $6300. Oh..and the baby was born January, under a new $6300 OOP.

Now I'm confused. Premium and MOOP changed effective July 1st? Had baby in January and it was under the new MOOP?

As far as the increase in premium, I'm sure they'd rather make $110k and pay $1,500 instead of making $32k and pay $340.

 

[AllenChicago]

Now I'm confused. Premium and MOOP changed effective July 1st? Had baby in January and it was under the new MOOP?

As far as the increase in premium, I'm sure they'd rather make $110k and pay $1,500 instead of making $32k and pay $340.

Deductible and OOP reset to $0 on January 1st for everyone on an individual plan, unless that plan has a "deductible carryover" feature. I've not seen one of those since ObamaScrew arrived though.

Right SMAN, there have been no gripes from this family over the premium increase, in light of the big raise in pay. They accept the new $6300 OOP with grace as well.

I've had a few other clients who lost their APTC and CSR subsidy over the past 2 years because they didn't send something into the marketplace, but fortunately none of them had ongoing medical issues. All but one are business owners who legally manipulated their MAGI to qualify for the APTC/CSR. You just re-enroll these folks into a fresh APTC/CSR plan each open enrollment if they lost it due to not sending in paperwork. This strategy might not go so smoothly for 2016 however.

 

[sman]

Deductible and OOP reset to $0 on January 1st for everyone on an individual plan, unless that plan has a "deductible carryover" feature. I've not seen one of those since ObamaScrew arrived though. Right SMAN, there have been no gripes from this family over the premium increase, in light of the big raise in pay. They accept the new $6300 OOP with grace as well. I've had a few other clients who lost their APTC and CSR subsidy over the past 2 years because they didn't send something into the marketplace, but fortunately none of them had ongoing medical issues. All but one are business owners who legally manipulated their MAGI to qualify for the APTC/CSR. You just re-enroll these folks into a fresh APTC/CSR plan each open enrollment if they lost it due to not sending in paperwork. This strategy might not go so smoothly for 2016 however.

I get that deductibles and MOOP's reset every January. Where I'm confused is, as I understand it, these people had both the APTC and CSR which began in January. Got a new job and reported the change which meant they lost both effective July 1st. But they had the baby in January and you are saying that fell under the new higher MOOP.

So hear's my confusion I guess. Are you saying that claims now have to be reprocessed retroactively? For example, will the insurance company now have to request reimbursement from any providers they may have paid and then the providers go after the patient for those funds?

I guess I assumed when someone loses the CSR mid-year, all claims processed prior to the change would stand based on the lower deductible and MOOP.