HHS Major Announcement Coming on Monday

[CHUMPS FROM OXFORD]

So...Let's say a healthy couple in their 50s (kids are grown) makes 250K per year. No subsidy.

They want to buy a high-deductible plan...maybe 10K or so. I assumed that there will be many options available outside of the Exchange that are NOT available inside the Exchange.

Also...you might see this.

Couple makes 65K and wants cat coverage. Rate is 6k per year for Bronze plan inside Exchange less 2K subsidy for 4K net.

Outside Exchange, they can buy plan for 3K with less coverage and that's what they want to do.

 

[Yagents]

So...Let's say a healthy couple in their 50s (kids are grown) makes 250K per year. No subsidy.

They want to buy a high-deductible plan...maybe 10K or so. I assumed that there will be many options available outside of the Exchange that are NOT available inside the Exchange.

Also...you might see this.

Couple makes 65K and wants cat coverage. Rate is 6k per year for Bronze plan inside Exchange less 2K subsidy for 4K net.

Outside Exchange, they can buy plan for 3K with less coverage and that's what they want to do.

First, this couple would not buy on the exchange, why deal with the gov't. (Instead they will hopefully buy from one of my private exchanges at www.statehealthexchanges.com ). Second, we can only hope the bronze plan allows a high deductible of 10k, remember, 70% actuarial value may not allow that high of a deductible (even though tied to HSA maximums). Third, you must buy coverage that qualifies you to have creditable PPACA coverage to avoid the penalty. The products inside and out will be the same. Anything products that are different outside the exchange will only be ancillary or supplemental in nature.

In your other scenario, a bronze plan will be the same price inside or out, so this person would choose the exchange bronze with subsidy

 

[CHUMPS FROM OXFORD]

"The products inside and out will be the same"

I think that's what doesn't make sense.

By the way...interesting website you have with all of the "Exchange" domains.

But..."This website is designed to connect consumers with local insurance experts." Is that really true? GoHealth is not a local expert. In fairness, I only checked one state.

 

[Ann H]

I was under the impression that the plans offered outside the exchange didn't necessarily have to be identical to the plans offered inside the exchange.

That's the way it is for HIPAA portability plans. The insurance company must offer the HIPPA member a plan that's identical to what's being sold to underwritten individuals, but insurance companies only offer one or two plan designs to HIPAA applicants. They offer a lot more plan designs to underwritten applicants.

If there are a lot more options outside the exchange than inside, we don't have so much of a problem. I understand that inside or outside the exchange, they must all meet PPACA's minimum coverage rules, but since the minimum coverage is written as an actuarial value of 70%, 80% or 90%, then plan design options should be pretty open.

I'm not SURE of my understanding of this, however, so it's subject to correction. Must the insurance company offer exactly the same plans INSIDE the exchange as they offer outside it?

 

[Yagents]

"The products inside and out will be the same"

I think that's what doesn't make sense.

By the way...interesting website you have with all of the "Exchange" domains.

But..."This website is designed to connect consumers with local insurance experts." Is that really true? GoHealth is not a local expert. In fairness, I only checked one state.

Ann/Chumps, remember this is gov't controlled healthcare. Do you really think their going to let a rich person/family buy a cheaper plan, or a richer benefit plan, that is not available to everyone else in the exchange?

I guess I'm assuming that GoHealth is selling that lead to an In-state agent. Maybe not, maybe keeping it for their own agent/agency. Maybe I will change "local" to "licensed". OR, If you start buying leads from them in your state, then you could be that local expert too!

 

[CHUMPS FROM OXFORD]

"then you could be that local expert too"

Hey...I might take you up on that idea! I'll call you in late 2013, when things will get really interesting!

 

[Dave020]

I seems that it is a very complicated issue and likely we will have to wait and see the guidance or implementation of the plans both inside and outside of the exchanges. One key is QHP status. All plans sold in the exchanges MUST be QHP (Qualifying Health Plans) and meet strict guidance. Not having a QHP means that they can levy the fine (unless you remain on a grandfathered plan).

So the question is: since anyone not on a QHP outside of the exchange is subject to the fine for not buying a QHP (excepting those with a valid waiver which is a whole 'nother issue), would health insurance carriers consider selling plans that don't meet QHP standards simply to offer potentially lower premiums but expose subscribers to potential fines?

Ann H - in California HIPAA plans must be identical to their correspondent underwritten version however they only have to offer the "two most popularly marketed plans" which is code for plans earning the most premium dollars.

 

[Ann H]

So the question is: since anyone not on a QHP outside of the exchange is subject to the fine for not buying a QHP (excepting those with a valid waiver which is a whole 'nother issue), would health insurance carriers consider selling plans that don't meet QHP standards simply to offer potentially lower premiums but expose subscribers to potential fines?

Interesting idea. Let's say that you make over 400% of FPL, and purchase a plan OUTSIDE the exchange for 15% less than INSIDE the exchange, but incur a $700 IRS penalty for non-compliance. I know of several who would do that, yet some who would not break the law whether the penalty is low or not. Of course, if the Supreme Court rules the individual mandate unconstitutional, the penalty goes away completely.

By the way, some posters are saying that "400% of FPL is nearly $90,000, which is most of middle class." That's for a family of four. For a family of 2, it's $58,840. Most couples earn more than that when their children are grown. Most childless couples earn more than that. There's a whole segment of "middle class" that won't fall into the 400% of FPL. Also, remember that the credit is graded, so the closer you are to the 400% level, the less credit you get. The credit is also based on a percentage of premium, so younger people (who are charged less premium) will get less of a credit. People who live in a geographical area with lower premiums will get less of a credit (but conversely they also earn less and would be more likely to qualify for the credit).

There's another segment of middle class, however, that will be well within that 400% of FPL. For instance, a family of six can earn $119,600 before the credit is lost.

All of these figures are using 2011 FPL rates. It will be a bit more in 2014.

In any situation, though, even for clients who are nearing the 400% level, be aware that the dollar amount of the credit is substantial. We're not talking about pennies here. The credits are substantial, and agents should work hard to lobby for the subsidies to be available to those who purchase OUTSIDE the exchange.

 

[dgoldenz]

What a cluster...

 

[pahealthquotes]

The credits are substantial, and agents should work hard to lobby for the subsidies to be available to those who purchase OUTSIDE the exchange

this could be the single most important factor for our survival as indy agents