By the way, here's a plug for our favorite, YAgents. In the meeting both of us attended, he asked some questions that were perfectly stated and accurate in their assumptions. But he stumped the guest speaker who fumbled in her answer. The guest speaker is nationally known and held in high regard for her knowledge of PPACA. We are lucky to have YAgents on this Forum, and I was pleased to be seated next to him in the meeting, where I could say, "I know him, yep, he's my friend!"
Policy Renewals
- Thread starter taterpeeler
- Start date
You're a sweetheart, and was a pleasure seeing you today. She and I walked away from the meeting thinking that most brokers don't know shiat about the law, and those here on this board are far ahead of everyone else. Those "in the know", will be an asset to clients, and make the most money providing real solutions.
- 1,896
What was the question that stumped the presenter? And is there an answer, or has it not been decided as of yet?
This was one of the questions:
If my husband/wife client makes under 400% FPL, but the husband is on medicare or VA already, and the wife is age 60, will the wife be eligible for subsidies on the exchange? For example: if they make $55,000 combined a year, it is too high for 1 person, but below the 400% FPL for two people. Will the wife get subsidies based upon half of that income? Too many similar situations, and quite common.
The other was related to small group under 50 ee's that are lower paid ee's, wouldn't it make sense to drop the group and let the whole family get subsidized on the exchange.
- 1,896
Unintended consequences. Again, something that no one thought of when designing this plan (said as I laugh to myself and shake my head).
With there being no participation requirements, there should be someone advising the employees what they have available via the exchange yet keeping the group plan, right? Well, I guess that still screws the families, doesn't it?
Dammit, this thing is like an evil Rubik's cube.
- Thread starter
- #26
and that question came up 2 times today alone... that's the most asked question for those of us also doing t65 medicare... ad they don't know..... geez Louise golly bum
The "no participation" issue is a little more complicated. The recent guidance says that the "guaranteed availability" requirement means that insurance companies cannot turn away groups that don't meet the participation and contribution requirement, however, they can give them a separate open enrollment that is only from November to December each year. So... a business of 2-50 employees could conceivably leave the group plan intact, make the contribution such that it fails the "affordability" test of the premium for self-only coverage being less than 9.5% of income, and still not disqualify the employee or family from subsidies.
Example: A business has highly compensated owners, managers and upper income personnel (say a law firm, engineers, CPA's, etc.) They don't want the exchange plans. (no kidding). They want a tax deduction for having group insurance because they are in a high corporate tax bracket. They want to cover families, with high Employer contribution because most of them insure their own families and because it attracts and retains the type of employees they want. But a good number of their employees have income below 400% of Federal Poverty Level and could have qualified for the exchange if it weren't for the fact that the Employer offers coverage that is "affordable" according to the 9.5% rule for "self-only" coverage for the employee. So, the business chooses an Employer Contribution design where the employer pays very little for employee-only coverage to make sure that it's not "affordable" according to the rules for subsidy eligibility. Then they offer to pay a very rich amount for the spouse & kids. Result? Employees who could qualify for subsidies in the Exchange still can do so, because the Employer group plan has failed the 9.5% of self-only premium test for affordability. Those employees can get subsidies for their spouse and children now, too. Higher income folks, and those who want to stay on the group plan may do so, with a great Employer contribution toward the overall premium. They can use the special open enrollment for group plans that don't meet the normal participation and contribution requirements.
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Oh, by the way, at a seminar today we were told that this issue of participation and contribution is a HOT BUTTON with carriers and their lobbyists in DC. This might get amended. As you can imagine carriers do NOT like this.
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- 8,448
There's NO WAY Navigators and ASSsisters will be able to accurately answer questions related to what's being discussed in this thread, and probably 90% of anything else.
Even I'm stupefied by the participation and income-year issues. I bet we'll have to get some kind of special E&O insurance due to the heightened potential for mistakes. If a client has to repay a few thousand dollars in subsidy $$$ to the IRS and says that the Exchange Certified Insurance Broker gave him bad guidance, all kinds of state and federal investigations, paperwork and monetary fines will come knocking on our door.
There's probably plenty of attorneys getting their TV commercials ready: "Have you received bad advice regarding the new health insurance law and now owe the IRS thousands of dollars? Call me, attorney Sue Em @ (202) 3358, and we'll recover all funds...plus damages!"
-ac
Even I'm stupefied by the participation and income-year issues. I bet we'll have to get some kind of special E&O insurance due to the heightened potential for mistakes. If a client has to repay a few thousand dollars in subsidy $$$ to the IRS and says that the Exchange Certified Insurance Broker gave him bad guidance, all kinds of state and federal investigations, paperwork and monetary fines will come knocking on our door.
There's probably plenty of attorneys getting their TV commercials ready: "Have you received bad advice regarding the new health insurance law and now owe the IRS thousands of dollars? Call me, attorney Sue Em @ (202) 3358, and we'll recover all funds...plus damages!"
-ac
Of course the Nav's won't be able to answer questions like that, and neither will most agents.
Fortunately most consumers will not know enough to offer up questions like this. They just barely know enough to pick a plan that includes full Rx coverage now.
I expect most who apply through HIX will become frustrated at the lengthy process and probing financial questions to make it all the way through.
Fortunately most consumers will not know enough to offer up questions like this. They just barely know enough to pick a plan that includes full Rx coverage now.
I expect most who apply through HIX will become frustrated at the lengthy process and probing financial questions to make it all the way through.
- 1,896
That's what I was thinking as well, but how does that mesh with the rule that you can't have waiting periods before eligibility of longer than 90 days? It seems that one rule is contradicting the other ...
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