Required to Join the Exchanges

[HoosierLife]

I got a PDF from Humana and in it I read that those in the lowest income bracket would be required to buy into the exchange. My question is, does this apply to those with GF plans? My pastor has 8 in his household and makes around $42K/yr. He is well below the poverty line in our Dear Leader's opinion. Will he be required to buy into the exchanges?

 

[leevena]

I got a PDF from Humana and in it I read that those in the lowest income bracket would be required to buy into the exchange. My question is, does this apply to those with GF plans? My pastor has 8 in his household and makes around $42K/yr. He is well below the poverty line in our Dear Leader's opinion. Will he be required to buy into the exchanges?

Sorry, but I do not know what is meant by "GF" plans. But, no one is required to buy from the Exchange. The law requires individuals to have minimum essential health insurance for themselves and dependents. They can obtain this from a variety of sources; government sponsored plans, employer sponsored plans, an individual plan, etc.

 

[Yagents]

I got a PDF from Humana and in it I read that those in the lowest income bracket would be required to buy into the exchange. My question is, does this apply to those with GF plans? My pastor has 8 in his household and makes around $42K/yr. He is well below the poverty line in our Dear Leader's opinion. Will he be required to buy into the exchanges?

GF stands for grandfathered plan. He can keep it if he wishes.

Family of 8 has a 400% poverty level of about $150k. So, 133% = about $50k. He may be able to get on to medicaid for free, much cheaper than his current GF plan. If not medicaid, he will be heavily subsidized. The only reason why he wouldn't buy in the exchange is if he doesn't want to be on medicaid due to lack of doctors.

 

[HoosierLife]

From Humana's PDF:

Individual with annual
income of $10,830 to
$43,336
OR
Family of 2 with annual
income of $14,470 to
$58,280
OR
Family of 3 with annual
income of $18,310 to
$73,240
OR
Family of 4 with annual
income of $22,050 to
$88,200
Must purchase ON the
Exchange in order to receive
government subsidy, or
may be eligible for Medicaid
coverage

Oh now that I actually read it, he has to be on the exchange to be eligible for the subsidy or medicaid. So you think he might be eligible for medicaid and not have to pay anything? If he wasnt on medicaid do you know how much he would pay for each plan platinum through bronze?

 

[Yagents]

As the humana brochure also states, he will either be on medicaid for free, or he will have to pay 2% of his income, worst case 3-4% of his income....per YEAR. Plus, he'll get cost sharing subsidies that will help him pay his out of pocket expenses. It doesn't matter what the policy costs, and the premium subsidies and cost sharing subsidies will be based on the SILVER plan.

 

[sman]

From Humana's PDF:

Individual with annual
income of $10,830 to
$43,336
OR
Family of 2 with annual
income of $14,470 to
$58,280
OR
Family of 3 with annual
income of $18,310 to
$73,240
OR
Family of 4 with annual
income of $22,050 to
$88,200
Must purchase ON the
Exchange in order to receive
government subsidy, or
may be eligible for Medicaid
coverage

Oh now that I actually read it, he has to be on the exchange to be eligible for the subsidy or medicaid. So you think he might be eligible for medicaid and not have to pay anything? If he wasnt on medicaid do you know how much he would pay for each plan platinum through bronze?

Since no carrier has published plan designs and rates for plans to be offered through the exchange, it would be virtually impossible to give you those rates.

However, the Kaiser Family Foundation has a nifty little tool to give you an estimate, but it only offers options for a single individual or family of 4.

Health Reform Subsidy Calculator - Kaiser Health Reform

 

[Dave020]

If he's at 250% or lower down to 133% (Medicaid cutoff) then he may be limited to selecting only the Silver tier (and possibly the Bronze tier).

My understanding is no one at 250% or below can move to Platinum nor Gold Tiers and receive a subsidy for those more expensive coverage plans.

 

[Yagents]

My understanding is that if he can't get medicaid, anyone can get a platinum/Gold plan, but the subsidies will be based on the silver plan pricing.

 

[Dave020]

I've heard it both ways, we'll have to wait and see what the final rules are on this.

If you look at the CA plans grid I posted on another thread the plans in the Silver Tier for certain income levels are specifically designed for co-pays and other benefits for that income level. Income level caps at 250%.

I will put the question to my contact at the CA HBEX and see what the answer is.

 

[Yagents]

I've heard it both ways, we'll have to wait and see what the final rules are on this.

If you look at the CA plans grid I posted on another thread the plans in the Silver Tier for certain income levels are specifically designed for co-pays and other benefits for that income level. Income level caps at 250%.

I will put the question to my contact at the CA HBEX and see what the answer is.

Also ask them if the employee only has affordable health coverage through a group plan, can the spouse and kids be spun off onto the exchange and get subsidies if lower income