Crab...how long ago was it that u figured out u didn't have the skill and got out of health? U stopped selling to hack failed associations and websites...go away
Selling Outside the Exchanges
- Thread starter insurehound
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Crab...how long ago was it that u figured out u didn't have the skill and got out of health? U stopped selling to hack failed associations and websites...go away
- 8,448
ABC, do you feel that health insurance plans sold outside of the exchange cost less? According to this HHS Fact Sheet Essential Health Benefits: HHS Informational Bulletin | HealthCare.gov policies sold OUTSIDE the exchange must have the same benefits and protections as those sold INSIDE the exchange.
States that are further along in setting up their exchanges are formulating rules that prohibit a company from charging less for outside-exchange policies than inside-exchange policies. This is to prevent adverse selection. How can you get adverse selection if both exchange and non-exchange plans have to offer the same Bronze/Silver/Gold/Platinum benefits?
-Allen
Looks like there are not many states wanting to set these things up.
State Actions to Implement the Health Benefit Exchange
I count 12 states with established exchanges.
Obama needs to remind the laggards that they don't have to build them on their own. The government will help them . . .
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I think your figures are high, ABC. The CBO estimated that 20 million would qualify for subsidies and 24 million would buy from the exchange by the year 2019, which is 5 years after the exchanges are set to begin.
Go to Mapping the Effects of the ACA's Health Insurance Coverage Expansions - Kaiser Health Reform and enter a zip code and it will tell you how many people in that zip code will probably qualify for a subsidy. In my zip code it is 18%.
Lots of people look at the $88,000 figure and think it's almost everyone. But that figure is 400% of Federal Poverty Level (FPL) for a FAMILY OF FOUR in year 2010. Let's use 2012 figures for several family sizes. For a single person 400% of FPL is $44,680. For a couple it is $60,250. For a 3-member family it is $76,360. For a 4-member family it's now $92,200.
Think about that. How many single people make more than $44,680? Almost all college graduates. How many 2-earner couples make more than $60,250. Most of them. It's the families that may get the subsidies.
But it doesn't stop there. Just because your income is less than 400% of FPL doesn't mean you get a subsidy. You must pay up to the first 9.5% of your income for your premium before a subsidy applies. ( It's actually a sliding scale, and it's less than 9.5% at lower income levels, but most of those people aren't in our book of business because they never bought health insurance anyway!)
Younger people have lower premiums. If you make 380% of FPL, and you're single age 20, you get no subsidy because the premium is so low at age 20 that it's below your 9.5%. Change the age to 30, and there's still no subsidy. At age 40, there's $347 of a subsidy. At age 50, it's $2825 in subsidy. It's not just young people. Take that family of four for instance. At 400% of FPL ($92,200), the 9.5% rule is $8759 annually ($729.92 monthly). That means the family must pay the first $729.92 in monthly premium, and the subsidy applies to the rest.
There are other disqualifiers. If you are ELIGIBLE to join any employer group plan where your portion of the premium is less than 9.5% of your income, then you won't get a subsidy. Next - drumroll please - this also holds true for dependents. So, take a very common example where the employer pays a large portion of the premium for the employee, but almost nothing for dependents. Due to the fact that the EMPLOYEE portion is less than 9.5% of the FAMILY income, the entire family is disqualified from a subsidy even if the employer pays nothing for dependent coverage. Actually, the employer doesn't even have to pay a large portion in order for this to kick many families out of the subsidy. In the last paragraph, I said that a family of four must pay $729 in premium to equal 9.5% of their income if they make 400% of FPL. That means that any employer group health plan that charged that employee less than $729 for the EMPLOYEE-ONLY coverage would disqualify him and his dependents from receiving a subsidy. Nice. They should have read the law before passing it.
More. The subsidy is on a sliding scale. The closer you are to 400% of FPL the less money you get for subsidy. For instance, 300% of FPL is $33,510 for singles, $45,390 for families of 2, $52,270 for families of 3 and $69,150 for families of four. They may get a subsidy, but the amount they receive is nearing the end of the sliding scale.
Clawbacks. If you have an increase in earnings, putting you over the limit part of your subsidy can be taken from you later.
There are a few other glitches. You can only get subsidies by purchasing through the exchange ONLY if your State runs the exchange. Currently some states are considering opting out. There may be provisions for the federal government to run that exchange, but the PPACA law specifically allows subsidies only through State-run exchanges.
So here's a flow-chart:
- if your family earns a MAGI (modified adjusted gross income) of less than 400% of FPL;
- and you are not eligible for any group health plan (including your spouse's or parent's employer's plan), in which the employee contribution to the EMPLOYEE-ONLY premium is less than 9.5% of the family income;
- then you will receive a premium subsidy on a sliding scale that begins at 133% of FPL and reaches $0 at 400% of FPL,
- which only pays the excess over a certain percentage of your income that you must spend on premium. (6-9.5% for most people).
Now, to be fair, I should point out that many who receive a premium subsidy may also qualify for a cost-sharing subsidy to help them pay those copays and deductibles on those rich benefit gold-silver-bronze plans. (Novel way to control costs, isn't it?) But I digress. Also, people earning under 133% of FPL qualify for Medicaid, provided that the new SCOTUS decision doesn't put a hole in that bucket.
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Here's some good reading material:
This is very informative and very readable, and it's from the CBO just after the bill was signed: http://www.ncsl.org/documents/health/HlthInsPremCredits.pdf
Final regs from the IRS - not so readable!
Treasury Department and IRS Issue Final Regulations Implementing Affordable Care Act's Health Insurance Premium Tax Credit – Martindale.com
Federal Poverty Level tables for year 2012 (note, when people say $88,000 for a family of 4, they are using the much-publicized figures from year 2010) - Federal Poverty Guidelines
Enter a zip code and find the estimated number of people from that zip code who will qualify for health insurance premium subsidy: Mapping the Effects of the ACA's Health Insurance Coverage Expansions - Kaiser Health Reform
The Kaiser subsidy calculator - note that this is a handy calculator, but it misses a lot. For instance, you can put in a single person or family of four only. It's not perfectly accurate in other ways too, but it's very handy in helping with this complicated formula - Health Reform Subsidy Calculator - Kaiser Health Reform. Also, once you put in some data and calculate a subsidy, go to the bottom of the results page and click on links for other tables of information.
Another calculator that takes many family sizes into account and other data that the Kaiser calculator does not use - What does the Supreme Court's health-care ruling mean for me? - The Washington Post
A flow-chart of eligibility for subsidies - http://www.chrt.org/assets/aca-flowchart/CHRT-ACA-Flowchart-2011-12-Tabloid.pdf
Happy reading! Ann H
- 4,096
Ann,
You have provided some great information.
I looked at the Kaiser Mapper for % of zip code that will qualify for subsidy. It was a lot lower than what I expected.
The methodology is assuming that people will continue to have access to group health plans. I personally do not believe the small groups will continue employer sponsored plans.
I am hope I am wrong.
You have provided some great information.
I looked at the Kaiser Mapper for % of zip code that will qualify for subsidy. It was a lot lower than what I expected.
The methodology is assuming that people will continue to have access to group health plans. I personally do not believe the small groups will continue employer sponsored plans.
I am hope I am wrong.
CURRENT premium levels are low.
Won't be that way after GI, community rating, unisex and rate compression.
Younger ages projected to increase significantly while older ages will be "lower" than they should be without compression.
Pelosi and Reid are (now) aware of that and supposedly that will be fixed before 2014.
Maybe, maybe not . . .
chrisbeyersinut
New Member
- 19
Insurance agent here. Don't currently sell health insurance though and am trying to get a better understanding of the changing landscape.
Does the impending Obamacare motivate agents focused on health insurance to abandon health insurance sales completely, focus on ancillary lines like medicare supplements & group or just go forward business as usual?
Also, do the govt. imposed caps on non medical expenses (overhead/sales costs) as a % of premiums figure to curb commissions significantly?
Does the impending Obamacare motivate agents focused on health insurance to abandon health insurance sales completely, focus on ancillary lines like medicare supplements & group or just go forward business as usual?
Also, do the govt. imposed caps on non medical expenses (overhead/sales costs) as a % of premiums figure to curb commissions significantly?
