ObamaCare Info

[lauradis]

I support the ACA

This is a known issue without a known fix. When the language about affordability was written the language wasn't specific, and now there's no fixing it for the time being because of the current political climate regarding the whole subject.

Keep the support going. We are stuck with it for long time just like food stamps section 8 medicaid. this is just a new tax, just hidden.

Love your post colleen they are always well written and smart.

Now that the prices are unfolding and people are shocked it isn't cheap aka affordable. Hmm im wondering what middle class will be giving up cable, dinning out, vacations, saving for retirement, college funds, retail shopping... what business will this hurt. Not the government they have a new tax and oh this is like the lottery for the insurance companies.

 

[mikek]

...

5) Deciding to drop insurance and become uninsured and pay the penalty is not off the table. But, right now the least likely decision.

gotta say that MATHEMATICALLY this is the smartest thing to do for many. Especially myself. CUrrently I'm paying about 20% of my income for healthcare.

I could bail on the system and then just pay a 1% fine (THIS YEAR) then pay cash for everything.

One of the other things the ACA didn't touch is all the lying about prices charged and paid. Providers who deal with insurance have book rates that make you think Dr's are making 3 million a year. Insurance says "NO" and they pay something that i dont think covers the providers costs (once you look at the huge office staff dealing with insurance). If you tell them you dont have insurance (or aren't covered for the service)- they usually charge you something like 4 times what insurance would pay- it's a big discount off their book rates but still feels "too much".. But if you find a dr who has opted out of the BS he usually charges a fair price right up front that you a middle class person could afford.

So anyway- I could pay the fine. Then go all cash. and I'd probably cut my healthcare costs to just 10-15% of my income.

If god forbid something bad happened you just buy insurance then since it's take all comers.

MATHEMATICALLY it's a no brainer. But it "feels" too stressful. If I could just get myself to be cold and calculating then I could probably save myself a sizable sum.

One thing that makes me go that much closer to doing that- and screwing the system up even more- is that they blew up my existing plan. If I could keep my existing plan then inertia for sure would keep me in it. But since i already have to feel uncomfortable and perhaps find all new dr's and all that- why not?

it's a mess

Sadly it's a mess.

 

[mikek]

...

This is a known issue without a known fix. When the language about affordability was written the language wasn't specific, and now there's no fixing it for the time being because of the current political climate regarding the whole subject.

this is why many are cynical that the government can ever be a solution to problems. It screws up often. The pols pass bills that they apparently didn't have time to really think about (If they did in fact read it). There's tons of unintended consequences with everything they do (and sometimes evil intended consequences becasue of lobbyists).

I'm still floored that there is(maybe now resolved i the past couple weeks) even a discussion about whether or not pharma can STILL give free drugs, coupons, or rebates, to the poor who might now get coverage through the exchanges. WHo disagrees with that? Progressives would see a system that "big business" helps the poor folk- perhaps at the cost those better well off. Conservatives would point that it's an example of private entities on their own helping to fix a problem voluntarily.

Anyway, I'm still not sure what i think about the ACA. For sure I'm not against what it appears to have wanted to do- give the poor subsidies to buy insurance and perhaps cut some costs by making better efficiencies. But I think it didn't address the REAL problems at all- and there is plenty of blame to go around the table. - lawyers, Doctors, insurance companies, the government, consumers, and then some are all contributing to the excessive costs.

 

[Colleen27]

Keep the support going. We are stuck with it for long time just like food stamps section 8 medicaid. this is just a new tax, just hidden.

Love your post colleen they are always well written and smart.

Now that the prices are unfolding and people are shocked it isn't cheap aka affordable. Hmm im wondering what middle class will be giving up cable, dinning out, vacations, saving for retirement, college funds, retail shopping... what business will this hurt. Not the government they have a new tax and oh this is like the lottery for the insurance companies.

You're not seeing the flip side of that, though - the people like my family who will likely have several hundred dollars a month in savings from this act and the people who are suddenly free to leave steady, benefit-providing jobs to start businesses or pursue better paying opportunities. Believe me, we'll be out spending. DH has twice taken sizable pay cuts to "chase" benefits; that's money that came directly from our disposable income category, and to a lesser degree from our college and retirement savings. And I'm only measuring in the tangible - the amount the paycheck went down - not the intangible costs of changing fields or leaving situations where he had experience, expertise, and seniority in order to start on a lower rung of the ladder elsewhere. We are very excited at the prospect that we can once again entertain the idea of a family business, without the cripplingly high insurance costs that were instrumental in sinking us the first time around.

I don't think this law is perfect. But I don't believe in the notion of a perfect first-edition, whether it is a piece of software or a new model of car or a law. Heck, even our Constitution needed fixes over the years. In a proper spirit of democracy - that is, respect for the will of the people as expressed through duly elected representatives, and compromise between the parties who keep the best interests of the nation as their uppermost priority even when they disagree - glitches and loopholes can be fixed. But our system is far more broken than any individual law at this point so part of the process is not functioning.

 

[Colleen27]

So anyway- I could pay the fine. Then go all cash. and I'd probably cut my healthcare costs to just 10-15% of my income.

If god forbid something bad happened you just buy insurance then since it's take all comers.

Something to keep in mind about that route - it works if the "something" that happens is a diagnosed illness. Not so much if it is an accident or catastrophic medical crisis (heart attack, stroke) that would incur large medical bills before you had opportunity to purchase insurance.

 

[j's m]

If god forbid something bad happened you just buy insurance then since it's take all comers.

This year the open enrollment is 6 months, but will that change to be like medicare that open enrollment is only 2 1/2 months with coverage beginning Jan 1? If so, if you don't have insurance you might only be able to get in the following January. I would assume you would be allowed to sign up any time if you lost coverage.

But where are the rules on this?

 

[barkley]

This year the open enrollment is 6 months, but will that change to be like medicare that open enrollment is only 2 1/2 months with coverage beginning Jan 1? If so, if you don't have insurance you might only be able to get in the following January. I would assume you would be allowed to sign up any time if you lost coverage.

But where are the rules on this?

current enrollment is open until march 31, 2014. when that ends yearly open enrollment will be October 15th-december 7th of each year.

there are certain 'life changing events' that allow enrollment outside that time frame, but they are limited to things such as marriage, move to another state, marriage/divorce/having a baby...


people who don't enroll during open enrollment are ineligible to any government subsidies for healthcare.


I suspect allot of people are considering this though-there's been a flurry of news articles on the very subject yesterday and today.

 

[j's m]

current enrollment is open until march 31, 2014. when that ends yearly open enrollment will be October 15th-december 7th of each year.

there are certain 'life changing events' that allow enrollment outside that time frame, but they are limited to things such as marriage, move to another state, marriage/divorce/having a baby...

people who don't enroll during open enrollment are ineligible to any government subsidies for healthcare.

I suspect allot of people are considering this though-there's been a flurry of news articles on the very subject yesterday and today.

But is a life changing event losing your current insurance? Since we are self employed we pay our own group coverage and the plan is good until next September. However, our plan will have to be upgraded and then I might want to go on the exchange instead. Would I be allowed to get a subsidy not during open enrollment?

Thanks for your help, I've spent the last 4 days just reading everything I can get my fingers on, and I can't even see straight any more. Where are you finding any reliable info?

 

[njcarita]

But is a life changing event losing your current insurance? Since we are self employed we pay our own group coverage and the plan is good until next September. However, our plan will have to be upgraded and then I might want to go on the exchange instead. Would I be allowed to get a subsidy not during open enrollment?

Thanks for your help, I've spent the last 4 days just reading everything I can get my fingers on, and I can't even see straight any more. Where are you finding any reliable info?

we are self employed in nj too........ if u figure anything out please pass on the info........ my husband and i are our group..... still havent been able to get on the website past the 3 security questions............. my renewal is up in feb...... and i honestly dont think my plan will be available anymore....... the info is very confusing...........

 

[njcarita]

Well day 4 still cant get on............. Please note that two or more answers to the security questions cannot be the same. You must provide distinct answers to the chosen security questions.

Please wait a few moments and try again........................ this error everytime........... even though my answers are all different............ this is starting to almost.... i said almost be funny..................... if it werent my tax dollars in action............... decided to click the chat thingy.... will see how long it will take someone to be available........ so far 4 minutes and counting

 

[j's m]

njcarita, please don't hold your breathe while you are waiting!

In my quest for enrollment knowledge I found on Kaiser:

For individuals and families buying non-group coverage on their own, outside of the Marketplace, you can only enroll in coverage during Open Enrollment periods and special enrollment opportunities, as well.

So you're not allowed to get private coverage unless they approve when you get it.

American Indians and Alaska Natives can enroll in coverage throughout the year, not just during Open Enrollment.

Why are they the exception? This just doesn't seem fair.

 

[mom2rtk]

This just doesn't seem fair.

I'm not sure anyone would expect fairness out of any of this mess.

 

[Marie17]

What exactly is considered a life changing event?

I see that you have to enroll during open-enrollment (oct 1- march 1) for this year - all upcoming years are to be October - December 7th only. I also saw that individual and family plans are supposedly going to be that same open enrollment period too.

BUT what happens if your current employer decides to not offer HEALTH insurance once their current plan year expires. Our enrollment is actually in the summertime of each year so that's why I am inquiring. Is losing access to current employer based health insurance considered a life-changing event? I see that having a baby, losing your job or quitting your job, etc BUT do not see if insurance is just no longer offered is considered a life-changing event. Anyone know where I can find the actual wording because I can't.

 

[njcarita]

njcarita, please don't hold your breathe while you are waiting!

In my quest for enrollment knowledge I found on Kaiser:

For individuals and families buying non-group coverage on their own, outside of the Marketplace, you can only enroll in coverage during Open Enrollment periods and special enrollment opportunities, as well.

So you're not allowed to get private coverage unless they approve when you get it.

American Indians and Alaska Natives can enroll in coverage throughout the year, not just during Open Enrollment.

Why are they the exception? This just doesn't seem fair.

well my hsubands grandfather was full blooded black foot indian..... that make us exempt??lol........... i am now more confused........

 

[j's m]

I found a good Q & A on Kaiser Family Foundation, KFF.org Health Reform, Frequently asked questions


In general, you can have a special enrollment opportunity to sign up for private, non-group coverage during the year, other than during Open Enrollment period, if you have a qualifying life event. Events that trigger a special enrollment opportunity are:

Loss of eligibility for other coverage (for example if you quit your job or were laid off or if your hours were reduced, or if you lose student health coverage when you graduate) Note that loss of eligibility for other coverage because you didn’t pay premiums does not trigger a special enrollment opportunity
Gaining a dependent (for example, if you get married or give birth to or adopt a child). Note that pregnancy does NOT trigger a special enrollment opportunity.
Divorce or legal separation
Loss of dependent status (for example, “aging off” a parents’ plan when you turn 26)
Moving to another state or within a state if you move outside of your health plan service area
Exhaustion of COBRA coverage
Losing eligibility for Medicaid or the Children’s Health Insurance Program
For people enrolled in a Marketplace plan, income increases or decreases enough to change your eligibility for subsidies
Change in immigration status
Enrollment or eligibility error made by the Marketplace or another government agency or somebody, such as an assister, acting on their behalf.
Note that some triggering events will only qualify you for a special enrollment opportunity in the health insurance Marketplace; they do not apply in the outside market. For example, if you gain citizenship or lawfully present status, the Marketplace must provide you with a special enrollment opportunity.

When you experience a qualifying event, your special enrollment opportunity will last 60 days from the date of that triggering event.

States have flexibility to expand special enrollment opportunities for consumers. Check with your State Marketplace for more information.

Also found this on healthcare.gov:

Outside of an open enrollment period, you may not be able to buy or change health plans inside or outside the marketplace unless you experience certain qualifying life events for example marriage, birth of a child, or LOSS OF OTHER HEALTH COVERAGE.

 

[mikek]

You're not seeing the flip side of that, though - the people like my family who will likely have several hundred dollars a month in savings from this act ...

with all due respect- it is REALLY HARD TO SEE THE OTHER SIDE when you are the flip side that is paying several hundred dollars more a month.

that's the thing- there shouldn't be winners AND losers. And if there are losers it should be a handful not wholesale.

 

[mikek]

Something to keep in mind about that route - it works if the "something" that happens is a diagnosed illness. Not so much if it is an accident or catastrophic medical crisis (heart attack, stroke) that would incur large medical bills before you had opportunity to purchase insurance.

If i was the type of person that would go that route- (I'm probably too much a rule follower)- i'd just sue "whoever caused the accident" to deal with it.

And maybe you hit something on the head with the heart attack and stroke thing. Maybe we can make money setting up a brokerage that sells insurance to people in the ambulance on the way to the website- J/K

 

[mikek]

This year the open enrollment is 6 months, but will that change to be like medicare that open enrollment is only 2 1/2 months with coverage beginning Jan 1? If so, if you don't have insurance you might only be able to get in the following January. I would assume you would be allowed to sign up any time if you lost coverage.

But where are the rules on this?

good point. someplace i saw the open enrollment is like now in that you have X days (i think ikt was 30) after a change in situation to do something (lost coverage, new job, etc)

 

[mikek]

we are self employed in nj too........ if u figure anything out please pass on the info........ my husband and i are our group..... still havent been able to get on the website past the 3 security questions............. my renewal is up in feb...... and i honestly dont think my plan will be available anymore....... the info is very confusing...........

Same spot as you- I have a partner but he is covered under his wife. All our handful of employees work maybe 100 hrs a year oer diem basically. (when the economy tanked we were forced to let our only full timer go so he came off) So my family is the only covered in the group.

On the exchange I've gotten to make an account, security questions, reply to email verifying address, fill out application. But can't get my identity verified by experien (well today i can't even get on the site to see if i was experien verified)

We got the letter ~2 weeks ago that our NJ small business plan (horizon BCBS) is no longer allowed to be renewed- so keep checking the mail. there's a nother thread about private insurance here. SEEMS THIS MAY BE A WHOLESALE OCCURRENCE. Posts from people in CT and i think Michigan also getting nuked. Seems the lie about keeping the insurance we have is the biggest political lie ever short of read my lips (which honestly was a flip flop not a lie in my humble opinion- haven't seen anyone come out and say 'never mind we did in fact outlaw all the current plans')

I did read someplace they have to notify you x days in advance that they will not renew but think it was just like 30 or 60. So you may not get a letter till much closer to year end.

My broker can't get access to 1/1/14 plans just yet. So i'm stuck with looking at the exchange for now.

But someone suggested checking the individual websites of BCBS, etc and the 'individual plans' sounds like they are obamacare plans (the use the same bronze, silver, etc thing)- and i can save you the time- THOSE LOOK HORRIFIC. All just EPO's - ZERO NADA ZILCH out of network allowed. rates much worse than our current direct access small business plan. When ever I can get on the exchange then I'll confirm that my sinking suspicion is true. If i ever get there i will post back. Also- about half (the small handfull) of companies listed on the NJ insurance and banking regulator website tell you screw off when you put in you wnat ccoverage beginning 1/1 so looks like just 3-4 will be left in NJ on 1/1 - so much for competition helping to control costs....

 

[mikek]

...
But I also think government needs to encourage real job growth, particularly small business growth, and that means narrower and more focused regulation.....

I think you are spot on with your point above- in fact seems almost everyone says the same things, joe six pack, economists, pols from all parties, etc. Small business job growth is what is/will drive the economy going forward.

So when as i read more and more of my fellow small business owners getting the apparent shaft in this thread, i have to wonder how much damage this giant law with it's mess of related unfocused regulations is going to do to the economy.

I say wonder in that i hope once the smoke clears in a few weeks that the truth is all will be well for this group (who knows, when i asked my broker at renewal a few months ago he sounded optimistic that in fact my deductibles and out of pockets would actually go lower on my old plan...) . But in the vaccum of information today (all we know is our existing plans have been destroyed by the law) it doesn't look good.