ObamaCare Info

[Marionnette]

nope not my problem.... i get all the way thru to the 3 security questions and get an error message about my security questions being the same..... and they are not and than loops me back to start..............really annoying.......

I've been trying to create an account for our small business (under 50 employees). We thought that perhaps joining the exchange would empower us to offer a health insurance plan that would make it more affordable for our employees than what they can get on the individual market. Unfortunately, I cannot even set up an account on the federal website (where PA business owners need to start). I fill out the first 3 steps, including security questions, and then the darn thing tells me that the "site is unavailable". Very frustrating since our employees don't participate in the current plan that we offer due to it being too expensive for them, yet they need to be signed up for *something* by the first of the year!

 

[johde]

I manage the economic support division, including all public assistance programs (and other programs like child support) in a MN county. I am implementing the ACA at the county level for those on medicaid. Unfortunately, I am living and breathing this stuff, and I know way more than I want to this point, but not near enough to understand it inside and out yet. I have had specific training from the MN department of human services on the household comp stuff, so feel pretty confident in the info I provided.

That's one job I don't think I'd like to have. I'm a part time Accounting and Business Math instructor trying to figure this stuff to be able to do what's best for me and to be able to explain things to my students. So, on the one hand, I know way more than I want to, but on the other hand, still have questions I need answered for me an my situation.

So, in my previous reply I was agreeing with you and reiterating what you said in the terms I've been reading. Any trepidation in my answer was a combination of my lack of knowledge and the fact at times they seem to be making it up as they go along.

One question I have been having trouble answering is when I'm required to update income information with the government during the year. Being part time faculty, my pay is based on how many of my classes end up going. So my pay is extremely variable from month to month.

January I normally have almost no income I get paid for spring classes over Feb, March, April, and half of May. I miss another pay and get summer pay over June July and August. Finally fall pay is the half of Sept, Oct, Nov, Dec. Normally, Fall is my best semester for getting classes so most of my income normally comes in the fall and I don't have a good handle on annual income until late August early September. To make matters worse, I'm right on the boarderline of 200% FPL. One class one way or another can potentially on one side or the other of that line.

 

[lauradis]

I manage the economic support division, including all public assistance programs (and other programs like child support) in a MN county. I am implementing the ACA at the county level for those on medicaid. Unfortunately, I am living and breathing this stuff, and I know way more than I want to this point, but not near enough to understand it inside and out yet. I have had specific training from the MN department of human services on the household comp stuff, so feel pretty confident in the info I provided.

Please share any info you can for your area, we really need to know how this works.

 

[lauradis]

No m'am, at one time was posted on the Obamacare site (healthcare.gov) that it would be free healthcare.

It used to read:
“Where can I get free or low-cost care in my community?”

“If you can’t afford any health plan, you can get free or low-cost health and dental care at a nearby community health center.”

Now, it reads:
If you can't afford any health plan, you can get low-cost health care at a nearby community health center.

It really wasn't a lie most people don't understand how expensive insurance is.

Most people can still go to free health clinics even if they have insurance.

 

[blanq]

That's one job I don't think I'd like to have. I'm a part time Accounting and Business Math instructor trying to figure this stuff to be able to do what's best for me and to be able to explain things to my students. So, on the one hand, I know way more than I want to, but on the other hand, still have questions I need answered for me an my situation.

So, in my previous reply I was agreeing with you and reiterating what you said in the terms I've been reading. Any trepidation in my answer was a combination of my lack of knowledge and the fact at times they seem to be making it up as they go along.

One question I have been having trouble answering is when I'm required to update income information with the government during the year. Being part time faculty, my pay is based on how many of my classes end up going. So my pay is extremely variable from month to month.

January I normally have almost no income I get paid for spring classes over Feb, March, April, and half of May. I miss another pay and get summer pay over June July and August. Finally fall pay is the half of Sept, Oct, Nov, Dec. Normally, Fall is my best semester for getting classes so most of my income normally comes in the fall and I don't have a good handle on annual income until late August early September. To make matters worse, I'm right on the boarderline of 200% FPL. One class one way or another can potentially on one side or the other of that line.

Oh, I knew you were agreeing with me, and my post actually was meant to tell you that you are right! There should not have been any trepidation in your answer.

I wish I knew your answer to reporting income changes. I know for the IAPs (Insurance Affordability Programs with government funding such as Medicaid, BHPs and subsidies) applicants must report income changes within 10 days, but I am not exactly clear, based on the limited training I have received to date, what constitutes an income change (in terms of percentage of income). I do know for you, and your ability to qualify for the IAPs, the health care exchange you use will compare your reported current annual income against the federal data hub, and if there are differences an individual will need to independently verify via other evidence. You are not alone in having more seasonal-type income, and having swings in your income, due to the type of job you have, but it's your annual adjusted gross income that will be looked at to initially set your eligibility for IAPs during open enrollment for the following year. I do know that medicaid does not have an open enrollment period...so if someone initially qualifies for a subsidy, for example, and next May loses their job, they can update their income and qualify mid-year for medicaid, if they qualify.

I have a ton to learn about this stuff!

 

[mikek]

Except the subsidies go by household income, don't they? So I'm not sure a 24 year old still living at home would be able to benefit from the exchange as an individual.

As far as a situation where keeping the 26 year old on your plan is cheaper, that's easy - when s/he isn't an only child. We have three options from our insurance company - individual, individual and spouse, or family. The family premium is the same whether it covers one child or five, so there'd be no additional cost for us to cover our oldest two children until they're 26 because we'll still be paying family rates in order to cover the youngest anyway.

I think the "move" as you put it is simply to prevent a mass enrollment of young adults in medicaid. One of the eligibility tests is whether you have access to private coverage, so by extending the insurable age on parental policies to 26 this makes parents (rather than public assistance) the back-up plan for their young adults' insurance if they cannot provide it for themselves.

interesting point about if the subsidies go by "household income"- i don't really know. But like i said they should have just defined "household income" as what's on your taxes. My kids income when they are 26 dont count on my taxes.

Your other theory about making parents be the backup rather than medicare also makes sense- so it might be that too.

But i think perhaps you are in for something of a rude awakening with the obamacare plans- there doesn't really seem to be "family coverage" anymore - you basically seem to be charged for each individual. I priced 3 of the 4(I think) NJ providers on their websites. All now assign a cost per person. My cost for example was around 400, my wife was about 20 more (she's only a year older and i thought age wasn't supposed to matter so i think it could be more for women?) and my kids were each 1-200 bucks. I've NEVER seen anything like that in the past and we've had our share of insurers over the years looking for any edge. I think it has something to do with how they sometimes figure things like subisides and the 9.5% thing on a per person basis- cant really say.

In fact- you might have really hit on something that explains the large increase in plan prices for me - i have a family of 5. Probably family plans where based on the average family size which was less than 5 people. Now that they charge per person I'm actually paying for the 5th. Perhaps that is what's going on????

I wonder if families of 3 see big price drops- that would confirm that we are now paying per person now per family. Give me a few minutes and i'll go try to brice BCBS obamacare pricing for family of 5 and then make it a family of 4 and 3 and see what happens.

 

[mikek]

This is the part I really didn't like since we have an only child and all these years we were subsidizing large families.

I just priced different amounts for kids on the obamacare BCBS NJ plans. and that IS NO LONGER the case. 3 kids is less than 4. And 5 is less than 5. On the EPO gold plan (just the top one on their website so it was easier to go back and fourth adding kids) it's about $215 bucks a month more for each kid.

actually as you point out it is fairer. But Boy it would have been nice if the tools in charge had warned me the past several years so i could have budgeted.

 

[mikek]

Have you tried just looking at the individual plans listed on BCBS and AmeriHealth? I have a feeling that they will be the same as the small group plans since all previous small group plans are eliminated at renewal in 2014. There is nothing to compare to our previous direct access plan, in coverage or benefits.

I think the Amerihealth POS+ national access is the closest to BCBS's former direct access but i am not sure at all.

 

[njcarita]

I just priced different amounts for kids on the obamacare BCBS NJ plans. and that IS NO LONGER the case. 3 kids is less than 4. And 5 is less than 5. On the EPO gold plan (just the top one on their website so it was easier to go back and fourth adding kids) it's about $215 bucks a month more for each kid.

actually as you point out it is fairer. But Boy it would have been nice if the tools in charge had warned me the past several years so i could have budgeted.

you got ON THE NJ SITE..........................

 

[mikek]

...

I am not sure I understand the crabbing from other posters about kids being able to stay on their parents health insurance until they are 26. The govenment is not requiring parents to do this; it's an option and a choice. I....

I was "crabbing" until just this minute becasue until 1/1/14 a family plan was a family plan was a family plan. So if person X decided to add their 25 year old to their family plan - their premium still was the same if it was a family plan anyway. Since the premium didn't go up that meant everyone else paid more to cover all the kids who previously had to have their own coverage.

Now that I see we all pay per person no matter what- I have no complaint. It's "fairer" that way in my humble opinion even though I wind up paying more for it because we procreated several times- lol.

 

[mikek]

I've been trying to create an account for our small business (under 50 employees). We thought that perhaps joining the exchange would empower us to offer a health insurance plan that would make it more affordable for our employees than what they can get on the individual market. Unfortunately, I cannot even set up an account on the federal website (where PA business owners need to start). I fill out the first 3 steps, including security questions, and then the darn thing tells me that the "site is unavailable". Very frustrating since our employees don't participate in the current plan that we offer due to it being too expensive for them, yet they need to be signed up for *something* by the first of the year!

no rush- i believe the SHOP exchanges (for small businesses) aren't coming on line until around 11/1

that said I'm day 9 in and been trying to get an individual account for all 9 days. I don't think I'm exaggerating that I've attempted to move forward on the website at least 200 times and today I'm still at the step where they are trying to verify my existence (mind you I just want to LOOK at prices, i don't need to buy today nor do i believe i can get a subsidy so i told it to forgo looking that up) Today it took about 8 times to log in before i got to the page that showed me I'm still not verified (the first 7 times i get to the prank page that is titled "success URL" but is blank)

 

[mikek]

you got ON THE NJ SITE..........................

NO NO NO- sorry- wasn't clear.

you can go to http://www.horizonblue.com/ and tell it you want coverage on 1.1.2014 and the plans APPEAR to be the obamacare plans. No one has said for sure but they use similar terms and wording.

I'm still trying to get on the obamacare exchange site for NJ ran by the feds to confirm that the pricing from BCBS and amerihealth websites is the same as the fed site.

 

[j's m]

I think the Amerihealth POS+ national access is the closest to BCBS's former direct access but i am not sure at all.

That's the plan I will have to go with when our group plan is up next September. I have a DS in college and whatever extra I pay for the POS gets better coverage than an EPO and additional college plan.

From my freshman year of college to now, 45 years of continuous coverage by NJ BCBS, and how many thousands of dollars in premiums, they are kicking me to the curb with their lousy EPO plans, with no out of network, no national access and not even coverage 40 miles away in Delaware.

 

[mikek]

That's the plan I will have to go with when our group plan is up next September. I have a DS in college and whatever extra I pay for the POS gets better coverage than an EPO and additional college plan.

From my freshman year of college to now, 45 years of continuous coverage by NJ BCBS, and how many thousands of dollars in premiums, they are kicking me to the curb with their lousy EPO plans, with no out of network, no national access and not even coverage 40 miles away in Delaware.

I'm in same boat of getting kicked to the curb. (although no where near as 'loyal' customer as you).

I wish i could trust a politiician to help but they all stink so wont bother- they're all busy lying to each other in DC now anyway...

But i want someone to explain to us the letter that horizon BCBS is sending that says

"The ACA required all health insurance plans to meet new requirements. Because of these requirements, your current insurance plan cannot be renewed on your groups anniversary date in 2014"

The way they worded it they are clearly blaming the act. I want to know who is the liar- the government who says we could keep our old plans or BCBS who is blaming the government while it's not true. One of them is a liar and i want to know.

 

[Gracie09]

I was "crabbing" until just this minute becasue until 1/1/14 a family plan was a family plan was a family plan. So if person X decided to add their 25 year old to their family plan - their premium still was the same if it was a family plan anyway. Since the premium didn't go up that meant everyone else paid more to cover all the kids who previously had to have their own coverage.

Now that I see we all pay per person no matter what- I have no complaint. It's "fairer" that way in my humble opinion even though I wind up paying more for it because we procreated several times- lol.

Although all thoses healthy young kid are subsidizing your insurance rates in any group plan. In the last year my two four year olds have been to the doctor four times total. Once each for a physical and once each for a sick visit. My husband in contrast has been about ten tmes in the same amount of time.

Once kids get past the infant stage, except for a few boken limbs etc, they tend to be healthy. Its us old people that cost money. That's why the outrage about keeping young, genrrally healthy people on their parents insuance is puzzling.

 

[mikek]

Although all thoses healthy young kid are subsidizing your insurance rates in any group plan. In the last year my two four year olds have been to the doctor four times total. Once each for a physical and once each for a sick visit. My husband in contrast has been about ten tmes in the same amount of time.

Once kids get past the infant stage, except for a few boken limbs etc, they tend to be healthy. Its us old people that cost money. That's why the outrage about keeping young, genrrally healthy people on their parents insuance is puzzling.

If the young healthy kids say from 24-26 paid for individual plans then they would be paying in the system. this is healthy person paying to help keep rates down.

Keeping them on as the 4th, 5th, etc on a family plan they didn't pay into the system anything so they knocked the rates down.

One point though that was pointed out to me about is folks with a single kid- if 24-26 year old kid were a single child and the parents bought a family plan instead of primary+spouse then that family probably paid "more than their fair share" and it helpd balance out.

anyway it's all moot now since going forward we are all apparently going to be paying per person. Might not even be a discount for a family at all- never mind 'a deal' if you have 2 or more kids like before.

 

[Auntrosie]

I am interested in giving US Citizens who earn a low wage access to affordable healthcare Insurance. No solution is perfect. Let's start with The Affordable Healthcare Act and work on it from there.

 

[Marionnette]

I'm in same boat of getting kicked to the curb. (although no where near as 'loyal' customer as you). I wish i could trust a politiician to help but they all stink so wont bother- they're all busy lying to each other in DC now anyway... But i want someone to explain to us the letter that horizon BCBS is sending that says The way they worded it they are clearly blaming the act. I want to know who is the liar- the government who says we could keep our old plans or BCBS who is blaming the government while it's not true. One of them is a liar and i want to know.

I think that both the insurance companies and the government are guilty of lying.

The claim that "if you like your plan, you can keep it" should have had "if it meets the standards we have dictated" somewhere in the small print.

Insurance companies, OTOH, are using dictates such as 100% coverage for preventive care, birth control prescriptions and routine mammogram coverage as legitimate reasons to dump plans that don't include them. My insurance rates are going up because my plan has to cover maternity care under the new law. I'm post-menopausal. Why do I need maternity coverage? I don"t. But the law dictates that my policy must include it.

 

[mikek]

yep - all becoming very clear now.

EVERYTHING is an individual plan. You pay per person. No family discount. At least with NJ BCBS. I'm pretty sure it's the same with the others as they all show the cost per person breakdown.

I added and subtracted different "people" and each person is charged individually based on age and sex.

no matter how you slice it on the NJ BCBS plan i mentioned above I cost $470.45. If I'm single. plus spouse. plus spouse and 1,2,or 3 kids - I always cost $470.55

Similarly my wife is always $484.31

and each kid is the same(doesn't appear to matter what age or sex as mine have a 7 year spread and are of either flavor)- each one is $220.14 no matter how many i slap on there.

This makes everything much more simple and yet way more complex. If you are a gambler and different folks in your family are much more or less healthy then the others it might make sense to split them off into different plans. If you have very healthy folks who you dont think will ever go to the dr except for preventative checkups then you perhaps you should split them off and buy them the highest deducible/copay/bronze plans you can get your hands on. Then you could put the chronically ill folks (cough cough asthma- lol) folks on a plan with less out of pocket.

this just added another 3 worksheets to the spreadsheet.

 

[j's m]

I'm still trying to get on the obamacare exchange site for NJ ran by the feds to confirm that the pricing from BCBS and amerihealth websites is the same as the fed site.

A few people on another chat board have reported that on or off exchange prices are the same.

"I believe the law requires that every company on the exchange also offer identical plans off-exchange, for the same prices as the on-exchange twin policy. Off exchange they can also offer additional plans which comply with ACA requirements, so some exchange providers are offering some different alternatives off-exchange."

Of course, it probably doesn't apply to our great State of New Jersey.