@calmom — was this the ‘diagnostic’ vs ‘screening’? My insurance pays for screening, and I have not been called back for diagnostic. Years ago, the GYN always requested diagnostic because it was covered by insurance. Probably wasteful, but disappointing that the patient is penalized when the diagnostic exam was indicated from the screening.
For 2017 we are a household of three (husband, wife, daughter). For 2018, it is unclear. We currently buy our insurance on the exchange with a subsudy and cost sharing.
In 2017, we started a small online business (LLC) selling products. No real equipment or employees. Using IRAs to reduce our income, we will try to keep our income low enough to get the lower decutibles and copays. For 2017, I suspect our daughter maximum income will be about 25-30K. However, she is considering getting a job in early spring and finishing her degree online so that could change but I doubt it will happen.
Can we afford full pay? Yes but paying 25K more not counting the additional prescription costs and copays will hurt. With my and my spouse health, a bronze plan would work. For my daughter, it would not be a good option.
You are right that I am overstressing this. I have try to research this issue and am uncomfortable how the laws apply in my case. In past years it was very clear. However, I am still researching how life changes work.
You are stating that once she if off our insurance that her income from that point on does count? Does it matter if she is a dependent?
I had a “screening” (paid for) and then they called me back. I checked with the billing office at the facility and they told me the follow up is billed as “diagnostic.” This is consistent with a previous incident many years ago when the same thing happened. I jut think that any call back is automatically billed out as “diagnostic”. Insurance covers, but it falls under my deductible, which is $4800. So far this year, as of October, I’ve used $7 of the deductible… so no chance that the insurance will pay. But they will cycle it through the claims process so I probably won’t get billed until November or December… 
On the subject of mammograms, another benefit to ACA worth pointing out. Mammograms screenings are covered in full under ACA’s preventative care coverage without copays, along with a whole host of other preventative care items specific to women - for both those on the exchange and for all private insurers. Here’s a laundry list of covered procedures that could go away without ACA:
https://www.healthcare.gov/preventive-care-women/
None of us can say more than how this is supposed to work, and what we’ve learned by looking, options in our own states, and for our own family particulars. Fang’s looked into some other states. Calmom supplies logic. But when considering enrollment, you have to get the hang of this, as it applies to you, your income, details, etc.
Yes, it can spin your head. Yes, some will need a CPA who understands or a sit-down with a Marketplace advisor.
This may help some. I can’t seem to link it.
IRS Pub 5187. Affordable Care Act: What You and Your Family Need to Know. Good overall.
“You are stating that once she if off our insurance that her income from that point on does count?” Count for what? She’s not in your “coverage family” if she is no longer a dependent. Yes, I keep saying it matters if she’s a dependent.
Try that IRS doc.
Sorry, it was late and I meant “not count”. Thanks for the IRS reference.
A broker just sent me the link for Maine plans. Our bronze Harvard Pilgrim HMO for three people is going up 38%, to $1,817. We can get a bronze Anthem HMO for $1,764, whoo hoo. We won’t qualify for a subsidy (with two kids in college, though, we’re broke, ha).
It’s tempting to go catastrophic, for $1,226! Deductible is $7,350 compared to $6,350 for bronze plans. I’m sure prescriptions wouldn’t be covered, but thanks to our wonderful system I can’t find out what my prescriptions would cost per month until I purchase them. So crazy. 
Catastrophic is for people 30 or under.
Yep. I’m bracing for bad news re: high premiums.
I can imagine people opting to pay the penalty instead of paying so much money for health insurance.
One of my coworkers said she needs that money for dental work!
Sigh.
Wasn’t Trump pushing for catastrophic policies to be allowed for everyone? I guess it hasn’t happened yet.
Yeah, our daughter needs to have her wisdom teeth removed, and it’s more expensive than for most people because of the meds required to prevent problems due to her bleeding disorder. Grr.
The bipartisan Alexander-Murray plan being put forward in the Senate in the Senate would allow catastrophic plans for all, but Trump opposes it.
However, Alexander-Murray does not change the maximum out of pocket limit, so the catastrophic plans it allows would be the same as Bronze plans. In order to offer a plan that covers less than a Bronze plan, either the maximum out of pocket would have to be raised, or some essential benefits would have to be removed. Removing mental health and maternity wouldn’t be enough, I don’t think. They’d have to go after something expensive like prescription drugs.
FWIW - My son works for a multinational company based in the US and their renewal increase is only 7%. I guess it pays to work for a large company - plus they pay 75% of his premium!
@noname87 – ok, going from household of 3 to 2 changes the numbers a little. For a household of 3, cutoff for subsidies is $81,680; household of 2, cutoff is $64,960. So your daughter’s income would make a difference if she earned $16,720 or more.
And yes I think it does matter if she is a dependent.
Bottom line if your AGI is going to be over $65K and you are fairly confident that your daughter will be working, then you probably should assume you won’t be subsidy eligible. Ther is a lot of wiggle room in that $65K with self-employment in the mix, but I’m guessing that the reason this is stressing you out may be that your income has been straddling that $80K mark, which means you can qualify for subsidies with a familiy of 3 but too high for a 2-person household. In which case you really should assume no subsidies for the coming year, but make sure you understand the ins and outs of the self-employed health insurance deduction. Because whatever part isn’t subsidized is subtracted from your AGI.
My advice: hire a CPA to do your taxes, under your business. (So what you pay the CPA is a business expense). Then have the CPA advise you and you can figure out whether it is feasible to reduce your AGI to quailfy or not, with the whole array of choices to write off expenses and manipulate income that are available to self-employed people. I am reasonably sure that a self-employed couple can have income of upwards of $100K and still have an AGI of under $65K with maximum retirement account contributions, self-employment tax deduction, self-employed health insurance deduction, etc. I have to add an HSA deduction into the mix to make it work for me.
Even if you are buying on the exchange and including your daughter, she does not have to be on the same health plan as you. So you can buy bronze for yourself and your husband, silver or gold for your daugher. Because of her age, her premiums will be lower so that may vere well come out cheaper than having all 3 on a silver plan.
Well my insurance company has a program called “Healthy Rewards” and they are going to send me $25 as a reward for having had a colorectal screening this year. (which they paid for). Amazon gift card but they gave me a choice of all sorts of different cards. This has nothing whatsoever to do with ACA, but its why I’m relatively happy with insurance company and plan. (Hey, we high deducible bronzers have to take anything we can get).
If I show proof that I belong to a gym, Harvard Pilgrim will send me $150. I agree with calmom, we take what we can get!
My kid 2 got a $100 gift card of some sort from Anthem for getting her annual physical.
Or course…they then turned around and cancelled their plans in her area.
So Anthem is not on the exchange in Maine, but they sell plans off-exchange that may work for us. They have a better network of providers than Harvard Pilgrim or Community Health Options. Those are our only three choices.
Anthem isn’t selling on or off exchange in my kid 2’s county in GA. She bought directly from the company…full price…no subsidy.
The company pulled out of the northern counties of GA altogether.
No extras from my insurance company, and, with one week until sign-up begins, still no word from my current carrier on what my renewal premium would be.
Window shopping is up on the federal exchange for many states. Brokers probably have prices for those states for off-exchange plans.