Affordable Care Act Scene 2 - Insurance Premiums

Parent Cafe
2981

<p>Answering GP’s question:

400% of FPL is close to median income.</p>

<p>As I’ve posted before, something like 70% of all Californians are living in households at or below the 400% mark. (See [Distribution</a> of the Total Population by Federal Poverty Level (above and below 400% FPL) | The Henry J. Kaiser Family Foundation](<a href=“http://kff.org/other/state-indicator/population-up-to-400-fpl/]Distribution”>http://kff.org/other/state-indicator/population-up-to-400-fpl/)) </p>

<p>So basically the answer is that I live quite comfortably, although I have a modest lifestyle. “Modest” means I live in a small tract home, drive a small sedan that I bought used about 10 years ago, eat at home most of the time, etc. It helps that I am a homeowner (so I don’t have to worry about market rate for rentals – I did a refi this spring and my mortgage rate is down to under 3%). </p>

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<p>You do know that other people live here as well, don’t you? Estimated per capita income in my community is something under $42K.</p>

2982

<p>GP wrote

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<p>Yes it can be done, even if the 26-or-under kid isn’t a dependent, but it cuts both ways. The kids income is counted, so its very possible that the combination of incomes could be what pushes the family over the subsidy level. For example, imagine a single parent who makes $40,000, with a 24 year old daughter earning $24,000. Separately they would each qualify for a subsidy, but with their income counted together they would be above the 400% mark. So I think that once the young adults are really living independently, the family will generally be better off to let the kids buy their own insurance.</p>

2983

<p>That’s interesting that you can include your 18-26 year-old kids in determining your family size for subsidy eligibility even if they are not dependents on your tax return. I didn’t know that.</p>

2984

<p>That’s because the law allows the child to remain on the parent’s plan until age 26, whether or not the child is a dependent. The subsidy determination is made by counting each person in the group that is getting coverage together. </p>

<p>It makes sense if you assume that the intent of the law is to provide coverage for young people who are not yet launched, because they are still in school, or have not yet been able to really establish themselves.</p>

2985

<p>Calmom, I would quibble with your use of per capita income to measure average household wealth in a given community. Per capita income encompasses the entire population including children. So the number is always going to be lower than household median income or wealth. I think most towns in the Bay Area and Silicon Valley have median or average family income that is appreciably higher than 42k.</p>

2986

<p>Can you count your 24-year-old kid in your family for subsidy determination if the kid is eligible to receive insurance from his/her employer?</p>

2987

<p>^good question. Don’t know the answer to that one (yet :)</p>

<p>I did want to contribute info that BCBS gave me yesterday (in Mi) which would seem to confirm that a) non-dependents under age 26 do not have to be included in plan b) that so-doing is a wash price wise on the individual market and c) in my case, rates aren’t dramatically different but for my employee, dramtically better under ACA.</p>

<p>Our present plan (small biz, pooled care, age-rated) is $1128. Per month per family.</p>

<p>Comparatively, on the BCBS individual market, a premium PPO silver HSA for my family (ages 48, 58, and 22) will be $1226. Ded is 400 more at $1400 but OOP is slightly less.</p>

<p>If we remove son (we’re told we can as he is not a dependent as defined by IRS) the premium is $996. Without subsidy, single same plan for son is $230. Subsidized, it would be $76.</p>

<p>By comparison although I don’t yet have my group quote, I believe the small group plan would come in slightly less, but would render my single-earner employee with a family of 4 ineligible for subsidy. If we go individual market, he will be able to cover a family of four in a ppo with vision and dental for about $360/mo, (after subsidy) which is only slightly more than his current 30% contribution and the current plan doesn’t include vision and dental.</p>

<p>BUT what I as employer can’t beat is the exchange-adjusted $600 family deductible and $2800 OOP. That is exactly the scale of financial protection he needs, and I even with a platinum plan can’t get the OOP as low as the exchange. So in a way, in this case, it might be cruel to keep a co. plan if I can’t rationalize a full HRA to sufficiently neutralize higher deductible and OOP. Won’t know that part until I get my group quotes. I’m pretty certain employee would prefer a raise :)</p>

<p>I did ask about out of state coverage should mcson go to grad school in the next few years. The BCBS PPO plan has about 80% national in-network coverage. Where available, that might be a decent option for those concerned about covering their kids in school.</p>

<p>Of course, these premiums are considerably higher than many HMO plans to be had, but the PPO makes sense for us for the choice, mobility and out-of-network coverage components.</p>

2988

<p>"I did ask about out of state coverage should mcson go to grad school in the next few years. The BCBS PPO plan has about 80% national in-network coverage. Where available, that might be a decent option for those concerned about covering their kids in school.</p>

<p>Of course, these premiums are considerably higher than many HMO plans to be had, but the PPO makes sense for us for the choice, mobility and out-of-network coverage components."</p>

<p>Thanks for that info.</p>

2989

<p>I didn’t know that starting 2014 employers had to keep under 26 kids on their plan even if they had other insurance available. Told my daughter she had to take out her employer’s coverage that is now available to her. She just did all the signing up yesterday - wish I’d read this before!! (actually cost wise her plan is about the same as we were paying for her on our plan - a little less - and we have said we will pay hers until the end of 2014 when her husband finishes his masters and hopefully their income becomes more liveable. But having her on my HDHP meant I could max out my HSA which was nice).</p>

2990

<p>Swimcatsmom, is it possible for her to cancel? I would have her ask. The worse they can say is no.</p>

2991

<p>dstark, not sure the out-of-state coverage for BCBS in Michigan applies to Anthem or Blue Shield in Ca.</p>

2992

<p>If I am understanding correctly the employer is required to offer for 26 and under but set their own rules on it terms of how much they want to subsidize?</p>

<p>As I mentioned before, we got a notice saying dental/vision won’t be covered for 19 and over if they are not in school fulltime while health will be.</p>

2993

<p>Marin County has a median household income of $48K,#1 in the state (based on tax returns). Alameda County (in the East Bay) has a median income of $42K, #8 in the state. The other Bay Area counties are in between.</p>

<p>So yea, the Bay Area is an expensive place. But half of the families in the Bay Area make less than, around, $45K.</p>

<p>[Bay</a> Area tops state again in median income - On The Block](<a href=“SFGATE: San Francisco Bay Area News, Sports, Culture, Travel, Food and Drink - SFGATE”>SFGATE: San Francisco Bay Area News, Sports, Culture, Travel, Food and Drink - SFGATE)</p>

2994

<p>Emilybee, there a number of parents I know who are retiring and getting their health insurance needs coverd by Cobra but the cost of adding a child to the coverage is very high. College health insurance is now undergoing a revampt to conform to ACA standards which means the cost may be increasing for many schools. When one has a child who is under 26 but is still dependent due to being a full time student, it precludes getting them subsidized ACA insurance, including the very inexpensiver Catastrophic coverage. You can’t go that route if the child is considered dependent. </p>

<p>So now there is a reversal of circumstances from earlier years when you could keep your college kid on your health care but not your kid who did not go to college and is working a job without insurance, and to ge that kid insurance meant buying it individually which was often pricey. Now the sitaution is that you can’t get those subsidies if your kids is your dependent, so college kid now can be the expensive one premium wise. The kid not in college making very little and under the age of 30 can get susidized cheap insurance. His twin in college cannot. Gotta add him to your insurance which could be very pricy, especially when going the Cobra route. </p>

<p>My one son is turning 26, and to get him covered under COBRA would be very expensive. But he is a starving low paid artist so he can get catastrophic coverage for a song, and subsidized insurance at any number of levels far cheaper than what DH’s company COBRA quotes for him were. We are just in time to take advantage of this windfall, because we’d be the one paying, not him, as he truly doesn’t have a dime to spare and comes by for handouts from us at times. We want him to have insurance in case of any health catastrophe–ACA’s rules of having to cover kids up to age 26 came just in time for us to keep him covered at no additional charge through employer insurance even after he graduated college, since we needed famliy coverage anyways and the cost is the same regardless of number of kids covered. When he turns 26, it’s onto the the Obama care options and he’s subsidized heavily due to lack of income, instead of COBRA. </p>

<p>As with all systems there are the windfall niches, and the shortfall ones. We’ve hit both under many circumstances. I’m glad we make out this time. The parents getting COBRA coverage with a depended adult child, cannot get subsidizes for the child, and te COBRA costs can be very high when one extra child is added to the insured group. I saw our rates, and I am glad he doesn’t have to go that way. Big cost difference.</p>

2995

<p>CF, I am seeing HUD household median income data for Marin and Santa Clara Counties as $96,700 and $105,000, respectively. </p>

<p><a href=“https://sites.google.com/site/camortgagelimits/hud-median-income-limits[/url]”>https://sites.google.com/site/camortgagelimits/hud-median-income-limits&lt;/a&gt;&lt;/p&gt;

2996

<p>cpt, does your son have a preexisting condition which would exclude him from the individual market pre-ACA?</p>

2997

<p>CNN is reporting that due to security flaws, healthcare.gov is vulnerable to hacking. Their tech reporter said this would be relatively easy to do. So your SS number and other personal information is vulnerable to identity theft. Talking about it right now on CNN.</p>

2998

<p>Offhand, I can see a few differences in the studies. Goldenpooches shows median income for 2013. Cf’s study is in 2009, and reflects the “midpoint of tax returns filed,” which I’m not sure exactly what that means. Is that before or after deductions? What about married filing separately, does this just show individuals and not households?</p>

2999

<p>Goldenpooch, my son does not. But go on the websites for what it would cost for a 26 year old to get insurance in NYC without subsidies. DH and I were cringing at the costs, and the COBRA costs were even higher for him to continue with the comparable coverage that he now has, but with individual deductibles. He’s just a notch over qualifying for Medicaid, though he is hoping to be well over that level next year. </p>

<p>Many of his peers without insurance just hit up the ERs and apply for help from hospital funds for low income patients when they need care right now. When you make about $16K a year and live in NYC, ain’t no way you can pay $400-500 a month for insurance. You need a hundred just for transportation, and even group home rent is about $600 amonth. So you do the math. Many of them will just pay the fine and continue the way they have been, but at least there is that fine going into the pot. Right now it’s nothing, they tend to walk away scott free. </p>

<p>My son cut his hand a few years ago, which was an scary, bloody injury and an ambulance was called and he was immediately admitted to ER. It turned out to be a temporary problem, healed just fine, but the cost was way up there. He didn’t have his insurance info and so they just ran it through the hospital charity funds. It took me a whle and a couple thousand dollars to run it through our insurance and pay the copays and deductibles, as he was covered by our very good insurance, that still has copays and deductibles, something he did not quite get. Had to sit down and explain how health care coverage works, and that having it doesn not mean you don’t pay anything for health care. My fault in not going through this with him and my older son who was outraged at his medical bills Both had enjoyed excellent health and my paying what little costs there were each year, so they had no idea what it can cost when there are medical issues. </p>

<p>The Catastrophic options is less costly, only if the person does not have medical issues during the year. The deductible is about $6K,and that still would not have covered the ambulance, ER admission and all the other related cost of my son’s hand injury. Something like that happen under ACA, anything over the $6K would be coverd by ACA catastrophic insurance and the rest would go on appeal for under the hosptial charity fund, which by the way, was generous in covering that injury. I think about 90% was covered, though I ended up having all payments rescinded and running it through our insurance and paying the rest out of our pockets, something I won’t do anymore unless the circumstances are extreme. I felt that because he was covered at no charge to us under our insurance, we could pay the deductibles, but I think we could have just left it as it was and son would have just owed the 10%.</p>

3000

<p>Two people living together could file separately. What I quoted was tax returns.</p>

<p>The difference between 2009 and 2013 would be something, but probably not a lot. That certainly wouldn’t explain the difference between $48K and $97K!</p>