Affordable Care Act Scene 2 - Insurance Premiums

[Cardinal_Fang]

<p>Medicaid eligibility in the expansion states is based on income, just like the subsidies. If a grad student has a low enough income, they would qualify for Medicaid. Some grad students have fellowships that would put them over the Medicaid line, but those that have low enough incomes would be eligible.</p>

<p>The intention of the Medicaid expansion was to cover people with low incomes. That would include grad students as well as everyone else.</p>

[busdriver11]

<p>“The intention of the Medicaid expansion was to cover people with low incomes. That would include grad students as well as everyone else.”</p>

<p>I’m pretty sure you have to have low assets too, and until recently, there had to be some other factor involved, like a dependent child, for example.</p>

<p>I doubt the intention was to cover people purposefully not working at all so they can go to med school or Harvard business school. If you can borrow or get your parents to pay 200K for that, you ought to spring for a few thousand more for health insurance. Seems like a scam to me. What next, food stamps and welfare for grad school students? Just my opinion, but I think grad school is a luxurious choice, and people shouldn’t be taking money from programs for the poor for that.</p>

[cartera45]

<p>Medicaid eligibilty varies from state to state and it will also matter whether the state is participating in the Medicaid expansion.</p>

[texaspg]

<p>I think whether it is ethical is a different discussion.</p>

<p>My question is what is expected that is part of the law for low income grad students who can’t afford to pay 3-4k for school insurance.</p>

[Cardinal_Fang]

<p>

I’m pretty sure you have to have low assets too

</p>

<p>Not with the expansion.</p>

<p>No point in arguing about the intention. Let’s just examine what is true under the current law, in the expansion states.
<a href=“http://www.medicaid.gov/AffordableCareAct/Provisions/Downloads/MedicaidCHIP-Eligibility-Final-Rule-Fact-Sheet-Final-3-16-12.pdf[/url]”>http://www.medicaid.gov/AffordableCareAct/Provisions/Downloads/MedicaidCHIP-Eligibility-Final-Rule-Fact-Sheet-Final-3-16-12.pdf&lt;/a&gt;&lt;/p&gt;

<p>

Beginning in 2014, the Affordable Care Act extends Medicaid coverage to all individuals between ages 19 and 64 with incomes up to 133 percent of the federal poverty level, or $14,856 for an individual and $30,656 for a family of four (based on the 2012 federal poverty level)

</p>

<p>

Simplifying Medicaid and CHIP. The final rule codifies the streamlining of income-based rules and systems for processing Medicaid and CHIP applications and renewals for most individuals. Eligibility, enrollment and renewal processes will be modernized, building on successful State efforts that are already underway. Specifically, the rule:<br>
 Simplifies financial eligibility by relying on a single “Modified Adjusted Gross Income” (MAGI) standard for determining eligibility for most Medicaid and CHIP enrollees (children and non-disabled adults under age 65) and by consolidating eligibility categories into four main groups – adults, children, parents and pregnant women

</p>

<p>(my bold)</p>

[younghoss]

<p>Does in tent matter much( at least to some people)?</p>

<p>It wasn’t the original intent of social security to pay retirement benefits for 20 years, or to pay for college for a child that lost a parent…</p>

[dstark]

<p>Ok…back to medicaid.</p>

<p>I wonder how long the medicaid application takes to be processed.</p>

<p>I wonder if there will be gaps in insurance. Some kids might work 5 or 6 months and have insurance from their employers. Take a month off. Start school.</p>

<p>How is this going to work?</p>

[dstark]

<p>Wow CF. I had no idea how medicaid works.</p>

<p>I found this article interesting.</p>

<p><a href=“Bloomberg - Are you a robot?”>Bloomberg - Are you a robot?;

[Cardinal_Fang]

<p>The Medicaid reimbursement issue is not new under the ACA, though it may come to be more prominent as millions are added to the Medicaid rolls.</p>

[cptofthehouse]

<p>It’s not an instant qualification for Medicaid in NY. It does take some time. There is a search/check to make sure your income is not over what you say it is. </p>

<p>The problem with Medicaid is that there are even more doctors that do not take it as compared to most of the insurances, especially the mainstream ones. Of course, here in NY, there are doctors that don’t deal with any insurance. You pay them and get the reimbursement yourself. But, yes, there are doctors who specificallly exclude Medicaid and Medicare because they do not feel the payments are sufficient and/or they don’t like the rules.</p>

[Cardinal_Fang]

<p>cptofthehouse, isn’t it true that if a patient is admitted to a hospital, and that patient would be eligible for Medicaid, they are signed up for Medicaid and Medicaid pays the bills incurred from the minute the patient came through the hospital doors?</p>

<p>That is, my understanding was however long it takes to actually complete whatever verification is done, the enrollment is retroactive to when the patient showed up, and the hospital sends all the bills to Medicaid.</p>

<p>For example, suppose a woman in labor shows up at the hospital. She is low income, so she is eligible for Medicaid, but she has never enrolled. Doesn’t that birth end up being paid for by Medicaid?</p>

[lerkin]

<p>

I doubt the intention was to cover people purposefully not working at all so they can go to med school or Harvard business school.

</p>

<p>Many years ago the rule was that if you were a full time student you were not eligible for welfare benefits including Medicaid. I am not sure if the rules changed now, because recently I think I’ve seen some posts regarding students getting food stamps.</p>

[lerkin]

<p>Insurance Premiums:</p>

<p>I meant to post for a long time that as a small business owner I received a letter from Medica asking if we want to switch to a new renewal date - December 2013.</p>

<p>They were warning us that 2014s renewal rates are going to be much more expensive and switching will allow us to postpone paying high insurance premiums.</p>

<p>Our renewal date was September 2013, so switching would only save me 3 months. Also, it was not clear if changing the renewal date will also result in changes of the premiums starting December (because they always go up anyway on the renewal date). I declined, since we already had rate increase in September, albeit small.</p>

<p>We also have a grandfathered plan and I did not want to risk that status too. It is not a bad plan - no deductible, only $30 co-pays. However it is not ACA compliant as preventative care is not free (requires copay). This plan suits my employees better than the one with deductible.</p>

<p>By the way, none of the employees asked me how ACA affects their insurance. Also, none of the employees who currently do not buy insurance from us or anyone else asked me if they could sign up starting January 2014.</p>

[Cardinal_Fang]

<p>Let me repeat this (and recall, this is for the states that did the Medicaid expansion):</p>

<p>

**Beginning in 2014, the Affordable Care Act extends Medicaid coverage to all individuals between ages 19 and 64 with incomes up to 133 percent of the federal poverty level, **

</p>

<p>This is the new law. People up to 133% of the poverty line are covered by Medicaid, people with incomes up to 400% of the poverty line are eligible for subsidies under a sliding scale, everybody under 65 has to have insurance or Medicaid. Everybody is supposed to be covered.</p>

[Cardinal_Fang]

<p>

The Obama administration is considering a fix to the president’s health care law that would expand the universe of individuals who receive tax subsidies to help buy insurance, an administration source told The Huffington Post.

</p>

<p>

According to the administration source, the White House is “looking at an administrative fix for the population of people in the individual market who may have an increase in premiums, but don’t get subsidies.” Such a fix would address the issue of “sticker shock” that has been popping up across the country, as individuals are losing their coverage and finding only higher-cost alternatives. Under the ACA, there are tax subsidies to help individuals and families with income between 133 percent and 400 percent above the poverty level purchase insurance. Those with incomes higher than 400 percent above poverty get no such assistance. The proposed administrative fix would address this group.

</p>

<p>[Obama</a> Considers Administrative Fix To Health Care Law](<a href=“HuffPost - Breaking News, U.S. and World News | HuffPost”>Obama Considers Administrative Fix To Health Care Law | HuffPost Latest News)</p>

<p>It sounds like they might be thinking about addressing the “cliff” for some people at 400% of poverty. We talked about this issue earlier in the thread, and some of us speculated that the cliff might be an area where the law might be modified.</p>

[Goldenpooch]

<p>Wouldn’t this require legislation to change the subsidies? I have heard there is a bipartisan group in Congress proposing to pass legislation to allow people to keep their plans as of Dec 31, regardless of whether they have been grandfathered.</p>

[dusktodawn]

<p>^ you would think, but the employer mandate was delayed without congress. Who knows what is going on…what a mess</p>

[Cardinal_Fang]

<p>They’re looking for an administrative fix. Doesn’t mean they’ll find one. I suspect they’d need legislation.</p>

<p>I doubt that any legislation can force insurance companies to allow people to stay on plans that have been cancelled.</p>

[TatinG]

<p>Why not? Individuals are being forced to buy.</p>

<p>Maybe some of you know more, but I heard a snippet that if the insurance companies lose money under this new law, that the law guarantees a taxpayer paid bailout?</p>

[Cardinal_Fang]

<p>Cites, please? It’s confusing if people post rumors that may be unfounded, without any sourcing.</p>