<p>I just spent most of today in a class about the tax aspects of all this. Good Lord. My head is spinning. Could they have made it any more complicated.</p>
<p>LasMa, in fairness, ACA may make it a lot easier for agents to sign people up. In the past, agents were often confronted with potential clients who had some sort of medical issue or pre-existing condition. They’d have to screen carefully, because they could spend a good deal of time working with a client and then have the insurance company reject that person. How often that happened I don’t know – but I do remember agents coming to meet with me & my ex-husband at our home or offices and spending quite a lot of time going over options and making recommendations. That’s how we ended up with different insurance policies in the first place – the agent told us she could me on the kids onto a better policy without my husband – his medical history made him harder to insure. </p>
<p>I don’t know what the difference will be in commissions, since I’m not in the business – just that the concept of a commision entails a certain amount of work from the agent – and independent agents get nothing if the policy isn’t approved. </p>
<p>Under ACA, that’s not longer an issue. I think somemom is in a better position to figure out whether the reduced commission is going to be offset by the larger pool of potential clients.</p>
<p>swimcatsmom … did your class in anyway cover how the math is going to work for the self-employed? I would feel so much better if I could only see what a 2014 1040 is going to look like.</p>
<p>calmom, our insurance agent wasted a lot of time on us over the years. I think she felt bad for us. She’d spend hours and hours every year looking for a plan which was affordable and yet would take us with our preexisting conditions. Almost always, the end result of all her effort was our staying with our substandard plan because it was the only way we could avoid rating. She was a saint. (I need to send her a bouquet of roses. :))</p>
<p>BTW, the only time in 20+ years that we got to step up our coverage was as a result of a class action lawsuit against Blue Cross California. Under the settlement, we got to choose any plan they sold without being underwritten. </p>
<p>My post to somemom was actually in response to her post on the previous page, regarding a nameless insurance company already apparently laying the groundwork for big increases in 2014.</p>
<p>It’s true about the uninsurability for things you and I would not think are a big deal. I had a guy with a broken leg history and screws in it, not insurable by company A, but okay with company B…oh, but no, company B would not take him due to another odd thing that laypeople would not think is a big deal.</p>
<p>Lamasil for toenail fungus, not okay with some companies.</p>
<p>Thanks, CalMom, I will check that out.</p>
<p>And God forbid you’d ever been treated for depression or any other mental illness. I took Lexapro for a year, and was later told that that made me uninsurable for at least 10 years afterward. </p>
<p>You didn’t even need to see an MD or take medication to be black-balled. D saw an MFT during HS for stress issues. “Automatic decline,” the agent told me. There’s nothing quite like being severely punished because you did the right thing for your child.</p>
<p>For my relatively healthy just graduated college S, I could not find an individual policy that would take him. He has well controlled asthma and another well controlled condition. He hadn’t gotten treatment for either in years. Still, the only options we could find after extensive searching were alumni insurance from his or the BCBS policy we bought and paid minth to month. They said they only offered it because he had never had a gap in his BCBS coverage.</p>
<p>We were so happy when due to ACA, he was eligible under H’s policy until he turned 26 and we could stop paying for this lesser coverage with higher deductible. There was no increase in our policy for both our kids to remain covered until they age out at 26, regardless of marital status or even whether another policy is available to them.</p>
<p>(S has chosen NOT to get coverage until after he ages out of H’s policy at age 26, later this year, even tho his employer would pay 66-75% of the premium. Coverage would be similar to what he already enjoys under H’s policy. S has not had many medical expenses since HS, but I sleep better knowing he has good coverage and has never had a gap. </p>
<p>My mom couldn’t understand why I was so set on being sure there were no gaps in his coverage. She’s always been covered by excellent BCBS coverage through my dad’s employment and later retirement from the state, as well as Medicare since age 65. She has NO idea about Pre-existing conditions and the hassles that go with them. Lucky her!</p>
<p>LasMa, I don’t know what other post of somemom that you are referring to, but her post #1978 specifically referred to the insurance company “applying a new commission schedule for U65 policies sold on and off the Federally Facilitated Marketplace (FFM)”. </p>
<p>Here’s another issue: many companies will be selling the exact same policies on or off the exchange. I know that Blue Shield of Cal. plans to be doing that. I think there could be a problem with differential commision rates – (somewhere I read that agents in California can get an $85 commission for exchange policies) – it would be easy enough for me to buy the new policy direct from the BS web site, but as far as I can tell, I need to go to the exchange if I want the subsidy or tax credit. Since my income is near the 400% mark and fluctuates from year to year – that means I need to go to the exchange.</p>
<p>As I’m easy to insure and have actually been with Blue Shield for 20 years, I wouldn’t be dealing with an agent anyway - but I can see there being something of a conflict of interest for an agent if there are differential commission rates for identical policies, depending on whether or not they are purchased through an exchange. </p>
<p>Obviously, somemom is now working harder than ever just trying to figure out all the ins and outs of the new law. Her clients won’t need her any more to navigate the problems with the pre-existing conditions, but they certainly will need her help to figure the ins and outs of whether they are eligible for the exchange and which policies are best for their needs. But at least she knows that she won’t spend hours helping a client fill out an application form and gathering all the materials, only to get a terse denial letter from the insurance company because of some trivial ailment way back when.</p>
<p>Layoffs:</p>
<p>What to do? </p>
<p>My friend was laid off yesterday. She expects to get another job with benefits in a few months. </p>
<p>Meanwhile, there’s the sign-up period now. What if she decides to go bare or use Cobra in the interim? When does the IRS count someone as uninsured? When you file taxes? What if she doesn’t get a job during the sign-up period and then decides she wants to get insurance later? Will she be penalized? I don’t know her earnings to date, let’s say, under $90,000?</p>
<p>What are people who get laid off supposed to do? What if they get laid off after the sign-up period?</p>
<p>I would use cobra until Jan 1.</p>
<p>Cobra allows you to opt out when you want to. However I believe once you opt out that’s it. There is no going back. She can sign up through exchanges into next year not just until Jan 1.</p>
<p>This is what I remember …not gospel.</p>
<p>
</p>
<p>If she wants COBRA, she has 30 days to decide…by that time, she’ll be able to scour the exchanges for rates/coverage effective Jan 1.</p>
<p>She could accept COBRA through Dec 31 and hit the subsidized exchange Jan 1.</p>
<p>This might be helpful info for your friend. </p>
<p>[Daily</a> Kos: Laid off workers will have alternative to expensive COBRA coverage](<a href=“http://www.dailykos.com/story/2013/09/17/1239570/-Laid-off-workers-will-have-alternative-to-expensive-COBRA-nbsp-coverage]Daily”>Laid off workers will have alternative to expensive COBRA coverage)</p>
<p>If you get laid off after the open enrollment period ends you can purchase insurance on the exchanges as it is a change of circumstances.</p>
<p>Can you drop out of exchange when you are employed again?</p>
<p>Can one use an exchange like COBRA (the story above says people should but lacking specifics)? The big thing I keep seeing in the posts here is there are enrollment periods and if you don’t use them, then you need to wait until next October. Is there a process where laid off employees can fall back on exchanges and then leave when they get a job which covers them again?</p>
<p>I am thinking of someone laid off in February 2014.</p>
<p>This is so complicated.</p>
<p>And when are you counted as ‘uninsured’ for purposes of the ‘fine’ ‘tax’. </p>
<p>Just on April 15? At any time during the year?</p>
<p>And when you do get a new job that has health insurance, there’s usually a 90 day period before the health insurance starts for you. Do you go on the exchange in the meantime? Or do you have to do Cobra in that window if the exchange is closed?</p>
<p>In most cases with health insurance, you are able to change your coverage when there is a “change in circumstances.” There are specific events that trigger such changes:</p>
<ul>
<li>marriage</li>
<li>birth of a dependent</li>
<li>loss of a job (and the coverage that goes with it)</li>
<li>gaining eligibility at a new job</li>
</ul>
<p>The idea is to force people to make a commitment during enrollment, but to allow for changes that would not have been appropriate during open enrollment. If you are single, you will have single only coverage. When you get married, you might add your spouse to your coverage, or you might switch to be covered under your spouse’s plan. You also might keep your plan, but make changes based on overlapping coverage.</p>
<p>For a laid off worker, they can choose between COBRA (for which they will pay 100%), or the exchanges. Once on the exchange, if they get a new job that includes health insurance, they can switch to that coverage once they are eligible.</p>
<p>The big differences between COBRA and exchanges are cost (with COBRA you pay the full cost your employer used to cover ), options (with COBRA, you are stuck with the same plan you had as an employee), and length of coverage. COBRA can run out, and is not meant as a permanent solution. If you switch to an exchange, you can stay there indefinitely. If you go with COBRA, you might eventually still have to switch to an exchange.</p>
<p>Calmom, bcbs told me we’ll have 2 choices: buy direct or, if we qualify for subsidy, buy through the exchange, which will process the discounts. I believe we’re talking same plans. I also have been told my phone reps are neither commissioned nor credited for a sale. </p>
<p>As for Cobra, I believe the window depends and should be checked. You can make coverage retroactive. The friend needs to check benefit descriptions. In addition to answers from the benefits coordinator (sometimes an outside co,) there is a govt coordinating helpline.</p>
<p>If you are laid off after the enrollment period, that’s supposed to be a life event trigger like marriage, birth or adoption that allows enrollment. As I understand it.</p>
<p>“For a laid off worker, they can choose between COBRA (for which they will pay 100%), or the exchanges.”</p>
<p>Can someone enroll in an exchange if they are laid off in February?</p>
<p>
</p>
<p>Under federal law, someone has 30 days to enroll, and since COBRA must be continuous, that means that they can wait to retro the 30 days.</p>
<p>The only issue is the last day of coverage under the plan as an employee, since the 30 day COBRA clock starts then. Some companies’ medical coverage continues until the last day of the month. Others terminate on the last day of work. HR will be able to address that issue, but which should be provided in writing.</p>