Affordable Care Act Scene 2 - Insurance Premiums

Parent Cafe
4021

<p>No, people on Medicaid are not counted as uninsured. They are counted as being covered by Medicaid.</p>

<p>To recap:</p>

<p>Uninsured people in the US are overwhelmingly US citizens. The majority are in working households. The large majority have been uninsured for over a year. They are not covered by Medicaid, because then they wouldn’t be uninsured. A good estimate is that at least 4 million Americans have high health costs and are uninsured.</p>

<p>TatinG, when you say it would have been important to know these numbers, would have been important to who? People who want to know the numbers can easily discover them. I know for a fact that the people who wrote the legislation knew the numbers, because I took a class from Ezekiel Emanuel, one of the writers of the ACA, and he was the one who pointed us to the Kaiser Foundation numbers.</p>

4022

<p>

</p>

<p>That’s a fair estimate. Low, probably, but a good ballpark estimate. Another issue to consider is that the people with high health costs aren’t always the same people year to year, particularly when we are considering the non-elderly, as we are here. So over a ten year period, the number of people who had high health costs and were uninsured for one of those years would be higher, maybe 2 or 3 percent.</p>

4023

<p>Important because that’s where the problem really lies. With the chronically uninsured, who couldn’t get insurance who also have high health costs.</p>

4024

<p>That 1% can’t be right because the Kaiser paper says that 1% of the population had health spending above 50,000 dollars. Most of that number were insured.</p>

4025

<p>Texas, re:

</p>

<p>YMMV, but yes, I believe the tax credit would still sunset in two years, which is not to say that it’s NOT worth taking the credit for the next two years if you can get it :wink: </p>

<p>THAT I suspect it would depend on the following:</p>

<ol>
<li>Is the average earned wage below $50,000/year? If so, you may qualify for the full or a PORTION of the up-to 50% credit.</li>
</ol>

<p>THEN the personal “unique” question becomes something along the lines of:</p>

<p>Are most of my employees at 200/300/400/more % of the poverty level for their family size? </p>

<p>For example, if the the majority were at say 200% for a family of 4 (eg. rougly $42,000) then in essence they <em>might</em> be better off on the exchange, depending on:</p>

<p>a) the comparative company group rates
b) the portion of premiums your company pays
c) whether or not you can competitively fund a HRA etc</p>

<p>So, a family of four with children would need pediatric dental, etc. A single person over a certain age would not. At 200 or 300 percent of the poverty line, deductibles are dramatically less than what full-pay comparative group plans would be. But a single person who makes in the mid 40s is full pay on the exchange, and a head-of-householder of a family of four whose spouse doesn’t work is at 200% of the poverty level.</p>

<p>IF YOUR COMPANY OFFERS GROUP benefits, your employees CANNOT get subsidies, even if they’re at the appropriate wage levels, unless their share of premiums are more than 9% of their gross income, I think. SO it warrants consideration of what’s in the best collective interest – more pay with more freedom to pursue options available, or less pay with a co. plan that may provide more or less protection than you want/need.</p>

<p>Those are the kind of variables involved, and that’s why I suspect every case is different.</p>

4026

<p>thanks kmcmom. Some of them are on a visa too which might complicate it even further!</p>

4027

<p>

</p>

<p>The Kaiser figure is that the sickest 10% averaged $50K. That includes Medicare recipients. I surmise that Tom1944’s correspondent’s figure of around $20K is the average cost for the sickest 10% of under-65s.</p>

4028

<p>Www.thehealthsherpa.com is apparently a website set up by three young men. You plug in your zip code and plans and prices are available for you to see.</p>

<p>Anyone see this yet…or care to comment on it.</p>

4029

<p>Prices are not accurate even though they ask for ages. For the top silver plan in NJ. Priced for a 63 year old and 19 year old.</p>

<p>Healthcare.gov 826.40
Healthsherpa 872.91
Amerihealth 1232.55 (correct dates of birth direct from their website)</p>

4030

<p>Great site. It doesn’t include all states. I was able to find out rates for California, but they don’t have the New York rates yet.</p>

4031

<p>I wonder if the Sherpa is only giving plans from the exchange? That would explain why it doesn’t have that expensive Amerihealth Silver plan; maybe it’s not on the exchange.</p>

4032

<p>My zip code has exchange plans. The link is great thumper1. I hope NY is added soon.</p>

<p>The site even has catastrophic plans for those over 30 that qualify.</p>

<p>Looks like catastrophic plans are priced 15 percent below bronze plans.</p>

4033

<p>CF- the information I posted was for individuals below 65.</p>

4034

<p>I started another thread only about this Sherpa site. Didn’t know if maybe it would better be discussed there.</p>

4035

<p>It looks like Healthsherpa is built around publicly available data bases from the exchanges - so it is as accurate as the available data allows it to be. Very accurate for California – but not so accurate for the federal exchange because the data tables there are not broken down into 1-year age categories. But it is a wonderful site and also a good illustration (I think) of the best thing about the internet: techies who are happy to lend time to do something for free for the benefit of others. (I suppose down the line there is a potential to monetize their site, but it seems that their primary intent was to fill a needed information gap created by the weaknesses of the exchange site).</p>

<p>This task is something that is up their alley – they also run a startup company called rentmetrics that reports data on apartment and home rental prices. Here’s an article about the creation of HealthSherpa: [George</a> Kalogeropoulos, Ning Liang, Michael Wasser, Health Sherpa: Young coders build site in 3 days](<a href=“http://www.wptv.com/dpp/news/national/george-kalogeropoulos-ning-liang-michael-wasser-health-sherpa-young-coders-build-site-in-3-days]George”>http://www.wptv.com/dpp/news/national/george-kalogeropoulos-ning-liang-michael-wasser-health-sherpa-young-coders-build-site-in-3-days)</p>

<p>(quick note: the article obviously has their ages wrong – it says they are three 20-year olds - but other internet resources make it clear that it would be more accurate to describe them as 20-somethings)</p>

4036

<p>CF, I think that HealthSherpa is limited to the exchange because they are relying on public datasets, such as the information available at <a href=“https://data.healthcare.gov/[/url]”>https://data.healthcare.gov/&lt;/a&gt;. It’s unlikely that the private insurance companies are making that sort of information available – also the HealthSherpa site gives a way to quickly calculate subsidies, and it would add another programming wrinkle for them to distinguish between on-and-off exchange plans in a way that would ensure that the subsidy discounts were only applied to eligible policies.</p>

<p>Though I do see that the private companies could easily choose to make it worth their while to address that little programming issue. They could set things up so that the search tool results showed both exchange and off-exchange options, with the off-exchange results consisting of clearly labeled paid listings from the companies that want the exposure.</p>

4037

<p>Tom1944, thanks for confirming that the ~$20K per year was for the most expensive 10% under 65s.</p>

4038

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<p>My company keeps sending emails reminding people to get a mammogram every couple of months. Is this free under the new rules?</p>

4039

<p>Yes, it is free assuming that you are in the recommended age range. (In other words, free for me at age 59, not free for my daughter at age 25 – but my daughter gets to take advantage of all of the free contraception instead).</p>

<p>Keep in mind that is free for the initial screening. If they see anything that requires further or repeat screening, it becomes diagnostic rather than preventive and then your copays or deductible kicks in. (At least for me, there’s a tendency for them to see something fuzzy and want to followup with a 2nd mammogram or ultrasound – then it always turns out to be nothing, but it becomes something that is chargeable).</p>

4040

<p>Has anyone ever had a monogram that didn’t show at least something?</p>