<p>I don’t know, geeps. That’s why we’re going to check. She does live in Indiana, though, whereas we are in California. That might make a difference.</p>
<p>Geeps, that is the way that the exchange/ ACA policies are priced. But that per-person pricing is new to the insurance industry – so grandfathered policies and employer-provided policies may not work that way. </p>
<p>Families at the lower end of the economic spectrum who buy via the exchange may also find that the parents are getting heavily subsidized Silver policies while the kids are on Medicaid. That is because the income threshold for coverage of children on Medicaid is higher than the ACA provisions - that goes back to the CHIP expansion, which predates ACA. </p>
<p>LasMa – I think your daughter would have a choice and could purchase on via the federal exchange for Indiana – however, I don’t think that she would be able to get subsidies if she is still your dependent for tax purposes. So you probably want to price that all out.</p>
<p>Patsmom, I have heard from at least one person who was able to successfully complete their registration on the healthcare.gov web site – but I would strongly encourage you to simply wait until things have died down and the technicians have had a chance to iron out any bugs. I am quite confident that this will happen. </p>
<p>I certainly understand your frustration – but I also appreciate the scope of the problem on the technical end to get everything ready for launch, and I know that in some cases the insurance companies have been slow to provide important data this is supposed to be displayed on the exchange. At least here in California, the companies have been delayed in updating provider network lists – we are being told that will be online at Covered California on Monday. (We’ll see).</p>
<p>calmom, good to know @ dependent for tax purposes. Thank you.</p>
<p>patsmom, I echo what calmom says about giving it a few more days or a week. You have until Dec 31 to sign up if you want your coverage effective Jan 1. There’s no rush to do it this week.</p>
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<p>thanks calmom…I would add that BC/BS of RI non exchange new policies are also priced…per person. I was wondering if other states providers are doing the same.</p>
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<p>CORRECTION: You need to sign up by Dec. 15th for the insurance to be effective Jan. 1.</p>
<p>You have until March 31, but Dec. 15 is the deadline for Jan 1 coverage. If you sign on between Dec 15-31, coverage will begin on February 1. </p>
<p>From then on, if you sign on in the first half of a month, you can get coverage starting on day 1 of the following month; but if you sign up after the 15th, your coverage won’t start until the next successive month. So someone who signs up on January 14 with have coverage for February 1 – but someone who signs up on January 16 won’t have coverage until March 1. </p>
<p>So a person who waits until the last minute and signs up on March 31 won’t actually have coverage until May 1.</p>
<p>In subsequent years the open enrollment period will be from October 15-December 7 each year. Thus, absent a change in circumstances, a person who foregoes signing up in 2014 would not be able to obtain insurance via the exchange until Dec. 1, 2014, at the earliest (assuming he signs up between Oct 15-Nov 14th).</p>
<p>Thanks, calmom!</p>
<p>You can get insurance on the exchanges outside the enrollment period if you move to a new state.</p>
<p>Moving to a new state is one of the “changes in circumstances” I mentioned. So is losing your job, getting married, having a baby – or even moving to a new region within a state.</p>
<p>Does everyone in the family have to get the same plan? We are a family of 3 and will qualify for a subsidy. I would like the Silver Enhanced but my husband/son rarely need medical care so they would be fine with the Bronze. Is this allowed?</p>
<p>How do you handle things when you have a dependent who has insurance elsewhere, and has an income? Do you count them as a member of your household, and include their income, when filling out the application for your own insurance?</p>
<p>Fresno, you should be able to buy policies separately for all the adults in the family.</p>
<p>FresnoMom, you can only get one subsidy for your family. So you could put husband & son on the Bronze, it would effectively reduce your subsidy and you would be paying the full premium for husband and son.</p>
<p>Here’s why it reduces your subsidy. Let’s say that your family income is $70,000 – based on that number for a family of 3, your maximum premium is $554/month* (my math is for illustration only – I think its correct for that income level, but you should rely on the online calculator instead)</p>
<p>So lets say that full cost premiums are (I am making up these figures for purposes of illustration:</p>
<p>Wife: Silver: $450 Bronze: $370
Husband: Silver: $480 Bronze: $390
Son: Silver: $120 Bronze: $80</p>
<p>That leaves a premium total for the family of $1050 (Silver) or $840 (Silver)
With a subsidy, based on my above assumption, you would pay $554 for the whole family.</p>
<p>But breaking it up – you get no subsidies at all, because your $450 premium by itself isn’t high enough to be subsidy eligible, nor is the combined amounts of Husband & Son’s bronze policies ($460) enough to pull a subsidy. And again – the subsidy can only be used once- you’d have to choose which parent uses it. </p>
<p>The exact math may differ depending on circumstances, but I don’t think you will ever get to a point where it is better for a subsidy-eligible family to break up their purchases… You only get that subsidy once… </p>
<p>You’d end up paying $920 a month (by the numbers in my example) along with a higher family deductible to put Husband & Son on the Bronze, as opposed to $554 for everyone to be on Silver.</p>
<p>If your family income is lower and falls within 250% of the FPL, you’ll qualify for cost sharing subsidies, so it is probably best for everyone to be on the Silver plan.</p>
<p>If your income is in the 300%-400% range and you and husband are older – so that you are seeing high end premiums for everyone – you might look into an HSA eligible plan for your family. </p>
<p>Have you had insurance in the past? What do you think the range is for YOUR medical expenses? </p>
<p>Here’s some quick and dirty math to compare options:</p>
<p>For each plan, calculate and compare the minimum & maximum payment each year. Your minimum is the total of the premiums you are required to pay. </p>
<p>The maximum is the total of the premiums plus $12,700 (maximum annual out of pocket for per family). </p>
<p>That way you can see what the difference is in premium cost for the year – and compare that to what you think your post-deductible medical costs are likely to be. </p>
<p>I’ve posted above about the Bronze plans being generally more economical on an individual level, but I think the situation is very different for a family that qualifies for subsidies. Basically the more people in your family, the more generous that subsidy is, because it creates a cap on your total premium amount.</p>
<p>axw, I do think that you would include the dependent as a member of your household, but I’m not sure about the income. I’m assuming that the dependant’s income can’t be very high, or else you would no longer be able to claim the person as a dependent. If it is – then you might want to reconsider whether or not you will want to claim that person as a dependent for 2013.</p>
<p>On a side note, I have figured out what Covered California is doing to confirm income, at least for online applications – it’s also probably part of what is slowing the system down.</p>
<p>Apparently when you complete first part of the application online, your income statement is confirmed against a federal database keyed to your social security number – that check won’t tell the exchange your actual 2012 AGI, but it will return a report as to whether the numbers are “reasonably consistent”. I don’t know how much wiggle room is in that, because I decided to work off of my 2012 tax return when filling out the form online --so my numbers were very close. (I was rounding things off for the online app, so there was a minor discrepancy – but my financials were approved easily).</p>
<p>Part of the reason I used the 2012 figures it that the financial app is worded in a way that doesn’t make sense for people with fluctuating income – it asks what your eared income was “last month”. Obviously that’s silly for most self-employed people, as well as employees who are paid by commission or work flexible and varying hours. So I just opted to disregard the instructions – and I’ll keep on doing things annually. </p>
<p>But I thought I’d post this because you could inadvertently run into problems qualifying for a subsidy if you follow the instructions too literally – at least in California. That, lets say on average an individual earns $42,000 a year, but they work on a base pay plus commission basis for a company that pays out commissions on a quarterly basis. I don’t know whether there are any companies that actually work that way, but it servers for my hypothetical. So I’ll assume that this person typically gets $2000 a month, but every third month they get an extra check for about $4500. </p>
<p>So when that person answers the “how much did you earn last month” question, it could be $2000 or it could be $6500 depending on the month. So that person’s “last month” figure is probably not going to validate. (I think that this is a problem and told that to the poor guy from Covered California who got stuck taking my phone call – I say “poor guy” because I am 100% sure that the people answering the phones have no voice whatsoever in how the forms are designed. But it felt good to get it off my chest – it would have been very easy for the system to simply provide the option of either providing monthly or annual income figures).</p>
<p>^ So you are saying rather be literal about last month’s income, use an expected average monthly?</p>
<p>First-time poster who has been following this thread. I live in California and the other day I received a letter from Blue Shield saying that they are going to terminate my HSA $5,200 deductible plan for my wife and me and transition us to a new ACA-compliant bronze plan on Jan 1, 2014. My rate is going from $679 a month to $1110. My out-of-pocket maximum is going from $5,200 to $6,350 per individual. In addition, they are narrowing my PPO network considerably. Blue Shield is not including UCLA or Cedar Sinai in my network, a deal breaker for me.</p>
<p>I intend to purchase a plan off the exchange but right now I can’t find a plan in the individual market that includes both hospitals. In my region I am limited to two plans, Anthem or Blue Shield. That’s it. Anthem is supposedly coming out with non-mirror, ACA-compliant plans but no one knows if they are going to include these hospitals in the network. Blue Shield will only have mirror plans and they will have identical networks as their exchange plans. Unfortunately, Anthem is eliminating the Blue Card program which allows you to go to any health care provider in the US that accepts Blue Cross/Blue Shield insurance. I feel like I have been shoehorned into a box without any choice and a subpar network for a lot more money</p>
<p>We make more than $62,000, so no subsidy. Although even if there was a subsidy, I would not go to the exchange if they don’t have the health care providers I want. Interesting, a couple in our circumstances, would pay 9.5% of their income if they make a dollar less than $62,040 but pay 24% of income if they make a dollar more than $62,040. I wouldn’t have believed it if I didn’t see it with my own eyes.</p>
<p>Unfortunately, I lost my grandfather status 2 years when I changed to a less expensive plan because of a premium increase. I knew I was giving up a grandfather plan but it wasn’t clear what it meant then. It is unbelievable I had to decide between staying in a more expensive plan or losing my grandfather status. I wonder if the people who wrote this law really understood what they were doing. I thought if you liked your plan, you could keep it.</p>
<p>Anyway, I am worried because my premiums are going up around $5,200 a year and I am losing the best health care providers in my area. Not sure what I am going to do if Anthem doesn’t come out with acceptable plans.</p>
<p>I am most concerned about my son in AZ. He currently has an individual policy with a carrier who is NOT on the exchange list in AZ. He would like to keep that plan, we think, mostly because we do NOT want him on Medicaid, and that likely is where his income would place him. We are wondering when his current carrier is going to double his rate, discontinue his plan…or whatever. </p>
<p>I guess we will wait and see…and he will apply for coverage beginning January 1 if that happens. </p>
<p>Wondering if he can just buy an individual exchange plan…without having to be included in Medicaid.</p>
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<p>I think it depends on your own situation; use common sense. The questions may be worded differently on different exchanges in any case. I think the California people decided to keep it simple, and they assumed that most applicants are either employed or not employed, and the most recent month’s income is probably reflective of what 2014 income will be. If they asked people for their annual income, then that would understate the income for anyone who had gotten a recent raise or promotion. They also may have wanted a way to reconcile the answers on the California exchange application to past applications from the same family for MediCal (our name for Medicaid) -and the MediCal apps have historically been done monthly. </p>
<p>The key is that you should be giving them a number that reasonably relates to what you expect to be earning in 2014. </p>
<p>The Covered California site also makes it very, very clear that you should come back and update things if income changes. So that works fine for a wage earner who gets a raise or a new job. But I don’t want to be signing again and again through the year every time I have a particularly good month or a particularly bad one. So for me it makes a lot more sense to give them a figure that represents my best guess based on averages. </p>
<p>Keep in mind that there is no harm in “misunderestimating” your income as long as it is ballpark reasonable and you understand that you could have to pay back any advance tax credit (i.e, “subsidy”) that you later turn out to not be entitled to. You will sign the financials under penalty of perjury, but “perjury” means knowingly and intentionally lying about a material fact. If I made $40K in 2012, make $44K in 2013, and make $48K in 2014 — I’ll lose my subsidy, but I won’t get in trouble because I’ve got a subsidy taken based on $40K estimate. (I wouldn’t take that amount anyway – I’ll do my own math and take a reduced subsidy - so that I know I won’t have to pay anything back unless I bump up past that 400% level).</p>
<p>How does this all work if one spouse is already on medicare and the other is not? Do you split the income somehow to see if you get a subsidy?</p>
<p>(not eligible right now as my job offers medical, but interested or future reference).</p>