<p>Goldenpooch, I am in a situation very much like yours – but think of it this way: if your premium for two people was only $679 a month, then you were getting a very good deal at the expense of the people with pre-existing conditions that BS refused to insure. (I had an HSA with a $3500 deductible, $5000 maximum out of pocket – I have been paying $402 per month and the plan with a spouse would have cost $860. (seriously: BS was penalizing married couples in may age group by charging them an extra $56 per month). </p>
<p>I also am waiting to see which providers will be on the respective exchanges. For me, Anthem’s policy is $50 cheaper, but will they take my doctor? None of the insurance companies has fully updated their provider lists, so I just have to hold on a while longer.</p>
<p>If the companies end up cutting me off from preferred providers, I’m thinking I might go to Kaiser. I think that would be a tough adjustment for someone who is used to being able to choose my own doctor – but I also know that if I sign up for Kaiser and don’t like it, I’ll be able to change in a year. </p>
<p>I think Cedars Sinai is being dropped because it is one of the most expensive facilities in the area – they probably aren’t willing to agree to accept the rates the insurance companies are willing to pay. I don’t understand the UC hospitals being dropped. </p>
<p>Check their web sites. The Cedars Sinai site says that Health Net is offering a Bronze level PPO that includes them, and they are waiting to hear from Anthem. </p>
<p>Are you sure there are only 2 plans in your area? I entered a LA area zip code (Region 16) and there were 6 different companies offering Bronze plans – including Health Net.</p>
<p>It’s like college: you only have to fill out the FAFSA if you want financial aid.</p>
<p>If your son is comfortable with the unsubsidized rate, then he can simply skip the financial part (check whatever box you need to to say that you aren’t applying for subsidy) and opt to pay the full cost – which tends to be pretty minimal for the under-30 set. </p>
<p>One of the reforms of the ACA is that there is a maximum range of premiums. For any given policy, the rate charged to a 64 year old can be no more than 3 times the rate charged to a 21 year old. That sucks for us boomers, but not so bad for the millennials. From what I can tell, Arizona has a pretty competitive market with fairly low premiums.</p>
Yes, but you may have to pay a “clawback” tax in 2015 when the 2014 tax return is filed, and income is not enough to qualify for the subsidy. However, the maximum “clawback” for a low income individual is $600-- so if the subsidy was more than that (let’s say, $100 per month, or $1200 for the year) – then it doesn’t all have to be paid back. Also there is no mechanism for the government to collect back the cost-sharing payments on the silver plan for low income individuals – that’s the program that leaves a patient paying only $3 for a doctor visit when the copay for everyone else is $45. </p>
<p>I think there will be cleanup legislation to address these issues in 2015. But I mean that I think that’s when the legislation will be passed, at the earliest. (I don’t think that much of anything can happen with the current Congress. )</p>
<p>Thank you Calmom. Honestly, you have done tons of work on this. I have to say…it doesn’t seem as easy as I had hoped it would be. We too need to make sure the doctors are participating. And that the out of pocket costs aren’t too high. </p>
<p>I also wonder if there will be increased availability for well priced dental plans as the exchanges don’t include this.</p>
No – the non-medicare spouse’s rate is based on household income, for a household of 2 people – so the cutoff or a subsidy is around the $62K mark.</p>
<p>Dilemma: It seems like I now know more about ACA than 99% of the people I talk to. If I re-activate my law license in 2014, I can run a little side business and charge people $300/hour to give them legal and tax advice about what insurance to get and how to maximize eligibility for subsidies. However, if I do that, I might make too much money in 2014 to qualify for a subsidy on my own policy. What to do? </p>
<p>[Only joking: Health insurance, shmealth insurance. I’d never be able to afford the legal malpractice premium]</p>
<p>I live in region 12 but have used both those hospitals. Health Net has the narrowest network of any the insurance companies in that region despite including Cedar Sinai. Calmom, I don’t see any silver lining to what has happened to me. Unlike you (I think) I don’t qualify for a subsidy.</p>
<p>The silver lining, in theory, is that your neighbor the cancer survivor can now get health insurance, when last year she couldn’t get health insurance at any price. But maybe that’s not a silver lining in your view.</p>
<p>If the exchanges are verifying income using SS number information, it will be VERY clear that my kid is underestimating his income. Some of his income is wages, some tips, and some from his self employment.</p>
<p>Golden, don’t assume: there is about an 80% chance that I don’t qualify for a subsidy either. My problem is that I am borderline on that and I am going to have to plan things very carefully. </p>
<p>You can still go out of network for health care, you just will face a somewhat higher deductible and I think it adds something to the maximum out of pocket you can be charged – but not a whole lot. Also, when you are in network the provider has to accept what the insurance pays – out of network you could have a situation where you are billed $1000, the insurance company decrees that $300 is a fair price and pays 60% of that – counting your “share” of $120 toward your deductible or out-of-pocket max, but the provider is still looking at you for the other $700.</p>
<p>If you are not subsidy eligible then you aren’t limited to the exchange. Look into that Health Net plan mentioned on the Ceders Sinai site. It may be worth working with an insurance agent. </p>
<p>If you can’t find an off-exchange plan that meets your needs, then go for the cheapest bronze HSA available. In my area, the Anthem plan is cheaper than BS. You can still spend your HSA dollars wherever you want.</p>
<p>You know my main problem with the law is not having to pay over $5,000 more for insurance (although I am not happy about it) but not allowing me any health care plans that include the health care providers I want. At least provide me the choices if I am willing to pay for it. It’s the lack of choices that is really annoying me.</p>
<p>Calmom, if a hospital is not in your network, it would be unbelievably expensive to go there. Everything in excess of the allowable charge would have to be paid out of pocket. I have explored the options off the exchange and right now none of them include the providers I want. The Anthem plans are still waiting for regulatory approval. All of Blue Shield plans are identical to the exchange. Heath Net has the worst network of all the insurance companies plus they don’t have UCLA.</p>
<p>It’s the insurance companies and the hospitals that made the choice, not the legislation. It’s not like Obamacare made it illegal to offer you a policy that includes the UCLA hospital.</p>
<p>Calmom has talked about how some policies listed in Covered California have incomplete provider lists. Is it possible that might be the case for the policies you’ve been looking at?</p>
<p>Thumper, I don’t know how broad that “reasonably consistent” band is. Maybe it’s +/- $10,000, maybe it’s within $15K. People who haven’t been working in the past get jobs. People who are self employed can do better as the economy improves. It’s not in the state’s interest to keep people on Medicaid if they are capable of working and potentially can earn more. </p>
<p>I’m sure that if the automatic verification system doesn’t confirm, it is followed up by an interview or a request for more information. A full time job at minimum wage is enough to get a single person up to the income range where the Medicaid eligibility cuts off. </p>
<p>If your son is out of school, and has self-employment income on top of wages, why isn’t it within the realm of possibility that he will earn more than 138% of the FPL in 2014?</p>
<p>Back a few pages, axw asked about a dependent’s income. Dependents are counted as a member of your household. Their income is added to parents’ income (that is, modified adjusted gross income) for figuring the health insurance premium credits IF the dependent is required to file a tax return. So for those of us with college students who have taxable scholarships, the approx. $6100 income limit becomes much more important.</p>
<p>I just found out that the largest outpatient health care provider in my community is not included in the exchange. They said the reimbursement rates are so low, they would go out of business if they agreed to them. I know this is a minority view but I am pining for the status quo, even with its many problems. What good will it be to have insurance if you can’t see a doctor.</p>
<p>Thanks, calmom. Yeah, I had read that article, but I was hoping – for a few minutes while I waited for your reply – that you had different inside information that would say that taxable scholarships were excluded. Thanks for looking it up, though.</p>
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