That is generally true for people who are on the lower end of the economic spectrum, and qualify for cost-sharing subsidies (which are a true subsidy) as well as the advance premium tax credit. The subsidies are most significant for those between 100-250% of the FPL:</p>
<p><a href=“A”>quote</a> in the case of an eligible insured whose household income is not less than 100 percent but not more than 150 percent of the poverty line for a family of the size involved, increase the plans share of the total allowed costs of benefits provided under the plan to 94 percent of such costs;</p>
<p>(B) in the case of an eligible insured whose household income is more than 150 percent but not more than 200 percent of the poverty line for a family of the size involved, increase the plans share of the total allowed costs of benefits provided under the plan to 87 percent of such costs; and</p>
<p>(C) in the case of an eligible insured whose household income is more than 200 percent but not more than 250 percent of the poverty line for a family of the size involved, increase the plans share of the total allowed costs of benefits provided under the plan to 73 percent of such costs.
<p>busdriver, why do you even believe the number on your W2 is comensurable with insurance premiums? What is the year-to-year fluctuation in reported costs for your self-insurance? Does the number you quote include the reinsurance premium? Does it include the various wellness costs your company is incurring, like on-premises health clinics?</p>
<p>Individual plans were a lot cheaper before Aca. If a plan cost 600 a month in the beginning of 2010, at a 15 percent a year increase for 3 years, the same plan would cost 912.50. More than a 50 percent increase in 3 years.</p>
<p>At 10 percent a year, a 600 a month plan would cost $799 after 3 years.
A 33 percent increase.</p>
<p>From what I know of the Washington market, they probably had low policy maximums – that is what I saw when my son needed to shop the market. I saw them as essentially teaser rates – they might have had low premiums, but maximum annual benefits in the range of $10,000 or $20,000. To buy anything approaching real insurance cost a lot more.</p>
<p>Post 4663, should be reposted every 100 to 200 posts. </p>
<p>So what happens between 250 and 400 percent? Nevermind… I see it. Sorry.</p>
<p>"(IV) 70 percent in the case of an eligible insured whose household income is more than 250 percent but not more than 400 percent of the poverty line for a family of the size involved."</p>
<p>TBH busdriver, I can’t figure out if the individual market is being asked to support the entire group of uninsurables as well as lowering the cost to the pre exisings, or if this is just the first step in the dance. </p>
<p>Right now, however, that is obviously where the price pressure is coming from. The 3X rule will have to be changed over time, I think. It’s too much. They’ll need gradations of that, I would imagine, with the balance of the population getting older. </p>
<p>Either that or they will have to asset test for the subsidies.</p>
<p>"busdriver, why do you even believe the number on your W2 is comensurable with insurance premiums</p>
<p>Good point, I don’t really have much reason to believe it, except based upon the assumption that the amount they put on the W2 is the amount they write off per person in taxes, and it would be to their benefit to make that number as high as possible. Of course, when they get their tax attorneys involved, I’m sure it’s far more complicated and declared in a way most beneficial to the company.</p>
<p>“What is the year-to-year fluctuation in reported costs for your self-insurance? Does the number you quote include the reinsurance premium? Does it include the various wellness costs your company is incurring, like on-premises health clinics?”</p>
<p>I’ll have to look at my years prior W2’s when I get home. I don’t know if there’s any way to figure out what they include in the cost, nor if they have any on-premise health clinics.</p>
<p>Highlighted quote:
<a href=“B”>quote</a> Coordination with actuarial value limits</p>
<p>(i) In general The Secretary shall ensure the reduction under this paragraph shall not result in an increase in the plans share of the total allowed costs of benefits provided under the plan above
…</p>
<p>(IV) 70 percent in the case of an eligible insured whose household income is more than 250 percent but not more than 400 percent of the poverty line for a family of the size involved.</p>
<p>(ii) Adjustment The Secretary shall adjust the out-of pocket [1] limits under paragraph (1) if necessary to ensure that such limits do not cause the respective actuarial values to exceed the levels specified in clause (i).
[/quote]
</p>
<p>Silver plans, by definition, are set at an actuarial value of 70%. So what that provision says it that cost-sharing reductions shall NOT be applied in a way that increases the insurer’s overall share of costs beyond a normal Silver plan. Since subsidies are keyed to a Silver plan, this means that at 250% FPL+ there is no particular benefit for a subscriberto sign up for the Silver plan, other than the other factors.</p>
<p>It really would depend on the math to see the comparison in subsidized premiums for the Silver vs. Bronze plans, as well as the individual’s typical health care needs. The problem with the Bronze plans are the higher deductibles. Full premium payers are paying most of that deductible in advance through their premium dollars, but because the deductible governs when other benefits kick in, people who need to visit the doctor frequently or need expensive prescription drugs might do better with the lower deductible and co-pays, subsidized or not.</p>
<p>But any money that they spent in adminstration or anything like that, in-house, would also be deductible. Say they spent $X on claims, and $Y on the in-house staff that do whatever they needed to do to self-insure: lawyers, and accountants, and so forth. The $Y would also be a business expense. They don’t need to put the lawyers’ and accountants’ salaries into the medical claims to make them deductible.</p>
<p>Maybe so, cf. Anything I think would be purely speculation, so without the facts, I have no idea how they decide to claim it. But I guarantee you, however they do it, works to their maximum tax advantage. If only I had the same tax attorneys.</p>
<p>What is the difference between uninsurables and pre-existings? I thought someone was uninsurable precisely because they had a pre-existing condition.</p>
<p>A lot of people who currently don’t have insurance will not be involved in the individual market; they will instead get Medicaid.</p>
<p>Busdriver, I’m less interested in their tax advantages (they have great tax attorneys, of course they do) than an apples-to-apples comparison of self-insuring versus purchasing insurance in the group market versus purchasing insurance in the individual market.</p>
<p>I imagine that self-insuring saves money, or why would companies do it. I’m more than skeptical that it saves 50% over an equivalent group plan, if you make an honest comparison of the cost, the kind of comparison that a CEO would do before choosing to self-insure.</p>
<p>Pre-existing conditions did not necessarily make you uninsurable. </p>
<p>Underwriters would often simply adjust rates, upward. </p>
<p>I had a minor pre-existing condition that Aetna, Kaiser and Blue Cross wouldn’t touch for a period of months. But, Anthem covered it. In hindsight, they did for a really good price, comparatively for what I am seeing now only a couple of years later. My policy was a PPO, 80/20 plan, low copays, about $234 a month. That policy was in December 2011, and even then the agent on phone said the prices were starting to rise…because of ACA. </p>
<p>Uninsurables are those that blew through their insurance because of a major, major illness. You might fnd a policy, but it would be exorbinant. Or you could go through high risk insurance through your state. I am not sure if every state has this, but California did.</p>
<p>FWIW, how it worked for me is this: for those that would insure us, they wouldn’t cover any conditions that had been diagnosed and/or treated within the last x years (usually 3 or 5). Sometimes this would be waived after 180 days. </p>
<p>The policy that I’m currently on did not treat any pre-existing conditions for 180 days.</p>