<p>I would think twice if you are planning to elect a new plan and hoping the out of network coverage will be adequate for your kid. Remember, the balance billing or the amount billed which exceeds the allowable amount is not credited to your deductible. If your kid needs to be hospitalized for any reason, it will cost you a fortune. If I were you, I would keep your current plan (Anthem?) for 2 more months.</p>
<p>You can keep kids on your plan up to 26.<br>
"If a plan covers children, they can be added or kept on the health insurance policy until they turn 26 years old.</p>
<p>Children can join or remain on a plan even if they are:
•married
•not living with their parents
•attending school
•not financially dependent on their parents
•eligible to enroll in their employer’s plan"</p>
<p>Was there something that led you to believe dstark couldn’t?</p>
<p>
Disgraceful. Is this the sort of thing that was promised to be fixed by November 30th? (Or was it just that the website would be able to handle more traffic?) </p>
<p>I read in the Washington Post that one man had a situation that was too complicated for the website to handle. He is married to an illegal alien. So how would he be covered? I assume she would not be allowed to be on an exchange family plan? Would her income be counted in the family’s total to receive a subsidy? Also appalling is that the Spanish language version of the website isn’t up and running yet. </p>
<p>It’s a shame that this thread has become so CA-centric. I see that many are no longer posting, because they get constantly lost in the static of CA issues. (To a lesser extent, there’s also a lot of NY-centric posting.) There are those of us who are in states that aren’t running their own exchanges. Some of us are looking for information on the small business policies, too. Perhaps we should start our own thread?</p>
<p>CTTC, the online SHOP aspect of the ACA (for small businesses) has been delayed by a year. You can still sign up and be eligible for the tax credits through your regular broker in the interim, and ask them to prepare a list of options for employees to choose from.
I know that you were waiting information on this. Your best option would be your broker or preferred insurance co for information.</p>
<p>In my case we’re proceeding without the SHOP exchange entirely and forfeiting the tax credits because they sunset in two years anyway and in our unusual and tiny case, wouldn’t apply to half of us (two partner/owners do not qualify and if your average employee income is greater thn 50k it also renders credits non-applicable. So each case really depend on the kind of payroll and ownership you’re dealing with. Eg. A restaurant or small service firm with lower paid employees would likely see a full 50% tax credit for premiums…a law firm or design agency might not see anything at all, depending on payroll average.)</p>
<p>Even though I’m in Michigan, I’m grateful for the CA-centric nature of this thread in that since they have a working exchange and Calmom at the helm testing it, my broker says I’m way ahead of the curve in figuring out all the implications of ACA :)</p>
<p>It’s finally working for me here in MI. 
</p>
<p>I’m currently picking out my plan. I am so happy!! </p>
<p>(KMC- I ended up going with setting my income to 16.5k to avoid the Medicaid… my subsidy is $126/month in case anyone is looking for comparisons)</p>
<p>Just curious, but if you over-estimate income to get the subsidy and avoid Medicaid what happens at tax time? Could they require you to pay back the subsidy, somehow?</p>
<p>Flossy, I don’t know, but the alternative is to not have insurance for 3 months and I won’t do that. Considering I legitimately have NO idea what my income will be next year, I picked an amount close to what I’ve made for the last two years. </p>
<p>I am now all set up on BCBS’ Select Silver Plan + Dental. I had to get dental because I have really weak teeth. The cost savings compared to what I’m paying this year is about $30 and I finally have prescription coverage, vision and dental coverage, a very low out of pocket max, and just in general much better insurance. I’m happy as a clam :)</p>
<p>ETA: OH and when it finally came time to pick which plan was best, I went to the all-powerful, all-knowing mommy ;)</p>
<p>Ha ha, romani. Nice. It is pretty complicated stuff. Glad your mom could help you wade through it all!</p>
<p>True, SLS, but honestly- it was MUCH easier than when I was picking it out in April. If nothing else, at least the exchange has all the plans in one place. Jumping from website to website to website was far more complicated. </p>
<p>Honestly, this is such a huge relief off of my shoulders. Anyone who has been uninsured before (especially without being exactly the healthiest…) understands just the weight that gets lifted when you finally have that card in your wallet :). </p>
<p>Now I just have to call BCBS and see if there’s anything else I have to do to switch from this plan to the other I picked. I’m leaving nothing to chance!</p>
<p>This is what CA has to say about overestimating your income to stay off Medicaid (Medi-Cal):</p>
<p>[Overestimating</a> Income to Avoid Medi-Cal? - Covered California Q&A](<a href=“http://www.cahba.com/advice/2013/10/overestimating_income.html]Overestimating”>http://www.cahba.com/advice/2013/10/overestimating_income.html)</p>
<p>Well, if that’s the case, I’ll wait until Medicaid is expanded in MI and then weigh my options. Again, that’s not until April though.</p>
<p>ETA: Alternatively, I just ran the calculators and it might make sense for my fiance and I to get married legally this year (2014) rather than next year when our wedding is (2015). Our incomes combined are between 138% and 200% of FPL for a two person household. That would solve a lot of issues.</p>
<p>Well crap, now that I’m looking through things, I might actually be on the hook for the whole cost if I don’t make 138% of FPL. </p>
<p>Whatever, if that’s the case, I’ll figure out how to pay the ~$1500 (126*12 months) or whatever it is. If I get a decent paying internship in the summer or a GSI position in the fall, I should be in the clear for the income. If not, I’ll deal with whatever it is.</p>
<p>[Medicaid</a> and CHIP Eligibility Levels | Medicaid.gov](<a href=“http://www.medicaid.gov/AffordableCareAct/Medicaid-Moving-Forward-2014/Medicaid-and-CHIP-Eligibility-Levels/medicaid-chip-eligibility-levels.html]Medicaid”>http://www.medicaid.gov/AffordableCareAct/Medicaid-Moving-Forward-2014/Medicaid-and-CHIP-Eligibility-Levels/medicaid-chip-eligibility-levels.html)</p>
<p>By state and individual vs other categories.</p>
<p>This is pretty eye opening. Someone had brought this up before, but the Seattle Times just published an article in the newspaper today, bringing up the specifics. It is shocking how few of our top hospitals are in the exchange networks. Only one offers access to Seattle Cancer Care Alliance, and only two insurers offer access to Children’s. I know there are some of you apologists who think this is just a fine thing, and maybe if people really need that specialized care they might be able to beg their insurers to pay for it (or go broke, or without), but it’s really going to disgust people around here who need the care.</p>
<p>[Health-exchange</a> plans’ limits shock shopper | Local News | The Seattle Times](<a href=“http://seattletimes.com/html/localnews/2022371201_exchangenetworksxml.html]Health-exchange”>http://seattletimes.com/html/localnews/2022371201_exchangenetworksxml.html)</p>
<p>"Hospital officials say it is “unprecedented” for major insurance plans in the local market to exclude the region’s top pediatric hospital. But Children’s is not the only hospital left out of most exchange plans.</p>
<p>The Seattle Times asked the seven insurance companies selling individual policies in the exchange in King, Pierce and Snohomish counties to list their in-network hospitals.</p>
<p>The results show that only one — Community Health Plan of Washington — includes Seattle Cancer Care Alliance, which offers treatment for some of the most complex cancer cases in the region. </p>
<p>Four of the seven insurers do not include the University of Washington Medical Center or the UW’s Harborview Medical Center — which has the state’s only Level 1 trauma center and burn unit."</p>
<p>"If a patient needs a covered service, such as a heart transplant, but it’s not provided at in-network hospitals, insurers must cover it elsewhere.</p>
<p>But for patients in other circumstances, plans with lower premiums could end up costing more if they receive care from a provider outside their plan’s network. Not only could they wind up paying most or all of the bill, they would lose the law’s cap on out-of-pocket expenses"</p>
<p>It’s uncomfortable to see all others called apologists. Or smug. Some of us are just asking that others be informed before calling this all a dud, for everyone in every state. Some posters seem not to be checking as much as others. </p>
<p>Bear with me, for a moment.
This is from a mid-Nov similar WPost article.
*In Seattle, the region’s predominant insurer, Premera Blue Cross, decided not to include the children’s hospital as an in-network provider except in cases where the service sought cannot be obtained anywhere else. “Children’s non-unique services were too expensive given the goal of providing affordable coverage for consumers,” spokesman Eric Earling said in an e-mail.</p>
<p>For example, a pediatric appendectomy at Children’s costs about $23,000, he said. At another community hospital, the cost is closer to $14,100. Melzer said his hospital often bills more than community hospitals for comparable procedures because the children it treats are often gravely ill, so even a routine tonsillectomy may be more complicated.*</p>
<p>That suggests to me that it is not a fully done deal that a child who properly needs Children’s will be excluded, now and forever. Only that the at-will choice may not automatically grant coverage. “…except in cases where the service sought cannot be obtained anywhere else.”</p>
<p>And the ST includes: *Dan Dixon, a Swedish vice president, said discussions with Premera continue. “You captured us at a moment in time,” he said. “We’ll get there sooner or later.” * </p>
<p>Yes, I wish this had all been clarified. Perhaps there will be a provision to, eg, change plans as they evolve. </p>
<p>I think the issue for some is complaining to their state insurance commissioners or those in charge of their exchange negotiations. I find it hard to blanket blame ACA, when the rollout depends on state actions. Just sayin’. Don’t jump me.</p>
<p>So, fwiw if anyone is wondering, after looking at where Medicaid is going to be accepted (my hospital system is included), what Medicaid covers, and the possibility of dealing with a headache at the end of the year- I’ll be switching over to Medicaid in April. This will work out well as my job will be ending in April (it’s a job only during the university year) so I’d have to report it anyway. </p>
<p>I might just pay the full price until then. I’m going to talk to someone about it first… it seems that Michigan doesn’t really fall neatly under any rules because, AFAIK, we’re the only ones not expanding on Jan 1st that are ultimately expanding.</p>
<p>“Just sayin’. Don’t jump me”</p>
<p>Don’t worry, lookingforward. I’m heterosexual, and happily married. There is no chance that I would jump you :D</p>
<p>“It’s uncomfortable to see all others called apologists. Or smug”</p>
<p>That’s too much of a generalization. My post did not call all others apologists. Nor did it say the word “smug”. But I knew there were those who were going to rationalize why this was just fine. I think you generalize too much that people who are upset with certain aspects of this law as being hyper critical of all of it. I think people can look at something this huge and find things that they like and dislike. I’m merely bringing an aspect that people in Washington need to be very aware of. This is a big deal. People around here are used to access to the best health care, and assuming our local top hospitals will be a part of it. Surprise, they aren’t. People need to start screaming, right now, and this may become an issue of the past. They need to get to that moment sooner, rather than later. They don’t need to find out after the fact, when they get their bill.</p>
<p>My kid could have seen any neurologist, but luckily was able to see one of the top children’s neurologists around, at Children’s. Did he have something exotic, needing to go there? No, but he was treated there, and I believe that being treated by a top researcher in the field that affected him allowed him significantly different treatment than he would have gotten. Would we really have wanted to beg the insurance company to allow this, or pay massively out of pocket? People with individual insurance are really getting the worst treatment out of this deal.</p>
<p>
No. People who have been living in the bubble of having employer-provided healthcare given to them for next-to-nothing may be used to it, but not people buying on the individual market – at least not for non-wealthy people buying on the individual market. We’ve gone to HMO’s or to very high deductible plans years ago because we couldn’t afford the premiums on the cadillac plans that many with employer-provided insurance take for granted. And those of us who opted for high-deductible because we can’t afford a high premium are also cost-conscious – we don’t want to go to the most expensive facility in town when the first $5000 or whatever of any bill is coming straight out of our pockets. The only limitation is that the system makes it hard to comparison shop – we may not realize that a particular facility is charging us well above the average in our communities. </p>
<p>It’s called the “affordable” care act for a reason: for some of us the $$$ are the biggest barriers to health care. And I am not referring to the cost of chemotherapy – I am talking about the costs for relatively routine items.</p>
<p>I was not all right with people who needed health care not having access. I was not all right with insurance companies kicking people off when they got sick. But I’m not all right with insurance companies dictating this new reform either. And, quite frankly, nobody should be if the issue was access to health care not access to highly priced taxpayer subsidized insurance.</p>
<p>
No, the worst case scenario is that you could owe $300, but if your income comes in at below FPL it would be 0. </p>
<p>That’s because there is one provision of the law that says that if someone has purchased insurance on the exchange and their end-of-year income comes in at under FPL, they will be treated as if their income was exactly 100% FPL. (So that essentially also sets the maximum available subsidy as that which is keyed to the 100% line). That part of the law was probably intended to cover the many situations where a person experiences unexpected loss of income during the year, such as being laid off, missing work due to illness, or having another reduction of hours and income. </p>
<p>Then there is another provision of the law that says that if a taxpayer underestimates income and gets a subsidy that is larger than they are entitled to, they may have to pay back the difference, but if their year-end income is under 200% of FPL, the maximum that an individual could have to pay would be $300 ($600 for joint filers). But the only situation I could see that happening in line with your hypothetical would be if someone was able to enroll with an income estimate of 101% of FPL but they actually end up making $130% of FPL-- but should have been on Medicaid because they are in an expansion state and the cutoff for Medicaid is 138% FPL. (That’s assuming the system even allows them to enroll with the 101% estimate). So in that case you’d have the overpayment situation.</p>