<p>“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.”</p>
<p>With all due respect, this is very misleading. If you need to be hospitalized or need outpatient surgery, you are going to run through the $5,000 deductible regardless of what facility you end up at. There are plenty of us out there who would like to choose the facility without being limited by these very restricted networks. This is not rocket science. The problem is that many people don’t pay attention to the network until they need care and then it is too late.</p>
<p>cal, I obviously believe you (and thank you again for everything you’ve done) but can you point me to where it says this: </p>
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<p>Or is that just about California’s? </p>
<p>My situation is that I’m claiming to be ~138% of FPL but in reality I’ll likely make around 100% FPL in a state that is expanding but not until April.</p>
<p>Bay, that is not what “CA” has to say-- you linked to a private web site for insurance agents. </p>
<p>The Covered California site is CoveredCa.com </p>
<p>The site you linked to- Cahba.com-- is a good site, but very often the Q&A answer is mistaken and corrected by contributors in the comments section. You’ll notice that sometimes there is also a healthy debate going on among many people who are professionals but still uncertain of the answers. </p>
<p>Please be careful to distinguish between the official sites and the many well-intentioned informational site run by insurance agents or interested bloggers. I am a regular participant at the site you linked to as well as now running my own Obamacare Guide blog on the topic – so I am all in favor of that kind of site – but I still think it’s important to be aware of whether or not a site can be regarded as an authoritative source.</p>
<p>I haven’t been back on site for a while for Covered Califormia. Can you buy a policy there for say, 3 or 6 months? Or do you have to commit for one year?</p>
<p>You could probably cancel after 3 or 6 months but then what would you do. Unless you have a qualifying event, you would be without insurance until the next open enrollment period.</p>
<p>You could still buy on ehealth.com at that time. Right? </p>
<p>I am thinking you have all kinds of situations - people move, get raises, lose jobs, age off parent’s plan, self employment income might be more than anticipated…so wondering could you go from exchange to a non-exchange plan, mid-year? I can cancel my cable and do not have a contract. So, wondering if exchange plans are 12 month contracts, or is it more like 12 month guaranteed premiums?</p>
<p>Flossy, the answer is still the same. Romani doesn’t have to worry about a negative consequence if she signs up and takes a subsidy. If she says she earns $16,000 and ends up making an amount that is less than that, but above 100% of FPL, she might actually receive an additional tax credit at the end of the year. If she says she earns $16K and ends up earning less than 100% FPL, her tax credit will be calculated as if she made exactly 100% of FPL – again, possibly resulting in an additional tax credit. </p>
<p>The only way she can expect to owe money to the IRS would be if she earns MORE than she estimates. That’s the way the law was written: no one ever anticipated the possibility that there would be extremely low income people willing to lie because they prefer to pay for insurance rather than get coverage for free.</p>
<p>Samurai, when you buy from the exchange, the policies are good for a year, but you pay month-by-month. So you can always cancel at any time during the year. But you would not be able to change to a different exchange policy within the open enrollment period.</p>
<p>The problem is that the way the law is worded, the only way the can even charge you back that amount is if the math works out that – based on your income – your subsidy was too large. If your subsidy is calculated at 138% FPL and your income is lower, then there is no form of math that leaves you owing any money. There just isn’t going to be an IRS worksheet or calculation that leads to the result — they can’t impose a retroactive determination that you should have been on Medicaid, because IRS doesn’t have the information to make that finding. IRS will see year end totals, not month-to-month accounting.</p>
<p>Maybe, maybe not. The private insurers are under no obligation to sell you a policy. I think they would be free to impose medical underwriting for policies sold outside enrollment periods, or exclusion periods for pre-existing conditions, or jack up the rates on the policies sold during the year – subject to whatever state regulations might apply. </p>
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<p>Those are all changed circumstance that would allow the person to buy on the exchange outside the enrollment period.</p>
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<p>Also a changed circumstance which will be reported to the exchange and can be grounds to change to a different exchange policy outside of the open enrollment period if the income changes materially impact affordability. </p>
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<p>Also a changed circumstance allowing the young person to buy on the exchange mid-year.</p>
<p>I know that some people are worried that if they chose a plan with a narrow network, and then ended up with a rare condition that the network didn’t have the ability to treat, they would get bad care or something. I have one data point here.</p>
<p>I was on a bike ride today with a neonatologist at Kaiser. He had previously been at Stanford, so I asked him how his new job was different. He mentioned that Kaiser doesn’t handle certain serious conditions: babies with those conditions are sent to hospitals that have expertise. Babies with heart problems that need surgery are sent to UCSF, and babies with… something else, I forget, maybe just severe prematurity… are sent to Stanford. Or if the doctors already know before birth that the babies have or are at risk for having these conditions, the mothers are sent to the specialized hospitals to give birth. He said we really want the surgeons who operate on babies’ hearts to do that surgery frequently, so it would make no sense to handle it in-house. </p>
<p>I’m sure that there are disagreements about whether some conditions can/should be handled in-network. But in many cases, apparently, there is no disagreement at all: the patient is just sent to the specialized facility for specialized care.</p>
<p>Okay, I won’t assume. Off-exchange plans are subject to the open enrollment period. You have anything that contradicts this or suggests there is still medical underwriting in 2014? Or are you just assuming?</p>