<p>I have redneck relatives from Kentucky. Their offspring included a couple of generations of excellent engineers.</p>
<p>Btw, for Rx, Step Therapy is just one of the options. All the BC sites I saw have words about their various possible exceptions. And when I called mine the other day, they said the annuals with your primary and the gyn, a pap and a mammo are considered preventative, No idea whether seeing a Tier 2 gyn would have some cost.</p>
<p>My exchange site is well-run also. My complaint is that printed or web insurance info available up-front, even with some checking, never answers all the questions.</p>
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<p>We have not paid yet. As busdriver implied, we are not enrolled until we actually pay, and even then I will need confirmation from BCBSNC before I know I am enrolled. According to the website they will be in touch. I will contact them in a few days if I don’t hear anything. We currently have health insurance with BCBSNC that will automatically renew if we did nothing, so even if this enrollment somehow did not go through I don’t expect to be without health insurance. </p>
<p>One (more) thing that is a little annoying is that I was very diligent about using the Healthcare.gov website because I wanted to be sure we would be eligible for subsidies and my understanding is you have to apply and purchase on the exchange to be eligible for subsidies. Yesterday I learned that according to the BCBSNC website, I could have started my application on their website and they automatically transfer applicants to the healthcare.gov website at the appropriate time so they will qualify for subsidies. That way they are aware of your application. But we will see how the linkage works between Healthcare.gov and BCBSNC.</p>
<p>So I have a question and am wondering how to find out the answer! From a preliminary review, it looks as if we can get cheaper insurance as individuals on the health exchange than our broker is quoting for our small group (DH and myself). For 2014, I think we will qualify for at least a small subsidy, since the economy is still not so great, at least in Maine (we always lag behind the rest of the country). Is there any problem signing up for individual coverage in 2014 through the exchange, and then switching back to group coverage in 2015? I understand that there should be group plans for small businesses starting in 2015. I just don’t want to switch to individual coverage if it would be difficult to switch back at some point in the future.</p>
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<p>This is interesting since we have always said in order to get a subsidy one has to go through healthcare.gov. </p>
<p>Is this something they have changed in the past month?</p>
<p>MaineLonghorn, Have you talked to an insurance agent? People here on this thread have been saying that if you want insurance for your small business, talking to an agent is the way to go.</p>
<p>ML, This doesn’t answer enough but suggests Anthem and CHO may be offering 2014 small group through the exchange. I think this question merits a call to the exchange. <a href=“https://www.maine.gov/pfr/insurance/faq/EmployerSponsoredCoverage.html[/url]”>https://www.maine.gov/pfr/insurance/faq/EmployerSponsoredCoverage.html</a></p>
<p>Maine, if the “group” is just you and your spouse, you won’t qualify for small group coverage on the SHOP group exchange – you would need at least one other employee. I don’t know whether or not you would still be able to buy off-exchange group coverage.</p>
<p>Other than that, you would be able to switch during any open enrollment period, but of course there are no guarantees one way or the other as to future plan availability or premium levels. But then, the whole point of shopping around is to get the best price and plan available at the time. You may find that over time you do better if you continue to qualify for subsidies on the individual exchange – the FPL numbers will go up slightly each year, so there will be a little more breathing room in 2015 for subsidy eligibility, so you might continue to qualify. As long as you are eligible for even a small subsidy, that functions as a cap on the maximum that you would have to pay for the benchmark Silver plan – so it also offers some protection against rising premiums.</p>
<p>About the small-group exchange: where does it exist? The website for small groups won’t be available until next year. Is there actually some sort of conceptual exchange for small groups, that pools the small businesses to get a better rate? If so, how do you buy policies from it? An insurance agent? And how do you get the subsidies?</p>
<p>CF, from that Maine site, dated 10/9: For 2014, two insurers currently offering small group health insurance plans – Anthem and Maine Community Health Options – have chosen to sell their plans through Maine’s Health Insurance Marketplace. Obviously to be confirmed. Maybe this is delayed. My greater point is this really needs a Maine answer.</p>
<p>Calmom, how Maine words it-</p>
<p>*Can sole proprietors buy small group coverage either through the Maine’s Health Insurance Marketplace or in the outside market?</p>
<p>Federal law does not let health insurers sell small group plans to self-employed individuals with no common law employees, whether they are doing business as sole proprietors or as corporations. For a sole proprietor to qualify for small group coverage, the business must have at least one employee who is not the owner or the owner’s spouse.*</p>
<p>So, ML’s status in 2015 would need to be confirmed. I would think.</p>
<p>If I am confusing something, apologies.</p>
<p>At the end of November the SHOP exchange website was delayed for a year:</p>
<p>[Another</a> HealthCare.gov delay announced](<a href=“http://www.usatoday.com/story/news/politics/2013/11/27/shop-website-delay/3768761/]Another”>Another HealthCare.gov delay announced)</p>
<p>That’s what occasioned my comment. But reading that article again I see that small businesses can still file paper applications. The article also says that most businesses are using agents and brokers.</p>
<p>I stick by my advice to use an agent. Or a broker.</p>
<p>If I am not mistaken, SHOP does give subsidies to small businesses but now they have to go through a broker.</p>
<p>Whether ML’s business qualifies for SHOP or subsidy is an entirely different question.</p>
<p>CF, I think I misinterpreted; maybe ME was referring to SHOP. But ML has a broker and is finding it’s possibly cheaper as individuals/family on the exchange. If the point is, could they switch to small biz in 2015, that needs a confirmation.</p>
<p>You’re right, lookingforward.</p>
<p>“GP, we should have this option. How much would you pay for expanded networks?”</p>
<p>I would definitely pay more, but I would really like to have the option of paying higher deductibles, co-pays, foregoing some of the benefits I don’t need to offset the cost of the expanded networks. Choice is good…too bad it has been severely curtailed.</p>
<p>Well GP, there are winners and losers under ACA and right now, you are a loser.</p>
<p>Well dstark, that is not what some of our illustrious leaders are telling us.</p>
<p>I am not into the politics.</p>
<p>BTW, I am going to have to wait until tomorrow to disclose what I have learned about Anthem. The telephone call with my contact at Anthem has been delayed one day. Need to confirm this new development before spilling the beans. </p>
<p>Hint: It is a good news/bad news deal.</p>
<p>Is it so bad I am going to switch to Kaiser? :)</p>