<p>dstark, the unsubsidized person who has individual insurance, but is an employee of a small company that doesn’t provide insurance, will really get screwed by the ACA. They will have to pay these outrageous premiums for limited networks, and they get no tax deductions for the premiums. At least the self-employed can write off the premiums.</p>
<p>Goldenpooch, we get that you think you should be able to have cheaper health insurance, and other people your age who have pre-existing conditions, either because they were unlucky or because they have bad health habits, should have to either pay much more than the premiums you are now facing or should simply not be able to buy insurance at any price. We get that. You don’t have to keep saying it.</p>
<p>Goldenpooch, dont you read Hanna’s posts?</p>
<p>In the state of Cal this is what happened to me and a whole lot of other people.
I developed a precondition. I could not change my plan. I got locked in. Others got locked in to the same plan as me because of preconditions. Rates started going up 20 percent a year. Healthy people changed plans and left my plan. That increased rates more. People in my plan were the sicker people or people with preconditions. So rates went up. More healthy left the plan. Repeat. Repeat for several years. Repeat until people like me were stuck with exorbitant costs, terrible plans, or they could go without insurance. I could afford the exbortitant costs. </p>
<p>Blue Cross was eventually sued for the way they treated people like me and they settled. That is how I was able to change plans. I was allowed to change plans once and I did. This isn’t a secret. </p>
<p>By the way, the last I looked Blue Shield is also getting sued. Blue Shield is getting sued for rate hikes way beyond the cost increases of health care. </p>
<p>So… You were lucky…</p>
<p>I tried to switch plans for several years without luck. It is funny, after I switched, I was talking to Anthem and I asked what category I was in and I was told I was in their healthiest customer category. Lol… I guess the joke was on me.</p>
<p>I have a basic question I need help with. If our family’s new insurance premiums will cost us approximately 15% of our 1040 AGI, does that mean that the difference between 15% and the 9.5% is refunded through taxes or something? Is the full amount refunded, or does that 5.5% difference just count as a ‘deduction’ to reduce taxes?</p>
<p>Or, because we are above the income threshold, it doesn’t matter how much our premiums cost, we will just have to pay them? (Self employed, individual family plan through California Covered)</p>
<p>Goldenpooch, there are always people getting screwed. You are getting screwed because employees with paid for health care benefits are getting a better subsidy than you.</p>
<p>You are right about people who have to buy health care insurance on their own and they cant write off the premiums. I may be in that situation myself someday soon. Luckily, my wife is still working for a few more years.</p>
<p>I dont like the cost of my health care plan either. It is what it is…</p>
<p>By the way goldenpooch, I am pretty healthy. My precondition, an irregular heartbeat, went away and I was still stuck for several years. I had a precondition that I didnt have. :)</p>
<p>I had an irregular heartbeat one time and I was screwed for 7 or 8 years. I dont take any drugs. I rarely drink. I have had 3 drinks this week which is more than I have had during the rest of my life. I dont smoke. My weight is perfect. Etc. I walked 22 miles today. No problem. </p>
<p>But that irregular heartbeat one time…</p>
<p>Coralbrook- as far as I know, what you say is correct. If you make less than 400% of the FPL, your net premium cost is capped 9.5%; if you are $1 over that limit, you pay whatever the market will bear.</p>
<p>It will be a time to evaluate all facets of page 1 income, make sure your older kids are or are not dependents, make sure you have taken all IRA/SEP/retirement or any other page 1, pre 1040 AGI deductions, if that could bring you into a subsidized income range.</p>
<p>RE: Credit reports to verify eligibility</p>
<p>I mentioned this last week, the classes talked about using the credit report, but not how. I now know how it will be used, it will be used to verify your identity by presenting questions that theoretically only you would know in order to verify you are the person online.</p>
<p>Coralbrook, you get a subsidy if your family earns less than 400% of the poverty line, whic h for a family of four will be $94,200. If your family income is more than that, you get no subsidy 
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<p>Older people in California have it tough as far as the ACA. In our high-cost state, health insurance for people over 50 is expensive, and people who are slightly over the 400% threshold are socked with big premiums, hard to afford on a moderate income. If you don’t get a subsidy, and your insurance would cost “too much” (I forget the exact value of too much, but I think 15% of your income qualifies) you are not subject to the individual mandate, but that is little comfort because you probably want to buy health insurance. You are also allowed to buy catastrophic insurance only, if your insurance would cost “too much.”</p>
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<p>Goldenpooch, I was also included in the class action settlement which dstark is talking about. In my 20 years of involvement with Blue Cross, this was the ONLY time I was able to get good insurance for a price I could afford. And it wasn’t because of Blue Cross’s generosity. It was because a judge in San Mateo FORCED Blue Cross to do it. This is how it was before ACA – you were completely at the mercy of the insurance company, unless you were lucky enough that a judge or jury stepped in.</p>
<p>dstark is also correct that pre-existing conditions don’t necessarily involve being at death’s door. My DH’s pre-existing conditions were high blood pressure and high cholesterol, not exactly uncommon among men his age. Both are very well controlled, but that doesn’t matter. It’s the diagnosis that insurance companies looked at, and penalized you for, sometimes severely.</p>
<p>I also want to address this, which you’ve said several times:</p>
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<p>That’s true NOW. It WASN’T true before ACA. Previously, they could and did drop coverage for people who were very expensively sick. Not every sick person got dropped, but it wasn’t for lack trying. The insurance companies used to employ whole departments whose job was to look back at 10, 20, 30 years of your medical history to see if they could find some tiny discrepancy. Blue Cross used to pay bonuses to employees based on the amount of money they saved the company by rescinding. And remember, these were subscribers who desperately needed their insurance.</p>
<p>I and all members of our family would be uninsurable but for having group coverage from H’s very large employer. S will age out and be covered by his large employer group plan. We are asthmatic, as is about 10% of the population. Despite the fact it’s been very well controlled and we have never been hospitalized and my kids rarely even need Rx for it, they couldn’t get individual policies because of this pre-existing condition. I have another chronic medical condition, as do our kids and H. We are very fortunate to have H’s work policy, for our lifetimes.</p>
<p>I am very grateful for the ACA, even with its faults, it is in many ways a fairer system for those of us with chronic health conditions than what we had before. I am grateful that we will be able to purchase an individual policy for D when she ages out of our family policy at 26, even though she has chronic health conditions that may require treatment. </p>
<p>I hope the system will be improved but am so grateful it exists.</p>
<p>I have been playing with the federal exchange in one state tonight, I got halfway through entering data, save & continue the entire time, then lost connection. When I got back on, nothing had saved & live chat said:</p>
<p>The best advice that I can give you at this time is to wait a week and then try again. Hopefully at that time the system will be fully functional.</p>
<p>Goldenpooch, you say that your insurance is going to cost you about $13,000 a year to cover two people, which comes to about $1,085 a month. The published rate for coverage for my Blue Shield policy from LAST YEAR (from a March 2013 rate sheet) for a couple, aged 60-64, was $1095 per month. That’s a high deductible, HSA eligible plan. You’ve posted elsewhere that you are within that age range. </p>
<p>As long as I have had Blue Shield, rates have typically gone up at least 12-15% each year. So a conservative estimate for the rate that the hypothetical 60 year old couple would have been paying in 2014 without Obamacare would have been $1,215 a month, or $14,580 for the year. </p>
<p>So how is that couple being screwed when they (a) have income that puts them in the [top</a> 1/3 of earners in their state and country](<a href=“http://kff.org/other/state-indicator/population-up-to-400-fpl/]top”>Distribution of the Total Population by Federal Poverty Level (above and below 400% FPL) | KFF), and (b) are paying a rate for insurance that is the same as they were paying the previous year, and probably less than they would have paid without insurance reform? </p>
<p>I’d note that if they have an HSA eligible policy, then they can deposit $7550 in 2014 in to sheltered account and deduct it; and if they earn less than $95000, they can each contribute $6000 to an IRA and deduct that as well. So that’s $19,550 in writeoffs from their income – which pushes the true income level at which a subsidy cuts off for a married couple to $81,550.00. </p>
<p>You say you are self-employed, so if you are paying $13,000 in premiums, you will also be able write off that amount from your income, as well as 1/2 of your self employment tax; you can also establish a SEP IRA and contribute up to 25% of your net SE earnings, up to $51,000 – and write that off of your income as well. </p>
<p>So here’s another hypothetical:
Married couple, age 60, breadwinner earns $100,000 from self employment.</p>
<p>Deductions:</p>
<p>Health Savings Account: $7,550
1/2 of self employment tax: $7,000
Self Employed SEP: $18,500
Self Employed Insurance Deduction: $13,000</p>
<p>So that’s $46,050 in potential deductions – subtract that from the $10K net from self-employment, and you have an AGI of $53,950, which means the couple qualifies for an Obamacare tax credit of $7875 based on the insurance premium they paid. </p>
<p>I haven’t done the math to figure out how high that self employed breadwinner needs to go income-wise to get to the point where the couple no longer qualifies for a subsidy. Plus I left another possible self-employed deduction of $3600 for long term care insurance on the table. </p>
<p>So do you see why I’m not all that dismayed over the plight of the upper third of earners? Especially not the self-employed ones? (I’ve left off all the things that the self-employed can do to manipulate their business income, such as buying and writing off the cost of new business equipment, etc. )</p>
<p>Somemom, California has a paper application form you can fill out. Are you seeing that for the state exchanges? Unless you own the dog that ate the homework, you could probably save yourself a lot of aggravation by taking the info down on paper, and then either waiting until the online system was available or else submitting the paper apps by mail or fax if they allow you to.</p>
<p>(You might note that I gave advice upthread that it was a bad idea to enter data on a sluggish computer system, lest the exact thing you describe happens. Data has a way of getting lost when the system crashes and has to be rebooted; And yeah, I ignored my own advice and set up an account for myself at Covered California… but I do enough computer programming that I tend to be very philosophical about crashes.).</p>
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<p>ONLY if your MAGI is under 400% of the federal poverty level AND you have purchased a “qualified” plan, which basically means a plan purchased on the exchange. So exact same policy purchased directly from the insurance company won’t yield a refund, nor will a employer-provided policy. </p>
<p>So IF you are in position of needing to buy insurance, then if there is any chance that you might qualify for a refund, you will want to buy on the exchange.</p>
<p>And if you do get a tax credit, it is money that can be sent to you like any other tax refund.</p>
<p>Calmom, you are assuming the couple with $100,000 of income has $26,000 of cash lying around to contribute to a self employed IRA or a HSA account. That could be a very incorrect assumption for many couples with this amount of income. </p>
<p>dstark, I changed plans many times over the years without underwriting. I always went into a plan with a higher deductible or lesser benefits. It was never a problem. Blue Shield always had many plans I could change into without underwriting. </p>
<p>Can anyone tell me what percentage of the people who had catastrophic illnesses lost their policies because of rescission. I will bet you money that is was less than 1/10 of 1%, if that. Provide with me some statistics from a reputable source.</p>
<p>Cardinal Fang, I am not saying the current system is perfect. Yes, it needed to be reformed but this is the not the way to do it. The middle class shouldn’t get screwed (and I would bet many readers would be dismayed to read some of the comments here about how they deserve what is happening to them) to ensure that poor people get their highly subsidized insurance (in many cases they will not be poor because of their assets or deductions taken) and then get better insurance than the unsubsidized person.</p>
<p>Coralbrook, if you’re above the threshold, you will have to pay the 15%. I have shown examples where it can be 24%.</p>
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<p>Of course they did. The insurance companies were quite happy to give you lesser benefits or higher deductibles. The problem was that if you ever wanted to improve your benefits or your out-of-pocket, they’d underwrite. </p>
<p>We also changed plans many times, always downward. And every time we were forced to take a step down, we agonized about it, because we knew that once we stepped down, we could never again step back up. And going to another carrier was impossible, because any level of coverage would have required underwriting. That was the whole problem. People were trapped.</p>
<p>LasMa, maybe you’re right but under ACA I am being moved to a plan with a higher out-of-pocket maximum, an inferior network and much higher premiums. This never happened with the current system (pre-ACA).</p>
<p>Actually, I wish Blue Shield had not let me change plans; then I would have been grandfathered.</p>