<p>The very sick cannot be denied coverage because of pre-existing conditions, and if they have low incomes because of their illnesses, their care will be heavily subsidized. The very young are entirely covered. And the very old are covered as they are now.</p>
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<p>I think you need to double check with your agent. As I understand the law, if your daughter is eligible for employer based coverage, and the cost she is paying for her own premium is 9.5% of her salary or less, then she would not be eligible for the exchange.</p>
<p>There may be some nuances about what “eligible” and what an “employer plan” means. Historically, some employers have offered employees an insurance option which is not employer subsidized and was never a particularly good deal – I saw this mostly when my kids were working part-time and told that they could buy these policies if they wanted. Those plans were pretty weak in terms of the benefits offered --assuming they even exist post ACA.</p>
<p>texaspg - yes, my comment was tied to the newborn baby question.</p>
<p>Even if a company is not required to provide insurance under ACA, I believe that if they do provide coverage, then they have to provide coverage that meets the ACA requirements. </p>
<p>I’m just thinking from a logistical standpoint: somewhere along the lines there has to be verification. So I am thinking that employers will have at least one additional IRS form to fill out that indicates whether or not they offer insurance – so that the eligibility issue can be cross-checked against the employee’s W2 - otherwise you could have people going to the exchanges saying that they weren’t eligible for employer insurance when in fact they were. </p>
<p>But you could be right – there might be more leeway if the company is not subject to an employer mandate. I just don’t think there’s much of a marketplace anymore for noncompliant plans.</p>
<p>Not my daughter, just a client. She is not eligible. She is a dentist and makes a lot of money. Her employer pays her whole premium but does not cover her husband. They may be forced to offer it to the baby, but they don’t have to pay for it. From what I saw on the Kaiser subsidy calculator, covering just a child is not an option:</p>
<p>[Subsidy</a> Calculator | The Henry J. Kaiser Family Foundation](<a href=“Health Insurance Marketplace Calculator | KFF”>Health Insurance Marketplace Calculator | KFF)</p>
<p>So if she has to pay for the baby more than it would cost her to buy it for both of them on the exchange, she can. But if not, then she has to pay for it through her employer</p>
<p>“Except that if her employer pays for her now, and has to offer it to the baby, but doesn’t have to pay for it, the employee has a choice whether to pay for the baby through her employer, or both go to the exchange. She can’t continue to have her employer pay hers and buy insurance for just the baby through the exchange.”</p>
<p>And if there was no ACA and no exchange they wouldn’t even have the option for both of them to go on the exchange. The baby would have to go on the father’s plan. ACA gives them an additional option - which is a good thing, imo.</p>
<p>“They may be forced to offer it to the baby, but they don’t have to pay for it.”</p>
<p>So the couple will pay for it. Having children leads to expenses one doesn’t have otherwise. Either they will pay the child’s coverage under the mom’s plan or the father’s plan. </p>
<p>I don’t see what their particular situation even has to do with ACA. The marketplace is not intended for everyone.</p>
<p>I agree that it’s a good thing that there’s an option. It’s just very confusing. We’re just trying to figure out what the options are. As others have said: there’s nothing wrong with figuring out what the best options are and going with it.</p>
<p>The father owns his own business which is what makes it even more complicated. </p>
<p>Again…we’re all in agreement that more options are better. Just trying to figure out what those options are.</p>
<p>The premium cost for a child isn’t that high – and your high earning dentist wouldn’t be eligible for a subsidy on the exchange, so it’s likely that the exchange premiums would be higher. </p>
<p>As the father is a business owner, that provides some other options, as one way or another the cost of adding the baby to the insurance shows up as a business expense and reduces his taxable income. </p>
<p>I don’t think that particular client has anything at all to worry about, other than the usual- hoping that her baby is born healthy! </p>
<p>And that’s where ACA benefits her the most: if for any reason that baby is not healthy, your client will not be faced with the prospect of continuing to work full time in order to maintain health insurance for a sick child when she would rather be staying home to provide full time care for her sick child. If the baby has exceptional medical needs, she will not have to worry about the potential of exhausting health policy limits to provide the care the infant and ailing child needs. And she will not have to worry that any medical problem that crops up at birth or infancy will be a pre-existing condition that will prevent the family from getting insurance for years down the line.</p>
<p>So in a way, ACA covers her whether she buys from the exchange or not. She’s got a safety net to protect her from all those things that expectant parents fear the most but pray will never happen.</p>
<p>3bm103, sorry if I misconstrued your posts. My apologies.</p>
<p>^^No problem. I know how hard it is to understand someone on here sometimes.</p>
<p>I’m just trying to answer some of the questions my clients are posing and it is SO complicated. Our insurance agent told me he has spent hours studying this stuff and when I asked him if the baby could get the insurance on the exchange without his parents, he had to o find out the answer to the question.</p>
<p>The problem is that in this case, it affects to many people: the mother, the father, and all the employees of the father’s business. For the father to buy the insurance on the exchange he has to stop offering insurance to his employees which is something he doesn’t want to do. But when I looked up how much it was on the exchange vs what he is paying now, it would save about $600 a month. It’s hard to pass that up.</p>
<p>calmom- I’m wrong about the way PPO vs HMO works, apparently- good to see you have a few PPO options. According to the CoveredCalifornia website, we only have one insurer offering a PPO in our area- Blue Shield. Anthem offers an EPO, but all the others, including Anthems Gold are HMOs. I really don’t know what this will even mean with the new system- maybe not much. If the network has your doctors, that’s what matters.
I’m very eager to see the list of providers. It’s supposed to be available on their website on October 1.</p>
<p>3bm103 – Keep in mind there are two exchanges – one for individuals, one geared to small businesses. Perhaps the father’s solution will be to shop for a new plan for all his employes on the small business exchange - his rates may be a lot better that way, and his business may be eligible for a significant tax break or subsidy when he does that.</p>
<p>Yup. That just adds another wrinkle. The business gets the tax breaks now, but starting in 2014 they only get them if he buys the insurance on the exchange. On the other hand, saving that much money might be even more beneficial.</p>
<p>Seems like the possibilities are endless.</p>
<p>moonchild, I’ve had Blue Shield forever, and I’d tend to recommend that people go with either BS or Kaiser if they want the HMO. That’s personal – anecdotally I’ve heard of too many problems in the past with Anthem, so I just don’t trust them. BS is far from perfect, but I think their market dominance will mean that they probably will have the broadest provider network. BS of California is also a not-for-profit corporation, so at least when my rates go up I can take some comfort in knowing that the money isn’t going to enrich shareholders or pay some top executive a multi-million dollar salary. </p>
<p>I would note, however, that the BS policies seem to be the most expensive of the options offered. For the Silver plans and above, subsidies are indexed to a lower rate. (Not applicable for me, as I’ll be going with the bronze HSA plan.)</p>
<p>3bm, the whole point of the small business exchange is to assist business owners like that father by giving them access to a more competitive market. The reason his rates are so high is that that his premiums are based on the age and health profile of his own employees. He would be nuts not to check the premiums on the new exchange, as soon as that information is available.</p>
<p>Agree, the father should definitely look to see what plan he can get on the exchange for his business.</p>
<p>3bm, I just checked and need to correct something I wrote in post #2067. The person with employer coverage IS eligible to buy on the exchange, but she would not be eligible for an exchange SUBSIDY except under limited circumstances.</p>
<p>Hi guys. You don’t have to do my googling for me – I will when. Get some surf time 
– but I missed the part about he small business exchange option.
I’m hoping to meet with my broker after next week anyway, but will a company with current coverage be able to opt to change to the small business exchange so that employees with large families, one earner and less than 400% poverty line are eligible for subsidy on their share of premiums?</p>
<p>Any tips on how this works would be welcome. We presently pay 70% of family coverage for one such individual. It’s a pretty hefty benefit with pretty substantial increases each year because we’re tilting the age pool 
I am betting a small business exchange would tilt it back the other way a little.</p>
<p>Did anybody ever answer the question for sure of whether the baby can get its own insurance on the exchange without the parents having to buy it too? Since the baby is not covered under anybody’s plan, wouldn’t they have to let him?</p>
<p>Well, in WA, at least, it appears that a exchange health insurance policy can be purchased for just the child: [Enroll</a> your kids](<a href=“http://www.insurance.wa.gov/your-insurance/health-insurance/individuals-families/enrolling-kids/]Enroll”>http://www.insurance.wa.gov/your-insurance/health-insurance/individuals-families/enrolling-kids/) . When is the baby due? The mother’s maternity care is obviously covered by her present plan (and newborn care). But what is the “newborn” period? And what happens to the baby if there is a gap between when that ends and the coverage on the exchange would begin? It seems like it would be prudent for the father to add the baby’s coverage from the end of the newborn period to when the coverage on the exchange would start.</p>
<p>“but will a company with current coverage be able to opt to change to the small business exchange so that employees with large families, one earner and less than 400% poverty line are eligible for subsidy on their share of premiums?”</p>
<p>No, because the business is already subsidizing employees insurance by paying for a portion of their premium - but the small business will gets tax breaks and may have a choice of more plans which likely will be less expensive than what they have now. </p>
<p>However, if the business does not pay any of the employees premiums it may be more advantageous to not offer employee insurance at all and let the employees purchase individual/family coverage on their own and be eligible for a subsidy depending on their income/age/family size, etc.,</p>