<p>There’s a subsidy in the sense that the person doesn’t have to pay the full price. The person can get the subsidy advanced to them through the year, and then if their taxes aren’t high enough they just don’t have to pay the subsidy back. Is that the question you’re asking?</p>
<p>Okay. So if someone makes 15k, then they will have their whole premium subsidized and not pay anything. Then if they don’t owe taxes? It just gets paid by the taxpayers?</p>
<p>And the insurance companies set the price. </p>
<p>Sweet deal for the insurance companies.</p>
<p>But I’m glad they can get coverage. I was thinking it was going to be more like other write offs, where first you have to pay.</p>
<p>^^ I think even the 15K person pays something, but not very much. But otherwise, that’s the idea: the taxpayers pay the subsidies.</p>
<p>The deal for the insurance companies gets less sweet in two ways. First, if they don’t put 85% of the premiums toward actual health care, they have to pay the extra premium back, and second, the insurance companies are businesses, competing for customers. So if Acme Insurance Company sets a high rate for the Bronze Plan, people just won’t buy from Acme; they’ll buy from Suregood Insurance instead and Acme will get nothing.</p>
<p>Calmom, we obviously have very different ideas about health insurance. The way I look at it is I want protection from the expenses incurred as a result of catastrophic diseases and accidents. I don’t mind paying the first $5,000, but I would really like to avoid the $250,000 bill. Thankfully, my wife and I have been relatively healthy and we have not incurred a lot of expenses; however, I have had friends and relatives who have not been so lucky. </p>
<p>I don’t know about you but I know quite a few people who have been referred to UCLA, Cedars and other great facilities and are now doing quite well. The type of care necessary for them was just not available at the local community hospital, or if it was, it was not considered to be nearly as good. I also know quite a few specialists or surgeons I would not want to have to rely upon if I needed extensive medical care. So, I would prefer a plan which provides me the widest number of providers in the event of a worse case scenario. If I had the choice, I would dispense with many of the essential benefits mandated by the new law or Ca law to keep the premiums at a reasonable level. </p>
<p>Now I know you have a very different take on this and would seek insurance very different from what is attractive to me. Great - I have no problem with this. I would like a marketplace that gives us many different options so we could both be accommodated. Obviously, we are moving toward a model of one size fits all and I think in the long run that will detrimental for the system, qualitatively and cost-wise. </p>
<p>I know you are philosophically opposed to the type of system I just described. It is obvious from your posts that you are bewildered by my preferences. I guess you could say we are like two ships passing in the night, who will never agree on what the problem is and how to devise the solution.</p>
<p>Goldenpooch, have you worked out that you’re not eligible to buy a catastrophic policy? Seems like you might be in the ballpark.</p>
<p>Do your premiums exceed 8% of your income?</p>
<p>
The person does not have to have paid taxes in the past in order to get the advance credit, but anyone who gets a credit will have to file a return the following year in order to confirm the credit. This is similar to people who file solely to claim the earned income credit. </p>
<p>If the person paid more for the premium than they had to, then they can get the credit in the form of an IRS refund – again, just like the earned income credit. This might happen with a younger person who has buys minimal coverage for a low premium, and then ends up making less money than anticipated for the year – for example, someone who works part time and ends up working less hours than they had hoped.</p>
<p>
If the cost of the premium is more than 8% of the person’s income, then there is no fine or penalty. So if I make $48,000 (too much for a subsidy) and I can’t find insurance for $320/month or less – then there is no fine. </p>
<p>Anyone who is eligible for a subsidy would not have to pay more than 9.5% of their income ($356/month for a $45,000 earner)-- with the percentage being smaller at lower income levels.</p>
<p>GP, How much are HealthNets ppo bronze plans in Southern Cal? HealthNet covers Cedars and has the most doctors in its networks.</p>
<p>Ok…I see BS might have more doctors in its networks…</p>
<p>dstark, you’re right that HealthNet covers Cedars but my understanding is that it has the most limited network of all the plans offered in Southern Ca. Also, I don’t live in that region, and they don’t offer insurance in my area.</p>
<p>CF, my insurance premiums will exceed 8% so maybe I should investigate this option; but I don’t think this is going to give me the wider network I am looking for.</p>
<p>The regions are not tiny…I don’t think you will be giving anything away by stating what region you live in. So…which region do you live in?</p>
<p>I am curious about this…</p>
<p>What do these PPO plans mean?
If I live in Nor Cal with Anthem’s PPO, can I go to UCLA for treatment in network?</p>
<p>Region 12</p>
<p>Yes, with Anthem you can go to the UC hospitals, assuming it is a PPO and not a EPO. My understanding is that in many regions Anthem will only offer EPO’s.</p>
<p>Our premiums went down. PPO with CIGNA - GWH. All benefits stayed essentially the same.</p>
<p>Goldenpooch…thanks. That is a pretty nice area you live in. Blue Shield is supposed to be a PPO there. Anthem too. At least in May. Did BS bail?
Maybe you saw this…</p>
<p>[Purchasing</a> Individual Coverage - Cedars-Sinai](<a href=“http://cedars-sinai.edu/Patients/Insurance-Exchanges/Options-for-Purchasing-Individual-Coverage.aspx]Purchasing”>Purchasing Health Insurance on Your Own | Cedars-Sinai)</p>
<p>Looks like the private individual market is dropping Cedars. Cedars does charge too much for many procedures. </p>
<p>Cromette, nice. Which state?</p>
<p>dstark, yeah I live in a pretty nice town but it is certainly not cheap. BS and Anthem will continue to offer policies. Only Anthem will have what they call non-mirror plans. These plans are sold off the exchange, and although they are ACA-compliant, they do not have to be identical to exchange plans. It remains to be seen how they will differ and if they will provide a wider network. As of now, these plans have not been approved by CA regulatory authorities so nobody knows what’s in them. Blue Shield only has plans identical to those on the exchange. Currently, the largest outpatient clinic in town and my own doctor have been excluded from both plans.</p>
<p>Cromette, like dstark, I am also curious where you reside. What does the GWH stand for.</p>
<p>CalMom- you are right, I misspoke, you CAN do an HSA and subsidy, what you cannot do is an HSA and a subsidized plan with CSR, the reduces out of pocket costs for people with the lowest income (<200%).</p>
<p>You can do two out of three, HSA & subsidy or Subsidy & CSR. There is no clawback on the CSR if you did not end up at a low enough income in April 2015, so you really need to plan well for that choice- HSA or CSR, if that applies to your situation</p>
<p>
</p>
<p>This is an often-expressed sentiment over on the Parents Caring for Parents thread. My very elderly parents have gotten millions of dollars’ worth of care over the past couple of years, not so that they can recover to live a full, active life, but so that they can recover only to stagger to the next expensive health crisis. It’s certainly not good for the country, and it’s not even good for my parents.</p>
<p>
Cost-sharing subsidies are available only on Silver plans. California’s individual exchange only offers HSA-compatible Bronze policies. An HSA-compatible Silver is available via SHOP, but I would assume that SHOP policies aren’t eligible for CSR, as my understanding is individuals don’t get subsidies for employer-provides SHOP policies. </p>
<p>Anyway, I’m not sure that it would even be possible to have an individual HSA-compatible plan that was any stronger than Bronze level, because of the combination of the ACA actuarial value requirements issues and the rules requiring high deductibles for HSA’s. That is, I don’t think it would be possible on the individual market to construct a plan with a high enough deductible to qualify as a HDHP/HSA plan and a the same time pay out the required 70% of health care costs needed to qualify for Silver designation. </p>
<p>So I agree that you can’t have the HSA deduction as well as the cost-sharing subsidies, but I think that’s just because the plans are incompatible. Do you have another reference or article about this that you can share?</p>
<p>Cal mom, depending on the company, the SHOP plan may still be cheaper for employees if the employer passes on the 50% tax credit savings…that depends on average income of 50k across full-time-equivalent employees. However, if an employer offers a SHOP plan, you are correct that said employees are then rendered in eligible for subsidy. Which seems fair, otherwise it would be double dipping.</p>
<p>Because our employee is the sole earner in a family of 4, its something we have to take into consideration as we’re planning our next heathcare move. His premiums for a family of four appear to be about 30% less than our present coverage…although we’re expecting our own to be higher as he formerly brought down our age pool. Thursday my agent admitted at this point that we’re about as informed as he is, and he’s had to submit our specific questions to his providers to get answers 
</p>
<p>In other healthcare news, just wanted to share a caution about this comment way back:
</p>
<p>The IRS is on high alert right now for employee classification changes and intends to audit same. So if someone were formerly W2 and deigns to change that to 1099 this year, the reclassification has a high likelihood of audit.
Criteria includes the following : (my paraphrasing, but you’ll get the gist)</p>
<p>Who directs the work, or defines the way the work has to be done?
Who says when the work has to be performed, and are there set hours during which the work has to be performed
Is any of the work done onsite
Has the person ever participated in mandatory training by the employer
Does the person use any equipment owned by the employer
Is the person reimbursed for expenses (eg TME)
- You get the idea. Pretty rigorous criteria.</p>
<p>There are penalties for misclassification of employees, plus now a min. $2,000 per EMP retroactive penalty if same was shown to cause employer to come under the 50 employee number to avoid the mandate.</p>
<p>Also, GoldenPooch, since you favor catastrophic insurance anyway, aren’t you eligible to do that instead if your new premium is, as I recall, 24% of your income? Or was it strictly theoretical when you asked several days ago about that?</p>