<p>dstark, wishing your daughter all good luck and that she is well on her way to a complete recovery.</p>
<p>How much is the cost of maternity care spread out among a large group. Would it really make the premiums double? Also wouldn’t someone’s premiums be reduced if they needed maternity coverage and now the risk was spread over a wider base?</p>
<p>It seems that we could ‘manage’ our income to be such that subsidies would kick in. It is tempting…but does anyone know the answer to the following (CalMom?)</p>
<p>We are currently a small group, and are covered by a group plan. If we leave the small group (we are both the employer and employees)to go to an individual exchange policy…how easy is it to go back to being a ‘group’ if things don’t work out. It is my understanding the the CA exchange for group policies is not up and running at this time. This is why we were given and an extension on our policy by BS.</p>
<p>I have an employer health plan. How can I tell if it is a “Cadillac” plan? I wouldn’t consider it Cadillac, but how broad is the umbrella?</p>
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<p>I don’t think so. This year, it is still legal to consider gender in health insurance premiums. Yet a 25-year-old woman doesn’t pay twice as much as a 25-year-old man.</p>
<p>A couple of people here have commented that they wish they had a policy that didn’t cover maternity care. Recall that your premium is calculated by figuring out the costs for everyone in your situation, which in this case is everyone your age. So let’s say you’re 57. Then the costs would include the costs of all the 57-year old subscribers who get pregnant. I suspect that number is in the noise.</p>
<p>There’s one wrinkle. The ACA mandates that the the highest premiums for a plan can be no more than three times the lowest premiums for that plan, which is to say that the oldest subscribers, the 64-year-olds, can pay no more than three times what the youngest subscribers, the 21-year-olds, pay. But that means our 57-year-old is even paying less of the costs for 57-year-old pregnancies. Rather than 57-year-olds subsidizing maternity care, the reality is that 25-year-olds are subsidizing heart attacks and other health conditions that occur in older age groups.</p>
<p>A Cadillac plan, as defined in the legislation, is a plan with a premium greater than $10,000 for individuals, or $27,500 for a family. </p>
<p>The cost of your health premium to your employer is reported on your W-2.</p>
<p>dstark - just read your post. I am sorry your family is in this struggle and hopeful the ACA may make things a bit easier.</p>
<p>Cardinal Fang, and itl’s not indexed to inflation so 75% of employer plans could be affected as costs go up.</p>
<p>The article TatinG pointed to describes an older couple in California:</p>
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<p>So far so good. But then the article goes on to say:</p>
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<p>The article insinuates that these mandates are increasing Proctor’s premium. To a first approximation, they are not. Kaiser has to budget money for well-child visits and maternity care for people in Proctor’s age group, and include that money in the calculations of Proctor’s premium. But I think we’re safe to say that they can budget zero dollars and zero cents, or close to it. Kaiser also has to allow adult children on their parents’ policy-- but not for free! </p>
<p>This is why the Proctors’ premium has gone up:</p>
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<p>Now the Proctors are sharing a plan with people who have chronic health conditions like emphysema, heart disease and diabetes, as well as people who are currently being treated for conditions like cancer. That’s where the money is going, not to pregnant 63-year-olds.</p>
<p>I’m not optimistic that Congress will tinker with the ACA, though in this thread we’ve identified several areas where the legislation is ragged. One is the subsidies suddenly ceasing at 400% of the poverty line, and a second is what riprorin brought up, the Cadillac tax. </p>
<p>The Cadillac tax penalty should be indexed for inflation, though that doesn’t make much difference now because inflation is low. It should also probably be adjusted for cost of living in different areas. A $10,000 insurance plan in upstate New York is a gold-plated diamond-studded Cadillac, but a $10,000 insurance plan in Silicon Valley for a 64-year-old is pretty good but not fantastic. For a 64-year-old in my area, all the Platinum policies, all the Gold policies and most of the Silver policies have premiums greater than $10,000 per year.</p>
<p>In certain cases, an older couple like the Proctors in the SF GATE story, who are looking at paying 25% of their after tax income for insurance, getting divorced could save them money. The subsidy ends at $60,000 for married couples but at $45,000 for individuals. So two people making say $40,000 each would qualify for the subsidy if they divorced and just lived together and filed separately.</p>
<p>The Cadillac tax should stay. It’s income. The sooner employers stop giving insurance, the sooner well get to a universal system</p>
<p>Seems Healthcare.gov isn’t the only website with big problems:</p>
<p><a href=“Online Application Woes Make Students Anxious and Put Colleges Behind Schedule - The New York Times”>Online Application Woes Make Students Anxious and Put Colleges Behind Schedule - The New York Times;
<p>Yes, the Higher Education Consultants’ Association listserv has been blowing up over the Common App problems for months now. It doesn’t excuse the problems with healthcare.gov in the least, but it is a good reminder that major troubles with web site rollouts are common in both public and private arenas.</p>
<p>What is the benefit to keeping your child on your plan to age 26, post-ACA?</p>
<p>Bay, it may take young person a while to get a job. And jobs may not offer health coverage (remember, not all young people go to college. Some go to Wal-Mart). And the premium of an individual policy may be more than they can afford on a just-starting-out salary. The extra few years allows them to stay covered while giving them time to get settled into adult life.</p>
<p>But Bay’s point might be-- at least, my point is-- why would it be better for me to have my 23-year-old son on my policy, instead of buying him his own policy? Particularly since a lot of 23-year-olds would be eligible for subsidies?</p>
<p>One reason would be that perhaps my employer subsidizes my health insurance, and if I can get them to subsidize my son’s as well, so much the better for me. But that’s poor social policy, it seems to me.</p>
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<p>None of this is a reason to stay on a parent’s policy anymore. Unemployed/low income adults can get health care for free via Medi-cal/caid, correct? And according to our state exchange calculator, the cost to cover 3 adults is exactly the sum of the cost for each individual. </p>
<p>So again, why would anyone continue to cover their kids in a family plan manner?</p>
<p>Emilybee and cartera45, thanks.
If a 23 year old buys his own plan instead of joining with his parents, the out of pocket cost caps may rise depending on subsidies. </p>
<p>No subsides and the out of pocket maximum could rise over 6,000 for each kid that gets health insurance on his or her own. Depends on the policy. </p>
<p>Isnt the above correct or is my memory failing me? :)</p>
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<p>In some states. But not in the states that didn’t do the Medicaid expansion.</p>