<p>Lucky is. We have one kid who will be 26 at the END of March…of course. She is healthy and we don’t anticipate an issue finding her a plan through CT’s exchange.</p>
<p>The other kid has an individual policy that excludes a preexisting condition he has (which had been covered continuously until this current policy. Apparently it is grandfathered and can continue to NOT cover this condition which is fully controlled, by the way. His current United Health Care Plan is $197 a month including medical with a $3500 deductible, $35 unlimited office visits, RX coverage, and basic dental (premium is really low for,this dental and it is a decent policy. This plan is a PPO. His doctor for his preexisting condition takes all PPO plans, and he needs to be sure this doctor is ON whatever plan he has.</p>
<p>Will there be a better plan for him through the exchanges? Somehow, I doubt it. However, the loose cannon…will his individual premium escalate once the exchanges start.</p>
<p>So…we will be helping two twenty somethings look for coverage.</p>
<p>That’s the difference between the lower priced policies and the higher ones within the same metal brackets. It’s how the plans that are able to offer lower premiums are able to contain their costs.</p>
<p>Son will be turning 26 and is in grad school. He is covered under H’s employer plan. Should we do COBRA until Jan 1 and then look for a new less expensive policy through exchange? He has history of bad sports injuries/surgeries but these won’t matter anymore, right?</p>
<p>First, I hope you are doing well. Second, the more I think about it, the more I’m convinced that people with coverages through exchanges will be denied expensive treatments/diagnostics. The problem is going to be worse than it’s right now. This is the only way to keep the rates down.</p>
<p>Hilldweller, does the grad school have a plan available? My son is in grad school, covered through fall on the insurance plan sold by the university, will go to the exchange in January. Based on current income in his state, I think he’ll have medicaid unless he really doesn’t want it. (He can always estimate his 2014 income as being somewhat higher to get him above the medicaid mark).</p>
It wouldn’t be legal for any insurance company to deny treatments or diagnostics that fall within the accepted standard of care. If “expensive” is simply the way it is under current medical practice – then they’ll have to pay for it. If “expensive” means new or experimental, then you might be right – but insurance companies have historically balked at those type of expenses anyway.</p>
<p>When you have cancer that recurs or is resistant to standard treatment, there is no standards if care. It’s up to the doctor to decide what protocol to follow and for insurance company to approve it, or not.</p>
<p>You seem to put too much faith in insurance company to make the right decision.</p>
<p>No, I just don’t know is different between past and future. The insurance companies have always called the shots on what they would or would not pay for. Except that before ACA, if the costs were too high it would use up the lifetime policy maximum, and the patients would be dropped entirely.</p>
<p>Calmom,
He’s in second year of program at overseas U., doing research here, so no go on a policy through school. He’s doing two small part-time jobs, but sounds like we’ll need to research income limits. This is making my brain hurt.</p>
<p>D was required to have local insurance in order to get/keep her visa when she was on long-term study abroad. Our US-based coverage for her was not acceptable. Maybe your son has something similar with his?</p>
<p>Our dilemma with the kid with the individual policy…will we KNOW if his rates are going to increase on the individual plan before the enrollment for the exchanges ends? We can live with the $197 a mont for his coverage. We do NOT want him on Medicaid. His current policy is OK.</p>
<p>Calmom, thanks for your responses a few pages back. I turned 60 this year, but my wife turned 60 late last year. We never had need based financial aid, but I did have a tax credit disappear due to a very small amount of interest income. I was railing at the 100% increase in monthly premiums, not the disappearing subsidy. I wonder if that would have happened due to age even without the ACA. We may never know.</p>
<p>Just checked our BC/BS HD plan rate sheet from last year and the increase from 59 to 60 was marginal…$577 to $627 for a family plan. Of course, those rates are long gone starting next year.</p>
<p>That’s actually exactly the plan I have now. My agent had warned me it was teetering on the brink of Cadillac, and now I see what he means :)</p>
<p>I had a conversation with the employee I’m most concerned about yesterday. In his case if we switch to the small business exchange, he’s not actually worried about the out of pocket limit increasing because he already views the $5000 limit as catastrophic to him budget-wise. I wonder if we would benefit from a higher deductible plan that cost less and gives the new 50% small-biz tax credit and find a way to add an hsa element. Eg. offset the savings by increasing his pay to fund an hsa. So many questions around this – it’s a bit distracting to be trying to map it out when work is already so busy. Good grief. My broker will be earning his keep n coming weeks!</p>
<p>It looks like I am just going to have to wait until Tuesday Oct 1 to get some key information. Based on what I have learned so far - and I have to thank this thread (Calmom) for much of that, a very important piece of information is going to be the $ value of the 2nd least expensive silver plan offered in NC because that will determine my subsidy amount. Right now I don’t believe that information is available. BCBSNC on their website is providing online quotes for 2013 plans!!! I just wasted time with that, couldn’t figure out why I was getting quotes showing different amounts for me and my spouse (no gender differences allowed under ACA) and finally noticed they were giving me quotes for 2013 plans! Then I called the 24 hour number on the healthcare.gov page and reached a representative that was so ignorant it was scary. She didn’t know what a subsidy or tax credit was… honest… I swear. </p>
<p>So, it seems to me, if the 2nd lowest silver plan in NC somehow is $500 per month, then it is unlikely I will be able to stay with my mapped/similar BCBS silver plan because the premium is going to be $1550 per month, and even with a subsidy I will be paying over $1000 per month. So I just have to wait and see what that “magic number” is, and then shop different plans. And it’s sad, but here I am hoping the 2nd least expensive plan offered in NC will be high cost, which will maximize my tax credit.</p>
In California, the small business exchange (SHOP) will have one HSA eligible plan, which is a silver plan. There is a way that an employer can fund the HSA as well, to whatever extent the employer chooses – so a good option for you might be to switch to the SHOP plan, and also fund the employee’s HSA to some extent. The maximum contribution to an HSA in 2014 for an individual is $3300 – so you could perhaps come up with a plan where you fund 1/3 or 1/2 of that, letting the employee know that he can supplement and telling him about some of the long term benefits. Then he’s got cash in the bank in his own HSA to help pay some of his out-of-pocket health care costs, and it simply feels like he’s getting something extra, because he’s got a bank account he can look at rather that it all being a payroll deduction.</p>
<p>Obviously the plans available in other states may be different.</p>