There is no way she’s legally meeting the threshold to be financially independent unless she’s on disability payments or something.
@doschicos because she would pay 240 a month with a 6k deductible under the family plan.
What is the threshold to be financially independent? She has worked in the past
Why wouldn’t the sister just stay on the parent’s plan? My 23 yr old working son with terrific salary is still on our plan and likely will stay on until he turns 26. He even has the option of going on his companies plan, but why spend the money when he can be on ours -especially since it doesn’t cost us any addition $ to keep him on. We don’t even claim him as a dependent anymore.
I don’t understand your point, doschicos. Medicare is a single payer system. But the federal government’s employee health care is not a single payer system. The government uses existing insurance companies; employees are given a choice between various insurance policies, just like employees at other large employers. The federal government IS doing the same thing for everyone in the individual market-- letting them choose between various insurance plans. Employers ARE doing the same thing for their employees-- letting them choose between various insurance plans.
Are you saying that the federal government should throw everyone on the exchanges? If the federal government covered everyone’s health care, why on earth would they involve insurers?
@Jpgranier she has to pay for 1/2 of her upkeep which includes rent, food, etc.
I can’t think of a scenario where living with your parents, rent free, would result in your paying over 1/2 of your own expenses.
ETA: Answer from 2015 but it hasn’t changed: https://ttlc.intuit.com/questions/2553227-do-i-claim-myself-as-an-independent
@“Cardinal Fang” Whatever way works. My point is I think it is silly we don’t have universal healthcare (yea, I know, political challenges and all) when so many people in this country are already under the federal government’s thumb when it comes to healthcare. I’m a fan of ACA but I think it can be improved upon. The old way doesn’t work. My only point is that numbers-wise, so many people are already covered through the federal government that moving everyone on isn’t a stretch IMO. I guess my comments are geared more towards those wanting to repeal ACA and/or against universal healthcare.
The leading candidate for DHS is Tom Price of GA. He’s been a leading proponent of ACA repeal.
He supports high risk pools for pre-existing conditions. Price’s plan provides $3B for high risk pools while Paul Ryan’s plan has $25B for them. Yikes
The provisions people are complaining about (mental health coverage, maternity coverage, $1mm to now no annual lifetime cap, no pre-existing exclusions, can buy with qualifying event etc) were all in the fed plan before ACA and premiums haven’t risen much in the 30+ years H and I have been married. We are fortunate that the fed govt as employer pays 75% of the premiums and there has never been a deductible. There is an out of pocket maximum–once you hit it, insurer pays 100%. It used to be $2500/person, $7500/family but is now $3000/person $9000/family.
You can appeal denials to insurer and then appeal to Office of Personnel Management. For the most part, we have been very happy with our excellent coverage and wish it were available to all at reasonable rates.
We have reached the OOP cap several times (including this year) and it has saved us from crushing bills in tough medical years.
^ HHS not DHS.
The national government is large enough that insurance plans are willing to compete for business within the realm of national government employees (instead of being a monopoly or oligopoly for a given employer). Here are the available plans for national government employees:
https://www.opm.gov/healthcare-insurance/healthcare/plan-information/plans/
The fed govt also employs a lot of YOUNG, healthy workers and has a big enough pool to help spread out risk, not all older, sicker workers. Nearly all workers get the plan, even some of those covered by other plans. This helps spread the risk and their using fewer services when they are younger and healthier offsets using more as they age.
When you reach the age of Medicare eligibility, the plan pays at the Medicare rates and if you are retired, Medicare is primary and it becomes secondary. If you keep insurance in retirement with Medicare, you generally have no copay, except for some medications.
@JustGraduate It sounds to me like your sister IS a dependent. Are your parents then looking for a way to not claim her as such to take advantage of reducing their healthcare expenses for her? If so, that doesn’t sound too kosher to me. Has she applied for medicaid? Given your parents income level and ability to pay, and the fact that their insurance coverage might be more generous than a plan she can afford on her own, $240/month doesn’t seem outrageous to me.
Actually, a single payer system with a voucher-for-private-plan option (Medicare Advantage).
If such a thing were to come in the form of something like “Medicare for all”, it is entirely possible for it to include the Medicare Advantage option, since some people may prefer that over traditional Medicare.
@doschicos she did live away from home for a year and a half to where she was financially independent. My dad thoroughly looked through and made sure it was legal to do.
If there is an option to pay 80 a month with no deductible vs 240 with 6k deductible, which one would you choose? She has reached her deductible every year for the past 4 years. I guess that’s a way of balancing out their 18k yearly deductible for the two of them and large deductibles.
It’s not really a matter of choosing. Legally, you either qualify for a subsidy or you don’t. You’re either dependent or you’re not.
This doesn’t sound kosher to me as someone who was trained to help young people navigate the marketplace but hey, maybe it’s a very out there situation. If things don’t sound right, they can ask for more documentation so I’d be prepared for that.
My dad’s insurance broker of 10 years went through her all of the information in depth and said she would
Your dad’s insurance broker is in a good position to help her choose a plan that is best for her circumstances.
Small nit, but most large employers do not insure their employees in the sense of insurance. Instead, large employers self-insure – just pay all the bills as they come due. However, they do pay large insurance companies a fee for claims processing, and for access to network discounts. By self-insuring with an ERISA-type plan, large employers are exempt from state insurance taxes.
The federal govt does NOT self insure for medical for its employees. We and the govt pays premiums to local insurer. They pay the bills. If there’s more going on, we’ve never been informed. They give employees a range of companies to choose among–some local and others national.
Self insuring is a significant risk, especially if lots of employees need expensive treatments at the same time–neonatal ICU, cancer, lung transplants, IVF, monthly infusion treatments running $100k apiece for life, etc.
My former employer worked the same way, @HImom - choice of companies and insurance plans, premiums paid, etc. It all looks like a normal insurance plan. I didn’t know for years that they actually self-insure but that is what they do, transparent to the employees. To the employee it looks no different than a traditional insurance plan, just that because of the large pool, the company is willing to take that pool risk instead of paying someone else a profit to do so. I would’ be surprised if the fed gov’t does the same given the huge size of the pool. As @bluebayou states above, it is very, very common for large employers.