Healthcare Exchanges

[poweRob]

This thread is to describe the healthcare exchanges that are coming. Love or hate them I don't care. This is to just show what they are...


Healthcare exchanges have to begin enrolling people as of October 1st. There will be four tiers of plans to shop.

Bronze - covers 60% of expected medical costs
Silver - covers 70%
Gold - 80%
Platinum - 90%

Companies get into these exchanges are told "your plans have to cover at least these things" that way your shopping for a plan is assured that you are comparing apples to apples.

Each state has the opportunity to set up their own exchanges so they can run them however they want. 16 states have opted to do this while the other 34 states have opted to go for the federal healthcare exchange set up.

When you get your plan chosen, you then can qualify for a federal tax credit based on your household's income to drop that cost lower.

There are also going to be healthcare exchange business plans out there so I'm curious to see how those prices go as well.

All politics aside... these are the choices we have starting next month.

 

[ttwtt78640]

What I do not understand is how the PPACA subsidy works. Say a person makes 133% of the FPL. I have read that they pay 2% of their AGI and the taxpayers pick up the rest of the exchange premium cost. Why not choose the Platinum Plan since your cost is fixed and let the taxpayers take a bigger hit?

 

[Thrilla]

the federal government will be running the exchange here in Texas..... and they haven't released pricing yet.

meh, it's only pricing, it's not like it's important to know how much the insurance you are required to purchase is going to cost.




according to your link, it would run me... just me... $600 a month for coverage.
I pay less for more coverage now ( before the penalties on cadillac plans)... and this is somehow "affordable"?

 

[poweRob]

What I do not understand is how the PPACA subsidy works. Say a person makes 133% of the FPL. I have read that they pay 2% of their AGI and the taxpayers pick up the rest of the exchange premium cost. Why not choose the Platinum Plan since your cost is fixed and let the taxpayers take a bigger hit?

When you figure it out put it in here. I want this thread to be about learning what we have here, hopefully without all the "Obamacare will save the world" and "Obamacare will destroy the world" kind of talk.

 

[poweRob]

the federal government will be running the exchange here in Texas..... and they haven't released pricing yet.

meh, it's only pricing, it's not like it's important to know how much the insurance you are required to purchase is going to cost.




according to your link, it would run me... just me... $600 a month for coverage.
I pay less for more coverage now ( before the penalties on cadillac plans)... and this is somehow "affordable"?

Can you not keep your plan? Is your insurance company getting rid of that plan?

 

[Thrilla]

Can you not keep your plan? Is your insurance company getting rid of that plan?

I can keep it for now.... but it will eventually be penalized as a "Cadillac plan" ( starting in 2018)

the "penalty" is a 40% excise tax on the value of the plan.

my insurance underwriter has not said of they will do way with the plan or not..... I don't see any reason for them too, though.

 

[ttwtt78640]

When you figure it out put it in here. I want this thread to be about learning what we have here, hopefully without all the "Obamacare will save the world" and "Obamacare will destroy the world" kind of talk.

The best explanation that I have been able to find (so far) is in the attached link. It seems to say that the subsidy is limitted to the cost of a silver plan (70% coverage estaimate) but not only is the premiium subsidized but the deductable is lowered by 2/3 as well. For someone making 133% of the FPL the maximum annual additional out of pocket cost (deductable) is $1,981 for single coverage and $3,963 for family coverage.

http://kaiserfamilyfoundation.files.wordpress.com/2013/01/7962-02.pdf

 

[Dickieboy]

Can you not keep your plan? Is your insurance company getting rid of that plan?

I currently have an individual plan with BCBS that has a $5k annual deductible. They sent a letter indicating they were getting rid of the plan as it doesn't comply with PPACA. I would be way money ahead to keep the plan (if possible), pay the premium (without subsidy) and paying the fine for the next THREE years (as it increases annually).

 

[poweRob]

I can keep it for now.... but it will eventually be penalized as a "Cadillac plan" ( starting in 2018)

the "penalty" is a 40% excise tax on the value of the plan.

my insurance underwriter has not said of they will do way with the plan or not..... I don't see any reason for them too, though.

Got it. Just did some reading on the cadillac tax because I couldn't figure out motive:

To encourage employers to move away from plans that insulate workers from the cost of care and often lead to excessive procedures and tests, and galvanize employers to try to control ever-increasing medical costs. But the tax remains one of the law’s most controversial provisions.
link...​

Being that it doesn't kick in until 2017 I'd bet that that can either gets kicked down the road by then or that newer legislation alters it.

 

[Thrilla]

Got it. Just did some reading on the cadillac tax because I couldn't figure out motive:

To encourage employers to move away from plans that insulate workers from the cost of care and often lead to excessive procedures and tests, and galvanize employers to try to control ever-increasing medical costs. But the tax remains one of the law’s most controversial provisions.
link...​

Being that it doesn't kick in until 2017 I'd bet that that can either gets kicked down the road by then or that newer legislation alters it.

their motive is bull****..... they would have to penalize all insurance plans if their motive wasn't bull****.
for them to penalize me for bringing my employees a better plan, at no additional cost to them , is bull****.

I doubt it will be nixed... Democrats won't let it happen for anyone other than unions... and even that's up in the air.

 

[poweRob]

their motive is bull****..... they would have to penalize all insurance plans if their motive wasn't bull****.
for them to penalize me for bringing my employees a better plan, at no additional cost to them , is bull****.

Yeah this doesn't sound too kosher.

 

[The Man]

Obamacare: It's so awesome a Congressman wouldn't do it!

 

[DVSentinel]

This thread is to describe the healthcare exchanges that are coming. Love or hate them I don't care. This is to just show what they are...


Healthcare exchanges have to begin enrolling people as of October 1st. There will be four tiers of plans to shop.

Bronze - covers 60% of expected medical costs
Silver - covers 70%
Gold - 80%
Platinum - 90%

Companies get into these exchanges are told "your plans have to cover at least these things" that way your shopping for a plan is assured that you are comparing apples to apples.

Each state has the opportunity to set up their own exchanges so they can run them however they want. 16 states have opted to do this while the other 34 states have opted to go for the federal healthcare exchange set up.

When you get your plan chosen, you then can qualify for a federal tax credit based on your household's income to drop that cost lower.

There are also going to be healthcare exchange business plans out there so I'm curious to see how those prices go as well.

All politics aside... these are the choices we have starting next month.

I'm glad I don't have to figure all this out. My plans stays the same and for the foreseeable future it will not be going away. Although they have been screwing with the Tri-Care portion but I never actually use it.

 

[Velvet Elvis]

My wife and I both work for employers who offer medical benefits.

Because my benefits are so much more expensive, she carries me as a dependent on hers. Simple enough, right? Oh no...not anymore! Because under Lord 0bama's plan, the Imperial Government frowns on these "shenanigans." Now, just because I have "access" to a plan of my own (regardless of it's cost, coverage, etc.) my wife is penalized $100.00/month for carrying me on her own plan.

Welcome to the new order. Do as Mother Government wants, or pay a fine. Here's the best part....what you make in salary is totally irrelevant. We could both be making minimum wage, and still be penalized the $100.00.

F.U. 0bama, and F.U. to the politicians who "signed the bill, so we could see what's in it."

 

[Greenbeard]

What I do not understand is how the PPACA subsidy works. Say a person makes 133% of the FPL. I have read that they pay 2% of their AGI and the taxpayers pick up the rest of the exchange premium cost. Why not choose the Platinum Plan since your cost is fixed and let the taxpayers take a bigger hit?

The subsidy available to a person or family is a fixed amount. It's determined by a formula that takes into account the person's income, as well as market factors (i.e. it's pegged to the value of the second cheapest silver plan in the market). That is, each person or family eligible for a subsidy gets a fixed amount equal to the value of the 2nd cheapest silver plan available in their market, minus some percentage of their income.

So that person's cost isn't fixed at all, as he can pay less than that percentage of his income by buying the cheapest silver plan or a bronze plan, and he can pay more than that percentage of his income if he prefers a more expensive silver plan, a gold plan, or a platinum plan. The 2% of income "cap" in your example is only realized if that person happens to choose the 2nd cheapest silver plan, which he doesn't have to do.

People getting subsidies can then take that fixed amount and apply to any plan in the exchange they like (except the catastrophic--sub-bronze--plans). So they can buy a platinum plan, but that means they pay more for the premium. Similarly, they can take the subsidy and apply to a bronze plan, in which case they end up paying less. The market dynamics are still there.

 

[274ina]

Some better links to fingure your bill and get other info.

Subsidy Calculator | The Henry J. Kaiser Family Foundation

Kaiser Family Foundation - Health Policy Research, Analysis, Polling, Facts, Data and Journalism

 

[274ina]

The subsidy available to a person or family is a fixed amount. It's determined by a formula that takes into account the person's income, as well as market factors (i.e. it's pegged to the value of the second cheapest silver plan in the market). That is, each person or family eligible for a subsidy gets a fixed amount equal to the value of the 2nd cheapest silver plan available in their market, minus some percentage of their income.

So that person's cost isn't fixed at all, as he can pay less than that percentage of his income by buying the cheapest silver plan or a bronze plan, and he can pay more than that percentage of his income if he prefers a more expensive silver plan, a gold plan, or a platinum plan. The 2% of income "cap" in your example is only realized if that person happens to choose the 2nd cheapest silver plan, which he doesn't have to do.

People getting subsidies can then take that fixed amount and apply to any plan in the exchange they like (except the catastrophic--sub-bronze--plans). So they can buy a platinum plan, but that means they pay more for the premium. Similarly, they can take the subsidy and apply to a bronze plan, in which case they end up paying less. The market dynamics are still there.

do you have a link on that?

 

[Greenbeard]

do you have a link on that?

The law itself establishes that eligible shoppers will get a premium tax credit, whose value is calculated in the way I described above. The value of the credit is based on the value of a benchmark silver plan but it doesn't scale with the plan the shopper actually chooses. So more expensive plans still cost people more money and less expensive plans cost them less, as it should be in a market.

If you're asking for me to find someone more reputable than me saying this, the journal Health Affairs has been doing a great series of briefs on key issues. From the one relevant to this:

AMOUNT OF CREDIT: The premium tax credit will vary based on family income and the cost of health insurance in the exchange available to the taxpayer. The credit will equal the difference between the premium for the second-lowest-price silver plan (also known as the benchmark plan) and a specified percentage of income. In 2014 the percentage ranges from 2 percent for those with incomes below 133 percent of poverty and scales up to 9.5 percent for those with incomes up to 400 percent of poverty (see Exhibit 1). The percentage will be adjusted in subsequent years to account for any excess in the rate of premium growth over the rate of income growth.

The benchmark plan is used only for determining the amount of the tax credit. Individuals may apply the credit to any plan available in the exchange and pay the difference between the credit and the premium for their plan of choice. It is possible, therefore, for exchange participants receiving tax credits to pay no premium for coverage if they choose a plan with a premium substantially lower than the benchmark or to pay more than the percentage of income indicated on the table in Exhibit 1 for a plan more costly than the benchmark. They would never pay less than zero dollars, however.

For example, the Smith household consists of a couple with two children. Their income is $47,100, placing them at 200 percent of poverty. The annual premium for the second--lowest-price silver plan available to them in the exchange is $10,000. The amount of tax credit they will receive is $10,000 less $2,968 (6.3 percent of $47,100), or $7,032. They chose to enroll in a plan offered by the exchange with an annual premium of $9,000. As a result, they will pay $1,968 a year ($164 per month) for their premium, and the IRS will send the insurer $7,032 a year ($586 a month).

 

[274ina]

The law itself establishes that eligible shoppers will get a premium tax credit, whose value is calculated in the way I described above. The value of the credit is based on the value of a benchmark silver plan but it doesn't scale with the plan the shopper actually chooses. So more expensive plans still cost people more money and less expensive plans cost them less, as it should be in a market.

If you're asking for me to find someone more reputable than me saying this, the journal Health Affairs has been doing a great series of briefs on key issues. From the one relevant to this:

Yes cornell law school is much better than someone who might be just another paid indian shilling for the GOP at .50 day........(nothing personal of course)

Great link, and it clearly states how the law works in ENGLISH......

 

[Greenbeard]

Yes cornell law school is much better than someone who might be just another paid indian shilling for the GOP at .50 day........(nothing personal of course)

Great link, and it clearly states how the law works in ENGLISH......

Fair enough.

 

[opendebate]

This thread is to describe the healthcare exchanges that are coming. Love or hate them I don't care. This is to just show what they are...


There are also going to be healthcare exchange business plans out there so I'm curious to see how those prices go as well.

All politics aside... these are the choices we have starting next month.

This is new information to me. Are you saying they are going to be offering special plans for businesses to offer employees? I know alot of the discussion about the plans to date has centered around individual plans.

 

[opendebate]

I currently have an individual plan with BCBS that has a $5k annual deductible. They sent a letter indicating they were getting rid of the plan as it doesn't comply with PPACA. I would be way money ahead to keep the plan (if possible), pay the premium (without subsidy) and paying the fine for the next THREE years (as it increases annually).

Provided you have no medical expenses over that period of time? The coverage provides for more at 100%(it is mandatory) so those costs which you may or may not have paid out of pocket before would no longer be your responsibility.

 

[Greenbeard]

This is new information to me. Are you saying they are going to be offering special plans for businesses to offer employees? I know alot of the discussion about the plans to date has centered around individual plans.

Small businesses are going to be able to shop for plans in the new marketplaces, as well (this functionality is called the SHOP exchange--as in Small Business Health Options Program).

Ultimately, small employers are going to be able to specify some contribution (as part of their employees' compensation package) and let their employees shop for a plan of their choice, at least within a specified metal tier. That's called an employee choice model and it makes the small group market work more like the individual market, in which each family chooses the plan that's best for it instead of relying on an employer to make that choice.

Most of the states running their own exchanges are going to offer that functionality next year. Given the unexpected workload the feds have had to pick up, the federally facilitated exchanges aren't going to offer that functionality until 2015--next year, a small business owner who uses the new marketplace in a state where the feds are running it will still have to pick a company plan on behalf of his employees (an employer choice model). But that will change in those states in the year after next.

Starting in 2017, states can allow larger businesses to start letting their employees shop in the exchanges, as well. So while they're generally thought of (correctly, for the first few years of their operation) as applying to the small minority of people who have to buy insurance on their own because they don't get it through an employer-based group, the new marketplaces have the potential over the next decade to start transforming even the group markets by bringing in real market dynamics where people are making their own choices about coverage for their families (while still allowing employers to offer a health benefit as a compensation enticement).

For people who recognize the deficiencies of the employer-based system and for those who recognize its benefits alike, this is the way forward. One of the underappreciated aspects of what's going to happen under reform.

 

[Fisher]

Why would a small business elect to if they are not required to? People will get the subsidy and have insurance either way.

 

[poweRob]

This is new information to me. Are you saying they are going to be offering special plans for businesses to offer employees? I know alot of the discussion about the plans to date has centered around individual plans.

I've read very very little on it but it looks that way. Probably bulk buy-in specials I'd imagine but I'm not sure.