Signing up for health care

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rkhusky
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Re: Signing up for health care

Post by rkhusky »

This may be true:
magellan wrote: Also, the rule that limits premiums for older folks to a set multiple of premiums for younger folks means that at around age 40-50 folks start to get a built-in premium subsidy under ACA, and pay somewhat less than the full actuarial cost of their policy.
But this isn't
magellan wrote:ACA plan premiums are set by age, based on the actuarial value of the healthcare consumed by each age cohort. Since the actuarial value of providing maternity and well-baby visits to a 50 year old is pretty close to zero, adding this benefit won't have much impact on the premiums charged to the 50 y.o. age cohort.
There is very little actuarial analysis in the ACA, other than for the entire pool of enrollees. Once that is determined, one uses the maximum ratio between smokers/nonsmokers and the young/elderly to determine the rates.
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magellan
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Re: Signing up for health care

Post by magellan »

rkhusky wrote:There is very little actuarial analysis in the ACA, other than for the entire pool of enrollees. Once that is determined, one uses the maximum ratio between smokers/nonsmokers and the young/elderly to determine the rates.
I'm certainly not an expert on this, but I didn't realize there was anything in the ACA that prevents insurers from doing it exactly the way I suggested. If some insurers don't closely track their pool's expenditures by age and set premiums accordingly, that seems like more of a free market issue than a regulatory issue. Again AFAIK, the only thing ACA says is that the highest age-based premium can't be more than 3x the lowest age-based premium.

Anyhow, it seems that we agree that for the 50 y.o., the limit on premium multiples between young and old is probably the dominant factor anyway. So on balance, a 50 year old is basically shielded from any impact on premiums from the maternity coverage mandate by the 3x requirement.

Jim
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dm200
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Re: Signing up for health care

Post by dm200 »

Actually the ACA requires each age (through 64) have the age adjusted premiums as specified very explicitly - either for the state specific (in a few states) OR the default federal factors.

As far as I understand - the actual actuarial experience for the specific ages is irrelevant to the age factor that must be used.
rkhusky
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Re: Signing up for health care

Post by rkhusky »

magellan wrote: Anyhow, it seems that we agree that for the 50 y.o., the limit on premium multiples between young and old is probably the dominant factor anyway. So on balance, a 50 year old is basically shielded from any impact on premiums from the maternity coverage mandate by the 3x requirement.
Jim
I don't know if I would call it shielded. Basically, those that don't use much health care are subsidizing those that do. Young healthy non-smoking males are subsidizing most everyone else. Insurance companies need these guys to sign up, so they have to offer them the lowest rates they can, within the constraints of the government mandated ratios.
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Bustoff
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Re: Signing up for health care

Post by Bustoff »

Pretty decent article explaining the process.

The ultimate guide to buying insurance on HealthCare.gov
http://www.washingtonpost.com/blogs/won ... hcare-gov/
Jack
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Re: Signing up for health care

Post by Jack »

rkhusky wrote:Basically, those that don't use much health care are subsidizing those that do. Young healthy non-smoking males are subsidizing most everyone else. Insurance companies need these guys to sign up, so they have to offer them the lowest rates they can, within the constraints of the government mandated ratios.
Old healthy people are paying the most and getting the least. They are paying three times the rates of young people.

Smoking is the one criterion (besides age) for which insurers are permitted to charge higher rates, so they aren't getting a free ride on non-smokers.

As with all insurance, the lucky people pay for the unlucky people. The people whose houses don't burn down pay for the people whose houses do burn down.
Eureka
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Re: Signing up for health care

Post by Eureka »

bpg1234 wrote:Yes we received a "Status: Complete" on the incorrect marketplace Medicaid determination and you then can't remove the app at that point. You also can't "Apply for new coverage" under that account since only one application allowed per state so you need to create another email, ID, etc. and start over with brand new application.
Another ID? I have several email addresses, but I have only one name, address and Social Security number. Do you have to create a new account with a new user name and password -- in other words, start at the very beginning?
bpg1234
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Re: Signing up for health care

Post by bpg1234 »

Eureka wrote:
bpg1234 wrote:Yes we received a "Status: Complete" on the incorrect marketplace Medicaid determination and you then can't remove the app at that point. You also can't "Apply for new coverage" under that account since only one application allowed per state so you need to create another email, ID, etc. and start over with brand new application.
Another ID? I have several email addresses, but I have only one name, address and Social Security number. Do you have to create a new account with a new user name and password -- in other words, start at the very beginning?
Yes you need to start at the beginning since the incorrect Medicaid application is considered complete. I'm not sure if you can use one of your existing email addresses or not (thought I heard it may work now) but you still do need to create a different Healthcare.gov account with new username. You then can use your name, address and SS#, etc.
Eureka
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Re: Signing up for health care

Post by Eureka »

bpg1234 wrote:
Eureka wrote:
bpg1234 wrote:Yes we received a "Status: Complete" on the incorrect marketplace Medicaid determination and you then can't remove the app at that point. You also can't "Apply for new coverage" under that account since only one application allowed per state so you need to create another email, ID, etc. and start over with brand new application.
Another ID? I have several email addresses, but I have only one name, address and Social Security number. Do you have to create a new account with a new user name and password -- in other words, start at the very beginning?
Yes you need to start at the beginning since the incorrect Medicaid application is considered complete. I'm not sure if you can use one of your existing email addresses or not (thought I heard it may work now) but you still do need to create a different Healthcare.gov account with new username. You then can use your name, address and SS#, etc.
I think after reading that USA Today story and comments that the problem may be the question in which it asks you how much you made "this" month. Nearly all my income is from IRA distributions, which I take once a year. I took one in November, but I was answering the question in December, when my income will be about $65.

An insurance broker in the comments said he always makes sure the monthly figure is higher than the Medicaid limit. I'm not sure how to do that honestly, though. One could argue, I suppose, that federal tax withholding on an IRA distribution taken at any time during the year is treated by the IRS as having been paid throughout the year. That's why you can take a big distribution on Dec. 31 and not get dinged for failing to file quarterly income estimates.
rkhusky
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Re: Signing up for health care

Post by rkhusky »

Jack wrote: Old healthy people are paying the most and getting the least. They are paying three times the rates of young people.

Smoking is the one criterion (besides age) for which insurers are permitted to charge higher rates, so they aren't getting a free ride on non-smokers.

As with all insurance, the lucky people pay for the unlucky people. The people whose houses don't burn down pay for the people whose houses do burn down.
Older healthy people still use more health care than young healthy people.
It's not clear if the extra cost for smokers compensates for the extra payout.
Home insurance is voluntary, unless you have a mortgage, which is also voluntary. And the rates reflect the actual risk, without being distorted by government interference.
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magellan
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Re: Signing up for health care

Post by magellan »

rkhusky wrote:Young healthy non-smoking males are subsidizing most everyone else.
If they actually buy insurance that's true. Although due to their lower income, that age group will get a disproportionate share of the subsidies that more than offsets the burden from the age ratings compression. In any case, I agree that there will be many individual higher income young people who will pay higher premiums to subsidize older and sicker folks.

As an aside, I was curious which age group was most likely to have uninsured folks in need of uncompensated care. Pre-ACA, it was the young healthy folks that were doing the most free riding.

This 2008 report by the nonpartisan group the New America Foundation breaks down the users of uncompensated care. The likelihood of people aged 19-24 getting uncompensated care was 12%, for people aged 25-34 it was 8%, and for people 45-64 it was 4%. In terms of costs, despite their generally 'healthier' status, folks under 45 accounted for nearly 60% of the total costs of uncompensated care.

Jim
toofache32
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Re: Signing up for health care

Post by toofache32 »

rkhusky wrote: Home insurance is voluntary, unless you have a mortgage, which is also voluntary. And the rates reflect the actual risk, without being distorted by government interference.
But for homeowners there is no equivalent to EMTALA laws which would require others to pay for your house if you could not.

http://en.wikipedia.org/wiki/Emergency_ ... _Labor_Act
floydtime
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Re: Signing up for health care

Post by floydtime »

Bustoff wrote:Pretty decent article explaining the process.

The ultimate guide to buying insurance on HealthCare.gov
http://www.washingtonpost.com/blogs/won ... hcare-gov/
Thanks for the link - this was helpful. Sadly, it bypasses one question I am still unsure of...
After account creation comes the application process. If you want the absolute easiest process, you can decide not to apply for financial assistance.

Deciding not to apply for financial assistance will mean you don't answer a number of questions about how much you earn and move a bit faster to the shopping process.

The downside of skipping this step is that you could miss out on a tax credit to help purchase insurance coverage. If you earn less than $45,000 -- or are a family of four that earns less than $96,000 -- there's a decent chance that you do qualify for some help and so its likely worth taking the extra time to go through the additional questions about your income. You can also use this Kaiser Family Foundation calculator to estimate whether you would qualify for financial help.
So, if my income is below 4x poverty, but I don't need the tax credit up front, can't I bypass the "financial assistance" part? And if I do bypass, won't I still get the credit come tax time next year? The part that concerns me above is where it says I "COULD miss out on a tax credit".
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rkhusky
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Re: Signing up for health care

Post by rkhusky »

toofache32 wrote:
rkhusky wrote: Home insurance is voluntary, unless you have a mortgage, which is also voluntary. And the rates reflect the actual risk, without being distorted by government interference.
But for homeowners there is no equivalent to EMTALA laws which would require others to pay for your house if you could not.

http://en.wikipedia.org/wiki/Emergency_ ... _Labor_Act
Would a more apt analogy be that there is not a law that requires a private firefighting company to put out a fire in your house. An equivalent to the ACA would be a requirement that all homeowners have insurance sufficient to rebuild their houses.

If Medicare and Medicaid payments drop too much, perhaps there will be fewer hospitals subject to the Act.
rwm
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Re: Signing up for health care

Post by rwm »

rkhusky wrote:
toofache32 wrote:
rkhusky wrote: Home insurance is voluntary, unless you have a mortgage, which is also voluntary. And the rates reflect the actual risk, without being distorted by government interference.
But for homeowners there is no equivalent to EMTALA laws which would require others to pay for your house if you could not.

http://en.wikipedia.org/wiki/Emergency_ ... _Labor_Act
Would a more apt analogy be that there is not a law that requires a private firefighting company to put out a fire in your house. An equivalent to the ACA would be a requirement that all homeowners have insurance sufficient to rebuild their houses.

If Medicare and Medicaid payments drop too much, perhaps there will be fewer hospitals subject to the Act.
Homeowners insurance and health care insurance are really apples and oranges and it's pointless to go down this rathole. I think when Jack brought home insurance into the discussion he did so only to emphasize the pooling of risk, not to equate them in any other way.

Automobile insurance is slightly less apples and oranges, since auto insurance *is* mandatory in most places. You don't hear many complaints about that.
rkhusky
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Re: Signing up for health care

Post by rkhusky »

rwm wrote: Homeowners insurance and health care insurance are really apples and oranges and it's pointless to go down this rathole. I think when Jack brought home insurance into the discussion he did so only to emphasize the pooling of risk, not to equate them in any other way.

Automobile insurance is slightly less apples and oranges, since auto insurance *is* mandatory in most places. You don't hear many complaints about that.
Auto insurance is only required if you drive on government roads, but I don't want to go down that rat hole either.
ieee488
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Re: Signing up for health care

Post by ieee488 »

rkhusky wrote:
rwm wrote: Homeowners insurance and health care insurance are really apples and oranges and it's pointless to go down this rathole. I think when Jack brought home insurance into the discussion he did so only to emphasize the pooling of risk, not to equate them in any other way.

Automobile insurance is slightly less apples and oranges, since auto insurance *is* mandatory in most places. You don't hear many complaints about that.
Auto insurance is only required if you drive on government roads, but I don't want to go down that rat hole either.
LOL. You really are persistent, aren't you?
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dm200
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Re: Signing up for health care

Post by dm200 »

Success - for my wife's enrollment from healthcare.gov. We financially (the week before Dec 1) got through the web site process, enrolled my wife in a plan (same provider, but an ACA plan, from kaiser, with credit/subsidy). In yesterday's mail - she received the bill for the first month - due by 12/31/2013. The bill also had the correct credit/subsidy amount deducted from the amount due. :sharebeer
J295
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Re: Signing up for health care

Post by J295 »

Went on the site Monday night and successfully signed up for a BCBS plan with a 30% premium reduction (without any subsidies -- previously I paid the full premium as one of the partners in my firm). Now we just need to get the welcome packet and pay the invoice by the end of the year. We are glad to have insurance available that covers pre-existing conditions as I've transitioned to part time (thus losing group coverage, which is not available to part-timers, upon expiration of COBRA) and both my wife and I have pre-existing conditions that made us "uninsurable" under individuals policy before ACA.
denovo
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Re: Signing up for health care

Post by denovo »

dm200 wrote:Success - for my wife's enrollment from healthcare.gov. We financially (the week before Dec 1) got through the web site process, enrolled my wife in a plan (same provider, but an ACA plan, from kaiser, with credit/subsidy). In yesterday's mail - she received the bill for the first month - due by 12/31/2013. The bill also had the correct credit/subsidy amount deducted from the amount due. :sharebeer
congratulations
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BruDude
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Re: Signing up for health care

Post by BruDude »

Had several clients this week get placed in Medcaid purgatory. State did not pass Medicaid expansion and all they were deemed eligible anyway. HC.gov phone dummies told them to contact the state Medicaid office or file an appeal. And now they get to start all over again...
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FrugalInvestor
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Re: Signing up for health care

Post by FrugalInvestor »

BruDude wrote:Had several clients this week get placed in Medcaid purgatory. State did not pass Medicaid expansion and all they were deemed eligible anyway. HC.gov phone dummies told them to contact the state Medicaid office or file an appeal. And now they get to start all over again...
At least one on the Early Retirement forum reported that starting over wasn't an option. They were told that they must go through the appeal process since a determination (although faulty) had been made and that the process could take up to 90 days.
Have a plan, stay the course and simplify. Then ignore the noise!
BruDude
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Re: Signing up for health care

Post by BruDude »

FrugalInvestor wrote:
BruDude wrote:Had several clients this week get placed in Medcaid purgatory. State did not pass Medicaid expansion and all they were deemed eligible anyway. HC.gov phone dummies told them to contact the state Medicaid office or file an appeal. And now they get to start all over again...
At least one on the Early Retirement forum reported that starting over wasn't an option. They were told that they must go through the appeal process since a determination (although faulty) had been made and that the process could take up to 90 days.
There is now an option to delete the application and start a new one.
bpg1234
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Re: Signing up for health care

Post by bpg1234 »

BruDude wrote:
FrugalInvestor wrote:
BruDude wrote:Had several clients this week get placed in Medcaid purgatory. State did not pass Medicaid expansion and all they were deemed eligible anyway. HC.gov phone dummies told them to contact the state Medicaid office or file an appeal. And now they get to start all over again...
At least one on the Early Retirement forum reported that starting over wasn't an option. They were told that they must go through the appeal process since a determination (although faulty) had been made and that the process could take up to 90 days.
There is now an option to delete the application and start a new one.
Can't delete a completed application at this point (says coming at some point) so one needs to start a new application from scratch with new account (not sure if need new email or can reuse old one at this point), verified identity, etc.
bpg1234
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Re: Signing up for health care

Post by bpg1234 »

bpg1234 wrote:
Mick wrote:
bpg1234 wrote:
goaties wrote:
bpg1234 wrote: So any thoughts with a "supposed" completed incorrect enrollment in Medicaid is it now possible to still go in and do an entire new application with new email, identity verification, etc. or do we have to wait to change the app or what other option exists?
If you've been reading this thread, you can probably guess my answer: start over, don't wait for things to be "fixed", particularly if you need Jan 1 coverage. I'm sure the people at your state Medicaid office will realize right quick that you don't qualify for Medicaid! They, at least, are on top of things.
Thanks, I spoke to a supervisor last night who told me to wait for app change. I'm thinking I may have to proceed with a new email, id, etc. but not sure what happens if already have a completed application out there for Medicaid. So I proceeded to supposedly" speak to an Advanced Resolution Specialist today who was also of no use and the final determination was that since the system somehow incorrectly enrolled us in Medicaid that we would have to de-enroll through the state agency before I could get back and redo the application to be able to shop for plans on healthcare.gov.

The problem in speaking with the state Medicaid office of course is that they haven't and won't likely see the application information from heathcare.gov for a while and she indicated it usually takes 30-45 days for the Medicaid office to review, process and ultimately deny the coverage. Until then it sounds as though I likely won't be able to do anything with this enrolled Medicaid application the system incorrectly created for us.

So I'm not sure if creating another email account, ID, etc. under my SS# would work or not since the system may see me/us as having a completed Medicaid application but am curious if I were to create another new application with my wife SS# as primary and the rest of us as family members under her whether that would potentially work? Any thoughts?
I had three accounts with me as primary person using different email addresses. One hung up on logon, one on identity verification, and one after the app. My successful try was to use my wife as the primary. So not sure if it double checks for existing SS# or not. Note that at one point is did say that SS# was optional. I would go for it with your wife as primary.

Good luck!
Want to provide an update on this in case others experience something similar.

First I did the new email with wife as primary, etc. which resulted in the eligibility of my wife and me to shop on the exchange with a subsidy but one of my children was completely declined for any coverage whatsoever while the other was indicated as being eligible for Medicaid.

Decided then to create a new email, id, etc. back with my SS# as primary again to see what will happen and whether we would even be allowed to resubmit a new application since they already had a completed one for all of us indicating we qualified for Medicaid. This time though, I got the same eligibility as above with my wife's primary SS# with me and my wife being eligible for the exchange with a subsidy but one child completely declined for any coverage whatsoever and the second eligible for Medicaid. I tried various applications with both SS#'s as primary with different insurance options and all resulted in the same eligibility determination.

I have nothing unique in my family case of four and we all should be eligible for the exchange and family subsidy as was initially determined in our original app from early Oct that got stuck which was also substantiated by an number of subsidy calculators such as Kaiser and others.

All I can think is that something must now be screwed up with the algorithm for our state. I saw a similar situation posted from someone on the site blog (not sure if our state or not though) so think not just me but have no idea what to do at this point other than wait and hopefully gets resolved. Calling the 800# as I did initially will result in a CS rep indicating the need to file an appeal that can take 90 days for resolution. What a PITA!!!
So I proceeded to actually enroll in a plan with a new account/application. I got all the way to the "Congratulations!" screen with the info in a box indicating that to activate we must pay the first month's premium by the end of December due date. It also noted that the company will contact us in next few days with detailed info on how to pay or visit your health plan online to make payment now if your plan accepts online payments... There was a "Pay For Health Plan" button on the bottom of the screen which I clicked a few times but screen came right back to same place each time so I can only assume (which I hate to do!!!) that BCBS in our state doesn't accept online payments

When I log back in now to account it shows the app as "Complete" with the ID under it, while the status page shows "Initial Enrollment". Does this all sound correct and based on what I've read from prior member posts I should not wait for BCBS to reach out and instead give them a call on the Customer Service number they provided? Any other ideas as only 20 days and counting to be enrolled and make payment? Thanks in advance for any suggestions.
Last edited by bpg1234 on Thu Dec 12, 2013 12:52 pm, edited 1 time in total.
BruDude
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Re: Signing up for health care

Post by BruDude »

bpg1234 wrote:
BruDude wrote:
FrugalInvestor wrote:
BruDude wrote:Had several clients this week get placed in Medcaid purgatory. State did not pass Medicaid expansion and all they were deemed eligible anyway. HC.gov phone dummies told them to contact the state Medicaid office or file an appeal. And now they get to start all over again...
At least one on the Early Retirement forum reported that starting over wasn't an option. They were told that they must go through the appeal process since a determination (although faulty) had been made and that the process could take up to 90 days.
There is now an option to delete the application and start a new one.
Can't delete a completed application at this point (says coming at some point) so one needs to start a new application from scratch with new account (not sure if need new email or can reuse old one at this point), verified identity, etc.
Could be, not sure, but two of the ones that were "eligible" for Medicaid did start new apps and got approved with a subsidy after changing their answers. What a mess.
bpg1234
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Re: Signing up for health care

Post by bpg1234 »

BruDude wrote:
bpg1234 wrote:
BruDude wrote:
FrugalInvestor wrote:
BruDude wrote:Had several clients this week get placed in Medcaid purgatory. State did not pass Medicaid expansion and all they were deemed eligible anyway. HC.gov phone dummies told them to contact the state Medicaid office or file an appeal. And now they get to start all over again...
At least one on the Early Retirement forum reported that starting over wasn't an option. They were told that they must go through the appeal process since a determination (although faulty) had been made and that the process could take up to 90 days.
There is now an option to delete the application and start a new one.
Can't delete a completed application at this point (says coming at some point) so one needs to start a new application from scratch with new account (not sure if need new email or can reuse old one at this point), verified identity, etc.
Could be, not sure, but two of the ones that were "eligible" for Medicaid did start new apps and got approved with a subsidy after changing their answers. What a mess.
Yes you can start a brand new application as I did with complete new account (can't delete completed one yet - see post above) and got approved with a subsidy.
Eureka
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Re: Signing up for health care

Post by Eureka »

bpg1234 wrote:Yes you can start a brand new application as I did with complete new account (can't delete completed one yet - see post above) and got approved with a subsidy.
I wonder if it's possible to be honest in filling out the application (you have to submit it under penalty of perjury) and still get the correct determination. It has now been four business days since I was told by two people at healthcare.gov that an advanced resolution center specialist would call me in two to five business days. No call yet. At 1 a.m. CST Friday, I will call healthcare.gov again and ask them, "Now what?"
BruDude
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Re: Signing up for health care

Post by BruDude »

Eureka wrote:
bpg1234 wrote:Yes you can start a brand new application as I did with complete new account (can't delete completed one yet - see post above) and got approved with a subsidy.
I wonder if it's possible to be honest in filling out the application (you have to submit it under penalty of perjury) and still get the correct determination. It has now been four business days since I was told by two people at healthcare.gov that an advanced resolution center specialist would call me in two to five business days. No call yet. At 1 a.m. CST Friday, I will call healthcare.gov again and ask them, "Now what?"
The advanced resolution team has about 12 inquiries from me. I've never heard back from them once.
goaties
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Re: Signing up for health care

Post by goaties »

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bpg1234
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Re: Signing up for health care

Post by bpg1234 »

Eureka wrote:
bpg1234 wrote:Yes you can start a brand new application as I did with complete new account (can't delete completed one yet - see post above) and got approved with a subsidy.
I wonder if it's possible to be honest in filling out the application (you have to submit it under penalty of perjury) and still get the correct determination. It has now been four business days since I was told by two people at healthcare.gov that an advanced resolution center specialist would call me in two to five business days. No call yet. At 1 a.m. CST Friday, I will call healthcare.gov again and ask them, "Now what?"
Not doing anything dishonest as you ultimately true up at tax time and more importantly some individuals can realize additional income throughout the year depending on what they choose to do or not to do such as sell some investments, part-time work, TIRA to Roth conversions, etc. so completely legitimate.
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tc101
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Re: Signing up for health care

Post by tc101 »

I am single, 63, retired and will only show income of about $25K next year.

According to the Kaiser calculator for subsidies
Household income in 2014:218% of poverty level

Maximum % of income you have to pay for the premium, if eligible for a subsidy:6.92%

Health Insurance premium in 2014 (for a silver plan, before tax credit):$2,351 per year
You could receive a government tax credit subsidy of up to:$623 per year
(which covers 26% of the overall premium)

Amount you pay for the premium:$1,729 per year
(which equals 6.92% of your household income and covers 74% of the overall premium)
Two questions -

1. Am I correct in understanding that this means my total premium for the year would be $1,729, or a little under $150/month?

2. Since the premium is being subsidized so much by the government, does it make sense for me to get the best, most expensive policy on the exchange?
. | The most important thing you should know about me is that I am not an expert.
cubedbee
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Re: Signing up for health care

Post by cubedbee »

tc101 wrote:I am single, 63, retired and will only show income of about $25K next year.

According to the Kaiser calculator for subsidies
Household income in 2014:218% of poverty level

Maximum % of income you have to pay for the premium, if eligible for a subsidy:6.92%

Health Insurance premium in 2014 (for a silver plan, before tax credit):$2,351 per year
You could receive a government tax credit subsidy of up to:$623 per year
(which covers 26% of the overall premium)

Amount you pay for the premium:$1,729 per year
(which equals 6.92% of your household income and covers 74% of the overall premium)
Two questions -

1. Am I correct in understanding that this means my total premium for the year would be $1,729, or a little under $150/month?

2. Since the premium is being subsidized so much by the government, does it make sense for me to get the best, most expensive policy on the exchange?
Your premium for the second lowest silver plan would be the $150 a month. Your subsidy is a fixed $ amount to get you there. Gold or platinum plans have significantly higher base rates, so you would pay more after your subsidy.
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FrugalInvestor
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Re: Signing up for health care

Post by FrugalInvestor »

tc101 wrote:I am single, 63, retired and will only show income of about $25K next year.

According to the Kaiser calculator for subsidies
Household income in 2014:218% of poverty level

Maximum % of income you have to pay for the premium, if eligible for a subsidy:6.92%

Health Insurance premium in 2014 (for a silver plan, before tax credit):$2,351 per year
You could receive a government tax credit subsidy of up to:$623 per year
(which covers 26% of the overall premium)

Amount you pay for the premium:$1,729 per year
(which equals 6.92% of your household income and covers 74% of the overall premium)
Two questions -

1. Am I correct in understanding that this means my total premium for the year would be $1,729, or a little under $150/month?

2. Since the premium is being subsidized so much by the government, does it make sense for me to get the best, most expensive policy on the exchange?
Your subsidy is a fixed dollar amount - $623/yr - providing you choose a policy which costs more than that. You'll need to look at the available policies and choose the one that makes the most sense for you considering the full cost will be reduced by $623/yr. The federal and state exchanges work somewhat differently. Some will show you the subsidized policy amounts once your eligibility and subsidy have been determined but to my understanding this is not the case for all exchanges.

Edit: Jack (below) is right, I didn't pick up on your mention of the Kaiser Calculator. The information you're seeing does not look right. Also, if you don't already utilize an HSA you may want to consider one as it could reduce your income and, therefore, increase subsidy and possibly cost sharing. Below 250% FPL you should be eligible for cost sharing which your estimate doesn't mention. Cost sharing can significantly reduce deductible, max oop and co-pays so if you use medical care it can have a large impact on your costs.
Last edited by FrugalInvestor on Thu Dec 12, 2013 11:24 am, edited 2 times in total.
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Jack
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Re: Signing up for health care

Post by Jack »

tc101 wrote:I am single, 63, retired and will only show income of about $25K next year.

According to the Kaiser calculator for subsidies
Household income in 2014:218% of poverty level

Maximum % of income you have to pay for the premium, if eligible for a subsidy:6.92%

Health Insurance premium in 2014 (for a silver plan, before tax credit):$2,351 per year
You could receive a government tax credit subsidy of up to:$623 per year
(which covers 26% of the overall premium)

Amount you pay for the premium:$1,729 per year
(which equals 6.92% of your household income and covers 74% of the overall premium)
Two questions -

1. Am I correct in understanding that this means my total premium for the year would be $1,729, or a little under $150/month?

2. Since the premium is being subsidized so much by the government, does it make sense for me to get the best, most expensive policy on the exchange?
1. Go back and check the calculator again. You may have entered your age incorrectly. Although the bottom line number looks right, $1,729, the cost of the plan without subsidy is about $7,284 and you will get a $5,555 subsidy. However, this is just an estimate. Depending on your state, the cost of insurance could be either higher or lower. Each state has its own insurers. Better to go to your state exchange and do your shopping there to get more accurate prices.

2. Since your income is below 250%, you may also receive a cost sharing reduction but only if you chose a silver plan. This cost sharing will reduce your deductible and co-pays below that of a standard silver plan. However, between 200% and 250%, the actuarial value of this cost reduction is only 3%. It might not make a big difference compared to the premium differences between higher or lower plans.

Whether you should choose a higher metal or lower metal plan depends on your health care expectations. You will find that even with the subsidy, you will pay thousands more for a gold or platinum plan than a bronze plan. The dollar amount of the subsidy is fixed at approximately $5,555 for you. You pay the difference for selecting a higher plan or save the difference for selecting a lower plan. A silver plan adds the possibility of a cost sharing reduction.
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tc101
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Re: Signing up for health care

Post by tc101 »

Great information. Thanks for your help.
. | The most important thing you should know about me is that I am not an expert.
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tc101
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Re: Signing up for health care

Post by tc101 »

I finally got on the site and all my questions about price were answered when I filled out my application. I was having a problem because of a credit freeze due to identity theft, but I got that fixed and now the site seems pretty user friendly.

I have 2 new questions.

1. Can I change plans a few months after selecting one, or am I making a one year commitment when I make a selection?

2. Which plans tend to have the biggest and best list of available doctors? The plans have a doctor lookup, but it is still hard to compare the general availability of docs on a plan.
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Jack
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Re: Signing up for health care

Post by Jack »

tc101 wrote:I finally got on the site and all my questions about price were answered when I filled out my application. I was having a problem because of a credit freeze due to identity theft, but I got that fixed and now the site seems pretty user friendly.

I have 2 new questions.

1. Can I change plans a few months after selecting one, or am I making a one year commitment when I make a selection?

2. Which plans tend to have the biggest and best list of available doctors? The plans have a doctor lookup, but it is still hard to compare the general availability of docs on a plan.
1. Just like Medicare, it is a one year commitment. You can only change plans during the annual open enrollment period and new plans start on January 1 each year. This first year enrollment is extended until March 31. I don't know what would happen if you selected a plan now and tried to cancel and re-enroll before the end of March. You may or may not be able to re-enroll.

2. HMO (Health Management Organization) plans typically have the smallest networks. PPO (Preferred Provider Organization) plans typically have wider networks, but these can vary considerably between insurers. Typically, when comparing similar PPOs the cheapest insurer will have the narrowest network.

The only way to know for sure is to check for each provider with each insurer. Some state exchanges have better mechanisms than others to assist in this look up. You should check for each doctor that you are interested in. You should also check for each hospital you are interested in because some might be excluded from the network. For example you probably want to check the nearest hospital you would normally go to, the nearest major trauma center for major emergencies, and maybe a specialty hospital for something like cancer treatments.

Checking on network providers has always been a big pain for the individual insurance market. Hopefully in future years the exchanges will simplify this. It took a couple of years for the Medicare prescription website to become really useful when comparing prescription plans. I expect things to be much improved next year.
jwa
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Re: Signing up for health care

Post by jwa »

Eureka wrote:
bpg1234 wrote:Yes you can start a brand new application as I did with complete new account (can't delete completed one yet - see post above) and got approved with a subsidy.
I wonder if it's possible to be honest in filling out the application (you have to submit it under penalty of perjury) and still get the correct determination. It has now been four business days since I was told by two people at healthcare.gov that an advanced resolution center specialist would call me in two to five business days. No call yet. At 1 a.m. CST Friday, I will call healthcare.gov again and ask them, "Now what?"
Eureka in Illinois? Is Eureka where you live or is this a moniker based upon something else? I ask as I live in the Peoria area.

I applied last week and waited a week for my application "to be completed." Then I was denied Obama Care and advised that I would be place in Medicaid (like the state of Illinois will get around to doing this in a timely fashion.) Like many here I have some flexibility in how I time income so I logged on again and called the 800 number. Told the gentleman what the situation was, that I really didn't want to be on Medicaid and that I could start a small pension a year earlier than I planned. He said that the application would have to be deleted and that couldn't be done until 12/27 but since I haven't accepted Medicaid he could start a new app for me. He told me whenever Illinois Medicaid contacts me to tell them there was an income adjustment and that I am now enrolled through healthcare.gov for the company plan I chose. We did this on the phone from the beginning all the way through him actually enrolling me in a BC/BS plan that I had previously decided on. I received a couple emails this morning from BC/BS so it looks like it worked.

I know it is fashionable to bash the government, it's bureacrats and all their employees in general. However, this young man was incredibly helpful, patient and helpful throughout the process. When we were done I asked him to transfer me to his supervisor as I wanted to express how helpful and polite he had been which is what I did. He helped me so I hope what I passed on helps him.
jwa
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Re: Signing up for health care

Post by jwa »

I should also add that the income I reported on the initial application was in excess of the minimum not to be on Medicaid by a couple thousand so I was confused by this. When I added another $7,000 to my income everything was copesetic.
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Re: Signing up for health care

Post by FrugalInvestor »

tc101 wrote:
2. Which plans tend to have the biggest and best list of available doctors? The plans have a doctor lookup, but it is still hard to compare the general availability of docs on a plan.
In my experience the Blue Cross and/or Blue Shield affiliates tend to have large networks and some of the best if you travel. I say this not only due to my personal experience with BCBS plans in early retirement but also because when working our company had employees spread out across U.S. with many located in rural communities. We used Blue Cross to administer our plan because it was one of very few (possibly the only) company with a network of providers that could blanket our entire service area.

However, BC and BS affiliates may also have different networks for different plans so you can't assume. We picked our new plan based on cost and other factors and then called the insurance company (a BC affiliate) and asked about the network. We were able to go onto their site as a guest, choose the proper network name (that they provided us but I later noticed it on the plan description documents available online) from a menu and then look at providers in different areas where we spend time. Their network is huge, which is what we were looking for since we travel regularly and spend winters away from home in multiple locations.

I tend to look at local (to where I may be) large well known medical centers which are often more expensive as well as my own doctors. If I need to be referred to a specialist I want to have the option to go to the best available, especially if the condition is serious. I also look at hospitals and clinics that I have read in the news are opting out of ACA plans such as the Cleveland Clinic, Memorial Sloan Kettering in NY, Cedars-Sinai Medical Center in LA, etc.
Have a plan, stay the course and simplify. Then ignore the noise!
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Re: Signing up for health care

Post by Jack »

FrugalInvestor wrote:In my experience the Blue Cross and/or Blue Shield affiliates tend to have large networks and some of the best if you travel.
I would be very careful with that generalization. At least in some states, the BCBS affiliates have decided to compete on price rather than on service for their exchange plans. The new exchange plans may have limited networks. Make sure you check network hospitals as well as network doctors. If you go to the provider website, make sure that you are looking up the network that specifically applies to the plan you choose. They may have different networks for plans on and off the exchange.
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Re: Signing up for health care

Post by FrugalInvestor »

Jack wrote:
FrugalInvestor wrote:In my experience the Blue Cross and/or Blue Shield affiliates tend to have large networks and some of the best if you travel.
I would be very careful with that generalization. At least in some states, the BCBS affiliates have decided to compete on price rather than on service for their exchange plans. The new exchange plans may have limited networks. Make sure you check network hospitals as well as network doctors. If you go to the provider website, make sure that you are looking up the network that specifically applies to the plan you choose. They may have different networks for plans on and off the exchange.
Exactly Jack. This is why I went on to state that it can vary, even within the same insurer's plans, and so needs to be carefully verified by by looking at the applicable network. It takes a lot of questioning and sleuthing to be sure you know what you're getting, especially since the the system is so new and not exactly working smoothly yet.
Have a plan, stay the course and simplify. Then ignore the noise!
Eureka
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Re: Signing up for health care

Post by Eureka »

jwa wrote:
Eureka wrote:
bpg1234 wrote:Yes you can start a brand new application as I did with complete new account (can't delete completed one yet - see post above) and got approved with a subsidy.
I wonder if it's possible to be honest in filling out the application (you have to submit it under penalty of perjury) and still get the correct determination. It has now been four business days since I was told by two people at healthcare.gov that an advanced resolution center specialist would call me in two to five business days. No call yet. At 1 a.m. CST Friday, I will call healthcare.gov again and ask them, "Now what?"
Eureka in Illinois? Is Eureka where you live or is this a moniker based upon something else? I ask as I live in the Peoria area.

I applied last week and waited a week for my application "to be completed." Then I was denied Obama Care and advised that I would be place in Medicaid (like the state of Illinois will get around to doing this in a timely fashion.) Like many here I have some flexibility in how I time income so I logged on again and called the 800 number. Told the gentleman what the situation was, that I really didn't want to be on Medicaid and that I could start a small pension a year earlier than I planned. He said that the application would have to be deleted and that couldn't be done until 12/27 but since I haven't accepted Medicaid he could start a new app for me. He told me whenever Illinois Medicaid contacts me to tell them there was an income adjustment and that I am now enrolled through healthcare.gov for the company plan I chose. We did this on the phone from the beginning all the way through him actually enrolling me in a BC/BS plan that I had previously decided on. I received a couple emails this morning from BC/BS so it looks like it worked.

I know it is fashionable to bash the government, it's bureacrats and all their employees in general. However, this young man was incredibly helpful, patient and helpful throughout the process. When we were done I asked him to transfer me to his supervisor as I wanted to express how helpful and polite he had been which is what I did. He helped me so I hope what I passed on helps him.
Yes, Eureka, Illinois. Thanks for the information. Every bit helps. It has now been more than five business days since an advanced resolution center specialist was supposed to call in "two to five business days." No one has called. I was going to call healthcare.gov, but the website is down so anyone I talked to there wouldn't have access to it.

I talked to a navigator at the Woodford County Health Department on Thursday afternoon. He took the numbers of both my applications and said he'd see what he could do. If the problem is still unresolved next week, I have an appointment with him. He has a couple ideas that might work.
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Re: Signing up for health care

Post by ieee488 »

Update:

I managed to get through the entire process on the federal website HealthCare.gov on the Wednesday before Thanksgiving, Nov 27.
Today I received an email from that website reminding me to complete the enrollment, i.e. pay the premium.
That was ironic since I had been intending to check on my enrollment today, anyway.
I called up Blue Cross Blue Shield and lo and behold, they have my information!
The welcome kit is going out in the mail starting on Monday, Dec. 16.
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dm200
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Re: Signing up for health care

Post by dm200 »

My wife finally was signed up successfully, with a credit/subsidy, the week before November 30. Yesterday, she received the bill from Kaiser for the selected plan at the correct premium, with the correct credit/subsidy - and the new (based on President Obama's extension) required due date for receipt of payment of December 31, 2013 for plan coverage effective January 1, 2014. This is a Virginia plan through healthcare.gov (Virginia did not set up its own exchange). :happy
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dm200
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Re: Signing up for health care

Post by dm200 »

dm200 wrote:My wife finally was signed up successfully, with a credit/subsidy, the week before November 30. Yesterday, she received the bill from Kaiser for the selected plan at the correct premium, with the correct credit/subsidy - and the new (based on President Obama's extension) required due date for receipt of payment of December 31, 2013 for plan coverage effective January 1, 2014. This is a Virginia plan through healthcare.gov (Virginia did not set up its own exchange). :happy
I hope her positive experience with healthcare.gov is some indication that the logjams and backups are and will be cleared up and folks who want/need to enroll in a plan are now more likely to be successful.
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magellan
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Re: Signing up for health care

Post by magellan »

magellan wrote:[On Tuesday Dec. 3rd] I finally decided to enroll in an Anthem exchange plan, but directly through Anthem instead of bothering with healthcare.gov.

... I faxed the application back to Anthem and am waiting for a reply.
I called Anthem and so far there's no record of the application I faxed Dec 3rd. My credit card definitely hasn't been charged for the first month's premium. Anthem's phone support person wasn't surprised or concerned. She said they're at least 2-3 weeks behind in processing applications. So much for my bright idea that staying in the private sector would give me a less painful experience than using healthcare.gov.

Next week I'm supposed to pay the January premium for my old grandfathered plan to keep that coverage alive. You'd think Anthem would have made this easier for existing customers, especially considering I have an account with them and can even login and see all my history and claims!

Jim
Eureka
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Re: Signing up for health care

Post by Eureka »

dm200 wrote:I hope her positive experience with healthcare.gov is some indication that the logjams and backups are and will be cleared up and folks who want/need to enroll in a plan are now more likely to be successful.
I wish. I called Friday afternoon and talked to an advanced resolution specialist. She said nothing can be done about my incorrect Medicaid eligibility determination until the feature to delete it is restored to healthcare.gov. This feature apparently disappeared more than a week ago when it was tweaked. She said that if I was unable to sign up by Dec. 23, I'd just have to wait for coverage to begin Feb. 1. I told her that would cost me a lot of money, as the premium on my existing coverage will rise by 64 percent in January. She seemed unmoved.

I also asked her if creating a new account using a new email address might work, as I had heard anecdotal evidence that it might. She said that wasn't recommended. She said that was a suggestion when the website was generating corrupt accounts earlier but that my account was active and not corrupt. She didn't know what difficulties might be generated by creating a new account and submitting an application from it.
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Re: Signing up for health care

Post by rwm »

ieee488 wrote:Update:

I managed to get through the entire process on the federal website HealthCare.gov on the Wednesday before Thanksgiving, Nov 27.
Today I received an email from that website reminding me to complete the enrollment, i.e. pay the premium.
That was ironic since I had been intending to check on my enrollment today, anyway.
I called up Blue Cross Blue Shield and lo and behold, they have my information!
The welcome kit is going out in the mail starting on Monday, Dec. 16.
Ditto, called and got confirmation that my local BCBS received my correct enrollment info from healthcare.gov. My final start-from-scratch application was a breeze.
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