Anyone sign up with Obamacare yet?

[SteamKing]

How does it work for married couples? Can you apply individually? Like IRS tax; married but filing separate tax returns?

It depends. If you are looking to get a subsidy to pay for your coverage, the combined household income will normally be used to determine if you qualify and what amount of subsidy you can get. Different marital situations will have (like if you are separated) will have different rules to follow.

Different marital situations are covered here:

http://www.healthreformbeyondthebasics.org/question-of-the-day/

 

[Evo]

Steamking, I don't know anyone that had to change doctors. I heard that it affected some people because their insurance company changed their list of "in-network" providers, but this has always happened in the past, policies change, prices change (always increase) and the doctors and hospitals willing to accept the insurance negotiated fees back out of the plans. Do you have any documentation on how many doctors and hospitals were *removed* by the ACA and not because of normal changes, that the doctors opted out because of the money? My health insurance is going up next year, same policy, but an increase of $39 a month. But that's not unusual, my employer was always shopping for the best deal and it was not unusual for our health insurance provider to change. And it always meant it wasn't as great, in the last ten years, we had started to see annual deductibles that we'd never had before and this was before Obama was even elected. Insurance changed every year. My company had a fight with the largest, best hospital near me, so that hospital was no longer an option for me, they denied insurance coverage for it. That was 12 years ago, now that I am on medicare, I can go to that hospital, not going to name it, but it's a name you'd recognize.

Also, it has to be an official site, not some complaint site. I am in my open enrollment period for health insurance right now and was looking at some *sites* where people make complaints and some of the complaints were utterly ridiculous. The things people believe are just mind boggling.

 

[Evo]

Different marital situations are covered here:

http://www.healthreformbeyondthebasics.org/question-of-the-day/

Steamking, this is for Medicaid and SSI. This is for people below the poverty line and extremely low income individuals. It's not for people with normal incomes. Where exactly in that link does it address the question dlgoff posed for people with normal incomes, not the impoverished that qualify for medicaid and SSI? I am on Social Security and I don't qualify for either Medicaid or SSI (Social Security supplemental income) because my Social Security payment is too high. I don't work anymore. I am on Medicare due to disability, not old age.

 

[SteamKing]

Steamking, this is for Medicaid and SSI. This is for people below the poverty line and extremely low income individuals. It's not for people with normal incomes. Where exactly in that link does it address the question dlgoff posed for people with normal incomes, not the impoverished that qualify for medicaid and SSI? I am on Social Security and I don't qualify for either Medicaid or SSI (Social Security supplemental income) because my Social Security payment is too high. I don't work anymore. I am on Medicare due to disability, not old age.

I think you got confused because at the link cited, the Question of the Day dealt with Medicaid and SSI.

If you scroll down the page, you will see a variety of different FAQs for ACA enrollment. These FAQs are grouped into different topic sections, the first of which deals with questions about Modified Adjusted Gross Income (MAGI).

For dlgoff and his question on the effect tax filing status and marital status have on ACA enrollment, the section entitled

"Tax Filing Status and Eligibility for Premium Tax Credits"

might answer his specific questions.

 

[Evo]

I think you got confused because at the link cited, the Question of the Day dealt with Medicaid and SSI.

If you scroll down the page, you will see a variety of different FAQs for ACA enrollment. These FAQs are grouped into different topic sections, the first of which deals with questions about Modified Adjusted Gross Income (MAGI).

For dlgoff and his question on the effect tax filing status and marital status have on ACA enrollment, the section entitled

"Tax Filing Status and Eligibility for Premium Tax Credits"

might answer his specific questions.

What are "Premium Tax Credits"? I want to thank you for all of your helpful information, just not sure who this applies to.

I believe this site is better.

Basic Information
Starting in 2014, if you get your health insurance coverage through the http://www.irs.gov/uac/Newsroom/The-Health-Insurance-Marketplace, you may be eligible for the premium tax credit. This tax credit can help make purchasing health insurance coverage more affordable for people with moderate incomes.

http://www.irs.gov/uac/The-Premium-Tax-Credit

The Health Insurance Marketplace is the place to go to learn about financial assistance options.
When you get health insurance coverage through the Marketplace, you may be able to lower your monthly premium through advance payment of the premium tax credit. The credit is generally for people who have household income between one and four times the federal poverty level.

http://www.irs.gov/pub/irs-pdf/p5121.pdf
.

 

[SteamKing]

Steamking, I don't know anyone that had to change doctors. I heard that it affected some people because their insurance company changed their list of "in-network" providers, but this has always happened in the past, policies change, prices change (usually increase) and the doctors and hospitals willing to accept the insurance negotiated fees back out of the plans. Do you have any documentation on how many doctors and hospitals were *removed* by the ACA and not because of normal changes? My health insurance is going up next year, same policy, but an increase of $39 a month. But that's not unusual, my employer was always shopping for the best deal and it was not unusual for our health insurance provider to change. And it usually meant it wasn't as great, in the last ten years, we had started to see annual deductibles that we'd never had before and this was before Obama was even elected. Insurance changed every year.

Also, it has to be an official site, not some complaint site. I am in my open enrollment period for health insurance right now and was looking at some *sites* where people make complaints and some of the complaints were utterly ridiculous. The things people believe are just mind boggling.

Like I said, Evo, I'm pleased you and you daughter are being treated right under ACA.

However, just because you personally do not know anyone who has been adversely affected doesn't necessarily mean that such people and situations do not exist. I don't think any insurance policy, whether for health care, automobiles, home owner's, etc., can reasonably be expected not to change at all over time, either in terms of coverage or amount of premium charged.

For example, I used to have a perfectly affordable home owner's policy which cost less than $1000 a year for the premiums. It had been this amount for ages, and I never had filed any claims. Because I live in the SE US and there was an uptick in claims filed on HO policies by folks living in Florida and other coastal regions who sustained losses in hurricanes a number of years ago, my company dropped my coverage because they claimed I lived too close to the water (I'm at least a half hour away from a protected bay, and about an hour away from any sea). Wind coverage is all but unobtainable now, at any price, and the last time I renewed my HO insurance (about 4 years ago), the premiums had increased from less than $1000 a year to just under $3000 annually. I couldn't afford this, so I dropped it.

People are having to make the same decision with regard to health insurance, even though coverage is mandated. Sure, subsidies are available for some who qualify, but even with these, it comes down to whether the cost of the coverage is affordable.

 

[SteamKing]

What are "Premium Tax Credits"?

It's how the premium subsidies are administered:

http://www.cbpp.org/files/QA-on-Premium-Credits.pdf

 

[mheslep]

It would be a bad thing if it did that, but that's not what the ACA does. It couldn't even if someone wanted it to; it should be obvious that the American federal government has very little power to limit hospital construction and expansion.
...
So under this part of the law no one is stopping anyone from building or expanding any hospital or other medical facility. They're just saying that you can't take it for granted that the government will pay for any treatments delivered by this new capacity and that are recommended by the hospital owner.

Per the CMS reference that SteamKing provided earlier, the ACA states that physician-owned hospitals are "prohibited from expanding facility capacity", i.e. no new and no expansion of existing. Apparently the prohibition applies to any doctor-owned hospitals that would accept Medicare or Medicaid beneficiaries. The Stark Law as I understand it blocked referrals from physician-owners, but not any and all payments to Medicare/Medicaid beneficiaries at such physician-owned as does the ACA. By blocking the customer base (~49 million people for Medicare), it is obvious that the government has a great deal of power to limit hospital construction. One can argue the rationale, the avoidance of conflict of interest, etc, but not that the federal government has acted to block physician-owned hospitals. This source suggests the restriction was intentionally placed in the law to win acceptance for the ACA from other hospitals.

...the restrictions [on physician-owned hospitals] were a deal-breaker for hospitals when the White House sought their support for the law in 2009, industry lobbyists say.

 

[jz92wjaz]

We're on the exchange. Our prior policy covered more providers, including out of network. We lost one major provider and a minor one, but it wasn't a big deal. In spite of being in the highest risk group on our old policy, the premium without a subsidy went up. For the extra 80 or so a month (which is about what our subsidy was this last year), we now have pregnancy coverage, which we couldn't get before. Our pre-exchange policy had a much lower deductible but an ever so slightly higher maximum out of pocket. The cheapest exchange policy was beyond horrific when it came to the network.

Pre-exchange and post-exchange, we're forking out roughly $15,000 for medical on a yearly basis, because we have a family member with a lot of medical needs. If we hadn't been able to get onto an insurance policy when my work coverage ended, we'd have been thrown into a high risk pool, which could have cost us over $25,000 every year for the next few years, and that would have tipped us over the edge. We would have been better off making less money so we'd qualify for government medical assistance.

There are still substantial problems with the new law, but the ACA starts to fill in that gap where people who make just a little too much were funding all sorts of medical assistance for most everyone else though their taxes (medicare, medicaid, and tax breaks for employer sponsored insurance), and yet were going broke themselves.

 

[Astronuc]

It seems implementation of ACA is inconsistent?

And now - Exclusive: U.S. CEOs threaten to pull tacit ACA support over 'wellness' spat
http://news.yahoo.com/exclusive-u-ceos-threaten-pull-tacit-obamacare-support-120556143--sector.html

It is necessary to have health insurance, but it doesn't help so much if it isn't affordable, since one must chose whether or not to seek treatment based on affordability. As it was, and probably still is, some are still forced to go without.

The problem with affordable health insurance is that so many people need significant care. If only 1% or 0.1% needed costly health care, it might be affordable. However, if something like 30% +/- need costly healthcare, then that would impose a burden. On the other hand, a free market system would mean a lot of folks going without healthcare, that is beyond an annual or periodic visit to the doctor.

There needs to be a nationwide wellness program in order to reduce the incidence of heart or pulmonary disease, diabetes, cancer, . . . . I remember when the President's Physical Fitness program was an annual event in school. I don't hear much about it anymore.

 

[Danger]

I hate Papa John and will never patronize his business because of his hypocrisy in this matter. He loudly announced that he would have to lay off hundreds of employees due to cost if Obamacare was enacted, then a couple of weeks later bragged that he was giving away 2 million free pizzas for Superbowl weekend.

 

[Medicol]

http://www.papajohns.com/index.html

Yes, one of the problems of the First World is it has a lot of such people who always create "fake gravities".

 

[edward]

Here is a good cost calculator from the Kaiser Foundation that gives people a starting point.

http://kff.org/interactive/subsidy-calculator/

 

[mheslep]

As it was, and probably still is, some are still forced to go without.

The insured rate in the US has hovered around 84% to 88% for decades. As of the first part of this year the insured rate was 86%.

 

[Locrian]

Concerning network size,

For 2014, there were lots of large, extended network plans on the exchange. I don’t think I ever looked at a region and didn’t find a broad-network choice available.

However, nobody bought them. The exchange emphasizes price, and did a very poor job of informing the consumer around network size, resulting in people mostly purchasing the cheapest plans.

So, I think it is not true that exchange plans (or ACA plans, however you want to put it) have narrower networks. It is, however, true that many (most?) plans purchased on the exchange have narrower networks.

 

[Locrian]

As for provider reimbursement,

I see no evidence whatsoever that the .60 cents on the “private” dollar listed earlier in this thread is accurate. As far as I can tell, it’s a number from an article that quotes another article, which is merely listing a very specific instance for one insurer in one state.

I look at unit costs almost every day, and I can tell you that ACA plans at multiple large insurers are paying much more than Medicare for almost all services. However, this varies by type of service, provider and insurer. I have no doubt that there are specific CPT codes for particular insurers that are bringing in low dollars, but it would be spectacularly wrong to extrapolate that. Providers make up for Medicare’s low payment by overcharging commercial plans, and they’re very good at it.

On the other hand, the problems providers are having with bad debt are very real. Thankfully, provider networks are mostly locked in for 2015-2016, but suffice it to say there are going to be some very intense negotiations going on over the next few years.

 

[Locrian]

Just a thout to keep in mind,

A great deal was made of the price of 2014 ACA policies. The same is true for the price of 2015 ACA policies, which were compared to 2014 policies.

Which is silly, because in many instances these estimates were shots in the dark. They were sometimes good shots in the dark, but the target is very small.

When 2015 rates were set, actuaries had, at most, three months of claims with no runout, and the vast majority of membership had signed up days before, with no claims data to study.

Keep in mind that central to the ACA is risk adjustment – I would actually place it as more important than the exchanges, more important than the mandate, and possibly more important than guaranteed issue. The edge servers were supposed to be online and working in 3rd quarter 2013, but weren’t functioning properly the same time a year later. Actuaries, for both 2014 and 2015, were having to price policies assuming a risk adjustment system that was ill-defined and of questionable functionality.

2015 rates weren’t interesting, and you should glean absolutely nothing from them.

2016 rates are another matter entirely.

 

[edward]

Rates will always go up as long as the cost of health care keeps going up.

To help pay for ACA Medicare payments to providers is going down and at the same time providers are charging more. I have Medicare plus a supplemental policy that costs me $250 per month. My supplemental policy pays for everything that Medicare doesn't pick up right down to the last dime.

Today I called to make an appointment with my orthopedic surgeon to schedule an appointment to get another synvisc injection in my knee. The receptionist told me that the Dr. has dropped all Medicare patients because reimbursement for Medicare patients is dropping.

The irony here is that the supplemental policy would still pay for what Medicare doesn't, but the Doc will never know how much Medicare doesn't cover because he no longer sees Medicare patients. <(@^^@)>

I am in pain and sol. This might have been a good post for the First World Problems thread.