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Posted 10/6/2013 by gale w in NSBR Board
 

gale w
shiny farmwife

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Posted: 10/6/2013 3:49:08 AM
Right now we pay $606 per month for a plan that has an $11,000 deductible. Price goes up to $732 in December. The absolute cheapest one that BCBS offers is $1232 per month for $12,000 deductible. WTF. DH is going to flip when he hears this.

eta: I haven't looked at the state exchanges yet. We can keep our current plan until 12-1-14 so that's most likely what we'll do.


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GroovyPea
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Posted: 10/6/2013 4:43:20 AM
Not exactly affordable


Steph

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Posted: 10/6/2013 4:48:17 AM
Wow...that's crazy expensive.


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enjoytotheend
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Posted: 10/6/2013 5:48:55 AM
Affordable is a joke. On what alternate universe?!? I hate what he is doing to the country I love. It's disgusting. So many people right now are barely doing well enough to put food on the table. Now this? And I do realize part of the blame lands on the Senate and House when this vote was taken. I doubt anyone read the bill!

DinCA
AncestralPea

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Posted: 10/6/2013 5:48:59 AM
That is ridiculous! It's twice as much as you are paying now. I wonder if other people are encountering the same. If so, this is really sad. That is not affordable healthcare.


Diana

Kluski
AncestralPea

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Posted: 10/6/2013 6:47:55 AM
What happens if you don't sign up for it?

What would happen if you do sign up and don pay bc you can't afford it?


Dee

scraps_of_time
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Posted: 10/6/2013 7:23:19 AM
Indiana doesn't have a state exchange. The state opted out of doing there own and the federal is the only option. We haven't been able to get on yet.




Rhonda

gerryglow
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Posted: 10/6/2013 7:27:32 AM

What happens if you don't sign up for it?

What would happen if you do sign up and don pay bc you can't afford it?


Nothing happens if you don't sign up. The penalty for 2014 for not having insurance is $95.

If you do sign up and don't pay you get get cancelled.

Regarding the premiums - here's some common sense 101:
Jane Doe dutifully pays for insurance her entire adult life. At age 50 she gets cancer and she's covered.
Joe Smith would rather spend his money on other things (wouldn't we all?) so he has no insurance his entire adult life. At age 50 he get cancer and is now able to buy health insurance. Kind of like buying car insurance after you have an accident.
This law flies in the face of the very definition of insurance.
The uninsured who are uninsured by CHOICE are not going to get insured now - and the rest of us are going to pay the price. And yes, I understand there are people who want insurance and up until now couldn't get it but there's got to be a better way.


Gerry



amom23
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Posted: 10/6/2013 7:35:24 AM
We are self employed and pay $1200 per month and have for years. I'd love to have some of the lower costs lots of you complain about. It totally sucks to have to pay so much.


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gale w
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Posted: 10/6/2013 11:13:19 AM
What kind of deductible do you have for that $1200? We're also self employed and we get no discounts. Our current policy is only about 2 yrs old. Before that we were paying more, because according to United Health, who was our former company, they increase premiums yearly and new equivalent plans are cheaper. Not different plans, but new applicants. So at that time, we got a new plan. With a different company.


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Posted: 10/6/2013 11:32:59 AM
Ugh, I looked up mine through the state exchange. Nope, cant afford it. The bronze plan is 400 for me and DH with a 12000 deductible. What is the point of that deductible I ask you?

I know that isn't as much as others stated on here, but for our income it just isn't feasible.

I will take the fine that is $95 or 1% of annual income


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Posted: 10/6/2013 11:55:20 AM
Wow, my employer is $26 a month with no deductible. The ACA, which I do support in theory, is so much higher than that its insane. I would NEVER be able to afford that. And it doesn't make sense...but federal definition i meet the income guidelines to be considered living in poverty (I'm a grad student). Who in their right mind can afford several hundred bucks a month in insurance if they're living in poverty??

In theory, I support insuring the uninsured. In implementation, this plan makes no sense.



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peapermint
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Posted: 10/6/2013 12:16:07 PM
Have you tried the calculator at Kaiser Family Foundation?.

I think you might be confusing the deductible (which is showing as $2,000 and $5,000, respectively, for the Silver and Bronze plans -- ETA: For my state, which is California) with the annual out-of-pocket maximum, which is around $12,000. Also, a lot of preventative stuff and meds are covered outside of the deductible.

Also, since it seems you don't qualify for a subsidy/tax credit, I can't think of a reason for you to buy off the Exchange. We contacted a local insurance agent who had been through the training and got quotes for better plans/rates, and I think they include dental as well. Since they can't penalize for pre-existing conditions anymore, there were a lot more options than last time I checked. I'm in California, and for our three-person family the Blue Cross/Blue Shield Silver plan would be $879 a month (unsubsidized), or Bronze about $200 less, which is much less than we were paying to COBRA ($1,330 a month.)

Maybe are you using the calculator for small business owners? The figures just don't seem right. Also, you can of course call the number or, in some states, ask questions on the Facebook page.

I'm pretty sure that in most cases, premiums can't exceed 9.5 percent of your adjusted gross income.

ETA:
KFF article


In addition, people who earn 250 percent of the federal poverty level or less will also have their maximum out-of-pocket spending capped at lower levels than will be the case for others who buy plans on the exchange. In 2014, the out-of-pocket limits for most plans will be $6,350 for an individual and $12,700 for a family. But people who qualify for cost-sharing subsidies will see their maximum out-of-pocket spending capped at $2,250 or $4,500 for single or family coverage, respectively, if their incomes are less than 200 percent of the poverty level, and $5,200 or $10,400 if their incomes are between 200 and 250 percent of poverty.

In California, for example, a standard silver plan will have a $2,000 deductible, a $6,400 maximum out-of-pocket limit and a $45 copayment for a primary care office visit. Someone whose income is between 150 and 200 of the poverty level, on the other hand, will have a silver plan with a $500 deductible, a $2,250 maximum out-of-pocket limit and $15 copays for primary care doctor visits.


ETA #2:
In California, you would have to have 4 kids, make $400,000 a year and be around 50 years old for your premiums to be over $1200/mo and that's for a Silver plan; Bronze would be $973. And the deductibles would still be $2,000 or $5,000, not $12,000.

I think something is funky with the site or your state or something. Try calling.

gale w
shiny farmwife

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Posted: 10/6/2013 12:42:07 PM

Have you tried the calculator at Kaiser Family Foundation?.
Yes. We don't qualify. Just barely.


I think you might be confusing the deductible (which is showing as $2,000 and $5,000, respectively, for the Silver and Bronze plans -- ETA: For my state, which is California) with the annual out-of-pocket maximum, which is around $12,000. Also, a lot of preventative stuff and meds are covered outside of the deductible.
The deductible is clearly listed as $12,000 per family ($6000 for prescriptions per family member) and the annual OOP max is $12,700. The exact same preventive care is covered on our current plan that is covered on the new plans. screenshot


Maybe are you using the calculator for small business owners?
I'm just using the shop feature at anthem's website and to see about subsidies, I used the calculator you linked above.


I'm pretty sure that in most cases, premiums can't exceed 9.5 percent of your adjusted gross income.
Our income changes every year. Sometimes drastically. The subsidies calculator is based on the previous year's income but the premiums would be paid out of the current year.

We have one year to shop for a better plan (well not the whole year-we can only buy a plan during open enrollment right? ) so we'll be doing that but right now it's not looking good.


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peapermint
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Posted: 10/6/2013 12:50:20 PM
Ah, thanks. I thought the subsidies calculator was based on projected income for 2014. The KFF calculator doesn't just calculate for subsidy recipients, though, I don't think. It should give a figure for everyone.

I don't know anything about Indiana; I guess Anthem's tool is what you guys have to look at instead of a state Exchange site? It looks very different than what we're seeing here in California.

I'm sorry; that's a bummer. I'm not excited about paying $879/month but I'm excited at least to have the option to buy insurance (couldn't before privately). The cutoff for qualifying for a subsidy is 400% of the poverty level.

I still think you should give them (Feds, state, insurance agents) a call. I found more options for my family when I started poking around.

ETA: Also, I assume you know about the longtime standard medical expenses tax write-off options for the self-employed? My accountant gave me some tips on how to structure things to receive that.

SDeven
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Posted: 10/6/2013 12:51:31 PM
I spend less of my own money by paying 100% out of pocket for all my families medical events and saving up for the *what ifs* and paying the fine, than I would spend if I purchased insurance that only covers a portion, has a high deductible and costs an arm and a leg. I am a type 2 diabetic and I have a son with a seizure disorder and Autism...so it's not like we are in the healthy crowd. We spend alot on medical...but it's still a better deal to pay cash for everything than to try to purchase insurance for the two of us.

My family participates in a private medical co-op for the super-sized incidents.

We have been operating this way for about 16 years. When our big name insurance company illegally dumped us and left us uninsured and uninsurable, we had to find another way.






gale w
shiny farmwife

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Posted: 10/6/2013 12:55:26 PM

I thought the subsidies calculator was based on projected income for 2014.
It might be but there's no way for us to project our 2014 income. It depends almost 100% on weather, and the grain markets, both of which, as we all know, are pretty unpredictable.


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gale w
shiny farmwife

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Posted: 10/6/2013 12:58:08 PM

Also, I assume you know about the longtime standard medical expenses tax write-off options for the self-employed? My accountant gave me some tips on how to structure things to receive that.
As a business we deduct our premiums (after FICA is calculated, I believe) but other than that we don't have any write-offs. We don't itemize. We do use an accountant and she does ask what we spent each year on medical expenses.

eta: beyond the cost of premiums I don't think we've ever spent more than 7.5% (or whatever the limit is) of our income on medical expenses, and you can only deduct expenses in excess of that percentage.


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joyce22
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Posted: 10/6/2013 1:00:19 PM
I heard Obama say (on Tv)you would be able to get insurance for the price of cable. Are you saying that's not true?

gale w
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Posted: 10/6/2013 1:02:53 PM
We pay about $80 for directv so even if we figured that for each family member (family of 5) it's still less than insurance. Maybe he means cable with every premium channel plus all sports packages plus all pay per view options.


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peapermint
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Posted: 10/6/2013 1:11:03 PM
One year our medical expenses were 23% of our AGI

I think it you're close to the subsidy cutoff, then sign up for an exchange plan but don't claim the credits month-by-month. There's abs option to get them at the end of the year, so if you earned more than expected you wouldn't have to pay back the subsidy.

My income fluctuates a lot as well, due to things outside of my control, so I can see why that would be frustrating.

Maybe a Farm Bureau-endorsed agent would have good ideas?

ETA: We were able to include premium costs in our tax deduction calculation the year we paid COBRA.


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Posted: 10/6/2013 1:14:45 PM
Any co-pays?


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Posted: 10/6/2013 1:17:20 PM
Read the act, this coming year it is $95, it goes up each year.


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Posted: 10/6/2013 1:18:54 PM
I haven't been able to get on, but I am really curious. I started working for a small company and won't be eligible for insurance until 10/15. Before I sign on, I want to see if I can find "affordable" insurance.



peapermint
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Posted: 10/6/2013 1:24:57 PM
If your company offers insurance, you can't get Exchange/subsidized insurance unless employer plan is "unaffordable" aka 9.5% of income. *I think*


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PeaNut

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Posted: 10/6/2013 1:43:00 PM
"I heard Obama say (on Tv)you would be able to get insurance for the price of cable. Are you saying that's not true?"


I don't have cable cause I cant afford it

"Read the act, this coming year it is $95, it goes up each year."

the fine is $95 OR 1% of your annual income taken out of your tax refund. Whichever is higher.

So, the poverty level for 2013 is about 20k give or take for a family of 2. That's a fine of $200 per person


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Posted: 10/6/2013 2:08:59 PM
The fine for 2014 is $95 per adult and $47.50 per child up to $285 a family or 1% of income, whichever is greater.

The fine for 2015 is $325 per adult and $162.50 per child up to $975 a family or 2% of income, whichever is greater.

The fine for 2016 is $695 per adult and $347.50 per child up to $2085 per family or 2.5% of income, whichever is greater.



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SabrinaM
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Posted: 10/6/2013 2:26:43 PM
I'm so glad that Conservatives had nothing to do with pushing this mess onto the American people.


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Posted: 10/6/2013 2:29:07 PM
So what do you do when you work hourly and have no idea what your 2014 pay will be? I started a new job in January, got a raise in February, and didn't work a typical number of hours this year (my son ran track and played football so I worked extra hours when he had practice). I haven't worked a full year at this pay so I don't know my salary (yes, I can figure it out approximately for the end of the year). But, my son *says* he's not running track next year and will be playing football. So my salary this year won't be the same as next year anyway, way off. So what happens if I put an amount in, things change, he decides to run track OR decides not to play football, and my salary is thousands off by the end of next year? Will I owe the difference or get a credit (ha!)? I can't be the only hourly employee that works different hours every month.


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peapermint
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Posted: 10/6/2013 2:32:55 PM
If you need to take the credit month-by-month rather than at the end of the year, they (in my state anyway) said to call as your income changes and they will adjust it. As long as you don't reach 400% of poverty level and still qualify for a subsidy. That's about $94,000 for a family if four.


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gale w
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Posted: 10/6/2013 6:10:18 PM
I doubt it'll work that way for us. Some months we have zero income. Some months we make way more than 400%. It all averages out but there is no way to know, month by month, what our income even is due to having farm expenses from time to time. Every May (and November) we pay out about $40,000 in cash rent. We generally have no income in May so if we did the math we would be way in the red. Then there are months with no expenses other than pickup fuel and lots of income. It varies every single month.


Any co-pays?
The plan we're looking at doesn't appear to have any co-pays. But we have to meet the deductible before anything is covered.


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peapermint
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Posted: 10/6/2013 6:23:41 PM
I don't think a marketplace (Exchange) plan is allowed to have copays for preventative services, or maybe it's that you don't have to reach the deductible first. It's part of the 10 Essential Benefits.

Definitely talk to Farm Bureau, the ACA business help line (not just the individual line), the local service centers that are being set up, accountant, insurance agent (one trained/certified in ACA implementation), attorney, etc.

If what you have is working, stick with it. But the numbers you're getting in Indiana are nowhere near what I'm getting in California, especially for the deductible. Good luck!

ETA: If I'm understanding the 9.5 percent of income cap on premiums correctly, you'd have to be making $150,000 a year to be getting quotes of $1,200+ a month. I'm awful at math, though, and could be misunderstanding it. The ACA hotline people and whomever is staffing the state Facebook page answered a lot of the questions about our specific situation.

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Posted: 10/6/2013 6:43:32 PM
Yeah. DS and I are hosed. My ex doesn't work. I don't have healthcare through my job an the lowest price is $400/mo with a 12,700 deductible. Even with what little subsidy I would get I can't afford the over $200/mo for nothing.


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raindancer
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Posted: 10/7/2013 12:18:24 AM

I'm so glad that Conservatives had nothing to do with pushing this mess onto the American people.






You aren't serious?

I agree, the Affordable Care Act is a misnomer. I'm sorry you are dealing with it Gale. I'm sure I'll hear more about this as my sister is self employed. It's not going to be fun for her I'm sure.


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CreativeEngineer
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Posted: 10/7/2013 6:42:18 AM
I think what people are seeing is a huge wake-up call. These numbers are what insurance costs. Some people have their employer pay for most or all of it so they don't necessarily "see" just how big that number really is.

I'm really grateful for my employer sponsered insurance but I know that the number I see deducted from my DH's check is only about 25% of the total cost. And that's a pretty hefty number in and of itself without the 4Xs multiplier.

Insurance is spendy. There's no doubt about that. I'm so sorry Gale that you are losing your current plan. You seem like someone who was "doing the right thing" before the ACA (ie having insurance even though you pay the full premium and it's spendy) and yet you are paying yet again. Best of luck to you.





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Posted: 10/7/2013 6:51:20 AM
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Posted: 10/7/2013 8:05:00 AM

Our insurance through our employer will be going up a lot because of this crap. It really is a joke at this point.


Ours went up $60 a month. Not that bad but seeing as my DH hasn't had a raise in years, due to freezes, it's hard to ever get "caught up".
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