Something you may not know about the ACA

[Ms. Toad]

There are two components to the subsidy - and most people are only aware of one.

Most people are aware of the premium subsidy, but there is also a cost sharing subsidy which reduces the copay/coinsurance and out of pocket annual maximum for most people who are eligible for premium subsidies.

So even though the plan you are buying may have a $6350 out of pocket maximum, your actual cap may be much lower.

And, even though the plan you are buying may have 20% coinsurance, your actual coinsurance may be lower.

In Cuyahoga County, Ohio (Cleveland) for a single individual with a $20,000 income:

A silver plan would cost a maximum of $1021/year (a premium subsidy of $1312)
Your out of pocket maximum would be capped at $2250 (a cost sharing subsidy of up to $4100 - depending on the plan you buy)
Your coinsurance would be capped at 13% (a cost sharing subsidy of 7%)

Since the plans I have seen quote the face values of out of pocket maximum, and coinsurance (not the subsidized value), many people are not aware that if they are eligible for premium subsidies, their other costs may also be lower.

A calculator which can give you information about your own situation is here.

Finally - even if you never hit the out of pocket maximum - or your deductible, what your premium buys you (in addition to the preventative care) starting with your first medical dollar is a discount on your medical bills. Based on the last two years of our family's extensive medical bills - that discount alone was worth around 35%. (85-90% on lab fees, 5-15% on doctor's bills, and everything else somewhere between those two extremes).

No - ACA is not a perfect solution. And I'm pissed that the delay of the merged medical/prescription cap will cost me, personally, at least $2900 this year, that in up to 25 states the governors/legislators have refused to expand medicaid, and that because many plans have adopted the highest possible out of pocket caps, my daughter will likely be paying premiums plus $6350 or more every single year until it is changed.

But as many holes as there are - there are also benefits which many who are weighing whether it is worth it to buy insurance may not be aware of. . . so this post is just in case you aren't aware of them and it might help you make a decision (or be information you can pass on to help others make a decision).

[Hoyt]

1. Very good info.

I agree there are holes that have to be filled, but this is so much better than what we had, and improvements were limited by right wing opposition. Yet people gripe.

[Cha]

2. Thanks Ms Toad!

[sabrina 1]

3. My head is spinning. Why should my head be spinning over trying to stay alive?

And if MY head is spinning, I can only imagine what is going on with a single mom, working two jobs, who doesn't own a computer, might feel trying to negotiate all of this, depending on what state she lives in, whether or not she is earning too much or too little, while she is trying to feed her kids, find reliable baby sitters, worrying about the imminent threats to her children's well being, such as whether or not she can afford oil to keep them warm.

It's just great that some people have the time and energy to try to work their way through this maze of complexity. But I assure you, poor people are not even TRYING to deal with it. I guess they will simply be forced to pay the fines and what happens if they can't afford the fines? What a mess. For the working poor.

[belltower]

6. go to a broker !!!

I'm in the State of Washington with an income about the level quoted in the above article, and saw the out of pocket listed on the main insurance selection page different than the higher amount listed on the detailed page. I would not make any selection until I had that figured out. And, incidentally, I happen to be a highly accomplished software developer with an econ degree, so I aint no slouch about these things.

So I went to a local, approved ACA broker, who happened to be the same insurance agent I used to have in the past. She spent 40 minutes with me and my wife, explained essentially the same story as the above article, and explained that signing up with her firm wouldn't cost me a dime (thus netting our local town's economy a little every month). We went ahead with that advice and we're very happy with the results.

SO PLEASE GO TO A BROKER IF YOU DONT UNDERSTAND THE OBAMACARE WEBSITE.

[merrily]

9. I never heard anyone mention problems rolling out

Social Security or any of the New Deal programs, like the FDIC and the Conservation Corps. They didn't even have Wite Out then, let alone computers, at least one TV in every home, etc. And I don't know if people then had anything in their past experience to compare them to, any frame of reference.

The Great Society at least had TV and the history of the New Deal going for it, but I've not heard of problems rolling out Medicare, Head Start, etc. Somehow, word got out and people understood it and thought these were good things for society.

Of course, media was also a lot different than it is now.

[Ms. Toad]

12. One difference is that they didn't have the lie machine

which can spin and distribute lies instantaneously to deal with.

[merrily]

13. Are you also referring to today's media or to something else?

[Ms. Toad]

14. less formal than "the media"

More the lie creators, and the informal media via Facebook, twitter, etc., which spread the lies around the globe faster than they can be corrected - and the undeadness of any debunked lie, which continues to come back to life (like the death panels, which resurrected themselves not very long ago)

[merrily]

15. Ah, social media.

Lies are hard to debunk. http://mindhacks.com/2011/05/04/why-the-truth-will-out-but-doesnt-sink-in/

I know nothing about this particular source, but I read about the study mentioned a few years ago in a newspaper.I just don't feel like looking for a source I recognize more. So, I apologize if the source is dicey, but I stand behind the info about the study.

[jeff47]

17. There were large problems rolling those out

but those problems were vastly overwhelmed by the benefit since then. Additionally, no Internet meant it was much harder to hear someone's error-filled ranting about how bad the programs "really are".

If you'd prefer a more modern example (which makes it much easier to find the problems, thanks to the Internet), look at the rollout for Medicare part D. It took a while to iron out the bugs.

[merrily]

18. Any source for your info about the New Deal and Great Society rollouts?

Last edited Tue Feb 25, 2014, 01:18 PM - Edit history (1)

My reply 9 said nothing about Medicare Part D, for good reason.

I have heard some Democrats in the Obama administration--none of whom was born at the time of the New Deal-- claim there were problems, but they don't get specific, they have every incentive to say that now and I have not seen that claim made before the rollout of Obamacare.

And then the echo chamber takes it up, or at least so much of the echo chamber that buys the story. Here is an example of that, with nothing specific and no reference to any source whatever. http://blogs.reuters.com/great-debate/2013/10/28/what-about-social-securitys-rollout/

I've known people who were alive then. No mention of problems. I've seen fairly comprehensive PBS shows about things like the Conservation Commission. No mention of problems.


But again, even if there were problems no one has mentioned in my hearing, things in the 1930s were very different from now. Legislation was rammed through. As mentioned before, there was not even Wite Out, let alone computers that can fit into the palm of one's hand. And there were not three years to prepare for the rollout and for educating the public.

[jeff47]

21. You could try the 3rd Google result.

http://ourfuture.org/20131023/social-security-flubbed-its-rollout-no-one-remembers

That also leads to a page that lists problems with Medicare (the original part and D), Social Security, the Peace Corps and Income Taxes.
http://theweek.com/article/index/251475/5-other-botched-rollouts-of-government-programs

[newfie11]

10. Exactly! Nt

[missingthebigdog]

27. You don't have time for that, but you have time for this?

You have posted this and similar sentiments on several threads. The time it has taken you to make these arguments would have been enough time to "try to work your way through this maze of complexity."

And continuing to complain about the fines, when it has been repeatedly pointed out that there are exemptions for those who cannot afford health insurance, calls into question your motives.

I am sympathetic to the plight of the single moms you are concerned about. How will incurring potentially tens of thousands of dollars in medical expenses for, say, appendicitis, affect their situation? Isn't it worth the time it takes to make a phone call to find out if there is help available?

We ALL would rather have single-payer. That is not the reality right now. The ACA has some drawbacks, but is hugely superior to what we had before. Call them and apply, or just to ask questions- it doesn't take very long, and doesn't cost you anything. Their number is 800 318-2596.

[sabrina 1]

28. I am not speaking for me, I am capable of taking care of myself. Literally speaking of course

I see you are not able to understand someone speaking for others. I'm okay, so I should ignore those who are not. No thank YOU. The FACT is that the people I am speaking about don't have time to try to sort these head spinning details, as I might, and if you don't get that, you make my point regarding the total lack of empathy among those who claim to be liberals.

I see that you have a tendency to question someone's 'motives', imagine that!! Now on DU if you stand up for Liberal Policies, your 'motives' are in question. I'm certainly not saying anything I have always said over the many years I have been on DU. When did the motives of Liberal Democrats become suspect on this forum??

Perhaps we should refrain from supporting Liberal values here on DU so that our 'motives' won't be considered 'questionable'.

Here's what I consider questionable, anyone claiming to be a Progressive/Liberal Democrat, questioning the motives of those who continue to do what they have always done, support Liberal policies, oppose Republican policies.

But you demonstrated perfectly, the point I was making to the OP. I felt sad to see someone, not many do anymore, expecting to find much empathy here since this legislation passed, for any issues they may have trying to get what should be a right, Health Care.

If you don't mind, my motives, suspect to you apparently, will remain the same as they always have been as a Liberal Democrat. Regardless of whether they may be at times, be politically inconvenient to those who put politics ahead of people.

[missingthebigdog]

29. I question your motives

Because you continue to insist that people will be fined who cannot afford health insurance.

What is your liberal, progressive purpose in doing that?

[pnwmom]

4. Thank you -- this is information that is seldom reported anywhere, even when reporters

are debunking the right wing horror stories about the ACA.

[merrily]

5. Leaving anything to the discretion of today's media is very bad strategy.

[passiveporcupine]

7. thank you for posting this

It answered some questions for me that had been bothering me.

[Sherman A1]

8. Thanks for posting!

[merrily]

11. Good information, which media should be publicizing.

Too busy with the celebrity news and "he said, then he said" shlock that passes for news these days, I guess.

[seveneyes]

16. Healthcare payment should be a flat rate for everyone

Say 5 percent of income. That way, someone making 30k would pay 1.5k per year, those making 300k would pay 15k and so on. That should provide plenty of money to pay for healthcare for everyone in the USA. It's simple and everyone has skin in the game.

[jsr]

19. Also, this cost-sharing subsidy is only available through a silver-level plan

[Ms. Toad]

23. Thanks for the addition. n/t

[frazzled]

20. Please note: You must buy a SILVER level plan to get this important benefit

I've been trying to note this for people for the past six months. You may be way better off getting the silver plan if your income level is at a lower level. So while you may think a bronze level plan may be better for you because of lower premiums, you could be wrong and miss saving significant money on the silver plan, especially if you have fairly high need for medical use. Please read this very clear article on cost-sharing in its entirety:

Cost-sharing reductions will be applied automatically for consumers who qualify based on their income, but only if they buy a silver-level plan, considered the benchmark under the law.

Silver plans are one of the four categories that will be sold on the exchanges, each named for a precious metal. Premiums for the plans will vary, and each will offer a different level of cost sharing for the consumer through deductibles and copayments, among other things. A silver plan will generally pay 70 percent of covered medical expenses, leaving the consumer responsible for 30 percent.

...

The federal cost-sharing subsidies essentially increase the insurance company's share of covered benefits, resulting in reduced out-of-pocket spending for lower-income consumers. A family of four whose income is between 100 and 150 percent of the federal poverty level ($23,550 to $35,325) will be responsible for paying 6 percent of covered expenses out-of-pocket compared with the 30 percent that a family not getting subsidized coverage would owe in a silver plan. A family with an income between 150 and 200 percent of the poverty level ($35,325 to $47,100) will be responsible for 13 percent of expenses, and one with an income between 200 and 250 percent of the poverty level will be responsible for 27 percent ($47,100 to $58,875).

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.

http://www.kaiserhealthnews.org/features/insuring-your-health/2013/070913-michelle-andrews-on-cost-sharing-subsidies.aspx

[Ms. Toad]

22. Correct. I made this point in response to a question

In another thread (or subthread - I've lost track) about why anyone would buy a nominally high deductible/out of pocket max silver plan when a bronze plan has cheaper premiums. You don't get the subsidies for the bronze plan.

[bvar22]

24. These "subsidies" go straight into the pockets of the Health Insurance Industry.

Instead of squashing these blood sucking predators, we are now subsidizing and "Industry" that:

*Manufactures NOTHING

*Provides NO useful service

*creates NO Value Added Wealth

Access to the Public Treasury without any serious Cost Control
is the Holy Grail of an American Corporation.
The Public Tax Money going into the pockets of this useless "industry" will eclipse the subsidies to the Oil Industry by many BILLIONS.

At least the Oil Industry provides us with OIL.
What do we get by subsidizing the Health Insurance Industry?
NOTHING.
and THAT (sadly) IS "The Uniquely American Solution!"


There were better ways of dealing with this problem besides throwing BILLIONS at the people who were causing it.
Throwing BILLIONS is a 3rd Way/Republican solution,
NOT a Democratic Party solution.

I am glad that sick people will be able to go to the doctor,
but the price we are paying for abandoning traditional Democratic Party principles (New Deal/Great Society) is VERY HIGH, and won't be apparent for a few years.

[Ms. Toad]

25. This thread is intended to provide information about how the law works -

Information many people who need to make decisions about health insurance don't know.

I'd appreciate it if you didn't derail the discussion about subsidies many people are not aware they are entitled to, with a discussion about whether insurance or something else would be the ideal way to make health care accessible to everyone. Insurance is obviously not the best way to do that - but that doesn't change the reality that people need to make decisions now, and need accurate information in order to do that.

[missingthebigdog]

26. +1 Thank you! eom