I’m the family health insurance guy as I’ve worked in the industry long enough to ocassionally have a clue. Thanksgiving is my peak family question time of the year as quite a few group insurance plans are in their open enrollment slots right now, so Sister #1 wants to know if she do an HSA or a PPO and my brother in law wants to know why his insurance company won’t let him get his elbow fixed by the same guy who took care of his favorite team’s quarterback last off season.
This year, I figure my question load will be higher, so here are my talking points and some links:
- Be aware that Cyber Monday will also apply to the Exchanges — be patient on Monday or let’s grab a beer and get you signed up tonight.
- Payment needs to be received before the policy is valid
- If you’re making less than 250% FPL and think you’ll have more than three sick PCP visits this year, go Silver with Cost Sharing instead of Bronze. You’ll pay more after subsidy but could cut your out of pocket by 90%.
- Medicaid is not shameful. It is to help people who need some help right now.
- No, this will not make America like Sweden.
- Look at the networks, make sure either your doc is in the network or you are okay with getting a new doc.
- Shop like you are buying porn
- Income estimates are just that, estimates. Good faith estimates are expected so if you’re low by a little bit, you will owe some money on the back-end on the 2015 tax filing season… If you are only a W-2 or regular check family (disability, pension, SSI, Social Security) take the gross amount and multiply it by the number of checks you get and then maybe add 2%. For the damn freelancers, take your best guess.
- I get a 85% subsidy via work, we just hide it better than the subsidy people get on the Exchanges.
- This will work, you can get that mole checked out sometime this winter.
Bangor Daily News has a great column on health insurance: Health Unsurance
Health Sherpa for a good guesstimate on subsidies and policy options.
Kaiser Family Foundation calculator and consumer information….
OhNoNotAgain
Thank you Richard, excellent as always. Could you please post more on what you mean by the “85% subsidy via work” ? I constantly hear people talking about the subsidies for the exchange insurance as if it were welfare, and it would be nice to be able to counter it with some comparative information on the same regarding employer-provided insurance.
Vaughan Thomas
Um, what do you mean by Shop like you shop for porn? Honestly don’t buy porn and don’t understand this.
C.V. Danes
Excellent post, and excellent series overall. You have undoubtedly been extremely helpful :-)
Just a couple of observations:
1. Please don’t assume that any of us know what the industry standard abbreviations and associated jargon are.
and
2. I can think of worse things than being like Sweden ;-)
Richard Mayhew
@Vaughan Thomas: Go to “Private Browsing’ mode, disable cookies, clear cache/history before and after a session — that seems to help people go through a lot cleaner and faster.
Karounie
Nice pun in the title. It made me smile that this was the first year in history where it had that meaning. Do you do song lyrics?
C.V. Danes
@Vaughan Thomas:
Well, I’m assuming what he doesn’t mean is shopping with one hand on your credit card and the other on your you-know-what ;-)
Richard Mayhew
@OhNoNotAgain:
By 85% subsidy, that is what the combination of what my employer pays in premiums and the benefit I get from the tax exclusion of employer sponsored premiums. So if a family’s raw monthly premium (Box 12DD on your W-2) is $1,000 a month, the company might kick in $800 and the employee kicks in $200/month pre-tax which reduces the tax bill by another $50 or so, so it actually works out to be $800 from the company, $50 from the Feds, and $150 visible out of pocket from the employee.
The example is highly dependent on reality and tax circumstances, but the employer provided subsidy cost is very high when viewed with this lens (how much is the raw premium and how much does the employee actually see leave there paycheck)
Richard Mayhew
@Karounie: poorly — music is one of those things I enjoy, but I have never been able to fully internalize to a point where I can be appropriately witty on a regular basis….
magurakurin
@Vaughan Thomas: no real need to buy porn. If anyone by some bizarre chance needs to, I can supply some URL’s…….not that I have any personal knowledge…but I HEARD that…..
sparrow
Yeah being like Sweden would be TEH WORST.
Valdivia
Richard–been meaning to drop this in one of your threads. As a naturalized immigrant, at least in the DC health exchange, I have to go sign up in person at the local Economic Security Office (where they do SNAP benefits and the like) so they can verify my naturalization certificate. This seems to apply to people who were naturalized since the creation of Homeland Security Dept (or maybe even a little before). Perhaps it would be useful to let naturalized individuals know they are in for extra scrutiny.
I really don’t mind jumping through this hoop since I support the law, know that I will be saving money and will be having insurance no matter what. But it is one of the many extra layers of work we have in applying because of Republican paranoia about immigrants getting free health care. I am looking at you Joe ‘you lie’ Wilson.
maximiliano furtive, formerly known as dr. bloor
Pity.
Dead Ernest
@Richard Mayhew:
Oh. So you didn’t mean immerse one’s self in imagining every possible, um, configuration and layout of a plan …before moving on to do the same for the next, possibly more exciting, plan?
That seemed like such good advice.
former Walmart lady
My new job is providing customer service at a Tier 1 level for Health financial services. In case anyone wonders, that includes Health Savings Accounts, Health Reimbursement Accounts, and Flexible Savings Accounts. Three days a week I work on behavioral claims, and I won’t go into nightmarish scenarios on claims there, suffice to say thank the goddess for regalatory commissions.
In any case some pointers if you are considering a High Deductible Health Insurance Plan with an HSA option. or are transitioning out of an HSA plan.
HSAs are basically personal medical checking accounts, aka consumer driven accounts. You will be responsible for managing the HSA, including insuring its open, funded, and once you are using it, using it properly under irs.gov. guidelines. Pub 502 and Pub 969 at the irs website should answer most of your questions. Be leery of tax advisors, they call me with their questions.
If your employer is making you get one of these, just because you signed up for the health plan does not mean your HSA automatically opens. Go the HSA adminstrator’s website and enroll or call their CS and check your application status if you did a paper form during open enrollment. I will be honest, with my bank online enrolling is the way to go, and I spent half my day walking the fifty year olds through the enrollment process. Call me or the customer service hotline if you have questions, I get paid to be friendly and helpful.
Once your account is open it’s yours. Your employer doesn’t manage it, your health insurance co. doesn’t manage it. Make sure to save your reciepts for Qualified Medical Expenses. We got a rash of calls in August when the IRS audited for 2011 tax returns. Make sure it’s funded, check in once a week to make sure the debit card is not being used by children to buy pizza, or has been compromised. Make sure you register at the website once the account opens, we are big on the self-serve option at my bank.
you don’t have to call to get my permission to pay for little suzy’s dental visit. I don’t care what you spend your HSA money on, it’s up to you to determine you are using it correctly.
HSA funds don’t expire. Ever. The accounts don’t close just because you got fired. Call and close the account if you don’t need it anymore. We will charge the Monthly maintenance fee if you are no longer with an employer who covers that fee. Your balance will go down, you will call and yell at me that the bank should have known you were fired and you are not paying one red cent because the account should have closed when they wrongly fired you. I will just ignore your yelling tell you that I can close the account and that will be that. Don’t go through that blood vessel bursting stress, just call and close the account if you don’t need it anymore.
If you close the account and you have money in it, you have 60 days to get it into a new HSA or spend the money on Qualified Medical Expenses to avoid IRS penalities.
All in all Health Savings accounts help offset with the pretax dollars-payroll deductions-or deductions when you file your taxes., the high deductible a lot of employers are going with these days.
Just some pointes, I have to go answer phones are people who need help enrolling and who want to yell at me about why the account they thought closed five years ago is still open. leave HSA questions here, I will answer when I get home.
low-tech cyclist
Richard, what do you mean by PCP? The only PCP I’ve ever heard of was that nasty stuff that people used to smoke before crack came along. (Google isn’t much help, either.)
CarolDuhart2
@low-tech cyclist: Diabetic here. PCP means primary care physician, like your internist or general practitioner. Compared to a specialist you only see when needed.
gene108
@low-tech cyclist:
Primary Care Physician = PCP
low-tech cyclist
Thanks, Carol and Gene!
NotMax
Subsidies for viewing Swedish p0rn…
/reverie
@magurakurin
Totally different out of pocket outlay.
MomSense
@low-tech cyclist:
PCP = Primary Care Physician
satby
Richard, I just wanted to thank you for all your posts on this. I will be unemployed as of Monday, and now will be going out to the exchanges to get insurance. Your advice and insight have been so very helpful! Esp. since as a 58 year old woman, without the ACA I would have had no insurance, COBRA is not an option on unemployment compensation.
gene108
@sparrow:
I don’t want to be like Sweden. Cold crappy climate, where it is dark 6 months out of the year and you still need a jacket to go out during the summer months.
Sure the people have to be extra polite, because if they acted like normal people with their crappy weather, they’d just murder everybody around them in a fit of seasonally affected rage.
Valdivia
@low-tech cyclist:
Primary Care Physycian
ETA: like so many already said! :)
OhNoNotAgain
@Richard Mayhew: Thanks, Richard. I haven’t worked for anyone for almost 20 years, so I always forget how much of the health insurance costs are typically covered by the employer (we just pay the full freight in the individual market in NYS, so we’ve been “getting it good” these last few years).
CarolDuhart2
@satby: Depending on your state, you may qualify for Medicaid or nearly !00% subsidy.
Patricia Kayden
Richard, you’ve done an excellent job of being the healthcare expert. Very informative posts. Hope your family lets you enjoy Thanksgiving in the midst of the onslaught of queries.
just_kate
Anyone considering an HSA option (like having a checking account) should check the associated bank, make sure you trust the institution with your money and research the fees. Of the two HSA plans offered through my employer one option uses a bank that is a well known fraudster and the other plan did not have my doctor in the network. I chose to stay with the PPO because I would never trust my money with that bank and didn’t want to change doctors.
Southern Beale
This needs some explanation for those of us who do not buy porn.
Southern Beale
@gene108:
Actually, last time I was in Stockholm in June it was 85 degrees and we were sweating like pigs. Yes it’s dark in the winter months but in the summer it stays light all night, so it’s a tradeoff.
I love the Scandinavian countries. And when I was in Norway in 2008, socialized medicine saved my vacation.
satby
@CarolDuhart2: I know! And that is one real bright spot. I’m not all that unhappy to have been RIFed, because the job had become unbearable for the last year. But at my age finding substitute employment as other than a Walmart greeter may be a challenge (I will not go back to IT, unless starvation is my only other option).
Dead Ernest
@Southern Beale:
See Richard’s comment at #4.
That browser set-up is apparently what he meant, and not something like what I first guessed.
Kay
Ezra Klein:
I like Ezra Klein, I read him occasionally, I think it’s fine he was a critic of the roll out, I don’t think it’s his job to sell the law, BUT he is kidding himself if he thinks “the political system” (which includes the punditry and paid media hacks) will “adjust.”
They will keep repeating that the law is a massive failure for months, years, despite any facts to the contrary, and Ezra Klein should know that and admit it, even if some of the people in the “political system” are his personal friends and associates.
This is a failure narrative now. They’re invested in it. They move so insanely and recklessly in one direction it then becomes impossible for them to adjust the narrative as new facts emerge without discrediting themselves, so they simply don’t change the narrative. He knows that, or he should know it. He gives them waaayy too much credit.
rdldot
@satby: You sound like me two years ago. I don’t know where you live, but I’m in Texas so Medicaid isn’t an option. But I have decided to take some money out of my 401k early, and even with the penalty I will be able to get good, cheap insurance through the Exchange because of the subsidy. That may be something you want to look into.
rdldot
@Kay: Exactly right. The press hasn’t been interested in reporting factual information to the public for years now. We’re going to have to get the info out by work-of-mouth. Luckily, most of the people who pay attention to network or cable news are the people who work in NY and DC, not the rest of the populace. Do your own talking to the people around you and let them know to sign up. It’s working pretty well now.
sherparick
Besides having some rather grim homicide detectives and expensive beer, I am not sure why we would not want to become like Sweden. Except there Central Bank is currently run by some hard money types who give the economists at the Hoover Institute like John Taylor a thrill up their leg.
Villago Delenda Est
Patience, my ass. Impeach the blah now!
/wingtard
sherparick
Yep, those Swedes,Norwegians,and Danes truly suffer under the tyranny of secular social democracy. http://www.swedishwire.com/nordic/18934-norway-leads-in-economic-growth
KInd of make one wonder how history would have turned out if Harald Hardrada, King of Norway, had beaten Harold Godwinson at Stamford Bridge, and then beaten William to become KIng of England in 1066. Perhaps we would all be Norwegians now, even in Texas.
http://www.swedishwire.com/nordic/18934-norway-leads-in-economic-growth
Kay
@rdldot:
I mean, he’s writing in the Washington Post and he’s admitting there’s some kind of “theme” thing going on here, so he’s AWARE that this goes on, but why would they have to adjust and why would that take X amount of time? Why should I accept this from people who are supposed to be telling the truth? How about next time they don’t establish a whole narrative around events and then we won’t have to wait until they can walk back their narrative? They’re out in front, again. They’re telling a story that hasn’t happened yet. That’s not “coverage”, it’s story-telling.
Jim
I’m sure I’m not the only one to compare Richard Mayhew to Paul Krugman: Clear, factual explanations of complex issues, with only a few forays into wonkishness when unavoidable. OK, maybe Richard isn’t as famous, and he doesn’t have a Nobel prize under his belt, but I for one am not embarrassed to include his name and Krugman’s in the same sentence (as I did above). Thanks for the info and advice, Richard. We’re listening.
Richard Mayhew
@Jim: Thank you, but no, my name should not be in the same paragraph as Krugman’s.
Kay
@rdldot:
I read this stuff and I’m just flabbergasted:
“How the pundit class turned on Obamacare”
I mean, really. What nerve. First, that they would think they have some legitimate, outsized role in a health care law that affects hundreds of millions of people (not them though, they’re all employer-insured) and second, that they now admit they “turn on” laws. WTF?
Why would anyone outside this tiny little circle of insiders accept this sort of behavior? It’s outrageous how much power they’ve given themselves. “We can MAKE or BREAK this law!” Oh, bullshit, you self-aggrandizing, egotistical fools. The reality of the thing in peoples’ lives counts for something, I would hope.
rdldot
@Kay: Hey, you don’t have to convince me. I’m so fed up with those people and their drivel I could spit nails. Sickening really.
Another Holocene Human
@Southern Beale: Crud, that’s kind of awesome. When I got sick on vacation in Canada, I ended up spending more out of pocket at the doc in the box than I expected, AND the motherfucker refused to write me a scrip for anti-biotics, even though I KNEW who the fuck got me sick. But he–and later the pharmacist–did suggest I hit up the pharm for Tylenol+codeine. Nice offer, but I passed. Went to another doc-in-the-box when I got home to the states (lower overall fee, plus my insurance ate most of it) and this time, I got the antibiotics I needed because I KNEW who the fuck got me sick!!!
But besides that unpleasant experience I still would prefer to pay a big Medicare tax and have single payer to the ridiculous jungle we deal with now. My only consolation is that after Solantic and Florida Blue tried to collectively fuck me over earlier this year, I made THEM pay. I mean, in the end, we all pay, but I got them good for WASTING MY FUCKING TIME I CAN’T BREATHE YOU ASSHOLES I CAN’T EVEN.
gelfling545
And more’s the pity.
Another Holocene Human
@Another Holocene Human: Let me clarify here–I know what antibiotics are used for. I’ve been stubborn about this shit in the past… but after a three-week bout with bronchitis that cleared up after my roommate, who worked for a doctor, made me get a z-pak, I also know that bacteria love my fucking lungs and don’t like to move out.
This woman at work had this horrific, wracking cough. I think the deal at the time was she was a temp* so she refused to pay $100 to go to doc-in-the-box and instead coughed all over us daily. Of course once I was on vacay and in beautiful Vancouver I got sick as a dog and start… coughing.
Ya, codeine will take the edge off a cough but that’s not the fucking point! When I got back to the US I had been coughing for like a week and a half (let’s not forget the fevers, etc) & I got my antibiotics and that shit stopped. Middle of the summer, btw.
*-hiring a temp was more bullshit, but the union leadership at work at the time had totally lost the plot by this point
Not my real pseudonym
For the damn freelancers, take your best guess.
Yeah, easy for you to say . . . it’s a bit nerve-wracking. If I don’t take the subsidy through the year, I won’t be able to afford the premium. If I take it, but my income is a hair higher than my estimate, then I’ll be on the hook for more than I can afford to pay back, unless my circumstances take a dramatic and quick turn for the better.
On the bright side, it appears that the cheapest silver plan is less expensive than I thought it would be, and the coverage is better . . . I just can’t afford it right now.
Jules
My son’s girlfriend (22 with chronic health issues) for various reasons is living with us and I helped her sign up for Obamacare the other day. She had tried numerous times since October to sign up but always Got errors and could not validate. Yesterday we tried again but this time she used a different Gmail account and it went through. Took 10 mins. She will now have health insurance via the Medicare expansion and we are all very, very happy.
Now waiting for Arkansas DHS to do their part.
Jules
Ugh, can’t edit on mobile, I of course meant the Medicaid expansion.
Richard Mayhew
@Not my real pseudonym: If you make a good faith estimate of your income and you qualify for subsidies on that good faith estimate, and your actual 2014 income turns out to be higher, I think you only need to pay back the first $1,500. Now if you make 5x what you estimated to qualify for subsidy, good faith goes out the window real fast without a good explanation but if you make 7% more than estimated, and you can show variable income history with highs and lows, good faith is a reasonable defense.
gogol's wife
@Richard Mayhew:
Thank you again for all your work here. I wish you had Krugman’s platform. But that ain’t gonna happen. The Times has its story and it’s sticking to it.
Not my real pseudonym
@Richard Mayhew:
Richard, thanks. That’s semi-comforting.
Yeah, if I made WAY more than I estimated, paying back the subsidy wouldn’t be a problem. My worry is that I would go somewhat over and then be scrambling to cover what wouldn’t be a humongous bill, but big enough to hurt.
I’ll be talking to a CPA before I sign up for anything. Shit. I kind of miss the days of just collecting a paycheck and enjoying my pretty-decent employer health plan . . .
Richard Mayhew
@Not my real pseudonym: Yeah, speaking with a CPA is a good idea
Also look at this article:
http://www.businessweek.com/articles/2013-09-26/explaining-obamacare-subsidies-for-the-self-employed
TriassicSands
I knew that, but I’m still disappointed.
former Walmart lady
sorry, i apologize for the typos earlier, I was rushing out the door!
former Walmart lady
@Patricia Kayden:
My bank doesn’t handle the insurance portion. We don’t make you change doctors, switch insurance plans, approve claims, or anything else, we don’t even make sure you have the high deductible insurance plan you say you do, hence the name consumer driven health plans. I tell people to think of it like you would your IRA, for better or worse, you are totally responsible for the HSA.
If your HSA administrator sets controls like that, it is probably handled at the Employer level. I can’t speak to what your Employer is giving you for choices. The only think I can do is explain my bank’s policies, and in my off time, work towards electing politicians who support a single payer option, like oh Sweden. And I would gladly give up my job to have a single payer system in the States.
mclaren
@Vaughan Thomas:
He means that most of his posts are pure wanking off, and this is more of the same.
Richard Mayhew as usual tries to present the Potemkin-village illusion that the ACA has fixed America’s broken healthcare system and now all that matters is the cleanup.
In reality, the health care industry is still rearing up like the Titanic just before it splits in half from all the water in the stern, then breaks in half and slides under. The killer here remains the astounding insane utterly unsustainable cost of medical procedures in America.
Richard Mayhew assures us that “medicare is not shameful,” yet he fails to mention that states are slashing their medicare rolls because the cost of medicare is bankrupting the states.
Source: “For Governors, Medicaid Looks Ripe for Slashing,” The New York Times, 28 January, 2011.
The most hilarious example of Mayhew’s wanking in this particular post? “This will work, you can get that mole checked sometime this winter.” Riiiiiiiiiiiight, and if that mole is melanoma, bend over and kiss your ass goodbye, because if takes a couple of months, you’ve passed the point at which it could have been treated. And now you’re dead.
And of course Mayhew never bothers to mention why checking that mole is going to take so goddamn long. Everything takes so goddamn long in the broken and collapsing American healthcare system because America isn’t graduating nearly enough doctors — and the reason America isn’t graduating enough doctors is to keep the salaries of doctors 2x to 5x times what doctors make in Europe. Not 2% or 5%, mind you: U.S. doctors make 200% to 500% what doctors make in Europe.
So the way you do that is by withholding medical care from the average American. There are two choices here: America could reduce its medical spending by cutting the insane cost of the individual medical procedures, like the $3500 MRIs that cost $250 in Germany…or America can reduce its medical spending by withholding medical care from the average citizen, thus ensuring less spending.
Before the ACA, America just prevented its citizens from getting access to medical care by pricing them out of the market. After the ACA, America now prevents its citizen from getting access to medical care with absurd multi-month waiting periods to do simple tests and scans.
Naturally, Mayhew never mentions this. Pay no attention to the dying sick people: everything is working great!
Source: “The Medical Cartel: Why are MD Salaries So High?” The Medical Cartel: 24 Jun, 2009.
We now return you to the regularly scheduled wanking by Richard Mayhew which makes no mention of words like “AMA restraint of trade,” “medical cartels,” “nondisclosure agreements,” “sweetheart contracts,” and “bribes.”