I just want to respond to some really interesting comments over the past week
First up is Xantar on the Maryland Health Connection website
News for Marylanders: the new Maryland Health Connection website works. I’ve been beta-testing it for months as part of my job, and it fully opened for business today. I had an account created and started shopping within 15 minutes (I didn’t enroll because I’m going to get insurance through work next year)…
This is the dog that has not barked in the night. There are no huge clusterfucks this year at the federal or state Exchanges that I’ve heard about. Corner solutions concerning odd immigration and family status are still creating hassles and crapping out on people, but common scenarios are going through cleanly.
Satby raises the point about affordability:
I should be looking into renewing, but I think my coverage lapsed when I couldn’t even pay my subsidized premium. Do I just go onto the site and put in my even more reduced income for next year?
Yes, go online and look at your options even if your income has dropped. If you live in a Medicaid expansion state, a dropping income could qualify you for Medicaid which has minimal to no premiums (depending on what waiver the state got). Even if your income dropped but it is above 100% of FPL in non-Expansion states or 138% FPL in Expansion states, the premium subsidy will go up dramatically plus cost sharing Silver assistance could get a whole lot better. At the very worst, it is a wasted twenty minutes if income is below 100% FPL and you live in a non-Expansion state or the subsidized premium is still not affordable. But there is a decent chance a better situation could come about.
And some more below:
Mike E asks about income variability:
I have no idea what my income will be since my two part time jobs are supervisor dependent–meaning, one won’t/can’t predicted how he’ll use me in the next month let alone an entire year, and the other is a nonprofit that uses me as contract worker (1099 misc) and although they can ballpark it, this too can change.
DHHS wants precision. I guessed for the Dec ’13 sign up by adding 10% to that year’s haul and will prolly exceed that pulled-outa-my-ass mark by another 10%. This year? Who knows.
When applying for Exchange insurance, you should give your best estimate of your 2015 income. You need to operate in good faith. Mike’s method of adding 10% is a reasonable good faith method. A reasonable estimate is what is used to calculate the subsidies. We’re all going to miss by something, but try to keep it close. If there is a big change in income (promotion, perpetual overtime, job loss etc) then as soon as you know that your previous good faith estimate is going to be off by a lot, you should go onto the Exchange and update your income information. At that point, the IRS will change your subsidy to reflect what you should be getting. You’ll even out when you file your 2015 taxes in 2016 by either getitng a bigger refund if you overestimated your 2015 income or a smaller refund if you underestimated your 2015 income.
If you have no idea what your income will be and you can afford to front the premiums, this would lead to a big refund in 2016.
Joy in FL has a question on navigators:
You mention navigators in your last paragraph. Would you name an example or two of navigators, please? I have no idea what those are.
I assume brokers are entities such as my local Humana office (I went there in August when I retired and gave up my sweet employer-sponsored health benefit. I had studied health plans online but saw that I needed help knowing what I was looking at). Are there other kinds of brokers?
Navigators are people employed by non-profits who assist people with enrolling in government medical programs. The relevant ones for you are PPACA naviagotors who will help you with Exchange enrollment. They are paid by non-profits who are paid by the Federal government to help people explain what is going on. Navigators are not able to tell you to buy Mayhew Narrow Silver EPO over Mayhew Broad Bronze PPO over Wellspan Super Duper National Gold. They can not tell people what plans to buy. Instead they will explain what a deductible is, how co-insurance would be applied to a scenario from a variety of plans, whether or not Dr. Patel and Dr. Smithison are in the same network and what that cost sharing Silver thing means. They explain the map, you decide what direction you want to go.
Brokers are different. They can make a recommendation. They’ll do all of the same explaining and option lay-outs, but they’ll make a recommendation. They will provide this service free to you as the insurance companies will pay them a small fee per month you stay active on the policy they recommended. This gives the broker an incentive to get you a policy that you’ll keep. They get a flat fee instead of a percentage so there is no incentive for them to get you to buy up past your comfort level. The downside is that not every broker is able to offer all products in a region. Additionally, getting subsidies could be a pain in the ass going through brokers.
Another reader in an e-mail went on the Exchanges instead of Cobra and found big savings. The reader is in their mid-40s and illustrates the massive subsidy the young and healthy give to the old and sick in Employer Sponsored coverage. The Exchanges subsidize the old less than employer plans:
Everything went fine. I bought a… BC/BS platinum hmo. My existing doctor is on the plan. $420ish a month premiums. Don’t have to go through the primary for a specialist. Was able to retroactively cancel the cobra back to the start date, so never spent a thing on that. Looked at what I was paying, even with the employer contribution, from my BC/BS ppo when I was employed and the exchange plan I bought, which gets me just about all the same stuff and copays as the employer provided, and the exchange plan is about $700 a month cheaper. Once I’m back on the job I’m likely to stay on an exchange plan and pocket the difference.
The Exchanges have community rating by geography, smoking status and age. All 33 year olds in a zip code or county get the same rate for Plan X. All 47 year olds in the same zip code get the same but higher than the 33 year old rate for Plan X, all 64 year olds in the same zip code get the a rate that is no more than three times higher than the 21 year old’s rate for Plan X. Employer sponsored health insurance for Plan Y have everyone paying the same amount so the 21 year old is paying $1,200 a month and the 64 year old is paying $1,200 a month despite the 64 year old costing the insurance company five or six times as much as the 21 year old. Cobra will be a narrow niche program for people in their late fifties and early sixties as almost everyone else will find a better deal on the Exchanges between the combination of lower age rated premiums and the potential for subsidies. Cobra will fade away as a consideration.
Great post, Richard, and good morning. I think we’re all open threading it below.
I need to purchase insurance. Have been uninsured for years, and the premiums will still be a bite.
Will check in with some brokers. Although I’m thinking Kaiser, because I want to USE my insurance, not search for a doctor that will take it. And you can pay a premium for that.
I’m going to upgrade to a slightly more expensive (premiums anyway) cost-sharing silver because there are lower copays, out of pocket costs, etc. It’s just easier for me to budget a premium instead of worrying about additional costs and I don’t want to fall into the trap of avoiding going to the doctor because of cost.
Thanks for all the information.
I noticed that the evilness that is Walmart was advertising that they are a licensed broker for Covered California. Presumably they are performing the same service in other states, too.
That’s where we’ve been this year. Switched to the lower cost but higher deductible plan and then when January hits you start all over having to hit that deductible. It’s a real thing, the putting off until next month, or avoiding altogether going to to the doctor because you can’t afford the cost.
Is Noridian still involved in any of the Exchanges? Here in North Dakota, BCBS pretty much has a monopoly, with only an HMO style policy from an aggressively growing hospital chain as an alternative on the state exchange. It sounds like ND BCBS is increasing premiums that will be higher than the national average this. I’ve heard rumors that the increase is high because they have to make up for Noridian’s losses in MD, as Noridian is a subsidiary of ND BCBS originally set up to do its billing. Is there any way to figure out if that’s true?
@justawriter: Good question on Noridian, I don’t think they are. As for transferring Exchange revenue from premiums to cover losses, BCBS can’t do much as the medical loss ratio makes it hard for cross-corporate subsidization to occur. Sure, they can raise claims pay-out as well to get 20% MLR on a bigger base, but at that point, the aggressive HMO should clean their clocks on new and healthy enrollment as I would think a broad network BCBS with national coverage will attract sicker people on average than a local hospital HMO plan.
Is it really by postal (ZIP) code? I ask because zip-codes correlate with income, which seems like a source for enormous amounts of unfairness in health care…
@Chris T.: In most areas of the country it is by county. There are a few plans which will only cover a part of a county (the example in the webinars that we got were if a county was split in two or more segments by a large body of water then it might be permissable to only sell a plan in Segment 1 if the network was adequate there) and at that point ZIP code can be used. Most areas are rated by county, but there are exceptions.
@Chris T.: In California, the state is split into 19 regions. Los Angeles County is split into two regions. Eight of the others consist of single relatively densely populated counties. The largest region is made up of 22 sparsely populated rural counties in the north of the state, and the remaining eight regions are groups of 2-5 counties each.