Oh, I see. Yes, that’s true.
Enroll America seems to be aimed at health care providers–but also has a section with information for individuals.
I’m not confused. The state of Indiana and the Feds worked out a compromise strictly for Indiana. Eligible Indiana residents will have access to the Federal exchanges. It’s a done deal and not connected to the Oklahoma court case.
That’s not a compromise. Every state which refuses to set up its own exchange gets access to the federal exchange. The issue yorick is talking about is whether citizens of those states will also get the federal subsidies.
What** RNATB **said. You seem to be confused about what I’m saying. There is a possibility, however slim, that people on the federal exchange will not be elegible for any subsidy because of the way the ACA was written.
But I have no idea about this compromise. AFAIK everyone in the country will have access to the federal exchange if their state does not set up a state-run exchange.
I have been assured by multiple sources that Hoosiers will have access to the Federal subsidies as well as the Federal exchanges.
That is the IRS’ current plan - not for Hoosiers but for everyone. Depending on how the courts rule in the cases under discussion, you may not have access to the subsidies.
Are your sources clairvoyant? If not, I give up trying to explain this.
As noted, unless a court case upsets the status quo that is what will happen - everyone with access to the Federal Exchanges will also have access to the Federal subsidies. What’s so mysterious about that? Or are you just here to scare people rather than sticking to the facts?
I’m not digging up the cite so don’t ask me to go searching for it, but…
FWIW, I remember reading not too long ago from a legal scholar (I believe he was from the Uni. of Virginia but I could be wrong) that the reconciliation bill that passed alongside the ACA specifically addressed the issue of IRS subsidies in federal marketplaces and dictated in no uncertain terms that, yes, the IRS has the authority to offer insurance subsidies in the government exchanges. The cite is out there somewhere if somebody wants to dig for it.
So, basically, the only way the Oklahoma lawsuit is going anywhere is if some judges somewhere decide to be really activist and create a whole slew of new precedents. I can’t imagine that the SCOTUS is going to want to touch the ACA again anytime soon (read: if ever), and even if it did the entire law wouldn’t be able to be struck down.
OK, IN residents aside for the moment, if I may, I have 2 questions about the “Benefits Summary”.
It’s pop-up, and I have no idea how to link to a pop-up, so:
Metal Tiers: Platinum, Gold, Enhanced Silver 73, and Bronze*
<snip>
Key benefits by Metal
Bronze 60 Silver 73 Gold 80 Platinum 90
<snip>
Out-of-Pocket Maximum
Deductible
Preventative Care Copay1
Primary Care Visit Copay
Specialty Care Visit Copay
<snip)
etc.
<big snip>
What are prescriptions? Do they fall into “General Medication Copay”, “Brand Meds”, or “Preferred brand”? I understand formularies, and in-patent and generic.
I currently use 2 different (nasty benzo’s) drugs to get the effect available from one. That one is the one my insurance won’t cover, even with a doc’s letter stating that It would be much better for my quality of life to use the patented.
And on “Lab Testing Copay” - is that per sample, or per visit? If I go to the lab and they run 5 blood tests and a urine test, do I get hit for 1, 2, or 6 co-pays?
Maximum Out-of-Pocket For One/Family
What happens when I hit that max? are all co-pays waived? Are hospitals, surgeons, etc. now reimbursed 100%?
-
- this comes up on the CA site - haven’t tried the Federal.
For an example of coverage (again, CA): I receive the max monthly SS Disability stipend.
At that income level, the bronze plan is free to an individual, and the Silver is around $130-150, depending which company writes it. In my district, I get an option of HMO, HSA, or PPO. My current insurance is a PPO. The Silver PPO is 27% of my current policy.
I think you finally understand what I’m talking about so that’s a start. You specifically asked how the ACA would affect you. You live in a state that is not setting up a state-run exchange. The court cases addressing this may have an effect on you. That’s why I mentioned it…facts only. I have no interest in scaring people in GQ…I am just giving you the facts. The cases may or may not have merit and that is GD territory. I thought you should be aware of this but, since it appears that facts frighten you, I won’t waste any more energy on you.
Oh, please - the Republicans have been trying to overturn ACA for a couple years now to no avail, either in Congress or the courts. Unless you have some evidence that the Oklahoma case has an actual chance at an outcome you mention it’s nothing more than scaremongering.
On top of which, the agreement between Indiana and the Feds is separate from those of other states without state-run exchanges due to the involvement of the Health Indiana Plan.
I am not “scared”, I think you are injecting rumor and innuendo into what I had hoped would be a thread about what people should DO, not what they should be afraid of.
Can I piggy-back on this? Because I thought I understood, but now I am confused.
The premiums for my personal healthcare are well below the limit, but the premiums to cover my husband and so are another $9K a year, and amount to close to 10% of my take-home. Are they eligible for the exchanges? Last I heard they were not.
I’m guessing that it would come down to the definition of “Household”. How do you file taxes? Single? Head of Household? Anyone listed as a Dependent?
That’s all I can add - I’m looking for individual coverage, and have not looked into Family coverage.
Married, and one dependent. It’s about as traditional a household as you can have.
Sounds like your income is high enough that you wouldn’t qualify for subsidies anyways. I believe anyone can just go out and buy insurance on the exchange, and the “affordable” definition mess just determines whether you can get a subsidy. So perhaps you can find a cheaper plan for your family? It probably won’t be dramatically cheaper, but you should have some reasonable choices on the exchange.
If your husband doesn’t work, then the information you’ve provided makes it sound like he can shop at an exchange, because family coverage would be more than 8% of household income.
If he does work, then we have to see whether insurance is offered through his employer and whether that insurance (for him, single-only) is more than 9.5% of his gross wages. If it’s less than 9.5% then he has “affordable” coverage already available and then neither of your is eligible for shop through an exchange. Also, if he does work, we need to factor his wages into household income when calculating the 8% eligibility for the exchange.
And if your child works… rinse, lather, repeat.
I meant 20% of my household income. I make $50k-ish
He doesn’t work. Interesting. That could make a huge difference in our lives. Last I had heard, we were not eligible. Off to research . . .
Again - so far, the GOP has not won much in the way of killing it.
As the original plan, anybody - whether their State operates an Exchange o r not, is free to buy a policy - individual or family on the Exchange. If your income is too high, you will not qualify for a subsidy, but you will NOT be disallowed to apply.
Manda - does your State have an Exchange? If so, I know of no serious threat to the numbers you are seeing vis-a-vis rates and subsidies.