Author Topic: Obamacare Master thread  (Read 199537 times)

Offline avromie7

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Re: Obamacare Master thread
« Reply #600 on: February 21, 2019, 05:58:43 PM »
I hope you are doing the HSA contributions as employer contributions.
Why would it make a difference?
I wonder what people who type "u" instead of "you" do with all their free time.

Offline ExGingi

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Re: Obamacare Master thread
« Reply #601 on: February 21, 2019, 06:09:30 PM »
Why would it make a difference?
FICA
I've been waiting over 5 years with bated breath for someone to say that!
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Offline shaulyaakov

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Re: Obamacare Master thread
« Reply #602 on: February 21, 2019, 07:40:12 PM »
I had a $3,000 family deductible HSA until last year when the increase was so high that I shifted to a $10K.

I don't see how the lower deductible plans make any sense.

My renewal options for family of 5 are:
$3,000 deductible =$22,356/year premium
$6,000 deductible = $17,952/year premium
$8,000 deductible = $15,972/year premium
$10,000 deductible = $13,572/year premium
Crazy. I pay ~500 per month for a family through work, $500 deductible, 6400 family out of pocket max. Perk of not being self-employed/small biz owner.

At least you get generous vacation time.
« Last Edit: February 21, 2019, 07:44:26 PM by shaulyaakov »

Offline Dan

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Re: Obamacare Master thread
« Reply #603 on: February 21, 2019, 08:01:23 PM »
Crazy. I pay ~500 per month for a family through work, $500 deductible, 6400 family out of pocket max. Perk of not being self-employed/small biz owner.

At least you get generous vacation time.
I got zero vacation time until JJ came along :P

But yup, can't compare employee rates to self-employed.
Save your time, I don't answer PM. Post it in the forum and a dedicated DDF'er will get back to you as soon as possible.

Offline shaulyaakov

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Re: Obamacare Master thread
« Reply #604 on: February 21, 2019, 08:19:00 PM »
I got zero vacation time until JJ came along

But yup, can't compare employee rates to self-employed.
Casing the web for deals in mle? I wouldn't be able to.

Offline ExGingi

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Re: Obamacare Master thread
« Reply #605 on: February 21, 2019, 08:33:52 PM »
But yup, can't compare employee rates to self-employed.

And where do you suppose those subsidies for the employee benefits come from?
I've been waiting over 5 years with bated breath for someone to say that!
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Offline aygart

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Re: Obamacare Master thread
« Reply #606 on: February 22, 2019, 12:33:17 PM »
I wonder how long they will keep extending my grandmothered plan?


Good thing it is grandmother and not grandfather. Your grandfather may give you vaccines.
Feelings don't care about your facts

Offline gozalim

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Re: Obamacare Master thread
« Reply #607 on: February 24, 2019, 07:59:32 PM »
You can contribute to a (Roth) IRA to reduce your MAGI (and receive a larger APTC or even to qualify yourself for cost-sharing reductions on a Silver Plan.)
does roth contribution reduce MAGI? conversely, roth principal withdrawals (penalty free...) would count towards MAGI?

@ExGingi is that correct?

Offline ExGingi

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Re: Obamacare Master thread
« Reply #608 on: February 24, 2019, 08:13:35 PM »
does roth contribution reduce MAGI? conversely, roth principal withdrawals (penalty free...) would count towards MAGI?

@ExGingi is that correct?
AFAIK Roth contributions do NOT reduce MAGI. And principal withdrawals shouldn’t increase it.
I've been waiting over 5 years with bated breath for someone to say that!
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Offline gozalim

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Re: Obamacare Master thread
« Reply #609 on: February 24, 2019, 08:14:24 PM »
AFAIK Roth contributions do NOT reduce MAGI. And principal withdrawals shouldn’t increase it.
A. as I assumed, B. follows logically from there.
Thank you for the clarification.

@Moe Ginsburg 's statement should be true about regular IRA contributions

Offline ExGingi

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Re: Obamacare Master thread
« Reply #610 on: February 24, 2019, 08:30:03 PM »
A. as I assumed, B. follows logically from there.
Thank you for the clarification.

@Moe Ginsburg 's statement should be true about regular IRA contributions
Though regular IRA withdrawals are subject to a 10% penalty if done before age 59.5. A ROTH conversion is taxable and increases MAGI, after 5 tax years that is principal that can be withdrawn penalty free.
I've been waiting over 5 years with bated breath for someone to say that!
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Offline Moe Ginsburg

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Re: Obamacare Master thread
« Reply #611 on: March 03, 2019, 07:12:16 PM »
A. as I assumed, B. follows logically from there.
Thank you for the clarification.

@Moe Ginsburg 's statement should be true about regular IRA contributions

Thank you both for the correction. My point was that people could qualify themselves for a larger APTC by making an IRA contribution (or two, if married).
« Last Edit: March 03, 2019, 07:19:52 PM by Moe Ginsburg »

Offline Moe Ginsburg

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Re: Obamacare Master thread
« Reply #612 on: March 03, 2019, 07:17:30 PM »
Wow! I missed that I thought they didn't let Trump end the csr payments. Basically the insurance companies are getting the csr payments by inflating the price of the silver plan..Wish they they would just inflate it a bit more so you can get bronze or gold for free! I wonder if it's costing the government more as many people that are not eligible for csr but eligible for the tax credit, are now getting a larger tax credit based on the inflated silver plans...

Actually that's exactly what's happened. Because they raised the premiums on Silver, it raised the APTC for everyone, even those on other medal color plans. And the government effectively didn't save anything by stopping payments for the CSR, and in fact may be paying more now, as a result of its increased costs for the higher APTCs. Essentially, most people who get an APTC benefited as a result of this. The only ones who lost out where consumers on Silver who do not receive any APTC.

And Bronze, as a result of this, indeed has now become free for many across the US. And Gold is sometimes less expensive than Silver, since only Silver saw the premium increases as a result of the government no longer paying for the CSRs.
« Last Edit: March 03, 2019, 07:29:52 PM by Moe Ginsburg »

Offline ExGingi

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Re: Obamacare Master thread
« Reply #613 on: March 12, 2019, 06:11:50 PM »
Just got the following email, and I can say that I'm not surprised (will post some comments below):

Quote
New Yorkers Value Choice of Plans

2019 Enrollment is Spread Across NY State of Health’s 12 Qualified Health Plan Insurers and 16 Essential Plan Insurers

ALBANY, N.Y. (March 12, 2019) - NY State of Health, the state’s official health plan Marketplace today released 2019 health plan enrollment by insurer. Twelve insurers offer Qualified Health Plans (QHP) and sixteen insurers offer the Essential Plan (EP) statewide in 2019. Most consumers have a choice of at least four QHP and EP insurers in every county of the state.

“We are pleased to once again offer consumers a broad choice of high-quality, affordable health plan options in every county of the state,” said NY State of Health Executive Director, Donna Frescatore. “And the wide distribution of enrollment across insurers shows us that consumers value this choice.”

Marketplace enrollment is at its highest point ever. More than 1 million (1,062,025) people enrolled in QHPs and EP as of January 31, 2019, an increase of 70,072 from 2018.

2019 Enrollment by Insurer

Qualified Health Plans

The 12 insurers offering individual QHP coverage in 2019 each participate in five to 56 counties.  Fidelis, which offers QHP coverage in 56 counties of the state, has the largest share (39 percent) of total statewide QHP enrollment followed by Healthfirst (15 percent), which offers coverage in seven counties including New York City; MVP (seven percent), which offers coverage in 48 counties; and Empire BCBS (seven percent), which participates in 17 counties.  The balance of statewide enrollment was spread across the remaining insurers, as shown in the table below. 


Marketplace insurers each have different service areas comprising specific counties. Comparing enrollment by insurers’ respective service areas shows significant distribution of enrollment across plans. No one insurer has more than half of the enrollment in their service area and similar to 2018, most insurers have between five and 25 percent of the enrollment in their respective service areas.  Fidelis enrolled 40 percent of QHP consumers in its service area, followed by Excellus with 36 percent, HealthFirst with 25 percent, BCBS of Western NY with 23 percent, Independent Health with 22 percent, and MVP with 21 percent of enrollment in their respective service areas.  The remaining insurers each had less than 20 percent of enrollment in their respective service areas, as detailed below. 


The Essential Plan

Sixteen insurers offered the Essential Plan (EP) in 2019 – the same 15 insurers that offered EP in 2018 with one addition,  Capital District Physicians Health Plan (CDPHP) which offers EP in the Capital District. Statewide, 22 percent of EP enrollment was with Fidelis Care, 21 percent with Healthfirst, 15 percent with United Healthcare, 10 percent with MetroPlus, and the remaining 32 percent was spread across the remaining insurers. 


Comparing EP enrollment by insurers’ respective service areas likewise shows significant distribution of enrollment across plans. Excellus, which provides Essential Plan coverage in a 31-county service area serving the Southern Tier, Central New York, and the North Country, is the only insurer with more than 50 percent of EP enrollees in its respective service area. Four insurers – HealthFirst, Fidelis, Independent Health, and MVP – each have between 22 and 26 percent of enrollment in their respective service areas.  All other insurers have between four and 16 percent of EP enrollment in their respective service areas.


Additional demographic and health plan specific information for the 2019 Open Enrollment Period will be available in the coming weeks.

-###-

Contact: New York State Department of Health
518-474-7354, Ext. 1
press@health.ny.gov

I recall that when the exchange started, UnitedHealtcare was used as a benchmark to compare to. As their QHP network became terrible (and premiums high), they seem to have moved down in enrollment (one should keep in mind the power of inertia, when people have a plan, they will stick to it unless they have a reason to change).

Fidelis is priced very well (compared to other carriers with decent networks) and that shows in the numbers.

However, oddly enough UHC Community Plan seems to have wider acceptance than the UHC QHP network, so when it comes to the highly subsidized UHC community plan marketed as the Essential Plan (which also includes Medicaid equivalent for people that are here legally but are not Citizens or Resident Aliens), UHC has a larger marketshare than otherwise.
I've been waiting over 5 years with bated breath for someone to say that!
-- Dan

Offline Moe Ginsburg

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Re: Obamacare Master thread
« Reply #614 on: March 13, 2019, 07:02:28 PM »
Just got the following email, and I can say that I'm not surprised (will post some comments below):
How does one go about receiving these emails?
Quote
I recall that when the exchange started, UnitedHealtcare was used as a benchmark to compare to.
Why were they the original benchmark?
Quote
As their QHP network became terrible (and premiums high), they seem to have moved down in enrollment (one should keep in mind the power of inertia, when people have a plan, they will stick to it unless they have a reason to change).
Their QHP network is (very) different than their EP network? Why did they significantly raise their premiums (when others haven't)? How do you know a lot of folks who signed up earlier kept them as their premiums rose?
Quote
Fidelis is priced very well (compared to other carriers with decent networks) and that shows in the numbers.
Fidelis is indeed the lowest cost provider. But I've found their network to be quite lacking and poor compared to United and to HealthFirst.
Quote
However, oddly enough UHC Community Plan seems to have wider acceptance than the UHC QHP network, so when it comes to the highly subsidized UHC community plan marketed as the Essential Plan (which also includes Medicaid equivalent for people that are here legally but are not Citizens or Resident Aliens), UHC has a larger marketshare than otherwise.
That really isn't that odd. EP (and Medicaid) plans all cost the same regardless of which carrier you choose. As such cost is a non-factor so consumers will simply choose the one with the best networks.

Offline ExGingi

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Re: Obamacare Master thread
« Reply #615 on: March 14, 2019, 07:27:21 AM »
How does one go about receiving these emails?
IDK. Maybe by becoming certified/authorized to sell on the exchange. Though I suppose there might be other ways (there’s a phone number and email address at the bottom).

Quote
Why were they the original benchmark?
IDK. Possibly because they had the biggest network and might have been the largest insurer (Oxford/UHC).

Quote
Their QHP network is (very) different than their EP network?
QHP network is the Oxford Metro network IINM. EP and Medicaid is the Community network. My evidence is extremely anecdotal based on local PCPs and client feedback.

Quote
Why did they significantly raise their premiums (when others haven't)? How do you know a lot of folks who signed up earlier kept them as their premiums rose?
I don’t know that they significantly raised their premiums. On the contrary, their premiums have been amongst the highest since the inception of the NYS exchange (I’ve contended that it was due to their experience, while other players were underpricing (and we’ve seen failures)). The Metro network was introduced in order to contain costs.

Quote
Fidelis is indeed the lowest cost provider WITH A DECENT NETWORK. But I've found their network to be quite lacking and poor compared to United and to HealthFirst.
FTFY.

As for the network, which counties are you comparing, and are you talking QHP or Medicaid/EP? In NYC there’s no comparison, it’s hands down Fidelis (for QHP). The only insurer with a (possibility) better network is Empire Blue Cross Blue Shield (I am talking NYC) and their premiums are significantly higher than Fidelis (FWIW, Empire used to be non-profit years ago, and then switched. Fidelis is non-profit).

Quote
That really isn't that odd. EP (and Medicaid) plans all cost the same regardless of which carrier you choose. As such cost is a non-factor so consumers will simply choose the one with the best networks that works for them, with inertia being a factor.
FTFY.
« Last Edit: March 14, 2019, 07:37:22 AM by ExGingi »
I've been waiting over 5 years with bated breath for someone to say that!
-- Dan

Offline Moe Ginsburg

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Re: Obamacare Master thread
« Reply #616 on: March 15, 2019, 10:41:09 AM »

I don’t know that they significantly raised their premiums. On the contrary, their premiums have been amongst the highest since the inception of the NYS exchange (I’ve contended that it was due to their experience, while other players were underpricing (and we’ve seen failures)). The Metro network was introduced in order to contain costs.


How does HealthFirst and Fidelis significantly undercut United and Empire BCBS' premiums and remain able to continue with their lower premiums year after year while United and Empire cannot?
Quote
FTFY.

As for the network, which counties are you comparing, and are you talking QHP or Medicaid/EP? In NYC there’s no comparison, it’s hands down Fidelis (for QHP). The only insurer with a (possibility) better network is Empire Blue Cross Blue Shield (I am talking NYC) and their premiums are significantly higher than Fidelis (FWIW, Empire used to be non-profit years ago, and then switched. Fidelis is non-profit).


I'm referring to NYC. And in NYC I believe Fidelis is the lowest cost carrier regardless of network (decent or not) but HealthFirst costs only a very small amount more than Fidelis. And I've found Fidelis' network lacking compared to both HealthFirst and United. AFAIK that is applicable to both QHP and EP. When I checked with doctors many accept HF and UHC but not Fidelis. (Ironically among dentists I've found the opposite, with more accepting Fidelis. But that's only relevant if getting dental too on the marketplace, and even then it is a secondary consideration to the medical network.)
« Last Edit: March 15, 2019, 10:47:03 AM by Moe Ginsburg »

Offline ExGingi

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Re: Obamacare Master thread
« Reply #617 on: March 15, 2019, 12:31:03 PM »
How does HealthFirst and Fidelis significantly undercut United and Empire BCBS' premiums and remain able to continue with their lower premiums year after year while United and Empire cannot?
I am not an actuary. IINM there might be at least one around DDF. The rates are highly regulated so there's not that much leeway there. Though two possible points might be that both Fidelis and Healthfirst are not for profit insurers, and they both begin with a strong presence in the Medicare market, slowly penatrating into the individual Metal level market (and now Healthfirst seems to be going into small group coverage as well). Another difference might be in the reimbursement rates, which is why UHC/Oxford has 3 networks in NYC Freedom, Liberty and Metro. I've found Liberty to be as good as Freedom in most cases (even though the official provider count of the Freedom network is larger), which the Metro network is limited, with many doctors not participating.

I'm referring to NYC. And in NYC I believe Fidelis is the lowest cost carrier regardless of network (decent or not) but HealthFirst costs only a very small amount more than Fidelis. And I've found Fidelis' network lacking compared to both HealthFirst and United. AFAIK that is applicable to both QHP and EP. When I checked with doctors many accept HF and UHC but not Fidelis. (Ironically among dentists I've found the opposite, with more accepting Fidelis. But that's only relevant if getting dental too on the marketplace, and even then it is a secondary consideration to the medical network.)
As I said, my evidence is extremely anecdotal and local. The bottom line for many people in my community is that the most significant medical office in Crown Heights doesn't take HealthFirst or UHC QHP, while they do take Fidelis.

What you mention about dental is interesting, and again this seems to be extremely provider specific. My kids dentist will only take UHC Community Plan (and no private paid insurance, or other Medicaid/EP). I do have a client that switched from Fidelis to Healthfirst due to the fact that Healthfirst offers adult dental as an option.
I've been waiting over 5 years with bated breath for someone to say that!
-- Dan

Offline Moe Ginsburg

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Re: Obamacare Master thread
« Reply #618 on: March 16, 2019, 09:59:17 PM »
Another difference might be in the reimbursement rates, which is why UHC/Oxford has 3 networks in NYC Freedom, Liberty and Metro. I've found Liberty to be as good as Freedom in most cases (even though the official provider count of the Freedom network is larger), which the Metro network is limited, with many doctors not participating.

Between Medicaid, EP, QHP, small business and large business, which networks does UHC/Oxford offer with which plans?

Quote
What you mention about dental is interesting, and again this seems to be extremely provider specific. My kids dentist will only take UHC Community Plan (and no private paid insurance, or other Medicaid/EP). I do have a client that switched from Fidelis to Healthfirst due to the fact that Healthfirst offers adult dental as an option.

I should've stated that my above dental network comparison was only between Fidelis and HealthFirst. UHC community plan I've found actually has a better dental network than both of the aforementioned.

That said, generally speaking most or many people are better off forgoing adult dental from the marketplace and either paying out of pocket or getting a non-marketplace dental plan.

Even getting a separate QHP dental plan off the marketplace from your marketplace health plan is usually better. New York doesn't allow a separate QHP dental plan in the marketplace than your healthplan (though it does allow it by EP.) Adding adult dental unto the same plan as your health plan can cause a higher combined health+dental deductible than worthwhile.
« Last Edit: March 16, 2019, 10:28:11 PM by Moe Ginsburg »

Offline Moe Ginsburg

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Re: Obamacare Master thread
« Reply #619 on: March 27, 2019, 11:47:11 PM »
(FWIW, Empire used to be non-profit years ago, and then switched. Fidelis is non-profit).


Fidelis also became for-profit:

https://www.prnewswire.com/news-releases/centene-completes-transaction-with-fidelis-care-300675485.html