Obamacare Master thread

[aygart]

I live in NJ and currently have a catastrophic plan, I expect my wife to lose coverage in the middle of the year. Would I be able to change plans in the middle of the year to one with better coverage?

I think that you can, but if it is a business plan the new one may need to be an "available plan" for the business from before.

[ExGingi]

I am pretty certain that you can, but if it is a business plan the new one may need to be an "available plan" for the business from before.

I've never seen Catastrophic plans available as business plans. (disclaimer: I don't do large business, and I haven't yet done small business in NJ)

[aygart]

I've never seen Catastrophic plans available as business plans. (disclaimer: I don't do large business, and I haven't yet done small business in NJ)

Depending on what you call catastrophic, I have.

[ExGingi]

Depending on what you call catastrophic, I have.

The current definition of Catastrophic plans available on the exchange are very high deductible plans (usually about $8,500 deductible) that pay 100% after the deductible. They are NOT HSA compatible. Obamacare allows them to be purchased only up until age 30 (or older with a hardship exemption - a utility turn off notice being one of them, though I've never tested it).

[avromie7]

I think that you can, but if it is a business plan the new one may need to be an "available plan" for the business from before.

Just an individual plan from the marketplace.

Losing coverage is a reason to be able to get individual coverage outside of the open enrollment period. Your wife can have a different plan than you (if you're on Catastrophic, you're not getting subsidies anyway).

Would the premiums be cheaper by having the same plan? I also would rather not be subject to both deductibles.

Unfortunately, I found the NJ marketplace website so much more difficult to navigate than the obamacare website.

[ExGingi]

Just an individual plan from the marketplace.  Would the premiums be cheaper by having the same plan? I also would rather not be subject to both deductibles.

Unfortunately, I found the NJ marketplace website so much more difficult to navigate than the obamacare website.

I'm not sure if outside NY is the same as NY (I would assume it is, or at least close). Couples rate is 2x single rate. Family (couple + 1 or more children) rate is 2.85x single rate. Parent+Child(ren) = 1.7x individual rate.

So to answer your question, unless there are subsidies which are available only if getting couples coverage and not individual coverage, there is no savings by having the same plan for both spouses (at least in NY).

[avromie7]

I'm not sure if outside NY is the same as NY (I would assume it is, or at least close). Couples rate is 2x single rate. Family (couple + 1 or more children) rate is 2.85x single rate. Parent+Child(ren) = 1.7x individual rate.

So to answer your question, unless there are subsidies which are available only if getting couples coverage and not individual coverage, there is no savings by having the same plan for both spouses (at least in NY).

So basically the only thing I lose by having different plans is seperate deductibles

[ExGingi]

So basically the only thing I lose by having different plans is seperate deductibles

Not necessarily lose, as the family deductible is usually 2x the individual deductible.

[ExGingi]

https://www.governor.ny.gov/news/part-new-yorks-ongoing-response-covid-19-pandemic-governor-cuomo-announces-open-enrollment

NY Open Enrollment extended to March 31

As part of New York's ongoing response to the COVID-19 pandemic, Governor Andrew M. Cuomo today announced that the Open Enrollment Period for uninsured New Yorkers will be extended through March 31, 2021. New Yorkers can apply for coverage through NY State of Health or directly through insurers. Coverage start dates will vary:

·         Enroll by February 15: Coverage starts March 1

·         Enroll by March 15: Coverage starts April 1

·         Enroll by March 31: Coverage starts May 1 

Individuals who are eligible for other NY State of Health programs - Medicaid, Essential Plan and Child Health Plus can enroll year-round.

[ExGingi]

And on Healthcare.gov rather than extending open enrollment period, they are calling it Special Enrollment Period (through May 15!)

Today, in accordance with the Executive Order issued today by
President Biden, the Department announced a Special Enrollment Period (SEP) for individuals and families for Marketplace coverage in response to the COVID-19 Public Health Emergency, which has left millions of Americans facing uncertainty and exceptional circumstances while millions of Americans have experienced new health problems during the pandemic. This SEP will allow individuals and families in states with Marketplaces served by the HealthCare.gov platform to enroll in 2021 health insurance coverage.
 
Beginning February 15, 2021 and through May 15, 2021, these Marketplaces will operationalize functionality to make this SEP available to all Marketplace-eligible consumers who are submitting a new application or updating an existing application. State-based Marketplaces (SBMs) operating their own platform have the opportunity to take similar action within their states.

[av83]

I have Ameri Health NJ-Obama Care. Need labwork done, my doctor says i nee to go to a labcorp. Does anyone know if there is any other option I would like to have it done over the weekend and Labcorps are only open Mon-Fri.

[yesitsme]

I have Ameri Health NJ-Obama Care. Need labwork done, my doctor says i nee to go to a labcorp. Does anyone know if there is any other option I would like to have it done over the weekend and Labcorps are only open Mon-Fri.

the one on 101 2ND STREET, LAKEWOOD NJ 08701
opens 6:00A

[ExGingi]

https://www.governor.ny.gov/news/11th-anniversary-affordable-care-acts-signing-governor-cuomo-announces-expanded-eligibility

Extends Open Enrollment Period to the End of 2021

NY State of Health's Implementation of the American Rescue Plan Will Lower Premiums for Most Consumers

Higher Tax Credits Also Available to Current Enrollees in Early April and to Higher-Income New Yorkers For the First Time Starting in June

Governor Andrew M. Cuomo today announced expanded tax credits available through NY State of Health, New York's health plan marketplace. The expansion will result in more New Yorkers being eligible for financial assistance and the further reduction in health insurance premiums in New York State. Through the American Rescue Plan, which President Biden recently signed into law, increased tax credits are available to more than 150,000 consumers who are already enrolled in coverage, further lowering health care costs. In addition, in June 2021, NY State of Health will for the first time expand tax credits to tens of thousands of additional New Yorkers with higher incomes who, before the American Rescue Plan, did not qualify for financial assistance to lower the cost of premiums. Governor Cuomo also announced that the 2021 Open Enrollment Period will be extended through the end of this year. The announcements come on the 11th anniversary of President Obama signing the Affordable Care Act into law.

"Access to high-quality affordable health insurance is crucial at any time, but the COVID-19 pandemic has made it even more important to make sure New Yorkers are insured in case they face the virus or other health issues," Governor Cuomo said. "With the availability of increased tax credits and the extended Open Enrollment Period, health insurance premiums will be reduced for more New Yorkers than ever before. I encourage anyone who needs health insurance to sign up through NY State of Health." 

Beginning in early April, enhanced federal tax credits will be available for low- and moderate-income consumers (income up to $51,040 for individuals and $104,800 for a family of four) to lower the cost of Qualified Health Plans. Individuals already enrolled through NY State of Health at these income levels will be notified to visit NY State of Health, call the NY State of Health Customer Service Center, or contact a certified NY State of Health assistor to update their information. Consumers who complete their updated enrollment in April will receive a premium invoice from their health plan that reflects the lowered premium amount beginning in May.   

NY State of Health Executive Director Donna Frescatore said, "As we continue to respond to a global pandemic that has impacted our lives for more than a year, the American Rescue Plan has provided some very good news for New Yorkers. We are working to make enhanced tax credits available to New Yorkers as quickly and as seamlessly as possible."

By June 2021, NY State of Health will update its system to automatically apply the enhanced tax credits without the consumer needing to take any action to receive them. Also in June, NY State of Health will update its system so that higher income consumers (income above $51,040 for individuals and $104,800 for a family of four) can access the federal tax credits. Consumers at these income levels were not previously eligible for tax credits.

To allow as many consumers as possible to access these enhanced tax credits, and in light of the ongoing public health emergency, NY State of Health is also announcing an extension of the Open Enrollment Period to December 31, 2021.On February 17, Governor Cuomo announced that New York's health insurance Open Enrollment Period was extended to May 15, 2021, aligning with states across the country. Ensuring access to affordable health coverage and care is more important than ever, so that individuals do not avoid seeking testing or medical care for fear of cost during the ongoing public health emergency. This deadline extension allows consumers additional time to enroll for 2021 coverage.   

Over the past eleven years, New York has led the nation in its implementation of the ACA and made more than $4.4 billion in federal tax credits available to New Yorkers to lower the cost of Qualified Health Plans purchased through the NY State of Health Marketplace. More than 5.8 million people, nearly 1 in 3 New Yorkers, now access health coverage through NY State of Health, New York's official health plan marketplace. The state has seen an unprecedented reduction in uninsured - from 10 percent to 5 percent between 2013 and 2019.

Now, with the passage of the American Rescue Plan, NY State of Health will build on these gains to further extend affordable coverage to hundreds of thousands of New Yorkers. Depending on enrollment levels, New Yorkers could receive more than $700 million in additional tax credits in 2021 because of the American Rescue Plan.

Individuals who are eligible for other NY State of Health programs—Medicaid, Essential Plan and Child Health Plus—can enroll year-round. As always, consumers can apply for coverage through NY State of Health online at nystateofhealth.ny.gov, by phone at 1-855-355-5777, or by connecting with a free enrollment assistor. 

[PlatinumGuy]

You probably saw a personal benefit from Obamacare, but from my experience (and I probably have a lot more than yours) Obamacare hurt more people than it helped in NY.

More importantly, I am convinced that Rush Limbaugh was exactly on the mark when he said it was INTENTIONALLY designed to fail (so that they can come with the next fix - single payor). Anyone with a little understanding of how insurance works could see that there is no way it could lead to lower costs.

The entire approach was flawed from the outset. Trying to apply a Federal law to State regulated business. While initially it seemed like competition increased, with new insurers coming to market, those insurers are either totally collapsing or having to adjust to the realities of pricing the risks, that the experienced players have known all along.

There's a lot more to be said, but the bottom line is that Obamacare will not exist 5 years from now. It simply is unsustainable.

ANd its all over folks.

Don't seem to have aged well... AFAIK the only thing that changed is the individual mandate, and removing it only made it less sustainable by removing the mandate for healthy people to join the pool.

[ExGingi]

Don't seem to have aged well... AFAIK the only thing that changed is the individual mandate, and removing it only made it less sustainable by removing the mandate for healthy people to join the pool.

Definitely unsustainable. But covid-19 threw all financial sustainability out the window. Medicaid for many has been extended without need to recertify. Let's see what happens in 2022.

[aygart]

Don't seem to have aged well... AFAIK the only thing that changed is the individual mandate, and removing it only made it less sustainable by removing the mandate for healthy people to join the pool.

How long is the aging process?

[PlatinumGuy]

How long is the aging process?

You predicted its imminent demise in 2016 and he confined his prediction to August 2021, neither of which materialized, although he has a better defense.

The bottom line is the US essentially has universal healthcare by redistribution, but where most of the developed world fund it by general taxes collected as a percentage of income and/or consumption, the US in effect makes everybody pay their per capita portion of the collective healthcare burden by making the insurance companies charge identical premiums regardless of the true cost.

While clearly not libertarian, it is better for the rich than other developed countries, at least conceptually. The middle class are paying a much larger portion of the overall bill than other expenses like education and defense.

There are essentially only two ways to change it. Either cancel the coverage mandates, taking away insurance from people who only have it because the government forces insurers to provide, which would lose Republicans blue collar support, or have the government fund the people who cost more via single payer or other schemes, which increases the role of government and ultimately shifts some of the burden from the middle class (average insurance buyer) to the rich (who pay larger tax amounts)


And yes I absolutely agree with @ExGingi that price transparency is a huge part of the problem that can be easily remedied.

[Dan]

2011: 2 adults
$3,000 family deductible =$3,422/year premium
$6,000 family deductible = $2,743/year premium
$8,000 family deductible = $2,442/year premium
$10,000 family deductible = $2,061/year premium

2012: 2 adults, 1 child
$3,000 family deductible =$5,414/year premium
$6,000 family deductible = $4,333/year premium
$8,000 family deductible = $3,852/year premium
$10,000 family deductible = $3,269/year premium

2013: 2 adults, 1 child
$3,000 family deductible =$6,723/year premium
$6,000 family deductible = $5,424/year premium
$8,000 family deductible = $4,840/year premium
$10,000 family deductible = $4,131/year premium

2014: 2 adults, 2 children
$3,000 family deductible =$9,856/year premium
$6,000 family deductible = $7,993/year premium
$8,000 family deductible = $7,156/year premium
$10,000 family deductible = $6,140/year premium

2015: 2 adults, 2 children
$3,000 family deductible =$11,969/year premium
$6,000 family deductible = $9.668/year premium
$8,000 family deductible = $8,633/year premium
$10,000 family deductible = $7,376/year premium

2016: 2 adults, 2 children
$3,000 family deductible =$13,378/year premium
$6,000 family deductible = $10,778/year premium
$8,000 family deductible = $9,610/year premium
$10,000 family deductible = $8,191/year premium

2017: 2 adults, 2 children
$3,000 family deductible =$14,164/year premium
$6,000 family deductible = $11,390/year premium
$8,000 family deductible = $10,143/year premium
$10,000 family deductible = $8,630/year premium

2018: 2 adults, 3 children
$3,000 family deductible =$19,385/year premium
$6,000 family deductible = $15,577/year premium
$8,000 family deductible = $13,865/year premium
$10,000 family deductible = $11,788/year premium

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 2019 renewal options for 2 adults, 3 children 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

2020: 2 adults, 3 children

$1,500/person deductible/$3,000 family deductible =$25,038/year premium (+12%)
$3,000/person deductible/$6,000 family deductible = $20,093/year premium (+11.9%)
$4,000/person deductible/$8,000 family deductible= $17,871‬/year premium (+11.9%)
$5,000/person deductible/$10,000 family deductible = $15,174/year premium  (+11.8%)

2021: 2 adults, 4 children

$1,500/person deductible/$3,000 family deductible =$27,210/year premium (+8.7%)
$3,000/person deductible/$6,000 family deductible = $21,829/year premium (+8.6%)
$4,000/person deductible/$8,000 family deductible= $19,411‬/year premium (+8.6%)
$5,000/person deductible/$10,000 family deductible = $16,476/year premium  (+8.6%)

[joe1234]

I don’t see how most of the middle class can afford insurance... Obamacare is terrible prices.... regular insurance is through the roof... personally I have United Refuah HealthShare. I would much rather have a real insurance but it’s just way out of reach...

[sillypainter]

I don’t see how most of the middle class can afford insurance... Obamacare is terrible prices.... regular insurance is through the roof... personally I have United Refuah HealthShare. I would much rather have a real insurance but it’s just way out of reach...

I pay $1275/ month for bronze fidelis care for the entire family. It has a 8k deductible I think, but it has a few doctor visit allowance. We don't go to doctors much so I consider it a catastrophic insurance plan, better than a healthshare.