and you are within 400% of the FPL...you qualify to use the Subsidy Exchanges. That is someone that makes under $45,000 a year for a single person. So rounded off to 10% that means that your healthcare cost is more than $4500 a year.

Someone correct me if I am wrong here....

My out of pocket costs would end up being a quarter of more of my income, easily, in these circumstances.

I found that out for my friend...this is for her at $19,000 a year.

Your out-of-pocket maximum for a Silver plan (not including the premium) can be no more than $2,250. Whether you reach this maximum level will depend on the amount of health care services you use. Currently, about one in four people use no health care services in any given year.

You are guaranteed access to a Silver plan with an actuarial value of 87%. This means that for all enrollees in a typical population, the plan will pay for 87% of expenses in total for covered benefits, with enrollees responsible for the rest. If you choose to enroll in a Bronze plan, the actuarial value will be 60%, meaning your out-of-pocket costs when you use services will likely be higher. Regardless of which level of coverage you choose, deductibles and copayments will vary from plan to plan, and out-of-pocket costs will depend on your health care expenses. Preventive services will be covered with no cost sharing required.

For example, you could enroll in a Bronze plan for about $315 per year (which is 1.66% of your household income, after taking into account $1,784 in subsidies). For most people, the Bronze plan represents the minimum level of coverage required under health reform. Although you would pay less in premiums by enrolling in a Bronze plan, you will face higher out-of-pocket costs than if you enrolled in a Silver plan.

cause you are eligible for the subsidies if you make less than 400% of poverty and your healthcare coverage is more than 9.5% of your salary (this calculator doesn't adjust for that).

http://kff.org/interactive/subsidy-calculator/

and that's for the minimum we would need, a silver plan, but with the cost sharing we would qualify for, we would be able to get her medications for a lot less than a straight silver plan, at least that's my hope.

the ledge has been beaten once again!

Nothing has been beaten.

my friend makes $19,000 a year and she does...

my hours.

if your healthcare cost is more than 9.5% of your salary....you are allowed to use the Exchanges...read what it says on the calculator. It estimates your healthcare cost...and then tells you how much each plan would cost you if you chose that instead. Just put in NO in the question about employmer provided as this calculator doesn't take that situation into account. Anyone that has answers yes just get booted out...when that is not the fully the case. Just relax and apply...call if you can't

On the calculator...read the whole page...it tells you this right there at the bottom.

Due to my hours varying, my premium may fall under the 9.5% threshold.

If you do, then you'll qualify for cost sharing which will push down the cost of the copays and deductible for whatever plan you choose.

But it's hard for you to know whether you do, because your income varies. This is the question I would ask of someone at the ACA number. What do you do when you don't know whether you qualify for a subsidy because your pay changes and you are close to the line? It seems to me that you in good faith could say that was so, because right now it looks like it is not within the 9.5%.

Obviously if you dropped your work plan, went on the exchange and then found out that they were taking away the subsidy and the cost-sharing help, you'd be in one heck of a fix.

I'm sure I'm not the only hourly worker out there with this as an issue, most people at my work make close to, or even slightly more than me, I would say I'm in the middle when it comes to income level at work.

Hope the Experian Pro Brono Human Verification Team doesn't crap on your thread

Wouldn't you qualify for Medicaid on $15,000?

Medicaid Income Requirements In Missouri
Infants ages 0 to 1: 185% FPL.
Children ages 1 to 5: 133% FPL.
Children ages 6 to 18: 100% FPL.
Parents/caretakers living with children ages 0 to 18: 25% FPL.
Pregnant women: 185% FPL.
Aged, blind, and disabled: 85% FPL with asset limit of $1,000 for singles and $2,000 for couples.
Limited assets such as cash, savings, stocks and bonds.

http://www.medicaidoffice.net/missouri-medicaid-eligibility

I'm employed after all, this is based on my latest check stub.

Also, in Missouri you damn near have to be living in a cardboard box to get Medicaid, the only reason my fiancee was able to get on it is because she is on disability.

something needs to be done.

money comes from disability.

you are under 150% there...

We know that because it's the plan the Heritage Foundation came up with.

I remember when we got Medicare. It was also written by the rich for the rich. It needed a great deal of reworking over the years by a reasonably sane Congress.

This plan is no different.

So hang in there. If we can kick the lunatics out of Congress, maybe we'll get a sane insurance plan.

the bronze plan is less

Missouri: At 197 percent of FPL, $22,600, the premium is $1,389 for a silver plan or $598 for a bronze.

U.S.: At 197 percent of FPL, $22,600, the premium is $1,389 for a silver plan or $955 for a bronze.

like deductibles and co-insurance.

Just the premiums.

This is cost-prohibitive to many low-income people/families, particularly in states that did not expand medicare.

eta: And at the levels of income we are talking about, any additional monthly bill can be impossible for some, whether or not there is a subsidy involved.

unless a person goes in for certain medical treatment, hospitalization, etc. In addition to the list of preventive care services, there are plans that don't charge for other procedures. These costs are also not applied in full. The relevant treatments have specific limits on what portion of deductibles apply.

In other words, unless a person has a serious medical condition or is hospitalize, these will be negligible. In some cases they will not even kick in. The limits on out-of-pocket is designed to prevent people from ever having to incur thousands, tens of thousands or even hundreds of thousands of dollars that was typical before the law.

Link to list of free preventive services
http://www.democraticunderground.com/10023828253

I did it enough times when the ACA was being formulated and written and voted on.

You are misrepresenting reality. Aside from the few things considered 'preventative', the deductibles and coinsurance DO apply. And they apply up to a maximum that often exceeds 5 figures, depending on the income, family size and type of plan, and a few other factors.

Stop misleading people. Apparently people with serious medical conditions aren't on your radar, don't need real health care.

Come back at me with whatever links you want, I am not getting sucked into your false arguments. You speak in vague terms and make misleading claims. Fortunately most people can see it. Unfortunately, the reason many of them are seeing it is because their experiences with ACA are not what folks like you have been trying to claim for the last few years. They still won't have affordable health CARE.

"Come back at me with whatever links you want, I am not getting sucked into your false arguments. You speak in vague terms and make misleading claims. Fortunately most people can see it. Unfortunately, the reason many of them are seeing it is because their experiences with ACA are not what folks like you have been trying to claim for the last few years. They still won't have affordable health CARE."

You mean like people would be interested, qualify for Medicaid and save money?

Your comment is no different from the anti-Obamacare misinformation that has been spewed for the last three years plus.

Are you saying the concern being express is for "people with chronic health conditions"?

From what I've seen, there are people implying that these costs are related to a doctors visit.

Why anyone would forgo low cost health coverage because of an out-of-pocket limit is beyond me.

our income on healthcare alone, and that's excluding prescriptions. This would be with the health plan my employer provides.

You have to understand, at this time, I DON'T KNOW if I qualify for opting out of my employer's plan and qualifying for subsidies at the same time. If I don't, then I'm remaining uninsured because I can't afford the premiums as is, because there is no help for me based on income level alone.

"What low cost? Even with our combined income, my fiancee and I would be projected to spend 20% of...our income on healthcare alone, and that's excluding prescriptions. This would be with the health plan my employer provides."

My statement was about the exchange not your employer plan. Also, if it's more than 9.5 percent of your income, you are exempt from the fee.

"You have to understand, at this time, I DON'T KNOW if I qualify for opting out of my employer's plan and qualifying for subsidies at the same time. If I don't, then I'm remaining uninsured because I can't afford the premiums as is, because there is no help for me based on income level alone."

Based on 197 percent of FPL, if you shop the exchange you will be eligible for subsidies.

As I said:

Missouri: At 197 percent of FPL, $22,600, the premium is $1,389 for a silver plan or $598 for a bronze.

U.S.: At 197 percent of FPL, $22,600, the premium is $1,389 for a silver plan or $955 for a bronze.

OK, so I went to the subsidy calculator and put in the projected combined income(maximum) of both my fiancee and I, assuming we get married. This is my max income, from 2012, plus her monthly times 12, which equals to a total of 36,300 for both our incomes. This is what Kaiser put out:

The information below is about subsidized exchange coverage. Note that subsidies are only available for people purchasing coverage on their own in the exchange (not through an employer). Depending on your state's eligibility criteria, you or some members of your family may qualify for Medicaid.

Household income in 2014: 234% of poverty level Unsubsidized annual health insurance premium in 2014:$6,176 Maximum % of income you have to pay for the non-tobacco premium, if eligible for a subsidy: 7.49% Amount you pay for the premium:$2,719 per year
(which equals 7.49% of your household income and covers 44% of the overall premium) You could receive a government tax credit subsidy of up to:$3,456
(which covers 56% of the overall premium)
BRONZE PLAN

The premium and subsidy amounts above are based on a Silver plan. You have the option to apply the subsidy toward the purchase of other levels of coverage, such as a Gold plan (which would be more comprehensive) or a Bronze plan (which would be less comprehensive).

For example, you could enroll in a Bronze plan for about $1,662 per year (which is 4.58% of your household income, after taking into account $3,456 in subsidies). For most people, the Bronze plan represents the minimum level of coverage required under health reform. Although you would pay less in premiums by enrolling in a Bronze plan, you will face higher out-of-pocket costs than if you enrolled in a Silver plan.

OUT OF POCKET COSTS

Your out-of-pocket maximum for a Silver plan (not including the premium) can be no more than $10,400. Whether you reach this maximum level will depend on the amount of health care services you use. Currently, about one in four people use no health care services in any given year.

You are guaranteed access to a Silver plan with an actuarial value of 73%. This means that for all enrollees in a typical population, the plan will pay for 73% of expenses in total for covered benefits, with enrollees responsible for the rest. If you choose to enroll in a Bronze plan, the actuarial value will be 60%, meaning your out-of-pocket costs when you use services will likely be higher. Regardless of which level of coverage you choose, deductibles and copayments will vary from plan to plan, and out-of-pocket costs will depend on your health care expenses. Preventive services will be covered with no cost sharing required.

You don't current pay for insurance, but if you did shop the exchange you would qualify for subsidies based on your own income.

If you get married, the combined incomes would put your household income at 234 percent of FPL.

Do you plan to sign up for the exchange until you get married?

If we get married, we may end up in a similar situation as we did in 2011, where we had to pay COBRA for her insurance, which we couldn't afford, because she didn't yet get approved for Unemployment or Disability, so everything was carried by two things, my credit cards and my parents pitching in. Her medical costs damn near broke the bank for more than one family. And this was just for about 6 months, I don't see how we can do it for years on end. Pretty much all her income would go to her medical expenses if we get a private plan.

I don't know if I can, I tried applying through healthcare.gov, but it just throws me script errors, or doesn't let me login(already registerd and applied, no results, too many errors).

My issue is that, if we go by what I earned in 2012, the current premium for my individual employer provided plan is 8.9% of my income, puts me above the 8% threshold to not be penalized, but below the 9.5% threshold to allow me to get a subsidized plan on the exchanges.

Last edited Fri Oct 11, 2013, 10:05 PM - Edit history (1)

if I make just a hair too much this year, no exchanges or subsidies, but I also will be exempt from the mandate, apparently.

My employer plan is 2,000 dollar deduct/max out of pocket for individual, 6,000 dollar deduct/max out of pocket for family in network plan(double that for out of network). Copays for prescriptions don't contribute to either, I think.

ON EDIT: Correction, out of pocket for out of network is greater than the deductible, at 8,000/16,000.

Note, the plan pays nothing(except rx copays), until the deductible is met, if I read the documents correctly. Exceptions include preventative care doctor visits and contraceptive coverage.

We are gluttons for punishment.

Look how the stupidity of the system even affects your marital considerations. That's wrong for government policy to distort how people live their lives.

We can't leave it at the ACA. We need to move our sights to single payer now.

That doesn't work. People demand change when the situation is untenable. So thinking it will move us to single payer is admitting it will suck.

"That doesn't work. People demand change when the situation is untenable. So thinking it will move us to single payer is admitting it will suck. "

What's your time frame? Do you think the millions of newly eligible Medicaid recipients should skip the ACA and wait with you?

is a fact. Getting the ACA is proving to be a heavy lift due to backward red state governors and legislatures and the people those red states send to Congress and the Senate. I favor a plan that allows like minded states like the majority of Blue states to band together to deliver affordable, or a Single Payer style health system to their citizens. Imagine the health care system their citizens could have if deep blue states joined to form one system for their citizens, without concern about what the fuck red states think.

Look at all the problems going from a bad situation to a marginally better one (old system vs ACA).

While I believe single payer is the best situation, and hopefully the end game for this, you can't make that leap in our society too fast.

Nothing is perfect, and sometimes we have to deal with the concept that the Perfect is the Enemy of the Good.
I try to look at it as a process.

Clinton got farther than Carter
Obama has gotten farther than Clinton in regards to the healthcare mess.

Disregard the R years as they are fairly transparent in the long run, almost "breathing space" between each set of changes.

We will get there, but it may take another decade or so.

Saskatchewan brought it in at a provincial level, then the Canadian federal gov't a few years later enticed all other provinces by offering to pay 50 pct of the costs for every province who adopted it.

I suspect a batch of northeastern states will band together to start it off. States like MA, NY, VT...

I'd seriously consider moving to a better state.

We need to encourage the states that do implement these changes with a robust population so they can have a good tax base.

If you can move, I'd highly suggest doing so.

are you offering?

giving me scripting errors when I try to log in or, when I try to see my eligibility results, redirects me to a null page.

for a bronze plan or a silver plan.

http://kff.org/


You can also use the HRSA clinics and other sites listed for applying for ACA in person. And they'll help you figure out what your best option is. Take your job-based insurance policy info with you so they'll know what compares to it in coverage but might cost you less.

http://www.democraticunderground.com/10023826338

Star Member DevonRex (22,015 posts)

Apply for ACA Exchanges IN PERSON at HRSA Clinics. Link:
First, HRSA is Health Resources Services Administration. It's part of the Department of Health & Human Services. HRSA awarded grants to over 1,100 of its federally funded, qualified health clinics across the U.S. to help people get informed and to help them apply for ACA. You can go to these clinics for assistance in the application process.

http://www.hrsa.gov/about/news/2013tables/outreachandenrollment/

Just click on your state for the one nearest you. Some states have a lot, some have only one. Others simply haven't been updated since the shutdown. They aren't operated by the Feds, so they are open. They receive funding from HRSA.
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with combined income for me and my fiancee, we are looking at premiums that are 200+ dollars a month and maximum out of pocket, that we will get close to reaching every year, of about 10,400 dollars. I guess we could declare bankruptcy every year, but I don't know if that's legal.