A Detailed Analysis of the Republican Alternative to Obamacare

Bob Laszewski has offered a detailed look at the Republican's alternative to "Obamacare".  I agree with Bob, that it may have been easier to accept "Obamacare" as the baseline, in need of major renovations - but it seems that it won't happen.

Some of the ideas in these proposals make perfect sense, but they will have different consequences for different consumers within the market.  The other big challenge here is that these solutions proposed are also very complicated for the average person to really understand.  What do you think?

Here's Bob's article . . . .Health Care Policy and Marketplace Review - Bob Laszewski

Surprises Lurk for People Re-Enrolling on HealthCare.gov

This year, there may be surprises in store for those who do not do a subsidy "re-determination", and then shop for new plans and coverage.  If you were given subsidy money to purchase a policy under the new Affordable Care Act through Healthcare.gov last year, you may need to go back in and do a subsidy re-determination - especially if you believe your income for 2015 will be different than what you have projected for 2014.

Even if income stays the same, the plan choices and level of subsidy offered for the same income could differ considerably.

The Wall Street Article below spells it out pretty well. 

Surprises Lurk for People Re-Enrolling on Healthcare.gov 

I know that in the Kansas & Missouri markets there will be additional insurers entering the Federal Exchange/marketplace that were not present last year.  Insurers will also be offering some new plan designs that may impact what choices people make - even if they have been satisfied with their current coverage.

"Off-Exchange" policies will also offer more choice, for those who already know they will not qualify for subsidies.  If you do not qualify for a subsidy, there's really no good reason to shop through Healthcare.gov - unless you really want to go through the entire income verification process before you can purchase.

If you know you're going to purchase "off-exchange", you can go directly to the carrier to purchase, or work through an agent/broker (like me) who can run side-by-side quotes for you to choose from.

Open enrollment for individuals and families begins on 11/15/2014 and goes until 2/15/2015.  If you need to have coverage in place for a January 1 effective date, you'll need to be enrolled in a plan no later than 12/15/2014.

The Next Chapter of Obamacare

As we approach this next enrollment period (11/15/2014 - 02/15/2015) for individuals and families under the Affordable Care Act there are some things to be considered.

People who are receiving subsidies today, are being told that they can "do nothing" and automatically be re-enrolled in the plan they have today.  If that plan isn't going to be available for 2015, the insurance carrier will place you in a plan that's close.

But - even if you do want to keep the plan you have, you must keep in mind that if you do nothing, the subsidy amount you are currently receiving will stay the same and your share of the premium that you'll have to pay could increase.

So, most ACA subsidy recipients, should really go to the website (Healthcare.gov) when the enrollment period begins to re-apply and do a subsidy re-determination at that time for the year 2015.  If you don't, you may be surprised when the January 2015 bill comes.

In addition, you may want to re-visit things, simply because there will be some new plan offerings and, in some cases, some new carriers available on the exchange in your area.

Some of the Pre-ACA plans will only extend through the end of 2014 for some, so even if you are not receiving any subsidy money, you'll need to go shopping for a plan to begin on January 1.  If you don't qualify for the subsidy money, you can purchase "off-exchange" plans from a variety of sources - including your local agent or broker.

If you do qualify for subsidy money, then you can get assistance from a Navigator, Agent, or broker to review the process, help you access the local exchange in your area, and assist you with selecting plans.

People who had grandfathered plans (meaning, they were effective prior to 3/23/2010) can keep them as long as they desire.  Some others have received extensions of pre-ACA style plans that are not grandfathered beyond the year 2014.  Even though people can keep these plans - they must pay attention to note any rate activity on the plans that they currently have.  That may affect a decision on what to do in the coming year.

Each of you should be receiving some type of communication from your insurance carrier regarding your personal situation.

 - For policies to be effective on January 1, 2015 (i.e., for those who will absolutely lose coverage at the end of December 2014), you'll have to shop and be enrolled no later than December 15, 2014.

 - If you enroll by 1/15/2015, you'll have an effective date of 2/1/2015.  If you enroll by 2/15/2015, then your insurance will be effective on 3/1/2015.

 - If you do nothing, your insurance will continue and any price changes will be reflected in your first billing cycle in 2015.

Bob Laszewski's latest blog post outlines many things to be considered.  Read the blogpost here . . . .

What Are The Penalties For Not Getting Insurance By The March 31st Deadline?

Here's a very good synopsis of how the penalty works under the new healthcare law.  As we enter the last phase of the enrollment, many who have not purchased insurance may still be contemplating whether or not to buy it, or whether they should just pay the penalty.  This may help clarify that decision.

Individual Insurance Mandate & Associated Penalty Calculation

There is still a full week left to obtain coverage.  I'm busy helping people this week, but you can also go directly to Healthcare.gov or to a local Navigator to obtain coverage.

THIS JUST IN: White House offers exemption from insurance mandate for consumers whose plans were canceled

The White House released new guidance that offers some leeway to people who had policies cancelled and found that their options under the new law were more expensive.  They will now be able to qualify for catastrophic coverage (previously only available to those under 30 or who could demonstrate financial hardship), and avoid the penalty.

You can read the full article, from Modern Healthcare, here.  Within the article, you can access the actual .pdf that is the document issued directly by CMS.

There are only 4 more days left to enroll for those who need coverage to be in force by January 1, 2014.  Premium payments (which originally were required to be received by the insurance company prior to January 1), must arrive no later than January 10. Blue Cross Blue Shield of Kansas City requires their first payment no later than January 7.  If you are unsure, check directly with the carrier for clarification.

Enrollments after the 23rd will be processed for a 2/1/2014 effective date.  Enrollments processed after 2/15/2014 will be for plans effective on March 1, and those processed after 3/15/2014 will be effective on 4/1/2014.

Anyone who hasn't enrolled in a policy during this initial enrollment period, will have to wait until next year's enrollment to sign up or to make changes to existing plans.

Obamacare Week 10––A Dearth of Enrollment In the States and Continuing Backroom Problems

Here's an update from Bob Laszewski regarding the current status of the enrollments through the Federal Marketplaces, and in the states that currently have a state run marketplace.  There is also data here about how various aspects of system corrections and development are going. 

The one point here that I found very troubling was the item that notes that the federal government hasn't built a payment system that would provide insurance companies with the premium subsidy payments.  They are expecting the insurance companies to bill them for these amounts.  It makes me wonder how long it will take them to get paid, and how that money will be tracked through the various private & government systems.

Also troubling was all of the confusion and inability to deal with Medicaid enrollments.

We'll see how the end of the year plays out.  I am hearing from people I deal with that they are actually able to get through the process now using Healthcare.gov, so at least they've made improvements there and some are getting approved for subsidies and enrolled.  Let's hope the improvements continue.

To read Bob's blog entry, please click here.

Healthcare.gov Offers New Shopping Feature - Sort of . . . .

Here's a link to the Kaiser Foundation Blog describing the new "shopping feature" on Healthcare.gov. 

Read the Kaiser Foundation Blog Entry here . . . .

Limited as the shopping feature is, I guess it's better than nothing.  How they could have developed a huge system like Healthcare.Gov and not understood that people want to see rates & plan information before deciding to create an account and then load a ton of personal information into the system blindly.

They wasted a lot of money on a dysfunctional system and are now having to spend more to remedy it without having to totally dismantle it.  In the meantime, people who may have wanted to purchase insurance there, cannot.  I guess people may have to phone in applications or do them on paper - you know, just like in the "good old days" . . .

System Glitches? Really?

Haven't been able to get into the Federal Exchange to peruse pricing or see if you qualify for a subsidy?  Most people haven't.   The website & the press keep saying it's due to traffic and I say - not so.  Now, there's finally confirmation in print of what some agents have been saying all week. 

Read the Story Here . . . .

The Center for Medicare and Medicaid Services (CMS), who is running the Federal Marketplaces in 36 states could barely handle agent training, and then had a security breach after some agents completed the coursework - sending agent information along with related social security numbers "into the wind" by "accident".

I would advise anyone who feels they need Federal Subsidy money to pay for their plan, to wait and see through the month of October.  Wait to see how this plays out and to be sure that the systems are working and have some level of security before putting in all of your personal information.

You have plenty of time - if you want your insurance policy to take effect on January 1, 2014, you need to apply no later than December 15.  Then, you still have until March 31 during this initial enrollment for plans to begin with effective dates after that.

No hurry - believe me, they need time to work this out.

For those who feel they won't qualify for the Federal money, and still need or want to buy a new ACA compliant plan for 2014, the options are actually greater outside of the exchange.  You have more choices of companies and plans, and the plans have slightly different benefits than those on the marketplaces.

If you'd like any help in looking at those in MO and KS, I'd be happy to assist, as always.

Monthly Premiums For A 'Benchmark' Silver Plan In Federally Run Insurance Marketplaces

Here we are one day before the October 1 enrollment through the Federal Marketplaces begins for those of you who are under the age of 65 and do not receive insurance through your employer.

I still do not have actual pricing from any of my carriers in Missouri or Kansas yet, so advising people as to what to do has been difficult, if not impossible. 

Some of you who have "grandfathered" plans - meaning your plan effective date was prior to March 23, 2010 - can keep the plan you currently have.

Those of you who do not have a "grandfathered" plan may be able to keep your existing policy for an additional year, depending on how your existing carrier is handling things.  In these cases you may have received a letter already indicating that this option will be available to you and that you'll simply sign an addendum in December, most likely, and agree to a small rate increase at that time.  This would allow you to continue with your plan through the end of December 2014.

Depending on what the new plan pricing looks like, the options above may be appealing.

Those of you who feel you will qualify for Federal subsidies will have to apply through the exchanges to receive the federal money.

I am certified to sell policies within the exchanges, but do not know what that process will look like yet, since the exchanges (or marketplaces, as the Federal Government is referring to them) do not exist yet.  Supposedly these will be online tomorrow, October 1.

Once I have detailed plan & pricing information, I'll share that with all of my individual and family clients.

The article from the Kaiser Foundation this morning offers an idea of what a Silver plan may cost in various "areas" within a state where the Federal Marketplace will be offering plans.  You can see that here . . .Benchmarks for Silver Plans through the Marketplaces.

Simply find your county and you'll see how rates compare with other areas of your state.

Within this article you'll also see the link for the subsidy calculator where you can play around with your numbers to see what might happen in real time once the Federal Marketplaces are operational.

Once I see that enrollments are going smoothly I'll discuss options with my clients.  In the meantime, I'd advise waiting to see how the initial launch goes, before making changes.  (but, that's just my opinion . . . .)