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.

Obamacare: To Buy Or Not To Buy–––An Entrepreneur Would Have Done It Differently

Bob Laszewski's blogpost today discusses how the plans under the new Affordable Care Act were built and whether or not people will actually purchase them.  I have had discussions about this with my clients, as to what they will decide to do at the end of 2014, when they will no longer be able to hang on to their 2013 style insurance plans any longer.

Many of these people are self-employed, and do not qualify for any type of subsidy.  Most of them are relatively healthy, and have always carried health insurance on their own.  And yes, it was "real" insurance - not sub-standard coverage.  When the time comes for them to choose an ACA style plan next year for coverage to take effect in the year 2015, they are going to find that their premiums without a subsidy will double in many cases.  The reason for that is that all of the current plans include all of the "essential health benefits" that the government built into every health plan, whether you deem it essential or not.

That is not to say that plans previously didn't have their problems - access to maternity coverage was a huge problem in the individual market.  Often, it was not even offered as an option.  But, maybe they could have found a solution like having every insurance company offer a maternity "option", that people who wanted the coverage could purchase - rather than build it into every plan.  Same for things like pediatric dental.  There were many other ways to have offered these benefits to people rather than baking them into every plan.

As an individual in the marketplace, I should have the right to purchase a catastrophic plan if I so choose, but that right was also taken from me, in the government's zeal to have everyone own a plan that looked very much like employer based plans look and feel.  Well, that's great, if you have an employer either paying for the plan, or kicking in 50% or more.  For those of us who are self employed, or work in places where no health insurance is offered, buying a Cadillac is just not a feasible proposition.

Keep in mind too, that the self employed also pay the maximum amount already on things like social security contributions and Medicare contributions in the form of self-employment tax, since they don't have an employer kicking in a portion of that.  Read Bob's Blogpost Here . . . .

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.

Correction to Previous post regarding Hospital Subsidies . .

The article referenced in the previous post was from the New York Times (not the Wall Street Journal) - I apologize for the error.

Some Little Known Subsidy Cuts to "Safety-Net" Hospitals, May Leave Some Without Care . . . . .

As various subsidies to hospitals that provide care to the uninsured, especially those that do not qualify for Medicaid, are implemented - some could be left with nowhere to go for much needed medical care.

The Medicaid expansion under the Affordable Care Act would have provided coverage to many of these people.  But - since Supreme Court ruled that the states would have to be given the ability to "opt out" of the Medicaid expansion, many did.  That leaves a gaping hole in the body of people who would have been covered by the expansion.  Without the expansion, many of these individuals will not qualify for Medicaid - AND - they may not qualify for a federal subsidy to purchase health insurance through the new health insurance marketplaces.  An individual must have a Modified Adjusted Gross income of $11,490 to qualify for a subsidy.  If you make less, but do not qualify for Medicaid coverage, you will have no options other than to pay full price for a health insurance policy - which many cannot possibly afford.

Hospitals that previously might have cared for these patients because they were subsidized for doing so, will now have those subsidies cut and may need to begin to refuse care or turn people away.

The Wall Street Journal published a good article that explains the predicament very well.  Read more here . . . .

Obviously, some adjustments will need to be made to the health care law to compensate for these unexpected situations arising out of modifications in the law to date.  A lot of delivery of care and coverage issues were hoped to be solved with the Medicaid expansion.  Since that was limited significantly, large groups of people who had counted on it as a mechanism for health care coverage will be left behind once again and will remain uncovered, unless something is done to correct that.

"Bad Apples?" - Really?

Although there were some policies sold in the individual insurance market in the past that were not what I'd term "real major medical insurance", I know that those of us in the agent community did our best to educate our consumers and make sure they understood the differences and what to look for in a legitimate policy. 

My clients all had policies that offered them a good amount of financial protection for the money.  Yes - there were trade offs - if you wanted a lower premium, you could raise the deductible, or forgo other benefits.  But my clients made  those choices after discussing the ramifications of those decisions, so that they would buy a policy that would protect them in the ways that they thought were important to them.

The President made it sound as if the individual market was the wild, wild west and this total overhaul was the only way to protect the public.

Also, in the hearings on Capital Hill, they never once advised that people could get advice, or help from independent agents (like myself), while they try to fix their broken system and can't handle the phone traffic coming into their call centers with questions.

As Bob Laszewski sites in his post that follows, you begin to wonder if they understood anything about our insurance system at all.  I never would have dreamed that to be the case, considering that Kathleen Sebelius ran the Dept. of Insurance in Kansas before she was Governor.  I guess memories are short . . . . .

Health Policy and Marketplace Review

Personally, if my policy loses its "grandfathered" status, I have no idea how I'd ever afford an ACA compliant plan that would be comparable.  Hopefully, I won't have to ponder that decision (or "non-choice")  for awhile . . . . .