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View Diary: Healthcare.gov saga continues. What do I do now? (101 comments)

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  •  I may have an explanation (4+ / 0-)
    Recommended by:
    Pluto, agent, pollbuster, skohayes

    The Kaiser calculator is just parsng the income parameters and not taking into account a local plan-cost factor that can make a big difference n the actual (as opposed to estimated) amount of subsidy.

    In NJ, as well as NYS where I live, there is a at least one non-profit, Co-Op company  (Health Republic/Freelancers).  Their policies are very inexpensive, and at least in my area they offer more than one at the silver level.

    Low prices are generally a good thing, but they can have a  curious effect that intersects with incomes in determining potential subsidies.

    If your Mother's income (MAGI) falls between 300% -400% of the FPL, she is expected to pay up to 9.5% of it as a personal contribution towards her health insurance policy.  

    So multiply her MAGI  by 9.5%, that's her "personal contribution" to the costs of insurance.

    Then look for the second cheapest plan available on the SILVER  tier (never mind what tier she plans to purchase).

    If her income multiplied by 9.5% is greater than the monthly cost of the second cheapest SILVER plan available to her, she will get no subsidy.  If the second cheapest SILVER plan is less than 9.5% of her income, she will get a subsidy equal to that difference.

    This effect is particularly problematic in areas where there are traditionally high costs to health insurance plans, and it's compounded when there is an exceptionally low-priced insurance company, with more than one very low priced option in the silver plan.

    The problem with the Kaiser calculator is that it only calculates the subsidy based on income data input.  It really has no way of knowing what the second cheapest SILVER plan in your area is, so it can't take subsidy calculations the needed additional step.  That's why it's the estimated subsidy calculator.

    This discrepancy really boggled me for a while, but I finally dug deep within the government documents to get it clear in my mind.

    I doubt the website is getting confused about the SS income thing.  Part of my income is from SS, too, though I am below 65 and not on Medicare.  It handled things just fine.

    If your Mother doesn't fall between 300-400% of the FPL, then this doesn't apply and can't be your problem.  Though I think it may apply with a different -and much lower- required percentage as the personal contribution at the lower levels of the FPL.  I don't have the reference right at this computer, but I could look up the number for lower levels of the of FPL. I would be glad to do this if you want me to.

    If this seems right to you (based on your knowledge of your Mother's income) then the Exchange website calculations are probably correct. If not, press forward and get something else straightened out.  Good luck!

    Araguato

    •  Difficult to believe that the phenomenon you (3+ / 0-)
      Recommended by:
      agent, pollbuster, mrkvica

      are describing would reduce her subsidy from $550 to $0.

      As likely is that there is an error in what was entered, or as one commenter suggested, she's not asking for the rebate immediately, she's inadvertently indicating she will deal with it on her 2014 taxes in 2015.

      Or even a bug in the site subsidy calculator.

    •  Her income (net, before any adjustments at all) is (0+ / 0-)

      between 200-250% of FPL. To make the 2nd cheapest silver plan available to her affordable (i.e. premiums at 9.5% of HHI), she will need a $520 subsidy. Kaiser's estimate was $550. Not all that different.

      •  I think you mean her "gross" (2+ / 0-)
        Recommended by:
        agent, Nance

        rather than "net" income. For most people there are no adjustments, it's different from adjusted gross income on the tax form, especially if you get Social Security.

        But if her total income (including 100% of her Social Security benefit) is between 200 and 250% than there is probably something not working right.

        As an aside, expecting middle class, not upper, but middle class people to have to spend almost 10% of their income on health insurance premiums is ridiculous.

        "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

        by Alice in Florida on Sat Nov 16, 2013 at 06:57:24 AM PST

        [ Parent ]

      •  It doesn't seem like an income of (0+ / 0-)

        of between 200-250% of FPL would have the same effect as I described.  I will go and look up what the max. personal contribution is at that level.  More info as soon as I can wrangle it it out.

        Araguato

        •  OK, got the numbers of the max. personal contrib (1+ / 0-)
          Recommended by:
          agent

          At the levels of 200% of the FPL, the maximum personal contribution is 6.3% of your income.

          At 250% of FPL it's 8.05% of your (MAGI) income.

          At levels in between that, it's at some point on the slope of the line connecting them.

          But you could bracket this calculation by looking at the second lowest cost SILVER plan cost (be sure to look for the age adjusted cost) and seeing where this falls on a continuum between 6.3% and 8.05% of you Mother's income.  

          Simply put, if  the appropriately age-adjusted, second lowest cost silver tier insurance is higher than any amount between 6.3% to 8.05% of your Mother's  MAGI then the lack of subsidy being offered is due to some other counfounding factor or error.

          If it falls somewhere in between these limits, then depending on where and what your Mother's MAGI is, there may be a reduced, or no subsidy, compared to what was estimated on the Kaiser calculator.

          If the age-adjusted, second lowest cost silver plan is less than the lowest (6.3%) percentage of your Mother's MAGI (isn't there a song about that?) then no subsidy would be offered.

          I did a rough calc of the math for you.  If the age-adjusted, second lowest cost silver plan is less than @$120/mo and your Mother's income is closer to the 200% of FPL then no subsidy.  At the MAGI level of 250% then the plan cost could be as high as $192/mo and still result in no subsidy. (These figures for monthly premiums seem very low, so I'm thnking the lack of subsidy is NOT due to the personal contribution thing, but something else.)

          Math path: I start with 400% of FPL because I have a chart that calls that number out.  (It may be slightly out od date usng 2013 figures, not the slightly higher 2014 numbers. But it's good enough for the moment.) So, 400% of FPL, divided by 4; multiplied by either 2 or 2.5 to get the appropriate dollar-denominated amount of FPL for either 200% or 250%. Then multiply appropriately (6.3% of 200% of FPL income and 8.05% of 250% income).  Then divide these figures to arrive at the low and high ends of the range of maximum monthly personal contribution cost to be compared to monthly cost of available age-adjusted, second lowest cost silver plans. Got it?)

          So at least you have something to fiddle with over the weekend.

          I could post a link to the doc I used, if that would help. It's dense - and long. I have it stored on my hard drive as a .pdf, so no longer have its URL, but could rustle it up if needed.

          Araguato

    •  Health Republic's plans are very expensive in NJ (1+ / 0-)
      Recommended by:
      agent

      Araguato, not sure if you've seen the plan prices of Health Republic on their Web site. Their customer service said those were the correct list prices, and, it turns out, the prices listed in Healthcare.gov when you "view plans" before completing an application are entirely bogus. They lump huge age groups together, like everyone up to age 47.

      You would think a coop's monthly premiums would be cheap, but they're showing an astounding $2800-$2200 for a family of four -- more than twice what I'm now paying off-exchange to Horizon.

      Of course, subsidies bring that down, but I'm wondering what prices you're finding for HR in NJ -- eg, for a family of four?

      •  I'm looking Health Republics prices in NY, (1+ / 0-)
        Recommended by:
        agent

        not N.J.

        Their Platinum plans in the upstate Albany, NY area (for one 60+ y.o. person, which is what I am) are less than $400/mo with zero deductible and ridiculously low OOP max.

        They are new to the NY market, so maybe these are teaser rates for the first year.  I know they have been in the NJ market longer.

        But there may still be other low-cost silver-level plans driving down the insurance cost relative to the personal contribution, thus reducing potential subsidy amounts

        Araguato.

        •  teaser rates . . . (1+ / 0-)
          Recommended by:
          agent

          . . pretty sure there is a limit of 10% per year increase on the exchange. Also, the out-of-pocket limits are regulated also . .

          "We have the habeas corpus act, and we respect it." Dwight D. Eisenhower - November 23, 1953

          by malcolm on Sat Nov 16, 2013 at 08:51:18 AM PST

          [ Parent ]

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