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Whew! I'm done. I hope I am any way. My situation is such that I haven't had any large medical bills in years. Literally $0 from 2008 through 2011, $59 in 2012 and $80 this year. So I selected a Bronze plan for $446.45/month with a $6,350 deductible and $6,350 maximum out of pocket. I studied the other plans but there is no sense purchasing the higher priced plans with lower deductibles if I haven't needed that much coverage to date.

We spend more on veterinary bills for our cats and dog than we do on ourselves. Well, that is until this year. My husband turned 65 in 2012 so he's covered by Medicare and for the first time in years he's actually had major medical bills thanks to a 16-day stay in the hospital in October. And now he has to take several prescription drugs daily, so the last couple of months have been an eye-opener for us.

I had gone through the application process last month but was stopped in my tracks when I entered my husband's social security number incorrectly. I patiently waited for it to be fixed for several weeks before I finally gave up and created a second account with a different email address. Then I was able to get through the entire process, at the end of which I was presented with a choice of 96 plans. With my husband being released from the hospital, our days were filled with follow-up visits to doctors, and so I decided to wait to select a plan until things settled down around here and I had time to think. And so I went back to healthcare.gov on Tuesday where I discovered the waiting room and the fact that the 96 plans had diminished to 12 plans. I called the toll-free number and was told there was a glitch in the system, and to wait a few hours and log back in.

I waited until yesterday when I signed in to discover that the number of plans available to me went down to 9. I vented my frustration in a diary asking for help from this community. It turned out to be a good thing because I learned some additional information that I might not have found out if I hadn't written that rant.

Ignorance may be bliss but it is not a defense when it comes to following the law. For example, as I mentioned above, my husband turned 65 last year. He received his Medicare card in the mail, but we didn't sign him up for anything extra like a supplemental plan or a Part D prescription drug plan. For almost a year nothing happened until I had to call an ambulance to take him to the hospital in October because he couldn't breathe. He's doing very well now, and has some really great doctors.

This was a wake up call that we needed to take the time to actually understand how Medicare works and what our options are. We were already being bombarded with mail from every insurance company that offers Medicare Advantage plans, prescription drug plans and supplemental plans. Not that just having Original Medicare isn't a good option. It's worked out fine for us. Out of the approximately $31,000 in hospital stay, doctors visits and prescription drugs, that have come in for the ordeal, our out of pocket has been slightly over $2,000, and that includes the $1,184 deductible we had to pay for the 16-day hospital stay. On Saturday my husband had to go back into the hospital for four days, but because it was within 60 days of his last stay, the $1,184 deductible covers that second stay too. This also serves as a cautionary tale because if this had happened to uninsured me we would be looking at some major debt. I'm very relieved to know that there is a limit to how large the expense will be if I get sick in the future.

But I digress. We did sign up for a Medicare Advantage plan that takes effect in January. Since my husband was just in the hospital, he's not eligible to apply for a supplemental plan. We were mainly concerned about signing up for the Part D Prescriptions because that has become a very expensive part of his healthcare needs right now. What I did learn and wanted to share is that since we did not sign him up for a Part D plan when he first became eligible, we now have to pay a monthly penalty for the rest of his life. It works out to about $4.30/month, which isn't going to break us but had we known that by failing to sign up for Part D when eligible, we were going to have to pay this penalty we would have signed up. I just wanted to share this so those of you who haven't reached Medicare age yet will be aware of this when you qualify.

Along the same lines, I learned a similar important point in the comments from my rant last night. If you think you may qualify for the subsidy, you need to get your healthcare through one of the exchanges. I'm in a situation where I don't exactly know what my income will be in 2014 since most of my income comes from commissions and it fluctuates. Remember, yesterday all the plans available to me were not showing up. I mentioned that I didn't want to actually use the subsidy but would prefer to get it as a credit on my income taxes at the end of the year. Somebody mentioned that if I wasn't going to use the subsidy, I could just buy a policy online from any insurance company offering policies because they all had to be ACA compliant.

Turns out that further discussion proved that not to be true. I may or may not qualify for a subsidy in 2014. It really all depends on what my Adjusted Gross Income ends up being at the end of the year. From what I estimated, the healthcare.gov site said I qualified for $107/month (or $1,284 for the year). I had three choices. I could apply all of the $107 and reduce my monthly premium, I could apply part of it, or I could apply none of it and get a $1,284 credit against the taxes I owe for 2014 ... if nothing changes.

According to the comments in yesterday's diary, if I went online and purchased a policy, I would not be able to take the $1,284 credit on my income taxes if I did not apply for the policy through a state or the federal exchange, even if I qualified for it. I thought how strange that sounded. If you qualify for a credit you should be able to take it even if you didn't get your insurance through an exchange, Right? WRONG! WRONG! WRONG! According to the IRS:

Eligibility

In general, you may be eligible for the credit if you meet all of the following:

    buy health insurance through the Marketplace;
    are ineligible for coverage through an employer or government plan;
    are within certain income limits;
    file a joint return, if married; and
    cannot be claimed as a dependent by another person.

If you are eligible for the credit, you can choose to:

    Get It Now: have some or all of the estimated credit paid in advance directly to your insurance company to lower what you pay out-of-pocket for your monthly premiums during 2014; or
    Get It Later: wait to get all of the credit when you file your 2014 tax return in 2015.

The Premium Tax Credit

The IRS is very literal so when they say that one of the conditions is that you buy health insurance through the Marketplace (Exchange), you better buy it there.

I think that some time around April 2015 there are going to be a lot of angry Republicans throwing fits because they could have qualified for a tax credit, but since they stubbornly refused to go to the exchanges to find out what their options were, will not be able to take the tax credit. I met one of those people on Facebook (a friend of a friend) who was complaining that her insurance premium went up $250 per month. I asked her if she did comparison shopping on the exchange, and she was adamant that she wouldn't be visiting that website. I wonder how many Republicans are paying more for policies than they have to because of their partisan refusal to comparison shop at an exchange?

UPDATE: Just saw this on The Last Word with Lawrence O'Donnell guest hosted by Alex Wagner tonight. There's a great site to help remind friends to get covered. It's appropriately called Tell A Friend Get Covered, and this video is from the site.

Originally posted to hungrycoyote on Thu Dec 12, 2013 at 04:52 PM PST.

Also republished by Community Spotlight.

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Comment Preferences

  •  Tip Jar (160+ / 0-)
    Recommended by:
    leu2500, viral, Mary Mike, markdd, ItsaMathJoke, antooo, itskevin, slowbutsure, pico, Lorikeet, Glen The Plumber, Just Bob, WheninRome, a gilas girl, Its a New Day, northcountry21st, DRo, poliwrangler, janmtairy, MRA NY, TXdem, pickandshovel, petesmom, sc kitty, mrsgoo, Larsstephens, Habitat Vic, stevenwag, scamperdo, suesue, SaintC, happyshadow, Phoenix Woman, BlackSheep1, ichibon, asterkitty, Cassandra Waites, peagreen, worldlotus, celdd, badlands, terabytes, Pluto, this just in, elfling, NYWheeler, Involuntary Exile, NapaJulie, night cat, deepeco, annan, murphy, myboo, thomask, Fury, shesaid, BarackStarObama, vernonbc, Youffraita, WinstonsMyDog, chantedor, SneakySnu, Lujane, FloridaSNMOM, riverlover, Eileen B, Creosote, Capt Coyote, Puddytat, ladybug53, duhban, amsterdam, jcrit, kaliope, MartyM, hwmnbn, Rosewood, Betty Pinson, second gen, Nance, AllisonInSeattle, clutch1, Most Awesome Nana, eagleray, christine20, Spirit of Life, ZedMont, Rogneid, Pat K California, TofG, barbwires, guyeda, wdrath, Turbonerd, anodnhajo, wishingwell, Odysseus, Pinto Pony, JanetT in MD, OutCarolineStreet, CADeminVA, The Jester, Jakeston, No one gets out alive, afisher, chuck utzman, ruellia, BlogDog, trivium, Mayfly, manyamile, Wino, rhutcheson, Sun Tzu, Sylv, DeminNewJ, amyzex, dpinzow, scyellowdogdem, onionjim, el dorado gal, dksbook, Aaa T Tudeattack, sulthernao, Vatexia, boudi08, gmats, fixxit, pvasileff, msazdem, exNYinTX, LamontCranston, Heart n Mind, tofumagoo, 207wickedgood, eyesoars, urnumbersix, Wrench44, samddobermann, raines, stlsophos, cv lurking gf, tiredofcrap, OIL GUY, jguzman17, LNK, oceanview, Moody Loner, Oh Mary Oh, 2dot, Libby Shaw, Bill Roberts, politically indigo, foresterbob, Independent Musings, WisVoter, Ricochet67, Blue Bronc, mod2lib, indres

    “Mitt Romney is the only person in America who looked at the way this Congress is behaving and said, ‘I want the brains behind THAT operation.’ ” — Tom Perriello

    by hungrycoyote on Thu Dec 12, 2013 at 04:52:16 PM PST

  •  Good info! Thanx! eom (12+ / 0-)

    Reality has a well-known liberal bias -- Stephen Colbert

    by ItsaMathJoke on Thu Dec 12, 2013 at 05:14:41 PM PST

  •  I hope it gets less complicated.. (18+ / 0-)

    My employer's old plan didn't measure up to the ACA.  So they dropped it.  the replacement plan only covered 2 well visits, 2 sick visits and palliative prescriptions issued at those 2 visits.  My wive is on several maintenance medications that cost more than the difference in the plans, so I opted out.

    Replacing my $800 a month policy with a Silver policy that covers her meds will cost ~$1250 per month....   I make too much at the moments for subsidies, and the whole premium tax credit process is hard to decipher.  A navigator told me today, that it's one of the last screens on the sign up before the deal is finalized........

    “that our civil rights have no dependence on our religious opinions, any more than our opinions in physics or geometry.” Thomas Jefferson

    by markdd on Thu Dec 12, 2013 at 05:18:39 PM PST

    •  Yes, it was one of the last screens. First (19+ / 0-)

      you enter your basic information, then you get to the income section where it asks you if your income in 2014 will be the same as 2012. I tried saying yes, because it is close enough, but I kept getting an error message at the end. So I deleted the application, and started over, only this time I entered an amount for my guess at what 2014 income will be. That worked. After submitting the income information, it came back and told me that I qualified for $107/month subsidy.

      Then before it gives you a list of plans available to you, it asks you if you want to use all, some or none of the subsidy. I chose none because I'd rather just settle up at the end of the year.

      Thank goodness they added the ability to delete an application. I've learned it's easier to just delete it and start over. If you go back and try to fix one, you still have to go through every single screen so you might as well just start fresh.

      “Mitt Romney is the only person in America who looked at the way this Congress is behaving and said, ‘I want the brains behind THAT operation.’ ” — Tom Perriello

      by hungrycoyote on Thu Dec 12, 2013 at 05:24:59 PM PST

      [ Parent ]

      •  Thanks, I've got to do more figuring (9+ / 0-)

        We also tried an end run, since my wife owns a daycare business we thought we might try setting up a plan for the company (~25 employees).  No dice. In WA, only Kaiser Permanente is set up to offer small business coverage and then only in Clark and Cowlitz(?) counties.  Far, far away form the population centers of Seattle and Tacoma...

        “that our civil rights have no dependence on our religious opinions, any more than our opinions in physics or geometry.” Thomas Jefferson

        by markdd on Thu Dec 12, 2013 at 05:31:50 PM PST

        [ Parent ]

        •  Actually, I am the only employee of an (10+ / 0-)

          S Corporation, so I did research on this. Since I am the only employee, the company can't purchase insurance but it can reimburse the premiums since I am also a more than 2% shareholder. The corporation has to report the total premiums on the income portion of my W-2, but it is not subject to FICA or medicare tax. On my personal taxes, I have to report the premiums as income, but then I am able to take "an above the line" deduction for the premiums. So it zeroes out on my personal taxes and the Corporation deducts it as a payroll expense.

          What kind of business structure is the daycare set up as?

          “Mitt Romney is the only person in America who looked at the way this Congress is behaving and said, ‘I want the brains behind THAT operation.’ ” — Tom Perriello

          by hungrycoyote on Thu Dec 12, 2013 at 05:39:13 PM PST

          [ Parent ]

          •  LLC reports as a C (7+ / 0-)

            I'm not an official employee, but I do do the book keeping, so we could arrange something.  Since we can't purchase group coverage, we may be able to examine the reimbursement.

            Since most of our employees are just above minimum wage, they qualify for subsidized coverage here in WA.  They were concerned that if we offered insurance, they'd lose there low cost subsidized policies. so this might be a win-win this year.

            “that our civil rights have no dependence on our religious opinions, any more than our opinions in physics or geometry.” Thomas Jefferson

            by markdd on Thu Dec 12, 2013 at 07:28:46 PM PST

            [ Parent ]

      •  wow - did not know this (3+ / 0-)
        we now have to pay a monthly penalty for the rest of his life.
        So, basically we're penalized for being healthy!

        "Tax cuts for the 1% create jobs." -- Republicans, HAHAHA - in China

        by MartyM on Fri Dec 13, 2013 at 03:47:14 AM PST

        [ Parent ]

        •  No. You are (13+ / 0-)

          penalized for not paying attention when you start Medicare.

          •  Permanently? That sucks. (6+ / 0-)

            REgulations for Medicare, or for the Exchanges, etc., are among the banes of all our lives.  Not figuring out in advance what decision you can't just put off should not be a crime punishable by long-term consequences.  Even modest ones.

            --------------------- “These are troubling times. Corporation are treated like people. People are treated like things. …And if we ever needed to vote, we sure do need to vote now.” -- Rev. Dr. William J. Barber

            by Fiona West on Fri Dec 13, 2013 at 08:32:58 AM PST

            [ Parent ]

            •  As jasan points out down thread: (10+ / 0-)
              Your husband found out about the mandate that President Bush's plan had in it for Medicare Part D.  What you found was that we have been living with a health mandate that forces you to purchase a drug plan since 2003, long before Obamacare.

              Thu Dec 12, 2013 at 10:16:58 PM EST

              “Mitt Romney is the only person in America who looked at the way this Congress is behaving and said, ‘I want the brains behind THAT operation.’ ” — Tom Perriello

              by hungrycoyote on Fri Dec 13, 2013 at 09:06:04 AM PST

              [ Parent ]

            •  Those of you who have been deifying (1+ / 0-)
              Recommended by:
              hungrycoyote

              Medicare don't know what you have been wishing on the general population.

              Shopping for a prescription D plan or going with the privatized Medicare plans takes a lot of work.

              I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

              by samddobermann on Sat Dec 14, 2013 at 03:25:11 AM PST

              [ Parent ]

              •  Shopping for health insurance (1+ / 0-)
                Recommended by:
                hungrycoyote

                -- and any other kind, for that matter -- takes a lot more time and effort than it should.

                And while I don't think the lifetime penalty for not signing up for drug coverage when it is first available is necessarily kind or correct, the information I have seen on that option makes it very clear that the penalty exists.

                And, it seems to me, with some good reason. Like all insurance, if I wait until I need it and opt in then -- well, that's not how insurance works.

                I do think a lot of us who are new to private health insurance are going to be very unhappy with the way insurance works once we get to that point. Like Medicare, it's not a service you can sign up for and just forget.  

          •  Oh shit. (1+ / 0-)
            Recommended by:
            hungrycoyote

            I start Medicare in April.

            •  At least you know that you need to pick (1+ / 0-)
              Recommended by:
              Moody Loner

              a Part D plan. My work here has been accomplished knowing that I have saved you from having to pay the lifetime penalty.

              “Mitt Romney is the only person in America who looked at the way this Congress is behaving and said, ‘I want the brains behind THAT operation.’ ” — Tom Perriello

              by hungrycoyote on Sat Dec 14, 2013 at 09:40:30 AM PST

              [ Parent ]

            •  Medicare Penalty (2+ / 0-)
              Recommended by:
              hungrycoyote, Moody Loner

              Hope you opted to start Part B (doctors). If not you will pay a penalty for that. If you chose a Medicare Advantage plan, they require you to pay your Part B premium. So you will be ok as Medicare Advantage plans include the prescription component.  

        •  Medicare Penalties (1+ / 0-)
          Recommended by:
          hungrycoyote

          If you have credible insurance (from an employer which is equal to or better than Medicare) when you turn 65, you will have Part A (hospitalizations) as a secondary payer. It costs nothing as you paid for this all working years.  If you lose your credible insurance (retirement, layoff, etc.), you are required to sign up for Part B (doctors, labs, etc.) within a certain time or you will pay a penalty for the rest of your life once you do get Part B. Current premium is $104.90/month.  If you join a Medicare Advantage (MA) plan (as opposed to traditional Medicare), Part D (prescriptions) are included in most MA plans and you may not apply for a separate Part D plan.  You still must pay your monthly Part B premium.  Part D and Medigap Supplements are only available on traditional Medicare.

          •  And if you get Social Security ... that $104.90 (0+ / 0-)

            is automatically deducted from your social security payment each month.

            “Mitt Romney is the only person in America who looked at the way this Congress is behaving and said, ‘I want the brains behind THAT operation.’ ” — Tom Perriello

            by hungrycoyote on Sat Dec 14, 2013 at 12:11:22 PM PST

            [ Parent ]

  •  How were you able to pay for it? (13+ / 0-)

    Is it because you chose to defer the subsidy?  We signed up a week ago and chose our plans but I haven't yet received the paperwork.  It's listed in my on-line ACA account, just no verification from BCBS yet.  The general consensus (both here and on the healthcare.gov chatroom) was to wait a week and if I haven't heard from BCBS (I'm in FL, too, Lee County) I should contact them.  I've put the $$ aside and would like to get it paid for before Christmas and relatives start pouring into town.  

  •  I am signed up now too (24+ / 0-)

    and getting off my HIPAA plan, which was a horribly expensive stopgap. I am very thankful for the ACA, without which I'd probably have HIPAA as my only choice (well, technically I could sign up for the state high risk pool, but that is even crappier and more expensive).

    My current insurer played a long auto-recorded message while I was on hold to cancel with them, telling me that maybe I really wanted to keep my grandfathered healthcare plan. Yeah, sure, I really want to pay $800 a month more vs. what I can get on the exchange. They are counting on some people doing nothing and not going shopping.

  •  There might well be (15+ / 0-)

    plenty of noseless Republicans come April 2015:

    I asked her if she did comparison shopping on the exchange, and she was adamant that she wouldn't be visiting that website. I wonder how many Republicans are paying more for policies than they have to because of their partisan refusal to comparison shop at an exchange?
    I kind of like that image.

    ;-)

    Words can sometimes, in moments of grace, attain the quality of deeds. --Elie Wiesel

    by a gilas girl on Thu Dec 12, 2013 at 06:11:16 PM PST

  •  Re: Medicare -- SHIIP (13+ / 0-)

    Great to know  you got this sorted out. On the Medicare side, people should know that each state has a Senior Health Insurance Information Program that can provide free assistance in finding the best Medicare Part B (supplement) and Part D (prescription) plans.

    For a list of phone numbers:
    http://www.shiip.state.ia.us/...

    As you say, there can be penalties for not signing up timely and the options can be overwhelming (although maybe not compared with 96 plans)!

    •  I wrote this diary in part so (15+ / 0-)

      that people would be aware of that Medicare penalty that I didn't know about. My mother always told me nothing bad ever happens to you if you can take what you learned from the experience and help somebody else.

      Thank you for adding additional information to help people know the rules.

      “Mitt Romney is the only person in America who looked at the way this Congress is behaving and said, ‘I want the brains behind THAT operation.’ ” — Tom Perriello

      by hungrycoyote on Thu Dec 12, 2013 at 06:25:23 PM PST

      [ Parent ]

      •  Medicare is much more complicated than (2+ / 0-)
        Recommended by:
        hungrycoyote, foresterbob

        most people think.

        I wrote 2 diaries back in 2011 when I became eligible for Medicare.  I am linking below because every year of course there are more people who need the information.

        http://www.dailykos.com/...

        http://www.dailykos.com/...

        The premium and deductible information in those diaries are 2011 numbers so you would need to look up the figures for 2014 which are slightly different.

        Also, I don't think I mentioned in those diaries that if you don't sign up when you become eligible during your open enrollment, you do have consequences. As you note, you have to pay extra for Part D. Also, you will have to go through underwriting for a supplement if you do not sign up during your open enrollment which as you found out can mean you cannot get a supplement. It is my understanding that the ACA prohibition against pre-exisiting conditions exclusions do not apply to supplements since they are not primary insurance.
        I do not know what the consequences are if you do not sign up for Part B during your initial eligibility period but anyone considering that should find out what, if any, are the consequences.

        As to Part A, as you noted, since your husband was readmitted to the hospital within 60 days, he did not have to pay another deductible. However, if it had been 61 days, he would have started another benefit period and had to pay the deductible again, even if it was in the same calendar year. Part A benefit periods are counted as from day 1 of admission to the hospital, not a calendar year as most deductibles are.

        You can't scare me, I'm sticking to the Union - Woody Guthrie

        by sewaneepat on Sat Dec 14, 2013 at 05:18:02 AM PST

        [ Parent ]

  •  I really think that option (14+ / 0-)

    to go for the subsidy but defer its application until tax time is a really smart way to go for people who are not really sure of their 2014 income.

    I fear for people who take the subsidy up front and then have it yanked away from them in April 2015 because of bad guesstimates made in November 2013.

    The whole subsidy aspect of the legislation is extremely Rube Goldberg-esque. There are several aspects of it that worry me.

    First there seems to be a 'step function' aspect to the way it is calculated. There is a severe drop off in the amount of subsidy right at the upper limits and there may also be steps below the upper limits in the intermediate range of the subsidy. That means that people who underestimate their future income may see fairly large negative revisions when they do their taxes after their actual income is known. In addition there are some perverse incentives to lower one's income since getting it just below the threshold can result in such a large chunk of subsidy. Really the thing should have been designed to have a smooth gentle slope from a high subsidy down to nothing at the upper income limit. Just in general the basic idea of setting (and then spending) subsidies based on information guesstimated as much as 17 months before filing taxes seems pretty bad. Perhaps they should have just based it on a three year average including the (relatively stable) estimate for the immediately prior year.

    The other aspect of this that seems to stink is the fact that the subsidies are dependent on the 'second lowest cost silver plan' in a coverage region. Instead of setting the rate based on some average of health care costs (or average of plan premiums across all competitors) in a locality it is based on a quirk of how ONE or two insurance companies in a region has priced TWO plans (lowest cost and second lowest cost silver plans). Depending on the level of competition in that area as well as on the whims of a few executives of private companies - the entire subsidy structure of a locality can be disproportionately impacted. This seems fairly stupid to me.

    It's going to cause a lot of agita for the foreseeable future. For every 10 people who are helped by the subsidy infrastructure I have a gut feeling that 3-4 will be slammed in some way. That will produce lots of negative anecdotes for ACA foes to use (in addition to annoying the heck out of people who hit these various boobytraps).

    •  That's why I didn't want to use it on my (8+ / 0-)

      monthly premium. My income can easily fluctuate too much one way or the other.

      Of course, that's something that might need fixing except that the GOP is so against fixing anything in ACA because they just want to repeal it and nothing else.

      “Mitt Romney is the only person in America who looked at the way this Congress is behaving and said, ‘I want the brains behind THAT operation.’ ” — Tom Perriello

      by hungrycoyote on Thu Dec 12, 2013 at 06:46:55 PM PST

      [ Parent ]

    •  The highest priced option (6+ / 0-)

      in each of the metal categories for my zip code?

      Local-only PPO.

      As in, local to the nearest metropolitan area. Meaning just about any ER in-network is an hour or more ride away and while ambulances might be willing to take a request for a particular close-by hospital I really think that's a bit beyond requesting.

      Oh and you only find this out by looking through the provider directory. By going through the federal exchange, because the insurance company website doesn't tell you what the network you need to be looking at is. They have regional and nationwide PPOs, it's just that no one living near me has been deemed worthy of accessing them.

      And it's quite a bit higher premium in each case.

      The others available have nationwide doctor networks and PLENTY of access to local doctors and hospitals.

      Why the HELL are those plans from that one company even listed for this zip code? They have like three providers OF ANYTHING nearby, and the specialties are rather random.

      If their silver plan wasn't an option, like it really shouldn't be, the subsidy amount for this area would drop.

    •  I have to estimate too (3+ / 0-)
      Recommended by:
      barbwires, wishingwell, hungrycoyote
      I fear for people who take the subsidy up front and then have it yanked away from them in April 2015 because of bad guesstimates made in November 2013.
      I'm in California. I thought Covered CA told me I had to report any deviation in my income when I file by April 15, 2014 not 2015.
      Is my understanding wrong?
      I'm totally with you on the problem of the huge drop off in subsidy when income goes up to next higher bracket.

      "When I see I am nothing, that is wisdom. When I see I am everything, that is love. My life is a movement between these two." - Nisargadatta Maharaj.

      by mkor7 on Fri Dec 13, 2013 at 06:47:38 AM PST

      [ Parent ]

      •  When you apply at the healthcare.gov (2+ / 0-)
        Recommended by:
        Sylv, sewaneepat

        site, you have to agree to three statements. One of them is that if your circumstances change, you will notify the government. So if you have major change in income, I suggest that you contact the Exchange at their toll-free number and ask what process you have to go through to notify them of the change.

        “Mitt Romney is the only person in America who looked at the way this Congress is behaving and said, ‘I want the brains behind THAT operation.’ ” — Tom Perriello

        by hungrycoyote on Fri Dec 13, 2013 at 09:08:42 AM PST

        [ Parent ]

        •  Ahh. That makes sense. (3+ / 0-)
          Recommended by:
          hungrycoyote, gmats, mkor7

          It sounds like they warn you to report deviations from your estimates as soon as possible.

          That will ameliorate some of the shocks that might occur if you wait until the last minute which is tax filing time in April 2015.

          It's better to lose some subsidy in May of 2014 (say you get a bonus or raise or some new client) as opposed to having to give a much bigger chunk of cash back in April of 2015.

          Still the whole thing is a bit of a kludge. Damn it would have been nice to have a public option or medicare buy in for 55 and older. So much of this would have just washed away. Even the medicare buy in would have been a great compromise since the insurance companies would have been happy to be rid of my cohort so they could concentrate on the healthier, younger crowd. Lieberman and Baucus are the gifts that keeps on giving. They screwed up so many aspects of this.

          Consider that folks who are getting the subsidy tend to be folks who have not had to play complex games on their taxes. The vast majority probably file with the 1040EZ form.

          Now all of a sudden you have to be a junior tax accountant to work out all the angles.

          Oy.

          •  You would still have the same cost (1+ / 0-)
            Recommended by:
            hungrycoyote

            and pricing problems.

            Both of your choices would involve premiums which might need subsidies too.

            Medicare part B is ~$400 per person and who knows what part A would be. Then you would have to buy another private policy for prescriptions.

            So that could run some $1000 per month per couple.

            I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

            by samddobermann on Sat Dec 14, 2013 at 03:47:15 AM PST

            [ Parent ]

            •  Medicare Part A buy in in 2014 is $426 (4+ / 0-)
              Recommended by:
              hungrycoyote, paige, mkor7, indres

              which is actually a little less than the $441 it cost in 2013.

              So it could run to $1000 per month per person with Part D and even more with a supplement. Medicare is per person, not per family.

              Now, of course, those figures are for a 65 year old so it would be somewhat less for younger people.

              I think that a lot of people (like me before I turned 65) think that Medicare is free healthcare. It is wonderful health insurance but it is not free.

              Only Part A is free as far as premiums go (if you have paid in for at least 40 quarters) but it has substantial deductions and co-insurance for an extended hospital stay. Part B and D premiums are heavily subsidized (from the general fund) so that seniors pay only 1/4 of the actual premium. Part B will cost $105 per month next year and has a $147 deductible and a 20% co-insurance. If you make over $85,000 individually or over $170,000 jointly, you have a higher premium. Part D premiums depend on the plan selected and deductibles and co-pays also depend on your plan. Supplements are wonderful, but also cost money. Depending on the plan, they pay some or all deductibles and co-pays plus some extras such as more units of blood.

              I will pay just over $300/month next year for my Medicare and supplement premiums. I am not complaining, mind you. For that, all my costs except drug costs are paid by Medicare and the insurance companies. Affordable, but not free by any means.

              You can't scare me, I'm sticking to the Union - Woody Guthrie

              by sewaneepat on Sat Dec 14, 2013 at 05:37:09 AM PST

              [ Parent ]

              •  I would also add that the Advantage plans (0+ / 0-)

                are often free. The way I understand it is that the government pays the insurance company to manage your medicare benefits. The co-pays and deductibles are different than Medicare (a hospital stay is actually a bit higher), but there are caps on what your out of pocket can be each year as opposed to Original Medicare which includes no caps.

                We wanted to get the supplemental plan for about $220 per month for my husband in 2014, but since he was in the hospital within three months of applying he can not get that kind of plan. We can change over in 6 months if he is not readmitted or wait until next year's open enrollment.

                “Mitt Romney is the only person in America who looked at the way this Congress is behaving and said, ‘I want the brains behind THAT operation.’ ” — Tom Perriello

                by hungrycoyote on Sat Dec 14, 2013 at 07:40:16 AM PST

                [ Parent ]

          •  Thank you all for your answers. eom (1+ / 0-)
            Recommended by:
            hungrycoyote

            "When I see I am nothing, that is wisdom. When I see I am everything, that is love. My life is a movement between these two." - Nisargadatta Maharaj.

            by mkor7 on Sat Dec 14, 2013 at 11:52:19 AM PST

            [ Parent ]

  •  Some more Medicare tips: (13+ / 0-)

    If you'd like to switch back to Traditional Medicare during the next open enrollment period it may be possible to buy a Medigap (aka Supplemental) policy at that time.  Because a year on a MA plan is defined as "creditable" coverage, which is what you need to be able buy a Sppl. plan without too much hassle.

    However if you live in a state where medical underwriting is still legal, then health history may still bite you in the butt because of increased costs. I live in NY and we have community rating so there's no underwriting, a fact that several Supp. policy customer sales people I called seemed not to know.

    But the take away here is that for the first 6 months after you start Medicare you have the right to buy any policy you want that's sold in your state, but after that the window closes, at least until the next open enrollment period. (There still may be reduced coverage, or a black-out period if you haven't had Suppl. insurance, even if purchased during Open Enrollment.).  But once you have creditable coverage in place you can change polices pretty easily.  We are doing that this year and I thought it had to happen during the open enrollment period, but found that if you have a policy, you can change it whenever you want as long as you don't go w/o coverage for more than a month. (The month is to allow for getting all paid and signed up with the new guys if something is lagged.)

    My husband has major health issues and we were in a swivet last year because we didn't know about the 6-month window the year he began Medicare.  However, we had something called a Medicare Complementary Policy from our old insurance company (I kept them as I am younger than he is) for the months that year after he turned 65, and that coverage was deemed "creditable" so we were OK.  But it's another thing you have to know about and make decisions about that will follow you for the rest of your life.

    If you want a Suppl. policy, it pays to get quotes from everybody as there is an enormous difference in costs despite the fact that the policies must conform EXACTLY with the stated benefit level ordained by Medicare.  The quotes I got last week ranged from $139/mo to over $500 for the identical policy category.  Why would anyone pay more?

    Still another thing, there is a (temporary though it can last for years) catch-up charge if you don't enroll in PArt B right away.  It's not like the Part D penalty that never goes away, but it is calculated to re-capture some of the premiums you didn't pay by not signing up on time.  It's  not really to screw you but to try and avoid adverse selection where people don't buy insurance for medical care until after they've already called the ambulance.

    Finally, if you don't take any drugs, then hunt for the lowest cost, suckiest-benefit Part D policy you have on offer (usually that's a Humana/WalMart one, I'm sorry to report) and buy that one.  If your health changes drastically within a plan year and you wind up needing to take a lot of drugs you can exercise your right to change Part D policies to any of the ones that are four or more stars. You can do this even in the middle of the year, not just during open enrollment. These are more expensive policies, but more comprehensive and intended for those that do take a lot of drugs.  But you can start out cheap, but still count on getting a better, costlier policy if you wind up needing one later. Terrible thing to pay even $10/mo to Humana/Walmart or United Health scoundrels but what can you do? As far as I know there aren't any Co-Ops selling Part D plans.

    Hope these tips help!

    Araguato

    •  From what we learned from my FIL's experience - (7+ / 0-)

      buy the most supplemental insurance and part B you can afford. Someday - you're a gonna need it.

      if a habitat is flooded, the improvement for target fishes increases by an infinite percentage...because a habitat suitability index that is even a tiny fraction of 1 is still infinitely higher than zero, which is the suitability of dry land to fishes.

      by mrsgoo on Thu Dec 12, 2013 at 08:08:19 PM PST

      [ Parent ]

      •  You can't buy "more" Part B (7+ / 0-)

        There is only one Part B, and its premium is (currently) $104/mo.  The Supplemental plans cover the portions of Parts A & B that Medicare doesn't pay.

        Part A is hospital insurance and there's a set co-pay of $1184 a whack for each hospitalization (plus more after a certain number of say, up to as much as $500/day eventually) and Part B is pretty much everything else and you have a constant, uncapped 20% share of all costs.  That's where a Supp. plan really pays off. Part D is a stand alone and has its own monthly premium and then you still have to buy the drugs.

        Folks on this site who are clamoring for a Medicare For All Buy-In have clearly never grappled with the real costs of the program. It ain't cheap, even after you've been paying into it for a lifetime. Buying into it easily could cost as much as private insurance.  

        However it does come with the ability to choose your provider if you take Traditional Medicare.  But more and more people are giving up and selecting Medicare Advantage plans, which are just the same as the much-reviled private insurance that we have now.  And they won't cost any less to "buy-in."

        araguato

    •  For some reason, I can't tip your comments. (1+ / 0-)
      Recommended by:
      hungrycoyote

      So consider this a tip. Excellent information.

      You can't scare me, I'm sticking to the Union - Woody Guthrie

      by sewaneepat on Sat Dec 14, 2013 at 05:41:19 AM PST

      [ Parent ]

  •  Your husband found out about the mandate (22+ / 0-)

    that President Bush's plan had in it for Medicare Part D.  What you found was that we have been living with a health mandate that forces you to purchase a drug plan since 2003, long before Obamacare.  You are also correct that there will be a whole bunch of angry right wingers when they find out they screwed themselves out of a pile of moolah for being so damn dumb.  Funny how life is though.  

    Glad your sweety is on the mend.  Take care..

  •  Thanks for sharing your odyssey (6+ / 0-)

    and educating the rest of us in the process.

    All the best for you and your husband.

    I'm not liberal. I'm actually just anti-evil, OK? - Elon James White

    by Satya1 on Thu Dec 12, 2013 at 07:34:27 PM PST

  •  Can anyone answer this question? Do I use my (6+ / 0-)

    adjusted gross income or my taxable income to see what my subsidy might be?

    The price of anything is the amount of life we are willing to exchange for it.

    by theslinger on Thu Dec 12, 2013 at 07:34:52 PM PST

  •  Republican friend of a friend (8+ / 0-)

    I was struck by your comment about the FB friend of a friend who complained about what she's paying--but refused to comparison shop in the marketplace.

    I think you're absolutely right: she, and so many others who refuse to even check out the marketplace, are going to be white-hot furious in April 2015, when they find out they (a) paid too much and (b) won't get any tax deductions.

    Somebody has to be the early adopter, and somebody has to be the late adopter. It's probably a good thing if the last ones in at least knew about it, but refused to even look at what was available. They have only themselves to blame. (Not that they'll blame themselves, or Republicans, or the media . . . we know who they'll blame.)

  •  Love these diaries (14+ / 0-)

    I love all the diaries with the stories of people who have finally made it through the whole process, and have their insurance sorted out. It is even better when they're successful in getting better insurance or cheaper insurance or both.

  •  Great info (6+ / 0-)

    This was a great post. Thanks for sharing the info. I did read somewhere last month that at some point in the future, the insurance companies may be hooked up to deal with the subsidies as well. Stay tuned I guess.

  •  Another important money-saving thing, (18+ / 0-)

    that is not commonly known, is that if your income is below 250% pf poverty, then you qualify for a cost-sharing reduction (CSR) plan. This means your co-pays, deductibles and maximum out-of-pocket expenses are reduced, sometimes significantly. But ONLY SILVER plans are CSR plans.

    If you are single and your adjusted gross income is below $27,000, then you qualify. I signed up for a Silver CSR plan last week, and the benefits are equivalent to a Platinum plan.

    curious portal - to a world of paintings, lyric-poems, art writing, and graphic and web design

    by asterkitty on Thu Dec 12, 2013 at 08:36:19 PM PST

  •  I didn't know that. Thanks. (6+ / 0-)
    we had to pay for the 16-day hospital stay. On Saturday my husband had to go back into the hospital for four days, but because it was within 60 days of his last stay, the $1,184 deductible covers that second stay too.
  •  This has been very helpful to me. My (9+ / 0-)

    husband also turned 65 last year and just got the Part B with no supplement or advantage.  His prescriptions are low cost so no Part D.  My son and I are currently on his COBRA-I'll be on Medicare next year and he could stay on COBRA for another two years but they're a pain in the butt and keep jerking us around.  

    Unfortunately, there is no Medicaid expansion in our state and my son is in college w/o enough income to qualify for a subsidy.  Our family would qualify for a subsidy but because I'm going on Medicare we can't use our income to qualify-just his.  So we're dealing with a bunch of decisions that are probably more complicated than they need to be.

    "Forever is composed of nows." Emily Dickinson

    by Leftovers on Thu Dec 12, 2013 at 09:18:31 PM PST

  •  I continue to try once a day. (5+ / 0-)

    - One new application per day
    - One check of the only successfully "submitted" application per day
    - One call to the call center per day

    New Application: Every day, same result at this point: "Our verification system is temporarily down" and check back in 24 hours. I delete the application every day afterward. I clear cookies every day. I rotate my browsers, like magical thinking: Firefox today, Chrome tomorrow, Safari the day after that, IE in a VM the day after that.

    Submit check: Every day, same result at this point: "Approved" application nonetheless needs further documentation—which I have submitted (there's a green box that says "Submitted"). But the message still remains—in a red box—that I need to resolve issues. And I can't enroll. The submission happened in the form of a PDF upload containing scans of the necessary documents. The 800 number told me on Monday that files submitted by the upload process right now don't actually get checked, so there's no point paying attention to that application any longer. But I continue to log in and check every day just in case they open a department to check these files on some random day.

    Call to call center: Every day, I make the call. Did the phone thing, and was ultimately requested to send some documents off to an address in Kentucky. They tell me that it will likely take "a week or two" to process what I sent. It's been weeks, but they tell me the same time frame each time. Hopefully one of these days when I call, they will tell me that the documents are in and processed and I can see my options somewhere for the first time.

    Okay, here it comes: GRRRRRRUMBLE.

    I get that this whole process is working for a lot of people by now. But it's worth mentioning that for a lot of people (i.e. my family) it is still very broken on all fronts. And meanwhile, December 23rd gets ever closer.

    We'll be okay—we have individual insurance already, but it would be nice to at least get a chance to see what Obamacare might possibly offer to us in terms of plans or subsidies before the time window passes.

    But maybe it's just not to be.

    -9.63, 0.00
    "Liberty" is deaf, dumb, and useless without life itself.

    by nobody at all on Thu Dec 12, 2013 at 09:24:15 PM PST

    •  You can see the plans without an application (7+ / 0-)

      There's a box right on the home page to click to see the plans in your area. It doesn't help with the subsidy, though you can use the Kaiser thingy for that (it seems to estimate low, as in you pay less than what it says).

      "Madness! Total and complete madness! This never would've happened if the humans hadn't started fighting one another!" Londo Mollari

      by FloridaSNMOM on Fri Dec 13, 2013 at 12:31:49 AM PST

      [ Parent ]

      •  This. (3+ / 0-)
        Recommended by:
        FloridaSNMOM, Odysseus, hungrycoyote

        I haven't been able to get my identity verified with the website yet, but thanks to an application by phone and having that list in front of me, I'm nearly signed up.

        Before, the website only showed premium prices and wouldn't let you fine-tune age. Now, you can give an exact age, get exact deductibles, and even access the plan documents and provider directories. WITHOUT needing so much as a working login.

        After that, the system can take until March to verify me for all I care, since the website's mainly useful then for updating financial and other information in the system if it changes mid-year.

      •  valuepenguin also has the policies and premiums (2+ / 0-)
        Recommended by:
        hungrycoyote, indres

        as well as the subsidies and their site is very easy to use. I found it better than Kaiser since (at least when I used Kaiser) it only gives you the info for one silver plan. Valuepenguin lists all policies in your state and county.

        http://www.valuepenguin.com

        You can't scare me, I'm sticking to the Union - Woody Guthrie

        by sewaneepat on Sat Dec 14, 2013 at 05:51:00 AM PST

        [ Parent ]

        •  Very nice site. (2+ / 0-)
          Recommended by:
          sewaneepat, indres

          I just entered my information exactly the way I did at healthcare.gov and it matched. That's an easy way to find out how much your premiums will be.

          “Mitt Romney is the only person in America who looked at the way this Congress is behaving and said, ‘I want the brains behind THAT operation.’ ” — Tom Perriello

          by hungrycoyote on Sat Dec 14, 2013 at 07:28:03 AM PST

          [ Parent ]

  •  Let's hope those deductibles shrink (4+ / 0-)
    Recommended by:
    hungrycoyote, ruellia, gmats, Back In Blue

    Congrats on signing up!
    When anyone is at the income level to be eligible for the tax credits and is still facing over $6,000 per yr. in deductibles, that's still unaffordable health care.

    Part of the reason is the overall high cost of health care in the US.  Hopefully ACA will continue putting downward pressure on health care costs and our leaders will apply these savings to reducing the deductibles.

    Allowing the federal government to negotiate the price of prescription drugs will also help.  That's a correction that's long overdue.

    If cutting Social Security & Medicare benefits for low income seniors is what Democrats do after they win a budget standoff, I'd hate to see what they do after they lose one.

    by Betty Pinson on Fri Dec 13, 2013 at 04:42:52 AM PST

    •  Actually, it is affordable health care for me. (2+ / 0-)
      Recommended by:
      ruellia, sewaneepat

      I have more than that in the bank. What is not affordable for me is the entire bill if I get sick. The price I'm paying is based on my income ... if I made a lot less, than I would get a larger subsidy and if I expected to use all of that deductible, I would have chosen a plan with a lower deductible but higher premium.

      We spend $1200/year on auto insurance. We haven't had an accident or claim in 20 years. We still pay the premiums every month. Yes because it's the law, but also because we want coverage if something happens.

      Technically, if you look at the actual bills the hospital sent out for my husband's stay, the total price tag was over $200,000. Now what was actually billed was Medicare's negotiated price and so the bills actually total around $31,000 of which we have had to pay just over $2,000. The rep from the insurance company who sold us the $0/month Advantage Plan says that the difference between the $31K and $200K that was written off had something to do with the providers' tax write offs. Whatever.

      All I know is if I didn't have the umbrella of a medical plan negotiating prices, and an annual limit of what I can be charged, if it had been me that went in the hospital instead of my husband, we would have been deeply in debt from one illness.

      “Mitt Romney is the only person in America who looked at the way this Congress is behaving and said, ‘I want the brains behind THAT operation.’ ” — Tom Perriello

      by hungrycoyote on Fri Dec 13, 2013 at 09:21:16 AM PST

      [ Parent ]

  •  hey hungrycoyote (2+ / 0-)
    Recommended by:
    hungrycoyote, ruellia

    did you ever find out why you weren't seeing the Blue Cross plans and only had 9 choices available? was it a limit on your zipcode?

    "Kossacks are held to a higher standard. Like Hebrew National hot dogs." - blueaardvark

    by louisev on Fri Dec 13, 2013 at 05:14:22 AM PST

  •  You can use a Health Care Savings Account too. (2+ / 0-)
    Recommended by:
    glynis, hungrycoyote

    Since you have a qualifying high deductible plan you should be able to use an HSA if you want.  Put your money in their for out of pocket expenses and pay from that account and you get those medical expenses free of income taxes.

    So far I've found that State Farm Bank has about the cheapest deal on an HSA.

  •  Medicare part D (1+ / 0-)
    Recommended by:
    hungrycoyote

    Coincidentally I learned yesterday that I too will be charged a monthly fee forever because I mistakenly thought I could wait until the autumn Medicare open enrollment season to sign up for part D; six months after I enrolled in Medicare.

    Glad your dh is doing well.  What a fright.

  •  I know I am late to the discussion, and this is (4+ / 0-)
    Recommended by:
    wishingwell, Dvalkure, hungrycoyote, gmats

    slightly off topic, but there has been a lot of discussion of Medicare coverage.

    If you are on Medicare and have a very low income (such as only your Social Security), you may qualify for a good deal of help. There are asset limits but you can own your home and have a car, so don't think you won't qualify.

    I am not sure how other states handle this; I only have direct experience of Pennsylvania so these are the PA sites. The prescription program is partly PA only (paid for by gambling money) and part federal. The Medicare Part B program is federal but applied for through the state (there may be a direct program but I have no experience of the process).

    For prescription assistance, go to the PACE website here: http://www.portal.state.pa.us/... or call 1-800-225-7223. It is very simple to apply and the people are very helpful.

    For Medicare Part B assistance (you may qualify to not have to pay Part B at all) go to https://www.compass.state.pa.us/... where you can see what benefits you might qualify for without having to input your personal information. Check out everything and you might be surprised.

    In other states, I would check for PACE and COMPASS websites.

    Good luck!

    "May the forces of evil become confused on the way to your house." - George Carlin

    by Most Awesome Nana on Fri Dec 13, 2013 at 06:23:32 AM PST

    •  Basically a person would have dual (2+ / 0-)
      Recommended by:
      Most Awesome Nana, hungrycoyote

      coverage under Medicare and Medicaid. That is what you are describing. By breaking out an hiding the source of the extra benefits/coverage the Repubs in the prescription D bill hid how good Medicaid was.

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Sat Dec 14, 2013 at 04:07:23 AM PST

      [ Parent ]

      •  Yes, they just never call it Medicaid. (1+ / 0-)
        Recommended by:
        hungrycoyote

        And not much advertising is done about this. Most Seniors I know have never heard of either program and if they have, own a home and think they cannot qualify.

        "May the forces of evil become confused on the way to your house." - George Carlin

        by Most Awesome Nana on Sat Dec 14, 2013 at 07:13:25 AM PST

        [ Parent ]

  •  If only the general public knew that they could (1+ / 0-)
    Recommended by:
    hungrycoyote

    come here and access virtually all the information they will need in diaries like this one.  Most don't even know we exist and many would consider it treason to visit a "commie-nazi-pinko-socialist" website like ours anyway.

    I wish I could see the faces of the Republicans who refuse to buy insurance through the exchanges as they get their IRS "oops" notices.  Not only will they not get the subsidies, but they may have to pay interest and penalties if they wrongly claim the tax deduction.

    Ted Cruz president? Pardon my Vietnamese, but Ngo Pho King Way.

    by ZedMont on Fri Dec 13, 2013 at 06:32:35 AM PST

    •  Something else they won't know by (1+ / 0-)
      Recommended by:
      raines

      not coming to this site and watching MSNBC. As Lawrence O'Donnell has explained many times on his show, there is no mechanism to allow IRS to collect the penalty for not buying insurance. The law specifically prevents them from doing anything to collect the penalty. So, if people don't buy the insurance and don't pay the penalty, nothing happens to them. Well, except if they get sick they have no coverage.

      “Mitt Romney is the only person in America who looked at the way this Congress is behaving and said, ‘I want the brains behind THAT operation.’ ” — Tom Perriello

      by hungrycoyote on Fri Dec 13, 2013 at 09:26:52 AM PST

      [ Parent ]

      •  The IRS takes it out of your tax refund (2+ / 0-)
        Recommended by:
        hungrycoyote, samddobermann
        •  LOL! But I rarely have a refund if I can (1+ / 0-)
          Recommended by:
          samddobermann

          help it. I try to deposit just enough so that I owe less than $1,000 each year with my return.

          Strangely, the reason I do that is because of the fraud down here in Florida where people have been stealing identities and filing false returns and getting the refunds. It creates a nightmare for the real people when they file their return and can literally spend years trying to get the refund due to them. I figure if I owe, then I can just send in the money and never go through that nightmare.

          “Mitt Romney is the only person in America who looked at the way this Congress is behaving and said, ‘I want the brains behind THAT operation.’ ” — Tom Perriello

          by hungrycoyote on Fri Dec 13, 2013 at 10:20:10 PM PST

          [ Parent ]

  •  i wish things were going that well for me. (1+ / 0-)
    Recommended by:
    hungrycoyote

    I'm on day 10 of trying to pay my first premium to the jackasses at Florida Blue Cross.  And I still don't know whether they actually have my enrollment data.

    I am become Man, the destroyer of worlds

    by tle on Fri Dec 13, 2013 at 07:05:08 AM PST

  •  Well, I'm disappointed. Hope someone can help me. (2+ / 0-)
    Recommended by:
    hungrycoyote, raines

    I must admit I have not studied the details of the ACA, but I began yesterday looking into helping my brother sign up.  He's 50 and has a lot of  health issues, mostly due to substance abuse over many years.  My elderly parents have been paying $1,000/mo just for the most basic coverage ($5000 deductible).  He has more than $2000 in assets so he doesn't currently qualify for Medicaid, and the @#$@ Republicans in Virginia's General Assembly have refused to expand it.  

    So, anyway, I called the Marketplace Help # to ask how specific he had to be when reporting his income.  He doesn't make enough to have to file a tax return (just $1000 or so from the occasional odd job -- no W-2's involved), and that's not expected to change in the years to come.

    The nice lady on the phone didn't know the answer at first, but when she came back on the line, she told me my brother couldn't apply through the Marketplace because he didn't make enough?  Seems you have to make at least $11K or so?  Is that right??  If it is, then my brother (and my parents, who are paying the premiums) are screwed.  Even if Virginia wakes up and accepts the federal money to expand Medicaid, he still won't qualify for Medicaid if he has more than $2000 in assets, right?

    •  Unfortunately he is not eligible for subsidies (3+ / 0-)
      Recommended by:
      hungrycoyote, indres, Sherri in TX

      However, he can buy on the exchange.

      Your brother is not eligible for Medicaid because the slimemolds in Virginia didn't expand it. However, Medicaid no longer depends on assets in expansion states, so once Virginia does the expansion he will be eligible. He's not eligible for subsidies because he doesn't make enough money.

      However-- he can buy insurance on the exchange. He won't be subsidized, but he can buy an insurance policy. A Silver policy in Arlington would cost him $362 a month. He has plenty of other choices.

      Good luck!

  •  That is effectively $10,000 per year, horrible and (4+ / 0-)
    Recommended by:
    hungrycoyote, gmats, indres, Back In Blue

    way over even the insane avg per capita US healthcare cost of $7K+ vs The World.

    The US Senate comprehensive "plan" they have had for years, Cadillac Special, cost $5,500/year. The thing that killed me was if we just did Single Payer Medicare for All.... buying THAT PLAN, it would cost the US  ~ $770 Billion/year, which is 30% less than we as a nation already spend. Literally buying the ENTIRE POPULATION the gold plated Senate insurance ... Health AND Dental (and Mental Illness AND Contraception)... would cost less than we spend on insurance and emergency room "insurance" each year already.

    This should also require Congress forcing employers ... who no longer pay for healthcare at all ... to increase workers salaries equivalent to the amount that they had been spending on that worker's healthcare insurance, as this "benefit" was part of their compensation. We can't have National Health Insurance be a business windfall.

    •  Is that the real cost? (2+ / 0-)
      Recommended by:
      hungrycoyote, The Jester
      The US Senate comprehensive "plan" they have had for years, Cadillac Special, cost $5,500/year.
      Is that the cost employees paid, or is it actual cost to deliver those services? I suspect the former, in which case the rest of your (very suspicious) arithmetic is unjustified.
      •  That was the cost listed in the press for the plan (2+ / 0-)
        Recommended by:
        hungrycoyote, indres

        Te US Treasury paid it, that was the insurance cost FOR the US Senators.

        It was from back when Kerry was running in 2004 and one of the issues was healthcare reform.... if memory serves.

        It had really low deductible and co-pays too.

        Not that a real single payer National healthcare program should cost that much per household, just that even if it did, it would be cheaper for the entire population than we already paid as a nation. (while leaving millions without insurance coverage in the process)

        •  $5500/year health costs in 2004 (2+ / 0-)
          Recommended by:
          hungrycoyote, The Jester

          is about the same as $9800/year now.

        •  that is 25% of actual costs per policy to (1+ / 0-)
          Recommended by:
          hungrycoyote

          the government. The Gov as the employer pays 75%.

          Right now the Federal government spends about 1.3 Trillion a year on health care and related costs. Your $770 billion a lyear is absurd.

          The US spends about $2.5 Trillion a year on healthcare and related costs.

          I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

          by samddobermann on Sat Dec 14, 2013 at 04:17:18 AM PST

          [ Parent ]

          •  At that time... (2+ / 0-)
            Recommended by:
            hungrycoyote, indres

            The US Govt spending was $980 Billion ... now $1,300 Billion.

            The point was that AT THAT TIME, if we just bought the entire population the Senate insurance plan... which was $5,500 TOTAL COST at the time (they: members of the Senate, didn't pay jack shit, no premium deductible or copay on that plan) ... the entire population would be covered for $770 Billion, saving the government $200 billion and the private sector hundreds of billions more. Imagine the help to the economy if that extra hundreds of billion$ saved in the private sector was instead paid to employees in a raise and/or reinvested in the businesses.

            Yes, we are spending $2.5 Trillion, which is over 2X per capita higher than the next most expensive country on earth ... and that country has 100% complete coverage for it's population, we DO NOT. Twice the price and less coverage, brilliant!!

            So let's make this simple. Understand the basic concept of what INSURANCE is. Extend Medicare/Medicaid price limits, combined with the shift to patient outcome as the goal in treatment (eliminating multiple levels of needless expensive testing and treatment) to get the COST of the actual health CARE under control ... combined with ZERO PROFIT operation of the INSURANCE program, and we can turn that $2.5 Trillion into only $1.25 Trillion.

            Freeing up the saved resources to  reinvest in workers pay and business reinvestment and government infrastructure programs to get the economy going strong again.

            This really isn't rocket science. The powers the be, who are raking in the $$$ want you to think it is, that it is too hard to fix, so they can keep raping the economy and the people until we truly collapse as an economy... and remain Serfs for the filthy rich forever.

  •  The GOP are demanding personal responsibility (1+ / 0-)
    Recommended by:
    hungrycoyote

      and yet whine like a small child when they actually have to show everyone that they are responsible.    We have all read / heard about how hard it was for elected GOP officials to get signed up for ACA.    
        Sure, there have been some glitches - but all their whining demonstrated that they weren't being responsible.
        People here have had problems and questions, such as this diary.  And there have been others, where people ask real questions and get real answers.   People here have come back and explained their original problem and the resolution.
        Which is quite different than some sites which are :  tell me your problem, period....then used for a negative rant.

        Imagine the whine from the GOP who have said they refused to use the Exchanges - because politics!   When they ramp up the whine, we need to remember this diary information and ask them, didn't you do your own due diligence and learn the downside of not using the Exchange?

  •  Thank you for sharing (2+ / 0-)
    Recommended by:
    hungrycoyote, samddobermann

    especially the part about needing to sign up for part D immediately upon turning 65.  Congratulations on getting a plan through Healthcare.gov!  It does my heart good every time I read a diary like this!

    When the United States becomes a low wage country, only bobbleheads shall go forth from American soil.

    by amyzex on Fri Dec 13, 2013 at 12:34:52 PM PST

  •  Just signed up. (6+ / 0-)

    After a somewhat rocky start, I got through it.

    I have not been able to afford insurance for the last six years. Now I can get a plan for 53. 00 a month. Barak Hussein Obama, a fine patriotic American, I thank you. Really. Bringing a little sanity and humanity into the discussion of health care has been branded as extreme "socialism" give me a break. The idea that a certain level of compassion and understanding should be in the discussion is enough to drive the Fox panel crazy.

    I got Obamacare.

    A true craftsman will meticulously construct the apparatus of his own demise.

    by onionjim on Fri Dec 13, 2013 at 01:19:20 PM PST

  •  I bet the actual Prez just died laughing when (1+ / 0-)
    Recommended by:
    hungrycoyote

    he saw this.

    Loved it!

    Printing off info from healthcare.gov now on the plans available to me for comparison purposes, and checking with my doc to make sure she accepts payment from all my "finalists." (She does!)  Depending on my income next year, I should end up paying $200 to $250 less per month, for better health care.

    Thank you, Barry!

    Freedom has two enemies: Those who want to control everyone around them...and those who feel no need to control themselves.

    by Sirenus on Fri Dec 13, 2013 at 01:56:45 PM PST

  •  I think a problem for many people is that they (2+ / 0-)
    Recommended by:
    hungrycoyote, sewaneepat

    either were fortunate enough to get insurance through work (I did)- it was there & you got what you got - or they went without. Figuring out the best way to go based on one's particular situation can be pretty complicated.
    Next year I'll have to deal with Medicare & (I think) enroll in A&B but not supplemental or prescription due to my retiree insurance from work but I really have no idea how it all works so I after the holidays I need to start researching in depth.

    Where are we going and what am I doing in this handbasket?

    by gelfling545 on Fri Dec 13, 2013 at 04:33:14 PM PST

    •  211 (2+ / 0-)
      Recommended by:
      hungrycoyote, gelfling545

      Most states/regions have a 211 information and referral service. If they don't, your local United Way will usually prove the same resource. From either 211 or United Way, it is possible to find a local senior resource center, many of which have orientation to Medicare workshops before open enrollment and/or someone who can assist those new to Medicare. This is a much safer and impartial source for Medicare info than some insurance company's broker who is working on commission.
      In other words, you don't have to do all the research by yourself, and you will likely meet people who have experience of the local supplement and Part D options.

    •  Your retiree insurance acts as a (2+ / 0-)
      Recommended by:
      hungrycoyote, gelfling545

      supplemental and a prescription policy as long as it covers medications.

      So you won't need to get either add on. If you loose it you need proof of coverage and you won't get a penalty for late sign up either.

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Sat Dec 14, 2013 at 04:21:23 AM PST

      [ Parent ]

  •  Maybe I missed it or don't understand something... (2+ / 0-)
    Recommended by:
    indres, hungrycoyote

    If your husband is on Medicare then why did you need to include him when you purchased on the exchange?  Why couldn't you just sign up for yourself since he was on Medicare already?

    •  Income. (1+ / 0-)
      Recommended by:
      samddobermann

      At the beginning of the enrollment, I was able to specifically state that I was only applying for healthcare insurance for myself. However, to determine what subsidy I qualified for, I had to report the entire household income.

      Even though my husband is on Medicare, we are married so I had to report our joint income, which includes his social security benefits.

      In fact, one of the things you have to agree to when you apply for the subsidy is that you will file your income tax return as married, filing jointly for 2014.

      “Mitt Romney is the only person in America who looked at the way this Congress is behaving and said, ‘I want the brains behind THAT operation.’ ” — Tom Perriello

      by hungrycoyote on Fri Dec 13, 2013 at 06:54:51 PM PST

      [ Parent ]

      •  What would happen if you got divorced? (1+ / 0-)
        Recommended by:
        hungrycoyote

        Obviously, I'm not suggesting you would, but how can anyone truly claim to know?

        The priest said, "Today's sermon is called 'Liars', but first I have a question. How many of you have read Chapter 66 in Matthew?" Nearly every hand went up. "You're just the group I need to speak to," the priest said. "There's no such chapter."

        by Back In Blue on Fri Dec 13, 2013 at 08:43:16 PM PST

        [ Parent ]

        •  Then we would be single people, and (1+ / 0-)
          Recommended by:
          samddobermann

          would file separately just like everybody else does after they get divorced.

          That would also come under the heading "major change in circumstances" and would require notifying the Exchange.

          “Mitt Romney is the only person in America who looked at the way this Congress is behaving and said, ‘I want the brains behind THAT operation.’ ” — Tom Perriello

          by hungrycoyote on Fri Dec 13, 2013 at 10:14:33 PM PST

          [ Parent ]

          •  How do you know that? (1+ / 0-)
            Recommended by:
            hungrycoyote

            I actually searched for that info and couldn't find anything about it.

            The priest said, "Today's sermon is called 'Liars', but first I have a question. How many of you have read Chapter 66 in Matthew?" Nearly every hand went up. "You're just the group I need to speak to," the priest said. "There's no such chapter."

            by Back In Blue on Sat Dec 14, 2013 at 08:54:07 AM PST

            [ Parent ]

            •  IRS Publication 504. It's whatever you are (1+ / 0-)
              Recommended by:
              Back In Blue

              on the last day of the tax year (with some rare exceptions).

              Filing Status

              Your filing status is used in determining whether you must file a return, your standard deduction, and the correct tax. It may also be used in determining whether you can claim certain other deductions and credits. The filing status you can choose depends partly on your marital status on the last day of your tax year.

              Marital status.   If you are unmarried, your filing status is single or, if you meet certain requirements, head of household or qualifying widow(er). If you are married, your filing status is either married filing a joint return or married filing a separate return. For information about the single and qualifying widow(er) filing statuses, see Publication 501.

              Unmarried persons.  You are unmarried for the whole year if either of the following applies.

                 ● You have obtained a final decree of divorce or separate maintenance by the last day of your tax year. You must follow your state law to determine if you are divorced or legally separated.

                  Exception. If you and your spouse obtain a divorce in one year for the sole purpose of filing tax returns as unmarried individuals, and at the time of divorce you intend to remarry each other and do so in the next tax year, you and your spouse must file as married individuals.

                 ● You have obtained a decree of annulment, which holds that no valid marriage ever existed. You must file amended returns (Form 1040X, Amended U.S. Individual Income Tax Return) for all tax years affected by the annulment that are not closed by the statute of limitations. The statute of limitations generally does not end until 3 years (including extensions) after the date you file your original return or within 2 years after the date you pay the tax. On the amended return you will change your filing status to single or, if you meet certain requirements, head of household.

              Married persons.   You are married for the whole year if you are separated but you have not obtained a final decree of divorce or separate maintenance by the last day of your tax year. An interlocutory decree is not a final decree.

              Same-sex marriage.   For federal tax purposes, individuals of the same sex are considered married if they were lawfully married in a state (or foreign country) whose laws authorize the marriage of two individuals of the same sex, even if the state (or foreign country) in which they now live does not recognize same-sex marriage. The term "spouse" includes an individual married to a person of the same sex if the couple is lawfully married under state (or foreign) law. However, individuals who have entered into a registered domestic partnership, civil union, or other similar relationship that is not considered a marriage under state (or foreign) law are not considered married for federal tax purposes. For more details, see Publication 501.

              Exception.   If you live apart from your spouse, under certain circumstances, you may be considered unmarried and can file as head of household. See Head of Household , later.

              Married Filing Jointly

              If you are married, you and your spouse can choose to file a joint return. If you file jointly, you both must include all your income, exemptions, deductions, and credits on that return. You can file a joint return even if one of you had no income or deductions.

              Publication 504

              When you sign up at the Exchange for the subsidy, one of the things you have to agree to is that you will use Married Filing Jointly when filing your 2014 Income Taxes. Obviously, if you are legally divorced on the last day of the year, then you are no longer married and that is a major change in your situation which you probably should have reported to healthcare.gov when it happens.

              “Mitt Romney is the only person in America who looked at the way this Congress is behaving and said, ‘I want the brains behind THAT operation.’ ” — Tom Perriello

              by hungrycoyote on Sat Dec 14, 2013 at 09:36:35 AM PST

              [ Parent ]

  •  This is still ridiculous. (2+ / 0-)
    Recommended by:
    hungrycoyote, raines

    The ACA has been good for my family due to our pre-existing conditions, of which only one is real (me-high blood pressure) and the other is bullshit insurance co scammery.  I'm not kidding.

    My daughter was born with a soft-pallet cleft which is a fairly simple surgery to fix, her surgery went perfectly and she no longer has a soft-palette cleft, nor will she ever have one again. It's simple not possible.  But the insurance co's still classified her as having a cleft-pallette (had the surgery at 1yrs old—she's now 11yrs old)  and as such they lump her in with those who have hard palette clefts which is far more serious and can be a lifetime of problems.  It's unbelievable that they were ever allowed to get away with that.

    That said, navigating this nightmare of insurance (not Obamacare) where if you don't do this, and do that but forget to do this because no one ever actually gave you that info so you're screwed is just as stupid as it ever was.   And even Medicare has stupidity with things like the part D enrollment having to occur at 65 or your punished for life (why don't they tell you that? Probably cause you won't complain about $4something a month, but $48/year times 20 million people (just a guess at how many might fall into this trap) over 65 is almost a billion dollars.  

    Imagine how much money we'd save on "healthcare" if no-one had to do this insanity EVERY YEAR!  Imagine how much productivity would be gained!  Imagine how much healthier we'd all be if we just removed this stress?

    Medicare for all (with fixes)—anything else is stupid.

    The priest said, "Today's sermon is called 'Liars', but first I have a question. How many of you have read Chapter 66 in Matthew?" Nearly every hand went up. "You're just the group I need to speak to," the priest said. "There's no such chapter."

    by Back In Blue on Fri Dec 13, 2013 at 09:00:27 PM PST

    •  well, figure out how to raise the (2+ / 0-)
      Recommended by:
      sewaneepat, hungrycoyote

      taxes to cover that and it will be all good.

      The problem is that the funds for payment for health care now comes from  many different sources. So how do we gather all those funds to put it into the one pot we will call the single payer.

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Sat Dec 14, 2013 at 04:27:29 AM PST

      [ Parent ]

      •  Medicare (3+ / 0-)
        Recommended by:
        hungrycoyote, Cpqemp, indres

        Bring back Ike's tax structure with at least four more tax brackets above the current ones.  It's insane that people making millions pay the same rates as people making $250k. Raise capital gains.  Eliminate hedge fund giveaways.  Collect it all like Medicare does.

        Also, it won't cost as much without the rediculous amount of useless overhead generated by the insurance cartel, and reduce the rediculous cost of ER insurance because people won't use it as their normal source of health care access.  

        Considering that every other industrialized nation in the world has done it, it can't be that hard.

        The priest said, "Today's sermon is called 'Liars', but first I have a question. How many of you have read Chapter 66 in Matthew?" Nearly every hand went up. "You're just the group I need to speak to," the priest said. "There's no such chapter."

        by Back In Blue on Sat Dec 14, 2013 at 08:48:33 AM PST

        [ Parent ]

  •  I got through the sign up last month and paid my (4+ / 0-)
    Recommended by:
    hungrycoyote, Oh Mary Oh, jdld, indres

    first premium fee on the first of Dec. Because of my Native American status it is a little bit different for us regarding deductibles and co-pays.

    I had a choice of approx. 33 different plans and I chose the top of the line Silver Plan. It will cost me approx. 180. a month after the applied tax credit.  

    Yes hungrycoyote, you are very right about the Medicare Part D. It is extremely important for those who are set to go on Medicare to also sign up for Med. D at that time too. My husband as well as my mother both ended up having to pay nominal penalties for life because at that time they were not on any med.s and didn't think they needed it. Wrong!!!!

    The ACA is a good program and people should grin and bear it getting through the process and not give up. It is like a candy store of choices when you finally get to that part of the process..

  •  ACTION idea? Medicare prescription part D (2+ / 0-)
    Recommended by:
    hungrycoyote, indres

    Lobby Congress to change it.
    I never knew about the penalty for not signing up at age 65 and my advisors tell me they hear this all the time. So, since there was some kind of big gap in communication....waive or reduce the penalty.

    Going forward, do better outreach and publicity so the information isn't buried or confusing. Then, make people SIGN to confirm opting out of Plan D and then make them pay a penalty if the decide to join in subsequent years.

    My advisor said that Medicare Advantage plan is a good plan but it might not be available in future years, unlike the medigap options.

    But I am all for single payer, universal, and cut out the troublesome middlemen. For inspiration, watch SICKO.

  •  Sure hope you have $12,000 (2+ / 0-)
    Recommended by:
    hungrycoyote, raines

    Lying around in case you have need of it for your out of pocket and deductible.

  •  A $6,000 deductabile isn't even insurance. I (2+ / 0-)
    Recommended by:
    hungrycoyote, indres

    really hate how people are just accepting of these insane deductibles.

    •  It's all relative. The fact is that I earn too (1+ / 0-)
      Recommended by:
      raines

      much money to get one of those $2.67/month low deductible plans. That's the whole point though, isn't it? What's affordable for me is not affordable for somebody who does qualify for one of those plans.

      Frankly, $6,000 is not really a lot of money compared to how expensive the actual cost of getting sick can be. Do you have any idea how quickly those medical bills can add up to tens of thousands of dollars and move quickly into the $100,000s range?

      “Mitt Romney is the only person in America who looked at the way this Congress is behaving and said, ‘I want the brains behind THAT operation.’ ” — Tom Perriello

      by hungrycoyote on Sat Dec 14, 2013 at 08:06:39 PM PST

      [ Parent ]

    •  Low income folks get subsidies (1+ / 0-)
      Recommended by:
      hungrycoyote

      for co-pays, co-insurance and out-of-pocket.

      And higher income folks can afford a $6000 deductible.

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