Author Topic: Questions about ACA plans  (Read 2528 times)

NumberJohnny5

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Questions about ACA plans
« on: December 11, 2013, 04:34:42 PM »
Trying to help my mom get signed up for health insurance. She's had quite a time trying to go through the steps, but they've finally verified her identity and said she's eligible for a $259/mo tax credit. Here's what's confusing though. She says she can only pick Silver and not Bronze. When asked for a copy of the exact message she's getting, she says:

Quote
I don't know but that is what the message said once my application went through. I called and asked the hotline and they said "no bronze". I didn't ask why.

Any idea what she's talking about? Is it possible to get a subsidy only for a silver plan, but not bronze? I had found a plan that seemed good, but of course it's bronze.

The bronze plan details:

Monthly Premium
$283.38

Deductible
$5,300 / person
$10,600 / family

Out of Pocket Max
$5,300 / person
$10,600 / family

Cost Sharing

Doctor - No charge
Specialist - No charge
ER - No charge

Generic drug - No charge
Brand name drug - No charge


Now, for the silver plans, here's plan #1 she's looking at:

Monthly Premium
$344.86

Deductible
$2,000 / person
$4,000 / family

Out of Pocket Max
$4,000 / person
$8,000 / family

Cost Sharing

Doctor - 50% coinsurance after deductible
Specialist - 50% coinsurance after deductible
ER - 50% coinsurance after deductible

Generic drug - 50% coinsurance after deductible
Brand name drug - 50% coinsurance after deductible


And plan #2:

Monthly Premium
$344.86

Deductible
$2,000 / person
$4,000 / family

Out of Pocket Max
$4,000 / person
$8,000 / family

Cost Sharing

Doctor - 50% coinsurance after deductible
Specialist - 50% coinsurance after deductible
ER - 50% coinsurance after deductible

Generic drug - 50% coinsurance after deductible
Brand name drug - 50% coinsurance after deductible

A stupid question for me...20% coinsurance, does that mean SHE'S paying 80% of the costs after the deductible but before the out of pocket maximum? If so...I can't understand how that plan would be better than the bronze that had no charge. I mean, if she had a lot of health costs on a yearly basis, I can see it...but she's relatively healthy at the moment.

If we can figure out how to get that $259 subsidy applied to the bronze package, that seems like a no-brainer to me.

And another quick question from her:

Quote
I am trying to find one that allows the HSA (like a flex plan but rolls over each year) but I don't see it listed anywhere.

I have no idea about this. I mean, I know what an HSA is, but I don't know how to find a plan for her that would include that, or if it'd even be necessary.

randymarsh

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Re: Questions about ACA plans
« Reply #1 on: December 11, 2013, 04:53:52 PM »
20% coinsurance means you'd pay 20% and the insurer would pay 80% after meeting the deductible. I would have her call back and ask for more details. It's possible that no insurer in her area is offering bronze plans.

Heart of Tin

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Re: Questions about ACA plans
« Reply #2 on: December 11, 2013, 04:54:46 PM »
Trying to help my mom get signed up for health insurance. She's had quite a time trying to go through the steps, but they've finally verified her identity and said she's eligible for a $259/mo tax credit. Here's what's confusing though. She says she can only pick Silver and not Bronze. When asked for a copy of the exact message she's getting, she says:

Quote
I don't know but that is what the message said once my application went through. I called and asked the hotline and they said "no bronze". I didn't ask why.

Any idea what she's talking about? Is it possible to get a subsidy only for a silver plan, but not bronze? I had found a plan that seemed good, but of course it's bronze.

Is your Mom's AGI less than 250% of the federal poverty level? If so, she is eligible not just for premium subsidies but also for additional federal cost-sharing subsidies to help cover her deductible, copayments, and coinsurance, but she will only be eligible for these additional subsidies if she enrolls in a silver, gold, or platinum plan. The premium subsidies should apply to bronze plans in addition to the higher metal tiers. Here's a Kaiser Health article about the additional subsidies: http://www.kaiserhealthnews.org/features/insuring-your-health/2013/070913-michelle-andrews-on-cost-sharing-subsidies.aspx

A stupid question for me...20% coinsurance, does that mean SHE'S paying 80% of the costs after the deductible but before the out of pocket maximum?

She will pay 20%, the insurer will pay 80%.

And another quick question from her:

Quote
I am trying to find one that allows the HSA (like a flex plan but rolls over each year) but I don't see it listed anywhere.

I have no idea about this. I mean, I know what an HSA is, but I don't know how to find a plan for her that would include that, or if it'd even be necessary.

I'm not too familiar with healthcare.gov's layout, but this should be listed as a plan attribute in the details for each plan.

NumberJohnny5

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Re: Questions about ACA plans
« Reply #3 on: December 11, 2013, 05:28:21 PM »
Thanks for that info. I've forwarded it to her. Was not aware of higher tax credits/subsidies/whatever for certain plans if your income was below 250%.