Author Topic: What comes after the ACA?  (Read 1675294 times)

confused_person

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Re: What comes after the ACA?
« Reply #6850 on: August 20, 2021, 08:33:34 AM »
Question. The last stimulus package included ACA cost sharing subsidy increase for people who received unemployment at any point in 2021, reducing their insurance premiums to almost zero. When does this change expire?

This is what I'm referring to:

https://www.kff.org/health-reform/issue-brief/impact-of-key-provisions-of-the-american-rescue-plan-act-of-2021-covid-19-relief-on-marketplace-premiums/

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People Receiving Unemployment Insurance
The COVID-19 relief law makes special considerations for people approved to receive or receiving unemployment compensation at any point in 2021. Under the COVID-19 relief law, if a person is receiving unemployment compensation and she qualifies to purchase insurance on the Marketplace, she and any eligible dependents can get a silver plan with a $0 premium. That is because, under the proposal, any household income above 133% of poverty is not considered in the calculation of her premium tax credit if she receives unemployment insurance.

For people receiving unemployment compensation at any point in 2021, their income up to 133% of poverty is counted in determining eligibility for a cost-sharing reduction, which is only available to people with incomes between 100% and 250% of poverty. That is, a person with income, including unemployment compensation, of 260% of poverty would receive a premium and cost-sharing reduction subsidy as if her income is 133% of poverty. A person receiving unemployment income would still need to attest that they do not have an affordable offer of employer-sponsored insurance from their spouse or other family member. As the COVID-19 relief law does not change the so-call ďfamily glitchĒ in the ACA, if an employer offer is deemed affordable (9.83% of household income for 2021 for self-only coverage), this may disqualify people receiving unemployment income from receiving ACA subsidies if they still have a working family member with an employer offer.

secondcor521

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Re: What comes after the ACA?
« Reply #6851 on: August 20, 2021, 09:26:52 AM »
Question. The last stimulus package included ACA cost sharing subsidy increase for people who received unemployment at any point in 2021, reducing their insurance premiums to almost zero. When does this change expire?

This is what I'm referring to:

https://www.kff.org/health-reform/issue-brief/impact-of-key-provisions-of-the-american-rescue-plan-act-of-2021-covid-19-relief-on-marketplace-premiums/

Quote
People Receiving Unemployment Insurance
The COVID-19 relief law makes special considerations for people approved to receive or receiving unemployment compensation at any point in 2021. Under the COVID-19 relief law, if a person is receiving unemployment compensation and she qualifies to purchase insurance on the Marketplace, she and any eligible dependents can get a silver plan with a $0 premium. That is because, under the proposal, any household income above 133% of poverty is not considered in the calculation of her premium tax credit if she receives unemployment insurance.

For people receiving unemployment compensation at any point in 2021, their income up to 133% of poverty is counted in determining eligibility for a cost-sharing reduction, which is only available to people with incomes between 100% and 250% of poverty. That is, a person with income, including unemployment compensation, of 260% of poverty would receive a premium and cost-sharing reduction subsidy as if her income is 133% of poverty. A person receiving unemployment income would still need to attest that they do not have an affordable offer of employer-sponsored insurance from their spouse or other family member. As the COVID-19 relief law does not change the so-call ďfamily glitchĒ in the ACA, if an employer offer is deemed affordable (9.83% of household income for 2021 for self-only coverage), this may disqualify people receiving unemployment income from receiving ACA subsidies if they still have a working family member with an employer offer.

Currently (i.e., until/unless the law is changed again) it expires at the end of 2021.  In other words, it's a change for this year only.

jim555

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Re: What comes after the ACA?
« Reply #6852 on: August 27, 2021, 07:36:29 AM »
Looks like the Medicare age change is not happening...

"Meanwhile, one major progressive demand is probably on the cutting-room floor.

Democrats arenít expected to include a measure lowering Medicareís eligibility age in the package, first reported by Politico, and confirmed by a Senate Democratic aide and multiple sources off the Hill. "

https://www.washingtonpost.com/politics/2021/08/26/health-202-democrats-have-three-weeks-get-their-health-game/

brooklynmoney

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Re: What comes after the ACA?
« Reply #6853 on: August 28, 2021, 08:02:23 AM »
I will be so sad if the Medicare age is not lowered. I think Iím too risk adverse to quit more than 5 years out from Medicare age even though I pretty much have enough saved now. I am currently 18 years out from Medicare so I could work an extra 10 plus years just for reliable access to good health insurance.

American GenX

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Re: What comes after the ACA?
« Reply #6854 on: August 28, 2021, 09:41:33 AM »
I will be so sad if the Medicare age is not lowered. I think Iím too risk adverse to quit more than 5 years out from Medicare age even though I pretty much have enough saved now. I am currently 18 years out from Medicare so I could work an extra 10 plus years just for reliable access to good health insurance.

I know I brought it up, but I never really felt the lower age of eligibility had a good chance of making it through and would cost more than an ACA plan with subsidies.

It also looks like the other improvements will be scaled back, means tested, or otherwise scrapped as well.

https://www.politico.com/news/2021/08/27/health-lobbies-democrats-medicare-506977

jim555

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Re: What comes after the ACA?
« Reply #6855 on: August 28, 2021, 10:09:52 AM »
I will be so sad if the Medicare age is not lowered. I think Iím too risk adverse to quit more than 5 years out from Medicare age even though I pretty much have enough saved now. I am currently 18 years out from Medicare so I could work an extra 10 plus years just for reliable access to good health insurance.
Medicare will cost me more than the ACA by far.  If you are in NY coverage is basically free under 200% FPL with the ACA.

Exflyboy

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Re: What comes after the ACA?
« Reply #6856 on: August 28, 2021, 11:03:19 AM »
Yup.. I calculated that Medicare for DW and I will cost roughly the same as what I'll get from Social Security (after I get whacked with  WEP).

Hence I ignore SS in wealth planning because its gonna get burned up with HC costs.... Tax implications are not counted in my analysis.

Under the ACA I pay about $10/month for a Bronze plan.

brooklynmoney

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Re: What comes after the ACA?
« Reply #6857 on: August 28, 2021, 11:47:33 AM »
I will be so sad if the Medicare age is not lowered. I think Iím too risk adverse to quit more than 5 years out from Medicare age even though I pretty much have enough saved now. I am currently 18 years out from Medicare so I could work an extra 10 plus years just for reliable access to good health insurance.
Medicare will cost me more than the ACA by far.  If you are in NY coverage is basically free under 200% FPL with the ACA.

Yeah ACA for people 50+ in NY seems like a great deal. For better or worse, I moved to NJ and its different. The 50+ plans seem a lot more epensive.

pecunia

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Re: What comes after the ACA?
« Reply #6858 on: August 28, 2021, 12:36:41 PM »
Yup.. I calculated that Medicare for DW and I will cost roughly the same as what I'll get from Social Security (after I get whacked with  WEP).

Hence I ignore SS in wealth planning because its gonna get burned up with HC costs.... Tax implications are not counted in my analysis.

Under the ACA I pay about $10/month for a Bronze plan.

Yeh - You will be paying more than that with medicare premiums and in addition there will be supplemental insurance.  Medicare advantage may look cheaper, but it's got some holes in it.  It's actually an advantage to you if they do not lower the age.

jim555

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Re: What comes after the ACA?
« Reply #6859 on: August 28, 2021, 12:38:02 PM »
Yeah ACA for people 50+ in NY seems like a great deal. For better or worse, I moved to NJ and its different. The 50+ plans seem a lot more epensive.
Are you outside the subsidy zone?   

Exflyboy

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Re: What comes after the ACA?
« Reply #6860 on: August 28, 2021, 12:54:55 PM »
Yup.. I calculated that Medicare for DW and I will cost roughly the same as what I'll get from Social Security (after I get whacked with  WEP).

Hence I ignore SS in wealth planning because its gonna get burned up with HC costs.... Tax implications are not counted in my analysis.

Under the ACA I pay about $10/month for a Bronze plan.

Yeh - You will be paying more than that with medicare premiums and in addition there will be supplemental insurance.  Medicare advantage may look cheaper, but it's got some holes in it.  It's actually an advantage to you if they do not lower the age.

Exactly, and as the ACA is improved as of Jan 1st 2022.. Like you can go into an ER anywhere in the country and only pay your in-network rates.. Well the ACA looks like a much better deal... Still a $7k deductible/max OOP but the monthly is virtually free... Great if you are in good health and don't need more than basic teeth cleanings once per year.

brooklynmoney

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Re: What comes after the ACA?
« Reply #6861 on: August 28, 2021, 04:38:06 PM »
Yeah ACA for people 50+ in NY seems like a great deal. For better or worse, I moved to NJ and its different. The 50+ plans seem a lot more epensive.
Are you outside the subsidy zone?

I think so yes. If I buy a house with cash I could be in it I think so that's one thing to look at.

jim555

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Re: What comes after the ACA?
« Reply #6862 on: August 29, 2021, 06:50:01 AM »
I think so yes. If I buy a house with cash I could be in it I think so that's one thing to look at.
Check the subsidy calculator...

https://www.kff.org/interactive/subsidy-calculator/

2021 and 2022 have no max income cutoff for subsidies.

bilmar

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Re: What comes after the ACA?
« Reply #6863 on: November 08, 2021, 10:32:04 AM »
Anyone know what the trigger for additional income verification is for ACA 2022? 

Their 'Guide to confirming your income Information'  says
Youíll need to send more information about your income if itís lower than the amount shown in these data sources by more than 25% or $6,000.

But, it is not clear to me if this lesser of the two amounts or greater of:
e.g. if last year's MAGI was $50k is the threshold $44K ( $6k less) or is it $37500 ( 25% less)?

secondcor521

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Re: What comes after the ACA?
« Reply #6864 on: November 08, 2021, 11:39:41 AM »
Anyone know what the trigger for additional income verification is for ACA 2022? 

Their 'Guide to confirming your income Information'  says
Youíll need to send more information about your income if itís lower than the amount shown in these data sources by more than 25% or $6,000.

But, it is not clear to me if this lesser of the two amounts or greater of:
e.g. if last year's MAGI was $50k is the threshold $44K ( $6k less) or is it $37500 ( 25% less)?

Which state?  I think it's state dependent.

My state asked for income verification the first year and the sixth year, but not the second, third, fourth, or fifth.  The sixth year trigger may have been that I reduced my estimated income by - oh, that's interesting! - $6,010.

So maybe it's a 25% decrease or $6,000 decrease from your previous estimated income (so currently, 2022 estimated vs. 2021 estimated).

bilmar

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Re: What comes after the ACA?
« Reply #6865 on: November 08, 2021, 02:11:24 PM »


Which state?  I think it's state dependent.

My state asked for income verification the first year and the sixth year, but not the second, third, fourth, or fifth.  The sixth year trigger may have been that I reduced my estimated income by - oh, that's interesting! - $6,010.

So maybe it's a 25% decrease or $6,000 decrease from your previous estimated income (so currently, 2022 estimated vs. 2021 estimated).


The guide is a federal doc and I am in FL which uses the Federal gateway. 
Yes I  am assuming previous years MAGI is what they use but when is the decrease $6000 vs 25%?

American GenX

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Re: What comes after the ACA?
« Reply #6866 on: November 12, 2021, 07:16:44 PM »
Yup.. I calculated that Medicare for DW and I will cost roughly the same as what I'll get from Social Security (after I get whacked with  WEP).

Hence I ignore SS in wealth planning because its gonna get burned up with HC costs.... Tax implications are not counted in my analysis.

Under the ACA I pay about $10/month for a Bronze plan.

Yeh - You will be paying more than that with medicare premiums and in addition there will be supplemental insurance.  Medicare advantage may look cheaper, but it's got some holes in it.  It's actually an advantage to you if they do not lower the age.

Big price increase for Medicare Part B and deductible...

https://www.cnbc.com/2021/11/12/medicare-standard-part-b-premiums-for-2022-jump-by-14point5percent-.html

jim555

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Re: What comes after the ACA?
« Reply #6867 on: November 19, 2021, 06:18:15 PM »
The Build Back Better just passed by the House does some interesting things to the ACA. 

Extend the ARPA subsidy changes that eliminate the income eligibility cap and increase the amount of APTC for individuals across the board through the end of 2025.

Lowers the employer affordability test from 9.61% to 8.5% through 2025.

Enhanced subsidies for those with unemployment compensation  through 2025.

Closes the Medicaid coverage gap in the 12 holdout states by fully subsidizing the Silver benchmark plan for those under 100% FPL.

Makes the CHIP program permanent.

Extends 12-months of continuous coverage for children in CHIP.

Reduces by 3.1% Federal Matching Funds October 1, 2022 through December 31, 2025 for states that adopt Medicaid eligibility standards, methodologies, or procedures that are more restrictive than those in place as of October 1, 2021

It also does a bunch of stuff with Medicare.

The ball goes back to the Senate, we will see what happens.





American GenX

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Re: What comes after the ACA?
« Reply #6868 on: November 19, 2021, 06:42:09 PM »
It also does a bunch of stuff with Medicare.

Not nearly as much as what the original plan had because they cut some of the few good things out of it.  On balance, I hope the bill crashes and burns trying to get through the Senate.

chasesfish

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Re: What comes after the ACA?
« Reply #6869 on: November 20, 2021, 10:30:09 AM »
It's nice to see I'll be able to get a tax credit through 2025.

Now if my ACA plan would actually cover anything, that would be great.   Almost everything we've had done this year has been mired in pre-authorizations and denials and ultimately private paid.

The health insurer and the government run hospital are busy pointing fingers at each other and not taking responsibility.   

American GenX

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Re: What comes after the ACA?
« Reply #6870 on: November 20, 2021, 11:38:16 AM »
Now if my ACA plan would actually cover anything, that would be great.   Almost everything we've had done this year has been mired in pre-authorizations and denials and ultimately private paid.

Indeed, it seems to be a common issue.  I posted a link about denied claims a while back.

https://forum.mrmoneymustache.com/welcome-to-the-forum/what-comes-after-the-aca/msg2565366/#msg2565366

That reference is about 2 years old now - not sure if it's getting any better - probably not.

secondcor521

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Re: What comes after the ACA?
« Reply #6871 on: November 20, 2021, 12:35:33 PM »
It's nice to see I'll be able to get a tax credit through 2025.

Now if my ACA plan would actually cover anything, that would be great.   Almost everything we've had done this year has been mired in pre-authorizations and denials and ultimately private paid.

The health insurer and the government run hospital are busy pointing fingers at each other and not taking responsibility.

It amazes me still how much ACA experiences differ from place to place, even though it's all under one federal law.

I've been on ACA for about five years now.  Everything has been covered well, paid with no problem, low and generally stable premiums, etc.  There was a minor glitch this spring but I blame that on an administrative error on the H&W side.

jim555

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Re: What comes after the ACA?
« Reply #6872 on: November 20, 2021, 01:33:03 PM »
I've been on NYS Medicaid for 7 years now, I was supposed to leave it before the pandemic but they locked everyone in due to the pandemic emergency.  It has been great, no bills besides co-pays.  No risk of bills either since Providers can't bill Medicaid beneficiaries in NY.  I had a colonoscopy and the Anesthesiologist was out of network.  My plan paid him the plan rate and he has to accept it and can't bill me.