Friday, December 14, 2012

Health Care Exchanges made Easy!!!

I thought this easy to understand overview of the health care exchanges cleared up a lot of the mystery. And by the way, states can opt in to control the exchanges any time after their set up. By the way, "exchanges" is being changed to "marketplaces."
San Francisco Chronicle: Exchanges are supposed to make picking health insurance like buying an airline ticket from an online travel site.

There will be a website, and you'll be able to put in your ZIP code and get a list of available health plans. There will be a section where you can find out if you qualify for subsidies, or for Medicaid. There will be cost calculators to allow you to compare different levels of coverage: platinum, gold, silver and bronze. There will be tools that allow you to see if your doctor or hospital is with a particular plan.

Open enrollment for exchange plans starts Oct. 1, and coverage begins Jan. 1, 2014. Initially around 10 million people are expected to sign up, growing rapidly thereafter.
You can also see what you would pay in the Marketplaces with the Kaiser Calculator, as a single or a family, based on the "silver" level of coverage. That would provide 70% value, with a based on your income. At $75,000, a family would pay $7,100 a year, with a max out-of-pocket cost (not including premium) of $8,330.  A family making $35,000 would pay only $1,388 a year, with a max co-pay of $4, 100.

Other really interesting facts:

The Affordable Care Act does not include an employer mandate. In 2014, as a matter of fairness, the Affordable Care Act requires large employers to pay a shared responsibility fee only if they don’t provide affordable coverage and taxpayers are supporting the cost of health insurance for their workers.

The law specifically exempts all firms that have fewer than 50 employees – 96 percent of all firms in the United States or 5.8 million out of 6 million total firms – from any employer responsibility requirements.

Small employers with fewer than 25 full-time equivalent employees and average annual wages of less than $50,000 that purchase health insurance for employees are eligible for the tax credit.  Dental and vision care qualify for the credit as well. Starting in 2014, the small business tax credit goes up to 50% (up to 35% for non-profits) for qualifying businesses. This will make the cost of providing insurance even lower.

Starting in 2014, members of Congress will be getting their health care insurance through the Marketplace, and you will be able to buy your insurance through the Marketplace, too.

Under the health care law, employer-based plans that provide health insurance to retirees ages 55-64 can now get financial help through the Early Retiree Reinsurance Program. This program is designed to lower the cost of premiums for all employees and reduce employer health costs.

Tax credits to help the middle class afford insurance will become available for those with income between 100% and 400% of the poverty line who are not eligible for other affordable coverage. (In 2010, 400% of the poverty line comes out to about $43,000 for an individual or $88,000 for a family of four.)

The tax credit is advanceable, so it can lower your premium payments each month, rather than making you wait for tax time. It’s also refundable, so even moderate income families can receive the full benefit of the credit. These individuals may also qualify for reduced cost-sharing (copayments, co-insurance, and deductibles).

Once you enroll in a qualified health plan, you can control how much of your tax credit you want to use to help pay your monthly health plan premiums. If the amount of income you report isn’t accurate, you may not get the right amount of tax credit you’re eligible for, and it could mean you have to pay back money at the end of the year.

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