How does the ACA affect you?

Can anyone get this straight for me?

My father-in-law is on Medicare. My mother-in-law will be 64 next year.

My mother-in-law insurance was dropped. They are a household of 2. They made around 55,000 a year AGI last year on their tax return.

Is my mother-in-law eligible for Obamacare subsidies through the exchange? I think yes but not sure.

Her insurance broker told her no, that she made over 46K a year. But I thought since they are in a household of 2 she does get the tax credit which according to the Covered California website is less than 62K a year. It is around 45K for 1 person household and 62K for 2.

Try the Kaiser Family Foundation subsidy calculator.

It's likely going to come down to how the law interprets the fact they are a two-person/no dependent household with only one person signing up for insurance.

That calculator said the same thing the coveredca one did. She does get a tax credit. I don't think her situation is that unique. I am surprised there isn't more info about it out there and her broker said what she said to her.

goman wrote:

That calculator said the same thing the coveredca one did. She does get a tax credit. I don't think her situation is that unique. I am surprised there isn't more info about it out there and her broker said what she said to her.

Her broker is financially incentivized to have her sign up for insurance through him, not an exchange.

How to understand the subsidy: It's based on the household income compared to the poverty level for a household of that size. With CA's expanding medicaid, this means there's a sliding scale between 138% of the poverty line to 400% of the poverty line, where people in households at 138% of poverty pay ~10% of the premium on a silver plan, and people in households at 400% and up pay 100% of the premium on a silver plan. (The actual subsidy is based on the cost of a silver plan, I believe, so the same dollars that would pay for 90% of the premium on silver at 138% would be available for different plans, but will cover different proportions.)

In short: The cost of the plan is based on the number of people covered by the plan. The subsidy is based on household income compared to poverty.

I currently have a high deductible ($3.5k, but waived for all preventive care) 100% coverage with no limit individual plan. It's just me, no family or anything, and I'm a 32 year old male with nothing more exciting than mild insomnia in my medical history. For this, I pay $100/month. In December, it's increasing to $108. In January it will increase again to $111.72. I assume since this was communicated in a letter I received just today that this policy is not going to be cancelled, at least for the next year. The letter was careful to point out the $8 increase was increased costs of coverage and that the $3.72 was from a pair of ACA-related fees being added to all individual policies.

I don't qualify for subsidies, I live in TX, which didn't accept Medicaid expansion, and as an indie game developer living off savings who hasn't released anything yet, my income is $0: well below the minimum needed for subsidies. I haven't successfully logged into the marketplace yet, but the numbers I've seen floated suggest that I won't find a plan that is better than what I have now for the price I'd pay with no subsidies. I'd still like to see for myself though.

So, overall, it stings a bit, but not the end of the world or anything. I suspect the +$8 would have happened regardless, so really all that ACA did here was add a teeny amount to my monthly premium.

You make nothing but don't qualify for a subsidy? Weird. Hopefully there will be a better price out there for you. Or you could move to a blue state...

Robear wrote:

You make nothing but don't qualify for a subsidy? Weird. Hopefully there will be a better price out there for you. Or you could move to a blue state...

If I understand properly, the way it was supposed to work, if you made so little you don't qualify for subsidies, the Medicare (or was it aid? I always get them mixed up) expansion was supposed to take you in. But, if your state didn't accept that, no dice: the ACA didn't include subsidies for income that low because it assumed the Medi-whatever expansion (which was originally intended to be mandatory, but got ruled optional during the court battles) would cover those folks.

Medicare is for old people, Medicaid is for not-old people.

Ferret wrote:
Robear wrote:

You make nothing but don't qualify for a subsidy? Weird. Hopefully there will be a better price out there for you. Or you could move to a blue state...

If I understand properly, the way it was supposed to work, if you made so little you don't qualify for subsidies, the Medicare (or was it aid? I always get them mixed up) expansion was supposed to take you in. But, if your state didn't accept that, no dice: the ACA didn't include subsidies for income that low because it assumed the Medi-whatever expansion (which was originally intended to be mandatory, but got ruled optional during the court battles) would cover those folks.

Yes, that is my understanding as well. The ACA is specifically written for the brackets above when Medicaid kicks in. Sounds like you'll either have to move out of Texas or start making slightly more money to get cheaper healthcare costs.

Yonder wrote:
Ferret wrote:
Robear wrote:

You make nothing but don't qualify for a subsidy? Weird. Hopefully there will be a better price out there for you. Or you could move to a blue state...

If I understand properly, the way it was supposed to work, if you made so little you don't qualify for subsidies, the Medicare (or was it aid? I always get them mixed up) expansion was supposed to take you in. But, if your state didn't accept that, no dice: the ACA didn't include subsidies for income that low because it assumed the Medi-whatever expansion (which was originally intended to be mandatory, but got ruled optional during the court battles) would cover those folks.

Yes, that is my understanding as well. The ACA is specifically written for the brackets above when Medicaid kicks in. Sounds like you'll either have to move out of Texas or start making slightly more money to get cheaper healthcare costs.

But honestly, $112/mo isn't going to kill me. It'd be nice if I could get the subsidies, but I can live with $112. (If that small an increase was going to upend the boat, I had no business running off on my own to begin with. ) Only Medicaid-enabled place I could really move in my usual line of work would be CA, and the cost of living increase for moving to any of the game industry loaded parts of that state would probably pretty easily crush any benefits from becoming able to get subsidies.

So the only real option presently is to take contract work often enough to qualify. It'd probably only take a relatively small amount of that to pass the threshold. I may do that anyway to help stretch the savings out further while I do the indie thing.

There's some studios in the Baltimore area, right?

Robear wrote:

There's some studios in the Baltimore area, right?

That's true. There are a few other places besides CA that have smaller collections of studios. Most of them (including Baltimore) are also pretty scary CoL increases though. Housing alone's usually +50% or more over non-downtown Austin (where I live now.) And honestly, I don't really *want* to move. Austin's pretty awesome in a thousand ways.

No need to worry about me. I waited until I had enough stashed up to go for 2 1/2 years before I started the indie adventure, and I don't expect to need half that long to find out if it's going to work out or not. It'd be nice if I could have gotten cheaper health insurance instead of more expensive, but I have no real complaint. I'd included $100/mo for insurance in the budget, changing that to $112 doesn't have a real impact on me. I guess you could file my "how did ACA affect you" report under "no real change."

Austin? At least downtown, costs were about like they are here, I think. And Maryland is a pretty liberal state; you would not have to feel like you're living in an enclave. It's not as hip as Austin, overall, but there are pockets of awesome.

Cool that you're set financially. Good luck!

I'm kind of curious about this - call me somewhat unsure as to how everything works overseas, but seeing these numbers just make me go 'Are you fracking kidding me that's expensive'.

So I live in socialist paradise Australia (apparently ;)) where there is a two-tiered private/public health system. You *can* go without insurance entirely, and Medicare will cover most emergency stuff. Just means you have to go to the emergency room and wait for a (long) time in case of anything not completely life threatening.

We pay for dental / optical up front and get an immediate 80% discount (paid for by insurance via electronic system). Doctor visits are bulk billed and cost us nothing at all. Any prescription pills > $50 is also covered at 80%.

So, I'm head of a family of 7 - myself, the wife, 5 kids. We pay $140 /mo for 'gap' coverage - essentially gives us some extras cover like dental / optical along with any major catastrophic type stuff. And the hospital 'excess' is $500 - although if you stay in hospital more than 5 days you get *paid* $100 / day.

I went for heart surgery (valve replacement) in 2008, and my out of pocket costs were like $150 to let my wife sleep in my hospital room. And this was at a private hospital - the lobby looked like some plush hotel lobby! And not a quibble from the insurance company.

I mean, ok, I also pay about 30% in income taxes. Apart from that though.. why are your health costs so expensive?

Edit:
Also, an unemployed single friend of mine pays a grand total of $5 per week to get very similar cover, with just much lower limits on benefits.

Pawz wrote:

I mean, ok, I also pay about 30% in income taxes. Apart from that though.. why are your health costs so expensive?

Because in America, far too many people have come to believe that our beloved Constitution mandates capitalism at its very core, so nearly everything has to be a commodity distributed by corporations that are beholden to their shareholders instead of their customers. In such a case, profit is king and customer needs - even when it comes to providing insurance for life-saving medical needs - is secondary at best.

Shorter version: capitalism = freedom, and you should be grateful even if you can't afford health insurance because... capitalism!

Capitalism has turned out to mean the system by which capitalists get more money, and the rest of us surrender it to them.

Phoenix pretty much has the right of it, but he's leaving out some background info of why (IMO) people in America believe that.

(So many) Americans believe that corporations should provide these services, because they believe that the only way they can count on those services being high quality, is if competition over many providers forces them to stay on their toes.

This belief is the result of and is maintained by several factors. While this belief has been around for longer than this, I believe that the seminal moment for the older generations is the Cold War, where such talk was a large part of the Propaganda campaign against the Soviets. The collapse of the Soviet Union was seen as the proof that governments drooled and corporations ruled. Confirmation bias is largely at play here, where successful programs aren't recognized as being government programs ("Keep government out of my Medicare"). I don't think that it's just confirmation bias though, the US government does seem to struggle a lot more than civilized ones in providing these sorts of services. I believe that this is mostly a result of government workers and politicians who actively and passively work against the programs. Some of them do so for political power "Crap I said that this would fail, now it needs to fail" but I'm going to give them the benefit of the doubt and say that most do it with the countries best interests in mind "Government programs are guaranteed to fail, if I can break it now then it will die without taking more people with it later on after more and more people depend on it.

The ACA over the last few years has been a wonderful example of the sort of sabotage and attempted sabotage I am talking about. It's a vicious self fulfilling prophecy.

The second belief, probably just as important as the previous one, is the concern that if too much (and for some people "too much" seems to mean "anything at all") is done to help the poor, they will not try to stop being poor, and worse, non-poor people will look at their sweet life and decide to quit their jobs also, leading to the collapse of the entire US and World economy.

That whole "government workers are lazy and don't work for us, but against us" meme is dangerously outdated. It's perhaps more based on state and local services than on the Federal workforce, which has been winnowed six ways from Sunday and is *far* more efficient and motivated than it was in the 70's (as an example).

I have *never* seen any Federal government worker express any desire to make a program fail, and I've been working in and around the Federal government since 1980. I don't doubt that you could find a few small examples, but overall, even in deathly boring jobs you don't see that kind of disaffection. There's a real ethic of service that exists.

Now, contractors, that can be a very different story. They are not invested. But if a government employee finds his program is failing, he's going to work hard to fix it, because it's *his* evaluation that will suffer if it tanks, and that's no good for his career. Government workers have a strong self-interest in seeing whatever they do succeed, just as strong as those in the private sector, but often with the added desire to make life better for others that underlies career service.

I'm not saying they are lazy, and I'm also speaking for of the higher levels. Not the people just working a job, but mainly Congress-persons and staff and such.

Seth wrote:

BC/BS is hiring in Michigan!

So is the one in Chattanooga

Yonder wrote:

Not the people just working a job, but mainly Congress-persons and staff and such.

It's important to remember that they are not "government workers". They are elected officials. There's a huge difference. But I get your point now.

Robear wrote:

Capitalism has turned out to mean the system by which capitalists get more money, and the rest of us surrender it to them.

One could always move to Venezuela. I hear socialism is working out great there.

Because anything other than capitalism is socialism.

Nomad wrote:
Robear wrote:

Capitalism has turned out to mean the system by which capitalists get more money, and the rest of us surrender it to them.

One could always move to Venezuela. I hear socialism is working out great there.

Socialism is actually working quite better in the U.S. than in Venezuela.

Unless you want to tell us about the capitalistic enterprises known as:

Social Security
Medicare
Medicaid
Veterans' Benefits
WIC
Earned Income Credit
Public Education
The military
Home Mortgage Interest Deduction
NASA
Unemployment Insurance

Nomad wrote:
Robear wrote:

Capitalism has turned out to mean the system by which capitalists get more money, and the rest of us surrender it to them.

One could always move to Venezuela. I hear socialism is working out great there.

That is literally the only country in the entire world more liberal than the US, so... Yeah, I guess we need to swing more conservative still.

Phoenix Rev wrote:
Nomad wrote:
Robear wrote:

Capitalism has turned out to mean the system by which capitalists get more money, and the rest of us surrender it to them.

One could always move to Venezuela. I hear socialism is working out great there.

Socialism is actually working quite better in the U.S. than in Venezuela.

Unless you want to tell us about the capitalistic enterprises known as:

Social Security
Medicare
Medicaid
Veterans' Benefits
WIC
Earned Income Credit
Public Education
The military
Home Mortgage Interest Deduction
NASA
Unemployment Insurance

All funded by filthy money from taxes on capitalist profits and wages!

(My original point was poking fun at how both capitalism and socialism are only as good or bad as the people in the system. They can both either work, or be horribly corrupted.)

You misread my statement, Nomad. Usually, we use "capitalism" to be synonymous with "free markets". But we no longer have free markets (which are, remember, supposed to exist within a framework of regulations and limitations; for example, limits on banking and investment vehicles, the legalization of unions as a balance to owners, and so forth). We have laws and regulations that benefit one small group of citizens disproportionately. It's not *Capitalism* in the theoretical sense that is a problem, it's the fact that we've implemented in a way that guarantees extreme inequity that is doing the damage to our economy and our society.

In ACA-helping-people news: As of January 1st, my sister and brother-in-law have coverage under the medicaid expansion. My sister's relief at managing to get things done on the last day (January 31st) was really intense. She'd been working on it since October, but things got rather hectic and down to the wire, and she spent many hours (some of which she could have been at work if she hadn't had to be on the phone) waiting to talk to support because her SS info wasn't being accepted. (For some reason, the computer systems weren't recognizing her married name even though her name changed and she got a new SS card back in 2008. The tech on the phone prodded some system and told her it might take 24 hours to go through and if it did they wouldn't have coverage until Feb 1.)

Anyway, she's very happy now, and glad that they'll have dental coverage so that my brother-in-law can go in to have a bad tooth dealt with--he'd been putting it off because they simply couldn't afford the cost.

ACA has already potentially extended my mother's life. She was finally able to afford getting health insurance, and in the process of dealing with some long standing issues she couldn't afford to resolve prior to having insurance, they discovered she had early onset cirrhosis. Now she knows, and can take steps to fight it. Without the ACA, she'd still be without insurance and likely drinking her way to an early grave.