OT - Health Insurance Question

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AlyssaEimers's picture
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OT - Health Insurance Question

Not a debate, just asking for my personal information. (Because this is such a nice group of smart ladies Smile

After the new healthcare law takes effect, if your employer decides not to offer insurance (and pays the penalty), but you are Middle Class with medical conditions, how will you have insurance?

SID081108's picture
Joined: 06/03/09
Posts: 1348

"AlyssaEimers" wrote:

Not a debate, just asking for my personal information. (Because this is such a nice group of smart ladies Smile

After the new healthcare law takes effect, if your employer decides not to offer insurance (and pays the penalty), but you are Middle Class with medical conditions, how will you have insurance?

If your employer decides not to offer medical insurance, they will instead pay a penalty to the government, and you will recieve a voucher, which you will use to buy health insurance from the state exchanges. The voucher will essentially be like your employer's contribution toward your health insurance purchase in the exchanges, and the exchanges will be kind of like buying health insurance in the open market, only supposedly cheaper than it is today. There are still many unanswered questions about the state health care exchanges.

The government is, however, making it VERY easy for employer's to opt out of providing health insurance. I'm the Benefits Director for a company with about 1,400 employees and for us it would be substantially cheaper to opt out. However, maintaining an employer insurance plan helps to make you an employer of choice until everyone opts out, if it ever gets to that point.

ETA: I just noticed that you mentioned medical conditions...the plans in the exchanges will not be able to exclude you because of that. You may pay a slightly higher premium than a "healthy" person, but they will be severly limited as to the penalty they can charge for underwriting markups.

AlyssaEimers's picture
Joined: 08/22/06
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Thanks. So you still would be able to get health insurance even if you are not below the poverty line? What about if you were to have 2 part time jobs that equaled more than full time hours? Would you as an individual be able to buy health insurance? Or as a SAHM, would you be able to buy your own insurance?

(DH is trying to make job decisions for the future, and who will offer what is a big factor)

AlyssaEimers's picture
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"AlyssaEimers" wrote:

Thanks. So you still would be able to get health insurance even if you are not below the poverty line? What about if you were to have 2 part time jobs that equaled more than full time hours? Would you as an individual be able to buy health insurance? Or as a SAHM, would you be able to buy your own insurance?

(DH is trying to make job decisions for the future, and who will offer what is a big factor)

ETA - What if you were self employed, for example you free lanced, but worked for yourself?

SID081108's picture
Joined: 06/03/09
Posts: 1348

"AlyssaEimers" wrote:

Thanks. So you still would be able to get health insurance even if you are not below the poverty line? What about if you were to have 2 part time jobs that equaled more than full time hours? Would you as an individual be able to buy health insurance? Or as a SAHM, would you be able to buy your own insurance?

(DH is trying to make job decisions for the future, and who will offer what is a big factor)

Yes, everyone will be able to buy in the state exchanges. The only difference is how much your voucher will be for (which will reduce your out of pocket premium), and that will all be determined by your family income, and if you have coverage available elsewhere.

Even if you have coverage available through an employer, if they charge too much for it relative to your family's W2 income, you may be eligible for a voucher to purchase less expensive insurance through the exchanges. But most employers are making sure their premiums are just under that level so that they don't have to pay those penalties on any of their existing employees, while still offering a health plan (double whammy)

AlyssaEimers's picture
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So hypothetically, if a self employed person made $50,000/year with a family of 5, how much would they pay for insurance?

SID081108's picture
Joined: 06/03/09
Posts: 1348

Oh and just to clarify, because I know all of this is so confusing, anyone will be able to buy in the state exchanges, but you will only receive a government voucher if you meet the income guidelines (I'm not sure what those are at this point) or if you work for an employer that is required to offer health insurance but chooses to opt out and instead pay the penalties. So if a self-employed person purchases insurance in the exchange, they will pay for it in full themselves, just as if they were purchasing in the individual market today, except that the plans are supposed to be less expensive.

SID081108's picture
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"AlyssaEimers" wrote:

So hypothetically, if a self employed person made $50,000/year with a family of 5, how much would they pay for insurance?

No one knows the answer to this, unfortunately.

AlyssaEimers's picture
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"SID081108" wrote:

No one knows the answer to this, unfortunately.

Thanks anyway for your help.

GloriaInTX's picture
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"SID081108" wrote:

The government is, however, making it VERY easy for employer's to opt out of providing health insurance. I'm the Benefits Director for a company with about 1,400 employees and for us it would be substantially cheaper to opt out. However, maintaining an employer insurance plan helps to make you an employer of choice until everyone opts out, if it ever gets to that point.

They are making it easy because that is their ultimate goal, to get everyone off their employers insurance and onto the government plan.

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"GloriaInTX" wrote:

They are making it easy because that is their ultimate goal, to get everyone off their employers insurance and onto the government plan.

I have to say, when you've researched the bill as much as I have, it's hard to see it any other way. The penalty vs. the cost of insuring an employee is a ridiculous cost difference. As many in my industry have said, trying to convince a CEO (who mainly thinks MONEY) that it is still valuable to offer a health plan is almost laughable. Luckily our upper management value more than just the bottom line.

Joined: 05/23/12
Posts: 680

Bonita, just recently I was able to enroll my mom into govt health insurance with having preexisting conditions. We couldn't find insurance that accepted pre existing conditions or any that was not crazy expensive. Plus, there is a rule that I read coming into affect that pre existing conditions will have to be covered for all insurances.

Timeline of the Affordable Care Act | HealthCare.gov

Check out all of the information on the sliders. It is helpful. I can paste part here:

Providing Access to Insurance for Uninsured Americans with Pre-Existing Conditions
National program established July 1, 2010

A Pre-Existing Condition Insurance Plan (PCIP) provides new coverage options to individuals who have been uninsured for at least six months because of a pre-existing condition. States have the option of running this new program in their state. If a state has chosen not to do so, a plan has been established by the Department of Health and Human Services in that state. This program serves as a bridge to 2014, when all discrimination against pre-existing conditions will be prohibited.

Learn more about the Pre-Existing Condition Insurance Plan

AlyssaEimers's picture
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"myyams" wrote:

Bonita, just recently I was able to enroll my mom into govt health insurance with having preexisting conditions. We couldn't find insurance that accepted pre existing conditions or any that was not crazy expensive. Plus, there is a rule that I read coming into affect that pre existing conditions will have to be covered for all insurances.

Timeline of the Affordable Care Act | HealthCare.gov

Check out all of the information on the sliders. It is helpful. I can paste part here:

Thank you. I do not believe we would qualify for government insurance right now and I can not get individual insurance do to my health. Trying to understand the upcoming changes.

Joined: 05/23/12
Posts: 680

"AlyssaEimers" wrote:

Thank you. I do not believe we would qualify for government insurance right now and I can not get individual insurance do to my health. Trying to understand the upcoming changes.

I am not sure why you wouldn't qualify now? You do have to be without insurance I think for 6 months or your employer stops providing it. You can go through the wizard and it'll tell you what your options are. That is what I did for my own mom recently.

Here is the wizard:
Find Insurance Options | Finder.Healthcare.gov

p.s. by govt insurance I don't mean medicaid.

AlyssaEimers's picture
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When I went through all of the options I do not think we would fit any of the categories. Just looking into options right now. There is a job that DH would really like, but there would be no insurance as he would be considered either part time (But make quite a bit more than he does now) or self employed. We do have insurance now, so we have not been without insurance for 6 months. (Nor do I want to go without insurance for 6 months in the mean time). I am more thinking down the road what will happen.

Joined: 08/17/04
Posts: 2226

A business that consists of 1 person (say self employed free lance as you suggested) would not face a penalty for not having health insurance because their employee base is too small. You can, of course buy into the state exchange where there are no exemptions for coverage for pre existing conditions because due to NHCR that has been eliminated.

I would suggest if he is going the self employed route to still look a "group plan" through an insurer. They tend to be cheaper than direct pay plans as a family and give you more options. 1 employee is considered a group.

I have not seen a move here for employers to stop carrying health insurance. Most employers I know offered it before our mandate here in 2007 and of course still have to offer it. I forget what the employer penalty is in Mass. though.

I also don't see a move to a government plan. Again, as this is my everyday job we have too many employers that are contracting with us for the long term to think they are all going to stop offering it.

*Opinions expressed here are my own and not reflective of my employer*

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"Jessica80" wrote:

A business that consists of 1 person (say self employed free lance as you suggested) would not face a penalty for not having health insurance because their employee base is too small. You can, of course buy into the state exchange where there are no exemptions for coverage for pre existing conditions because due to NHCR that has been eliminated.

I would suggest if he is going the self employed route to still look a "group plan" through an insurer. They tend to be cheaper than direct pay plans as a family and give you more options. 1 employee is considered a group.

I have not seen a move here for employers to stop carrying health insurance. Most employers I know offered it before our mandate here in 2007 and of course still have to offer it. I forget what the employer penalty is in Mass. though.

I also don't see a move to a government plan. Again, as this is my everyday job we have too many employers that are contracting with us for the long term to think they are all going to stop offering it.

*Opinions expressed here are my own and not reflective of my employer*

Thank you. I was wondering what your opinion would be. I wish I could know what things would cost, so we could decide which job he would make more in the end, after you take into account for insurance costs.

Joined: 05/31/06
Posts: 4780

My husbands company was just ranked the #3 corportation to work for according to glassdoor. They have promised us a continuation of of our fantastic private insurance. I think that Gloria's doomsday scenario fails to remember that good employers will continue to contend to offer great health care for great talent.

The issue isn't that. It's those who have NOTHING. Now they have something. It's simply Christian.

Joined: 03/08/03
Posts: 3183

My company is pretty amazing in that regard too. (I'm at A&E.) There is no employee contribution to the health insurance, and it's good, solid insurance with lots of options and they don't plan to change it. When they were struggling with budget issues, the only change they made was that if your spouse CAN be covered by his or her own employer, they had to take that option. I thought that was an amazing compromise even though it did affect us. It seemed like a very reasonable way to keep the policy going that they have. I'm very very lucky.

Joined: 08/17/04
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Bonita~have your husband call around now to different local insurance companies. Their quotes may vary slightly for when you do sign up but it gives you a chance to confirm what type of plan you can afford either individually or as a group, if necessary and what company you want to use.

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"Jessica80" wrote:

Bonita~have your husband call around now to different local insurance companies. Their quotes may vary slightly for when you do sign up but it gives you a chance to confirm what type of plan you can afford either individually or as a group, if necessary and what company you want to use.

I did call around recently. They would not give a quote, just say that with my health we would not qualify, so right now our only option is for him to keep a job with insurance.

Joined: 08/17/04
Posts: 2226

Well it's a good thing then for NHCR since they won't be able to say that to you soon. Wink

Anyway, I would wait then to have him change his jobs. As long as you stay with company insurance when he leaves it is a smooth transition to a small group/individual plan because you have maintained coverage before needing to purchase your own.

AlyssaEimers's picture
Joined: 08/22/06
Posts: 6560

"Jessica80" wrote:

Well it's a good thing then for NHCR since they won't be able to say that to you soon. Wink

Anyway, I would wait then to have him change his jobs. As long as you stay with company insurance when he leaves it is a smooth transition to a small group/individual plan because you have maintained coverage before needing to purchase your own.

Thanks.