Tuesday, July 9, 2013

In Addition To Premium Credits, PPACA Offers Help Paying Deductibles And Co-Pays

Thankfully PPACA will not be confusing.  

Yes, you will have sliding premium subsidies for income levels of 100% to 400% of the federal poverty level (FPL) based on family size. You will be able to purchase platinum, gold, silver, and bronze plans with corresponding levels of actuarial values.  

What is an actuarial value?  Don't worry about that.  Bureaucrats defined it for you with a calculator that does not make sense.  

You will qualify for Medicaid at up to 138% of federal poverty level in 29 of the states.  If you are under 100% of FPL in some of the states you will be better off lying to overstate your income.  (See Persons living in states that have not expanded Medicaid will be better off lying to EXPAND income to over 100% of federal poverty level to get subsidized Obamacare.poverty level to get subsidized Obamacare.

If your employer offers affordable care you don't like, you can lie about that and get subsidies in 2014 as nobody will be verifying whether or not your employer plan actually was affordable.  (See Buried in the Federal Register is an announcement that the government won’t be able to verify whether or not applicants for Obamacare’s insurance exchange subsidies are actually qualified for the aid - it's on the honor system.

And now, if you are under 250% FPL you will get a few more taxpayer tokens to reduce deductibles and copays: but only in silver plans.  Clear as mud, right?  

Does anyone think this will be something other than one massive, unprecedented, taxpayer-leeching, boondoggle?  

This is from Michelle Andrews at KHN as reported in the Washington Post:  

When people talk about health insurance affordability, they typically focus on premiums, the sticker price for a policy. For the plans being sold through the online health insurance marketplaces next year, much of the discussion has been on tax credits that can reduce the monthly premium for people with incomes up to 400 percent of the federal poverty level ($94,200 for a family of four in 2013).

But the Affordable Care Act also established another type of financial assistance for people who buy plans on the marketplaces, also known as exchanges. Cost-sharing subsidies can substantially reduce the deductibles, copayments, coinsurance and total out-of-pocket spending limits for people with incomes up to 250 percent of the federal poverty level ($58,875 for a family of four in 2013). Those reductions could be an important consideration for lower-income consumers when choosing their coverage....

Cost-sharing reductions will be applied automatically for consumers who qualify based on their income, but only if they buy a silver-level plan, considered the benchmark under the law....

The federal cost-sharing subsidies essentially increase the insurance company's share of covered benefits, resulting in reduced out-of-pocket spending for lower-income consumers. A family of four whose income is between 100 and 150 percent of the federal poverty level ($23,550 to $35,325) will be responsible for paying 6 percent of covered expenses out-of-pocket compared with the 30 percent that a family not getting subsidized coverage would owe in a silver plan. A family with an income between 150 and 200 percent of the poverty level ($35,325 to $47,100) will be responsible for 13 percent of expenses, and one with an income between 200 and 250 percent of the poverty level will be responsible for 27 percent ($47,100 to $58,875).

In addition, people who earn 250 percent of the federal poverty level or less will also have their maximum out-of-pocket spending capped at lower levels than will be the case for others who buy plans on the exchange. In 2014, the out-of-pocket limits for most plans will be $6,350 for an individual and $12,700 for a family. But people who qualify for cost-sharing subsidies will see their maximum out-of-pocket spending capped at $2,250 or $4,500 for single or family coverage, respectively, if their incomes are less than 200 percent of the poverty level, and $5,200 or $10,400 if their incomes are between 200 and 250 percent of poverty.

Insurers have some flexibility in how they structure their plans to meet cost-sharing reductions. ...

In California, for example, a standard silver plan will have a $2,000 deductible, a $6,400 maximum out-of-pocket limit and a $45 copayment for a primary care office visit. 

Someone whose income is between 150 and 200 of the poverty level, on the other hand, will have a silver plan with a $500 deductible, a $2,250 maximum out-of-pocket limit and $15 copays for primary care doctor visits....

Employees still ask me what the difference between an HMO and PPO is.  Do the luminaries sitting atop their legislative and regulatory perches have any concept, whatsoever, of how the real world works?