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Old 11-01-2013, 03:05 PM
 
Location: Containment Area for Relocated Yankees
1,040 posts, read 1,635,383 times
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Quote:
Originally Posted by Jkgourmet View Post
I'm a little confused here.

I was speaking with BCBS of NC an hour ago. They told me that they do not have ANY individual policies that are not being sold through the exchange (except those that may be grandfathered). Even if you do not receive a subsidy, you are still buying through the exchange.

As a previous poster mentioned, if they sell you a policy on Dec 1, 2013, it will be cancelled on Dec 31, 2013 and you will have to purchase another policy. If you want to stay with BCBS, you have to buy one of those on the exchange.

So then I called Cigna. Yes, they will sell me an individual policy on Dec 1, 2013 and it will be effective through the end of 2014. What happens then? "It's unknown to us at this time." The 2013 policy would NOT have the "minimum essential coverage." I asked them if I would then be subject to the penalty (for adults, $95 or 1% of taxable income, whichever is higher.) He said no, no penalty. Which seems logical to me, but WTH to I know at this point. Come to that, WTH does anybody know at this point.
It's true that every plan that BCBSNC is selling is available on the exchange, but it doesn't mean you have to purchase it through the healthcare.gov website. In other words, yes -- it's true that (for a 1/1/14 start date), they aren't offering any individual policies that are not ALSO being sold on the exchange. However, it's not true that you can't buy one of those plans from them directly without going through the exchange.

As for the Cigna policy - it sounds like the companies that are not participating in the NC Exchange are taking advantage of a loophole that allows you to purchase a non-compliant policy before 1/1/14 and stay on it through 12/31/14 without incurring the penalty. I would assume if ACA is still around at the end of 2014, you would need to purchase a compliant plan at that point (through the exchange or off-exchange).

Does that make any sense? Or did I completely miss your point?

Last edited by TinkaMcKirk; 11-01-2013 at 03:08 PM.. Reason: I confused myself
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Old 11-01-2013, 03:17 PM
 
Location: Phoenix, AZ > Raleigh, NC
14,312 posts, read 17,519,551 times
Reputation: 22164
Quote:
Originally Posted by WorkingMomof2 View Post
It's true that every plan that BCBSNC is selling is available on the exchange, but it doesn't mean you have to purchase it through the healthcare.gov website. In other words, yes -- it's true that (for a 1/1/14 start date), they aren't offering any individual policies that are not ALSO being sold on the exchange. However, it's not true that you can't buy one of those plans from them directly without going through the exchange.
That makes total sense!

Quote:
Originally Posted by WorkingMomof2 View Post
As for the Cigna policy - it sounds like the companies that are not participating in the NC Exchange are taking advantage of a loophole that allows you to purchase a non-compliant policy before 1/1/14 and stay on it through 12/31/14 without incurring the penalty. I would assume if ACA is still around at the end of 2014, you would need to purchase a compliant plan at that point (through the exchange or off-exchange).

Does that make any sense? Or did I completely miss your point?
Yes, that makes sense. So you would agree that if someone HAS a non-compliant policy at the end of 2014, they will NOT have to pay the penalty?
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Old 11-01-2013, 04:21 PM
 
Location: RTP area, NC
1,277 posts, read 3,020,693 times
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The thought process should be less about any 'penalty', instead on the 'non compliant' policy judged on its own merits of whether it has the coverage you want and need.

IIRC, the penalty was $95 or so per adult. and less for a child. it was surprisingly low in comparison the costs of the policies involved.

so if you are looking for a policy for a single adult that provides good coverage, then go for it and risk the $95 penalty. But only if you are comfortable with the coverage it involves and doesn't involve.

Thanks for posting that such a thing exists! How are the rates?
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Old 11-01-2013, 05:45 PM
 
Location: Containment Area for Relocated Yankees
1,040 posts, read 1,635,383 times
Reputation: 1082
I think you guys will find this link helpful:

https://www.healthcare.gov/what-if-s...erage-in-2014/

Here is the info most relevant to the penalty:


Quote:
The penalty in 2014 is calculated one of 2 ways. You’ll pay whichever of these amounts is higher:

1% of your yearly household income. The maximum penalty is the national average yearly premium for a bronze plan.

$95 per person for the year ($47.50 per child under 18). The maximum penalty per family using this method is $285.

The fee increases every year. In 2015 it’s 2% of income or $325 per person. In 2016 and later years it’s 2.5% of income or $695 per person. After that it is adjusted for inflation.
Quote:
To avoid the fee you need insurance that qualifies as minimum essential coverage. If you're covered by any of the following in 2014, you're considered covered and don't have to pay a penalty:

Any Marketplace plan, or any individual insurance plan you already have
Any employer plan (including COBRA), with or without “grandfathered” status. This includes retiree plans
Medicare
Medicaid
The Children's Health Insurance Program (CHIP)
TRICARE (for current service members and military retirees, their families, and survivors)
Veterans health care programs (including the Veterans Health Care Program, VA Civilian Health and Medical Program (CHAMPVA), and Spina Bifida Health Care Benefits Program)
Peace Corps Volunteer plans
Other plans may also qualify. Ask your health coverage provider.
And thus ends our lesson on the "Individual Mandate" (aka "the penalty for not having insurance"). There may be a test later. But don't worry -- I don't give out zeros.
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Old 11-01-2013, 08:42 PM
 
995 posts, read 2,506,797 times
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Quote:
Originally Posted by Jkgourmet View Post
If you mean "I can always sign up for the govt plan since they do not care about preexisting" to mean that you believe you can sign up anytime you want/need the coverage - incorrect. The ONLY time you can sign up is during open enrollment. For now, that goes through March 31, 2014. Then reopens in October, 2014, for coverage that begins January, 2015. So - go ahead and get no coverage. Get sick on April 1, 2014. You're going to be footing the bills until January 1, 2015 before you get coverage in the exchange.
Yes I know I can sign up only during my wife's open enrollment or Oct 14. I am fairly young and got a clean bill out health at my last check up, knock on wood. I avg 2 Dr visits a year and one of those is a my annual physical. I just added 50k medical payments on my car today for a whopping $33 extra per year. Anyway what will happen if I walk into a hospital without insurance today or next year? Can they turn me away?
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Old 11-01-2013, 09:02 PM
 
Location: Phoenix, AZ > Raleigh, NC
14,312 posts, read 17,519,551 times
Reputation: 22164
Quote:
Originally Posted by stantheman78 View Post
Yes I know I can sign up only during my wife's open enrollment or Oct 14. I am fairly young and got a clean bill out health at my last check up, knock on wood. I avg 2 Dr visits a year and one of those is a my annual physical. I just added 50k medical payments on my car today for a whopping $33 extra per year. Anyway what will happen if I walk into a hospital without insurance today or next year? Can they turn me away?
Oh God, that opens a whole can of worms.

As a matter of respect for CD and the actual TOPIC of this thread, I'm going to keep my answer short as possible.

At 39 years old, without any warning, I showed up in an ER with the signs of a stroke. They did MRI's and CAT scans. They said, "We think you have brain cancer.". Without insurance, I would have had seriously limited choices of treatment unless I had a lot of cash. With health insurance, I received the best treatment available, including out of network and out of state (but I had doctors who fought for it).

That was 1998.

Do I think the ACA was the best, the right solution for better healthcare for our citizens? NO. But going without insurance is just plain foolish. No, they won't "turn you away". But you're not going to get much help either. Please, Don't do that to your family, or to yourself.

Last edited by Jkgourmet; 11-01-2013 at 09:24 PM..
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Old 11-02-2013, 08:41 AM
 
226 posts, read 433,338 times
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Quote:
Originally Posted by stantheman78 View Post
Yes I know I can sign up only during my wife's open enrollment or Oct 14. I am fairly young and got a clean bill out health at my last check up, knock on wood. I avg 2 Dr visits a year and one of those is a my annual physical. I just added 50k medical payments on my car today for a whopping $33 extra per year. Anyway what will happen if I walk into a hospital without insurance today or next year? Can they turn me away?
Good health is no guarantee of keeping your life.

Don't forget that it's not uncommon for flawlessly healthy people get mangled in car accidents or hit by busses, or suffer some completely devastating non-health related issue.

The hospital may not actually turn you away, but I noticed when I was in the ER earlier this week, the signage stated they will help you to as long as they are equipped to do so. In other words, you might get a minimal patch up, but I interpreted their signage to mean they can ship you off to another "equipped" facility afterwards.

Even though I am insured through my employer, my recent visit, plus overnight stay, plus a return to the ER the night after release is going to cost me a FORTUNE due to deductibles and co-insurance. Thank God my issue was bad enough but not something requiring extended treatment. I'll manage the expenses, but I also know of people who've gone bankrupt or lost their homes or savings thanks to medical bills.

Food for thought. Or not. Up to you.
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Old 11-02-2013, 09:43 AM
 
Location: Inactive Account
1,508 posts, read 2,372,789 times
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Even though I think paying the penalty can be a defensible decision if you're in good health and not married or with dependents - I would be VERY skeptical of the "health insurance" riders on an automobile policy.
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Old 11-02-2013, 10:00 AM
 
Location: Phoenix, AZ > Raleigh, NC
14,312 posts, read 17,519,551 times
Reputation: 22164
Quote:
Originally Posted by Sean_CLT View Post
Even though I think paying the penalty can be a defensible decision if you're in good health and not married or with dependents - I would be VERY skeptical of the "health insurance" riders on an automobile policy.
The medical payments that stantheman78 has added to his auto policy will be used ONLY in the case of an auto accident. Should he become ill or suffer an injury in a non-auto related accident, the auto insurer will not be paying anything.

And after that $50K is used up (which can be a matter of days should he suffer a serious injury), he will be personally responsible for all the expenses.
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Old 11-02-2013, 11:07 AM
 
Location: NC
6,394 posts, read 4,477,707 times
Reputation: 7154
Quote:
Originally Posted by stantheman78 View Post
I hear the same old story with the 10k deducatable plan from BCBS. I decided not to cary health insurance next year. I will pay cash as needed. I know I will get fined but it is still cheaper. We have savings for any major items. I can always sign up for the govt plan since they do not care about preexisting. I also change my car insurance plan to cover medical.
People like you are the reason a mandate is needed. No, you can't just sign up. If you are diagnosed with cancer, or if you have an accident doing yardwork, or something MAJOR, you won't be able to pay, and people like me, who are covered, will end up footing the bill. I totally agree with "high deductable" coverage for people that feel like they are healthy, but not for "no coverage", that's just not realistic, when an unexpected cancer diagnosis can add up to millions (or a heart attack, or stroke, or etc..) quickly. Most can't pay it.

And your car only covers medical if you get in a wreck. Not if you get sick.
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