10/16/2013 8:45 PM ET|
Obamacare vs. your employer's plan
Even if you have health insurance through work, you might still want to explore the Obamacare exchanges.
If you already have health insurance through your job, you're probably wondering whether Obamacare will give you some new options. Will you be able to comparison-shop for a plan on the new online exchanges that might be better than your employer health insurance? The answer is a big, resounding "maybe."
Like almost everything else having to do with health care reform, there are plenty of nuances and caveats. Trying to decipher them and choose the best health insurance plan for your situation "makes homeowners insurance seem really simple," says Brian Haile, senior vice president for health policy at the tax services company Jackson Hewitt.
Exchanges will be open to all, but ...
The exchanges are online health insurance marketplaces set up under the Affordable Care Act. In 34 states, the marketplaces operate through the federal government's HealthCare.gov website, while 16 states and the District of Columbia are running their own exchanges.
Even if your employer already offers health insurance, there's nothing to prevent you from shopping on your state's exchange. However, if you decide to leave your work-based plan and purchase coverage on the exchange, you "may not qualify for some of the benefits that the uninsured have," notes E. Denise Smith, a professor of health care management at Gardner-Webb University in Boiling Springs, N.C.
Here's the big hiccup: Unless your employer's coverage for an individual is considered unaffordable under the law (that is, if your share of the premiums costs more than 9.5 percent of your household income) or inadequate (picking up less than 60 percent of the cost of covered benefits), you aren't eligible for a government subsidy to help pay for your insurance. Subsidies are one of the things that can make plans on the new state exchanges appealing.
Subsidies in the form of tax credits are available even if you earn up to 400 percent of the federal poverty level, currently about $46,000 for an individual and $94,000 for a family of four. The subsidies vary based on income and the size of your family.
Trade in your employer plan?
And that brings us back to the central question: If you have employer health insurance, should you check out the Obamacare exchanges anyway? There are differing opinions.
"It would generally not benefit an employee to leave their employer-sponsored plan," Smith concludes, adding that your employer would be under no obligation to help pay for an exchange plan.
Haile says you may not be able to do better than your work-based coverage. "Look at how robust your employer plan is" and the benefits it provides, such as whether it includes dental and vision care, which are not part of the essential health benefits that must be offered with plans sold in the Obamacare exchanges, he says.
Still, if your employer-sponsored health insurance seems to eat up a big chunk of your budget, you might want to explore your options on the state exchange, Haile says.
Few workers have 'unaffordable' plans
Again, one of the key criteria of whether you'd qualify for subsidized insurance through your state's exchange is if your share of the premium for an individual health plan where you work would amount to more than 9.5 percent of your household income. Whether you take more expensive family coverage doesn't matter; the benchmark is what an individual policy would cost.
The rule means that someone earning $40,000 a year and paying $3,775 for individual coverage would not be eligible for a subsidy, says Brian Poger, CEO of Benefitter, a software company that's helping employers navigate their way through health care reform. That same worker paying even more for family coverage would still not be eligible because, again, the premium for an individual is less than $3,800 (or 9.5 percent of $40,000).
The 9.5 percent-of-income threshold is one that few workers would meet, according to one recent study. The ADP Research Institute found that only 8.6 percent of employees are required to pay premium contributions that would meet the Affordable Care Act's definition of "unaffordable."
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Republicans tried to save us from this fraud, so enjoy being broke. Just wait until next year when the premiums double for all.
THINK ABOUT THIS LONG AND HARD. The government can't efficiently nor cost effectively deliver the mail, but you want them to control your medical plans? REALLY?
A Manhattan Institute analysis found that, on average, the cheapest plan offered in a given state, under Obamacare, will be 99 percent more expensive for men, and 62 percent more expensive for women, than the cheapest plan offered under the old system. And those disparities are even wider for healthy people.
That raises an obvious question. If 50 million people are uninsured today, mainly because insurance is too expensive, why is it better to make coverage even costlier?
The answer is that Obamacare wasn’t designed to help healthy people with average incomes get health insurance. It was designed to force those people to pay more for coverage, in order to subsidize insurance for people with incomes near the poverty line, and those with chronic or costly medical conditions.
They work for us , but yet they excluded themselves from Obama Care .. IF IT'S GOOD ENOUGH FOR THE TAX PAYING CITIZEN , THEN IT SHOULD BE GOOD ENOUGH FOR THE HOUSE , AND THE POTUS.......
To the poster saying that doctors make $200 an hour and that equates to "400k" a year and can live on that. You are showing your ignorance. Their malpractice insurance is hardly their only expense. They may gross $400k a year, but they still have to pay the cost of an office, the cost of staff and a ton of other overhead. My husband has three full-time employees working for him just to handle insurance claims. Do you think they get free rent? Free electricity? That their employees work for free? On top of that, my husband has 14 years of education and nearly $150k in student loan debt...and that was just for medical school. He went to undergrad on a full-ride scholarship and got $20k a year in scholarships to medical school. A typical medical school education will cost the average student $200k-400k. How are they even supposed to pay back those loans (not to mention the years out of the work-force for all of that school) unless they have some sort of decent salary? And most docs work very long hours and are on call on nights and the weekends. Your typical family practice doc, ob/gyn, pedi, etc. is making NOWHERE NEAR $400k. Many are lucky to make $100k. I understand that may seem like a lot to some, but when you consider the years out of the workforce for all of the schooling, the massive amount of student loan debt, the number of hours they work, constantly being on call, what they could make in other professions, etc. it isn't that great of a deal.
ObamaScare is a scam to fleece those who worked their way up.
I'm not sure if anyone in here understands healthcare - socialists/dems/republicans/libertarians
The only thing that will bring down costs is the free market. We are so far from free market in the HC industry it's pathetic. Not just Medicaid, medicare, Tricare - but also the EMTALA law that granted everyone free care back in 1986 - and that's Ronald Wilson Reagan for those of you keeping track.
The other massive problem is employer based insurance, which is the biggest tax expenditure that there is. The employer writes the cost off, and the employee recipient is not taxed either. This establishes a third party payer system, where the consumer (patient) is fairly insulated from the cost of his care.
Write a personal check for your care, no tax deduction, and see how much our spending level drops overnight.
You guys are all dummies.
So what? Why push a Medical Care that most of working class can't use.
Obama will take all from the producers and give all to the couch potatoes. We are screwed.
BHO, worst president ever.
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