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Thread: Health care plans

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    Default Health care plans

    On October 1, 2013 we can start signing up through the health exchange marketplace.

    How does the Affordable Care Act affect me?


    How is you state's care changing?


    What kind of care do I possibly qualify for?


    ACA tax provisions


    Subsidy calculator


    Top 25 Health Insurance companies in the US


    I'm currently up for redetermination with medicaid, and after sitting on hold for 2 hours so I could ask them questions, I decided to hang up and just do my own homework.

    I want this thread to be a helpful starting point for those of us looking to get insured. If anyone else has any other helpful links, please add them. I would appreciate it if we can keep this to being helpful guidance only!

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    Arrow Re: Health care plans

    also for dancers and camgirls who have established LLC's or S-Corp, you may GREATLY benefit by having your corporation purchase public exchange health insurance FOR you via the S.H.O.P. exchange.

    from Forbes -

    (snip)"Why should small employers sign up for the SHOP exchange?

    My key pickup from the [ ObamaCare 'navigator' - sic ] manual? Currently, when employers purchase health insurance through insurance companies, most are required to pay part of the premium for the employee and the employee pays the rest. In my small company, since I have under four employees, I have to pick up 100% of the cost of the insurance. If I had over four employees, I would still have to pick up at least 50% of the cost as it is required by the insurance company to sell insurance to me and my employees. According to page 155 of the Navigator manual, with the SHOP exchange, the employer does not have to contribute ANYTHING to the cost of the premium – they can pay anywhere between zero and 100% of the premium, and the employee pays the rest. (Addendum – This is only for the federally run exchanges. State run exchanges may have different rules. For example, California requires small employers contribute 50% of premium costs.)

    You may be thinking, “Why would I go through the bother of signing my company up for the SHOP exchange if I am not going to pay any of the premium?” Pure and simple – the tax benefit for you and your employees.

    What is the tax benefit for buying insurance under the SHOP exchange?

    Health insurance premiums purchased through work are paid with pre-tax dollars. The employee or the company – whoever paid the premium – gets a nice tax break on the premiums. An example:

    “Employee A” makes adjusted gross income of $70,000 per year. Insurance for that employee and her spouse costs $9,000 per year. The employee is in a 15% tax bracket. By paying for health insurance with pre-tax dollars, the employee saves $1,350 in taxes, so the effective cost of their insurance is $7,650."(snip)

    (snip)"Are there any other tax benefits for small employers who provide health insurance?

    If employer pays at least 50% of the premium, they may be eligible for a small business tax credit for the premiums paid. The tax credit only applies if you have fewer than 25 employees and they average less than $50,000 per year in wages. Many employers eligible for the credit are not taking it, as the calculation is slightly cumbersome."(snip)


    As discussed in another thread, the best case scenario for a dancer or camgirl is to set herself up as an S-Corp ). Then for say $75k in total earnings, the S-Corp uses a few thousand pre-tax dollars of that to buy SHOP exchange health insurance for the 'employee' owner. The S-Corp also pays for various business expense items. Then from the $70k in dollars that are remaining, the S-Corp pays the 'employee' owner a $47k salary plus a $23k 'dividend'. Because the salary portion is below the tax credit threshold, the S-Corp then becomes eligible for a $2,000 tax credit to partially 'reimburse' the company for so generously providing health insurance coverage to its single 'employee' !!!

    The corporation paying for Public Health Exchange SHOP health insurance coverage with pre-tax dollars, versus an individual dancer paying for Public Health Exchange individual insurance coverage with after-tax dollars, given a ~$2-3,000 premium cost and a 25% effective tax rate, this change alone could save the dancer or camgirl $500-$1,000 per year. Then by the corporation filing for the employee health insurance tax credit, net income is increased by another $2,000. Additionally, the effective tax rate applying to the 'employee' owner's 'dividend' income will probably be lower than the effective tax rate applying to 'ordinary' income - which could reduce the total tax bill by another few hundred dollars.

    To take full advantage of ObamaCare, dancers and camgirls need to start thinking of themselves as businesses instead of individuals ...

    ... and this is especially true for any dancers or camgirls who earn more than 400% of the official gov't 'poverty level' = $46,000 per year ... the point at which all forms of Public Health Insurance premium taxpayer subsidies stop for individually purchased health insurance, and the person must then pay the full shot for health insurance premium costs using after-tax dollars.
    Last edited by Melonie; 09-27-2013 at 10:54 AM.

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    Default Re: Health care plans

    with the 'other' thread on American Public Health Insurance Exchanges having been closed and deleted, in the interest of the majority of SW readers who are American, I'll repost the most important points and changes from the perspective of dancers and camgirls.

    - ObamaCare imposes a 'personal mandate' that all Americans obtain 'qualified' health insurance coverage, or pay a new IRS penalty for failure to obtain 'qualified' health insurance. The new IRS penalty is included on the 2013 tax return which must be filed ( and taxes / penalty paid ) by next April 15th. For this first year, the IRS penalty amounts to 1% of adjusted gross income. Thus for a dancer or camgirl who does not obtain 'qualified' health insurance before filing her 2013 tax return, she will owe the IRS an additional 1% penalty ... which for a 'serious' dancer or camgirl earning $1000 per week will amount to an extra ~$400. This IRS penalty doubles to 2% =$800 next year, and increases to 2.5% = $1000 for all years after that.

    - dancers and camgirls have traditionally purchased 'catastrophic only' high deductible high co-pay low monthly premium 'limited' health insurance for themselves, because the odds of them developing serious health problems while 'young and strong' was tiny. However, such 'limited' coverage does not 'qualify' under ObamaCare because it does not include newly mandated coverage for things like substance abuse treatment, 'routine' exams, 100% free birth control drugs, and a host of covered items that the 'limited' insurance does not cover. Thus dancers and camgirls who continue to rely on 'limited' insurance coverage ( if it still remains available ) will also have to pay the IRS penalty as described above in addition to their low monthly 'non-qualified' health insurance premiums.

    - The cost of 'qualified' health insurance coverage varies from state to state, and from region to region within the state ... and also varies with the level of insurance coverage chosen ( 60% bronze, 70% silver, 80% gold, 90% platinum ) ... and also varies with age group. Thus it is impossible to accurately predict the actual cost of insurance coverage. However, for a 21 year old female, early numbers show something on the order of $175 to $250 per month for 70% silver coverage = about $2000 to $3000 per year.

    - The ACTUAL out-of-pocket cost for 'qualified' health insurance coverage via the new Public Health Insurance Exchanges may be subsidized by other taxpayers. To qualify for subsidies at all, your annual earnings must be less than 400% of the official gov't 'poverty' level, or about $46,000 per year. Subsidy amounts increase as income decreases, with breakpoints at 300% of 'poverty' level, 250% of 'poverty' level, 200% of 'poverty' level, and 133%-138%-150% of 'poverty' level ( depends on state Medicaid threshold ). Where young and healthy dancers and camgirls in the youngest age group are concerned, subsidies won't actually kick in unless your income level is lower than 300% of 'poverty' level or about $35,000 per year.

    - ObamaCare also imposes a new limit on health insurance premium costs that dictates that the maximum range of premium costs ... essentially the difference in health insurance premiums charged between young / healthy Americans and old / sick Americans ... can only be a 3 to 1 ratio. Since 'private' health insurance rates now vary by much more than this, ObamaCare health insurance premiums essentially 'overcharge' young and healthy dancers and camgirls in order to cross-subsidize health insurance premiums for older Americans. Thus the $175-$250 per month for expected health care premium costs. However, the level of 'deductible' is the same, which for 70% silver coverage is a $2000 annual deductible with a $6,400 annual 'out-of-pocket' limit ( over and above the $2-3,000 annual cost of the insurance coverage itself ).

    - ObamaCare also restricts the amount of 'out-of-pocket' medical expenses which must be incurred before a medical expense tax deduction is allowed to 10% of income. Thus for our $50k per year dancers and camgirls with silver coverage, between a $2-3,000 insurance premium, $2000 in deductible, and 30% copays, odds are that your total medical expenses will not reach the new 10% threshold over which you can claim a medical expense tax deduction.

    - Obamacare also restricts the annual contributions to ( tax exempt ) Health Savings Accounts to $2,500. In the past this was unlimited, and was very popular with young dancers and camgirls who chose to pay for occasional medical treatment out of their own pockets in lieu of purchasing health insurance.

    - On the opposite end of the dancer and camgirl income scale, if your adjusted gross earnings are below 133%-138%-150% of the official 'poverty' level ( = $ 15,300-$16,000-$17,000 for a single person ) you can essentially get 'free' health insurance coverage through the new Public Health Insurance Exchanges via expanded Medicaid. However, this 'free' health insurance coverage is still Medicaid, and still carries a 'clawback' provision where the state can and will attempt to confiscate assets upon the person's death ( houses, retirement accounts, savings and investments etc. ) to reimburse the state for the cost of Medicaid funded health care it has provided over the years. This has obvious ramifications regarding future decisions to own versus rent / lease, ramifications on inheritances for children etc.

    - subsidy amounts for Public Health Exchange insurance premiums change abruptly at the various income level 'breakpoints' ...



    ^^^ the amounts shown in black are the actual out-of-pocket monthly costs for 70% silver coverage for a 21 year old single person in California, which vary according to her income level. The three different price levels shown are options from three different health insurance providers to the Public Health Exchange, which probably involve different networks of hospitals / clinics / doctors that will accept their insurance ( with the least expensive also having the least number of participating hospitals / clinics / doctors ). The amounts shown in gray are the amount of subsidy ( collected from taxpayers ) applied against the actual cost of the insurance. A point of note is that earning 199% of the 'poverty' level versus earning 201% of the 'poverty' level, or earning 249% of the 'poverty' level versus 251% of the 'poverty' level, results in a LARGE increase in out-of-pocket cost of health insurance premiums due to the abrupt reduction in ( taxpayer funded ) subsidy.

    - Obamacare also includes it's own 'clawback' provision for recouping of ( taxpayer funded ) subsidies. For example, if a girl estimates that she will earn $28,500 or 245% of 'poverty' level during 2014, and is allowed to sign up for Public Health Insurance coverage at a subsidized cost of $108 per month ... but actually winds up earning $29,000 during 2014 or 255% of 'poverty' level thus was only eligible for a subsidized cost of $181 per month, the IRS will collect an additional ( $181 - 108 ) * 12 or $876 in Obamacare tax on her 2015 tax return to recover the subsidy money she already ( indirectly ) received, but for which she wasn't actually eligible !

    - Finally, Obamacare does away with changes in health insurance premiums based on actual health, and forces insurance companies to write new health insurance coverage regardless of 'pre-existing' medical conditions. Thus, theoretically at least, a dancer or camgirl can elect not to purchase Public Health Exchange insurance coverage, can elect to pay the new IRS penalty for failure to purchase health insurance, and potentially save $1500-$2500+ per year in the process. If the uninsured dancer or camgirl DOES become seriously ill, after paying for the first doctor's visit out of her own pocket, she can stop by the Public Health Exchange Insurance office to purchase health insurance on her way to the hospital and have insurance coverage in effect to cover the hospital bill !!! If the serious medical condition is fully resolved, she can then stop making payments on her Public Health Exchange insurance coverage and revert to paying the IRS penalty ... until the next time she becomes seriously ill ! Of course, this strategy doesn't work very well if unexpected injuries were to occur i.e. a car accident, since she will be placed in hospital before she can sign up for insurance coverage.

    While I welcome legitimate questions and comments that are economic / financial in nature, or which relate to Obamacare program 'rules', please refrain from ( again ) redirecting this thread towards a 'public policy' discussion or a political slugfest. Obamacare is what it is, and the Public Health Insurance Exchanges are about to open. I don't want to have to type all of this stuff a third time !!!
    Last edited by Melonie; 09-30-2013 at 03:37 AM.

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    Default Re: Health care plans

    This is important stuff. These are things a lot of S-Web members need to know. So please , PLEASE refrain from editorializing , going off on tangents or adding personal opinions ( political or otherwise ).

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    Default Re: Health care plans

    more info based on a PM'd question regarding smokers ...

    While the Obamacare law has no such provision, the Sec. of HHS has exercised her authority under Obamacare to establish a 50% 'smoker's surcharge' on Public Exchange Health Insurance premiums. Based on the previous example of a dancer or camgirl earning $1000 a month, if she is a smoker her $216 health insurance premium will increase to $324 per month.

    However, the HHS Sec. lacked authority to affect taxpayer subsidies. Thus for the other example, a dancer or camgirl earning $26,500 per year who is a smoker would see her monthly ( $216 - 107 ) = $108 insurance premium increase to ( $324 - 107 ) = $217 per month. However, the Obamacare law also limits maximum health insurance costs for the 200% of 'poverty' level bracket to 6.5% of income, which would limit monthly premiums to $143 per month.

    At this time it is not known whether the Secretary's surcharge for smokers will supercede the 6.5% limit that applies to the 200% of 'poverty' level bracket. Different limits apply to different % of 'poverty' level brackets. As the Public Health Insurance Exchanges actually encounter this issue during signups, a HHS directive and/or court ruling will be needed to resolve the 'conflict'. But in either case it is a certainty that tobacco users will wind up paying significantly higher health insurance premiums.

    In regard to 'enforcing' the 'smoker's surcharge', after next January Obamacare will require all health care providers to ask Public Health Insurance patients a battery of questions which in turn will be reported to the gov't. This includes tobacco use, along with a host of other types of questions. It is not known for a fact, but is likely, that patient blood tests and other tests paid for by Public Health Insurance next year will also include a test for nicotine, the results of which will be reported to the gov't. And as discussed above, the 'clawback' provisions of Public Health Insurance can result in people who lied about tobacco use when filing for Public Health Exchange insurance this year, who are subsequently reported to be using tobacco, being hit with an IRS charge for the difference in health insurance premiums on their 2015 tax returns ( i.e. for a dancer earning $26,500 who claimed to be a non-smoker at signup, but who had nicotine show up in a blood test or health care provider report, ( 217 - 108 ) * 12 = $1,308 ).
    Last edited by Melonie; 09-30-2013 at 10:08 AM.

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    Default Re: Health care plans

    Yet more info based on a PM'd question about Obamacare's 'Marriage Penalty' ...


    (snip)"Households with incomes between 100 percent and 400 percent of the FPL will be given subsidies in the form of refundable tax credits to help offset the cost of private coverage. Everyone else will have to pay his own way.

    The tax-credit subsidies are intended to serve as a cap on the amount of household income that a family must pay for a specified level of government-approved health insurance. The subsidy starts high so that a family earning 100 percent to 133 percent of the FPL will only have to pay 2 percent of their income for coverage, then gradually decreases as income increases, with a family earning between 300 percent and 400 percent of the FPL shelling out 9.5 percent of their income in premiums.

    Here is where the marriage penalty comes in. According to CNSNews.com’s Terence P. Jeffrey, “Married couples seeking the subsidy are required to file joint tax returns and whether their premiums are capped or not is determined by the couple’s combined income. The law thus imposes a steep penalty on Americans who live in traditional families.”

    In other words, though one or both members of a couple might qualify for subsidies if they remained single and thus had lower individual incomes, neither will qualify for a subsidy if they wed and their combined income exceeds 400 percent of the FPL. This, noted the House Committee on Oversight and Government Reform, is because “the tax credit amount is linked to [FPL] and FPL does not increase proportionally as household size increases.”

    The House Oversight Committee offered another scenario: “In 2014, 400 percent of the FPL will be about $45,600 for a one-person household, increasing roughly $16,000 for each additional household member ($61,600 for a two-person household). Thus, … two individuals who make between $61,600 and $91,200 (twice the FPL of a one-person household) will not benefit from the tax credit if they decide to marry since they will be over 400 percent of the FPL for a two-person household. These two individuals can benefit from the tax credit, however, if they remain unmarried or if currently married, they decide to divorce.”(snip)


    I would add that the 'Marriage Penalty' may become a much larger issue in the future based on another Obamacare requirement ... or lack thereof. For employers, Obamacare imposes a tax penalty if the employer fails to provide 'qualified' health insurance for full time employees. But Obamacare does NOT mandate that said employers must provide, or must continue to provide, health insurance coverage for the dependent spouses of full time employees. As a result a number of MAJOR employers have already started sending out notices that employee dependent spouse health care will no longer be offered, or will be severely restricted, after the end of 2013. See Major companies already announcing this policy change include UPS, various universities and hospitals, Northrup Grumman etc., and many more major companies say they are looking into the possibility of doing so.

    The relevant point from employers dropping health insurance for spouses ( and potentially children ) is that the dependent spouse ( and potentially children ) will then be forced to seek Public Health Exchange insurance coverage. However, the percent of 'poverty' level bracket ( thus available amount of taxpayer subsidies ) that will apply will be based on the family's total income level not just the dependent spouse's income level. And to make matters even worse, starting in 2014 the 'equivalent cash value' of any employee health insurance benefits received from an employer by the employee spouse and insured dependent children ( but not specifically charged to the employee ) will be counted as additional employee income where calculation of adjusted gross income is concerned !!! Not only is this likely to result in a higher amount of income taxes being due on the same amount of employer insured employee's gross income, but it also increases the amount of family income used for the Public Health Exchange % of FPL calculation thus decreasing any taxpayer subsidy that might have been available for Public Health Exchange insurance premiums to cover the uninsured spouse ( and potentially children ).

    The ambiguity in the above paragraph stems from the fact that employers are still mandated to provide dependent health insurance coverage for the dependent children of employees when employees request such coverage ... but at a potentially significantly higher health insurance premium cost to the employee spouse for 'family' coverage versus individual coverage ( even though that 'family' coverage may no longer cover the non-employee spouse ). Thus a major dollars and cents equation arises where the married spouses must evaluate the relative costs of insuring children under the employee spouse's employer health insurance, versus having the children seek Public Health Exchange insurance coverage along with the non-employee spouse. Secondary concerns arise where one spouse must operate on a totally different health insurance plan ( thus must potentially use different doctors, different health care facilities, different pharmacies etc. ) than the other spouse and children. This may be further compounded by separate health insurance carriers forcing the use of separate 'deductibles', separate annual 'out-of-pocket' limits etc.

    Also, as was the case with the Secretary's 'smoker's surcharge' versus the various percentage of income limits on Public Health Exchange insurance premium costs for the various % of FPL brackets, it is not known at this time how the employer's and/or employee spouse's 'contribution' to total employer provided employee ( and potentially dependent children ) health insurance premium costs will factor into the ( subsidized ) Public Health Exchange insurance subsidy calculation for the non-employee spouse ( and potentially dependent children ). The employer's 'contribution' will be included in the 'cash value' of employee health insurance benefits which will appear on the employee spouse's W2 for purposes of calculating income taxes, but under Obamacare it is unlikely that employer 'contributions' will be counted toward total percent of family income 'spent' on health insurance premiums for Public Health Exchange subsidy calculation purposes. For that matter, direct employee payments to the employer for individual or 'family' coverage ( which doesn't include coverage for the non-employee spouse only children ) may not be counted either. Again, a court ruling or HHS directive will likely result once Public Health Exchange sign-ups begin and the issue is actually raised for required resolution. But one thing is for certain, a married couple whose combined earnings are less than $91k per year will wind up paying a higher out-of-pocket premium for Public Health Exchange insurance coverage than if the couple weren't married ! And if children are involved, the $91k per year 'break even' threshold will move even higher.
    Last edited by Melonie; 09-30-2013 at 01:08 PM.

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    Default Re: Health care plans

    Saw this article with the average premiums in 48 states.

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    Default Re: Health care plans

    ^^^ the cost info in that report amalgamates Obamacare premium costs across all age groups, which is of limited value to most SW readers. Another report at breaks out both unsubsidized insurance premium costs ( for girls earning $47k+ per year i.e. 401+% of FPL ) and partially taxpayer subsidized insurance premium costs ( for girls earning ~$28k per year i.e. 250% of FPL ) for single 25 year olds as follows ...





    Obviously, there is a lot of state to state variation in the unsubsidized cost of Public Health Exchange health insurance, as well as a lot of state to state variation in the amount of taxpayer subsidies available ( mostly due to the Obamacare federal percentage of adjusted gross income limits on Public Health Exchange insurance costs for those earning less than 400% of FPL ). Note that a $193 limit kicks in for the 250% of FPL Silver category, which overrides the 'market price' of health insurance in that state. This will save LA and Cleveland girls earning ~$28k per year a few bucks via subsidies, but will save NY and Burlington girls earning the same ~$28k a couple of hundred dollars per month ! The premium cost limiting effects of the Obamacare federal X% of income limit overriding 'market prices' for health insurance coverage will definitely force dancers and camgirls in high insurance cost states to think long and hard about the net cost effects of earning one extra dollar over the 400% of FPL amount or $45,960 for a single person in the 48 'continental' states where a 9% = $344 per month overriding health insurance premium limit still applies.


    It should also be pointed out that the cost of monthly Obamacare health insurance premiums is not the only cost which must be paid out of pocket. As mentioned previously, silver coverage is 70% meaning that the 30% balance of medical costs must be paid out of pocket. Bronze coverage is 60% meaning that the 40% balance of medical costs must be paid out of pocket. But the 60% or 70% insurance payouts ONLY start happening after the person has first spent the amount of the annual deductible out of pocket.

    (snip)An independent analysis released Wednesday, on the heels of an administration report emphasizing affordable premiums, is helping to fill out the bottom line for consumers.

    The annual deductible for a mid-range “silver” plan averaged $2,550 in a sample of six states studied by Avalere Health, or more than twice the typical deductible in employer plans. A deductible is the amount consumers must pay each year before their plan starts picking up the bills.

    Americans looking for a health plan in new state insurance markets that open next week will face a trade-off familiar to purchasers of automobile coverage: to keep your premiums manageable, you agree to pay a bigger chunk of the repair bill if you get in a crash. Except that unlike an auto accident, serious illness is often not a self-contained event.

    Avalere also found that the new plans will require patients to pay a hefty share of the cost — 40 percent on average — for certain pricey drugs, like the newer specialty medications used to treat intractable chronic diseases such as rheumatoid arthritis and multiple sclerosis. On the other hand, preventive care will be free of charge to the patient.

    “Consumers will need to balance lower monthly premiums against the potential for unpredictable, expensive out-of-pocket costs in plans with higher deductibles,” said Caroline Pearson, a vice president of the private market analysis firm. “There is a risk that patients could forgo needed care when faced with high up-front deductibles.” (snip) from


    While health insurance costs in New York City are much higher than the national average, combining this info means that a 25 year old NYC dancer earning $1000 per week will wind up paying 12 * $308 = $3,700 for Bronze coverage health insurance premiums + another $2,000+ in annual 'deductible', before her Obamacare health insurance starts picking up 60% of the cost of additional medical treatments. Granted that certain services like routine checkups will be paid for. Once she has paid $3,700 for Bronze coverage health insurance premiums, plus has paid another $6,300 in out-of-pocket medical costs to reach the annual 'out of pocket' limit, her Obamacare health insurance will then pay 100% of any additional medical costs for the rest of the year.

    The underlying point, of course, is that the most affordable Bronze coverage ... in the final analysis ... actually doesn't provide a whole lot more health insurance coverage than the 'catastrophic only' high deductible limited health insurance plans which had monthly health insurance premiums that were only a small fraction of the Obamacare premiums, but are no longer being sold in New York due to failure to 'qualify'. However, unlike that 'catastrophic only' health insurance coverage, 'qualifying' Obamacare insurance will cover treatment for substance abuse, psychiatric treatment, pregnancy ( yes males also pay for pregnancy coverage ), etc.

    It should also be pointed out that these 'first year' Public Health Exchange insurance premium costs are based on a whole array of assumptions in regard to expected 'sign-up' rates for young and/or healthy people versus older and/or seriously sick people. Once the first year has passed, if the expected 'sign-up' rates don't actually happen, the next year's insurance premiums will need to be adjusted to allow the insurance underwriters to 'break even'. Along those lines, Huffington Post points out the following ...

    (snip)"Just five percent of Americans accounted for half of the country's health care costs in 2009, according to a report from the Agency for Healthcare Research and Quality. Though the findings indicate that a small share of the population is responsible for much of the country's health care costs, the concentration right at the top is actually going down, the report found -- one percent of Americans accounted for 22 percent of health care costs in 2009, down from 28 percent in 2008."(snip)

    ... thus for girls earning $46k+ per year, whose Public Health Exchange insurance premiums are not capped at a maximum of X% of adjusted gross income as those earning less than $46k per year are under taxpayer subsidized Obamacare, next year's Public Health Exchange health insurance premiums may wind up being significantly higher than the 'first year' premiums shown above. This will depend on how many young and healthy people earning $46k+ per year actually decide to sign up for Obamacare ( thus helping to subsidize health care costs for older, sicker people ) versus foregoing Obamacare, paying the new IRS penalty, and paying for their own medical treatments out-of-pocket. However, for this first year at least, the Public Health Exchange premiums ( and potential taxpayer subsidies ) have already been established.
    Last edited by Melonie; 10-01-2013 at 12:47 AM.

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    Default Re: Health care plans

    Young adult insurance quandary: Stay with parents, or go it alone?
    By Michelle Andrews Kaiser Health News

    NBCnews.com

    Oct. 1, 2013 at 10:36 AM ET

    One of the earliest provisions rolled out under the 2010 Affordable Care Act allows young adults to remain on their parents’ health insurance plans until they reach age 26. It was immediately popular.

    Before the law, dependent children often “aged out” of their parents’ health plan at age 19, or 22 if they were full-time students. Last year, an estimated 7.8 million adults between the ages of 19 and 25 were able to either join or stay on their parents’ plans, according to the Commonwealth Fund’s 2013 annual tracking survey.

    In 2014, options for young adults, many of whom either aren’t offered health insurance at their jobs or can’t afford it, will expand again with the opening of the state health insurance marketplaces and the expansion of the Medicaid program to low-income adults in many states. Here’s what to look for.

    Q. Who’s allowed to stay on their parents’ plan?

    A. Nearly all young people can do so until age 26, even if they’re married, financially independent and no longer live with their parents. Young adults who are offered coverage through their own jobs can choose that plan or stick with their parents’ plan if they prefer.

    Q. What about young adults whose parents don’t have insurance on the job? What are their options?

    A. If they don’t have insurance through work, starting Tuesday young adults can shop for coverage on the insurance marketplaces, also called exchanges, for coverage that begins in January. That open enrollment period will continue until the end of March.

    In addition, people up to age 30 will have the option of buying a catastrophic plan that will cover only minimal services until they meet a deductible of roughly $6,400.

    The private market will also have plans that are available to young adults. But subsidies will be available only for plans sold through the exchanges.

    Depending on their income and where they live, some young adults may qualify for Medicaid under ACA provisions that expand coverage to individuals with incomes up to 138 percent of the federal poverty level ($15,856 in 2013). States can decide whether to adopt the expansion; about half have done so.

    If a young person is enrolled in college, the student health plan is also an option. Although student health coverage has often been skimpy in the past, most student health plans offered this fall met many of the ACA’s requirements, and most will be fully compliant next fall.

    Q. Is there any reason not to sign on with the parents’ plan?

    A. Apart from general cost and coverage considerations, there are a few specifics to keep in mind when weighing a parent’s plan. If children are studying or working in areas away from their parents’ home, there may be no local providers who are in their insurance network, and going to out-of-network doctors or hospitals can be expensive. For young adults who are healthy, delaying a doctor visit until they return home may not be a problem, but for those with chronic conditions that may not be feasible.

    In addition, if a young woman plans to become pregnant while on her parents’ plan, she should check to make sure maternity benefits are covered. Although by law most group plans must provide maternity coverage for employees and their spouses, children aren’t protected by the law, and employers don’t always provide coverage

    Q. What if the parents are on Medicare? Can an adult child join them?

    A. No. Medicare is primarily a program for individuals who are 65 and older. There’s no family coverage available.

    Q. Can a young adult qualify for subsidies on the exchange even if she has access to health insurance on the job or through her parents’ plan?

    A. It depends. Assume for the moment that the young adult is not claimed as a dependent on her parents’ tax return. Even if she has access to her parents’ insurance, she can shop for a plan on the state marketplace. In addition, if her income is between 100 and 400 percent of the federal poverty level, she may qualify for subsidies as long as she doesn't have an offer of good health coverage through her own job.

    If her own job offers health insurance that meets the ACA’s standards for affordability and adequacy, however, she wouldn’t be eligible for subsidies on the exchange. Under the ACA, a plan is considered affordable if self-only coverage costs no more than 9.5 percent of a person’s income, and adequate if it pays for at least 60 percent of covered medical expenses.

    Q. What happens if the young adult is claimed as a dependent on her parents’ tax return?

    A. In that case, if she shops for a health plan on the exchange she will generally be eligible for subsidies only if coverage for an individual in the family’s plan is considered unaffordable based on the family’s income, and then only if her family’s household income is between 100 and 400 percent of the federal poverty level.

    Similarly, if she wishes to apply for Medicaid and lives in a state that has expanded coverage, she would generally be eligible if her family’s household income is less than 138 percent of the federal poverty level.

    Q. Young people’s participation in the health insurance marketplaces is considered crucial to keeping health care costs affordable overall. But if they’re healthy and don’t expect to need coverage, what’s the upside for them?

    A. It’s true that in order to keep health care costs on the marketplace affordable for everyone, it’s important that healthy young people sign up. Their participation will help balance out the generally higher health care costs of older, sicker members.

    Despite being generally healthy overall, however, young adults do use health care. Fifteen percent of young adults have a chronic condition such as asthma or diabetes. Young adults are also more likely than any other age group to make injury-related visits to the emergency department.

    Besides, as experts note, healthy young people today will age and eventually need more health care services themselves when they are older.

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    Crossfingers Re: Health care plans

    ^^^ I would point out that the % of Federal Poverty Level issue that 'rears it's ugly head' in a two singles versus getting married situation also applies in the age 26 and under scenario. The maximum threshold for eligibility for Public Health Exchange insurance coverage is 400% of FPL. For a single person, 400% of FPL is roughly $47,000 of income. For a two person household ( i.e. married couple ), that increases by ~$16k per year to the $63,000 ballpark for their combined incomes. For a three person household ( i.e. 25 year old 'child' with no siblings ) that increases by yet another ~$16k per year to the $79,000 ballpark for the combined incomes of father, mother and 25 year old 'child'.

    If total household income exceeds these 400% of FPL thresholds, ALL of the people involved lose eligibility for Public Health Exchange insurance subsidies. Thus it's necessary to perform several versions of math projections to actually determine the 'least expensive' option for all of the people involved.

    PS the above blurb's comment that "healthy young people today will age and eventually need more health care services themselves when they are older" is totally irrelevant in the Obamacare scenario where people will be allowed to sign up for future year Public Health Exchange insurance coverage at the same monthly premium price regardless of whether they have waited until they are sick enough to need expensive medical care almost immediately. As such, there is nothing to 'lose' and much to be 'gained' by young people simply paying the Obamacare IRS penalty and flying without health insurance until they actually NEED health insurance to pay for large medical bills !

    .

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    Question Re: Health care plans

    here's an article with actual cost info for a healthy 21 year old ... from


    (snip)"that person, Chad Henderson, admitted to the Washington Post that the premium for the plan he enrolled in was $175. Ouch! Wasn’t Obamacare supposed to lower premiums?

    Henderson’s going to pay a $175 premium and he won’t even receive vision or dental insurance. He has contacts, so not having vision insurance is kind of a bum deal.

    Henderson, as far as we know a healthy, 21-year-old college student at Chattanooga State Community College who lives in Flintstone, Ga., and works part-time at a day-care center, did not qualify for tax credits to purchase insurance, according to the Post.

    Without Obamacare, Henderson could have received health insurance for as little as $44.72 on eHealthInsurance.com, according to Michael F. Cannon of the Cato Institute.

    “I can’t yet say whether Chad’s $175 premium is the lowest-cost plan available to him through the Obamacare Exchange,” Cannon said. “[I’m in the process of researching that, and it’ll probably take a few hours.] But it’s probably close.”

    Thanks to Obamacare’s community-rating price controls that take effect in 2014, Henderson’s cheapest plan option on eHealthInsurance jumped up to $190.23.

    “So it appears that Obamacare quadrupled Chad’s premiums, and Enroll America thinks this is a success story,” Cannon said.

    One of the main reasons health insurance prices are going up under Obamacare is because of the one-size-fits-all insurance plans required by the health care law."(snip)


    Undoubtedly the $45 per month private health insurance premium which Chad had previously paid was for 'catastrophic only' coverage, where the $175 monthly Public Exchange health insurance premium or the $193 monthly private health insurance premiums for 2014 include 'qualifying' coverage for mental health treatments, substance abuse treatments, and other types of treatments that were NOT covered under Chad's previous 'catastrophic only' health insurance. Nonetheless, Chad is now forced to pay for these other areas of coverage since his private health insurer has chosen not to continue offering 'non-qualifying' limited coverage options into 2014.

    Also, undoubtedly, the reason that Chad was ineligible for subsidies through the Public Health Exchange is that his state elected not to provide Expanded Medicare coverage for state residents. As a result, eligibility for 'free' medicare coverage stops at whatever income limit the state has set ( which may be 50-100% of FPL ), but eligibility for taxpayer subsidies through the Public Health exchange stops at incomes below 133% of FPL. As such, people earning anything between the 50-100% of FPL cutoff for state Medicaid eligibility, and 133% of FPL cutoff for Public Health Exchange subsidy eligibility, are stuck paying the same non-subsidized Public Health Exchange insurance premiums as people earning more than 400% of FPL.

    This 'gap' in health insurance subsidies for low earning Americans in states that did not elect to provide ( and pay for ) Expanded Medicaid is the direct result of a recent US Supreme Court ruling that Obamacare's original mandate to force all US states to offer ( and pay for ) Expanded Medicaid for those earning less than 133% of FPL was unconstitutional. For poor Americans falling into this income 'gap' like Chad, they essentially have four choices. They can reduce working hours / stop working altogether to make themselves eligible for Medicaid under the state's standard Medicaid program. They can work their butts off to earn enough money to exceed the 133% of FPL lower limit for Public Health Exchange subsidies, in which case they will not only be earning a few extra thousand per year in paychecks but the net cost of their Public Health Exchange insurance premiums ( after taxpayer subsidies are applied ) will drop to near zero. They can pay $175 per month ( or whatever ) unsubsidized health insurance premiums. Or they can pay the new 1%, 2%, 2.5% IRS penalty and go without health insurance.

    Actually, more than one news report has also pointed out a fifth option ... low income people living in US states that are not providing Expanded Medicaid benefits can pack up and move to other US states that DO provide Expanded Medicaid benefits.
    Last edited by Melonie; 10-04-2013 at 01:06 PM.

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    Default Re: Health care plans

    yet another update ... this time concerning deductibles. From a Bloomberg article at


    (snip)"When Barbara Retkowski went to a Cape Coral, Florida, health clinic in August to treat a blood condition, she figured the center would bill her insurance company. Instead, it demanded payment upfront. Earlier in the year, another clinic insisted she pay her entire remaining insurance deductible for the year -- more than $1,000 -- before the doctor would even see her. “I was surprised and frustrated,” Retkowski, a 59-year-old retiree, said in an interview. “I had to pull money out of my savings.”

    The practice of upfront payment for non-emergency care has been spreading in the U.S. as deductibles rise. Now, the advent of the Patient Protection and Affordable Care Act is likely to accelerate that trend. Many of the plans offered through the law’s insurance exchanges have low initial premiums to attract customers, while carrying significant deductibles and other out-of-pocket cost sharing. The second-lowest tier of Obamacare plans in California, for example, carries a $2,000 annual deductible.

    Hospitals say they need to charge patients prior to treatment because Americans are increasingly on the hook for more of their own medical costs. And once care is provided, it’s often difficult for hospitals to collect. “It used to be taboo to look like you were looking for money at a time when you were supposed to be focused on patient care,” David Williams, president of Boston-based consulting firm Health Business Group, said. “It’s not taboo anymore.” (snip)

    (snip)"Consumer advocacy groups say the upfront payments limit access to medical care.

    “It puts the employee or patient at risk of not getting the service because the deductible may be a barrier to care,” said Mark Rukavina, executive director of the Access Project, a Boston-based nonprofit that focuses on health-care access.

    Hospitals counter that discussing payment upfront helps connect patients earlier to financial assistance programs while ensuring providers get paid."(snip)


    The major take-away here is that there is no mandate under ObamaCare that prevents health care providers from 'demanding' that would-be patients insured by ObamaCare pay both their annual deductible ( i.e. $2000+ ) plus their co-pay ( = 20-30-40% of the estimated cost of treatment ) prior to the health care actually being provided. As the article points out, this can translate into a person insured by ObamaCare who is in need of medical treatment having to either A. come up with $2,500-6,000 in cash to pay the health care provider prior to receiving treatment, or B. sign up for some other type of coverage where deductibles and co-pays aren't part of that coverage ( like Expanded Medicaid or 'charitable' programs ).
    Last edited by Melonie; 10-17-2013 at 03:34 AM.

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    Default Re: Health care plans

    this comparative chart of pre and post ObamaCare monthly health insurance premiums was just released ...





    Note that the relative increases in monthly insurance premium costs fall most heavily on the 27 year old age group

    Also note that ObamaCare health insurance premium increases also fall most heavily on residents of states which had previously allowed 'catastrophic only' and/or 'restricted coverage' private health insurance which previously allowed for low monthly premiums. Residents of states that had already required 'minimum' health insurance policies to cover things like substance abuse, mental health treatments, etc. will see little if any increase in premiums ( and actual reductions in premiums for the most heavily regulated states )

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    Default Re: Health care plans

    Thanks ladies, for breaking this down into a digestible and informative format. I saw a lot about tax breaks for under 400% above poverty level, are there penalties for being over? There was so much, sorry if I missed it

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    Default Re: Health care plans

    well, there are differences above the 400% level that will cost you money ... especially in certain situations ... but they're not officially considered to be 'penalties'. For example, below the 400% of FPL earnings level, total cost of insurance premiums are 'capped' by the Obamacare law to 9.5% of income level ( or less ). Above 400% of FPL earnings level, there is no cap on insurance premium costs. This could be very important next year if the actual total dollar amount of health care payouts by public health exchange insurance companies exceeds the total amount of revenues collected by those insurance companies from self-paid insurance premiums plus taxpayer subsidies ... which in turn will force an increase in monthly health insurance premiums to increase revenues.

    If the insurance companies are prevented by the 'cap' from increasing monthly health insurance premiums on those earning less than 400% of FPL, they'll be forced to increase premiums for those earning more than 400% of FPL by an even greater amount to make up the difference. Given early signup data that seems to show that 7 out of 10 people signing up are actually for Extended Medicaid ( i.e. not actually 'covered' by a health insurance company, but by the state ), and also given that a fair number of the remaining 3 out of 10 people signing up have pre-existing conditions or are 'older and sicker' ( which generate actual health care costs to the insurance company that far exceed the amount of monthly premiums paid in to the insurance company ), it would appear that 2015 public health exchange insurance premiums for those earning more than 400% of FPL will have to be significantly increased versus 2014. This could mean, for example, that a person earning $46k per year would see a monthly premium capped at $364 per month in 2015, while a person earning $47k per year could potentially see an uncapped monthly premium of $600+ per month !!! This won't be known until next October, once the actual 'mix' of healthy versus unhealthy people who have signed up for public health exchange insurance is known.

    I'm reluctant to discuss these sort of ACA particulars because the 'rules' still keep changing !!!

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    Default Re: Health care plans

    Young adult insurance quandary: Stay with parents, or go it alone?
    Since more than a few DD readers are age 26 or under, and/or college students, I feel obliged to point out another 'discovery' about most public health insurance coverage. This insurance is sold on a county by county basis. To minimize insurance premium costs, public health insurance coverage is limiting the 'network' of health care providers for which insurance benefits will actually be paid. Or put another way, being treated by a doctor or medical facility that is NOT part of the public health exchange insurance family plan's 'network' may result in a portion or even 100% of those costs NOT being covered by that health insurance plan.

    Thus staying on a parents' public health exchange insurance plan until you are age 26 may be a good deal ... provided that you are living near ( or with ) your parents to take advantage of the available 'network' providers. However, if you happen to be living some distance from your parents, or are attending a college some distance from your parents, it may turn out that few or no health care providers in close proximity to where you are living / attending college are actually 'network' providers under your parents insurance plan. As such, dependent coverage under your parents' public health exchange insurance will provide little or no cost 'relief' should you need local medical treatment. Granted that some 'gold' and 'platinum' insurance coverage may still offer significant 'out of network' coverage to one degree or another, but the monthly premiums for 'platinum' and 'gold' insurance plans are much higher than for 'bronze' or 'silver' plans ( thus buying a higher priced plan to obtain some amount of 'out of network' insurance coverage would significantly increase total costs for family health insurance coverage in order to provide 'out of network' coverage for a < age 26 'child' attending college or living away from home ).

    The big unknown in this equation so far is that the majority of Americans still receive health insurance via 'employers', plus the fact that the Obamacare mandates for 'employer' provided health insurance implementation has been postponed for a year. Thus it is not known ( but fairly probable ) that existing 'employer' provided health insurance coverage will reduce or discontinue existing 'out of network' insurance coverage once it must become 100% compliant with ACA mandates in 2015 ... to minimize the 'employee' insurance premium increases that would otherwise be necessary to cover the ACA mandated additional scope of the health insurance coverage ( i.e. substance abuse treatment, treatment for mental illness, removal of lifetime 'caps' on total insurance dollars paid out per insured person, etc. ). This is precisely what the 'individually purchased' health insurance providers ( who did not receive a 1 year postponement for compliance ) did when offering ACA compliant health insurance for 2014 through the public health insurance exchanges.

    I would also add that, while it is theoretically possible for a student living at a distance from her parents to purchase her own public health exchange coverage ... and thus access 'network' providers in the area where she is living / attending college, there are some practical problems. The first is that, below 133% of FPL income level ( or about $14,000 per year ), the person is NOT eligible to purchase health insurance through public health exchanges, and will be ( automatically ) directed to Expanded Medicaid for health benefit coverage instead. However, Medicaid eligibility is determined by individual states, who typically have official residency requirements, who typically have 'total family income' requirements etc. Additionally, persons under age 55 who receive Medicaid benefits are subject to the state keeping track of all expenditures made to doctors and hospitals for Medicaid funded health care ( plus an annual administration fee ), with the state then attempting to 'recover' all of these expenditures upon the person reaching 55 years of age. Thus even if a student living at a distance from her parents is able to qualify for Expanded Medicaid, this could very well translate into a bill for tens of thousands of dollars worth of medical treatments ( and administration fees ) from the distant past ( with 25 years worth of interest charges potentially added as well ) arriving on her 55th birthday !!! See for this seldom mentioned but potentially serious risk factor.

    In the past, states 'recovering' Medicaid benefit costs was really only an issue for people over age 55 who owned significant assets ( i.e. a house or business ) being placed in nursing homes etc. since, prior to Obamacare's Expanded Medicaid, recipients couldn't qualify for Medicaid if they owned houses, expensive cars, or other significant assets despite their low annual income level. But now that Obamacare has waived the 'asset' test for Expanded Medicaid eligibility, it may become a future issue for millions of Americans who have very low incomes 'now' but who manage to accumulate significant assets by the time they reach age 55, when ( based on previous state Medicaid cost recovery efforts ) the state may freeze ( a portion of ) bank / investment account balances, may place a lien on their house, business, expensive car, etc., to guarantee at least partial 'recovery' of the state's costs for previously provided Medicaid health care benefits.

    Another option is for a girl living at a distance from her parents purchasing private market health insurance in her own name that offers local 'network' providers. However, if her income level is below about $14,000 per year, and she chooses to avoid the potential future 'surprises' of Medicaid cost 'recovery', she won't be eligible for taxpayer subsidized health insurance premiums via the public health exchanges. Thus she will wind up having to pay the full market price for private market fully ACA compliant health insurance coverage ( potentially $300 to $400 per month ). To help cover this 'gap', the ACA allows insurance providers to still offer 'catastrophic only' health insurance for people under age 30 at a comparatively low monthly premium cost, BUT the coverage is extremely limited, no taxpayer subsidies are available to reduce monthly premiums, and the deductible is huge ( like $6,000 per year ). Previously available very low cost but 'non-ACA compliant' student health insurance coverage with low annual deductibles but also low annual coverage 'caps' formerly offered by many colleges can no longer be offered. See

    Ironically, however, if income level is slightly ABOVE 133% of FPL or $14k per year, she may be eligible for public health exchange insurance at heavily taxpayer subsidized discount prices ( like <$50 per month ) !!! Once 'word gets around' that earning $14k per year might also save $2-3k per year in ( unsubsidized versus taxpayer subsidized ) health insurance premiums ... as well as eliminating a potentially huge Medicaid reimbursement bill arriving on their 55th birthday ... it would not be surprising to see lots of college students trying their hand at exotic dancing or camming next year to help them 'jump' the $14k annual earnings 'hurdle' required for ( taxpayer subsidized ) public health exchange insurance eligibility.

    Please note that all of the above are based on 'as written' analysis of ACA law provisions as well as state Medicaid law provisions. However, as we have already seen, various 'rules of the game' are potentially subject to change by HHS directive changes, by IRS rule changes, by executive order etc. Such changes are a distinct possibility after the 1st of January, when public health exchange health insurance actually starts taking effect and these potential practical problems start receiving anecdotal news coverage.
    Last edited by Melonie; 12-16-2013 at 02:18 PM.

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    Default Re: Health care plans

    just a reminder that today is the deadline to sign up for Obamacare health insurance and thus avoid having to pay the new IRS penalty 'tax' for not having health insurance in 2014.

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    Default Re: Health care plans

    I had read somewhere if you are self employed, you're able to write off the expense of healthcare on your taxes. I'm not sure if this is true or not, but is it true with the federal insurance?

    It seems counter-intuitive that you could write off a federal program, so that's why I'm asking.

    ?

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    Default Re: Health care plans

    ^^^ unfortunately, for the moment at least, the IRS is interpreting 'sole proprietor' unincorporated businesses as being the same as 'individuals' re tax treatment of public exchange health insurance ... which means no tax deduction for health insurance premiums paid, but potential eligibility for taxpayer funded health insurance premium subsidies. Beyond that, 'individuals' are now only able to deduct actual health care expenses if and when they exceed 10% of income ( this used to be 7.5% but was raised by the ACA ).

    Incorporated businesses purchasing public health exchange insurance for 'workers' via the 'SHOP' exchange CAN take a tax deduction, but aren't eligible for taxpayer funded premium subsidies and are also faced with additional ACA related 'fees'. Under certain circumstances ( i.e. comparatively low average 'pay' levels for insured workers ), incorporated businesses become eligible for new ACA related tax credits. See my second post in this thread.
    Last edited by Melonie; 12-23-2013 at 07:57 PM.

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    Default Re: Health care plans

    If you are self employed, declaring a profit and fill out a Schedule C (or C-EZ) as part of your tax return, then the self employed deduction is generally available. See the link below:



    I do not believe that it matters whether you obtain your insurance from an exchange or directly, but you should talk to your tax pro about it.

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    Default Re: Health care plans

    If I am not self employed but my company offers shit health insurance and I choose to go through the exchange instead the monthly premium is not tax deductible?

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    Default Re: Health care plans

    ^^^ this may wind up going to the courts or an IRS ruling for clarification once tax filing season arrives, but as of right now ...

    (snip)"Under the new Affordable Care Act, self-employed people with no employees are considered individuals"(snip) see

    This strongly implies that, at best, sole proprietor unincorporated business operators may be able to still deduct ( non public health exchange ) private sector health insurance premiums paid, but are NOT able to deduct premiums paid for public health exchange based insurance. This is based on a legal premise that it is the 'individual' and not the 'sole proprietor' business, which is actually purchasing the public health exchange based insurance.


    With the additional info from Lynn that she is an 'employee', her 'employer' can ( but doesn't have to ) allow her to pay company sponsored health insurance premiums with pre-tax dollars ( which is better than a tax deduction !!! ). She can also elect not to purchase company sponsored health insurance and instead purchase public health exchange insurance coverage, but A. she won't be eligible for a taxpayer subsidized discount on public health exchange insurance premiums as long as her 'employer' offers alternative health insurance ( no matter how sucky ), and B. she won't be able to deduct the cost of health insurance premiums or out of pocket medical costs unless and until the total amount exceeds 10% of her income.
    Last edited by Melonie; 12-23-2013 at 08:22 PM.

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    Default Re: Health care plans

    Lynn, unfortunately that is the way of it right now. If you are employed and eligible for the employer's insurance, then it is the only option if you want to pay with pre-tax dollars.

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    Default Re: Health care plans

    That's awful

    My company is able to maintain it's BS insurance plans by getting grandfathered in around the law somehow. But it's still cheaper than the exchange cost and especially with the pre- vs post- tax issue. So sad and what a waste of money for me either way. I haven't signed up for anything yet since I technically am ok until March 1 and even then I might just pay the fine instead.

    Thanks for the confirmation though. Up until now I assumed it was a tax deduction.

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    Default Re: Health care plans

    Quote Originally Posted by Melonie View Post
    ^^^ this may wind up going to the courts or an IRS ruling for clarification once tax filing season arrives, but as of right now ...

    (snip)"Under the new Affordable Care Act, self-employed people with no employees are considered individuals"(snip) see
    This has to do with the requirement of sole proprietors to purchase insurance, not with whether they may then deduct the premiums. There is ample literature out there that makes it clear that the ACA did not materially change the self employment insurance deduction, regardless of where the insurance is purchased.

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