[Abby10]

Originally Posted by RickeyD

When you say you have to prove income, what exactly does that mean ?

So initially you fill out the application form and once it is entered into their database, they apparently have some kind of lottery system where they pick a certain percentage of applicants who must prove that what they said on their app is true. Basically, it seems like it should be a pretty easy process - they send you the info as to what they want for proof and you mail it in. Examples would be a copy of your tax statement showing adjusted gross income, paycheck stub, SS statement or whatever. The problem is they will not allow you to send it registered mail with return receipt - only regular mail, so there is no way to know if they got it or not. So far I have sent mine in 3 times and am still waiting to hear if they got it. The other method is by scanning and sending via their website. The only problem with that has been that I can't remember my password and they keep saying they will send it to me via email - never happened. It's the ineptness of the system that will kill ya! Every time I go to the PO with my letter to mail they just shake their head - apparently I'm not the first "victim" with this problem. Thank goodness we had a wonderful agent at the beginning who came right to our house and filed the app for us - at least we didn't have to deal with that headache!

[CathyandSteveG]

Originally Posted by Abby10

Yes. Basically, Cathy and Steve, it boils down to what your adjusted gross income is on your yearly tax return - line 37, to be exact. The subsidy is tiered depending on your adjusted gross income, but it must be $62,000 or less to be eligible for any subsidy. You can still buy insurance through the marketplace above that income, but it will not be subsidized - you pay full premium. That's what we were initially considering because buying insurance through the marketplace would have been cheaper than Cobra or going it on our own. Good luck with your search.......let's keep sharing info and knowledge!

thank you Abby! Steve is continuing to search. We are having trouble finding an insurance at a discount...and of course...since we have not retired yet...we are guestimating what our income will be.

But thinking we have to pay $7000 deductible and $1300 a month is really frightening! Granted...when Steve turns 65...that will decrease...he will get medicare...and then i will be 62 and can draw social security...but the next 2 years is a bit scary!

[Abby10]

Originally Posted by CathyandSteveG

thank you Abby! Steve is continuing to search. We are having trouble finding an insurance at a discount...and of course...since we have not retired yet...we are guestimating what our income will be.

But thinking we have to pay $7000 deductible and $1300 a month is really frightening! Granted...when Steve turns 65...that will decrease...he will get medicare...and then i will be 62 and can draw social security...but the next 2 years is a bit scary!

I hear ya! We are in the same boat trying to figure out the best thing to do for the next few years.......so many variables to consider. If you find something good, come back on and share with the rest of us!

[CathyandSteveG]

will do!

[blueash]

Originally Posted by Abby10

Yes. Basically, Cathy and Steve, it boils down to what your adjusted gross income is on your yearly tax return - line 37, to be exact. The subsidy is tiered depending on your adjusted gross income, but it must be $62,000 or less to be eligible for any subsidy. You can still buy insurance through the marketplace above that income, but it will not be subsidized - you pay full premium. That's what we were initially considering because buying insurance through the marketplace would have been cheaper than Cobra or going it on our own. Good luck with your search.......let's keep sharing info and knowledge!

Abby, not exactly true. Your eligibility is based on your household income, not your "taxable adjusted gross income" Line 37 does not include items that must be reported in determining eligibility. Simplest example is tax-free income. Social security income is included in the calculation. All family member's income must be reported not just the person applying for coverage. Thus if there is a person 65 on Medicare and a spouse 62 applying via the ACA, and a 30 year old living in the home who is your dependent , the income of all 3 persons must be reported. It does not matter if you file taxes jointly or not.
This is all household income.
Here are two sites that will give a better explanation
https://www.healthcare.gov/income-an...mation/income/

http://laborcenter.berkeley.edu/pdf/..._summary13.pdf

[TNLAKEPANDA]

A $10,000 deductible before ACA Was unheard of. Basically the insurance company is at minimal if any risk at all.

[billybye]

The ACA will ask you to estimate your net taxable family income and then send any proof of what you will earn or a letter explaining how you came up with estimate. Any mistake in estimating will wash out with following year's tax return. Net worth is not a consideration.
Anyone who does not at least check it out is probably missing out on a good policy that the government actually helps you pay for.
Some people who just hate Obama won't check it out for that reason. That is just ignorant.
The ACA allowed my wife to retire a few years earlier than she could without it.

[Abby10]

Originally Posted by blueash

Abby, not exactly true. Your eligibility is based on your household income, not your "taxable adjusted gross income" Line 37 does not include items that must be reported in determining eligibility. Simplest example is tax-free income. Social security income is included in the calculation. All family member's income must be reported not just the person applying for coverage. Thus if there is a person 65 on Medicare and a spouse 62 applying via the ACA, and a 30 year old living in the home who is your dependent , the income of all 3 persons must be reported. It does not matter if you file taxes jointly or not.
This is all household income.
Here are two sites that will give a better explanation
https://www.healthcare.gov/income-an...mation/income/

http://laborcenter.berkeley.edu/pdf/..._summary13.pdf

Thank you, blueash, for the links. Our agent must have simplified the process for us by telling us that we could use the adjusted gross income figure because it does work in our case - married, filing jointly, no one else living in the household, and none of the other items on the list pertain to us. But I can see how each case would be different when you take into consideration what they call MAGI. Good information! Thanks again, as I would not want to mislead anyone.

[RickeyD]

This is the Everything you wanted to know about the ACA but we're afraid to ask post. Good information with knowledgable and experienced posters !

[sunnyatlast]

Originally Posted by TNLAKEPANDA

A $10,000 deductible before ACA Was unheard of. Basically the insurance company is at minimal if any risk at all.

Patients are more at risk with these forced high deductibles, because the responsible newly insureds are now are not going to the doctor (if they could get one with their new insurance card but no dr. that can take more patients) nor to the ER when sick or in need of preventative care, because they do not have the cash up front to pay these bills while raising a family on a $60,000 household income and are trying to pay insurance premiums of $1100/month.

It also puts the hospitals and providers at more risk of uncollectible debt and insolvency, because more people now have a $5,000 - $12,000 deductible they don't have the money to pay when they absolutely HAVE TO go to the ER for a true emergency when they've not yet met their deductible.... to get some use out of the $1100/month premiums they're trying to pay!

Unpaid and uncollectible debt was a problem before the ACA changes, and now the high deductibles many insured people have are causing even more unpaid bills/uncollectible debt to hospitals and providers:

2011 - On average, uninsured families can pay only about 12% of their hospital bills in full.

Families with incomes above 400% of the poverty level, or about $88,000 a year for a family of four, pay about 37% of their hospital bills in full, according to the Department of Health and Human Services study.

Patients going without care because of high deductibles:

Example excerpt:

"Surgeon Paul Ruggieri of Fall River, Mass., says his patients with high-deductible plans often blanch at the out-of-pocket cost to electively treat two common ailments he sees regularly — gallstones and hernias — until they become potentially dangerous and costly emergencies.

If the procedures are done electively, patients are required to pay half of the cost upfront; a hernia repair done laparoscopically would cost about $4,000 at a surgery center. That's often about the amount of some patients' deductibles, so they would have to pay the full bill out-of-pocket. If the procedure is done at a hospital, even laparoscopically, it can cost as much as $17,000. If patients delay and are rushed to the emergency room for the procedure, the hospital would charge at least two to three times the amount of the surgery, Ruggieri says. It would also mean a two- to three-day hospital stay vs. two hours for the elective procedure, and much longer at-home recuperation.

Jan. 1, 2015 Dilemma over deductibles: Costs crippling middle class

Up to $49 billion unpaid by uninsured for hospitalizations - USATODAY.com

.

[gomoho]

However - apparently the deductibles work differently if you have subsidies. Not sure how but my friends are simply paying a co=pay whenever they go to the doc - not just for the things that are mandated free.