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Screenshot from HHS billboard marketing health insurance exchanges
Yep, you have to go back in there.
There is a slight downside to the fact that lots of new insurers are going to be getting into the Obamacare market this fall. Yes, it means more competition for consumers to benefit from, but it could also trigger an increase in costs of the plans people currently have. Sam Baker at National Journal explains that more insurers coming into the market have created a few issues that make it critical that people shop around again this fall instead of just staying in the same plan.

For one thing, many people chose the lowest-cost plans last year, and those are the plans that are "seeking above-average rate hikes." So if people just re-enroll in those plans, they could be hit with pretty high premium increases. But that's not the biggest potential hit that 85 percent of the Obamacare enrollees could face. That's the group with enrollees who have qualified to receive subsidies for their plans, and those people could find that their subsidies—while remaining essentially the same—will cover much less of their premium. It's because of how the subsidies are determined. Here's a hypothetical from Baker:

Let's say your income is at about 150 percent of the poverty line—roughly $17,000 per year. The law says you don't have to pay more than 4 percent of your income for the benchmark plan in your area. You chose that plan this year, and you're getting a pretty generous subsidy.

Your plan wants to raise its rates by 5 percent next year—not great, but not the end of the world when you're only paying about $50 per month out of your pocket. You like the plan, the premium increase doesn't seem like a lot, and HealthCare.gov was a headache last time, so you just auto-renew.

Unbeknownst to you, though, new insurers have started offering cheaper plans in your area. Your plan is no longer the benchmark plan; a cheaper one is. So now your subsidy is based on the cost of that plan, not the one you have. This means you're on the hook not only for every dollar of your plan's 5 percent premium increase, but also for every dollar of the difference in price between your plan and the new benchmark plan.

How do you protect yourself against a big premium hit? Find out below the fold.

The only real way you can find out if you are in that boat is by going back into the insurance exchange and asking for a redetermination of your subsidy level. Which means the best option for people is to shop for a new plan, get a fresh subsidy eligibility determination, and look for plans that will remain affordable. At the very least, going through that process will inform people of what their existing plans will cost them in the next year, and they won't be surprised at tax time when they find out about the gap between their subsidies and their actual costs.

Charles Gaba has a reasonable solution that the government should really consider—requiring annual renewals. At the very least, the government should now be preparing to send out 8 million letters telling folks to let them know it really is in their best interest to wade back into the marketplace this fall.

Originally posted to Joan McCarter on Thu Aug 07, 2014 at 11:13 AM PDT.

Also republished by Daily Kos.

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Comment Preferences

  •  Tip Jar (32+ / 0-)

    "The NSA’s capability at any time could be turned around on the American people, and no American would have any privacy left, such is the capability to monitor everything. [...] There would be no place to hide."--Frank Church

    by Joan McCarter on Thu Aug 07, 2014 at 11:13:57 AM PDT

  •  I have an ACA policy (9+ / 0-)

    and this is what I've been worried about - I picked a Blue Cross policy because it's accepted by the local hospital complex.

    I know Blue Cross is more than capable of manipulating the system to their best advantage, and I was anticipating a rate hike - 80% of premiums used for healthcare be damned.

    Good advice - I think I might have to get a new policy every year.

    We've been spelling it wrong all these years. It's actually: PRO-GOP-ANDA

    by Patriot4peace on Thu Aug 07, 2014 at 11:23:46 AM PDT

    •  It's a hassle... (1+ / 0-)
      Recommended by:
      Angie in WA State
      I think I might have to get a new policy every year.
      But requoting all your insurance needs annually is a good idea.

      A mind like a book, has to be open to function properly.

      by falconer520 on Thu Aug 07, 2014 at 01:59:21 PM PDT

      [ Parent ]

      •  It wouldn't be so bad if the networks (0+ / 0-)

        the insurance companies tell you about equalled the networks that exist in real life.

        Too many people have found out that their "in-network" doctor isn't, when they try to make an appointment.

        © cai Visit 350.org to join the fight against global warming.

        by cai on Thu Aug 07, 2014 at 04:10:13 PM PDT

        [ Parent ]

    •  I'm switching from Blue Cross (2+ / 0-)
      Recommended by:
      Angie in WA State, cai

      to something else.

      Their claim notices are completely unfathomable.  They list what is covered and what is not covered, but often those don't match up with what they actually pay.  Also, it is difficult or impossible to match up the bills from providers to the claim notices from BCBS.

      I realize that all the companies are probably similar.  Still, I'm going to switch unless it looks like BCBS gives me a much better rate for similar coverage.  Last year the Fed Exchange offered me policies from Humana and one other.

      I have BCBS TX, so other experiences might differ.

      •  Do you really want to know? (2+ / 0-)
        Recommended by:
        david78209, Audri

        It's because the billing system is based on BULLSHIT.

        Go ahead—ask how much something is going to be and enjoy the run-around.

        I would tell you the only word in the English language that has all the vowels in order but, that would be facetious.

        by roninkai on Thu Aug 07, 2014 at 07:31:47 PM PDT

        [ Parent ]

    •  question (0+ / 0-)

      when you set up your account to pay
      BC do they default to automatic withdrawals from your bank account?

      •  they'll bill you (0+ / 0-)

        They're real good at that.  They'll bill you for months you've already paid just in case you might get caught napping and pay them twice.

        On their web page you can "sign up" through a third party pay system that deducts from a credit card or bank account.

        I pay with a credit card - nobody has access to my bank account except my wife and sometimes I wonder why I signed up for that. ;-)

        We've been spelling it wrong all these years. It's actually: PRO-GOP-ANDA

        by Patriot4peace on Fri Aug 08, 2014 at 06:35:32 AM PDT

        [ Parent ]

    •  Hoag (1+ / 0-)
      Recommended by:
      Audri

      They will only take Blue Shield Silver plans and above.
      WTF? Talk about your two tier system and death panels.
      Every doctor should be required to take the plan you have, not the one they want.

      I would tell you the only word in the English language that has all the vowels in order but, that would be facetious.

      by roninkai on Thu Aug 07, 2014 at 07:30:14 PM PDT

      [ Parent ]

  •  The pain in the ass of Medicare Part D (9+ / 0-)

    ...just gets spread around to the entire insurance market.

    Sometimes Medicare Part D auto-renewal isn't possible; the plan disappears at the state level and the insurer auto-renews you in a plan with higher premiums.

    Time for Democrats to start campaigning for no co-pays, no deductibles, and stability of coverage.  The enrollment period bullshit has got to go.

    One of the many failures of forgoing the simplicity of single-payer coverage of health care as a part of societal infrastructure.

    50 states, 210 media market, 435 Congressional Districts, 3080 counties, 192,480 precincts

    by TarheelDem on Thu Aug 07, 2014 at 11:28:40 AM PDT

  •  Thanks much. My original rationale was just (7+ / 0-)

    ...that people wouldn't KNOW whether they were supposed to renew or not, and therefore they should just issue a blanket manual renewal policy across the board.

    However, the subsidy musical chairs situation makes it even more vital that EVERYONE do so.

    •  experience with open season insurance enrollment (1+ / 0-)
      Recommended by:
      Brainwrap

      Thank you again, Brainwrap, for your hard work and intellect and determination. We are all so amazed by your grand contribution!

      My husband has insurance as a retiree with the US Postal Service.  We utilize the website, make phone calls, and examine the printed material that we receive, with more info available by request. I know the ACA has healthcare.gov and the phone lines. I hope that they also mail out information. I hope that it is part of the law that the govt must provide up-to-date plans and rate options to current and potential consumers. These comments concern me! It's so difficult to get Republicans to help their constituents, and as a welcome additional result, the Democratic constituents!

      I know we have a long way to go!

      •  I had to enroll without ever seeing anything (0+ / 0-)

        but the summary of benefits on the .gov site. It took me 2 months to get printed material from Anthem BC/BS and that was just a fluke. There was no one on the phone that could mail me any printed info. They kept telling me that I could sign up at their website and view it there. Only I stopped trying to sign up on their website after 4 tries in a week.
        Just happened to get a mailing that had a page in it that one could send back in to get a explanation of benefits for my plan.
        Blue Cross/Bull Shit

        Only thing more infuriating than an ignorant man is one who tries to make others ignorant for his own gain. Crashing Vor

        by emmasnacker on Thu Aug 07, 2014 at 07:30:50 PM PDT

        [ Parent ]

  •  Single payer (21+ / 0-)

    This is all way, way too complicated.

    Mark Twain: It ain't what you don't know that gets you into trouble. It's what you know for sure that just ain't so.

    by Land of Enchantment on Thu Aug 07, 2014 at 11:54:11 AM PDT

  •  You shouldn't have to ask, the exchange (5+ / 0-)
    Recommended by:
    gypsytoo, hbk, cai, T Maysle, divineorder

    should do it automatically and provide notice.  The current regulations require the exchange to request updated income and family size information, make the eligibility redetermination, and provide a notice to the enrollee that includes

    The qualified individual's projected eligibility determination for the following year, after considering any updated information described in paragraph (b) of this section, including, if applicable, the amount of any advance payments of the premium tax credit and the level of any cost-sharing reductions or eligibility for Medicaid, CHIP or BHP.
    A proposed rule currently under consideration will also require the insurer to provide similar information.
    We propose that the additional information include the following: (1) Premium and premium tax credit information sufficient to notify the enrollment group of its expected monthly premium payment under the renewed coverage, in a form and manner specified by the Exchange, provided that if the Exchange does not provide this information to enrollees and does not require issuers to provide this information to enrollees, consistent with this section, such information must be provided in a form and manner specified by HHS; (2) an explanation of the requirement to report changes to the Exchange, the timeframe and channels through which changes can be reported, and the implications of not reporting changes; (3) for an enrollment group that includes an enrollee on whose behalf advance payments of the premium tax credit are being provided, a description of the reconciliation process for advance payments of the premium tax credit; and (4) for an enrollment group that includes an enrollee whose coverage includes cost-sharing reductions, if the enrollment group's coverage is being renewed in a QHP at a different (non-silver) metal level, an explanation that, unless the enrollment group changes its enrollment to select a new silver-level plan, cost-sharing reductions will not be provided for the upcoming year.
    It's still a good idea though, to shop around and compare plans as well as determine what plans your physician foresees accepting.
  •  I am completely in the dark (4+ / 0-)
    Recommended by:
    steelman, cai, TracieLynn, Audri

    When I enrolled last year, my only choice was extended Medicaid because my income the previous year was that low.

    My income fluctuates from month to month... some months it's just Social Security. If I pick up a temp job for a couple of weeks, that gooses my income for that month. The last time I managed to get through to someone at the exchange, he told me that I would need to report status changes each time they occurred with the possible consequence of having to enroll, un-enroll, enroll multiple times in a year!

    I would happily take the best subsidized silver or gold plan on the exchange, but the web site won't let me go there!

    There is no security in this. Single payer would have created a constituency pretty quickly... but, hey, real grownups don't believe in unicorns!

    If they can get you asking the wrong questions, they don’t have to worry about answers. - Thomas Pynchon

    by chuckvw on Thu Aug 07, 2014 at 01:00:30 PM PDT

    •  My understanding is that your access to the (3+ / 0-)
      Recommended by:
      bluenick, txdoubledd, cai

      expanded Medicaid and/or Federal subsidies is based on your yearly income.

      Beginning in 2015 they will be cross-checking your claimed income level with your tax return of the previous year (and comparing what income level you projected and what you made. If there is a significant difference you may be liable for the difference which a Subsidy paid on your behalf).

      I don't see how fluctuations of your income throughout the year have anything to do with your current enrollment.

      "I like paying taxes...with them, I buy Civilization"

      by Angie in WA State on Thu Aug 07, 2014 at 02:16:34 PM PDT

      [ Parent ]

      •  You are required to report (0+ / 0-)

        "change of status" throughout the year for extended Medicaid. That's what the guy told me and is also what the web site instructs.I didn't want to be on Medicaid, because I could have scratched up somehow and paid in advance a subsidized premium.

        So next year, if I'm $200 over the limit instead of $200 under, what do I owe them for this year's Medicaid? My income was literally a couple of hundred bucks under the limit for the exchange last year.

        Every time I call I end up on hold for at least an hour. I've simply given up on several occasions. My phone plan only covers 200 minutes! Maybe they'll make the process more intuitive in the coming year. I haven't seen any evidence of such an effort so far, but maybe...

        If they can get you asking the wrong questions, they don’t have to worry about answers. - Thomas Pynchon

        by chuckvw on Thu Aug 07, 2014 at 06:23:59 PM PDT

        [ Parent ]

    •  It is based on annual income (0+ / 0-)

      but what you point out is that for some people, especially free-lancers, it can be hard to estimate what your annual income is going to be.

      I discovered that the subsidy amount didn't vary much for about a $5,000 fluctuation in annual income, so I picked a reasonable figure in the middle of that range. If I come out a few thousand one way or the other, I figure I'll be pretty close.

      You do not need to recalculate every month.

      I don't know what they will do with people who are (on an annual basis, retrospectively) just above or just below the 138% line. I hope the regs will allow some leeway -- that as long as your estimate was reasonable, and you turned out not too far off, you won't have to pay back subsidies. I haven't seen the regs yet though.

  •  can't we just repeal it? (5+ / 0-)

    it was so much simpler when people had no insurance.

    The cold passion for truth hunts in no pack. -Robinson Jeffers

    by Laurence Lewis on Thu Aug 07, 2014 at 01:59:50 PM PDT

  •  You should never auto-renew. (1+ / 0-)
    Recommended by:
    divineorder

    Car insurance, health insurance, home insurance, none of them. Spend as much time to look around each year as you did your first year. If you shop around you may qualify for new customer discount / promotion with a new supplier, you may find better coverage over price.

    Insurance companies rely on people being lazy. In fact in the health insurance market they relied on people blaming "Obamacare". If people had said fck you I'm going elsewhere instead of "boo Obamacare" those rate hikes would have been much more controlled.

    •  Thanks, and I hope to do as you (0+ / 0-)

      suggest.  OT we were on auto renew on our car insurance and it went up $200 with no explanation and had we not  questioned it would have just continued. They said it was because of our  credit report . WTF? When we researched it we found mistakes on the CR.  We changed carriers.

      Move Single Payer Forward? Join 18,000 Doctors of PNHP and 185,000 member National Nurses United

      by divineorder on Fri Aug 08, 2014 at 05:44:08 AM PDT

      [ Parent ]

  •  My plan told me that they were asking for an (4+ / 0-)

    increase of between 16 and 17 per cent.  You betcha I will be shopping again.  I don't get a subsidy so I can also shop policies that are not on the exchange.  I bought a high end plan but my budget is limited to no more than a 9% increase, and there were three insurers to pick from last year, so I still feel confident I can make this work for me.  

    If love could have saved you, you would have lived forever. & http://www.dailykos.com/blog/Okiciyap

    by weck on Thu Aug 07, 2014 at 02:05:33 PM PDT

  •  Rec'd, Tip'd and Tweeted (3+ / 0-)
    Recommended by:
    leoluminary, Brainwrap, divineorder

    and now I'm going to commit the final and (for me) ultimate sacrifice.

    I'm going to post it to my FaceCrack.

    Yes, I loathe it there, but it must be done. Everyone I know (even the smart people I know) spend time on there every single day.

    One of the smartest people I'll ever know, my youngest sister, tells me, "It's how I keep track of what everyone I love is doing. If there were another, easier way, I'd do that instead. There isn't."

    :-(

    "I like paying taxes...with them, I buy Civilization"

    by Angie in WA State on Thu Aug 07, 2014 at 02:09:59 PM PDT

    •  Wasn't going to Racebook (0+ / 0-)

      it because have a few wingnut friends and former students among all the other lefties but what the hey, want this excellent post and comments to get as wide a read as possible.   FWIW after reading the comments went and searched for the State Navigator in NM.  Found out that Navigator contracts end August but new funding RFP went out in June for 2014.  Not sure when the Navs will be available.

      Move Single Payer Forward? Join 18,000 Doctors of PNHP and 185,000 member National Nurses United

      by divineorder on Fri Aug 08, 2014 at 06:07:18 AM PDT

      [ Parent ]

  •  Shaping up to be business as usual for insurers (2+ / 0-)
    Recommended by:
    divineorder, Audri

    As with all insurance, health insurers rely on complications and confusion to extract as much money as possible from their customers while delivering as little as possible.  With more insurers involved and complicated changes associated with subsidies and plans, they are sure to delight in the biggest gift ever to their industry: Obamacare.  

    The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt. Bertrand Russell

    by accumbens on Thu Aug 07, 2014 at 02:17:07 PM PDT

  •  Healthcare.gov should be OK (2+ / 0-)
    Recommended by:
    Brainwrap, divineorder

    I was at a post-primary thing Tuesday, and Suzan DelBene's other half (my erstwhile boss Kurt, who ran the Microsoft Office division) was there. He quietly completed his stint fixing healthcare.gov a month ago, and he seems pretty confident about its future.

    Use every man after his desert, and who should 'scape whipping?

    by UncleDavid on Thu Aug 07, 2014 at 02:30:26 PM PDT

  •  Anyone know when the new rates will be posted? (1+ / 0-)
    Recommended by:
    cai

    on the exchanges?

    •  probably depends on the state (2+ / 0-)
      Recommended by:
      divineorder, Peace Missile

      The exchanges don't open this year until Nov. 15. I expect that by the end of September there should be quite a lot of information out.

      I would also expect that with more companies entering the market, there will be a lot of advertising -- but how informative it is, remains to be seen. You would think that more companies would make the prices more competitive -- that's the theory of the whole ACA set-up -- but I'm not holding my breath on that.

  •  certificates of creditable coverage (1+ / 0-)
    Recommended by:
    divineorder

    I really, really wish that the health insurance exchanges (both state and federal) had done more to streamline the process of obtaining certificates of creditable coverage, to help protect people with pre-existing conditions. Yes, in theory the ACA is supposed to protect against that, but there are still the grandfathered plans.

    I also think that a nice "carrot" approach to getting people to get people to sign up for health insurance (in addition to or instead of the "stick" of a tax penalty) would have been...wait for it, wait for it...automatic enrollment into a megamillion lottery. Think about it: insurance is all about betting. It would be easy enough to make "winning the lottery" an "adverse event."

    A lot of the same people who were resistant to buying health insurance thought nothing of getting lottery tickets every day.

  •  Medicare Part D (1+ / 0-)
    Recommended by:
    divineorder

    I have always purchased an independent Part D plan because I don't take prescription drugs on a regular basis.  I have a high deductible and it's OK.

    Various companies offer very cheap plans for a couple years and then double the premium. When that happens I just call the expert at my local senior center and she tells me what the best deal is this year and she goes on the computer and does the switching for me.

    I'm sure there are similar centers that can inform the ACA people about what has changed over the past year.

    •  State navigators should do this (1+ / 0-)
      Recommended by:
      divineorder

      in the states that have been trying hard to implement the ACA in a consumer-friendly way.

      •  There are ACA navigators in all of the states (1+ / 0-)
        Recommended by:
        divineorder

        And getting in touch with them for advice is a great idea. You can see them in person if you want. The grants went to various organizations, social service, health, etc, so just google your town+ACA+ navigator.

        There were efforts in certain red states, trying to get in the way of the navigators, but I don't think they got very far with that.

  •  I want a different company (2+ / 0-)
    Recommended by:
    divineorder, Audri

    I can't stand using BCBS of NC !

    I also want to get a silver plan next time.

  •  Thanks... (1+ / 0-)
    Recommended by:
    divineorder

    we opted for MODA for our ACA policy. It was the second or third least expensive plan offered. I'm very happy with it.
    However, I just read last week that MODA is asking for a 14% increase in premiums. And, Providence Plan asked for a substantial reduced rate which hasn't been determined. They were one of the higher cost options.

    I hadn't thought about how the subsidies could possibly change...they are based on the 2nd least expensive Silver Plan, correct?

    I will definitely be rechecking the rates and our subsidy. Again, thank you!

    FORWARD! Obama/Biden 2012

    by Esjaydee on Thu Aug 07, 2014 at 08:07:57 PM PDT

  •  It still just pisses me off (0+ / 0-)

    that I have to buy health insurance. What a great scam!

    We don't need affordable health insurance, we need affordable health care.

    How can it be constitutionally legal to be required to purchase something?

    When lots of people show up to vote, Democrats tend to win.

    by Audri on Fri Aug 08, 2014 at 06:22:51 AM PDT

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