Individual Mandate. Penalty or Policy?

[WarrenG]

I have been under my wife's insurance offered by her employer (BC/BS) and it has been pretty decent with just a $30.00 co-pay. This year we found out the plan is changing drastically. 17% increase in the cost and now there will no longer be a co-pay option, as we will have to pay the full cost of the visits until we hit the $3,000.00 deductable.

With Obama Care fastly coming into play, we are trying to figure out what makes more sense, getting rid of her policy and getting one through me / the studio, or staying on her policy and soak up the $695.00 penalty? As I continue to compare costs, I started wondering how the other studios were addressing this?

http://www.ppmag.com/current_issue/p...thbill0910.pdf

[WarrenG]

Wow, really?

[jeffkohn]

Sorry to hear about the changes for the worse in your wife's coverage plan (although, one could argue that low co-pays have encouraged the overruse that is a big part of what has driven up the cost of health-care).

How many employees does your wife's company have? Generally speaking, any policy you get on your own is going to be substantially more expensive than what the same level of coverage through an employer group policy would be (unless the number of employees is small). Even if her employer isn't paying part of her policy premium, the larger the group the more spread out the risk and therefore premiums will be lower.

I guess it can't hurt to shop around.

[L Stegall]

I have a BC/BS policy through my work and I also cover my self-employed spouse on it. At this point, I haven't seen anything definitive about how my policy will change in terms of co-pays, etc., but the enrollment/change period will be coming up this fall, so I expect to know more in a month or so. It has never made economic sense for my husband to buy a separate policy, and I expect that will continue to be the case. I guess I'll be dreading seeing what BC/BS changes are in store for us, though, based on the changes you describe.

[Charles Putnam]

This is the "gotcha" of ObamaCare. All healthcare rates - be it on a group or individual plan, are going up (more than they would have if it wasn't enacted). Shop around, but make sure you compare benefits and what is/isn't covered and not just price. UnitedHealth Care has very broad benefits/coverage. I work for Methodist (hospital) and that's who provides our group coverage.

[SCone]

Simple math... cover more = cost more...

- "children" under 26 years old to stay on their parents' health care plans... Since when is a 26 year old a CHILD?
- insurance companies cannot "discriminate" against children with pre-existing conditions... Why bother with insurance until you have a need?
- insurance companies cannot drop coverage once a customer becomes sick, or if he or she made a mistake on their application... Is a "mistake" the same as a lie?
- bans insurance companies from putting lifetime limits on health coverage... Catch 22, why bother until you need insurance?

[texkam]

Simple math... cover more = cost more...

...and there just seems to be increasingly more "takers" than "makers".

Not sure what the best way is. It's really tough because things are changing so much.

[Howard Barlow]

We have had United Healthcare through my wife's employer, for years. They are great. We have always had the option of co-pay, or not. We choose not. To have co-pay, our deductible would be substantially higher, and the deductible doubles. Then, they pay 80% for most things, none on some.

Without co-pay, our premiums are lower, our deductible is lower, still $3K, but they pay 100% of everything, except meds, after that. Meds are tier priced, most $10-20, max at $60.

We do not need pre-approval for any procedure, nor referals for specialists. I love our plan.

I don't want State Farm to pay for my gas, oil changes, and car washes. I could not afford the policy, if they did.

[WarrenG]

Originally Posted by jeffkohn

Sorry to hear about the changes for the worse in your wife's coverage plan (although, one could argue that low co-pays have encouraged the overruse that is a big part of what has driven up the cost of health-care).

How many employees does your wife's company have? Generally speaking, any policy you get on your own is going to be substantially more expensive than what the same level of coverage through an employer group policy would be (unless the number of employees is small). Even if her employer isn't paying part of her policy premium, the larger the group the more spread out the risk and therefore premiums will be lower.

I guess it can't hurt to shop around.

I do not disagree with you on the low copay Jeff. They have about 40,000 employees... however, I thought the whole point of OC was to level the playing field so my small studio could have access to the same great health care coverage?

I am assuming the penalty is the way to go, but I should see some numbers tomorrow.

[WarrenG]

Originally Posted by L Stegall

I have a BC/BS policy through my work and I also cover my self-employed spouse on it. At this point, I haven't seen anything definitive about how my policy will change in terms of co-pays, etc., but the enrollment/change period will be coming up this fall, so I expect to know more in a month or so. It has never made economic sense for my husband to buy a separate policy, and I expect that will continue to be the case. I guess I'll be dreading seeing what BC/BS changes are in store for us, though, based on the changes you describe.

Lisa, under your system now (same as my wife an I) I am being told you will have to factor in the $695.00 penalty for your self employed spouse, regardless of whether or not he is covered under your policy?

[carrbowl]

We could never be without healthcare. Too many issues in the house, but we are all physically "well". But 5 out of 6 have a heart condition, so even if nothing happens, they all still have to have meds 365, a stress test yearly, a cardiolgist appt yearly, ekg yearly, and one has tonic clonic seizures. It's crazy....so even if we don't have any emergencies we are still very expensive. We always choose the big deductible, this was $5,000 and it was met in January. Talk about starting the year off wrong.
I'm dreading what the increase will be this year.

So the new health care is, you don't have to have insurance if you pay $695?? So, if you pay the $695, and then don't have health care and get a bill you can't pay, what happens?

And who is going to make sure everyone has health care? This seems like we are going down the same road as car insurance liability..they buy it one day, get their paper to prove they have it, then cancel it the next day and get a refund. Am I missing something??

[WarrenG]

You know, at the end of the day it will be a numbers game. If you shoot part-time and have a tax i.d., you just picked up a new year end gift of $695.00

The other part that is sad, is if you have only 1 full time employee, you do not qualify for any of the tax credits associated with the program. So if your an LLC with 3 people, but only one actually works full time in the business, you do not qualify.

Like I said, I was just curious if anyone else in the situation got a policy rather than just realizing they will essentially be taxed more?

Thanks for your input...

[WarrenG]

Originally Posted by carrbowl

We could never be without healthcare. Too many issues in the house, but we are all physically "well". But 5 out of 6 have a heart condition, so even if nothing happens, they all still have to have meds 365, a stress test yearly, a cardiolgist appt yearly, ekg yearly, and one has tonic clonic seizures. It's crazy....so even if we don't have any emergencies we are still very expensive. We always choose the big deductible, this was $5,000 and it was met in January. Talk about starting the year off wrong.
I'm dreading what the increase will be this year.

So the new health care is, you don't have to have insurance if you pay $695?? So, if you pay the $695, and then don't have health care and get a bill you can't pay, what happens?

And who is going to make sure everyone has health care? This seems like we are going down the same road as car insurance liability..they buy it one day, get their paper to prove they have it, then cancel it the next day and get a refund. Am I missing something??

Wow, sorry the year started that way... I hope it finishes much better

Basically, if you own a small business and are self employed (meaning just you) you must obtain a health care policy even if you have insurance through a spouse, etc, or you will be penalized at the end of the year on your taxes. This fee helps to pay for the insurance of people who could / would not otherwise have it. If you are Joe Citizen, without employment or under the income threshold, you can get credits, or goverment paid insurance (essentially) but, if you are over the threshold of income, but self employed... you cannot qualify. So if you are a stay at home dad who shoots on the side to make some income (legally e.g. - sales tax id, etc) then you do not qualify for the credits, but you do qualify for the penalty?

[Debbi]

Originally Posted by WarrenG

You know, at the end of the day it will be a numbers game. If you shoot part-time and have a tax i.d., you just picked up a new year end gift of $695.00

Interesting. What if you have insurance thru a full-time employer but shoot part time and have a tax i.d.? My employer currently provides the insurance for our family but I do have a legal business that employs no one but myself. What then?

[WarrenG]

Originally Posted by Debbi

Interesting. What if you have insurance thru a full-time employer but shoot part time and have a tax i.d.? My employer currently provides the insurance for our family but I do have a legal business that employs no one but myself. What then?

Debbi,

More or less, this is the dilemma we found ourselves in. If you have a Sales Tax I.D., it appears there is a $695.00 penalty regardless. In fact, let's say you work for an employer who DOES NOT provide insurance, guess what... $695.00. So if you are a full time emloyee of John Doe Construction, and he does not offer health care coverage... you need to purchase a policy or, pay the penalty.

We have been looking and looking for a loophole, but have yet to find one?