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KillHour posted:How are there actual people that look at this and go "the free market knows best"? We actually provide excellent care for a low price due to competition in the area, so. e: I mean I don't think free market solutions to health care are a thing since it's not a good that people can be strictly rational actors about. And insurance distorts the market to the point where any free market solution is bunk unless you eliminate insurance completely. The crazy libertarians at least understand this.
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Oct 27, 2017 19:39
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so I’ve never been on exchange insurance before, always employer, but I’m about to move back to MA and will probably shop on the Connector. What’s this about income? I should estimate it higher to get a better plan?
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Oct 27, 2017 20:25
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DAD LOST MY IPOD posted:so I’ve never been on exchange insurance before, always employer, but I’m about to move back to MA and will probably shop on the Connector. What’s this about income? I should estimate it higher to get a better plan? No, estimate low for more subsidies both APTC (Premium) and CSR.
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Oct 27, 2017 20:26
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Don't just "estimate low" for more APTC unless you're okay paying the difference back on your taxes. It's a bit more nuanced than that, friend. e: hope that didn't come off as rude, apologies if it did.
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Oct 27, 2017 21:33
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yeah there IS a mechanism to collect subsidies you weren't entitled to because you made too much money to qualify for subsidies
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Oct 27, 2017 22:44
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esquilax posted:I don't believe the feds claw back cost sharing reductions at all, even if you understate income - I could be wrong though. Whats to stop an entire generation of people from just saying gently caress it and lying? Not like Cheeto Benito, king tax cheat, is really gonna start pumping the IRS up.
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Oct 28, 2017 00:20
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BlueBlazer posted:Whats to stop an entire generation of people from just saying gently caress it and lying? Not like Cheeto Benito, king tax cheat, is really gonna start pumping the IRS up. 'And if everyone doesn't fill up our gas tanks on Wednesday, that will show those corporations that gas prices are too high!'
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Oct 28, 2017 00:33
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DAD LOST MY IPOD posted:so I’ve never been on exchange insurance before, always employer, but I’m about to move back to MA and will probably shop on the Connector. What’s this about income? I should estimate it higher to get a better plan? The "estimate high" is only relevant if you a) live in a state that refused to expand Medicaid, and b) fall in the Medicaid expansion gap where you make too much to qualify for Medicaid, but not enough to get a subsidized CSR plan. Fortunately, MA is not such a state! It might also apply if for whatever reason you qualify for Meicaid but would prefer to pay for a CSR plan, but don't quote me on that - I'm not sure if there's some penalty mechanism there.
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Oct 28, 2017 01:24
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BlueBlazer posted:Whats to stop an entire generation of people from just saying gently caress it and lying? Not like Cheeto Benito, king tax cheat, is really gonna start pumping the IRS up. There are certain ways you could finagle the system, although it takes a level of finesse that most probably would not know or care enough to bother with. You can, for instance, manually adjust the tax credits you accept on a monthly basis that is lower than the amount you are determined eligible (with your underestimated income), and receive the CSRs that you are not truly eligible for, and come out okay. Basic Example: You, a 45 year-old single person with no dependents. You are pretty sure you're going to make $40k/year, which means you'll get some sort of APTC to lower monthly premiums (let's say $100/month), but no CSR to lower co-pays, deductibles, or out-of-pocket maximum. An unscrupulous you may apply and only estimate $20k/year. Now you've qualified for $300/month APTC, and more importantly a generous CSR that reduces your co-pays by 75%, lowers your deductible from $5,000 to $1,000, and your out-of-pocket yearly maximum from $6,500 to $2,200. Again these are hypothetical but realistic numbers. You graciously accept the CSR reductions in full, and manually adjust your monthly APTC back to the $100 you know you will rightly qualify for when your real life annual income is calculated. The IRS will look at your form 8962, see that the APTC you actually took matches your eligibility, and say good job cookie, we're square. You've successfully lowered every effective cost and you've gotten away with it, you devil. Having said that, the exchanges are evolving, and will be much more diligent in checking income, either through e-verification or (failing e-verification) by requesting documented proof. So your little scheme probably won't work much longer. Highbrow Slick fucked around with this message at 03:43 on Oct 28, 2017 |
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Oct 28, 2017 03:40
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Highbrow Slick posted:There are certain ways you could finagle the system, although it takes a level of finesse that most probably would not know or care enough to bother with. You can, for instance, manually adjust the tax credits you accept on a monthly basis that is lower than the amount you are determined eligible (with your underestimated income), and receive the CSRs that you are not truly eligible for, and come out okay. The people I know who do something even remotely close to this do it in reverse. They know they qualify for the CSR and an APTC, but they overestimate on their income levels when signing up for healthcare while still estimating low enough to get the APTC. That minimizes the APTC - and they know the maximum level of income they can take in before they need to worry about paying it back - and in effect their higher payment of health insurance premiums every month, and the hand-in-hand underutilization of APTC, means they're basically "paying" monthly into their self-employment taxes. Because when the end of the year comes, and the APTC is reconciled, the calculation will clearly show that they should have received more. That cover their self-employment taxes, and currently the IRS also waives the lack of pre-payment penalty proportional to the APTC you're owed back. Highbrow Slick posted:Having said that, the exchanges are evolving, and will be much more diligent in checking income, either through e-verification or (failing e-verification) by requesting documented proof. So your little scheme probably won't work much longer. I'm not quite sure how the exchange is going to "check" income. The entire point of the sign up process is to estimate. Further, if you're self employed, you might literally be outright guessing what your income will be for the next year. Self employed contractors working on commission pretty much have no better than a ballpark idea of what they will make the following year. How is the insurer or the IRS going to find out mid-year that they've made too much money? The vast majority of ICs are sole proprietorships that don't do the slightest bit of accounting work. They certainly don't have quarterly accounting and pre-payment of taxes. The average humdrum American IC is just a guy or gal that works, gets the money deposited into their account, and uses TurboTax to input the 1099s they get. I cannot see any mechanism that could be created short of legislation that would regulate the gently caress out of sole proprietorships. Good loving luck passing that through Congress. I can't imagine any politician that would risk putting their name on that right now or anytime in the near future - especially considering there are 32 million sole proprietorships in the US as of 2010. What is the plan from the health insurance industry perspective? What is the IRS going to do to an IC who's married filing jointly with household income of $30k estimated on Healthcare.gov...but it turns out they had a blockbuster year and made $50k? Is your idea to force them to drop their CSR plan - and all the money they've paid towards their OOP max - and switch to a new plan mid-year? Because if so that's loving robbery and you're penalizing people for trying to be successful. If anything this whole concept of forcing people out of CSR plans if their income creeps up - even if you could find a way to enforce this - is just *begging* for tax evasion. It just means those ICs will, at a minimum, ask their payers to delay payment till January so they don't lose their health insurance.
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Oct 28, 2017 08:31
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healthcare.gov already requires you to verify income if your estimate is too different from the income you made last year (when you filed taxes) and they will kick you off of CSR plans and end APTCs around April if you don't send in documentation or if you're making too much.
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Oct 28, 2017 14:34
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The Phlegmatist posted:healthcare.gov already requires you to verify income if your estimate is too different from the income you made last year (when you filed taxes) and they will kick you off of CSR plans and end APTCs around April if you don't send in documentation or if you're making too much. What if you're between jobs, are you just barred from the exchange?
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Oct 28, 2017 14:39
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PerniciousKnid posted:What if you're between jobs, are you just barred from the exchange? Depends. If you enter $0 as your income then healthcare.gov will basically tell you to go sign up for Medicaid and won't let you enroll. If you estimate how much you were making at your previous job (or what you think you will be making at a new job) then you'd have until the end of March or April (I forget which) to get a job and then submit your W-2 or a pay stub. You could also use any unemployment benefits as proof of income if you're receiving them. e: you could also lie and submit a self-employment ledger with some made-up numbers on it. Healthcare.gov doesn't really look into stuff too much, but you are technically submitting documentation under penalty of perjury, so...
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Oct 28, 2017 15:05
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Yes, many self-employed folks keep minimal financial records and it is a pain to estimate profit after expenses, as it varies wildly and often they don't actually know until the year's over. In those instances, they would have to at least draw up a rudimentary year-to-date P&L that shows they made some effort to provide a reasonably accurate estimate. As for what the IRS would do to someone that estimated 30k but actually made 50k...well that's what the 1095-A & form 8962 are for. If that person never called to update their estimated income (something you can do at anytime and agree to do when you sign up for a plan), that person would have to pay back any APTC they received over their final eligibility. There can be limits on how much they have to pay back, though. Highbrow Slick fucked around with this message at 16:07 on Oct 28, 2017 |
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Oct 28, 2017 16:04
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From a policy perspective, I think the real take-away is that hard income cut-offs for benefits are never a good idea. If making a few extra dollars causes you to loose more than that few extra dollars in benefits, there's real incentive to fudge your numbers. It makes taxes more of a pain for everyone, including the IRS. For the ACA, that means both the CSR cut-off and the 400% FPL limit if insurance costs continue to rise faster than income. This problem could have been eliminated by simply scaling the CSR benefits and then including CSR benefits in repayment/additional subsidies calculations at tax time. I suppose this would, however, add a calculations of the amount of out-of-pocket maximum, co-payements, and deductible over- or under-used. This would require health expenditures in those two categories to be IRS reportable, but that seems easier than than auditing everyone's income to find the "cheaters" (who may not have intentionally cheated at all).
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Oct 28, 2017 20:21
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Yes, there should have been a better gradient developed in ACA to prevent the 400% FPL cliff which negatively affects a lot of older people. If you're 62 in my area and you make $48k a year, the government gives you $627 a month in APTC to help pay for health insurance. You hit $49k and that APTC disappears. That's $7524 that just went missing because you made a thousand bucks more. The Phlegmatist fucked around with this message at 20:47 on Oct 28, 2017 |
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Oct 28, 2017 20:39
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My parents often complained because they were typically just above the cutoff for a variety of things, it's definitely a sore spot among your average people in America.
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Oct 28, 2017 20:42
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Maybe the government should craft and implement policy that benefits everyone and not this means tested horseshit
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Oct 28, 2017 20:59
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Peven Stan posted:Maybe the government should craft and implement policy that benefits everyone and not this means tested horseshit Who'd have known healthcare was so easy?
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Oct 29, 2017 03:48
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Ok, I got a legit question here because I'm trying desperately to figure out how to help my sister. Mid 30s single female w/ 1 dependent child. Going back to school and on family support for the time being. She is being mostly supported by a family member who lives nearby and has recently undergone an organ transplant so my sister is legit spending the majority of non-school time as a caregiver to either her daughter or the supporting family member. Hence, no planned income this year. Considering both my sister and my niece have several existing medical conditions and they like/need the doctors they have, they would very much like not to go on medicaid where they would likely have to change primary care doctors. She can be fully reimbursed if her income was above $16,200 but of course get nothing if it's below that amount. I am recommending that a document be written up formalizing the caretaker job and formally moving a portion of the support she is receiving to reflect those payments as wages. She would, of course, pay taxes on those funds, both sides of payroll and fed/state income tax, but near as I can tell she'd still end up saving over $9k. Legally, how murky of water am I getting us into here? Like I said, this is caretaker work that absolutely needs to be done, I live much too far away to help with it at all so it's pretty much all on my sister's plate. It'd be nice to not have them pay completely out of pocket again this year. Note: Just to be clear, I'm not using this thread as legal advice, but rather as a sounding board before I take the plan to my tax person to get said advice. Anubis fucked around with this message at 06:53 on Oct 29, 2017 |
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Oct 29, 2017 06:48
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I'm not entirely sure I understand your question, you may want to ask in the Ask/Tell legal questions thread instead of here. That said, Google tells me thusly: https://www.caring.com/articles/payment-for-family-caregiver https://thecaregiverspace.org/paid-to-be-a-family-caregiver/ https://www.aarp.org/home-family/caregiving/info-2016/you-can-get-paid-as-a-family-caregiver.html I don't really know if these are relevant to your situation and this is moreso a thread about the political dimension of healthcare, not advice. 
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Oct 29, 2017 06:53
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Yeah you're right, that's a better place for it. The last 2 pages just had a lot of talk about people adjusting income to meet requirements. I'll take it to A/T. Let's chalk this up to another horror story how this bullshit non-single payer ends up affecting and stressing out even more people than just the directly affected. 
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Oct 29, 2017 15:35
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Don't get shot while on vacation https://twitter.com/kylegriffin1/status/924337987369996293
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Oct 29, 2017 15:46
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EugeneJ posted:Don't get shot while on vacation This would never happen, but I'd really love to see a federal law passed where unless both the shooter and victim were residents of the same state and physically in that state, then whatever state the shooter is from is automatically responsible for all costs related to the shooting (medical, lost wages, loss of use of limbs, funerals, property damage, etc.).
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Oct 29, 2017 18:32
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Kreeblah posted:This would never happen, but I'd really love to see a federal law passed where unless both the shooter and victim were residents of the same state and physically in that state, then whatever state the shooter is from is automatically responsible for all costs related to the shooting (medical, lost wages, loss of use of limbs, funerals, property damage, etc.). This would just breed resentment and be a problem if a guy from a poor state kills someone from a rich state. It also buys into collective guilting and shaming, and it doesn’t seem fair if say, a white dude from a Southern state with a large black population kills a bunch of Muslims in a Northern state and now a vulnerable minority population is punished for his actions. It would be funnier if you made gun manufacturers pay for it, if we’re talking about bad healthcare policy rooted in spite.
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Oct 29, 2017 18:42
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Lightning Knight posted:It would be funnier if you made gun manufacturers pay for it, if we’re talking about bad healthcare policy rooted in spite.
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Oct 29, 2017 20:14
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tetrapyloctomy posted:100% the weapons and ammunition manufacturers -- as well as the individual people who sold him that much ammunition -- should be on the hook for the repercussions, in the same way that a bar owner who continues to serve a clearly intoxicated client and then allows him to drive home is liable. So naturally there is a law preventing it! Oh I agree they should be on the hook for lawsuits, I just don't think they should be the source of healthcare funding as opposed to national healthcare. 
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Oct 29, 2017 20:16
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Anubis posted:Considering both my sister and my niece have several existing medical conditions and they like/need the doctors they have, they would very much like not to go on medicaid where they would likely have to change primary care doctors. She can be fully reimbursed if her income was above $16,200 but of course get nothing if it's below that amount. I am recommending that a document be written up formalizing the caretaker job and formally moving a portion of the support she is receiving to reflect those payments as wages. She would, of course, pay taxes on those funds, both sides of payroll and fed/state income tax, but near as I can tell she'd still end up saving over $9k. She may want to check with her Primary Care doc to see if she can keep them on Medicaid. I'm on WA State Medicaid, and I was able to keep my Primary Care doc, because we already had an established patient-doctor relationship, because I picked him when I was on an ACA BCBS plan. Maybe your doc is the same way.
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Oct 29, 2017 20:45
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Stickman posted:From a policy perspective, I think the real take-away is that hard income cut-offs for benefits are never a good idea. If making a few extra dollars causes you to loose more than that few extra dollars in benefits, there's real incentive to fudge your numbers. It makes taxes more of a pain for everyone, including the IRS. For the ACA, that means both the CSR cut-off and the 400% FPL limit if insurance costs continue to rise faster than income. The CSR benefits do scale a bit. Usually the income level right where APTC starts the CSR plans have a massively reduced deductible (sometimes none) and an OOP max of under $1000. Then the second step of the CSR has a higher deductible, and usually the OOP max is doubled. The third step of the CSR has a further slightly higher deductible, and the OOP max is tripled from the baseline CSR. The fourth step of the CSR has the same deductible as step 3, but the OOP max is half the non-CSR plan (and slightly above step 3). After that you're out of CSR land. But as everyone has pointed out the CSR cutoffs can be harsh. Making an extra $1000 in income suddenly means an increase in thousands if you hit the OOP max - and that's a tough pill to swallow.
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Oct 29, 2017 22:59
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Crashrat posted:and that's a tough pill to swallow.  Are you a dad too?
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Oct 30, 2017 02:35
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tetrapyloctomy posted:100% the weapons and ammunition manufacturers -- as well as the individual people who sold him that much ammunition -- should be on the hook for the repercussions, in the same way that a bar owner who continues to serve a clearly intoxicated client and then allows him to drive home is liable. So naturally there is a law preventing it! Should car manufacturers be on the hook for vehicular manslaughter?
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Oct 30, 2017 12:05
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SimonCat posted:Should car manufacturers be on the hook for vehicular manslaughter? People carry insurance for all things car-related, including wrongful death. Now, if you're going to suggest that the state start acting as an insurer of last resort for large liability cases like a mass shooting, that's a whole new can of worms.
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Oct 30, 2017 17:57
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SimonCat posted:Should car manufacturers be on the hook for vehicular manslaughter? Sure, when they design and market a car specifically designed to facilitate vehicular homicide as its primary function.
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Oct 30, 2017 18:12
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PerniciousKnid posted:
Heh I didn't even catch that. But seriously this chat about "kick those greedy poors off their CSR plans" is bullshit. There's no way in gently caress someone should be actively penalized for estimating their household would make $31k next year - but someone got a second PT job mid-year and they brought home $45k. It's already damned hard to estimate income. Most people signing up on exchanges are, by the literal definition of being able to sign up on the exchange, not in the position of knowing their income for the following year. If they had a salaried full-time job they'd have insurance through that job. There should absolutely be no disincentive for someone to try to improve their station in life out of shear fear of suddenly having their health care become unaffordable. Surely that's a concept everyone can agree on regardless of political persuasion. Conversely, though, if someone's been reporting 6-figure income to the IRS filing alone - but they just decide to report a take home of $20k on Healthcare.gov to get a cheap CSR plan - then yes that's something we should do something about. But going after people trying to come the gently caress up in the world? No. Leave them alone. Being economically precarious enough that your family's healthcare is fully dependent on the PP-ACA continuing to exist is scary enough in this political climate. Coming guns out to say "that person made $8k too much - fine that fucker and kick them off their healthcare plan" is Scrouge McDuck on a level that's only found in Ted Cruz's porn folder.
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Oct 30, 2017 23:47
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Crashrat posted:Heh I didn't even catch that. They really did a terrible job implementing APTC and CSR subsidies. Long Term Disability insurance has a similar effect with regards to salary offsets and how to handle them in order to ensure people would choose to return to work instead of staying on disability. You can apply the same theory to this situation and create a system where don't have dis-incentives to make more money.
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Oct 31, 2017 01:13
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Basing APTCs and CSR plan eligibility on FPL was a pretty lovely idea because the biggest determinant of healthcare expenditures on a macro level is age and FPL has no way to take that into account. It would have been better if ACA simply said "here's what your premium expenditure should be and here's what your maximum out of pocket costs should be based on the cost of the second lowest silver plan in your area and your income" rather than tiering it based on FPL. That way it takes age and regional variation in pricing into account and you'd avoid the CSR and APTC cliffs. e: like, writing good policy 101 is to make it so that you don't somehow become poorer when you make more money
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Oct 31, 2017 02:55
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Yeah but the deficit Gotta means-test everything, oh weird why do the poor people our means test has decided are too rich to deserve health care hate it, I guess they must be stupid.
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Oct 31, 2017 04:11
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I think a lot of the health insurers have been disingenuous in their press releases as well. The "shock" at how much "these people" are using their health care. How the gently caress would companies packed to the brim with actuaries be actually shocked at the usage levels? Seriously? They're either bald face lying or wholly incompetent. There's going to be a lot of people for the next decade or so slowly working themselves into the healthcare system that have neglected their healthcare for years - if not their entire life - and it will likely take them at least a year or two of HIGH utilization to get their personal healthcare sorted out. Sure maybe there are people who are the lucky one that are in their 30s, have no health issues whatsoever, and the only thing on your long-term horizon is a colonoscopy at 40. But the vast majority of people have hereditary conditions, injuries that never healed right, long-term issues that have been lingering but finally get caught in a 15+ vial blood work up a PC doc orders when their patient presents with no real medical history. That blood work will lead down a lot of pathways for further testing, specialists being seen to interpret results, procedures being done to stymie effects, and of course a huge uptick in prescriptions. Then in a couple years that boils down to something approximately close to the average utilization for someone their demographic makeup. But nope. The poors are using the ER too much. Yup. That's the problem.
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Oct 31, 2017 06:07
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Or it's that the ACA incentivizes people to go to the ER instead of a PCP. My girlfriend goes to the ER regularly for pain management and antibiotics (her jaw is messed up due to a botched extraction and gets infected) because it's free and faster. I'm sure her insurance pays out the nose for that.
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Oct 31, 2017 12:38
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Crashrat posted:I think a lot of the health insurers have been disingenuous in their press releases as well. Why don't you write up a paper about how we should have accurately predicted the healthcare costs for the uninsured population. You know, the one where absolutely no data was available? I look forward to reading it. Also make sure you include your justification of these rates for the start department of insurance and CMS. KillHour posted:Or it's that the ACA incentivizes people to go to the ER instead of a PCP. My girlfriend goes to the ER regularly for pain management and antibiotics (her jaw is messed up due to a botched extraction and gets infected) because it's free and faster. I'm sure her insurance pays out the nose for that. They do, there's two problems to that: first, emergency rooms, especially free-standing ones, abuse the fact that insurers have to pay in-network benefits regardless of their contracting status, and it's very difficult to prove when a trip to the ER could've been handled by a PCP because you have to give people that aren't medical professionals the benefit of the doubt. Reik fucked around with this message at 17:20 on Oct 31, 2017 |
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Oct 31, 2017 15:23
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