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Domicile & the Affordable Health Care Act


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#1 Zulu

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Posted 05 December 2012 - 11:56 AM

Another twist in selecting a domicile from 2014 on are the State Health Care Exchanges that will be set up by 2014. Kaiser provides some helpful info on the new Afforable Health Care Act:

- Implementation Timeline

- Requirement to Buy Health Care

- Health Reform Calculator


Since I'll be buying individual health care in 2013, it will be interesting -- to say the least -- how all this shakes out. This cost alone may equal or outweigh state taxes considerations.

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#2 Jack Mayer

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Posted 05 December 2012 - 12:06 PM

Interesting. I used the calculator in the last link. On an annual income of 25K it predicted my insurance cost would be.....wait for it...... $10,172.

BUT, my ACTUAL payment will be $1726, because the government subsidy will be $8445. This will be cheaper than I pay now (for basically NO coverage). But I wonder what it will cover.....

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#3 JohnandJanice

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Posted 05 December 2012 - 07:23 PM

Interesting. I used the calculator in the last link. On an annual income of 25K it predicted my insurance cost would be.....wait for it...... $10,172.

BUT, my ACTUAL payment will be $1726, because the government subsidy will be $8445. This will be cheaper than I pay now (for basically NO coverage). But I wonder what it will cover.....


I think the question isn't what will it cover, but where do they think they are going to come up with the $8445 subsidy?

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#4 Zulu

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Posted 05 December 2012 - 08:45 PM

I think the question isn't what will it cover, but where do they think they are going to come up with the $8445 subsidy?

A legitimate question, but since the act will probably be affecting a lot of us real soon (whether we like it or not), how about we try to figure out how the act may affect domicile selection.

So in this thread I think questions like What will it cover and How much will it cost are definitely on point.

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#5 D&J

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Posted 05 December 2012 - 09:49 PM

It's going to be interesting, our domicile state(Nebraska)isn't going to set up its own exchange so the feds will have to do it. I will be one year from medicare when it starts so that will also be a consideration Jami will be 6 years away. By looking at the calculator it will be cheaper than our 5K deductible plans we have know going with the plan but time will tell. I don't think the Feds can afford to set up plans in the 27 states that aren't planing on setting up their own.

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#6 Technomadia

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Posted 05 December 2012 - 09:58 PM

I've been watching this myself with curiosity in how this will impact us mobile folks. I think the state exchanges will definitely play an important role in selecting a domicile.

In addition to the costs of the plans themselves, there should also be particular concern on availability of plans that provide adequate access to nationwide provider networks. Already two popular states for RVers - SD and TX - have said they are not setting up their own exchanges and will default to federal. Florida is undecided. The ACA mandates that states offer at least two 'multi-state' plans, but will it actually be advantageous for a full-timers to select a state using federal exchanges for more non-regionally restricted options?

Interesting times ahead of us all to navigate.

BTW, we just made a huge blog post addressing healthcare as working-aged nomads, if anyone is looking for general information on these sorts of concerns:
http://www.technomadia.com/healthcare

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#7 richfaa

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Posted 06 December 2012 - 07:29 AM

remember now..If you are already covered by a health care plan provided by your employer such as retired military/Federal Employees and others you will not fall under the affordable health care act. The act addresses affordable health care for those who do not have it or can not afford it.
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#8 Jack Mayer

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Posted 06 December 2012 - 07:55 AM

The real question is will it evolve so that there are NO plans that address nationwide health care? In other words no PPO-type plans; only HMO type plans. It will be "interesting" to see. It may cause us to not be able to travel much. But I'm not worrying about it.....

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#9 Kirk

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Posted 06 December 2012 - 08:05 AM

remember now..If you are already covered by a health care plan provided by your employer such as retired military/Federal Employees and others you will not fall under the affordable health care act. The act addresses affordable health care for those who do not have it or can not afford it.

That isn't entirely true as some of us who worked for companies that had exceptionally good health care have already been impacted, other than union programs which were exempted. The last report that I saw there have been more than 30 management retiree plans penalized for what the bill calls "excess coverage" which seems to be paying too much. The plan for 3M company that I was part of has now been forced to push Medicare eligible retired folks off to the supplements that are available to everyone. To say more would be too political for these forums, but the important thing to note is that there are penalties to some of the best company plans in an effort to pay for the added recipients and if you have really good coverage you might be impacted. This has only been happening for about 18 months now and is being phased in so not all companies know if it will impact them.

I think that the main point is that with the new laws, most of us will not know the complete effect until the thing has completely gone into effect, which hasn't happened yet. Regardless of your support or dislike of this new plan, it is going to be interesting. For those currently one Medicare I would simply suggest that we continue to do what we have until we know of changes. I have found that the rumors of bad things are usually worse than the actual results. For us, the result seems to already be here, but who knows for sure???

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#10 richfaa

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Posted 06 December 2012 - 10:34 AM

That isn't entirely true as some of us who worked for companies that had exceptionally good health care have already been impacted, other than union programs which were exempted. The last report that I saw there have been more than 30 management retiree plans penalized for what the bill calls "excess coverage" which seems to be paying too much. The plan for 3M company that I was part of has now been forced to push Medicare eligible retired folks off to the supplements that are available to everyone. To say more would be too political for these forums, but the important thing to note is that there are penalties to some of the best company plans in an effort to pay for the added recipients and if you have really good coverage you might be impacted. This has only been happening for about 18 months now and is being phased in so not all companies know if it will impact them.

I think that the main point is that with the new laws, most of us will not know the complete effect until the thing has completely gone into effect, which hasn't happened yet. Regardless of your support or dislike of this new plan, it is going to be interesting. For those currently one Medicare I would simply suggest that we continue to do what we have until we know of changes. I have found that the rumors of bad things are usually worse than the actual results. For us, the result seems to already be here, but who knows for sure???





"As you know, the recently enacted health care reform law has fundamentally changed the health care insurance market,” the memo said. “Health care options in the marketplace have improved, and readily available individual insurance plans in the Medicare marketplace provide benefits more tailored to retirees’ personal needs often at lower costs than what they pay for retiree medical coverage through 3M.

“In addition, health care reform has made it more difficult for employers like 3M to provide a plan that will remain competitive,” the memo said. The White House says retiree-only plans are largely exempt from new health insurance regulations under the law.
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#11 Biker56

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Posted 06 December 2012 - 10:59 AM

The same happen to me as Kirk...The plan for DuPont company that I was part of was forced to push Medicare eligible retired folks off to the supplements that are available to everyone.
They did that starting 1/1/12. Before that I paid DuPont $396 a year for supplemental coverage the same as F & D.
In 2012 even with the Co. giving me a little tax free $$$$ for insurance. It cost me for the same coverage $1,707. :(
In 2013 the company is giving me 3% more over 2012. But both my F & D went up more then 3%. So it will cost me $1,848 for them in 2013. :angry:

If you are already covered by a health care plan provided by your employer such as retired military/Federal Employees and others you will not fall under the affordable health care act.

As you can see by Kirk's and my experience. Most privet employer's seen the writing on the wall and got out of providing affordable Insurance for their retires before 2014.
So that rule of not falling under the affordable health care act. Probably will not effect many retirees, if you check how many company's got out of the employee insurance coverage this past year.

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#12 Jim&Alice

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Posted 06 December 2012 - 11:47 AM

I am strongly plugged in to this conversation. In my just completed "career" life, I have seen the cost of employee medical insurance go up by close to 60% over the last two years. Indeed, many workplaces around us are considering dropping medical insurance coverage for employees due to this increase, and the expectation that the government will step in.

This is important to me because COBRA was an option to be considered for when we go full-time in January… An option that has now become quite a bit more expensive. So now I am taking a hard look at commercial medical insurance coverage - High deductible type, of course. So far, THAT looks affordable - if not as good as my prior insurance. As a matter of fact, we'll (DW & I) be making a decision on medical insurance coverage by the end of the week... working heads down on it as we speak. For the record, Michigan chose to not set up a State run exchange.

I have researched prior postings on medical insurance coverage from our site here, and from other sources as well... but I sure appreciate getting good suggestions & advice from those that have been there before.
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#13 JohnR49

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Posted 06 December 2012 - 01:42 PM

And I am following behind you in less than 4 months. So I am watching and reading.


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#14 Kirk

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Posted 06 December 2012 - 07:13 PM

The same happen to me as Kirk...The plan for DuPont company that I was part of was forced to push Medicare eligible retired folks off to the supplements that are available to everyone.
They did that starting 1/1/12. Before that I paid DuPont $396 a year for supplemental coverage the same as F & D.

The 3M Retiree Newsletter listed the first 10 company plans to be targeted and both 3M & DuPont were on that list. That began in 2010. At 3M the change was phased in and we shifted in the first group starting the new plan in Jan 2011 with the last of them to shift over by Jan. 2013.

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#15 sandsys

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Posted 06 December 2012 - 10:27 PM

Dave worked for a much smaller company than 3M but our retiree plan was only good until age 65 when you were expected to move to Medicare. Which we did. Now the plan we chose is being dropped so we've had to pick another one for next year. It's a good thing RVing has helped us develop our ability to go with the flow.

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#16 mrschwarz

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Posted 07 December 2012 - 10:51 PM

I also have a dog in this fight. I currently have about 7 more months of COBRA. After that, I have to go in the high risk pool in Texas since I cannot get private insurance due to a past heart attack. In January, 2014, Obamacare will require insurance companies to accept people, like me, with pre-existing conditions. It's going to make things interesting, to say the least.

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#17 Garry G

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Posted 08 December 2012 - 06:15 AM

I also have a dog in this fight. I currently have about 7 more months of COBRA. After that, I have to go in the high risk pool in Texas since I cannot get private insurance due to a past heart attack. In January, 2014, Obamacare will require insurance companies to accept people, like me, with pre-existing conditions. It's going to make things interesting, to say the least.

I'm in the same boat. My cobra ran out in 2010 and I have high risk coverage through my state pool. It's 600.00 per month for a 10k deductible policy. Between my wife and I we are paying over 1000.00 per month. I never had a heart attack but they (BSBC) think I could have so they won't insure me.
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#18 docj

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Posted 08 December 2012 - 08:18 AM

I also have a dog in this fight. I currently have about 7 more months of COBRA. After that, I have to go in the high risk pool in Texas since I cannot get private insurance due to a past heart attack. In January, 2014, Obamacare will require insurance companies to accept people, like me, with pre-existing conditions. It's going to make things interesting, to say the least.


My understanding of the way the new law will work is that each state will have its "marketplace" of plans for those who are not covered by employer plans and are too young for Medicare. All the plans will offer at least a specified minimum coverage level. You cannot be turned down for any plans, but the companies have the right to charge higher premiums to people with higher risks. However, the maximum premium anyone will pay is capped through the subsidy (tax credit) that Jack already discussed. Since, I believe, it is what is called a refundable tax credit, you will receive it even if it exceeds the amount of tax you are paying.

The rationale for the law is that by getting more people to pay for insurance the risk pool is increased; at present many of the healthiest people in the country, younger people currently not covered by employer or parents' insurance, are essentially not in the insurance pool. If they are added to the pool, the money they pay in is supposed to provide the funds to subsidize the costs for those who can't afford to pay. On a general level it makes sense, that is, you can afford to take on higher risk people if you have lots more low-risk people enrolled. But the devil's in the details as to how the money balances out.

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#19 Kirk

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Posted 08 December 2012 - 08:41 AM

The rationale for the law is that by getting more people to pay for insurance the risk pool is increased; at present many of the healthiest people in the country, younger people currently not covered by employer or parents' insurance, are essentially not in the insurance pool. If they are added to the pool, the money they pay in is supposed to provide the funds to subsidize the costs for those who can't afford to pay. On a general level it makes sense, that is, you can afford to take on higher risk people if you have lots more low-risk people enrolled. But the devil's in the details as to how the money balances out.....

How very true! The reason that folks such as Biker & I have the problems we do is that our plans were considered too lavish and so the feds charge them very excessive fees to help to pay that bill. But the catch is that those fees make plans such as we two had inoperable and so the result is that they stop running them.

The "pre-existing" problem is a serious one for everyone involved. Insurance companies are businesses, just like retail stores and so they compete for business, largely based upon price. Since the premiums collected must pay all of the claims, management costs, payroll & some profit, the underwriters have kept premiums down by refusing to cover those who they know are of high risk to cost more than most customers. That makes problems for those who have such issues, but to include them means that premiums have to be increased. Only government can continue to operate when running a plan that pays out more than it collects, year after year and even they will eventually fail if they do so for too long. There simply isn't any easy answer and probably none that all of us will approve of either.

Add into all of this mess the fact that most of us have increasing medical costs as we get older and you really complicate things. I read somewhere that Medicare studies have shown that about 60% of the money they pay out is spend on people who are in their final three years of life. I know that my sister who died of cancer cost her medical coverage far more in the 22 months that she hung on after diagnosis, they she probably had cost in the rest of her life, combined. There is no way that she or any of her family could have begun to pay what her treatment cost from our own pockets. That is one of the reasons that we keep hearing of some authority being set up to determine which patients have reasonable chance of recovery, to concentrate the resources that we have on those who a reasonable likelihood of living beyond 1 or 2 or 3 years. At what point does the cost cease to be justifiable because the patient will die soon anyway? :huh:

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#20 GzrGldGeo

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Posted 08 December 2012 - 08:50 AM

I know something has to be done. What is going on is criminal.

I am on Cobra now and will have to pay a lot more for less coverage soon, through my former (retired) employer. At least the tax refunds will help, but as long as this system is a for profit and maximum profit at that, we are just kicking the can down the road. I was supposed to get medical benefits in retirement only to have that taken away at about year 15. I also had my retirement taken away then only to have it restored (at a lesser amount) later. I am one of the "lucky" ones according to most people's thinking today. Imagine how lucky I would have been had I received what initially promised.

We can all hope this change will be great, I have a feeling it won't turn out quite as well as we all hope. I do think it is a step in the right direction, something has to be done.
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