"So @Reince, I know you just lost your insurance, but it's OK - you can STILL find coverage here: https://www.healthcare.gov/ Thank @BarackObama." - @AndrewBatesNC on Twitter
I made a comment on this, and I'm going to bring it up again.
This is not sexism against women for a very particular reason.
>Covered contraceptive methods
>FDA-approved contraceptive methods prescribed by a woman’s doctor are covered, including:
>Barrier methods, like diaphragms and sponges
>Hormonal methods, like birth control pills and vaginal rings
>Implanted devices, like intrauterine devices (IUDs)
>Emergency contraception, like Plan B® and ella®
>Patient education and counseling
>Plans aren’t required to cover drugs to induce abortions and services for male reproductive capacity, like vasectomies.
While birth control for women is covered from barrier methods (diaphragms, sponges) all the way through sterilization (IE, tubal ligation), no birth control for men is covered from barrier methods (condoms, vasalgel) to sterilization (vasectomies).
Worst case scenario, women working for religious asshole employers may be... treated just like men.
I guess that would be terrible.
Looks like there is still a "fee" for not enrolling.
Another source for same
I think your insurance company ripped you off, because out of pocket maximums are supposed to include copays
$6600 is still a lot of money, but most people should be able to work with that. It's certainly not the same financial doom that 150k is
You generally cannot qualify for subsidies for marketplace plans if your employer plan is considered "affordable". Unfortunately the definition for affordability is based on the expense of single coverage, not family coverage:
>A job-based health plan is considered “affordable” if the employee’s share of monthly premiums for the lowest-cost self-only coverage that meets the minimum value standard is less than 9.56% of their family’s income.
However, OP may be able to take the single coverage for himself and have his wife and child covered under a marketplace plan with subsidies.
(Also I'm not sure why OP thinks that crossing state lines for medical service will be a problem with a marketplace plan.)
You're right. I just downloaded version 2.0.14 and there appears to be a new objective to maintain your health bar at 30%. Anyone have any tips on how to avoid damage?
Edit: nm, just found a market selling health potion
You can get a hardship exemption so you wont have to pay the fee for not having health insurance
I used it for 2014. I marked the "other" option and wrote that I was an unemployed recent graduate student and about how world-crushing it would be if forced to pay the fee.
If you have absolutely no income and file as such properly, medicaid is 100% free.
Edit: There are a few states that disallowed expansion of medicaid, unfortunately. Talk to your local representatives and try to make a big deal out of it if you can.
The states that don't currently allow it are Texas, Florida, Kansas, Georgia, Louisiana, Alabama, and Mississippi.
Women's groups lobbied to get women's health issues covered. There isn't anywhere near as strong a lobby for male reproductive issues in terms of birth control.
First of all, have you called to try and figure this out? It sounds like you're already in over your head financially, so you might as well turn to the pros whose job it is to guide people through their health insurance options. The number to call is 1-800-318-2596.
I believe that emergency room treatment and subsequent care are not as severe Obamacare as they were in days prior.
So they might not be totally financially ruined. Maybe.
It is now illegal for health insurance providers to deny coverage, charge more, or deny treatment based on pre-existing conditions. This was one of the primary provisions of ObamaCare.
According to HealthCare.gov, the only exception to this is individually purchased (not job-based) grandfathered health insurance plans. So assuming the OP's family has insurance through the wife's employer, the insurance company isn't allowed to deny anything because of pre-existing conditions.
Not for a child it doesn't. She's just a piece of shit.
Source: family member is a low life
EDIT: Can't believe I'm having to explain CHIP to what I suspect are adults. Are there really that many people from the suburbs on this site?
You know this is bullshit, right?
The penalty maximum is around $2000, and the only you would be paying a $2500 is if you're household is earning $100k a year.
IRS employee here;
If your father claims you on his return for 2014, it is likely he will pay a larger Shared Responsibility Payment (SRP) if you don't meet one of the exemptions allowed by the Service.
Check your healthcare options through your community college, or try healthcare.gov.
Thank you for reading.
Actually, it's not stupid, and I am surprised that no one is making a point about it anywhere. He could simply pay the health coverage exemption instead, which is part of the law. If Mr. Cruz wants to stand on his ~~principals~~ principles about the ACA being bad for America, then he is well within his rights to legally not be a part of it.
> What county?
> Cheapest for Fulton (Atlanta area for those who aren't familiar) was $198/mo with a $4500 deductible.
Based on this guys comment, and OPs response. He may be lying to make the plan look better than it is.
That isnt true at all. The expansion is for people that didnt make more than 133% of the poverty line:
>If your state hasn’t expanded Medicaid, your income is below the federal poverty level, and you don't qualify for Medicaid under your state's current rules, you won’t qualify for either health insurance savings program: Medicaid coverage or savings on a private health plan bought through the Marketplace
> Plans in the Health Insurance Marketplace must cover contraceptive methods and counseling for all women, as prescribed by a health care provider. Plans must cover these services without charging a copayment or coinsurance when provided by an in-network provider — even if you haven’t met your deductible.
The requirement for coverage without copay was a significant element of the ACA.
How that effects frequency of abortions would be a separate issue to study.
Get insurance NOW. The ACA has made pre-existing conditions illegal with the exception of smoking. You can get insurance, and if there is a lag pay the bills with your assets. You are almost certainly not going to qualify for medicaid, but buy private NOW. I just sent you a private message, more people need to be aware of this
Pretty sure you can just exempt yourself completely from health care:
>Coverage is considered to be unaffordable if the lowest cost Bronze-level plan available to you through the Marketplace in 2016 is more than 8.13% of your household income.
>The total cost to you must be more than 8.13%, including any premium tax credit you would qualify for if you enrolled in that plan.
Considering its about 60% of your household income, I'm pretty sure you're exempt. Even if you qualified for 50% of your income in subsidies, that'd put you at 10% of your income and therefore exempt.
> The coverage they offer is absolute shit; $6,000 deductibles and no other benefits offered before you rack up $6,000 in costs.
This isn't exactly true. All new health insurance plans are required to offer free preventative care regardless of the size of the deductible. Some plans (like mine) also give you three free primary care visits per year, regardless of the purpose of those visits. I know it's not much... but just putting it out there in case you didn't know.
Possibly some good news for you though, if the employer sponsored plan(s) available to you costs more than 9.69% of your total household income, your employer sponsored plan is considered "unaffordable". As a result, you may be eligible for Marketplace coverage with substantial financial help. When you apply, you'll just need to attest the fact that your employer coverage is unaffordable according to the above standard.
Be sure sign-up during open enrollment!
> Is everyone who already retired early or is planning on retiring in say their 30's-40's still carrying health insurance?
Health insurance isn't really about saving a few bucks on a doctor's office visit or even a quick trip to the emergency room. It's for the stuff that can set you back hundreds of thousands of dollars. I don't know many people who can take that kind of hit.
Being FI does, however, mean that you can afford a higher deductible and save on those premiums. Lots of options on https://www.healthcare.gov.
Health insurance is just another expense. You aren't FI unless you can afford to pay for it along with any reasonable healthcare expenses.
Under the existing rules and fees,, this was somewhat true as well. It's just that the fees started at $695 for individuals and escalated quickly as your income climbed, to the point where you were paying the equivalent of an average "bronze" plan and might as well get insurance anyways.
Under this proposal, since they kept the pre-existing part, it may actually be to your financial advantage to not buy insurance until you really need it, saving thousands of dollars a year in premiums, and then jumping in and paying the uplift charge when you do need it. The disadvantage being that if you do have doctor visits, medications, and whatnot, you're paying at cost instead of getting negotiated insurer's rates, so those $200-instead-of-$20-copay trips start to eat away at whatever you think you're saving.
I was under the impression that if you have a life change that you are allowed to enroll outside of the normal open enrollment, under what is called "special enrollment". Granted this would be for an ACA plan I believe, but it might be cheaper than paying the penalty. You would have to run the numbers yourself.
It's a tweaked version or AGI, called MAGI:
>MAGI is adjusted gross income (AGI) plus these, if any: untaxed foreign income, non-taxable Social Security benefits, and tax-exempt interest.
The line is actually 400% of the federal poverty level, which varies with family size. The number you cite is for a family of four. For a single person, the line is $48240.
A couple that might count for you:
"You had medical expenses you couldn’t pay in the last 24 months that resulted in substantial debt"
"You experienced another hardship in obtaining health insurance"
Actually, they have to. By law. If costs are lower than expected, and they have spent 20 percent of their premiums on administration, they have to give the rest back. It's like, five bucks a person, but they have to.
Are you familiar with the affordable care act?
But Oregon should have plenty of low-cost/income clinics.
Here is more information.
But it still doesn't make sense that you should be required to pay the tax penalty when you would qualify for expanded Medicaid. That seems like a perverse side effect of the denial of the Medicaid expansion. If your local congressman is unresponsive, then contact someone nationally.
Quick search turned up this blurb on the healthcare.gov site:
>Under the law, most people must have health coverage or pay a fee. But you won’t have to pay this fee if you live in a state that hasn’t expanded Medicaid and you would have qualified if it had. This is called having an exemption from the fee. You can get an exemption when you apply for coverage in the Marketplace. Or you can apply for the exemption without having to fill out a Marketplace application.
While it is true that many plans have a $6k deductible, the vast majority do not.
Here's the complete 2014 pricing and coverage data for every plan offered through the 37 federal marketplace states:
> pre-existing condition
With Obamacare I don't think insurance companies can deny you for a pre-existing condition anymore. Maybe someone else more knowledgeable could verify?
Metrication of /r/metric
Just so people know: you can file an exception if you're in the income bracket which should have qualified you for state medicare, but your state didn't expand their package. AND there's lots of other reasons for exemptions as well!
Also, divorce only qualifies you for the special enrollment period if the divorce is the reason you lost insurance. If you don't have insurance when you get divorced, the divorce will not make you eligible for the special enrollment period. Here's the screener that explains it.
Hi, Tax Accountant here. And /u/infinitetbr is semi-correct. You have to APPLY for financial hardship and receive a certificate. You can't just claim financial hardship, even if you are denied Medicare (which is a strategy I've never heard of). Also, healthcare coverage based on month to month. So you can receive a hardship waiver for either part or the whole year. And the application process has no scheduled processing time. So it's unknown if you applied today when you would get your certificate. And you can't submit a return without the cert#. The IRS agent at our CPE said you can put "Pending", but if you don't get the exemption you are then subject to the penalty. But, once again. YOU HAVE TO APPLY FOR FINANCIAL HARDSHIP. Link below with more info.
Finally, don't get me started on how big of a mess this is. It requires more reporting and more filing, and on individuals who can't afford a professional to do it for them. It's a fiasco. Healthcare reform is needed, but this is just an f'n mess and has probably made the situation worse, if not just more complicated.
Edit: /u/flux_capicitated has correctly noted that there is a difference between "Financial Hardship" and "Unaffordable Coverage." Unaffordable coverage can be claimed on your return with no prior certificate.
$12/hr x 40 hrs/wk x 52 wks/yr comes out to a pre-tax yearly salary of $24,960. According to https://www.healthcare.gov/glossary/federal-poverty-level-FPL/ the poverty level for individuals in $12,060 so by technical definitions $12/hr is a little over double the federal poverty line, though the FPL seems insanely low, $25k is not a salary you can live well off with.
You won't be on the hook for the full amount. One of the regulations that came out of the Affordable Care Act was the implementation of Out of Pocket Maximums. The OOPM for 2016 health plans is $6,850 for individuals and $13,700 for families.. Your specific health plan may actually have lower OOPM's.
Inpatient/Outpatient and Mental Health are all Essential Health Benefits under the ACA and as such you won't pay more than $13,700 for the 2016 plan year.
That's a lot of money for any family, but it's not likely to cause a bankruptcy, which is one of the key benefits of the ACA legislation.
If you are in the US your insurance provider by law should be covering IUDs as of January 2013 unless they have a religious exemption. If they cover pills, they should cover IUDs. Definitely pursue other places to get it. Check with your local public health department, doctors office, or Planned Parenthood, because sometimes they are able to get you access to programs that help with covering contraceptive care.
Edit: This may also be a good resource for you if your insurance does not have an exemption and are for some reason giving you the run-around: "If it seems that your plan is not following the law, don’t despair! The National Women’s Law Center will help you sort this out for free. Call our toll-free hotline (1-866-745-5487), email us at , or visit CoverHer.org to get started. We are working with women across the country who are having trouble getting their method covered without a co-pay."
Yep. If the lowest-priced coverage available to you would cost more than 8.16% of your household income, then you can get an exemption from the individual mandate. Here's how: https://www.healthcare.gov/health-coverage-exemptions/hardship-exemptions/
>THIS IS NOT A FUCKING OPINION.
This isn't Tumblr. Cursing and writing things in all caps will not make people believe you. Giving a citation or two will get you much further. Especially ones from reputable sources.
Edit: I actually decided to look into it myself. It looks like according to that site's source, there is no correlation between income and obesity until you start looking at people who make over 400% the poverty level. The poverty level is based on the number of family members and listed here. That means that a single person making $47,000, or a family of 3 making $80,000 are as likely to be obese as someone living off welfare.
Once you are an adult he has no legal obligation to provide you with coverage. That he can do it until 26 under the ACA doesn't mean he must. The good news is that you can probably get reasonably priced insurance to cover you through the ACA insurance exchanges. Having been dropped from insurance you would have been eligible to get coverage regardless of open enrollment, but making it even easier is the fact that it now is open enrollment.
Take a look and see what coverage you can get to ensure you are able to get the treatment you need.
As another poster noted, try the personal finance sub about getting your other finances in order to help with this new obstacle.
Congress has been blocking, delaying, and preventing Obama from doing things from the day he took office.
ACA is the abortion it is because Congress put so many things into it and caused so many compromises that it took over 200 pages just to list the amendments.
Not quite. As I said, I've paid the penalty for not having insurance (when I wasn't even in the country for the time period that I was without insurance that year).
>What happens if I don't pay the fee?
The IRS will hold back the amount of the fee from any future tax refunds. There are no liens, levies, or criminal penalties for failing to pay the fee.
This honestly shows you don't have a full understanding of what you are discussing. If you want to put your money in the bank and pay cash as needed, do so. The penalty would be less than your total premiums.
According to this faq on the healthcare.gov website, if the cost of that single-person coverage health insurance through your employer is over 9.69% of your household income then you would qualify for subsidies if you signed up through the ACA marketplace. So based on the estimate you provided, if you're monthly household income is less than ~6,200 bucks you should look into if an ACA plan would make things more affordable (or if there is a lower cost coverage available through your employer).
Try relooking at current enrollment options before they expire December 15th, if you haven’t already. The suspension of the CSR payments may have resulted in better options. This may be redundant, and you may have already looked. This summer I was looking at $600 a month COBRA, but found an ACA Bronze plan for $235 instead (was changing jobs).
Did any of the physicians share why they were dropping the plan? That's very strange and terrible for their patients.
There are a list of qualifying events that allow you to switch plans. Can you make any of them happen? Such as: new job, moving zip codes or counties...
Isn't insurance required? This site outlines the minimum fines/penalties for not carrying insurance.
>$695 per adult
>$347.50 per child under 18
> Maximum: $2,085
So losing your plan is getting expensive. Up more than 50% from last year. ACA just looks like a tax sometimes.
Your points are valid, and represent some of the major issues with the ACA. However, I would argue a few points:
> I morally and philosophically do not believe the government has the right to force me to buy anything.
You live in a society, with costs of running that society that are not immediately apparent. This includes paying for roads that you don't personally drive on, paying for the National Guard to help people in disasters that don't affect you, or paying for healthcare of people who are not you. It is not fun to pay for others, but I'm sure you can empathize with the fact that sometimes others are more unfortunate than you are.
> When I hit that deductible, it would have transformed into 50/50 co-insurance. So, if I needed surgery or a long-term stay in a hospital, I would be stuck with 50% of the bill. Whether you're paying $200k or "only" $100k, that is a huge nut to crack.
While the premiums were getting out of hand, especially for young healthy people, your out of pocket max is limited to $7,150 so there is no way you would be paying $100,000 for anything.
That sucks. Sorry to hear that. I found this page dealing with the exemption from the payment. Maybe with the premium increase you'll fall within the exemption.
You can't use anyone else's number as a guess. It varies widely by age, location, and what level of plan you choose.
Assuming you're in the US, go to the ACA website at https://www.healthcare.gov/see-plans/ and walk through the questionnaire.
For me, the average costs are:
Illegal immigrants can't get federal health care
Food stamp access is extremely limited for illegals
This is a memo reminding federal workers that aliens can't get unemployment
I think you've been seriously misled.
Losing your job (and with it, your job-based insurance) would constitute a "life changing event" that would trigger a special enrollment period of 60 days. You would not need to worry about a fine and you wouldn't need to wait until November to enroll.
Example: You quit your job on June 1, you report your change in job status to the exchange, and you have until August 1 to choose an individual private health plan on the exchange. The other option, as the link below mentions, would be to enroll in COBRA coverage but you'll get a much better deal with an exchange plan.
If there's a stay, then they may be quite fucked.
The initial care would not be more expensive though.
I'm on my lunch doing this so I can't research too well on my phone.
>>I'm hoping maybe there's someone around /r/writing that's got insight into health insurance for independent authors. The ACA marketplace is kind of pointless for my particular situation -- at ~$300/month, I'd still have to pay out of pocket -- upwards of $25k/year in medication and doctor visits and likely no coverage at all for my eventual transplant procedure -
I'm a consultant who has signed up for a plan through the ACA. There should've been an individual annual out-of-pocket max for expenses. $25K sounds high. Since you know you will max-out, can you pick a plan with a lower out-of-pocket max cap and see how that works. Just run the numbers as if you pay the max. You may also be better choosing something other than a high-deductible plan.
Update - The maximum out-of-pocket for 2017 is $7,150 for an individual (and $14,300 for a family). There is no lifetime limit, no waiting period, and no penalty for pre-existing conditions. https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/
The affordable care act requires insurance companies to coverage contraceptives as long as they are prescribed by a doctor and FDA approved. If your employer has a religious based exemption, you can still get the coverage. It just has to come directly from the insurance company.
You really DON'T understand how this works.
The government only subsidizes premiums if you fall below a certain economic range. Most of the cost of health insurance premiums does not come from tax money. https://www.healthcare.gov/glossary/subsidized-coverage/
Which is why PP needs our support, and it will only get exponentially worse if ACA is repealed.
Under the Affordable Care Act, preventative services such as IUD insertions, STD Testing, birth control pills, Vaccinations, screenings for diabetes/cancer/blood pressure, etc, mammograms, alcohol counseling, immunizations, everything aforementioned, and more should have been free.
However, PP may not have been in your network, or you may have gotten services that aren't covered, (thanks, GOP and hobby lobby!)
I don't think you HAVE to be on Obamacare/ACA/parent's insurance when you're under a certain age. Gimmie a second to find a source.
Straight from the website it list options it doesn't state anywhere that you have to be on any of the plan's. You are free to find your own, and get what works best for you, it's just an option. The only stipulation is that you HAVE to have health insurance, or pay a fine.
I don't believe that's fair criticism. The ACA a/k/a Obamacare covers a majority of women's health issues, including reproductive health issues, as minimum insurance requirements. See this link.
The GOP's failed plan would have eliminated all of these requirements. You tell me who really cares about women's rights.
> I'm more concern about Viagra being covered by Insurance companies but not birth control
That is simply not true. The ACA mandates that insurers cover several forms of female birth control and other services/products related to female reproductive health. https://www.healthcare.gov/coverage/birth-control-benefits/
>Plans in the Health Insurance Marketplace must cover contraceptive methods and counseling for all women, as prescribed by a health care provider.
> Plans must cover these services without charging a copayment or coinsurance when provided by an in-network provider — even if you haven’t met your deductible.
> Plans aren’t required to cover drugs to induce abortions and services for male reproductive capacity, like vasectomies.
It is literally written into law that women's birth control and reproductive services are covered, not men's. I believe a big driver of the current discussion is that the new administration wants to roll back the ACA, which might entail eliminating the birth control aspect of it, so of course women are going to be worried. EDIT: And this renewed debate then ignites people who abhor birth control/government spending to start clamoring about affordable access to birth control, etc...
>Hopefully that was changed with the new health care law...
It was for Marketplace plans:
>The maximum out-of-pocket limit for any individual Marketplace plan for 2016 is $6,850 for an individual plan and $13,700 for a family plan.
I think you mean 2015 tax return. The penalty on your 2014 tax return would be for not having coverage in 2014.
Also note that there are several exceptions to the penalty based on financial hardship, religious objections, citizenship status, etc. More info here.
> How the fuck am I 25 an have no idea what to do here?
I'm 53 and you do get smarter as time rolls on but not that much ;)
Anyway, here is a link that might help or your state might have answers too. I would start with an email as this gives you a record for your files and, you can always go back and read things as you need to.
Copied from healthcare.gov
"You can stay on a parent’s plan until you turn 26
Generally, you can join a parent’s plan and stay on until you turn 26 even if you:
Have or adopt a child
Start or leave school
Live in or out of your parent’s home
Aren’t claimed as a tax dependent
Turn down an offer of job-based coverage"
Open Enrollment Period. The yearly period when people can enroll in a health insurance plan. Open Enrollment for 2018 runs from November 1, 2017 to December 15, 2017. Outside the Open Enrollment Period, you generally can enroll in a health insurance plan only if you qualify for a Special Enrollment Period.
In most places in the US you can get Government help for ensuring your children receive adequate medical and dental care. Also, schools require vaccinations and I'm pretty sure will point you in the direction of cheap/free resources for them. For children, the medical situation is a lot better than people believe.
Edit: I was on mobile. Here's the website for CHIP. Here's the website for Medicaid. Please don't let your kids go without health coverage.
In the US, at the moment, birth control coverage is required by all medical insurers. Being that she's 22 if she doesn't have her own insurance she's covered under her parents until the age of 26. I really doubt she paid out of pocket for her delivery.
Also, planned parenthood, and other agencies will help with birth control options to people who can't afford it.
Edit: There are some exceptions, but the vast majority of people are either covered or can get access. At the very least access to free condoms.
> The fee is calculated 2 different ways – as a percentage of your household income, and per person. You’ll pay whichever is higher.
> Percentage of income
> 2.5% of household income
> Maximum: Total yearly premium for the national average price of a Bronze plan sold through the Marketplace
Basically, the penalty, at minimum, is the price of getting healthcare at the cheapest, while being possibly vastly more at 2.5% of your income.
The problem isn't the mandate. People who 'can' get health insurance 'are' getting health insurance. The problem continues to be that there's a huge chunk of the country that needs it, but can't afford it, and can't afford to get on Medicaid since a good number of GOP states refused the Medicaid expansion for political reasons.
One of the provisions of the Affordable Care Act was the 80/20 Rule. This required health insurers to spend at least 80% of premiums on health care reimbursements, leaving 20% for administrative overhead and profit and so forth. The law actually required insurance companies to send consumers rebate checks, if they charged too much in premiums.
The intent here was of course to limit the proportion of premiums that would go towards insurance company overhead as opposed to paying for care.
Unfortunately this creates a pretty perverse incentive, where insurance companies no longer have any real incentive to control healthcare costs. Whatever they pay out just gets passed back to consumers in the form of higher premiums, but the more they pay out in claims the more they're allowed to take in overhead.
Paying for a $100 medication for a customer means they can take $20, but paying for a $1000 medication means they can take $200 in overhead. Which one do you think results in an insurance executive getting the fattest bonus?
The 80/20 Rule and it's unintended consequences
Hey, just so you're aware, most plans have a set of preventative care measures that should be free for you, such as an annual checkup and many vaccines. You should call your insurance provider and see if your plan provides those services. They are the kind of thing that saves insurance companies money overall, so they're generally willing to provide them at no cost these days.
In fact, here's a site with a list of covered, no-cost services for ACA marketplace plans. https://www.healthcare.gov/preventive-care-adults/
Are you in the US? Here's info on health insurance: https://www.healthcare.gov/
First -- I am seriously impressed that you're getting your shit together and planning everything and thinking about these details. That indicates resourcefulness and maturity.
Second -- I agree with your therapist.
Third -- being an adult is confusing, and we're all trying to figure it out. I don't even understand my own health insurance (but I have it).
Fourth -- Good luck.
> But with the removal of pre-existing conditions through the ACA, I could sigh up for health insurance if I felt I needed it at any point, IE: cancer.
This isn't true. This is why the period of open enrollment ends today (or already ended, depending on your time zone). You won't be able to sign up on your own again until the next open enrollment period, to prevent the problem of people signing up once they get sick.
You can read this for more info. tl;dr, if you get sick now, you have to wait until next November to sign up.
I think when you pay your workers so little that you have to choose between rent and food stamps, yes, they would mean you live in poverty. The company is literally stealing your tax dollars because they don't want to pay a living wage to their bottom line. So absolutely minimum wage qualifies as poverty.
Walmart regularly schedules their employees just below full time, to get maximum labor without providing benefits. In most states, this translates to 29 hours a week or so. We'll say 29 to make the math easy.
Minimum wage is $7.25, federally, but let's say they pay $8 because they do pay more depending on the state.
8 x 29 = 232 (per week)
231 x 4 = 928 (per month)
928 x 12 = 11,136 (per year)
The federal poverty line for an individual is $12,060 per year.
So there's really no question about it, their business practices, and many other companies like them specifically keep their workers in poverty. The only reason they can both afford rent is because of food stamps.
I'm not a latestagecapitalism person, far from it. But do you like subsidizing these companies with your tax dollars because they're unwilling to pay a fair wage? I sure don't.
Use Healthcare.gov to see what plans are available in your area. Be sure to include your income to see if you are eligible for subsidies. No matter which plan you pick, even if it is a catastrophic plan, you still receive preventative care for free. It is guaranteed by the ACA. So you can go to your yearly or semi-yearly (can't remember right now) well visit even if you haven't touched your giant deductible.
If there are changes in your income that affect the coverage you qualify for you qualify for a special enrollment period through the marketplace. So since you now make too much for medicaid, you could enroll through ACA.
What state are you in? The $215 price you mentioned is the full, unsubsidized cost of a Silver plan (give or take) for a single person who is relatively young. Obviously I'm not familiar with your circumstances, but I would strongly encourage you to meet with one of the Affordable Care Navigators in your area (which is free) for help to make sure you're getting all the help with paying for healthcare you can.
As an aside, according to the Kaiser Family Foundation's subsidy calculator, you should qualify for subsidies to bring a Silver Plan down to just over $50 a month or a bronze plan for less than $20.
The failure of some states to expand Medicaid, unfortunately, impacts people in your income range. For a state that didn't expand Medicaid, if your income is less than about $11,500 (if you're single) or $15,500 for a household of two, you may be in that coverage gap.
But, if you live in a Medicaid expansion state, you should be able to get that. Or, if your income is higher, you should be able to buy insurance on the exchanges and get the subsidies.
Yes I'm 100% sure.
The no pre-existing conditions clause went into effect at the same time as the exchanges started in fall 2013 for the 2014 enrollment period. It is in effect.
Also, if the lowest-priced coverage available to you, through either a Marketplace or job-based plan, would cost more than 8.16% of your household income, then you can get an exemption from the individual mandate. Here's how: https://www.healthcare.gov/health-coverage-exemptions/hardship-exemptions/
You may not have to pay the fine. If the lowest cost Bronze plan cost more than 8.05% of your income, you don't have to pay the fine (for each month this applied).
Here's a link to the general info and here's a link to the tax tool that lets you figure out the info you need for either premium tax credit or affordability exemption. No need to login to use the tool.
I haven't needed to pay a fee both years so far. However, I do know lots of people who end up paying the fee, even though they don't need to.
On top of the monthly cost of health insurance ( In Texas ~$150 a month for single income of ~$30,000), there is a deductible ~$6,000 that you have to pay before the insurance even kicks in. So the insurance is only good for stuff that cost over $6,000 and only if you have $6,000 in your personal savings to spend. Most people don't have an extra $6,000 and will just not go to the doctor unless they get hit with something life threatening. source
So yearly you pay $1,800 whether you use the insurance or not. If you use it, it costs an extra $6,000 a year if your health care goes up to or over $6,000 that year.
Are you in a state that expanded Medicaid? If so, you should be eligible for Medicaid since your income falls below 138% of the Federal Policy Level (FPL is $11,800 for a single person; 138% of that is $15,800).
If not, you should be eligible for an exemption from the penalty.
Was $57/mo a subsidized or unsubsidized price? If it's the latter, know that even if you were above the 138% FPL line but below 400% FPL, you would be eligible for ACA subsidies that would reduce your premium payment significantly.
Thanks to the ACA, the Fair Labor Standards Act was updated in 2010 to allow nursing mothers a "reasonable break time... to express breast milk for her nursing child for 1 year after the child’s birth." It's also good to note that
>Employers are also required to provide “a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, which may be used by an employee to express breast milk."
ACA also helped with breast pumps and breastfeeding education, which many don't realize. Aside from certain grandfathered plans, all insurance companies must cover the cost of breast pumps, and "provide breastfeeding support, counseling, and equipment for the duration of breastfeeding."
Personally, I'm quite thankful for this. 11 months in and I'm still pumping at work. I recognize I'm lucky, with the support I have (including some smazing lactation consultants) and job flexibility to pump without hassle, but there is help out there that I don't think many people are truly aware of.
Hopefully this type of support doesn't disappear.
Losing coverage through his wife's employer is likely a Qualifying Life Event that allows the family a special enrollment period.
It's because you have to deal with two different situations. If you make under 133% of the federal poverty line, you qualify for medicaid. The healthcare.gov website is letting you know that you qualify for medicaid and should get it. Since medicaid money is block granted to the states to do what they want to with, you need to sign up at a state level.
If your state refused medicaid expansion, then you may not qualify for medicaid. I'll bet though that the folks on the phone banks for the federal exchange have an answer for you. Try calling and asking.
The likely worst impacts are actually on people making more than 400% of the Federal Poverty level, or people making under 100% of the FPL in states which didn't expand Medicaid, which is where subsidies get cut off.
But if your insurance company goes bankrupt, that impacts all customers equally.
>They don't pay into social security
If this means you're classified as 1099 contractors and not as employees, they've almost certainly misclassified you. For example, I'm sure you have your hours set/scheduled for you and I doubt you have any opportunity to control your own profit/loss. Obviously parking attendants are critical to University Parking Services, so they can't claim you're not a core part of their business.
See here about filing a misclassification claim with the IRS so they have to pay your FICA, and make sure to file for unemployment or worker's comp if you ever need it.
Unfortunately, you can't make them give you paid medical benefits. Apply for ACA medical insurance if it's cheaper/better than the policy you can buy through them or through the private market. Getting reclassified as a W2 employee may also have some advantage here, although I'm not sure if it matters in 2016.
So a lot of things, but all prefaced by this:
You have to stand up for yourself and take responsibility for your own life. No one is going to do it for you. You have to do it.
That said, in order:
Stop using the word "free." I pay well over $400/month in insurance premiums. It's free in that there is no copay or deductible, as with the other preventative services below that you benefit from as well:
Abdominal aortic aneurysm one-time screening for men of specified ages who have ever smoked
Alcohol misuse screening and counseling
Aspirin use to prevent cardiovascular disease for men and women of certain ages
Blood pressure screening
Cholesterol screening for adults of certain ages or at higher risk
Colorectal cancer screening for adults over 50
Diabetes (Type 2) screening for adults with high blood pressure
Diet counseling for adults at higher risk for chronic disease
Hepatitis B screening for people at high risk, including people from countries with 2% or more Hepatitis B prevalence, and U.S.-born people not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence.
Hepatitis C screening for adults at increased risk, and one time for everyone born 1945 – 1965
HIV screening for everyone ages 15 to 65, and other ages at increased risk
Immunization vaccines for adults — doses, recommended ages, and recommended populations vary:
Human Papillomavirus (HPV)
Influenza (flu shot)
Lung cancer screening for adults 55 - 80 at high risk for lung cancer because they’re heavy smokers or have quit in the past 15 years
Obesity screening and counseling
Sexually transmitted infection (STI) prevention counseling for adults at higher risk
Syphilis screening for adults at higher risk
Tobacco Use screening for all adults and cessation interventions for tobacco users
MnSure is simply an exchange to help you buy private insurance. You don't have to use it. You can use the federal website at https://www.healthcare.gov/
MnSure was built as part of the ACA yes. If the ACA disappears then federal funding will. MnSures future will then be uncertain. The state could continue to fund it if so inclined.
Edit. Just to add. NOW would be the time to get it not because of Trump but because the Deadline for open enrollment is coming to a close.
You do not have to pay a penalty because your state didn't take the ACA. Here's the official healthcare website. Scroll down to " hardships" and look at reason #12.
>You were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid under the Affordable Care Act.
Unless you have health conditions that mean you're likely to need medical care before your new insurance starts, and you're not going to be without coverage for more than 2 months, you could just forget about it and wait for your new job to start. If you're healthy, this might be the best option. In your case, if your health insurance starts up immediately when you start your new job in January, you will, for tax purposes, have no gap in coverage.
Again, I would not advocate this for someone who has health conditions likely to need treatment in the interim, but if you don't, this is a valid option.
[Serious]: Historically, the list of Qualifying Life Events that bypass waiting periods includes:
So, babies can be added at birth. You can also get married or divorced for benefits. Keep in mind even under Obamacare, you generally can't get pre-natal coverage, just after the baby comes.
You will not be penalized at all.
Here is a list of exemptions to the ACA penalty. It sounds like you fall under several of them, specifically:
The lowest-priced coverage available to you would cost more than 8% of your household income.
You don’t have to file a tax return because your income is too low.
You were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid under the Affordable Care Act.
First of all, you need to immediately tell your friend that he needs to sign up through the exchanges if he hasn't already. At $35/hour, a family of four qualifies for subsidies.
Second of all, any family of four paying $175 a month for health insurance did not actually have health insurance--and certainly not if the two adults were in their 50's.
For a health insurance company, there would be no feasible way to structure a business model and provide coverage for things like lab tests, CT scans, ambulance rides, and basic preventative care. As a family of four, those are services that they will need. It simply is not mathematically possible for a company to offer real, comprehensive coverage to a family of four at $175 per month.
Your co-worker was getting screwed over beforehand, whether he realized it or not. It's not just a matter of his coverage being better or more comprehensive now. With his new coverage, his children will receive complete preventative care early on that will set them up for a healthy life.
Buddy, that's the truth of what's really happening.
Edit: I just checked the Healthcare.Gov exchange. For a family of 4 in Dallas County, Texas with ages 50, 50, 12, and 10 with an income of $70,000 annual, there are plans as low as $224/month.
In the US, health insurance is tied to your job. There is literally no way to know how much you'll be paying until you find a job. The offerings will be extremely different depending on where you live and who you work for. In fact it will vary so much that we can't even give you a ballpark estimate here. One thing you could do is head over to the Obamacare website, put in a ZIP code, answer the questions, and see some plans. But it won't be a good reflection of what you'd actually be paying, since your job is likely to offer you a much better deal than the exchanges.
Divorce only qualifies you for the special enrollment period if the divorce is the reason you lost insurance. Here's the screener that explains it.
> in a world where people can be denied coverage for preexisting conditions
In a pre-ACA world you mean? Pre-existing conditions are gone as far as I know. Unless you had health insurance you bought yourself and are still on the same plan as before the ACA, but you could just switch.
> I have a cheaper worse plan.
So by worse you mean slightly more expensive deductible and copay in exchange for consumer protections including not getting kicked off your policy when you get sick, not worrying about pre-existing conditions, no lifetime caps, and mandated insured services outlined here
Think before you speak.