Arizona Expands Medicaid

[Yagents]

I am really glad that AZ has decided to expand medicaid to take care of our lower income citizens. I was really dreading the conversations telling people that they fell into the "black hole" of the law where a low income person would not be able to secure health insurance coverage. If it wasn't expanded, those under 138% of federal poverty level (FPL) would not have received medicaid for free, nor would they have been eligible for tax credits through an agent like myself , or the HHS version that has yet to roll out. The only alternative would have been to pay full price for coverage, which they obviously couldn't afford.

Here are the cutoffs for 133% FPL based on 2013 levels:

Single = $15,282
Married = $20,628
Married + 1 child = $25,975
Married + 2 children = $31,322
Married + 3 children = $36,668
Married + 4 children = $42,015
Married + 5 children = $47,361

**There is a +5% buffer available on top of these numbers to be eligible for a total of 138% FPL

---------
Arizona Gov. Brewer secures Medicaid expansion
-----------
The Medicaid plan would cover people making between 100 percent and 138 percent of the federal poverty level and restore coverage to more than 100,000 childless adults who lost Medicaid coverage because of a state budget crunch. About 1.3 million Arizonans already are covered by the state's plan.

Read more: Arizona Gov. Brewer secures Medicaid expansion | Modern Healthcare Arizona Gov. Brewer secures Medicaid expansion | Modern Healthcare
?trk=tynt
​

 

[houcoogster]

[If it wasn't expanded, those under 138% of federal poverty level (FPL) would not have received medicaid for free, nor would they have been eligible for tax credits through an agent like myself on the private Arizona Health Exchange or the HHS version that has yet to roll out.]

Was this an Arizona decision?


Also could you post the FPL single with 1,2,3, children

 

[Yagents]

If a state does not expand medicaid, than those between 100-138% of FPL WOULD have received subsidies on the exchange.

If a state does not expand medicaid, and they currently do NOT cover childless adults (like AZ), then adults under 100% FPL would NOT have been eligible for subsidies nor medicaid (the "black hole")

I've attached the FPL and % of income chart, compliments of Ann

 

[houcoogster]

Gratzi!

I would like to run a test customer. Female and child $29500 AGI per IRS return. Has BCBSTX group plan she pays $200 a month just for her self the child is covered by her Fathers plan.

It looks like she is 200% FPL and max premium for her 6.3% which is $154.87 per month and she is paying $200.

Ok I know we are kinda speculating a little here but what do you think is a proper course of action given what we know from say cali?

 

[Yagents]

Too many unknown variables: What plan each owns now, what plans will be offered on the exchange, deductibles/copays/Rx formularies & networks? Price is not the only consideration.

This is why it will be imperative that people work with a skilled licensed agent. Every person is a different puzzle, and has different health care and budget needs. Factoring in future or fluctuating income will be another variable to consider.

 

[houcoogster]

Right, I hear you!

Tell me this if you know, would her employer get fined $3000 if she went to the exchange?

Even though her portion of the premium is under the 9.5% threshold.

I'm going to answer my own question; The answer is NO! Very Interesting indeed!

It is contemplated that under this proposed safe harbor, an employer would need
to meet certain requirements, including: (1) that the employer must offer its full-time
employees (and their dependents) the opportunity to enroll in minimum essential
coverage under an eligible employer-sponsored plan, and (2) that the employee portion
of the self-only premium for the employer’s lowest cost coverage that provides minimum
value (the employee contribution) must not exceed 9.5 percent of the employee’s W-2 4
wages. If the employer satisfies both of these requirements for a particular employee
(as well as any other conditions for the safe harbor), the employer would not be subject
to an assessable payment under § 4980H(b) with respect to that particular employee,
even if that employee receives a premium tax credit or cost sharing reduction.

 

[Yagents]

If employer offers Minimum essential coverage and meets actuarial value, and is less than 9.5% of the employees income, than she won't be eligible for subsidies, and the employer does not get fined.

Depending on the "renewal" strategy of the current carrier she is on, or moving her to another carrier that will allow her to keep her plan until 12/14', and factoring in the cost of the employer plan.........it may be best that she sticks tight on current plan, move to new private plan, or jump on the group plan at open enrollment, or when existing plan "renews".

 

[houcoogster]

If employer offers Minimum essential coverage and meets actuarial value, and is less than 9.5% of the employees income, than she won't be eligible for subsidies, and the employer does not get fined.

Depending on the "renewal" strategy of the current carrier she is on, or moving her to another carrier that will allow her to keep her plan until 12/14', and factoring in the cost of the employer plan.........it may be best that she sticks tight on current plan, move to new private plan, or jump on the group plan at open enrollment, or when existing plan "renews".

Bill,

According to the IRS she could go to the exchange and her employer would not get a penalty. She is under the 9.5 threshold but when you factor in members in the household she is subsidy eligible. Do you see what I'm talking about look at the chart you posted.

 

[Yagents]

Bill,

According to the IRS she could go to the exchange and her employer would not get a penalty. She is under the 9.5 threshold but when you factor in members in the household she is subsidy eligible. Do you see what I'm talking about look at the chart you posted.

If her employer offers her coverage that meets the standards listed, she is NOT eligible for a subsidy

 

[houcoogster]

If her employer offers her coverage that meets the standards listed, she is NOT eligible for a subsidy

Where are you getting this information?

Based on what your saying is: If a person has 10 kids and her portion of the premium is under 9.5% of income she gets NO subsidy.....really???

I posted straight off the IRS document.

Cite your source please.