Monday, November 17, 2014

Fleshing out a (real) ACA hardship story in the WSJ

It's inevitable that reporters' vignettes about ACA shoppers will often lack context or essential details. Print space is limited, readers' attention is limited,  reporters' time is limited, and protagonists' grasp of their own experience may even be limited.

Still, the back stories are often worth probing (3210). Here's one from today's Wall Street Journal, with Louise Radnofsky, Stephanie Armour, and Anna Wilde Mathews reporting on the first day of Open Season II. There's no inaccuracy, but the rate-shock subplot in this brief account does leave a question mark:
Michael Schade, a 67-year-old retiree in St. Louis, said worked well on Wednesday when he previewed plans for his 62-year-old wife. But on Saturday, he couldn’t sign in using an ID and password from a year ago. When he clicked on the tab “forgot password,” instructions didn’t arrive by email.

He was successful Sunday in his sixth attempt to reset his password after correctly answering three security questions. He found that to get a plan comparable to his wife’s existing policy, which is being canceled, they would pay $655 or $676 a month, up from their current premium of $372 a month. He is weighing a sparser exchange plan.
A price jump of close to $300 per month means one of two things. Either an increase in the couple's income pushed this woman over the subsidy cliff, which is quite steep for older buyers, or her cancelled plan was a non-ACA-compliant plan, "grandmothered" last fall when the outcry over cancelled plans led the Obama administration to grant extensions to noncompliant plans (subject to the cooperation of states and insurers).

Louise Radnofsky confirmed for me that Ms. Schade (if the couple shares a last name..) was indeed in a grandmothered plan. That suggests that the couple is paying full freigh for an exchange plan because their  income -- including the husband's Social Security, if he's taking it yet -- exceeds $62,920 -- 400% of the Federal Poverty Level for a household of two.

If their income were 62,919, Ms. Maybe-Schade would get a $251 tax credit, and that $655 plan (myCigna Health Flex, a silver plan) would be $404. Incidentally, that's considerably more than the cheapest silver plan, $315 with subsidy/$566 without, with a modestly higher deductible ($3750 vs. $3000) and better prices for some services before the deductible kicks in. But there's a lot of variants in that choice, and Ms. Maybe-Schade may have made the right one for her.

One last footnote: as far as I can tell, the shop-around feature doesn't work properly for a woman in this situation. If she enters her husband as a household member, and give his age, she gets quotes for two insureds -- the shoparound doesn't screen him out as Medicare-eligible. If she enters only herself, then the subsidy calculation is made on the basis of the Federal Poverty Level (FPL) for a household of one, showing an eligibility cutoff of $46,680 rather than $62,920.  I assume that an actual application would clear this up, but it's a serious flaw in the shop-around feature. If I could, I'd add it my shop-around review on
Re the cross-out: my error!  When you enter each household member in the shop-around, there's a prompt asking whether that person already has access to coverage outside the exchange -- from the employer, Medicaid/Chip, or Medicare. The filter works. I was able to get a quote for the 62 year-old with a Medicare-eligible spouse, with FPL calculated correctly for a two-person household. Apologies.

The Times wrestles with ACA re-enrollment
NYT spotlights plight of ACA bronze buyers, leaves out vital context
High-deductible hardship case should have bought silver
A correction in NYT ACA coverage
The WSJ spotlights an apparent anomaly in ACA subsidies

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