Affordable Care Act - catastrophic plans cancelled

[CarlF]

ACA cost is very sensitive to income. If you make a lot if money, you pay a lot. If, like most cruisers, you make little income -- it seems to be a great deal.

I checked the Rhode Island ACA site.

http://www.healthsourceri.com

A 58 year old couple making $40,000 a year would pay $3.12 a month (yes that's $3) for the cheapest plan. This has a $5000 deductible so it would work like a catastrophic plan. But unlike a traditional catastrophic plan, after your reach the out-of-pocket max of $6350, the insurance pays 100% of everything with no co-pays or limits. Incredibly good coverage. So your maximum cost a year for medical care is less than $6400 ($535/month). Of course, if you don't get sick during the year, it's almost free.

If you make over $40,000 then the cost goes up quickly to a maximum for a couple of $882/month.

So, if you make more than $40,000 now, then it would seem to make sense to try and shift some savings into non-taxable vehicles such as municipal bonds or investments that have deferred income ( like stocks with no dividends) to keep your taxable income down.

[Paul L]

Originally Posted by rebel heart

.... Bupa is a good example and common in Europe.
.....

Like most ex-pat policies sold to US residents, the pre-existing conditions are excluded. Many of these type policies have onerous pre-existing condition terms.

[rebel heart]

Originally Posted by Dockhead

Hi Eric:

That's a very nice and useful blog post about this issue.

One small quibble: you talk a lot about the "Physical Presence Test" for purposes of qualifying for the Foreign Earned Income Exclusion. Keep in mind that that is not the only way to qualify as a resident abroad -- there is also the Bona Fide Residence Test, which is an alternative to the Physical Presence Test. See: Foreign Earned Income Exclusion - Bona Fide Residence Test.

That's the one I have used for the last 22 years, although I probably always also meet the Physical Presence Test.

I think, and there is still confirmation coming back from the IRS, that it's only the physical presence test that matters. Correct me if I'm wrong, but the bona fide residence test only verifies that another nation declares me as a resident, right? I could still be in the US for 331 days and pass the bona fide residence test, I think.

This block from the IRS is where I see it as just being the physical presence:

12. Are US citizens living abroad subject to the individual shared responsibility provision?

Yes. However, U.S. citizens who live abroad for a calendar year (or at least 330 days within a 12 month period) are treated as having minimum essential coverage for the year (or period). These are individuals who qualify for an exclusion from income under section 911 of the Code. See Publication 54 for further information on the section 911 exclusion. They need take no further action to comply with the individual shared responsibility provision.

[rebel heart]

Originally Posted by Paul L

Like most ex-pat policies sold to US residents, the pre-existing conditions are excluded. Many of these type policies have onerous pre-existing condition terms.

Doesn't matter. At least for the next year, until they can provide better guidance, any expat policy that's a group plan (as opposed to you and your two friends squirreling away some cash) that requires you to be out of the country for six months counts.

http://www.dol.gov/ebsa/faqs/faq-aca13.html

For purposes of this temporary transitional relief, an expatriate health plan is an insured group health plan with respect to which enrollment is limited to primary insureds who reside outside of their home country for at least six months of the plan year and any covered dependents, and its associated group health insurance coverage.

[Dockhead]

Originally Posted by rebel heart

I think, and there is still confirmation coming back from the IRS, that it's only the physical presence test that matters. Correct me if I'm wrong, but the bona fide residence test only verifies that another nation declares me as a resident, right? I could still be in the US for 331 days and pass the bona fide residence test, I think.

This block from the IRS is where I see it as just being the physical presence:

It looks to me like it's linked to the Foreign Earned Income Exclusion:

"[A]n applicable individual is treated as having MEC for purposes of health care reform for any month during which either:
The individual’s foreign residency or physical presence in a
foreign country or countries qualifies him for the foreign earned
income exclusion."

http://www.bakermckenzie.com/files/P...gehc_jun13.pdf


Which would mean that either bona fide residency or physical presence would do it.

However, considering how new this legislation is and how much chaos has surrounded it, people should be very careful and get professional advice before relying on any one or two sources.

[Sam Plan B]

I have a helath insurance policy with Kaiser Permanente. It has an $8,000 deductable and costs me about $200 a month. I am 63 with no health issues (knock on wood). And I got a letter from Kaiser that stated my policy was Obamacare compliant. So far so good. However if things change and Kaiser is forced to cancel my policy due to a government mandate, well, its a big world out there.

[rebel heart]

Originally Posted by Dockhead

It looks to me like it's linked to the Foreign Earned Income Exclusion:

"[A]n applicable individual is treated as having MEC for purposes of health care reform for any month during which either:
The individual’s foreign residency or physical presence in a
foreign country or countries qualifies him for the foreign earned
income exclusion."

http://www.bakermckenzie.com/files/P...gehc_jun13.pdf


Which would mean that either bona fide residency or physical presence would do it.

However, considering how new this legislation is and how much chaos has surrounded it, people should be very careful and get professional advice before relying on any one or two sources.

There was a guy from the previous (locked) thread who said he emailed the IRS and then ended up on the phone with them, because even they didn't have a solid answer regarding what the rules were. Hopefully he can write back on here with what he finds out when they respond.

It's funny because as a software and insurance guy, I have a lot of patience for both. And they're both playing out right now on the national stage. In both arenas my experience is that solutions come from dealing with lots of minutia and nuance; there are no silver bullets and even the most elegant solutions still have you mopping gore off the walls for three years.

Production software is a thankless job. We usually get treated like the power company and use the slogan, "No one thinks about the electric company until the lights don't work one day." At least we get paid okay.

[JPA Cate]

I just wanted to say two things: first, Rebel Heart, thank you very much for posting this thread. It will be helpful for many of us. Secondly, it is the only thread so far during my participation on CF that I ever counted 20 other members reading it at the same time as me. Thanks again.

Ann

[zeehag]

having been a non user of the medicare i was granted achieving my disability status in 2005, i hopè the medicare systemless is maintained at least fro a few more years....
i raised my kid sans insurance as i needed to feed his face while he grew.
i didnt have the option, as an rn to earn a retirement benefits, as i worked sans benefits to gain extra money monthly to feed and house my son and self, plus child care during my shift work.
any and all illnesses were treated by me with a lil help from good friends indabiz, as it were, so i didnt have to pay out that which i could not afford.
my sons pediatrician was a prepaid thing, and was easy to afford. no insurance, merely pay as go. every check up was 20 usd. not too shabby for real pediatrician. no t given reciprocity on these..had to pay in full, all 20 usd for each check up. including shots and meds. not allowed to do that anymore... is too bad, as it worked.
i feel for the souls today having to pay out so much money monthly -- this is ridiculous way to solve a problem that was truly not there, as noninsured were being treated as were insured, side by side, and the non insured were essentially covered by slush finding of hospitals, which was done to keep them from losing too much money over uninsured and indigent patients.
we have progressed, as it were, from freedom to practice good medicine at cheaqp rates to being ford¡ced to pay out so mucvh insurance monthly to `reclude ability to evvect pro bono services as used to be done. the mds have to pay out 100-200 thousand usdollars annyually for their own malpractice insurance. that makes the patients fees higher, DUUHH.
the only souls benefiting from these changes to forced insurance coverage is the insurance company and lobby. health care is not benefited, nor is the user of the systemless. in fact, both are being punished in the effecting of these insurance lobby sponsored laws.
good mds are leaving the profession, and the ones remaining are not being paid enough to pay their own malpractice insurance fees.
we see how long it will take to totally implode, as these are dependent on financing that does not exist in reality,and is iffy at best on ¨paper¨

[Group9]

Originally Posted by transmitterdan

Since the preexisting condition limitation is gone can you go "naked" and if something happens sign up then?

That seems to be the best loophole in it for young, healthy, people (like many cruisers). Just pay the fine, and sign up if you do get hurt or get sick with something that is going to have a lot of medical bills associated with it.

I know that's my 28 year old stepson's plan.

The problem is, with finding anybody, government or private, who can give you a definitive answer on anything about the ACA. My brother is a CPA in a very large firm and he says after studying the act for three years, they are hanging caveats all over their advice to their clients, because they really are not sure how a lot of the provisions are going to be interpreted, especially by the IRS.

[lorenzo b]

Just come on down to Panama, or Malaysia, or the DR. You can get old, sick, and die for pennies on the dollar and eat great food, lay about in the sun, and swim in some beautiful seas.
Why do cruisers rush back to the USA to get lousy medical care at ridiculously high prices?

[Group9]

Originally Posted by lorenzo b

Just come on down to Panama, or Malaysia, or the DR. You can get old, sick, and die for pennies on the dollar and eat great food, lay about in the sun, and swim in some beautiful seas.
Why do cruisers rush back to the USA to get lousy medical care at ridiculously high prices?

That's the plan! My wife, my brother in law, my sister in law, and I were sitting around last night talking about retiring to Panama. We put ourselves on a three year plan to do it last night.

The ACA, and Panamanian healthcare, was definitely in the conversation a lot.

[Stu Jackson]

Originally Posted by Group9

Originally Posted by transmitterdan
Since the preexisting condition limitation is gone can you go "naked" and if something happens sign up then?

That seems to be the best loophole in it for young, healthy, people (like many cruisers). Just pay the fine, and sign up if you do get hurt or get sick with something that is going to have a lot of medical bills associated with it.

I know that's my 28 year old stepson's plan.

Could someone explain how that would work?

I broke my leg skiing five years ago. There wasn't a whole lot of time between the break and surgery to fill out insurance applications.

[Group9]

Originally Posted by Stu Jackson

Could someone explain how that would work?

I broke my leg skiing five years ago. There wasn't a whole lot of time between the break and surgery to fill out insurance applications.

No, if you find that person that can explain what is going to happen under the ACA, please turn us all on to him. The whole world is looking for him/her.

That's not political. That's the truth. Everyone is speculating at this point.

[lorenzo b]

I would suggest you come down and look around for a year or so before committing to buying anything. It's very easy to arrange a long term rental almost anywhere and untimely much cheaper than insisting on the American dream of home ownership. And you can move around every few years.
If you go to Bocas, almost every expat home on the islands is for sale, and cheap, I might add. Stay loose.