Health insurance question, please help!

redman2006 · Dec 19, 2012

I need some help. I am trying to get my ducks in a row. Without getting into politics, I need some info from those in the know about the new health care laws.

Specifically: I have to provide my own health care plan, so I have a major medical policy that suits me well at this time.
It is $5000 deductible with a 80/20 payout. An annual benefit cap at $350k and a lifetime max payout of $1million. It is very reasonably priced, and I am very content with it.

My question is this: under the Obamacare health mandate, will this level of coverage be enough to keep me from paying the $2000 fine?

I have been trying to find information on the subject, and have not had much luck.

Thanks for the help.

Gator Done · Dec 19, 2012

Are you self-employed? If you are under 50 employees you are exempt from ACA.

redman2006 · Dec 19, 2012

Gator Done said:
Are you self-employed? If you are under 50 employees you are exempt from ACA.

I do not own the business. We are a small business and the COMPANY is exempt, but I am not exempt from the individual mandate portion. That is my concern.

EDIT: I have been able to find references to minimum benefit standards, but not any real hard and fast rules about what these standards really are. The minimum benefits are all in my health plan, but only after I hit my $5k deductible. They are not specifically mentioned as benefits, but neither are they specifically mentioned as not being covered.

I just don't need a $2k fine on top of what I am paying for my insurance, because it does not measure up. Even the insurance company is not able to tell me for sure which plans will be adequate at this time.

Gator Done · Dec 20, 2012

redman2006 said:
I do not own the business. We are a small business and the COMPANY is exempt, but I am not exempt from the individual mandate portion. That is my concern.

EDIT: I have been able to find references to minimum benefit standards, but not any real hard and fast rules about what these standards really are. The minimum benefits are all in my health plan, but only after I hit my $5k deductible. They are not specifically mentioned as benefits, but neither are they specifically mentioned as not being covered.

I just don't need a $2k fine on top of what I am paying for my insurance, because it does not measure up. Even the insurance company is not able to tell me for sure which plans will be adequate at this time.

There is still a lot to be determined with the law. I doubt that a minimum threshold has been released yet.

buckmanmike · Dec 21, 2012

My understanding is that Obamacare will mandate that your insurance will have to meet certain minimuns. If the policy you have now does not, then it will be rewritten to comply with law and your rates may go up, or they may cancel you and not issue a policy.

JohnnyWalker · Dec 31, 2012

I wouldn't take any action unless they notify you that your's is not adequate. My reasoning is that they don't want to alienate potential supporters and besides they have bigger fish to fry in the form of taxing the (^&*( out of the so called rich.
I've never heard of an instance where you don't receive a warning before they take action.

elfiii · Dec 31, 2012

redman2006 said:
I just don't need a $2k fine on top of what I am paying for my insurance, because it does not measure up. Even the insurance company is not able to tell me for sure which plans will be adequate at this time.

That's because the minimum "must offer" standards haven't been finalized and they won't be for some time. Once they have, if your current policy doesn't meet the standard you will be the first to know.

The initial fine isn't $2,000. In 2014, the penalty will be no more than $285 per family or 1% of income, whichever is greater. In 2015, the cap rises to $975 or 2% of income. And by 2016, the penalty will go to $2,085 per family or 2.5% of income, whichever is greater.

The dollar amounts for a single adult would be $95, $325 and then $625 during that same time period. The dollar amounts per child would be half that of adults.

Health insurance question, please help!

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