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For the most part I like being an insurance agent.  But there are a few things I don’t like.  Having to tell someone that they are to heavy or too sick to qualify for insurance at any cost is the most noxious thing I have to do. The emotional impact that this has on me is often profound but always transitory. I realize that I am just visiting this reality, but the people I speak with live there.

Obamacare will have an impact on this. Health care reform means that I never have to tell an individual that he or she will be denied healthcare benefits because she is too sick to pass the underwriting screen. This is definitely a pro and not a con. This is great news, but it is the future. So let’s step back into the present. In 2013, it is business as usual. These protections and the new plans don’t go into effect until 2014.

Sometimes it seems like Ground Hog Day because the caller, her story and the emotions are often very much the same. Even though I’ve seen the movie many times before, I’m still moved by the tears during the reveal. Sometimes I still cry along with the lady on the screen.

Typically, it is a woman in her fifties who has worked all her life. She has followed the rules, never broken the law and has always paid her taxes. She has maintained a decent job with a good employer that she thought she would retire from after she paid off her home and her kids’ tuition bills.

Then she gets sick. This is a major disruption to her life but she has good benefits. So long as she stays employed, she stays insured. This means that her lifestyle doesn’t need to change too much. She may have a lot of physical pain and will probably have medical bills that aren’t fully covered by her insurance. This causes her to be stressed, but she can probably see the light at the end of the tunnel.

At some point, the illness makes working impossible or impractical and any sick days she had are exhausted. She says good-bye to her, soon to be former, fellow employees. She also says good-bye to her coverage shortly thereafter.

Then she calls me. I get to be the guy who adds a few cinder blocks onto her load of bricks. Until she spoke with me, she may have never realized that she, or any American, could be denied health insurance. She does some quick calculations and realizes that without insurance and without a job she will have to remortgage the house. She knows in that split second that unless she makes a miraculous recovery, she will never work again. If she can’t work again, she will eventually lose her house and be forced to depend on the kindness of relatives and possibly strangers.

Today things are different. We have the Affordable Care Act. No one can be denied a health insurance policy because of their medical history. I’m writing this on the second day of October 2013 and I can now help a person who has cancer or diabetes apply for a policy that starts on January 1, 2014. That is less than three months away.

I can now say “just hang on a little while longer.” You now qualify for insurance.

Hip Hip Horray? No.

I finally had a chance to look over the new rates for health insurance. The insurers just released the rates yesterday. I spot-checked a few rates. A sixty percent to seventy-five percent increase in premiums seems typical. The Affordable Care Act hardly seems affordable.

So now when the woman who calls me after she lost her job due to her sickness, I get to tell her that she qualifies for a good health insurance policy that will pay most of her expenses. I also get to tell her the price. Instead of hitting people over the head with a sledge hammer, I get to stab them in the heart. Happy days are here again.

About the Obama Care Subsidies

On the bright side, or the slightly less bleak side, my sick friend may qualify for a subsidy.

(Unfortunately, far too many people have no sympathy or empathy for the poor, so this is for them: Many of the poor were hardworking people making a decent living a month or a year ago. Then they got sick. Now they can’t work. Do the math.)

Please note that no attempt has been made to make the following calculations and figures precise or applicable to everyone. There are several reasons for this. One is that the income in question is household income for 2014, which can only be estimated. Also it is based on MAGI or Modified Adjusted Gross Income. You can find this on line 37 of your 1040. Explaining the MAGI and the other nuances is beyond the scope of this post. (And even if it wasn’t it is beyond the author’s ability to explain fully.)

If you live in the State of Connecticut, you can call me if you want help determining whether you qualify for a subsidy.

If you make up to 133% of the Federal Poverty Level, you either will qualify for Medicaid or be asked to pay no more than 2% of your income for their coverage. This means that an individual who grosses $15,274 per year or about $294 per week will need to pay a net of $305 annually for their insurance. (The government pays the difference between the cost of a relatively bare bones policy and the 2% the individual is required to pay.) A couple grossing $19,494 or $374.88 per week will need to pay a net of $389.

Families of four with a gross income of $34,532 or $664 weekly will be expected to pay a net of $1381.26. This is equal to 4% of their household income.

Families of four with a gross income of $69,093 or $1328.14 weekly will be expected to pay a net of $6560.99. This is equal to 9.5% of their household income.

If you make more than 400% of the FPL, you will not qualify for a subsidy. This is a little under $46,000 for an individual and around $92,000 for a family of four.

Now nearly everyone – sick or healthy – will qualify for health insurance. But, fewer people will be able to afford it. Do the pros outweigh the cons?

As always, call me or email me with questions about individual or family health insurance in the State of Connecticut. We will continue to help our fellow Connecticut residents apply for medical insurance through companies like Blue Cross Blue Shield, Connecticare and United Health One. By the end of the week, we expect to be working with the Exchange and will be able to help those who qualify get a subsidy. Our services are always free to the consumer. You pay the rates filed with the state whether you purchase through us, from an insurance carrier or through the exchange directly.

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Alston

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