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This Week In your Wallet: The Lowdown On Healthcare

If it’s October, then it’s Open Enrollment — or at least time to talk about it. The limited time period in which you can make healthcare changes if you’re on Medicare kicked off October 15. It starts November 1 for the ACA, and it’s on a similar schedule for most employers — which is why it’s so important that you understand exactly what’s happening in the world of health insurance and healthcare in Washington. First, the Affordable Care Act: It still exists. You’ll be able to sign up for coverage through the exchanges for 2018 as last year. 
But last week, President Trump signed an executive order that (although it may face legal challenges) paved the way to do the following:
  • Expand the availability of short-term health plans, which offer more limited benefits (they don’t include prescription drug coverage, maternity care, mental health care and substance abuse care). Currently, these plans can only remain in force for three months, then consumers have to re-apply for benefits. The order lengthens that period of time to one year.
  • Allow the formation of new associations to offer health insurance plans to their members (which can be small companies as well as individuals). The aim is to give these associations the purchasing power of large companies, which — because of their size — can buy health insurance at better rates. Note: Some existing associations already sell plans to their members. Associations, however, like short-term plans, don’t have to offer the same 10 basic benefits that Obamacare policies do.
  • And expand the use of HRAs — health reimbursement accounts, not to be confused by health savings accounts — by allowing pre-tax contributions to be used to pay for medical expenses, not just health insurance policies that meet ACA standards.

He also ordered the elimination of payments called CRAs, essentially cost-sharing subsidies, which are paid to insurance companies to lower the out-of-pocket costs (co-pays and deductibles) for some six million lower-income individuals when they see a doctor. Note: These are not the same as premium subsidies. If you make less than 400 percent of the poverty level ($48,240 as an individual in 2017, $81,680 for a family of three according to this chart from FamiliesUSA.org), you are eligible for these. These are not going away.

What happens now? There were some health insurers who saw the elimination of this cost-sharing subsidy coming. Some of them preemptively increased the costs of their coverage for the coming year as a result. Others who didn’t may drop out of the marketplaces. (In fact, Nate Purpura, VP of Consumer Affairs at eHealth.com, who helped me sort this all out, notes that some insurers, again preemptively, filed the paperwork saying that they were going to leave the marketplaces while simultaneously putting their policies and plans in place, effectively leaving themselves an out.) The irony is that the people who will pay more are not the people who qualify for the premium subsidies, but rather the middle class folks who make slightly more. Their premiums will soar, and many will not be able to afford it.

As you might expect, the insurance industry is in turmoil. It is possible that congressional Democrats and Republicans will come together to agree on something that will allow those cost-sharing subsidies to resume — in order to settle things down. That may even happen this week. So, stay tuned. And if you want to read more on this topic, check out this piece I wrote for SavvyMoney.com.

Sunday Styles = Finance 101?

I reached for the Sunday Styles section of The New York Times last week only to get a refresher course on two importance personal finance topics: prenups and wills. In the almost always excellent Modern Love column, writer Abby Mims went into went into detail about the painful process she and her husband went through negotiating a prenup before marriage. It forced her to confront her financial failings — lack of savings, credit card debt — on paper and in her face. As interesting as the column was, I found the comments even more fascinating. Some people ripped into him for marrying her because of her financial short-comings. Others felt the opposite — that she shouldn’t marry him if he demanded she sign something that made her so uncomfortable. And many hoped they got to the aisle both willing to rip the document up. My take: Prenups are more important than ever, particularly as we’re marrying later for the first time, and often for the second (or third) — and therefore coming to marriages with kids, businesses, assets, inheritances and the like. You can read it here.

And then click over to the latest Social Q’s column by the always wonderful Philip Galanes. A reader asked for his advice about what to do about an unsigned will. Her uncle had left everything to his nephew and his nephew’s wife, but because the will wasn’t signed, state law dictated his assets be divided among his three siblings — none of whom spoke to him.  It’s always surprising to read something like this, but it shouldn’t be. Most adult Americans don’t have wills. If you’re among them, you can pick up the phone and call a lawyer — or if you want a cheaper route, consider online resources like WillMaker ($55 through Nolo.com) or LegalZoom.com (DIY wills starting at $69). And while you’re at it, flesh out your estate plan by tacking on powers of attorney for healthcare and finances and a living will.

Fry For All

“What do Kim Kardashian, Ira Glass and Britney Spears have in common?” asks a story in The Wall Street Journal’s Women in the Workplace series. The answer: vocal fry. It’s a low, creaky or scratchy sound at the end of words and phrases, and it’s reportedly used equally by men and women. However, research suggests even though people can identify vocal fry relatively easily in both men’s and women’s speech, they only view it negatively in women. The story reminded me of a conversation I had with my husband about a young woman who was an up-talker. She ended every sentence as if it were a question, and it didn’t play especially well either. The takeaway? Just as we should pay attention to the image we’re presenting in our everyday lives — and make sure it lines up with the image we want to present — we might want to pay attention to how we sound as well.

Have a great week,


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