Color of Money Live

Sep 27, 2013

Join Washington Post nationally syndicated personal finance columnist Michelle Singletary for a live online discussion on Fri., September 27 at 11 a.m.

Michelle's guest will be Don Silver, author of "The Best ObamaCare Guide: For You, Your Family and Your Business." Silver's book is September's Color of Money Book Club pick.

Michelle will also be on hand to answer your personal finance questions.

--The Color of Money: Michelle Singletary on health insurance marketplaces

-- What you need to know about the health-care exchanges

-- Our looming long-term-care crisis

Welcome. Welll haven't money been the hot topic in the news this week? We've got the showdown on the budget and a possible government shutdown. The health care exachanges starting next week. The debt ceiling coming up. And on top of that our own personal finance issues.

Anyway, let's get started.

Most of the people I hear who hate it have health insurance or have never been seriously ill. I do have health insurance but I know young, middle age and too young for Medicare that do not have ANY health care. Any doctor visit with lab test is expensive. Our daughter's broken finger ten years ago had a cost of $1,000 that include, x-rays, and a specialist because the pediatrician did not treat broken fingers. So the cost included a visit to the pediatriacian, x-rays, and a orthopedic surgeon. I did not have time to call around for prices since the time was 4:00 pm. One parent had a heart attack and was flown to a hospital. $3,000 for the chopper. He would have died without the assistance of the chopper. Again, no time to compare prices. For all of those who oppose healthcare, give your health insurance up and get sick. Walk a mile in someone else's shoes.

Well said.


So what do you think of the Affordable Care Act?

How much have you read about it on

I would prefer to purchase health insurance and receive a subsidy, instead of being put into Medicaid. 1. Is it true there is a stigma attached to Medicaid, and that many doctors don't participate in Medicaid? 2. If I'm required to estimate my 2014 income and then at the end of the year it turns out to be lower than is needed to qualify for the subsidy (i.e., it's low enough to require me to use Medicaid), what happens? Am I put into Medicaid retroactively? Will I have to repay the subsidy that I received?

If you apply for government assistance under the Affordable Care Act and qualify for Medicaid, you must either accept Medicaid or pay for the insurance all out of your own pocket. (1) It is true that about 50% of doctors do not take on Medicaid patients. (2) It is important to promptly notify the Marketplace exchange of changes in income, family size and tax filing status. The exchange will determine where you should be placed. If a Marketplace exchange determines you qualify for the premium subsidy but not Medicaid and your actual household income turns out to be low enough to be eligible for Medicaid, you don’t need to repay the subsidy unless you received a larger credit than you were entitled to. If your household income is less than 100% of the Federal Poverty Level, you won’t have to pay back any of it.


What are the options for persons with SSDI who are not yet eligible for Medicare?

You'll want to check with two  places: your state's Marketplace exchange and your state's benefit agency.

You can find your state exchange’s website at

You can find your state's Medicaid agency at

Isn't the purpose of the new health-care exchange to make health care more affordable? I saw something that said that an average plan would cost $328 per month for an individual. How is that affordable? That is more than $10/day. That is close to $4000/year. For a healthy individual, that is money down the drain. For someone who gets sick, that is only the beginning, because they could still end up with another $6,350 in copays and deductables. If they want to call it affordable, it should be closer to $500/year and include two free visits to the doctor.

Certainly affordable is in the eye of the beholder. The average is just that. Means in the middle, some higher, some lower. The thing is go to the marketplace when it opens on Oct. 1. Put in your information and see what gets kicked out. The prices I've seen when you factor in income and family size is still lower than what many people face on the open market alone or with COBRA. And the thing is you wan't wait until you are sick to get insurance. Once open enrollment is closed you are on your own. But I hear you. Health insurance isn't going to be cheap for a lot of people, which is why many people were pushing for universal health care. As President Obama said yesterday people shouldn't go broke when they get sick. 

But at least we are trying something. What would you do? Keep having our insurance tied to our jobs and leaving millions of people without access to regualar care?

When our child reaches 26, and our health care insurance no longer covers [our child], how do we obtain coverage for the young adult still in college?

Your situation is exactly why the health care marketplaces were created. The young adult would go into the exchange to get coverage ( As President Obama pointed during a speech, on average in Maryland a 25-year-old with income of $25,000 would have a monthly premium of about $80. 

If I am ineligible for Social Security but eligible for Medicare and have a Federal pension and health insurance, how do I pay for Medicare? Is it even worth it?

You need to compare the costs and benefits of your health insurance and Medicare to see what is covered, what isn't and at what cost to you.

Why do health plans have enrollment periods? If I pay monthly premiums, why can't I decide at the end of any given month to change plans? More often than not, we have less than a month to decide at work because the details are sent out less than a month before the deadline.

Can you imagine the financial and logistical nightmare of people deciding month-to-month about their health coverage? How would you plan for that? And there is built-in flexibility to change if you have a life event such as having a baby or getting married. 

As for your job, clearly the HR isn't doing their job well if you aren't getting your information in a timely manner. 

I find it odd that many media people are filing reports along the lines of "mass confusion still exists about Obama care." OF COURSE there is confusion, very little has been explained yet. I think many newspapers are planning big Sunday supplements to explain it. I hope so, because my understanding is limited to the following: People without insurance are required to purchase it. On some kind of "exchanges." Depending on where you live and how much you make you will get a subsidy. That's it for me. Do you think those running the program are aware of how little information is out there yet? For example, what does it mean "to purchase health insurance on an exchange?" Do you write a check? To whom? Will you get offers in the mail like auto insurance? Also, what form will the subsidy take? Will you get a check in the mail? Sorry for the caps, but I HOPE WHOEVER IS RUNNING THESE THINGS KNOWS THAT THERE'S NOT MUCH INFO OUT HERE YET.

Actually there is A LOT of information out there. Here at the Post we have been writing for months and weeks about what to expect. Go to our homepage and click on the link that says "Obamacare" at the top of the page. That will link you a LOT of informatin.

It's a special section to help walk you through what's happening. Since summer I've been writing a lot about what to expect, including what happens when you are required to buy insurance and you don't. I've explained the marketplaces also known as exchanges. 

But the best source of informaiton is If your state has set up it's own marketplace, you can then be linked to that site. 

On, you wil find the answers to all your questions. For example you can direct the gov't to apply your subsidary right to your premium. And you can pay online. 

Just go to in addition to reading your local paper. All across the country media outlets have been trying to walk people through what is going to happen and many of those articles try to keep the politics out the explanations.

Thank you for the opportunity to ask a question. I am a small business owner from Michigan. My family and I run a small daycare in which only 2 of us have health insurance through a state program for small business owners, Wayne County Four Star initially it was about $80, that was a few years ago. As of January 2013 it was up to $125 or so, and then July 2013 it jumped again to $187! My question is I have no idea what to expect from the new Affordable Healthcare/Obamacare? Making under $40,000, single, no children --- it's frustrating to even think about. Where would I begin as a self-employed person to even discuss prices and options? And what price should I be expecting to pay? Thank you for any assistance.

The good news is that you should qualify for a premium subsidy on a Marketplace exchange because your income is below 400% of the Federal Poverty Level (FPL). This will reduce your monthly premium cost.


Subsidies are available for household income between 100% and 400% of the FPL. For a single person, 400% of the FPL is $45,960 based on 2013 numbers. You are below that amount. Be aware that if your 2014 household income is at or above the 400% limit, you would pay all of the premium cost out of your own pocket. That means you might want to carefully plan your 2014 income (including timing of purchases of equipment to get a deduction).


To know how much you'll pay after deducting the subsidy, go to the website of your state's Marketplace exchange. In your case, since the federal government is running the exchange, you should go to You can also call the federal government help center at 1.800.318.2596.

For other people on the chat, you can find your state's Marketplace exchange at

I went to a calculator link provided by WaPo... I think it was to a Kaiser website. Anyway, putting in my information the calculator asked if I use tobacco. Is that going to be the only lifestyle choice factored into premiums? What about obesity?

Here's a good link about smokers and the ACA

But here's the thing, starting next year thanks to health care reform insurance companies can't deny people because of pre-existing conditions. However, for smokers, they can charge more. Companies can charge tobacco users up to 50% more. And the use of any use of any tobacco product. 

As for people who are overweight. Insurers will have to screen and provide help for people who are obese. It's covered under preventive services.

Why should a healthy young person sign up for insurance. Can't he just wait and save that money?

Yes and no. If you stay healthy, of course you would save the money that would go towards a premium. However, if you have an accident or medical condition that requires medical attention, you are rolling the dice as to how your finances will be affected.

My suggestion is for you to investigate how much it will cost you to get health insurance on a Marketplace exchange. Cost means more than premiums. You may also face paying for a deductible, co-pays and co-insurance.

There are two types of subsidies that may be available to you to lower costs depending on your household income level. One is a subsidy to help pay premiums. The other is a cost-sharing subsidy that can reduce deductibles, co-insurance and the annual out-of-pocket maximum medical bill cost.

This is very important. If your income level qualifies you to get the cost-sharing subsidy, that subsidy is only available if you get a Silver level plan. The premium subsidy applies to the Bronze, Silver, Gold and Platinum plans.

It's worth your time to get a dollars and sense answer for your exact situation. Don't assume it won't be worthwhile for you to skip getting health insurance.

My sister, almost 61, has had health insurance for many years. Last year to lower her premium to increased her deducible. Now she has learned that with ACA her premium will double. Why should that be?

The Affordable Care Act requires health insurance plans to cover 10 essential benefits:

1. Ambulatory patient services (e.g., doctor office visits)

2. Emergency services

3. Hospitalization

4. Maternity and newborn care

5. Mental health and substance use disorder services including behavioral health treatment

6. Prescription drugs

7. Rehabilitative and habilitative services and devices

8. Laboratory services

9. Preventive and wellness services and chronic disease management

         10. Pediatric (not adult) services including oral (dental) and vision care

Most pre-ACA plans did not cover all of these benefits. That's why ACA plans may be more expensive--they provide additional benefits.

Something mentioned in the news (don't remember the source) is that people with ideas to start job creating businesses won't leave their secure jobs with benefits to do so. Health insurance is the biggest concern. Think about it--would you leave the Federal Government to start a business based on your craft/hobby? Not knowing if the new business would even support a healthy you? Health insurance ties bored and/or unhappy people to jobs they dislike.

Very interesting theory.

I think you are right that many people include in their employment decisions the need for health insurance. I certainly wouldn't leave a job with good coverage. I have three children with asthma. 

I ran the figures for what it would cost me to go on one of these health plans. The Kaiser Family Foundation calculator kicked out a price of better than $500 a month. Fortunately in fact I have health insurance from my job, but who thinks $500 a month is "affordable?" People moan that they can't even save 10% of their income, which is money they will have available to them, but Obama thinks paying nearly 10% of your income for health insurance, which will cost most people far more than they will ever see in benefits, is "affordable." I guess calling it the "really expensive health care act" would not have been a political winner, but would have been far more truthful.

I understand what you are saying and for some people premiums will be high or higher than they expected. But many of those folks have not had health care. So they may make the decision, especially if they have a family to find room in their budget to get coverage. 

But your tone lacks empathy. "People moan" they can't save. People are struggling especially in high cost areas. Can they do better. Sure, many can. However they often don't know how. They've never been taught or challenged.

As for truth, the truth is many people in this country didn't want the government to try universal health. And many of those fighting that were people with good jobs that came with health insurance. We barely got what we got, which is a system trying to get people covered at monthly premiums they can handle. However if you can't truly afford the premiums, you won't be made to buy insurance. You will end up exactly where you are...uninsured. Here's what the law says according to

Under certain circumstances, you won’t have to make the individual responsibility payment. This is called an “exemption.”

You may qualify for an exemption if:

  • You’re uninsured for less than 3 months of the year
  • The lowest-priced coverage available to you would cost more than 8% of your household income
  • You don’t have to file a tax return because your income is too low (Learn about the filing limit.)
  • You’re a member of a federally recognized tribeor eligible for services through an Indian Health Services provider
  • You’re a member of a recognized health care sharing ministry
  • You’re a member of a recognized religious sect with religious objections to insurance, including Social Security and Medicare
  • You’re incarcerated, and not awaiting the disposition of charges against you
  • You’re not lawfully present in the U.S.

It is my understanding the insurance works on the odds of any given person getting sick. If 100 people pay their premiums, it will cover the medical cost of the 5 people who get sick and have high medical expenses. It does nothing to actually lower the cost of medical care. It is also my understanding that in countries where the medical care is provided by the government, the government negotiates with the providers and offers a monopoly to anyone who gives the best priced deal, thus actually lowering the cost of medical care. It is sort of a bulk discount. The more you buy, the less you pay. The current act in the US only increases the pool of people paying premiums from 100 to 150. But, because they include everyone, including those with existing conditions, those with medical expenses goes from 5 to 10 or 20. Again, it does nothing to control the actual costs.

The Affordable Care Act does not give the federal government the ability to control premium costs or the underlying medical costs. Many states can control premium rates.

But your question deals with medical expenses so let me respond. The federal government is funding around 250 Accountable Care Organizations (ACOs) that will try to move away from a fee-for-service system to a system that rewards cost-effective care.

The ACOs are a pilot program. They are a hybrid of a fee-for-service approach and managed care. It will take some time to see how effective they are.

The ACA also has a rebate component on premiums but that doesn't really reduce the underlying medical costs.

Just like you can not guess the stock market you do not know when you will become ill or in an accident.

That's exactly right.

And here's something else that bugs me about people arguing that well folks, especially healthy young adults, should steer clear. What happens when they do need health care down the road? But they haven't been paying into the system. They haven't help even out the premium costs?

We all share the burden of having a society who cares about everyone. The key word here is "share."

So yes, you pay now for coverage you may not need (although people fail to recognize that the plans in the marketplaces include preventive care. So even if you are young you need to regularly see a doctor) but later when you do need the coverage there will be younger folks paying in to help keep your cost down.


I'm in the FEHB, and we have access to a data base that gives us information on the complete (true) cost of our plans, that is, one that not only looks at premiums but also includes the deductibles and several estimates of co-payments (low use, average use, high use). Sometime, you can see that a plan with lower premiums would actually cost you more over the long run than one with higher premiums but lower co-payments and deductible. Is there similar information for Obamacare plans? Thanks.

In most cases, you should be able to find that information.

The federal government is running the Marketplace exchanges for 36 states. The other 14 states and the District of Columbia are running their own exchanges.

The goal was for every exchange to provide an easy comparison of not only premium costs but also the deductibles, co-pays, co-insurance and annual out-of-pocket maximum. Since some Marketplace exchanges are having computer glitches, it is not always the case that all of the needed information will be displayed. However, in general, you should be able to find what you are looking for.

It is important to be aware of this, however. Originally, the website of every Marketplace exchange was supposed to make it easy to see which health insurance plans covered each doctor and each prescription drug. In many cases, that capability will not be there on October 1 when the exchanges open. Instead, you will need to search each health plan to see if your main doctors and drugs are part of the plan. Don't overlook this critical step in the plan selection process.

It's a huge issue - my friend stuck to her hellish job for a long time because her husband had cancer and he was getting better, less costly treatment with her work health insurance coverage than his. So even though both their work had health insurance benefits she still stayed. I've worked for myself since the late nineties and paid my own health insurance premiums each month until I married my government worker husband. That reduced our outgoing several hundred dollars a month!

Thanks for your story and really another reason why we may need to move away from our health insurance being tied to our jobs. So many people lost coverage during the recession because they were laid off.

For the Fed retiree wondering about Medicare - my husband and I were in the same position. He just turned 65 and we weren't sure about Medicare. After comparing carefully, we decided it was not worth it to get Part B. But we are both pretty healthy and both had long-lived healthy parents, and more important, we have a healthy amount in our savings. I've talked with former colleagues and almost no one chose to buy Part B. The plans in the FEHB might not cover every dime of health care costs, but generally you will come out ahead by using that, plus Part A, plus your own savings if and when necessary.

Thank you. But the key is you had savings. Keep that in mind when looking at your options.

Many people seem to have the mistaken impression that if they get sick while employed, their employer-sponsored healthcare will not go away. This is not true. I know of two heartbreaking cases where seriously ill people (both now deceased) were let go after they exhausted their medical leave and their health insurance went away, too. Disability insurance is not health insurance. Medicaid is for the poor, not people with assets. COBRA requires you to pick up the entire cost of your insurance. If you have assets, even if you have employer-sponsored health insurance, you want the ACA. In case the worst happens, your family will be more protected.

You may some good points. However, I wouldn't say drop your employer insurance . You may be gettinga better deal and have lower costs.

But should you be fired or let go at that point you can join the marketplaces. And now because of the law you can't be denied because of a pre-existing condition. Further, if you have limited income, you should be eligible for subsidies to bring the cost down even further.

Michelle stated in another comment: "Insurers will have to screen and provide help for people who are obese. It's covered under preventive services." But what if an obese person chooses to never visit a doctor? Does an ACA plan REQUIRE you to have an annual exam? Or do you have to answer some kind of questionnaire about your weight and smoking? What if you lie about smoking (or your weight, as most of us already do on our drivers licenses)?

You will not be required to have an annual exam. Weight is not a factor in setting premium rates. Smoking is.


Smokers may pay up to 50% more in premium costs under the ACA. However, this varies by state. States can reduce or eliminate the extra charge and some have done so. For a list, see


Disclosing tobacco use is on the honor system. As part of the enrollment process, tobacco users are supposed to reveal that they use tobacco. There is no real penalty if they don’t.

Obamacare aims at extending the pool of insured individuals (the demand side), but does it do anything to address current or future shortages of health care providers (the supply side)?

You are correct. There is a current shortage of health care providers and the demand for services will increase with the Affordable Care Act. We will know a lot more in the next couple of years as to how all of this will play out.

Good question and one a lot of people have been asking.

My hope is we can get some providers in the pipeline. And how do we do that? Make it not so costly to get medical training. 

Some of the people who will want get insurance will not have access to a privately-owned computer to use. It isn't really safe to give such information as your address and social security on a public computer such as libraries have. What is being done to address this issue?

You are correct as to security issues in using a public computer. You will probably want to sign up by telephone.

24-hour federal government help line: 1.800.318.2596.

TTY/TDD number for the hearing impaired is 1.855.889.4325., the official federal government health care website.

You can find your state’s website at and then call there. 


If someone who is part of this chat has a private computer, make sure you’re using a secure computer since you’ll be typing in confidential information such as a birth date, Social Security number and other personal and financial information for yourself and possibly your loved ones.


Make sure the computer has recently had an antivirus and an antispyware scan and that the browser (e.g., Internet Explorer, Firefox, Safari, etc.) and operating system (e.g., Windows) have the latest security updates. (If you need more information on making your computer or smartphone more secure and removing malware, refer to my e-book entitled the Computer Guru Security Guide.)

Is there any way under ACA to put my parents on my insurance? I think the answer is no, but I can't find anyplace saying for certain...

There are ways to add dependents. Dependent can mean more than children—it could include a grandchild, niece and other qualifying relatives if you provide enough financial support and meet other IRS requirements.


Check with both the federal help line and your state's Marketplace exchange.

24-hour federal government help line: 1.800.318.2596.

TTY/TDD number for the hearing impaired is 1.855.889.4325., the official federal government health care website.

You can find your state’s website at 

Now comes the time Don and I have to say so long.

But Don Silver has agreed to come back. We pick up this health care discussion taking your questions again after the marketplaces open. 

Please sign up for my weekly newsletter (delivered right to your email) or follow me on Twitter @SingletaryM to get an alert about about when we will pick up the ACA conversation  in coming weeks. 

Take care. And hope you have a financially safe weekend.

In This Chat
Michelle Singletary
Michelle Singletary writes the nationally syndicated personal finance column, "The Color of Money," which appears in The Post on Thursday and Sunday. Her award-winning column is also carried in more than 120 newspapers. In her spare time, Singletary is the director of a ministry she founded at her church, in which women and men volunteer to mentor others who are having financial challenges.

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