patrick.net

It's a good question, but I don't know if anyone can answer without reading the policy. In general, if they procured the policy on the exchange, I believe it would need to be a fully compliant policy. But, there have been numerous proclamations and waivers to allow certain non-compliant policies purchased prior to January, so if it was purchased outside of the exchange, then all bets are off. Either way, read the policy, and if it was purchased off the exchange, ask for confirmation in writing whether it complies with the Act or not. (I can't call it the ACA, because of the letters in the official title, the only one that is accurate is, it is an Act.)

curious2 says

In general, if they procured the policy on the exchange, I believe it would need to be a fully compliant policy. But, there have been numerous proclamations and waivers to allow certain non-compliant policies purchased prior to January, so if it was purchased outside of the exchange, then all bets are off.

I think because he has a pre-existing condition, he had to go to the Exchange and did so prior to January (I assume to prevent a lapse in coverage). He was able to get a plan from Humana, but when I select his State I only see MDwise and Anthem.

His Humana person is telling him that because he bought Family Coverage, he needs to hit his Family deductible, not the individual deductible, in order for them to start paying. That seems unlikely to me, and a chat with ACA Helpdesk folks confirmed what I thought (as far as you can believe them). They said he would only need to hit his individual deductible for ACA plans.

I'm wondering if:

*His issues have nothing to do with ACA, since it seems "off the Exchange".

*If that Humana issue is real or accurate? Seems like you have individual or family deductible on ACA plans. Do non-ACA plans have a policy deductible instead?

(and thank you)

non-aca plans are still aca compliant; they just aren't through the exchange.

To the best of my knowledge, an individual needs to meet their own deductible and the family deductible is there to protect against every family member being forced to meet the same deductible (for example, individual at $2500 and family at $5,000 so if two people meet their deductible the rest are already there). This is not an ACA issue.

Every policy is different - ACA or non-ACA. They all have to meet certain minimum criteria, tho.

elliemae says

To the best of my knowledge, an individual needs to meet their own deductible and the family deductible is there to protect against every family member being forced to meet the same deductible (for example, individual at $2500 and family at $5,000 so if two people meet their deductible the rest are already there). This is not an ACA issue.

I barely use insurance, but does that mean that if an individual on a traditional insurance plan met the individual deductible, their coverage would kick in, or would they need to hit the family deductible?

My friend bought on the Exchange last year due to his PEC. I'm guessing he could have waited until January 1, but didn't want to risk a lapse in coverage.

His company brought in help from Unum, at enrollment.com. They are saying that nearly all policies are now aggregate deductibles. My friend does not qualify for subsidies.

So, to me, it would seem as though the Unum guy is full of crap. Wouldn't it be that ACA demands a certain MINIMUM level of coverage? As far as I know, there is no mandate as far as what he termed "aggregate deductibles".

If it were the case, wouldn't it mean that all policies, even off the Exchange, would have aggregate deductibles? Am I missing something?