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ACA Insurance in the Time of COVID-19

The urgency of the pandemic ushered in important changes to the Affordable Care Act (ACA), including a steep reduction in premiums for health insurance policies purchased on the state and federal exchanges through the end of 2022. Now Congress is debating reforms such as making the larger premium subsidies permanent and broadening the reach of the federal-state Medicaid program beyond the expansion introduced in the 2010 ACA.

We spoke with Tyson Lester, an independent insurance agent in southern California, about what the changes so far have meant for consumers. Tyson is licensed to sell policies in California, Florida, and Texas.

Tyson LesterTyson Lester

Has the Affordable Care Act promoted disease prevention and care during the pandemic?

Some of the best feedback we got from our clients was about using the telehealth and remote options in their policies. It’s been an option for quite some time, but it was utilized more frequently during COVID-19. People were able to access primary care physicians, receive consultation and be diagnosed with COVID over the phone. It was amazing. It helped them because: 1) they were able to just make a phone call; 2) they were able to receive good consultation; and 3) if testing was necessary, they were able to go to a testing facility.

In response to COVID, did you see a rush into ACA policies last year?

ACA enrollment increased last year, but consumers’ response to the pandemic was mixed. In 2020, 12 states and Washington D.C. temporarily reopened their health insurance exchanges but people didn’t have the additional premium assistance to make it more affordable. In the remaining states, working people who lacked employer health insurance didn’t have the ACA as another option for coverage when the pandemic hit.

As for the workers who did have employer health insurance last year but then lost their jobs, they had to make a tough decision between whether they wanted to elect their employer’s COBRA, which is expensive, go uninsured, or go on the insurance exchange. But many people weren’t fully aware of the ACA’s longstanding option: when someone loses group health insurance from their employer, they can buy what’s known as a special enrollment ACA plan. In Texas, for example, part of the reason for last year’s increase in the uninsured population, in the midst of COVID-19, was that people who lost their jobs – and their employer coverage – weren’t even aware the ACA exchanges were available to them. We actually put a flyer together for this specific topic last year, because it was so important.

In March, the American Rescue Plan significantly increased the ACA premium subsidies through December 2022. What has been the effect?

For anybody who was previously enrolled, the American Rescue Plan significantly reduced premiums in California, Texas, and Florida and potentially their total out-of-pocket costs. As a result of the larger subsidies, I saw an influx of new customers throughout this year on California’s exchange, which – unlike most other states – opened a special enrollment for all of 2021. Earlier this year, the federal exchange opened, which caused an influx of customers too. This is where Texas, Florida and many other states sell their ACA policies. All states on the federal exchange shut down again in August but will reopen for 2022 in November. …
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People of various occupations

Retirement Saving is Focus of Popular Blogs

U.S. retirement preparedness can best be described as mediocre: about half of workers are not saving enough money to continue their current standard of living once they retire.

Judging by a dozen blogs that attracted the most web traffic in the third quarter, our readers understand the importance of the issue. Some felt strongly that workers need to take responsibility for their retirement finances. Workers “disregard the notion of saving for the future,” one reader said in a comment posted to “Onus of Retirement Planning is on Us.” “They have lived their lives like there is no tomorrow and spend money on any and everything they want.”

To boost savings, growing numbers of state officials and employers are taking charge. The article, “State Auto-IRAs are Building Momentum,” was a roundup of states that are either implementing or weighing a requirement that employers automatically enroll their employees in an IRA. The workers can always opt out if they want to, but they often remain in the plans.

And automatic enrollment in 401(k)s and 403(b)s is gaining traction in the private sector. The plans, which were virtually nonexistent in 2003, now make up a significant minority of corporate and non-profit plans, according to a unique database that tracked the changes in plan design. A summary of this research appears in “401(k) Plans Evolve to Boost Workers’ Savings.”

Baby boomers never seem to get enough information about the nuts and bolts of retirement. In “Enrollment Trends in Medicare Options,” readers had a vigorous debate about the advantages and disadvantages of supplemental Medigap plans versus Medicare Advantage insurance policies. The article revealed a major shift away from Medigap and into Medicare Advantage, which has the benefit of relatively low premiums, with the tradeoff being that Advantage plans tend to provide less protection from large medical bills than Medigap.

Our readers are also interested in the difficult decisions boomers are making about when to retire. The article, “Not Everyone Can Delay their Retirement,” highlighted the racial and educational disparities driving these decisions. And “Disability Discrimination and Aging Workers” dealt with the choice facing aging workers whose bodies are breaking down but who can’t afford to retire.

Here are a few more articles that attracted readers’ attention – some about retirement and some not: …Learn More

Retirees Can’t Afford Hearing, Dental Care

Hearing loss can amplify cognitive decline by isolating retirees and forcing them to divert precious brain power to participate in a conversation. People who lose teeth have trouble eating, sacrificing their health. And poor vision, uncorrected by cataract surgery or the proper magnification in eyeglasses, is dangerous when driving at night.

These problems are facts of aging. But Medicare doesn’t cover their often-expensive solutions such as hearing aids, dental implants, or eyeglasses. A report by the Kaiser Family Foundation identified a gap between need and access is wide.

Among the 16 percent of Americans over 65 who said in a survey that they couldn’t get hearing, dental or vision services, nearly three out of four couldn’t afford them.

Three charts, based on Kaiser’s analysis of the survey data, show the average out-of-pocket spending for hearing and dental care was around $900 for the Medicare beneficiaries who used the services in 2018. The cost of vision care was significantly less, averaging $230.

Retirees usually don’t need all three services in a single year. For example, dental implants cost thousands of dollars, and an individual might get one or two in a lifetime. But when retirees do get the expensive dental care, a new Kaiser report shows the bill can really pack a wallop – and become an obstacle to getting the necessary care. …Learn More

balancing balls

Social Security: Time for an Update?

The option to start Social Security benefits at any age from 62 to 70 – with an actuarial adjustment – is a key feature of the program. However, the adjustments – reductions in the monthly benefit for claiming early and increases for waiting – are decades old and do not reflect improvements in longevity or other important developments over time.

The option to claim early was introduced just over 60 years ago, when Congress set 62 as the program’s earliest eligibility age. The option to claim between 65 and 70 on an actuarially fair basis stems from the 1983 Social Security amendments, which gradually increased the annual “delayed retirement credit” from 3 percent to 8 percent. Also in 1983, reductions for early claiming were changed in tandem with the gradual increase in the full retirement age from 65 to 67.

The goal of actuarial adjustments to the monthly benefits has always been to ensure that retirees with average life expectancy could expect to get the same total lifetime benefits, regardless of when they started. But calculating lifetime benefits requires assumptions about how long people will live and assumptions about interest rates. The current calculations are based on life expectancy and interest rates in the early 1960s or 1980s.

Much has changed since those dates: life expectancy has increased dramatically and interest rates have declined. Longer life expectancy and, to a lesser extent, lower interest rates would each call for a smaller penalty for early claiming and a smaller reward for delaying claiming.

Consider what this means for baby boomers whose full retirement age is 67. Under the current system, if they claim at 62, they receive 70 percent of their age-67 benefit. However, to reflect decades of increasing life spans and falling interest rates, the researchers calculated that the accurate monthly benefit would be 77.5 percent of the age-67 benefit. That is, early claimers are penalized too much.

For workers who delay claiming, a discrepancy also exists between the current and accurate delayed retirement credits, though the difference is smaller since the credit was initially too small. Specifically, workers who wait until 70 to start Social Security today receive 124 percent of the benefit they would’ve gotten at 67, whereas 120 percent of the age-67 benefit would be more accurate. …Learn More

Video: Wisdom from Decades of Living

A Jewish child rides the Kindertransport out of Nazi-controlled Austria to safety in England, eventually coming to the United States. A Japanese-American mother is confined to an internment camp. A child of Mexican farm workers in California goes to bed hungry. A young African-American organizes sit-ins for Civil Rights.

Taken together, the early life stories shared by the individuals in a new PBS feature, “Lives Well Lived,” are a compendium of U.S. history. The trailer that appears above can’t do justice to the full video, which can be viewed free of charge on the PBS website until Sept. 29.

Despite their trials, these individuals have embraced life with a zeal and perseverance that are surely part of the secret to how they have made it into their 80s or 90s. And there is a growing body of scientific evidence that the healthy lifestyle and even the positive attitude these seniors display improve longevity.

“When I wake up in the morning, I expect something good to happen,” one woman said. “Sometimes it’s postponed to the next day or the day after, but inevitably something wonderful happens.” …Learn More

caregiving

Retirees’ Need for Caregivers Varies Widely

Nothing causes dread in a retiree quite like the prospect of having to go into a nursing home someday or becoming dependent on someone who comes into the house to help with routine daily needs.

But media reports or studies with alarming predictions of infirmity in old age are not very useful to retirees or their family members. A new study provides a more nuanced picture of the various scenarios that can play out.

home care tableResearchers at the Center for Retirement Research estimated that roughly one in five 65-year-olds will die without using any care, and another one in five will need only minimal care.

But one in four will have such severe needs that they will require high intensity support for three years or more. The largest group of people – 38 percent – will fall somewhere in the middle: they are likely to need a moderate amount of care for one to three years. A strong indicator of how much assistance someone will require is whether they are healthy in their late 60s.

To determine future need, the researchers combined two dimensions of care: intensity and duration. The intensity of care varies widely. Many retirees can remain largely independent if they hire someone for a couple days a month to clean house or manage their finances, while others will need round-the-clock support.

The duration of care also varies. The researchers divided duration into three categories: less than a year, one to three years, and more than three years. Many retirees need assistance for only a few days or weeks after being released from the hospital. But others, including people who develop severe disabling conditions such as dementia, may need years of care.

The researchers used 20 years of biennial surveys of older Americans and data on caregivers to predict the share of 65-year-olds who will have minimal, moderate, or severe lifetime needs.Learn More

Wanted: Workers without College Degrees

The PBS NewsHour has some terrific reporting on an important topic: the job market for the two-thirds of working-age adults who don’t have a college degree.

The problem facing many of them is that, despite their hard work, they will earn much less over their lifetimes than college graduates. In stories for the NewsHour, Paul Solman highlights the opportunities available to workers without degrees at a time that many employers are scrambling to find smart, energetic people to fill good-paying jobs with benefits in light manufacturing and the skilled trades.

Women of color are catching on and entering fields like carpentry and plumbing – in fact, they are over-represented in the trades. But Solman talked to employers early this year who cannot find enough young adults willing to consider working in the trades.

This new NewsHour video (above) features IBM, which has to compete for employees with flashy firms like Apple and Google. IBM created an internship program to train people like Reinaldo Rodriguez for “new-collar jobs” that don’t require a bachelor’s degree. The former supervisor for a drug store chain that cut his pay after he was promoted now works in an IBM electronics lab.

Opportunities like these pay enough for people to support their families. And they are a great alternative to borrowing a lot of money for a bachelor’s degree that won’t necessarily guarantee a job. …Learn More