Author Topic: 2017 ACA plan info now available  (Read 26268 times)

Exflyboy

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Re: 2017 ACA plan info now available
« Reply #200 on: December 04, 2016, 11:25:46 AM »
Just looked at the MA Connector website - my current plan ($286 Silver HSA-eligible HMO) is gone after this year, automatically replaced with a non-HSA-eligible HMO costing $525, the cheapest plan available from my current insurer in 2017. I looked but couldn't find an HSA-eligible replacement. I'll probably replace with something in the $330/year range from another insurer; hopefully my doctor is in the network, as these plans offer no out of network coverage. Does anyone else live in MA, and have you found an HSA-eligible policy? I guess no insurance provider wants to meet the $6,600 maximum out of pocket required. It will be too bad if no-one is able to fund their HSA because none of the policies qualify.

Even with the changes in the plan offerings this year, I'm grateful that I live in MA, home of Romney-Care, so a repeal of ACA shouldn't change much here, knock on wood. But the thought of ACA repeal nationwide is pretty scary. Back to people going bankrupt to cover health care costs.

It would be great if Republicans would consider a combination of
1) private catastrophic health insurance required to be purchased by those over a certain income level who theoretically could afford self-insurance for regular expenses, plus
2) single-payer coverage for everyone else.

Seems like that could work, especially if they added a second layer of single-payer coverage up to the catastrophic deductible (for those ineligible for the full single-payer coverage but not wealthy) to avoid a "cliff" effect with unaffordable results for folks with chronic diseases.

Why not just single payer for everyone?

Because thats socialism and therefore evil!.. So Newt Gingrich tells me anyway.

There are way too many powerful people getting backhanders from HC companies.. They never want the system to change

DavidAnnArbor

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Re: 2017 ACA plan info now available
« Reply #201 on: December 04, 2016, 11:41:42 AM »
The latest Republican efforts seems to be directed at immediate repeal of the Affordable Healthcare Act, but delaying it's implementation by several years so as to not wreck havoc in the health care insurance needs of millions. The repeal effort is the red meat for the base Republican voters.  Here's the NY Times article link:

http://www.nytimes.com/2016/12/02/us/politics/obamacare-repeal.html?rref=collection%2Fsectioncollection%2Fhealth&action=click&contentCollection=health&region=rank&module=package&version=highlights&contentPlacement=6&pgtype=sectionfront

jim555

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Re: 2017 ACA plan info now available
« Reply #202 on: December 04, 2016, 12:19:01 PM »
Obamacare is basically the Republican plan from years ago.  All they have to do is tweak some things and rename it FantasticCare. 

waltworks

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Re: 2017 ACA plan info now available
« Reply #203 on: December 04, 2016, 12:30:01 PM »
Yeah, this is humorous. Oh, shit, if we just repeal this it's going to f everything up.

Well, let's "repeal" it, but push back the implementation of the repeal a few years. Then in a few years... we can do the same dance all over again.

Pretty sad. I was hoping we'd see some actual improvements/tweaks at least.

That said, if they're actually not going to repeal the damn thing, that's sort of good news, I suppose.

-W

The latest Republican efforts seems to be directed at immediate repeal of the Affordable Healthcare Act, but delaying it's implementation by several years so as to not wreck havoc in the health care insurance needs of millions. The repeal effort is the red meat for the base Republican voters.  Here's the NY Times article link:

http://www.nytimes.com/2016/12/02/us/politics/obamacare-repeal.html?rref=collection%2Fsectioncollection%2Fhealth&action=click&contentCollection=health&region=rank&module=package&version=highlights&contentPlacement=6&pgtype=sectionfront

OutlierinMA

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Re: 2017 ACA plan info now available
« Reply #204 on: December 04, 2016, 07:51:19 PM »


Why not just single payer for everyone?
[/quote]

I want single payer for everyone, but I don't get the feeling that Trump and the Republican Congress agree.

brooklynguy

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Re: 2017 ACA plan info now available
« Reply #205 on: December 05, 2016, 09:13:15 AM »
That said, if they're actually not going to repeal the damn thing, that's sort of good news, I suppose.

As noted in the NYT article, a delayed effectiveness feature would hardly matter in terms of the havoc an immediate repeal of the ACA would wreak upon the heath insurance market, as long as uncertainty continues to exist regarding its replacement (or lack of replacement).  What the delayed effectiveness feature would do, though, is supply ammunition to those who want to categorize the ACA as a failure (by leaving it ostensibly intact for the specified transition period but precluded from properly functioning during that period by virtue of the sunset feature itself), which, perhaps, is at least part of the point behind the "repeal and delay" strategy.

jim555

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Re: 2017 ACA plan info now available
« Reply #206 on: December 05, 2016, 11:21:51 AM »
Wouldn't they need 60 votes to replace it since 60 was required to put it in place?  Parliamentarians here??

rayt168

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Re: 2017 ACA plan info now available
« Reply #207 on: December 05, 2016, 11:27:57 AM »
Wouldn't they need 60 votes to replace it since 60 was required to put it in place?  Parliamentarians here??

Based off of my readings, I believe their game plan is to repeal ACA first to satisfy their base.  They will need to get 60 to replace ACA with the hope of forcing the Dems up for election in 2018 to support their plan which will take place in 2 - 3 year timeframe.

Gin1984

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Re: 2017 ACA plan info now available
« Reply #208 on: December 05, 2016, 12:32:23 PM »
Wouldn't they need 60 votes to replace it since 60 was required to put it in place?  Parliamentarians here??
For certain parts of it they need 60%, for other parts not so much.  For example, they could stop funding the subsidies. 
Quote
Most Senate bills need 60 votes to overcome a filibuster. But Senate rules also allow bills to pass with a simple majority if they only relate to spending, a process known as reconciliation. Reconciliation bills need to be approved by a parliamentarian, who certifies that the content does indeed have budgetary impact.

Last winter, Republicans drafted a bill that would fit the parameters of the reconciliation process. HR 3762 was introduced into the House on October 16, 2015, by Rep. Tom Price (R-GA). The bill would repeal Obamacare’s tax credits for low- and middle-income Americans to purchase insurance at the end of 2017. It would end the Affordable Care Act’s Medicaid expansion at the same time, essentially creating a two-year transition period in which Republicans would presumably consider Obamacare replacement plans.

“Practically, you can’t turn everything off immediately,” says Chris Condeluci, who worked as tax and benefits counsel for the Senate Finance Committee's Republicans during the Affordable Care Act debate. “The GOP doesn’t want to get beat up over kicking 20 million people off of insurance.”

HR 3762 would also repeal Obamacare’s mandate. It would end many of Obamacare’s major taxes that helped pay for the health law’s insurance expansion.
http://www.vox.com/2016/11/9/13487772/trump-obamacare-repeal

CDP45

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Re: 2017 ACA plan info now available
« Reply #209 on: December 07, 2016, 11:04:43 PM »
Healthcare is now 17% of GDP, so to keep the same level of care/spending, but do away with all the insurance and games, everyone could just pay $9,402 per person. Per worldbank: http://data.worldbank.org/indicator/SH.XPD.PCAP?locations=US.

Now this level of spending doesn't please everyone, and there are still millions of uninsured, so to expand that the per-person cost would just be greater as well. Basically if you're paying less than $9,402, you're not paying your fair-share, but there's not much of a choice because the penalty is at least $2,400 right?

There are thousands of insurance products sold in the country, yet there is only 1 market in constant crisis, the Health insurance market. Can you point to a market where competition is limited but prices don't skyrocket or quality decreases? There's no magic folks, dollars spent can only come from dollars paid.

Clamoring for more free shit isn't going to fix this. [But here's a hint when the government pays unlimited dollars for those over 65: For survivors to age 85, more than one-third of their lifetime expenditures will accrue in their remaining years.]

You're competing for healthcare against (obese) geriatrics backed by unlimited government dollars, think you can win under the current system?

Ohh and diabetics (obese) spend on average $10,000 more each per year: https://www.ncbi.nlm.nih.gov/pubmed/18308683 [2007]

2012 update! https://www.ncbi.nlm.nih.gov/pubmed/23468086
Quote
People with diagnosed diabetes, on average, have medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of diabetes.

But we're evil for suggesting that people should pay for their lifestyle choices which should be 230%*$9,402= $21,624/yr/person for diabetics.

« Last Edit: December 07, 2016, 11:10:32 PM by CDP45 »

Exflyboy

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Re: 2017 ACA plan info now available
« Reply #210 on: December 07, 2016, 11:10:08 PM »
Healthcare is now 17% of GDP, so to keep the same level of care/spending, but do away with all the insurance and games, everyone could just pay $9,402 per person. Per worldbank: http://data.worldbank.org/indicator/SH.XPD.PCAP?locations=US.

Now this level of spending doesn't please everyone, and there are still millions of uninsured, so to expand that the per-person cost would just be greater as well. Basically if you're paying less than $9,402, you're not paying your fair-share, but there's not much of a choice because the penalty is at least $2,400 right?

There are thousands of insurance products sold in the country, yet there is only 1 market in constant crisis, the Health insurance market. Can you point to a market where competition is limited but prices don't skyrocket or quality decreases? There's no magic folks, dollars spent can only come from dollars paid.

Clamoring for more free shit isn't going to fix this. [But here's a hint when the government pays unlimited dollars for those over 65: For survivors to age 85, more than one-third of their lifetime expenditures will accrue in their remaining years.]

You're competing for healthcare against (obese) geriatrics backed by unlimited government dollars, think you can win under the current system?

Ohh and diabetics (obese) spend on average $10,000 more each per year: https://www.ncbi.nlm.nih.gov/pubmed/18308683

And the UK spends about $3500 per person.. thats the root cause issue that needs to be fixed. But of course, way too many powerful people getting fat to ever fix that issue.

CDP45

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Re: 2017 ACA plan info now available
« Reply #211 on: December 07, 2016, 11:13:18 PM »
Hmm but Norway and Switzerland spend more than the USA per capita..hmmmmmm.

jim555

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Re: 2017 ACA plan info now available
« Reply #212 on: December 08, 2016, 06:27:07 AM »
Wouldn't they need 60 votes to replace it since 60 was required to put it in place?  Parliamentarians here??
For certain parts of it they need 60%, for other parts not so much.  For example, they could stop funding the subsidies. 
http://www.vox.com/2016/11/9/13487772/trump-obamacare-repeal
The subsidies and Medicaid funding ends with 51 votes, that they can do.  That would make insurance unaffordable for most people.  The only upside is the catastrophic plans then become available due to a hardship exemption.

They don't have the 60 votes so they can't replace / repeal since the Dems will block it.  I am not seeing how this doesn't blow up in their faces.

Metric Mouse

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Re: 2017 ACA plan info now available
« Reply #213 on: December 08, 2016, 06:38:23 AM »
Wouldn't they need 60 votes to replace it since 60 was required to put it in place?  Parliamentarians here??
For certain parts of it they need 60%, for other parts not so much.  For example, they could stop funding the subsidies. 
http://www.vox.com/2016/11/9/13487772/trump-obamacare-repeal
The subsidies and Medicaid funding ends with 51 votes, that they can do.  That would make insurance unaffordable for most people.  The only upside is the catastrophic plans then become available due to a hardship exemption.

They don't have the 60 votes so they can't replace / repeal since the Dems will block it.  I am not seeing how this doesn't blow up in their faces.

Well, since insurance companies are dropping out, claiming losses are unsustainable, it kinda looks like the ACA as designed is blowing up already - all the opponents had to do to get it to fail is not a goddamned thing.

Even insurance companies have a whole host of suggestions for improving the system - it's not like the issues are super secret or something.
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jim555

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Re: 2017 ACA plan info now available
« Reply #214 on: December 08, 2016, 06:44:19 AM »
The law will still be on the books whether or not it works well.  In my state it works well.   
Obstructionists have made sure that it never gets improved.  That is the strategy, break it, and then kill it, claim it can't work.

Metric Mouse

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Re: 2017 ACA plan info now available
« Reply #215 on: December 08, 2016, 07:41:03 AM »
The law will still be on the books whether or not it works well.

This is sadly far too common in America.
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waltworks

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Re: 2017 ACA plan info now available
« Reply #216 on: December 08, 2016, 09:07:18 AM »
Yeah, the insurance companies have made it very clear what is required to make the system work well: HUGE penalties for not signing up.

Which makes a ton of sense if you think about it for about 5 seconds.

Personally I think the whole thing blows up and doctors/hospitals go out on their own and contract directly with patients. The insurance overhead is just nuts - one (big) local hospital has almost 1/3 of it's staff (1300 people!) employed as billing clerks. I can't imagine any other industry in which that would be considered acceptable.

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Exflyboy

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Re: 2017 ACA plan info now available
« Reply #217 on: December 08, 2016, 09:49:38 AM »
Yeah, the insurance companies have made it very clear what is required to make the system work well: HUGE penalties for not signing up.

Which makes a ton of sense if you think about it for about 5 seconds.

Personally I think the whole thing blows up and doctors/hospitals go out on their own and contract directly with patients. The insurance overhead is just nuts - one (big) local hospital has almost 1/3 of it's staff (1300 people!) employed as billing clerks. I can't imagine any other industry in which that would be considered acceptable.

-W

Exactly.. Which is what none of the (evil socialist "they have death panels over there") with single payer systems have. In the UK for example, all contracts are negotiated in bulk. MUCH more efficient.




Malum Prohibitum

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Re: 2017 ACA plan info now available
« Reply #218 on: December 08, 2016, 10:44:59 AM »
And the UK spends about $3500 per person.. thats the root cause issue that needs to be fixed.
  Assuming that is accurate, it is because of rationing.  In 2015, the system in Great Britain ran a huge deficit (I could not find 2016).  If you need a specialist in the US, you go see one.  If your doctor in the UK thinks you need to see a specialist, you could be waiting a month to six weeks.  Heart attack deaths are higher in the UK than in the US, in spite of the fact that the risk factors for heart attacks are much higher in the US.  There are twice as many heart bypass surgeries here and four times as many angioplasties. 

But, hey, at least the UK got its costs down.

If you want similar costs here in the US, then you would need similar rationing, delays, and deaths.

The problem in England was fixed back in 2010, though. England’s 2010 “NHS Constitution” declared that no patient should wait beyond 18 weeks for treatment – four months - after GP referral.  A very large percentage (43% in 2012) were not being seen by specialists in that timeframe.

Each system has things to critique, but please do not hold up the UK's system as the model.  It is cheaper per person, yes, but the reasons why it is cheaper are what keep the US from adopting it.
« Last Edit: December 08, 2016, 10:49:54 AM by Malum Prohibitum »

Spork

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Re: 2017 ACA plan info now available
« Reply #219 on: December 08, 2016, 10:48:38 AM »
Yeah, the insurance companies have made it very clear what is required to make the system work well: HUGE penalties for not signing up.

Which makes a ton of sense if you think about it for about 5 seconds.

Personally I think the whole thing blows up and doctors/hospitals go out on their own and contract directly with patients. The insurance overhead is just nuts - one (big) local hospital has almost 1/3 of it's staff (1300 people!) employed as billing clerks. I can't imagine any other industry in which that would be considered acceptable.

-W

Exactly.. Which is what none of the (evil socialist "they have death panels over there") with single payer systems have. In the UK for example, all contracts are negotiated in bulk. MUCH more efficient.

I think there is more to it than that.

This is just my observation, so take it with a grain of salt.  This is based on watching my father's practice (a physician) and watching his end of life.

I think there is an attitude in the US when it comes to health care that is something like "Damn the expense!  Buy the best!"  It gets even murkier when we get towards the end of life.  Where other cultures can see their mortality, we have some cultural idea that getting one or two more months of life (at any cost of dollars or suffering) is worth it.  Yet, often looking back on it, it seems clear that a few extra months -- especially bad months -- is just not worth it at any cost.

In short: often some old school, tried and true procedure may be less expensive and may be "good enough."  And more realistic expectations of mortality and suffering would greatly reduce costs.  Sadly, the latter is probably what is considered "death panels" by some. 

I think this is something really ingrained in our culture... and replacing "the system" isn't really going to fix it.  And I have no idea how to change the cultural norm.
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Malum Prohibitum

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Re: 2017 ACA plan info now available
« Reply #220 on: December 08, 2016, 10:48:45 AM »
Can you point to a market where competition is limited but prices don't skyrocket or quality decreases? There's no magic folks, dollars spent can only come from dollars paid.

Clamoring for more free shit isn't going to fix this.
  Best post of the thread.

Metric Mouse

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Re: 2017 ACA plan info now available
« Reply #221 on: December 08, 2016, 10:52:49 AM »
And the UK spends about $3500 per person.. thats the root cause issue that needs to be fixed.
  Assuming that is accurate, it is because of rationing.  In 2015, the system in Great Britain ran a huge deficit (I could not find 2016).  If you need a specialist in the US, you go see one.  If your doctor in the UK thinks you need to see a specialist, you could be waiting a month to six weeks.  Heart attack deaths are higher in the UK than in the US, in spite of the fact that the risk factors for heart attacks are much higher in the US.  There are twice as many heart bypass surgeries here and four times as many angioplasties. 

But, hey, at least the UK got its costs down.

If you want similar costs here in the US, then you would need similar rationing, delays, and deaths.

The problem in England was fixed back in 2010, though. England’s 2010 “NHS Constitution” declared that no patient should wait beyond 18 weeks for treatment – four months - after GP referral.  A very large percentage (43% in 2012) were not being seen by specialists in that timeframe.

Each system has things to critique, but please do not hold up the UK's system as the model.  It is cheaper per person, yes, but the reasons why it is cheaper are what keep the US from adopting it.

Interesting analysis. Thank you for sharing.
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Exflyboy

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Re: 2017 ACA plan info now available
« Reply #222 on: December 08, 2016, 11:02:16 AM »
Yeah, the insurance companies have made it very clear what is required to make the system work well: HUGE penalties for not signing up.

Which makes a ton of sense if you think about it for about 5 seconds.

Personally I think the whole thing blows up and doctors/hospitals go out on their own and contract directly with patients. The insurance overhead is just nuts - one (big) local hospital has almost 1/3 of it's staff (1300 people!) employed as billing clerks. I can't imagine any other industry in which that would be considered acceptable.

-W

Exactly.. Which is what none of the (evil socialist "they have death panels over there") with single payer systems have. In the UK for example, all contracts are negotiated in bulk. MUCH more efficient.

I think there is more to it than that.

This is just my observation, so take it with a grain of salt.  This is based on watching my father's practice (a physician) and watching his end of life.

I think there is an attitude in the US when it comes to health care that is something like "Damn the expense!  Buy the best!"  It gets even murkier when we get towards the end of life.  Where other cultures can see their mortality, we have some cultural idea that getting one or two more months of life (at any cost of dollars or suffering) is worth it.  Yet, often looking back on it, it seems clear that a few extra months -- especially bad months -- is just not worth it at any cost.

In short: often some old school, tried and true procedure may be less expensive and may be "good enough."  And more realistic expectations of mortality and suffering would greatly reduce costs.  Sadly, the latter is probably what is considered "death panels" by some. 

I think this is something really ingrained in our culture... and replacing "the system" isn't really going to fix it.  And I have no idea how to change the cultural norm.

Firstly, my aim was not to hold the UK as the ideal.. Its most certainly not perfect. But it is the example I have the most familiarity with. For example, my Dad see's a cardiologist every 6 weeks or so.. OOP expense = $zero!

The data for the $3500 per person came from the World bank study.

I think the point about cultural norms is valid, Hospitals routinely (according to my medical friends) ignore DNR's just because a long lost Son shows up and starts demanding more time with his Mother (who he hasn't seen in 10 years hardly)..

The question for me is what is the right balance of care vs cost.

Indeed in the US I can get anything whenever I want it.. In the UK you will wait, although emergency care is superb in my experience.

The problem it seems is we pay a hell of a premium for fantastic care. If you can't afford it though, then it simply becomes hc for the rich.


meerkat

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Re: 2017 ACA plan info now available
« Reply #223 on: December 08, 2016, 11:04:48 AM »
And the UK spends about $3500 per person.. thats the root cause issue that needs to be fixed.
  Assuming that is accurate, it is because of rationing.  In 2015, the system in Great Britain ran a huge deficit (I could not find 2016).  If you need a specialist in the US, you go see one.  If your doctor in the UK thinks you need to see a specialist, you could be waiting a month to six weeks. 

See, I don't understand this. I'm in the US and if I called up by OBGYN right now - the one I've been seeing for years - wanting a routine appointment, it would probably be four to six weeks out. Same for my endocrinologist. For my son's neurologist, our first appointment with him was booking out three months or more in advance. Same for a pediatric eye doctor. And I live in a reasonably sized city with two major hospitals and a bunch of other medical offices in town. Maybe a cardiologist is quicker if you're at risk for a heart attack, but all of my experience with specialists has led me to expect getting an appointment six weeks out if I'm lucky. So whenever this argument is brought up about the UK or Canada or wherever, it makes no sense to me as being worse than what I'm experiencing now.
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jim555

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Re: 2017 ACA plan info now available
« Reply #224 on: December 08, 2016, 11:34:02 AM »
The NHS uses a triage system for care.  Schedule priority is based on medical urgency.  In the US money sets schedule priority.
If politicians decide to short fund the NHS then patients suffer for it.  Because almost everyone uses it politicians will hear it if quality slips too low and corrections will be made.

The US system is a total scam and it is not even cheap for anyone.

Gin1984

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Re: 2017 ACA plan info now available
« Reply #225 on: December 08, 2016, 02:00:57 PM »
And the UK spends about $3500 per person.. thats the root cause issue that needs to be fixed.
  Assuming that is accurate, it is because of rationing.  In 2015, the system in Great Britain ran a huge deficit (I could not find 2016).  If you need a specialist in the US, you go see one.  If your doctor in the UK thinks you need to see a specialist, you could be waiting a month to six weeks. 

See, I don't understand this. I'm in the US and if I called up by OBGYN right now - the one I've been seeing for years - wanting a routine appointment, it would probably be four to six weeks out. Same for my endocrinologist. For my son's neurologist, our first appointment with him was booking out three months or more in advance. Same for a pediatric eye doctor. And I live in a reasonably sized city with two major hospitals and a bunch of other medical offices in town. Maybe a cardiologist is quicker if you're at risk for a heart attack, but all of my experience with specialists has led me to expect getting an appointment six weeks out if I'm lucky. So whenever this argument is brought up about the UK or Canada or wherever, it makes no sense to me as being worse than what I'm experiencing now.
I went to a pain doc and was informed that insurance would not cover my injections (which I have had before) without a separate, on a separate day, consultation appointment which had not been disclosed to me when I made the original appointment.  That meant that my inject day was two weeks after my original appointment (which I was lucky to get, if I had not been able to take time off work, I would have had to wait 4 weeks).   My original appointment was three weeks after my original call, btw.

Masstache

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Re: 2017 ACA plan info now available
« Reply #226 on: December 08, 2016, 02:31:47 PM »
Just looked at the MA Connector website - my current plan ($286 Silver HSA-eligible HMO) is gone after this year, automatically replaced with a non-HSA-eligible HMO costing $525, the cheapest plan available from my current insurer in 2017. I looked but couldn't find an HSA-eligible replacement. I'll probably replace with something in the $330/year range from another insurer; hopefully my doctor is in the network, as these plans offer no out of network coverage. Does anyone else live in MA, and have you found an HSA-eligible policy? I guess no insurance provider wants to meet the $6,600 maximum out of pocket required. It will be too bad if no-one is able to fund their HSA because none of the policies qualify.


I am also happy to be in MA with lots of options, but I also didn't find any HSA-eligible plans.   There seems to be a two-tier system at work in MA.  The cheaper plans (BMC, Minuteman, Celtic, and a couple others) have extremely limited networks and aren't accepted at any of the big hospitals in the Boston area.   The other plans (Tufts, Neighborhood, Harvard Pilgrim, BCBS) all have comprehensive networks but really high costs.   I was particularly disappointed in the sharp cost increase this year, given the competitive nature of the MA market.  My Harvard Pilgrim Silver HMO for a family of four went from $1217 to $1580.  I ended up picking the Neighborhood Health Care Standardized Silver plan for $1281. 

chasesfish

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Re: 2017 ACA plan info now available
« Reply #227 on: December 09, 2016, 05:13:22 AM »
I would slow down about all of the "repeal" worries - This may sound crazy, but Dr. Tom Price was the congressman next door to where I lived when Obamacare was passed (and now the new Secretary of HHS).   He was predicting the issues with the current plan six years ago when this thing was passed, saying the rates can't hold because the penalties for NOT having insurance are too low and sick people will wait to sign up.   

I'd expect this "reform" to be gradual - Increase the band of prices that can be charged and increase the penalties for not having insurance, both of which bring more people into the fold.   
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Gin1984

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Re: 2017 ACA plan info now available
« Reply #228 on: December 09, 2016, 11:46:24 AM »
And the UK spends about $3500 per person.. thats the root cause issue that needs to be fixed.
  Assuming that is accurate, it is because of rationing.  In 2015, the system in Great Britain ran a huge deficit (I could not find 2016).  If you need a specialist in the US, you go see one.  If your doctor in the UK thinks you need to see a specialist, you could be waiting a month to six weeks. Heart attack deaths are higher in the UK than in the US, in spite of the fact that the risk factors for heart attacks are much higher in the US.  There are twice as many heart bypass surgeries here and four times as many angioplasties. 

But, hey, at least the UK got its costs down.

If you want similar costs here in the US, then you would need similar rationing, delays, and deaths.

The problem in England was fixed back in 2010, though. England’s 2010 “NHS Constitution” declared that no patient should wait beyond 18 weeks for treatment – four months - after GP referral.  A very large percentage (43% in 2012) were not being seen by specialists in that timeframe.

Each system has things to critique, but please do not hold up the UK's system as the model.  It is cheaper per person, yes, but the reasons why it is cheaper are what keep the US from adopting it.
Where did you get this data?

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Re: 2017 ACA plan info now available
« Reply #229 on: December 09, 2016, 12:17:45 PM »
For those of you in MA how does Romneycare handle low taxable income high asset people? Does it work like the ACA where assets aren't counted only taxable MAGI income? Are rates much lower for low income people or are they shuttled onto Medicaid like they do in Medicaid expanded states with the ACA? How hard is it to get residency? I use the VA so (as of now) not effect by changes or repeal of the ACA so just asking out of curiosity.

Yes, just MAGI for determination of available programs.  Anything below 300+5% FPL forces you into one of the special plans, either Masshealth, which is the MA expanded Medicaid, or ConnectorCare plans from private insurers, which provide much lower rates but also very limited networks and coverage.

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Re: 2017 ACA plan info now available
« Reply #230 on: December 09, 2016, 03:06:21 PM »
So I think we signed up for an ACA plan for 2017.
Application shows complete, and that we will have health insurance as soon as we pay first month premiums.
Our tax credits cover entire premiums, so not sure if we have to do anything. Will wait day or two to see if we are contacted or otherwise updated, and otherwise call them next week
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stoaX

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Re: 2017 ACA plan info now available
« Reply #231 on: December 09, 2016, 03:08:19 PM »
And the UK spends about $3500 per person.. thats the root cause issue that needs to be fixed.
  Assuming that is accurate, it is because of rationing.  In 2015, the system in Great Britain ran a huge deficit (I could not find 2016).  If you need a specialist in the US, you go see one.  If your doctor in the UK thinks you need to see a specialist, you could be waiting a month to six weeks. 

See, I don't understand this. I'm in the US and if I called up by OBGYN right now - the one I've been seeing for years - wanting a routine appointment, it would probably be four to six weeks out. Same for my endocrinologist. For my son's neurologist, our first appointment with him was booking out three months or more in advance. Same for a pediatric eye doctor. And I live in a reasonably sized city with two major hospitals and a bunch of other medical offices in town. Maybe a cardiologist is quicker if you're at risk for a heart attack, but all of my experience with specialists has led me to expect getting an appointment six weeks out if I'm lucky. So whenever this argument is brought up about the UK or Canada or wherever, it makes no sense to me as being worse than what I'm experiencing now.
I went to a pain doc and was informed that insurance would not cover my injections (which I have had before) without a separate, on a separate day, consultation appointment which had not been disclosed to me when I made the original appointment.  That meant that my inject day was two weeks after my original appointment (which I was lucky to get, if I had not been able to take time off work, I would have had to wait 4 weeks).   My original appointment was three weeks after my original call, btw.
Oh so true! My sister has Kaiser and had a painful lump behind her knee. Took 6 weeks to get in to see the doctor and get an X-Ray. Then another 6 weeks to get an MRI and then 2 months to see a Orthopedic Oncologist - who was the only Orthopedic Oncologist Kaiser had to service the entire SoCal and Arizona area (WTF?!) - because they thought it was cancer ( it wasn't). So 5 months to get diagnosed using a well respected private insurance provider. Makes my week long wait and fairly rapid follow up with the VA seem pretty good. I've heard somewhat long waits for appt with both PCP and specialists when I used private insurance (BCBS) but not as long as my sisters experience with Kaiser.

My wife and I joined Kaiser in SoCal 3 years ago.  We've only needed to see a specialist twice but each time appointments were available the next day.  Perhaps the specialists we needed were more common than an orthopedic oncologist.

DavidAnnArbor

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Re: 2017 ACA plan info now available
« Reply #232 on: December 11, 2016, 04:30:35 PM »
California is one of those states where the state government made an effort to have an effective health exchange and it shows.

malacca

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Re: 2017 ACA plan info now available
« Reply #233 on: December 26, 2016, 10:39:18 PM »
Having lived abroad for 20+ years and used other countries' medical systems, I can't understate how insane ours is. This whole thread is just unreal to read. People in other countries would riot if they had to go through this.

Why is it so bad?

First off, we have one big monopoly. All medical is under the AMA - which is a trade union (yes, I know it is hard to believe). This is the real problem. This big fat monopoly just can't be satisfied - always wanting more and more of the GNP.

Second, we forgot what insurance actually is. Insurance is a socialist institution. Insurance is supposed to be a pool and the lucky people do not draw out much and the unlucky people draw out more. That simple. No massive teams of lawyers, accounts, and other assorted crooks needed.

Why have so many insurance companies stopped selling on the ACA exchanges? Because they couldn't make basic insurance cost calculations. Their only skill was to rip people off by deception and dishonesty and they haven't been able to adjust to the new reality.

Now we have a new group of clowns that will try to fix what is not broken - and completely miss the parts that need fixing.

The ACA brought us:

1. Pre-existing condition coverage. This is actually a boost to the economy as people now have the freedom to move employers or start their own businesses without losing coverage. A real godsend.

2. Everyone must buy insurance. This is controversial as it does infringe on peoples' rights. But many people don't buy coverage but use the emergency room when ill. Hmmm.... The Republicans have issue with this one.

2B. No McDonalds plans allowed. Many people bought cheap plans that weren't really insurance. When they got sick they ended up in emergency rooms as did the people without coverage.

3. Limit to insurance company profitability. This brings us back to what insurance is supposed to be.

4. Exchanges. Very good idea - bring clarity and access and no 30% sales commissions. But the execution has been very poor in most states.

5. Making coverage affordable for everyone. We need to realize that government regulations created our health care monopoly. A monopoly that 50% cannot actually afford. So we have subsidies to make insurance affordable. This is the only humane thing we can do. Before ACA a family of 4 faced a $20,000 a year insurance bill (before getting sick). Not everyone makes 100,000 a year. Even at 60,000 a year a family is one step away from a medical bankruptcy.

There is more but those are the basics. Other than #2, there really isn't any sane argument against the ACA.

But is doesn't actually address the REAL problem: our medical monopoly is insane. It is taking too much of our GNP. It is essentially self regulated. There is little incentive in the system to make people healthy - the only incentive is to sell more procedures and prescriptions.


I retired at 40. Have been having / raising kids since.

DavidAnnArbor

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Re: 2017 ACA plan info now available
« Reply #234 on: December 29, 2016, 05:39:29 AM »
A surgeon would be very angry at changes that would cut his pay below $600,000 a year

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Re: 2017 ACA plan info now available
« Reply #235 on: December 29, 2016, 06:54:08 AM »
A surgeon would be very angry at changes that would cut his pay below $600,000 a year

I know this is tongue in cheek.  But I think your estimate there is a little (a lot) on the high side.  It would also be gross, not net.  Gross would not be including: salaries for a couple of employees, malpractice insurance (> $200k a year), building payments/rent in one of the most expensive districts in the city, etc.

source: my father was a surgeon
« Last Edit: December 29, 2016, 06:55:50 AM by Spork »
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Re: 2017 ACA plan info now available
« Reply #236 on: December 31, 2016, 07:15:04 AM »


There is more but those are the basics. Other than #2, there really isn't any sane argument against the ACA.

But is doesn't actually address the REAL problem: our medical monopoly is insane. It is taking too much of our GNP. It is essentially self regulated. There is little incentive in the system to make people healthy - the only incentive is to sell more procedures and prescriptions.

I think the sane argument against the ACA is that it's a poor substitute for single payer.
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DavidAnnArbor

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Re: 2017 ACA plan info now available
« Reply #237 on: January 02, 2017, 03:33:50 PM »
Based on this article, the ripple effects of ACA repeal are going to be felt by all Americans. The beneficiaries will be rich people who won't be paying the Medicare surtax on AGI income above $85K, $170K for couples.

Seniors on Medicare (majority of whom voted Republican) are going to get a wakeup call.

http://pix11.com/2017/01/02/how-repealing-obamacare-would-affect-all-americans/

redrocker

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Re: 2017 ACA plan info now available
« Reply #238 on: March 24, 2017, 09:45:50 PM »
Well, looks like today's event bought a little more time for ACA. Hell, Paul Ryan called Obamacare "the law of the land." As I read somewhere, the rightwingers have been trying to destroy ACA for 7 years, while their proposed replacement was destroyed in 17 days.

For sure, ACA could use improvement. +20% increases in premiums (as many including myself saw this year) isn't sustainable in the long run. Those living in areas where there's only one participating insurance company (or none, as some here have reported) need options.

But I guess we'll have to see now that DT and the republicans failed on going their own way without any buy-in from across the aisle (or even their own constituents) if they'll try to make an honest effort to make the existing system better going forward. Not sure I'd hold my breath on that one.

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Re: 2017 ACA plan info now available
« Reply #239 on: March 25, 2017, 03:05:15 AM »
Based on this article, the ripple effects of ACA repeal are going to be felt by all Americans. The beneficiaries will be rich people who won't be paying the Medicare surtax on AGI income above $85K, $170K for couples.

Seniors on Medicare (majority of whom voted Republican) are going to get a wakeup call.

http://pix11.com/2017/01/02/how-repealing-obamacare-would-affect-all-americans/
in 2018 there is a new bracket that gets premium increases at 133k

DavidAnnArbor

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Re: 2017 ACA plan info now available
« Reply #240 on: March 27, 2017, 08:32:54 PM »
Well, looks like today's event bought a little more time for ACA. Hell, Paul Ryan called Obamacare "the law of the land." As I read somewhere, the rightwingers have been trying to destroy ACA for 7 years, while their proposed replacement was destroyed in 17 days.

For sure, ACA could use improvement. +20% increases in premiums (as many including myself saw this year) isn't sustainable in the long run. Those living in areas where there's only one participating insurance company (or none, as some here have reported) need options.

But I guess we'll have to see now that DT and the republicans failed on going their own way without any buy-in from across the aisle (or even their own constituents) if they'll try to make an honest effort to make the existing system better going forward. Not sure I'd hold my breath on that one.

Redrocker I'm trying to understand your 20% premium increase. Are you saying you aren't eligible for subsidies under the ACA for insurance in the marketplace?

redrocker

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Re: 2017 ACA plan info now available
« Reply #241 on: March 27, 2017, 10:25:10 PM »
Redrocker I'm trying to understand your 20% premium increase. Are you saying you aren't eligible for subsidies under the ACA for insurance in the marketplace?

No, I actually am eligible for subsidies. However even post-subsidy, premiums in my area for 2017 vs 2016 are about 20% higher. No complaints on my end, as I also qualify for cost sharing and even if I didn't, I'm paying right about the same amount for health insurance as I did on my previous employer's plan.

DavidAnnArbor

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Re: 2017 ACA plan info now available
« Reply #242 on: March 28, 2017, 08:06:56 AM »
Redrocker I'm trying to understand your 20% premium increase. Are you saying you aren't eligible for subsidies under the ACA for insurance in the marketplace?

No, I actually am eligible for subsidies. However even post-subsidy, premiums in my area for 2017 vs 2016 are about 20% higher. No complaints on my end, as I also qualify for cost sharing and even if I didn't, I'm paying right about the same amount for health insurance as I did on my previous employer's plan.

So if you're eligible for the subsidies then the money you personally shell out for that health insurance won't be affected by the 20% rise in premiums. The formula for determining how much you pay is based on your income, not on the cost of that health insurance. The amount the government pays you for that health insurance is what changes, not what you personally pay out.

This is important, because what it means for me ( I also receive subsidies ) is that my health insurance costs are not going to change much even if insurance premiums go up, as long as Trump and HHS Secretary Price don't purposely sabotage the ACA.

redrocker

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Re: 2017 ACA plan info now available
« Reply #243 on: March 28, 2017, 08:17:00 AM »
So if you're eligible for the subsidies then the money you personally shell out for that health insurance won't be affected by the 20% rise in premiums. The formula for determining how much you pay is based on your income, not on the cost of that health insurance. The amount the government pays you for that health insurance is what changes, not what you personally pay out.

I might have it wrong, since my situation is slightly different between those 2 years. I've been targeting the <200% FPL bracket of subsidies and I thought I'd put in the same income for both years. Maybe I didn't. Thanks for pointing that out.

DavidAnnArbor

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Re: 2017 ACA plan info now available
« Reply #244 on: March 28, 2017, 08:34:31 AM »
So if you're eligible for the subsidies then the money you personally shell out for that health insurance won't be affected by the 20% rise in premiums. The formula for determining how much you pay is based on your income, not on the cost of that health insurance. The amount the government pays you for that health insurance is what changes, not what you personally pay out.

I might have it wrong, since my situation is slightly different between those 2 years. I've been targeting the <200% FPL bracket of subsidies and I thought I'd put in the same income for both years. Maybe I didn't. Thanks for pointing that out.

Honestly, this is confusing for me. This is my first year in the marketplace. Also my tax accountant, who also happens to be my brother, was not really helpful, because he deals with rich clients. So he's unfamiliar with that form 8962 for the premium tax credit, and maybe his tax software works doesn't work well with this form, or he simply didn't know how to use the software with respect to premium tax credits.
Nonetheless, I read Form 8962 instructions and it's accompanying publication and worksheets through very carefully.
And ultimately, my understanding is that the ACA protects the consumer by stating there is a maximum fixed % of income that can be spent on the cost for health insurance ( 9.5% of income )

Spork

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Re: 2017 ACA plan info now available
« Reply #245 on: March 28, 2017, 08:42:27 AM »
So if you're eligible for the subsidies then the money you personally shell out for that health insurance won't be affected by the 20% rise in premiums. The formula for determining how much you pay is based on your income, not on the cost of that health insurance. The amount the government pays you for that health insurance is what changes, not what you personally pay out.

I might have it wrong, since my situation is slightly different between those 2 years. I've been targeting the <200% FPL bracket of subsidies and I thought I'd put in the same income for both years. Maybe I didn't. Thanks for pointing that out.

Honestly, this is confusing for me. This is my first year in the marketplace. Also my tax accountant, who also happens to be my brother, was not really helpful, because he deals with rich clients. So he's unfamiliar with that form 8962 for the premium tax credit, and maybe his tax software works doesn't work well with this form, or he simply didn't know how to use the software with respect to premium tax credits.
Nonetheless, I read Form 8962 instructions and it's accompanying publication and worksheets through very carefully.
And ultimately, my understanding is that the ACA protects the consumer by stating there is a maximum fixed % of income that can be spent on the cost for health insurance ( 9.5% of income )

My understanding (NOT AN EXPERT!!) is that the cap is for the 2nd lowest cost silver plan.  I believe, but I am not 100% certain, if you were to buy any other plan, then there is no such guarantee.  In other words, if you don't qualify for cost sharing and you want a different plan, the 9.69% cap (2017) may not apply.  [Please correct me if I am wrong... I like to understand this stuff!]
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DavidAnnArbor

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Re: 2017 ACA plan info now available
« Reply #246 on: March 28, 2017, 09:51:18 AM »
So if you're eligible for the subsidies then the money you personally shell out for that health insurance won't be affected by the 20% rise in premiums. The formula for determining how much you pay is based on your income, not on the cost of that health insurance. The amount the government pays you for that health insurance is what changes, not what you personally pay out.

I might have it wrong, since my situation is slightly different between those 2 years. I've been targeting the <200% FPL bracket of subsidies and I thought I'd put in the same income for both years. Maybe I didn't. Thanks for pointing that out.

Honestly, this is confusing for me. This is my first year in the marketplace. Also my tax accountant, who also happens to be my brother, was not really helpful, because he deals with rich clients. So he's unfamiliar with that form 8962 for the premium tax credit, and maybe his tax software works doesn't work well with this form, or he simply didn't know how to use the software with respect to premium tax credits.
Nonetheless, I read Form 8962 instructions and it's accompanying publication and worksheets through very carefully.
And ultimately, my understanding is that the ACA protects the consumer by stating there is a maximum fixed % of income that can be spent on the cost for health insurance ( 9.5% of income )

My understanding (NOT AN EXPERT!!) is that the cap is for the 2nd lowest cost silver plan.  I believe, but I am not 100% certain, if you were to buy any other plan, then there is no such guarantee.  In other words, if you don't qualify for cost sharing and you want a different plan, the 9.69% cap (2017) may not apply.  [Please correct me if I am wrong... I like to understand this stuff!]

So if you look at the Form 8962, the 2nd lowest cost silver plan helps delineate how much of a subsidy you will receive. From there, you apply that premium subsidy to any plan you choose, whether it is a bronze plan or a gold plan. You don't lose the 9.69% cap with respect to that "2nd lowest cost silver plan." 

Spork

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Re: 2017 ACA plan info now available
« Reply #247 on: March 28, 2017, 11:15:05 AM »
So if you're eligible for the subsidies then the money you personally shell out for that health insurance won't be affected by the 20% rise in premiums. The formula for determining how much you pay is based on your income, not on the cost of that health insurance. The amount the government pays you for that health insurance is what changes, not what you personally pay out.

I might have it wrong, since my situation is slightly different between those 2 years. I've been targeting the <200% FPL bracket of subsidies and I thought I'd put in the same income for both years. Maybe I didn't. Thanks for pointing that out.

Honestly, this is confusing for me. This is my first year in the marketplace. Also my tax accountant, who also happens to be my brother, was not really helpful, because he deals with rich clients. So he's unfamiliar with that form 8962 for the premium tax credit, and maybe his tax software works doesn't work well with this form, or he simply didn't know how to use the software with respect to premium tax credits.
Nonetheless, I read Form 8962 instructions and it's accompanying publication and worksheets through very carefully.
And ultimately, my understanding is that the ACA protects the consumer by stating there is a maximum fixed % of income that can be spent on the cost for health insurance ( 9.5% of income )

My understanding (NOT AN EXPERT!!) is that the cap is for the 2nd lowest cost silver plan.  I believe, but I am not 100% certain, if you were to buy any other plan, then there is no such guarantee.  In other words, if you don't qualify for cost sharing and you want a different plan, the 9.69% cap (2017) may not apply.  [Please correct me if I am wrong... I like to understand this stuff!]

So if you look at the Form 8962, the 2nd lowest cost silver plan helps delineate how much of a subsidy you will receive. From there, you apply that premium subsidy to any plan you choose, whether it is a bronze plan or a gold plan. You don't lose the 9.69% cap with respect to that "2nd lowest cost silver plan."

We may be saying the same thing in 2 different ways... but let me explain what I am saying with numbers from plans available to me.

Lets assume I am at just under a bit under 400% FPL for a family of 2: $47,550   <- edit: I grabbed the wrong number for 400% FPL... but I think this number still illustrates my point.
9.69% of $47,550 is 4607.59.   
The second lowest silver plan retails at 1037.10/month or $12,445/year
This gives a subsidy (based on the 9.69% cap) of:  12,445 - 4607 = 7838

What I was saying is:  It is not true that 9.69% (4607.59) is the maximum that can be spent on health insurance.  That number is just used to figure out the subsidy.

If I were to pick a plan other than the second lowest cost silver, it might be more than that.

For example, there are 2 providers in my area.  If I choose the silver plan that costs $1343.57 a month ($16,122/year) ... and I apply the subsidy: 16,122 - 7838 = $8284/year.
$8284 is 17.4% of my income. 

In other words: Yes, you can find a plan that will hit the 9.69% cap... but NOT ALL PLANS hit the 9.69% cap.  If an insurance company were to price the 2nd lowest cost silver very low and other plans high relative to that plan, you're possibly going to be out more than 9.69%.  (In my area, there are bronze plans that come out above 10% after subsidy... it all depends on the plan you choose.)
« Last Edit: March 28, 2017, 01:55:42 PM by Spork »
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DavidAnnArbor

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Re: 2017 ACA plan info now available
« Reply #248 on: March 28, 2017, 03:14:43 PM »

In other words: Yes, you can find a plan that will hit the 9.69% cap... but NOT ALL PLANS hit the 9.69% cap.  If an insurance company were to price the 2nd lowest cost silver very low and other plans high relative to that plan, you're possibly going to be out more than 9.69%.  (In my area, there are bronze plans that come out above 10% after subsidy... it all depends on the plan you choose.)

Yes I totally agree with you. I only ever contemplate getting some kind of bronze plan with an HSA because in my life at this point that's all I need.

Those of course that can get that MAGI down to below 250% of Federal Poverty Limit can also benefit not only from the premium subsidy but an additional "cost sharing" limited deductibles, etc.

Threshkin

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Re: 2017 ACA plan info now available
« Reply #249 on: March 29, 2017, 05:11:45 PM »
Please keep in mind that the premium increases are real.  They are just masked by the subsidy.  The money is still being paid to the insurance companies by the government.  Where does the government get its money?  From taxes.  This is an example of using OPM (other people's money).  OPM works until it runs out.

Also, the insurance companies are raising their rates and/or dropping out of the program because they are loosing money.  If they cannot make a profit they must either raise prices or stop selling the product.

ACA repeal failed, not because of Democratic opposition (though that was a factor) but because the Republican Freedom Caucus thought that the replacement plan was just as bad as ACA.  They want even more aggressive changes and would not support the Trump/Ryan plan because they considered it to be "ACA Lite".

This situation reminds me of the first two years of the Obama presidency where, despite holding majorities in the Senate an the House, the Democrats had trouble getting their agenda passed.  Just like now, this was not only caused by Republican opposition but also by disagreement within the Democratic party.

It is all the same shit all over again.

I am FIRE but not eligible for subsidies until 2018 (due to the sale of stock options)  As a result my best insurance option was COBRA at over $900/month for two healthy people.  This is an HSA plan and the deductibles are high, around $2500 as I recall.  The main thing my $900 a month gets me is the negotiated rates with the service providers.  Unfortunately, negotiated rates are completely opaque to the consumer.  There is no way to compare plans based on these rates.  This is my biggest pet peeve with health care because it means I cannot comparison shop using the criteria that matters.