Author Topic: ACA Post Fire Experiences?  (Read 3773 times)

swagster

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ACA Post Fire Experiences?
« on: February 06, 2019, 10:50:33 AM »
Hi- I'm new to the board and somewhat new to FIRE.  My wife and I are both 46 and are considering retiring early.  We have the amount we would need for early retirement but our biggest concern is healthcare / ACA.  We are in Texas so we have only the Federal marketplace (I have run some scenarios on their site).  I should also add we have two teens and my wife tends to have a healthcare issue about 1-2 times a year.  Nothing life threating but a knee surgery or gastritis type issue would be two examples.

My question is what experiences have others had who have FIREd early?  I have looked through the forums here and at other information sources and we could qualify for the subsidy by controlling income, which is discussed in great detail on other posts.  We are more concerned with what life is actually like on the other side.  We have "good" insurance now through our employers and I would like to know what your experience has been like with ACA insurance. For example:

Have you had to change doctors?
Is it hard to get appointments?
Is it hard to get seen by a specialist?
Are some drugs not covered?
Bronze vs Silver vs Gold?
Any good or bad surprises?

I would really appreciate any input on these questions plus the many more I'm probably not thinking to ask.  I would also greatly appreciate any guidance to other sources of this kind of information.  I'm usually pretty good at finding what I'm looking for, but most of the experiences discussed elsewhere relate more to those who were without insurance when they got coverage.

Thank you in advance.

jim555

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Re: ACA Post Fire Experiences?
« Reply #1 on: February 06, 2019, 11:44:53 AM »
Every state and county can be different when it comes to plans and networks.  So unless you can find someone in your immediate area on ACA I don't know how useful someone in another state will be to you.

My state has its own web site and enrollment period which differs from most other states.  I have been on a Medicaid Managed care plan for many years which has been very good.

geekette

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Re: ACA Post Fire Experiences?
« Reply #2 on: February 06, 2019, 07:29:56 PM »
We've gotten an ACA silver plan since (almost) the beginning (May, 2014).  Things change.  Doctors and insurance carriers come and go.  Even when we were on company insurance that happened.

That said, we haven't had much in the way of problems, even though we've gone back and forth between BCBS and United Health care.  We did lose our primary care doctor after 2015, but we found a new practice we like about the same.  No problem with specialists here.  We're in a very saturated health care area, though. 

From our experience, you can find out which practices participate for the current year and the current crop of plans, but there are no guarantees things won't change the next year. 

Goldendog777

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Re: ACA Post Fire Experiences?
« Reply #3 on: February 06, 2019, 08:16:14 PM »
I quit my job at the end of December to go back to school.  Our investments cover our basic living expenses.  I had great insurance with Aetna through my mega Corp with only a $500 deductible and I could see any doc I wanted.  We chose a silver plan on the exchange through Health Plan of Nevada (HPN). We only had 2 insurance companies to choose from and both are HMOs which Iím not used to.  We had a really hard time finding a PCP that would take it and the docs on the list that are accepting new patients do not get the best reviews.  Iím disappointed with what is offered but didnít have a choice unless I wanted to continue to work at mega Corp until Iím 65!  I believe TX is also one of those places you can only buy an HMO plan as well.  No great solutions. 

secondcor521

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Re: ACA Post Fire Experiences?
« Reply #4 on: February 06, 2019, 09:46:07 PM »
Have you had to change doctors?
Is it hard to get appointments?
Is it hard to get seen by a specialist?
Are some drugs not covered?
Bronze vs Silver vs Gold?
Any good or bad surprises?

For context, I'm in Idaho, I'm 49 with three kids, two of whom are in high school.  FIREd and have had an ACA plan with SelectHealth for 3 years.

I haven't had to change doctors, but I do check each year to confirm that my primary care doc is on my plan.  He's been on my plan every year so far.  I am relatively healthy and as long as the doctor is board certified I don't really care much.

Not hard at all to get appointments.  Being retired and having a relatively wide open schedule helps with this too.  Tomorrow at 2pm?  Sure.

Not hard to get seen by a specialist.  My plan is a PPO, though, so I don't need to clear it with my PCP.

I've never had a drug not covered.  I've had antibiotics covered for me, and ADHD meds covered for my son, and allergy serums covered for my daughter.

I like Silver with CSR 87, which IIRC means an AGI between 150% and 200% of FPL.  When my kids graduate off the plan I'll consider a Bronze plan which would probably be with $0 premium if I'm still in good health then.

Overall I've been pleasantly surprised.

Frankies Girl

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Re: ACA Post Fire Experiences?
« Reply #5 on: February 06, 2019, 10:21:16 PM »
I'm in a major metro city in a state that did not do a state exchange or expand medicare, spouse w/no kids, FIREd about 4 years ago and been on ACA ever since. We control our $ so I get the sweet, sweet subsidy and cost sharing and my insurance is cheapy cheap for a silver. No dental because we don't mind paying OOP for the occasional toothy needs.

Have you had to change doctors?
Only if I wanted to. 

Is it hard to get appointments?
Why would your insurance make a difference in getting appointments? I've never had any issues whatsoever. My insurance was once BCBS, and then a non-profit company well known in the city.


Is it hard to get seen by a specialist?
No? See above. Unless you're going for the bottom of the barrel "Crazy Juan's Insurancepalooza Company, LTD." I have no idea why seeing any specialist would be dependent on your insurance in a basically decent area that normally takes different insurances. If you have a small town where the specialists are not plentiful, then you likely would see a wait but that shouldn't have anything to do with insurance and has definitely not been my experience.


Are some drugs not covered?
Nothing I ran into that are any different than when I had work insurance. Most generic every day stuff is not even worth submitting through insurance for me anyway considering you can get them for like $4/30 days or $10/90 days. I also use things like GoodRX and RetailMeNot's script discounts and get things SUPER cheap even more than most insurance anyway.


Bronze vs Silver vs Gold?
We're basically healthy, but I worry so we did Silver. Again, we control our income tho, so it's like having a platinum level with the perks for the cost savings/subsidy.

Any good or bad surprises?
Our current insurance company gives us 10% off our monthly premiums just for taking a 2 minute health assessment survey (it's laughably easy and not at all intrusive). They are SO MUCH BETTER than just about all the companies I'd been with in past like BCBS, Humana, Signa, etc... nicer people, helpful people, and coverage has been so easy even for things like surgery. Hardly any paperwork or balanced billing garbage or runarounds with miscodes and all sorts of quibbles I used to have to untangle in the past. And I hadn't realized they were non-profit when I first went with them (literally just decided I was sick of BCBS BS) but they have been really amazing. They have had to increase prices slightly (under 5%/year) and they reduced a few coverages since I started with them but it's been really modest and you can tell they're trying to keep things as fair and evenly priced as they can.

Something to consider: since insurance is now state/region based, you may want to get traveling coverage if you vacation far outside your network area. You still get basic emergency coverage no matter what, but some insurance companies might be right bastards and try to stick you with out of state bills if they deem your emergency "not really an emergency emergency" or you linger longer than they feel is necessary in an out of network facility.
« Last Edit: February 18, 2019, 01:36:45 AM by Frankies Girl »

secondcor521

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Re: ACA Post Fire Experiences?
« Reply #6 on: February 06, 2019, 11:05:00 PM »
The above post reminded me...I joined a gym about a year ago and my insurance company will now reimburse me for my membership as long as I meet a few basic requirements (that I have already met).  So that's pretty nice.  I belong to a cheap gym at about $150 a year, but still better than a kick in the pants.

Mr. Green

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Re: ACA Post Fire Experiences?
« Reply #7 on: February 07, 2019, 06:19:33 AM »
Once you select a plan, you're just like any other person who has insurance with that company. You're not treated differently because it was purchased through the ACA. So it's all about the details of that particular plan, which really isn't any different than if you were getting insurance through an employer. You definitely want to do your due diligence on plans available to you for things like how big the doctor networks are, if they offer out of network coverage, etc.

EnjoyIt

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Re: ACA Post Fire Experiences?
« Reply #8 on: February 18, 2019, 01:06:41 AM »
In my area the ACA plans are very poor.  No PPO options, with very little choice on the physicians you want.  Many who accept the ACA plans are not very good physicians. 

For the comment above, being board certified does not mean one is a good physician.  it just means that physician was able to pass a test.  There is much controversy in the medical community lately that board certification is an expensive meaningless certification that has never been shown to provide better outcomes to patients.  The American Board of Internal Medicine is being sued for this.

Monkey Uncle

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Re: ACA Post Fire Experiences?
« Reply #9 on: February 18, 2019, 08:39:12 AM »
In my area the ACA plans are very poor.  No PPO options, with very little choice on the physicians you want.  Many who accept the ACA plans are not very good physicians. 

For the comment above, being board certified does not mean one is a good physician.  it just means that physician was able to pass a test.  There is much controversy in the medical community lately that board certification is an expensive meaningless certification that has never been shown to provide better outcomes to patients.  The American Board of Internal Medicine is being sued for this.

As jim555 said, it varies a lot from place to place.  My state only has one insurer that provides ACA plans, but it's a Blue Cross/Blue Shield affiliate.  I manage my income well enough to nearly max out the PTC and cost sharing on a silver plan.  It's as good or better than my previous employer provided plan, 95% of the providers in the state are in their network, they provide out-of-state coverage through other BC/BS affiliates, and I pay about $150 a year.  It's the best health insurance I've ever had, except maybe for a brief period in the early '90s when I worked for an employer that paid my premiums in full.

EnjoyIt

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Re: ACA Post Fire Experiences?
« Reply #10 on: February 18, 2019, 01:13:39 PM »
In my area the ACA plans are very poor.  No PPO options, with very little choice on the physicians you want.  Many who accept the ACA plans are not very good physicians. 

For the comment above, being board certified does not mean one is a good physician.  it just means that physician was able to pass a test.  There is much controversy in the medical community lately that board certification is an expensive meaningless certification that has never been shown to provide better outcomes to patients.  The American Board of Internal Medicine is being sued for this.

As jim555 said, it varies a lot from place to place.  My state only has one insurer that provides ACA plans, but it's a Blue Cross/Blue Shield affiliate.  I manage my income well enough to nearly max out the PTC and cost sharing on a silver plan.  It's as good or better than my previous employer provided plan, 95% of the providers in the state are in their network, they provide out-of-state coverage through other BC/BS affiliates, and I pay about $150 a year.  It's the best health insurance I've ever had, except maybe for a brief period in the early '90s when I worked for an employer that paid my premiums in full.

For me it is the exact opposite.  I was on the ACA plan for a few years and it was the worst insurance I ever had because the specialists I had access to were shit.  I am in a unique position to know these doctors and the quality of their work. 

tenant13

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Re: ACA Post Fire Experiences?
« Reply #11 on: February 21, 2019, 03:23:12 PM »
I've JUST FIRE'd and am finding hard way that ACA sucks. I live in NJ but always worked in NY and all my employer's sponsored plans covered both states. All my doctors are in NY. NJ ACA plans don't allow me to use any of them. They also don't cover anything that's out of network. So I'm basically forced to reset my whole healthcare situation. On top of that NJ passed its own individual mandate law so I must be insured or face penalty... I'm still in the state of WTF... so I'm not sure if I stick to my guns and stay FIRE'd, go back to work just for the insurance sake (ugh...) or do absolutely nothing, go on Medicaid (which nobody in NJ accepts anyway) and pay out of pocket for the doctors I actually want to see.

soccerluvof4

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Re: ACA Post Fire Experiences?
« Reply #12 on: February 22, 2019, 05:19:27 AM »
I've JUST FIRE'd and am finding hard way that ACA sucks. I live in NJ but always worked in NY and all my employer's sponsored plans covered both states. All my doctors are in NY. NJ ACA plans don't allow me to use any of them. They also don't cover anything that's out of network. So I'm basically forced to reset my whole healthcare situation. On top of that NJ passed its own individual mandate law so I must be insured or face penalty... I'm still in the state of WTF... so I'm not sure if I stick to my guns and stay FIRE'd, go back to work just for the insurance sake (ugh...) or do absolutely nothing, go on Medicaid (which nobody in NJ accepts anyway) and pay out of pocket for the doctors I actually want to see.

Not trying to be sarcastic at all but if nobody accepts Medicaid and ACA is that much of a nightmare , the way Healthcare is seemingly going for Fire it might be a good idea if your able to move to a more fitting situation. We kind of ran into the same situation as you and with 4 kids didnt want to take the chance with people we were talking to in our area so for now My DW took a very easy pleasy job with Health Insurance till we can figure out what were going to do. Maybe its just me but at the very least I think things are going to get worse before better.

EnjoyIt

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Re: ACA Post Fire Experiences?
« Reply #13 on: February 22, 2019, 04:37:12 PM »
I've JUST FIRE'd and am finding hard way that ACA sucks. I live in NJ but always worked in NY and all my employer's sponsored plans covered both states. All my doctors are in NY. NJ ACA plans don't allow me to use any of them. They also don't cover anything that's out of network. So I'm basically forced to reset my whole healthcare situation. On top of that NJ passed its own individual mandate law so I must be insured or face penalty... I'm still in the state of WTF... so I'm not sure if I stick to my guns and stay FIRE'd, go back to work just for the insurance sake (ugh...) or do absolutely nothing, go on Medicaid (which nobody in NJ accepts anyway) and pay out of pocket for the doctors I actually want to see.

Not trying to be sarcastic at all but if nobody accepts Medicaid and ACA is that much of a nightmare , the way Healthcare is seemingly going for Fire it might be a good idea if your able to move to a more fitting situation. We kind of ran into the same situation as you and with 4 kids didnt want to take the chance with people we were talking to in our area so for now My DW took a very easy pleasy job with Health Insurance till we can figure out what were going to do. Maybe its just me but at the very least I think things are going to get worse before better.

I agree that things will continue to get worse. It is so location dependent. Some areas the ACA offers excellent services and providers while other areas you are stuck with very poor choices and of those choices you get poor quality.

I wonder if the market has or will improved with non ACA plans if the individual mandate is not law anymore? I would love to purchase a similar plan I had prior to ACA even if I have to pay todayís prices.

TheWryLady

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Re: ACA Post Fire Experiences?
« Reply #14 on: February 22, 2019, 11:49:46 PM »
We've had ACA bronze for several years.  This year we have BCBS bronze ACA and I now have same doctor I had while working.  They have many doctors in network, but some other bronze never-heard-of-before insurance company options we had in prior years seemed to have less doctors, and iffy member services.  I think the negotiated rates, online member services and quality of doctors is better with a bigger company.

New with ACA is the ability to have some family members on one plan and other members on another, so if one needs gold, and others bronze, you can do that.

A good surprise...I just turned 50, and got a free colonoscopy...well I did have to pay $100 for the prep liquid.  I expected some bill to come later, like anesthesiologist not in network or some other BS, but that didn't happen.

soccerluvof4

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Re: ACA Post Fire Experiences?
« Reply #15 on: February 23, 2019, 03:37:15 AM »
We've had ACA bronze for several years.  This year we have BCBS bronze ACA and I now have same doctor I had while working.  They have many doctors in network, but some other bronze never-heard-of-before insurance company options we had in prior years seemed to have less doctors, and iffy member services.  I think the negotiated rates, online member services and quality of doctors is better with a bigger company.

New with ACA is the ability to have some family members on one plan and other members on another, so if one needs gold, and others bronze, you can do that.

A good surprise...I just turned 50, and got a free colonoscopy...well I did have to pay $100 for the prep liquid.  I expected some bill to come later, like anesthesiologist not in network or some other BS, but that didn't happen.
I've JUST FIRE'd and am finding hard way that ACA sucks. I live in NJ but always worked in NY and all my employer's sponsored plans covered both states. All my doctors are in NY. NJ ACA plans don't allow me to use any of them. They also don't cover anything that's out of network. So I'm basically forced to reset my whole healthcare situation. On top of that NJ passed its own individual mandate law so I must be insured or face penalty... I'm still in the state of WTF... so I'm not sure if I stick to my guns and stay FIRE'd, go back to work just for the insurance sake (ugh...) or do absolutely nothing, go on Medicaid (which nobody in NJ accepts anyway) and pay out of pocket for the doctors I actually want to see.

Not trying to be sarcastic at all but if nobody accepts Medicaid and ACA is that much of a nightmare , the way Healthcare is seemingly going for Fire it might be a good idea if your able to move to a more fitting situation. We kind of ran into the same situation as you and with 4 kids didnt want to take the chance with people we were talking to in our area so for now My DW took a very easy pleasy job with Health Insurance till we can figure out what were going to do. Maybe its just me but at the very least I think things are going to get worse before better.

I agree that things will continue to get worse. It is so location dependent. Some areas the ACA offers excellent services and providers while other areas you are stuck with very poor choices and of those choices you get poor quality.

I wonder if the market has or will improved with non ACA plans if the individual mandate is not law anymore? I would love to purchase a similar plan I had prior to ACA even if I have to pay todayís prices.


I just hope something gets put in place sooner or later because the whole plane when we fire'd four years ago was to be done and while my DW loves her job and its saving us about 5k a month when you consider get HC and not paying out of pocket and then adding to 401k , HSA and whats left savings it wasnt the plan. But with 4 kids we just couldnt take a chance so it was her or me and since i was the bread winner and gave up almost 30 years something she really wanted to do. Originally we said 3 years max but now since were stuck here for at least 3.5 years I would think she would keep working since as I said she loves it till then or we get something resolved with ACA that makes sense. Fortunately shes 4 years younger than me.

soccerluvof4

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Re: ACA Post Fire Experiences?
« Reply #16 on: February 23, 2019, 03:37:42 AM »
We've had ACA bronze for several years.  This year we have BCBS bronze ACA and I now have same doctor I had while working.  They have many doctors in network, but some other bronze never-heard-of-before insurance company options we had in prior years seemed to have less doctors, and iffy member services.  I think the negotiated rates, online member services and quality of doctors is better with a bigger company.

New with ACA is the ability to have some family members on one plan and other members on another, so if one needs gold, and others bronze, you can do that.

A good surprise...I just turned 50, and got a free colonoscopy...well I did have to pay $100 for the prep liquid.  I expected some bill to come later, like anesthesiologist not in network or some other BS, but that didn't happen.
I've JUST FIRE'd and am finding hard way that ACA sucks. I live in NJ but always worked in NY and all my employer's sponsored plans covered both states. All my doctors are in NY. NJ ACA plans don't allow me to use any of them. They also don't cover anything that's out of network. So I'm basically forced to reset my whole healthcare situation. On top of that NJ passed its own individual mandate law so I must be insured or face penalty... I'm still in the state of WTF... so I'm not sure if I stick to my guns and stay FIRE'd, go back to work just for the insurance sake (ugh...) or do absolutely nothing, go on Medicaid (which nobody in NJ accepts anyway) and pay out of pocket for the doctors I actually want to see.

Not trying to be sarcastic at all but if nobody accepts Medicaid and ACA is that much of a nightmare , the way Healthcare is seemingly going for Fire it might be a good idea if your able to move to a more fitting situation. We kind of ran into the same situation as you and with 4 kids didnt want to take the chance with people we were talking to in our area so for now My DW took a very easy pleasy job with Health Insurance till we can figure out what were going to do. Maybe its just me but at the very least I think things are going to get worse before better.

I agree that things will continue to get worse. It is so location dependent. Some areas the ACA offers excellent services and providers while other areas you are stuck with very poor choices and of those choices you get poor quality.

I wonder if the market has or will improved with non ACA plans if the individual mandate is not law anymore? I would love to purchase a similar plan I had prior to ACA even if I have to pay todayís prices.


I just hope something gets put in place sooner or later because the whole plane when we fire'd four years ago was to be done and while my DW loves her job and its saving us about 5k a month when you consider get HC and not paying out of pocket and then adding to 401k , HSA and whats left savings it wasnt the plan. But with 4 kids we just couldnt take a chance so it was her or me and since i was the bread winner and gave up almost 30 years something she really wanted to do. Originally we said 3 years max but now since were stuck here for at least 3.5 years I would think she would keep working since as I said she loves it till then or we get something resolved with ACA that makes sense. Fortunately shes 4 years younger than me.

Trifele

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Re: ACA Post Fire Experiences?
« Reply #17 on: February 24, 2019, 04:39:50 AM »
I was the sole breadwinner for our family (2 adults 2 kids), and just FIREd at the end of January.  We went on an ACA plan, bronze level high deductible.  So far so good.  The sign up process was fairly smooth and the ACA help desk people were really competent and helpful.  We kept the same doctors we had had before, as they also participate with the new plan.  We are normally extremely light users of insurance (no meds and almost no doctor visits in the past two years) and regard it as a safety net only.   

I can't help but think that this is a house of cards though, that can crumble at any time if the subsidies are tinkered with.  Without subsidies the price for our bronze high deductible would be $2100 a month.   That is insane.  Pay $2100 a month just to have high deductible insurance? 

We are lean-FIRE, so if the ACA subsidies go away then one of us will probably have to get a job with insurance until Medicare kicks in. 
   

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Re: ACA Post Fire Experiences?
« Reply #18 on: February 24, 2019, 04:56:38 AM »
I was the sole breadwinner for our family (2 adults 2 kids), and just FIREd at the end of January.  We went on an ACA plan, bronze level high deductible.  So far so good.  The sign up process was fairly smooth and the ACA help desk people were really competent and helpful.  We kept the same doctors we had had before, as they also participate with the new plan.  We are normally extremely light users of insurance (no meds and almost no doctor visits in the past two years) and regard it as a safety net only.   

I can't help but think that this is a house of cards though, that can crumble at any time if the subsidies are tinkered with.  Without subsidies the price for our bronze high deductible would be $2100 a month.   That is insane.  Pay $2100 a month just to have high deductible insurance? 

We are lean-FIRE, so if the ACA subsidies go away then one of us will probably have to get a job with insurance until Medicare kicks in. 
 


My concerns in a nutshell!

Trifele

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Re: ACA Post Fire Experiences?
« Reply #19 on: February 24, 2019, 05:10:18 AM »
I was the sole breadwinner for our family (2 adults 2 kids), and just FIREd at the end of January.  We went on an ACA plan, bronze level high deductible.  So far so good.  The sign up process was fairly smooth and the ACA help desk people were really competent and helpful.  We kept the same doctors we had had before, as they also participate with the new plan.  We are normally extremely light users of insurance (no meds and almost no doctor visits in the past two years) and regard it as a safety net only.   

I can't help but think that this is a house of cards though, that can crumble at any time if the subsidies are tinkered with.  Without subsidies the price for our bronze high deductible would be $2100 a month.   That is insane.  Pay $2100 a month just to have high deductible insurance? 

We are lean-FIRE, so if the ACA subsidies go away then one of us will probably have to get a job with insurance until Medicare kicks in. 
 


My concerns in a nutshell!

Yep, it's not good.  But for us -- after much consideration -- it was worth it to jump and take the plunge.   No regrets.  At the very least, even if spouse or I have to go back to work some day just for insurance, I will have gotten a much needed break of a year or more.   

Evgenia

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Re: ACA Post Fire Experiences?
« Reply #20 on: February 26, 2019, 04:31:56 PM »
We've been FIRE for almost four full years. The ACA was far better in the first two of those than in the last, for obvious political reasons well documented elsewhere. To the specifics you asked about:

* Re: "we could qualify for the subsidy by controlling income, which is discussed in great detail on other posts." Yes, do this whenever you can. It has worked out well for us.

* If you plan to work at all, as many FIRE types do, your monthly premiums are tax deductible. You can do that and qualify for the subsidy. Just something to consider if you have not already.

* Have you had to change doctors? No, we did not have to, but we did last month (at the 3.5 year FIRE mark) because we switched to Kaiser in CA to save $400/month on premiums. We are very glad we did.

* Is it hard to get appointments? No, it was not any harder than usual/before FIRE.

* Is it hard to get seen by a specialist? No, no harder than usual (the referral game, all that nonsense). It is MUCH easier with Kaiser, I'll say that much.

* Are some drugs not covered? It varied according to plan, but was no different than our pre FIRE plan.

* Bronze vs Silver vs Gold? We do a Bronze HDHP with HSA for additional tax savings purposes. We have used the HSA for co-pays and other things.

* Any good or bad surprises?

The bad surprise was a couple of doctors who saw the state exchange logo on our insurance card and looked at us like we were scum of the earth and the card might bite them as they dropped it on the counter and said "Ooooh, we don't take THIS Blue Cross insurance." Before you go to any doctor, call ahead and make sure they take not just the insurer name but your exact plan. Also, the doctors listed as in-network on the insurer websites are often not, in actuality, so I advise calling the doctor about that too. In many cases for us, the insurance was wrong, and we would have had to pay out of network. Also, doctors in the same office can be in-or-out-of-network. (I have family in the EU and have no words for how much I despise this inefficient, crazy, labor-making system in the US, but anyway.)

The good surprise is how much better Kaiser has been, for $400 less per month and the same deductible. So far, so good. Good luck!

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Re: ACA Post Fire Experiences?
« Reply #21 on: October 30, 2019, 01:55:18 PM »
I've JUST FIRE'd and am finding hard way that ACA sucks. I live in NJ but always worked in NY and all my employer's sponsored plans covered both states. All my doctors are in NY. NJ ACA plans don't allow me to use any of them. They also don't cover anything that's out of network. So I'm basically forced to reset my whole healthcare situation. On top of that NJ passed its own individual mandate law so I must be insured or face penalty... I'm still in the state of WTF... so I'm not sure if I stick to my guns and stay FIRE'd, go back to work just for the insurance sake (ugh...) or do absolutely nothing, go on Medicaid (which nobody in NJ accepts anyway) and pay out of pocket for the doctors I actually want to see.

UPDATE (I actually made a separate post about this because now I have some specific questions relating to my current situation): I (55) stopped working in May after making around 50k this year. Due to losing a job (it was a gig with an end date so Special Enrollment Period came into play ) I enrolled in an ACA plan but then almost right away had to leave the country for 4 months to take care of my mother in Europe. So I cancelled ACA and bought travel insurance for that period - ACA wouldn't cover me in Europe anyway. When I came back it turned out that I'm unable to re-enroll because I cancelled the coverage voluntarily. So I'd have to wait until open enrollment. All of this is new to me so it took me a while and a few phone calls to learn this. The exchange specialist told me however that since my monthly income (interest + dividends) is less than $1463 I would qualify for Medicaid which is called NJ FamilyCare here. Medicaid's eligibility is verified by checking monthly income so even though my MAGI for 2019 exceeds their threshold, they apparently don't care. Sure enough I did qualify and am now covered by Horizon FamilyCare plan. Zero premiums, deductibles, co-pays or drug charges... I have an option of going to ACA next year by inflating my income but I'll give Medicaid a shot and see how it works. I know it's basically a loan and they'll go after my estate after I die but it's fine with me, I have no heirs and don't plan to leave much behind.

Fishindude

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Re: ACA Post Fire Experiences?
« Reply #22 on: October 31, 2019, 08:23:37 AM »
Have you had to change doctors?
Is it hard to get appointments?
Is it hard to get seen by a specialist?
Are some drugs not covered?
Bronze vs Silver vs Gold?
Any good or bad surprises?

I'm in Indiana 60 years old, spouse is 57, we are on the Silver plan, no discounts due to income, costs $1185 per mo.

We are still using same doctors.
No issue getting appointments.
No issues seeing a specialist.
Have not run into any prescriptions that weren't covered.

We now have some co pays, no longer have dental or vision coverage, and the percentage we pay out of pocket on prescriptions and everything is higher than what is was with my employer's healthcare package.
Overall, no big complaints other than the cost of the plan.   Pre ACA you could buy a similar private insurance plan for half the price.


gatortator

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Re: ACA Post Fire Experiences?
« Reply #23 on: October 31, 2019, 02:31:22 PM »
I can't answer the question for the OP but I do have two questions to add-on to this general topic.

For Post-FIRE,  our projected monthly income will be low enough that our kids will qualify for CHIP while we (2 adults) will be on an ACA plan.  Has anyone else done  this and had any issue?


 

secondcor521

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Re: ACA Post Fire Experiences?
« Reply #24 on: October 31, 2019, 03:01:24 PM »
I can't answer the question for the OP but I do have two questions to add-on to this general topic.

For Post-FIRE,  our projected monthly income will be low enough that our kids will qualify for CHIP while we (2 adults) will be on an ACA plan.  Has anyone else done  this and had any issue?

I haven't done it, but depending on the family income and the way your state structures CHIP eligibility, that is one possible outcome.  If you're OK with you being on an ACA plan and your kids being on CHIP, then it's fine.

If you don't want your kids on CHIP for any reason, one thing you can possibly do is raise your AGI by doing traditional to Roth conversions.  Of course you would have to pay ordinary income taxes on the amount converted.

Also note that CHIP is usually evaluated on a monthly basis and ACA is evaluated on a yearly basis.  If you want to, I think there may be strategies that you can employ due to that difference to try to keep them on or off CHIP, whichever you are trying to do.

Padonak

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Re: ACA Post Fire Experiences?
« Reply #25 on: October 31, 2019, 03:02:36 PM »
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Financial.Velociraptor

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Re: ACA Post Fire Experiences?
« Reply #26 on: November 01, 2019, 01:43:15 PM »
My premium will go down for the first time this year.  I'll pay under 350/mo for Bronze plan in TX.  Single 47 yr old male, non-smoker.  It's net "free" after the subsidy most years.

Cali4en

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Re: ACA Post Fire Experiences?
« Reply #27 on: November 02, 2019, 05:03:10 PM »
Quote
I can't answer the question for the OP but I do have two questions to add-on to this general topic.

For Post-FIRE,  our projected monthly income will be low enough that our kids will qualify for CHIP while we (2 adults) will be on an ACA plan.  Has anyone else done  this and had any issue?

Our annual budget is low enough that our kids are forced into our state Medicaid system, which is effectively the same as CHIP without the copays, while we are on an (incredible) ACA silver plan.

Medicaid/CHIP is fine here in Texas, but as it is a state program I can't speak to how it is in other states.  Our kids kept all of their doctors and we haven't experienced any meaningful difference in terms of what Medicaid covers versus what our Cadillac employer-provided insurance covered when we were pre-FIRE.

Quote
My premium will go down for the first time this year.  I'll pay under 350/mo for Bronze plan in TX.  Single 47 yr old male, non-smoker.  It's net "free" after the subsidy most years.

Our premium is also going down this year for the first time.  After the cash-back incentives for things like getting an annual physical and a flu shot, our net cost for the entire year is going to be under $50.  Better insurance than when we had excellent coverage through work and it is effectively free in terms of cost to us.

Trifele

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Re: ACA Post Fire Experiences?
« Reply #28 on: November 03, 2019, 05:02:42 AM »
We are just finishing our first year on ACA coverage -- so far, so good.  Our premium for family coverage (bronze high deductible) is going down by about 10% for 2020.  We are debating whether to stay put on that bronze plan or hop over to a silver plan instead for the coming year.

Exflyboy

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Re: ACA Post Fire Experiences?
« Reply #29 on: November 03, 2019, 12:03:02 PM »
We are just finishing our first year on ACA coverage -- so far, so good.  Our premium for family coverage (bronze high deductible) is going down by about 10% for 2020.  We are debating whether to stay put on that bronze plan or hop over to a silver plan instead for the coming year.

We have had a bronze plan for three years and its been fine so far and its virtually free at our gerrymandered income level.

One wrinkle is that one of DW's asthma inhalers costs $270 from Walmart ($270 for a month so that you can do something optional.. like breathe!).

So this drug is actually made in the UK. If you hop onto "medixpharmacy.co.uk" and type in your drug name you'll see the price they can mail order it to you for.

In our case its $26.. And you know thats the "I can't believe what Americans will pay for this stuff" price. You just need to persuade your Doc to give you a prescription. I get them to give me the American prescription and the Pharmacy convert the trade names into the English version and they ship you that. You can get 90 days supply at any one time and the US Government "allows that".. How nice of them..:(

Everything else has been OK though, any other meds have been $10 generics from Walmart.. One of mine is $60 for a 90 day supply, but $21 with a Good RX coupon. I also discovered I get no symptoms by cutting my pills in half...:)