Author Topic: ACA Sticker shock, give me an alternative  (Read 38702 times)

jp

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ACA Sticker shock, give me an alternative
« on: February 28, 2014, 12:32:05 PM »
We currently have a $10k/person $20k/family deductible.  We are a family of 4 with 2 kids (5 & 7).  My current plan runs less than $250 per month and we have never had more than $1000 in medical expenses in a year in our lives.

I just got a cancellation notice, which I have been expecting.  I checked out some plans, and the very cheapest policy is $900 per month.  I flat out will not pay that, in all seriousness, I will not pay that.

I looked at putting the kids on a catastrophic plan and then the wife and I on a bronze plan (we can't because we are over 30), it is still like $750.  So, to hell with that.

I have read about health sharing ministries.  I haven't looked to see if that is available in my area.  (See here:   http://www.cnbc.com/id/100935430  ) 

If I understand the current law, I can just enroll in the open enrollment period in any year?  So even if I get cancer in June, I just have to survive until open enrollment in January?  Is that right?

I am not a political person, this isn't a left/right thing.  The law is passed, I just want to know how to get out of it if anyone has figured it out.  Ideas?

beltim

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Re: ACA Sticker shock, give me an alternative
« Reply #1 on: February 28, 2014, 12:42:35 PM »
You can still buy non-ACA compliant policies and pay the penalty for not having an ACA-compliant policy.  For the next year or two, that may save you a significant amount of money.

jp

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Re: ACA Sticker shock, give me an alternative
« Reply #2 on: February 28, 2014, 12:47:17 PM »
You can still buy non-ACA compliant policies and pay the penalty for not having an ACA-compliant policy.  For the next year or two, that may save you a significant amount of money.

Thanks, I didn't know that.  If only my policy was not being cancelled, I would just stay on that for a few years and pay the penalty.  Are there a lot of insurers  offering these plans?

Gin1984

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Re: ACA Sticker shock, give me an alternative
« Reply #3 on: February 28, 2014, 12:51:04 PM »
You can still buy non-ACA compliant policies and pay the penalty for not having an ACA-compliant policy.  For the next year or two, that may save you a significant amount of money.

Thanks, I didn't know that.  If only my policy was not being cancelled, I would just stay on that for a few years and pay the penalty.  Are there a lot of insurers  offering these plans?
Why don't you ask your current insurance company?

beltim

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Re: ACA Sticker shock, give me an alternative
« Reply #4 on: February 28, 2014, 12:57:53 PM »
You can still buy non-ACA compliant policies and pay the penalty for not having an ACA-compliant policy.  For the next year or two, that may save you a significant amount of money.

Thanks, I didn't know that.  If only my policy was not being cancelled, I would just stay on that for a few years and pay the penalty.  Are there a lot of insurers  offering these plans?
Why don't you ask your current insurance company?

That's a good idea.  Honestly, I don't know the number of insurance companies offering non-ACA compliant plans.  I do know there's still a decent market for short-term insurance policies, which may be another option for you.  They also are not ACA-compliant, but may save you money -- although you'll have to re--do it at least every 330 days or something.

jp

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Re: ACA Sticker shock, give me an alternative
« Reply #5 on: February 28, 2014, 01:05:47 PM »
You can still buy non-ACA compliant policies and pay the penalty for not having an ACA-compliant policy.  For the next year or two, that may save you a significant amount of money.

Thanks, I didn't know that.  If only my policy was not being cancelled, I would just stay on that for a few years and pay the penalty.  Are there a lot of insurers  offering these plans?
Why don't you ask your current insurance company?

 I did.  The only have these fixed benefit things, which are the opposite of what I need/want.  I can cover my own needs, unless it is something catastrophic.  I don't need insurance for a $100 check up.  It seems these are the only non ACA compliant policies that my current carrier provides.  The local insurance agent was no help.

clarkm04

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Re: ACA Sticker shock, give me an alternative
« Reply #6 on: February 28, 2014, 01:26:48 PM »
Have you been on healthcare.gov or your state's website?  Have you investigated if you eligible for a subsidy? 

Consumer Reports ran an article in December how companies are canceling policies and shoehorning people into more expensive policies then what they could find on the exchange.

Good luck!

bdh221

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Re: ACA Sticker shock, give me an alternative
« Reply #7 on: February 28, 2014, 01:29:25 PM »
Thanks for the post. I am going to have an issue similar to yours in the future. I am still grandfathered into my plan for this year but after that I will be stuck. I currently pay a total $450 for the 4 of us (similar make up as you) to each have HI with a $1,200 deductible. Other than my wife having a baby we have been no where near hitting this amount. My research on the new plans shows that similar coverage is around $1,000 a month. That just does not make sense as it only cost about 3-4k to have a baby. I could not imagine something that could happen to me that would justify these costs. So I thought about a dropping to Bronze but then that shows $550 a month and around a 10K deductible. After reviewing this I also have to scratch my head and say this does not make much sense. If you can find a place that just gives you catastrophic for a good price please share. As I agree that with the penalty might be the best option.

I keep hoping that they extend the grandfather rule which I read they might so I don't have to start thinking about dropping HI which really scares me.

Good Luck!



jp

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Re: ACA Sticker shock, give me an alternative
« Reply #8 on: February 28, 2014, 01:31:20 PM »
Have you been on healthcare.gov or your state's website?  Have you investigated if you eligible for a subsidy? 

Consumer Reports ran an article in December how companies are canceling policies and shoehorning people into more expensive policies then what they could find on the exchange.

Good luck!

Yeah, I checked all that.  I am not eligible for a subsidy.  I have checked the websites and also talked to an agent who found me the "cheap" plan of $900/mo.

There aren't going to be any affordable ACA policies, that's a fact.  So I am just looking for some way around the issue now.  Right now, the religious co-op medishare thing seems to be the only real option- or possibly a non-compliant policy (but I haben't been able to find a decent one yet). 

jp

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Re: ACA Sticker shock, give me an alternative
« Reply #9 on: February 28, 2014, 01:34:01 PM »
Thanks for the post. I am going to have an issue similar to yours in the future. I am still grandfathered into my plan for this year but after that I will be stuck. I currently pay a total $450 for the 4 of us (similar make up as you) to each have HI with a $1,200 deductible. Other than my wife having a baby we have been no where near hitting this amount. My research on the new plans shows that similar coverage is around $1,000 a month. That just does not make sense as it only cost about 3-4k to have a baby. I could not imagine something that could happen to me that would justify these costs. So I thought about a dropping to Bronze but then that shows $550 a month and around a 10K deductible. After reviewing this I also have to scratch my head and say this does not make much sense. If you can find a place that just gives you catastrophic for a good price please share. As I agree that with the penalty might be the best option.

I keep hoping that they extend the grandfather rule which I read they might so I don't have to start thinking about dropping HI which really scares me.

Good Luck!

I should have been grandfathered in, but apparently Assurant is dropping my plan, don't know why.  If I find something I will post it, but I am not having a lot of luck.  Your State sounds like it has better plans (or maybe you are quoting me your price with the subsidy- which I am not eligible for). 

bdh221

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Re: ACA Sticker shock, give me an alternative
« Reply #10 on: February 28, 2014, 01:45:00 PM »
I am in PA and it might be based on age, I am 30. I researched the Christian exchange ones and they seemed like a huge pain. I think they said you are treated as you have no insurance when you go to the doctor and you have to negotiate a better rate. Also there is no guarantee on some of them that you will get paid. I think the best option may be like you mentioned and get a non compliant penalty, pay the 2.5% of income and buy a noncompliant plan that actually makes financial sense. I hope/expect that next year when all the plans expire these strategies start to emerge and more people start selling the plans.

jp

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Re: ACA Sticker shock, give me an alternative
« Reply #11 on: February 28, 2014, 01:50:20 PM »
I am in PA and it might be based on age, I am 30. I researched the Christian exchange ones and they seemed like a huge pain. I think they said you are treated as you have no insurance when you go to the doctor and you have to negotiate a better rate. Also there is no guarantee on some of them that you will get paid. I think the best option may be like you mentioned and get a non compliant penalty, pay the 2.5% of income and buy a noncompliant plan that actually makes financial sense. I hope/expect that next year when all the plans expire these strategies start to emerge and more people start selling the plans.

Well I am only 36.  I don't think that it would make that much of a difference.  I will keep looking for a non-compliant policy.

beltim

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Re: ACA Sticker shock, give me an alternative
« Reply #12 on: February 28, 2014, 03:41:13 PM »
I am in PA and it might be based on age, I am 30. I researched the Christian exchange ones and they seemed like a huge pain. I think they said you are treated as you have no insurance when you go to the doctor and you have to negotiate a better rate. Also there is no guarantee on some of them that you will get paid. I think the best option may be like you mentioned and get a non compliant penalty, pay the 2.5% of income and buy a noncompliant plan that actually makes financial sense. I hope/expect that next year when all the plans expire these strategies start to emerge and more people start selling the plans.

Well I am only 36.  I don't think that it would make that much of a difference.  I will keep looking for a non-compliant policy.

What state are you in?  I've done some research on ehealthinsurance.com for these sorts of plans, but I don't know how good they are in other states.

the fixer

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Re: ACA Sticker shock, give me an alternative
« Reply #13 on: February 28, 2014, 04:52:31 PM »
This isn't a great option, but at this point it doesn't sound like you have any of those, so...

Can you move to, or at least establish residency in, a different state? Establishing residency may not be enough if the only health plans available to you don't cover a lot out-of-state.

FWIW I checked eHealthInsurance with your family's approximate ages in my zip code (Seattle) and got the cheapest bronze plan at $655/mo (deductibles $4k individual, $8k family). 5 of the 10 "featured plans" are below $700. It might be interesting to do the same check for various different places to see how much variation there is.

jp

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Re: ACA Sticker shock, give me an alternative
« Reply #14 on: March 12, 2014, 01:29:03 PM »
UPDATE:

my agent says that I can get a short term family plan for about the same as I pay now (less than $250 per month) and that this will allow me to avoid paying the penalty for noncompliance.  The downside is that we will have to requalify every 6 months.  Apparently I can do this up to 4x before I have to do something else, which works out, because it will be 2016 by then and ACA will be in full effect (of, fingers crossed, repealed). 

Just thought I'd let you guys know about this option in case anyone else is in the same boat

Daleth

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Re: ACA Sticker shock, give me an alternative
« Reply #15 on: March 12, 2014, 07:48:57 PM »
I don't know where you are or exactly how old you and your wife are, but in my state on the exchange a family of 4 with adults aged 33 and 35 and kids 5 and 7 can get coverage for $420/mo. Also--and I believe this is true everywhere--"If your individual insurance plan has been cancelled and you believe other Marketplace plans aren't affordable, you can apply for a hardship exemption. This will allow you buy a catastrophic plan."
https://www.healthcare.gov/can-i-buy-a-catastrophic-plan/

Also in my state, prices like what you're quoting ($920/mo or thereabouts) will get you a gold plan with a $2000 family deductible ($1000 individual), and that's an HMO so you get $10 doctor visits, $40 specialist visits, $175 ER visits and $8 prescriptions from day 1, without needing to ht your deductible.

So I can't help but wonder, is your state on some other planet, are you and your wife far older than I was guesstimating (like 45??) or did you not search the exchange correctly?

beltim

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Re: ACA Sticker shock, give me an alternative
« Reply #16 on: March 12, 2014, 08:31:30 PM »
I don't know where you are or exactly how old you and your wife are, but in my state on the exchange a family of 4 with adults aged 33 and 35 and kids 5 and 7 can get coverage for $420/mo. Also--and I believe this is true everywhere--"If your individual insurance plan has been cancelled and you believe other Marketplace plans aren't affordable, you can apply for a hardship exemption. This will allow you buy a catastrophic plan."
https://www.healthcare.gov/can-i-buy-a-catastrophic-plan/

Also in my state, prices like what you're quoting ($920/mo or thereabouts) will get you a gold plan with a $2000 family deductible ($1000 individual), and that's an HMO so you get $10 doctor visits, $40 specialist visits, $175 ER visits and $8 prescriptions from day 1, without needing to ht your deductible.

So I can't help but wonder, is your state on some other planet, are you and your wife far older than I was guesstimating (like 45??) or did you not search the exchange correctly?

Congratulations, you live in a low cost of health care area.  How does this help the OP, who has told you what the lowest priced plan on the exchange is?

Daleth

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Re: ACA Sticker shock, give me an alternative
« Reply #17 on: March 13, 2014, 08:15:37 AM »
I don't know where you are or exactly how old you and your wife are, but in my state on the exchange a family of 4 with adults aged 33 and 35 and kids 5 and 7 can get coverage for $420/mo. Also--and I believe this is true everywhere--"If your individual insurance plan has been cancelled and you believe other Marketplace plans aren't affordable, you can apply for a hardship exemption. This will allow you buy a catastrophic plan."
https://www.healthcare.gov/can-i-buy-a-catastrophic-plan/

Also in my state, prices like what you're quoting ($920/mo or thereabouts) will get you a gold plan with a $2000 family deductible ($1000 individual), and that's an HMO so you get $10 doctor visits, $40 specialist visits, $175 ER visits and $8 prescriptions from day 1, without needing to ht your deductible.

So I can't help but wonder, is your state on some other planet, are you and your wife far older than I was guesstimating (like 45??) or did you not search the exchange correctly?

Congratulations, you live in a low cost of health care area.  How does this help the OP, who has told you what the lowest priced plan on the exchange is?

I know two people who complained that all they could find was $X/month, and then when I went and looked for them, turned out they had somehow misunderstood something and lower-cost plans were available to them. So I was wondering if that's what happened with the OP.

huadpe

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Re: ACA Sticker shock, give me an alternative
« Reply #18 on: March 13, 2014, 08:44:08 AM »
I don't know where you are or exactly how old you and your wife are, but in my state on the exchange a family of 4 with adults aged 33 and 35 and kids 5 and 7 can get coverage for $420/mo. Also--and I believe this is true everywhere--"If your individual insurance plan has been cancelled and you believe other Marketplace plans aren't affordable, you can apply for a hardship exemption. This will allow you buy a catastrophic plan."
https://www.healthcare.gov/can-i-buy-a-catastrophic-plan/

Also in my state, prices like what you're quoting ($920/mo or thereabouts) will get you a gold plan with a $2000 family deductible ($1000 individual), and that's an HMO so you get $10 doctor visits, $40 specialist visits, $175 ER visits and $8 prescriptions from day 1, without needing to ht your deductible.

So I can't help but wonder, is your state on some other planet, are you and your wife far older than I was guesstimating (like 45??) or did you not search the exchange correctly?

If I had to guess, his state is California, where a silver plan for a family of 4 runs $12,000 a year unsubsidized.  Is it another planet?  Sometimes it sure seems like. 

Daleth

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Re: ACA Sticker shock, give me an alternative
« Reply #19 on: March 13, 2014, 09:00:11 AM »
I don't know where you are or exactly how old you and your wife are, but in my state on the exchange a family of 4 with adults aged 33 and 35 and kids 5 and 7 can get coverage for $420/mo. Also--and I believe this is true everywhere--"If your individual insurance plan has been cancelled and you believe other Marketplace plans aren't affordable, you can apply for a hardship exemption. This will allow you buy a catastrophic plan."
https://www.healthcare.gov/can-i-buy-a-catastrophic-plan/

Also in my state, prices like what you're quoting ($920/mo or thereabouts) will get you a gold plan with a $2000 family deductible ($1000 individual), and that's an HMO so you get $10 doctor visits, $40 specialist visits, $175 ER visits and $8 prescriptions from day 1, without needing to ht your deductible.

So I can't help but wonder, is your state on some other planet, are you and your wife far older than I was guesstimating (like 45??) or did you not search the exchange correctly?

If I had to guess, his state is California, where a silver plan for a family of 4 runs $12,000 a year unsubsidized.  Is it another planet?  Sometimes it sure seems like.

He's not shopping for a silver plan. He wants the barest-bones, cheapest policy he can find. I just randomly ran the numbers for Contra Costa County (it's a CA zip code I have memorized) for the same family of four described earlier (parents aged 33 and 35, two kids) and the cheapest plan is indeed way more expensive than in my state, but still not the $900+ he was talking about or the $12k/yr you describe. It's a $744/mo ($8928/yr) bronze plan that you can combine with an HSA.

And like any non-employer-sponsored health plan, the cost of premiums is a tax-deductible medical expense (to the extent your medical expenses exceed 10% of your AGI).

Anyone have thoughts on why some states are much more expensive than others?
« Last Edit: March 13, 2014, 09:02:27 AM by Daleth »

Daleth

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Re: ACA Sticker shock, give me an alternative
« Reply #20 on: March 13, 2014, 09:04:05 AM »
I don't know where you are or exactly how old you and your wife are, but in my state on the exchange a family of 4 with adults aged 33 and 35 and kids 5 and 7 can get coverage for $420/mo. Also--and I believe this is true everywhere--"If your individual insurance plan has been cancelled and you believe other Marketplace plans aren't affordable, you can apply for a hardship exemption. This will allow you buy a catastrophic plan."
https://www.healthcare.gov/can-i-buy-a-catastrophic-plan/

Also in my state, prices like what you're quoting ($920/mo or thereabouts) will get you a gold plan with a $2000 family deductible ($1000 individual), and that's an HMO so you get $10 doctor visits, $40 specialist visits, $175 ER visits and $8 prescriptions from day 1, without needing to ht your deductible.

So I can't help but wonder, is your state on some other planet, are you and your wife far older than I was guesstimating (like 45??) or did you not search the exchange correctly?

If I had to guess, his state is California, where a silver plan for a family of 4 runs $12,000 a year unsubsidized.  Is it another planet?  Sometimes it sure seems like.

Or New York. We got a rate of $10,000/yr for an unsubsidized silver plan. For two. We're 25 and 28.

You're young enough to get catastrophic plans (for way, way way less $), if you want.

beltim

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Re: ACA Sticker shock, give me an alternative
« Reply #21 on: March 13, 2014, 09:21:52 AM »
Or New York. We got a rate of $10,000/yr for an unsubsidized silver plan. For two. We're 25 and 28.

You're young enough to get catastrophic plans (for way, way way less $), if you want.

In the states where I've looked (small sample size of 2), the catastrophic plans are 80-95% of the cost of a bronze plan.  Neither of those were New York, though, and it appears you need to register to find the price of plans there.

beltim

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Re: ACA Sticker shock, give me an alternative
« Reply #22 on: March 13, 2014, 09:36:08 AM »
He's not shopping for a silver plan. He wants the barest-bones, cheapest policy he can find. I just randomly ran the numbers for Contra Costa County (it's a CA zip code I have memorized) for the same family of four described earlier (parents aged 33 and 35, two kids) and the cheapest plan is indeed way more expensive than in my state, but still not the $900+ he was talking about or the $12k/yr you describe. It's a $744/mo ($8928/yr) bronze plan that you can combine with an HSA.

And like any non-employer-sponsored health plan, the cost of premiums is a tax-deductible medical expense (to the extent your medical expenses exceed 10% of your AGI).

Anyone have thoughts on why some states are much more expensive than others?

Because health care costs vary a lot by state, just like everything else.  I just ran a calculation for Palo Alto for a family of four and the cheapest plan was $834 a month, so I don't doubt that it could be 8% higher somewhere else.

If he's ineligible for subsidies, he's unlikely to hit 10% of AGI unless he has significant non-insurance health costs in a year.

beltim

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Re: ACA Sticker shock, give me an alternative
« Reply #23 on: March 13, 2014, 10:37:46 AM »
Daleth - it occurs to me that I only partially answered your question, and that a full answer would require answering the question, "why do health care costs vary so much by state?"

I think the answer to that is: salaries, price of land, and taxes.  And it's a nonlinear response because every step is affected by the others.

huadpe

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Re: ACA Sticker shock, give me an alternative
« Reply #24 on: March 13, 2014, 11:25:11 AM »
I don't know where you are or exactly how old you and your wife are, but in my state on the exchange a family of 4 with adults aged 33 and 35 and kids 5 and 7 can get coverage for $420/mo. Also--and I believe this is true everywhere--"If your individual insurance plan has been cancelled and you believe other Marketplace plans aren't affordable, you can apply for a hardship exemption. This will allow you buy a catastrophic plan."
https://www.healthcare.gov/can-i-buy-a-catastrophic-plan/

Also in my state, prices like what you're quoting ($920/mo or thereabouts) will get you a gold plan with a $2000 family deductible ($1000 individual), and that's an HMO so you get $10 doctor visits, $40 specialist visits, $175 ER visits and $8 prescriptions from day 1, without needing to ht your deductible.

So I can't help but wonder, is your state on some other planet, are you and your wife far older than I was guesstimating (like 45??) or did you not search the exchange correctly?

If I had to guess, his state is California, where a silver plan for a family of 4 runs $12,000 a year unsubsidized.  Is it another planet?  Sometimes it sure seems like.

Or New York. We got a rate of $10,000/yr for an unsubsidized silver plan. For two. We're 25 and 28.

You're young enough to get catastrophic plans (for way, way way less $), if you want.

I'm well aware of that. The cost is still borderline madness comapred to other parts of the country. A catastrophic plan with a $12,700 deductible costs, minimum, $360/month. And the physician network is dreadful.

MMM is paying $470/month for his family of 3, on a plan with a $10,000 deductible. The closest equivalent policy in my area on the exchange is $720/month, for a family of two people who are younger than him and his wife.

Difference is NY doesn't allow different pricing by age.  If you're 60 you pay the same rate as if you're 25.

Daleth

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Re: ACA Sticker shock, give me an alternative
« Reply #25 on: March 13, 2014, 12:20:09 PM »
Difference is NY doesn't allow different pricing by age.  If you're 60 you pay the same rate as if you're 25.

Yowza. Has NY always had that rule about health insurance? I know they've always been a bit weird when it came to health insurance, but am unclear on the details.

I wonder why they're doing it that way. It's not like it's helping old folks on social security, since those folks are all on Medicare anyway. It seems particularly unfair since your average 25yo is not only less in need of medical care than your average 55yo, but also less wealthy.

Daleth

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Re: ACA Sticker shock, give me an alternative
« Reply #26 on: March 13, 2014, 01:09:27 PM »
NY State's health insurance market has been so batshit overregulated for so long (back in the 90's they forced insurers to accept everyone regardless of medical condition and most private insurers left the state as a result) that our costs actually dropped post-ACA.

Oh. So for all the New Yorkers here, their options are:
(1) continue having insurance (assuming you had it before) but pay less, although still a ton; or
(2) don't have insurance, and only pay the penalty IF the cost of insurance exceeds 8% of your income--in other words, if you're looking at $10k for the lowest-cost plan for your family size, your income would have to exceed $125k in order for you to pay the penalty. If you earn less than $125k, no penalty. For the under-30s, though, I'm guessing the lowest-cost plan they consider for penalty purposes is the catastrophic plan, so you'd have to be earning less than $54k to avoid the penalty.

Your other option is to move to a state where they let insurers charge people different rates based on age:

New Jersey: Move across the river from NYC and boom, you two as 25 and 28yo can get a silver policy with a $1350 deductible ($2700 family) for $520/mo, or $6240/yr. Catastrophic plans in NJ seem to be about the same price as NY, $350-ish.

PA: Move across the PA border and you can get catastrophic plans for $184/mo (that's for both of you!), or a silver plan with a $1000 deductible ($2000 family) for $372/mo. Heck, you can get a $0 deductible platinum plan for $481/mo!

I predict that NY will lose some good people because of their refusal to let insurers differentiate by age...

jp

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Re: ACA Sticker shock, give me an alternative
« Reply #27 on: March 13, 2014, 01:21:39 PM »


So I can't help but wonder, is your state on some other planet, are you and your wife far older than I was guesstimating (like 45??) or did you not search the exchange correctly?

I searched the plans.  I also had 2 separate agents search for me.   

I live in Indiana.  I am 36, my wife is 35, and my kids are 5 and 7.  My income is over the $94k subsidy threshold. 

FWIW, there are couple new plans since I looked that in the $800s, which is still way way more than I am going to pay.

« Last Edit: March 13, 2014, 01:23:31 PM by jp »

jp

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Re: ACA Sticker shock, give me an alternative
« Reply #28 on: March 13, 2014, 01:31:59 PM »
You can still buy non-ACA compliant policies and pay the penalty for not having an ACA-compliant policy.  For the next year or two, that may save you a significant amount of money.

Thanks, I didn't know that.  If only my policy was not being cancelled, I would just stay on that for a few years and pay the penalty.  Are there a lot of insurers  offering these plans?
Why don't you ask your current insurance company?

That's a good idea.  Honestly, I don't know the number of insurance companies offering non-ACA compliant plans. I do know there's still a decent market for short-term insurance policies, which may be another option for you. They also are not ACA-compliant, but may save you money -- although you'll have to re--do it at least every 330 days or something.

I somehow missed this when you posted it the first time... so thanks for the suggestion.  For whatever reason, my agent (who may well be wrong) is telling me that I won't have to pay the penalty if I go this route (at least until 2016). 

beltim

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Re: ACA Sticker shock, give me an alternative
« Reply #29 on: March 13, 2014, 01:35:35 PM »
You can still buy non-ACA compliant policies and pay the penalty for not having an ACA-compliant policy.  For the next year or two, that may save you a significant amount of money.

Thanks, I didn't know that.  If only my policy was not being cancelled, I would just stay on that for a few years and pay the penalty.  Are there a lot of insurers  offering these plans?
Why don't you ask your current insurance company?

That's a good idea.  Honestly, I don't know the number of insurance companies offering non-ACA compliant plans. I do know there's still a decent market for short-term insurance policies, which may be another option for you. They also are not ACA-compliant, but may save you money -- although you'll have to re--do it at least every 330 days or something.

I somehow missed this when you posted it the first time... so thanks for the suggestion.  For whatever reason, my agent (who may well be wrong) is telling me that I won't have to pay the penalty if I go this route (at least until 2016).

No problem!  I think your agent is right, just like I was back in February.  In between, the penalty for having a noncompliant plan was delayed until 2016 (http://blogs.marketwatch.com/health-exchange/2014/03/05/non-compliant-health-plans-given-2-year-extension-not-one/)

jp

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Re: ACA Sticker shock, give me an alternative
« Reply #30 on: March 13, 2014, 01:52:13 PM »

No problem!  I think your agent is right, just like I was back in February.  In between, the penalty for having a noncompliant plan was delayed until 2016 (http://blogs.marketwatch.com/health-exchange/2014/03/05/non-compliant-health-plans-given-2-year-extension-not-one/)

Thanks for the link.  I don't really keep up with these changes, so it is nice to have some support for her statement. 

I feel good.  I just saved $11k. 

kkbmustang

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Re: ACA Sticker shock, give me an alternative
« Reply #31 on: March 13, 2014, 05:01:31 PM »
We just went through this last year. I have a chronic medical condition and always hit the upper limits for everything. I'm still on COBRA from my former employer's plan. This is more cost effective than my husband's employer sponsored plan. We pay $1515 per month in medical and dental premiums for the family.  (43, 41, 11 and 9).  $4k individual OOP and $6k OOP family in network. $5/7k out of network. Total out of pocket = $24k. On my husbands employer plan this amount is $35k if we have to go out of network (most anesthesiologists are out of network and I have several procedures each year requiring anesthesia).

I went directly to two different insurance companies, through the exchange and through the American Bar Association. This was the best deal knowing that I would max out. We don't qualify for any subsidies. I won't qualify for COBRA beyond December of this year. Which freaks me out because, holy hell, it's bad enough now let alone piling on another $11k.

jp

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Re: ACA Sticker shock, give me an alternative
« Reply #32 on: March 13, 2014, 07:07:46 PM »

Just to verify, is your MAGI still over the $94k threshold?  That's one thing that threw me for a loop.  I kept thinking subsidies were based on gross income, but they're actually based on MAGI.  You can view some information at:

http://laborcenter.berkeley.edu/healthcare/MAGI_summary13.pdf

It might not help in your situation, but I figured I'd mention it just in case.

thanks for the info, but yeah, I am still over that.  A good problem to have in the scheme of things

beltim

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Re: ACA Sticker shock, give me an alternative
« Reply #33 on: March 13, 2014, 07:14:02 PM »
We just went through this last year. I have a chronic medical condition and always hit the upper limits for everything. I'm still on COBRA from my former employer's plan. This is more cost effective than my husband's employer sponsored plan. We pay $1515 per month in medical and dental premiums for the family.  (43, 41, 11 and 9).  $4k individual OOP and $6k OOP family in network. $5/7k out of network. Total out of pocket = $24k. On my husbands employer plan this amount is $35k if we have to go out of network (most anesthesiologists are out of network and I have several procedures each year requiring anesthesia).

I went directly to two different insurance companies, through the exchange and through the American Bar Association. This was the best deal knowing that I would max out. We don't qualify for any subsidies. I won't qualify for COBRA beyond December of this year. Which freaks me out because, holy hell, it's bad enough now let alone piling on another $11k.

What would the total cost be if you got the cheapest ACA plan and hit the max out of pocket every year?

kkbmustang

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Re: ACA Sticker shock, give me an alternative
« Reply #34 on: March 13, 2014, 07:42:46 PM »
IIRC, the medical premiums would be less (around $900ish) but max out of pocket would be $26k ish and not all of my doctors were in the network. Then I'd have to add dental on top of it.

beltim

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Re: ACA Sticker shock, give me an alternative
« Reply #35 on: March 13, 2014, 07:53:25 PM »
IIRC, the medical premiums would be less (around $900ish) but max out of pocket would be $26k ish and not all of my doctors were in the network. Then I'd have to add dental on top of it.

Does the max out of pocket apply to out of network too?  So the 26K would be more than under COBRA (yipes!) but potentially still better than under your husband's plan.

Also, thanks for humoring my curiosity.

Penelope Vandergast

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Re: ACA Sticker shock, give me an alternative
« Reply #36 on: March 13, 2014, 08:14:12 PM »
I'm not totally clear on what's going on here, but are you only looking at bronze plans? From what I understand, bronze plans are not eligible for subsidies.

Try a silver or gold plan and you might save a lot of money if you meet the income requirements. I think some people might be getting sticker shock because they are only looking at bronze plans, which they think are the cheapest -- but if you can get a subsidy they actually can be the most expensive.

beltim

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Re: ACA Sticker shock, give me an alternative
« Reply #37 on: March 13, 2014, 08:18:19 PM »
I'm not totally clear on what's going on here, but are you only looking at bronze plans? From what I understand, bronze plans are not eligible for subsidies.

Try a silver or gold plan and you might save a lot of money if you meet the income requirements. I think some people might be getting sticker shock because they are only looking at bronze plans, which they think are the cheapest -- but if you can get a subsidy they actually can be the most expensive.

This is false. The subsidy is based on the price of the second cheapest silver plan, but the subsidy is valid on bronze, silver, gold, and platinum plans.

Here's one source: http://www.valuepenguin.com/understanding-aca-subsidies

kkbmustang

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Re: ACA Sticker shock, give me an alternative
« Reply #38 on: March 13, 2014, 09:40:31 PM »
IIRC, the medical premiums would be less (around $900ish) but max out of pocket would be $26k ish and not all of my doctors were in the network. Then I'd have to add dental on top of it.

Does the max out of pocket apply to out of network too?  So the 26K would be more than under COBRA (yipes!) but potentially still better than under your husband's plan.

Also, thanks for humoring my curiosity.

Yes. The $26k plus the premiums would put us at $35k out of pocket total which is more than my COBRA. It's horrible. Then again, I hit my individual OOP max on January 8th, if that gives you an idea as to my medical issues.

huadpe

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Re: ACA Sticker shock, give me an alternative
« Reply #39 on: March 14, 2014, 07:57:52 AM »
IIRC, the medical premiums would be less (around $900ish) but max out of pocket would be $26k ish and not all of my doctors were in the network. Then I'd have to add dental on top of it.

The max out of pocket for a family plan that's ACA compliant is $12,700 for all family members combined.  I think you were misreading the out of pocket max as applying to each individually - it doesn't.

https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/

George_PA

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Re: ACA Sticker shock, give me an alternative
« Reply #40 on: March 14, 2014, 08:52:00 AM »
jp why don't ask you Obama how you are going to pay for it?  According to him, his health care law makes health care "affordable" for everyone in America.  Maybe a magical fairy will come to your house each month and drop $900 from the sky.


jp

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Re: ACA Sticker shock, give me an alternative
« Reply #41 on: March 14, 2014, 08:58:15 AM »
jp why don't ask you Obama how you are going to pay for it?  According to him, his health care law makes health care "affordable" for everyone in America.  Maybe a magical fairy will come to your house each month and drop $900 from the sky.

I have it, I just don't want to spend it on health insurance.

kkbmustang

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Re: ACA Sticker shock, give me an alternative
« Reply #42 on: March 14, 2014, 09:06:30 AM »
IIRC, the medical premiums would be less (around $900ish) but max out of pocket would be $26k ish and not all of my doctors were in the network. Then I'd have to add dental on top of it.

The max out of pocket for a family plan that's ACA compliant is $12,700 for all family members combined.  I think you were misreading the out of pocket max as applying to each individually - it doesn't.

https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/

No I wasn't misreading it. I have the chronic condition but based on my family's past few years we hit the OOP max for everyone. Not just me. I have to be prepared to hit all OOP maximums, including out of network,but thank you anyway. The out of network maximums are not reported on healthcare.gov but if you read the summary docs closely you should find it there..
« Last Edit: March 14, 2014, 09:09:29 AM by kkbmustang »

rocksinmyhead

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Re: ACA Sticker shock, give me an alternative
« Reply #43 on: March 14, 2014, 09:12:18 AM »
I really appreciated the president telling people like me that the insurance we were losing was lousy anyway. That's like someone running over your bicycle and then claiming that, well, it wasn't a really nice bike anyway and now you're free to buy a more expensive one!

haha, that is a most excellent analogy. and a super fucked up situation. as is the "health insurance costs the same no matter how old you are" rule... what the fuck?! sorry to all of you who are in this situation!

huadpe

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Re: ACA Sticker shock, give me an alternative
« Reply #44 on: March 14, 2014, 09:18:23 AM »
IIRC, the medical premiums would be less (around $900ish) but max out of pocket would be $26k ish and not all of my doctors were in the network. Then I'd have to add dental on top of it.

The max out of pocket for a family plan that's ACA compliant is $12,700 for all family members combined.  I think you were misreading the out of pocket max as applying to each individually - it doesn't.

https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/

No I wasn't misreading it. I have the chronic condition but based on my family's past few years we hit the OOP max for everyone. Not just me. I have to be prepared to hit all OOP maximums, including out of network,but thank you anyway. The out of network maximums are not reported on healthcare.gov but if you read the summary docs closely you should find it there..

Ok, yeah that makes sense.  I had been thinking it was a mis-read since the amount you quoted was about exactly double the in-network OOP max.  Is there a reason you can't find providers in network though?  I know it's hard finding specialists who you trust, but an extra $13,000 is a big price to pay.

kkbmustang

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Re: ACA Sticker shock, give me an alternative
« Reply #45 on: March 14, 2014, 09:28:31 AM »
IIRC, the medical premiums would be less (around $900ish) but max out of pocket would be $26k ish and not all of my doctors were in the network. Then I'd have to add dental on top of it.

The max out of pocket for a family plan that's ACA compliant is $12,700 for all family members combined.  I think you were misreading the out of pocket max as applying to each individually - it doesn't.

https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/

No I wasn't misreading it. I have the chronic condition but based on my family's past few years we hit the OOP max for everyone. Not just me. I have to be prepared to hit all OOP maximums, including out of network,but thank you anyway. The out of network maximums are not reported on healthcare.gov but if you read the summary docs closely you should find it there..

Ok, yeah that makes sense.  I had been thinking it was a mis-read since the amount you quoted was about exactly double the in-network OOP max.  Is there a reason you can't find providers in network though?  I know it's hard finding specialists who you trust, but an extra $13,000 is a big price to pay.

I need anesthesia and those people don't take insurance and aren't in any networks. I have no problem switching like my normal doc or allergist or dermatologist or whatever. Spine surgeon? Yeah, no. Not taking chances there.

dantownehall

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Re: ACA Sticker shock, give me an alternative
« Reply #46 on: March 14, 2014, 12:46:19 PM »
I also have a massively expensive chronic condition.

I still have employer health care that's pretty good, but I was wondering whether or not it might make sense for someone who knows they'll always hit OOP maximums and is getting an ACA plan to get one plan just for themself, and a spearate one for the rest of the family.

I'm assuming that OOP maxes go up with the number of people on the plan, and that you could lower your overall costs this way.

Failing that, it's just a matter of calculating the lowest cost combination of premiums and OOP max.  From what I hear from others with my condition, it's going to be really expensive for people with pre-existing conditions to get coverage.  After ACA, this is not because there's any sort of discrimination, but just because OOP maxes are high and premiums are high.  My current OOP max is $2500, but I've heard figures 4-5 times higher for ACA plans.

Being sick is really awesome.

greaper007

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Re: ACA Sticker shock, give me an alternative
« Reply #47 on: March 14, 2014, 12:57:30 PM »
Where do you live?   We're a family of four on the Bronze Kaiser plan and it's only $530 a month.   We've had the same plan for three years now and when we started it was only $250, that's what really pisses me off.   I'm not sure what justified that kind of rise in only a couple of years.

lexie2000

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Re: ACA Sticker shock, give me an alternative
« Reply #48 on: March 14, 2014, 06:10:20 PM »
I am not getting the impression that the ACA is going to make health insurance/care any more affordable than it was in the past (the one exception being those who were previously uninsurable).    DH gets subsidized health insurance as a retiree, but they can drop it any time they want to.  We pay $710/mo. for the two of us in an HMO so it's not exactly what I would call a cadillac plan.   I am praying that his company doesn't dump retirees before we can get on Medicare.  Oh the joys of early retirement.

OzzieandHarriet

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Re: ACA Sticker shock, give me an alternative
« Reply #49 on: March 15, 2014, 07:53:25 AM »
Here's a thought I haven't seen here: In the old health care system, people with higher incomes generally have had their costs subsidized by employers, so they were not paying the full premiums, let alone paying for the care itself. People with worse jobs or who were unemployed paid out of pocket or went without care at all. People in the latter group with "preexisting conditions" were uninsurable and got sicker --  and many people have died because they lacked care that was available to those in the first group.

The new system is an attempt to spread the costs out more equitably and insure more people. Those in the top income group should be grateful they can afford to pay their share. Life is not always about paying the least possible for everything.

If for some reason my husband and I need to buy health insurance before we are 65, my rough calculation (based on our current income) is to allot about $10,000 a year for it. In the big scheme of things (if, say, you have a MAGI of ~$100k), why is that so outrageous? Without life and good health, what do you have? Insurance as a concept sucks, but it's the way our society is structured and we're stuck with it for the foreseeable future.