Author Topic: Healthcare options  (Read 3433 times)

Cowardly Toaster

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Healthcare options
« on: January 02, 2017, 03:26:10 AM »
Looking around the boards, I'm surprised there isn't more about health care options on here.

What are my families options for affordable healthcare when I quit my job? It seems to be the biggest hurdle to my financial independence.

Monkey Uncle

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Re: Healthcare options
« Reply #1 on: January 02, 2017, 05:53:47 AM »
There's a sticky at the top of this sub-forum about optimizing your use of the Affordable Care Act (aka Obamacare).  But there's probably not much point in trying to optimize a FIRE health care strategy until we see how the Republican repeal/replace plan is going to shake out.  Unfortunately, those of us who don't have enough of a buffer to pay through the nose for a private fee-for-service plan are stuck in limbo for the time being.

ltt

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Re: Healthcare options
« Reply #2 on: January 02, 2017, 07:10:36 AM »
Yes, I'm not quite sure I understand this either.  I'd like to hear from people who are actually using the ACA plans and their thoughts regarding co-pays, if they have had to use their ACA plan for an illness, and how it has been working for them.  Do they like it and what would they have done differently?

Yes, I think we will be seeing some new replacement options soon. :)

geekette

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Re: Healthcare options
« Reply #3 on: January 02, 2017, 07:22:31 AM »
The ACA plans vary so much, how can you compare?

It's worked out well enough for us the last few years, but the future is far too vague for comfort.

jim555

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Re: Healthcare options
« Reply #4 on: January 02, 2017, 08:16:00 AM »
The ACA has been great for me.  Key is controlling your MAGI. 
Repubs are going to screw it all up.

Daleth

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Re: Healthcare options
« Reply #5 on: January 02, 2017, 08:22:31 AM »
It will work for at least another year (through 12/31/17), if you sign up this year (repealing the law will not cancel or change an already-existing insurance contract). But the enrollment deadline's coming up.

Call your senator and representative and tell them not to repeal Obamacare. It is an absolute godsend for the self-employed, entrepreneurs just starting out, people who FIRE, and more. It has truly been a game-changer for the self-employed and for startup companies, just to name two.

Late last year I transitioned from a corporate job to self-employment, and get this: the insurance I had through my former employer, which I could have continued through COBRA, would have cost over $1400/mo for my family--and it was HIGH DEDUCTIBLE insurance, so every garden-variety doctor's visit cost about $100, or $150+ for specialists! The high-deductible plan made sense at the employee price, but not once I left the firm. I found NORMAL insurance (non-high deductible) with which doctor's visits cost $10 (generalist) or $60 (specialist), all our doctors are covered, and at right around $950/mo for the whole family, it saves us almost $500/mo compared to the alternative. Thanks, Obama! ;)
« Last Edit: January 02, 2017, 08:24:54 AM by Daleth »

FrugalHeights

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Re: Healthcare options
« Reply #6 on: January 02, 2017, 10:36:33 AM »
Hi Daleth,

Thank you very much for sharing the details. Would you mind giving more specifics about the name of your current plan, how you found it, how you recommend  doing a search? Are there any state-specific aspects of plans for self-employed (if you know any)?

And also, do you know what would this plan cost for a single person? for a self-employed person with just a spouse?

Thanks a lot!

The Happy Philosopher

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Re: Healthcare options
« Reply #7 on: January 02, 2017, 10:46:20 AM »
Hi Daleth,

Thank you very much for sharing the details. Would you mind giving more specifics about the name of your current plan, how you found it, how you recommend  doing a search? Are there any state-specific aspects of plans for self-employed (if you know any)?

And also, do you know what would this plan cost for a single person? for a self-employed person with just a spouse?

Thanks a lot!
You need to do the research yourself. Each state has different options and the cost will be dependent on your age and family size. Your subsidy will be based on your MAGI.

https://www.healthcare.gov/

Spork

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Re: Healthcare options
« Reply #8 on: January 02, 2017, 11:09:40 AM »
It's going to vary fairly widely, but from what I've seen the high deductible plans are the way to go for generally healthy people.  If you generally not healthy or have chronic disease, then high deductible might not be for you.

Pre-ACA I had a high deductible plan for myself and my wife for about $250 a month.  Post ACA, plan costs have gone way up, but after the subsidy, our cost is again about $250 a month for a high deductible plan.

With a high deductible, you're basically going to be paying your own way unless you have a serious medical condition.  However, you're going to be paying at the rate the insurance company has pre-negotiated -- so it still can be quite a bit cheaper.  If you find one that is HSA compatible, you can contribute the max amount to your HSA and that reduces your income for the purposes of ACA qualifications (while sitting in an investment account).

Just as an example -- for myself the monthly (subsidized) cost of a high deductible bronze plan will be about $200 for 2017.  If I want low copays for the doctors/pharmacies, I can pay $450/month with the same company.  So it is a $3000/year difference in premiums.  As long as my doctor visits/meds are less than $3000/year, I come out ahead.

...but, as everyone says, this will vary wildly by your age/zip code.  Go to healthcare.gov and see what it will cost.

Daleth

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Re: Healthcare options
« Reply #9 on: January 05, 2017, 01:13:46 PM »
It's going to vary fairly widely, but from what I've seen the high deductible plans are the way to go for generally healthy people.  If you generally not healthy or have chronic disease, then high deductible might not be for you.

It depends on what's available in your area and what the cost difference is between HD and normal insurance plans. I had HD for my family at my last employer, because the premiums were almost $500/mo cheaper than the normal insurance offered at my workplace, and I got to contribute to an HSA. But to COBRA that plan would have cost over $1400/mo (wtf! for a high-deductible plan, two parents and two kids!). I looked at the HD plans available in my area and they were only, I kid you not, like $20/month cheaper than the SILVER (!) plan (both were on the order of $950/mo for my whole family--that's unsubsidized; we're not eligible for subsidies).

I have twin toddlers and didn't see the point of paying $120 EACH to bring them in when they have ear infections, etc., when I could pay the extra $20/mo and reduce the cost of visits to our family doctor from $120 per person to $10, and reduce the cost of specialist visits from $180+ to $60. We use our insurance enough that the silver plan worked best for us.

I also looked at bronze plans, which were a good deal cheaper, but in addition to having much higher copays (taking my kids in when I suspect they have ear infections = $50 each), they all had a provision I was leery of: instead of saying "emergency room visits = $250" (or $450 or whatever), they said that if you went to the ER, you would pay the entire cost up to your deductible, plus 20% of whatever exceeds the deductible unless you were admitted. And as those of us with aging parents may know, you can stay in the ER for up to three days without it counting as "being admitted."

If I knew I might be looking at $3000+ for an ER visit, I would not go to the ER unless, say, a limb was visibly separating from my body. I know the goal of plans with these provisions is to funnel people to their family doctor or to urgent care locations, but without going into medical details that's not the right solution for everyone. The silver plan has a fixed cost for ER visits and I prefer that, both for the drastic cost savings and for the transparency (knowing in advance what it will cost).
« Last Edit: January 05, 2017, 01:18:22 PM by Daleth »

lbmustache

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Re: Healthcare options
« Reply #10 on: January 05, 2017, 02:47:27 PM »
Looking around the boards, I'm surprised there isn't more about health care options on here.

What are my families options for affordable healthcare when I quit my job? It seems to be the biggest hurdle to my financial independence.

We need more info to help you out. What state are you in? What is your income? Any medical issues? Small kids?

For myself, a pretty healthy 28 year old, I am on a Kaiser Permanente Bronze plan (not through Covered CA... just my own plan purchased myself). I do think it's expensive for what it is, but I will be sad to see ACA go. Doubt the Republicans are gonna have free pap smears or birth control. Under ACA care for women has to cost the same as for men, that will probably change too. Ugh.

Altons Bobs

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Re: Healthcare options
« Reply #11 on: January 06, 2017, 12:48:51 AM »
I'm staying on my group plan as long as I can. There aren't any good Individual plans in my area at all, they are all crappy and more expensive than what I pay now.

ShoulderThingThatGoesUp

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Re: Healthcare options
« Reply #12 on: January 06, 2017, 05:35:47 AM »
All the rich people on here talking about their subsidies might have something to do with why the law isn't working as planned...

Spork

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Re: Healthcare options
« Reply #13 on: January 06, 2017, 08:27:47 AM »
All the rich people on here talking about their subsidies might have something to do with why the law isn't working as planned...

Indeed, there is some kernel of truth there.  I say this as someone that is FIRE and on the receiving end of subsidies.  It's tax code.  I don't agree with it.  I didn't write it.  Sadly, that's the way the law was written, so had someone thought it through, they'd see that it is working exactly as planned.  It was just poorly planned.

ShoulderThingThatGoesUp

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Re: Healthcare options
« Reply #14 on: January 06, 2017, 09:13:50 AM »
Yeah, I use the tax code however I can too; I'm not saying rich subsidy recipients are immoral -just that the whole "bend the cost curve" thing didn't really work out.