Author Topic: when ACA says max out of pocket is X dollars does that include premiums?  (Read 934 times)

honeyfill

  • Bristles
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  • Age: 63
  • Location: Tucson
Dumb question.
I went to the a ACA calculator site and put in income as 375% of poverty level for 3 for my state.
It told me my premiums would be 610 a month (7321 a year) .
then it said my max out of pocket would be 14700.

If We had a major health event with large costs would I pay the 7321 in premiums + 14700 or would I only have to pay the difference   14700 -7321?

honeyfill

  • Bristles
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  • Posts: 311
  • Age: 63
  • Location: Tucson
Google is my friend:
https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/

"The out-of-pocket limit doesn't include your monthly premiums. It also doesn't include anything you spend for services your plan doesn't cover."

Yikes, a silver plan un-subsidized is 1810 a month for a "true" max out of pocket of $21,700+$14,700 of $36,400.  Using the 25X rule , that means you need an extra $910,000 saved up just to pay for health care!!

dandarc

  • Magnum Stache
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#1 - eventually you'll qualify for medicare.  The "Pay for healthcare" portion of the portfolio doesn't have to last forever.

#2 - unsubsidized once you're retired is a pretty big assumption - once you're in the withdrawal phase, you can control your income to a greater degree.

#3 - that silver plan premium might be artificially high.  Subsidies based on "2nd most expensive silver level plan" have led the silver plans to increase in price faster than the other plans.  For example, in my county, the average premium for an unsubsidized silver plan is actually a bit higher than for a gold plan.  Insurers and state insurance boards have set prices to maximize the federal dollars flowing in.

But overall, yeah healthcare is crazy expensive in the US.  It has been for a long time.  One thing the ACA has done is make more people aware of that.  Before, many were sheltered from the cost of insurance by employer subsidies, or on the individual market by the fact there was no guaranteed issuance - fairly easy to keep insurance cheap if you only have to write policies for healthy people.
« Last Edit: March 01, 2018, 12:14:05 PM by dandarc »