Health Insurance in NJ?

[IronInTheFIRE]

Hi All,

I did try to search for this, but without success.  I am married with 2 little ones in Norther NJ and was wondering what others here might have currently for self-funded health insurance in NJ (monthly rate/deductibles/co-pays/extent of coverage, etc.

Wife and I are both 45 and currently covered by my work plan, and expecting that to end come July 1 this year.

So far my search efforts on healthcare.gov have yielded a palns with monthly preiums over $1,000, not what I was expecting.

I'd love to see what others are paying & getting for their money & what is reasonable for us.

Thanks in advance!

[seattlecyclone]

$1,000/month for unsubsidized health insurance sounds pretty standard for a family of four. Why were you expecting it to be much lower? Check your latest W-2 to see how much your employer-subsidized health insurance actually costs. You may be surprised.

The ACA has income-based subsidies that should help when you retire and have a lower income. If you're still planning to work and earn a pretty high income, but without employer-provided insurance, you'll have to pay the full cost yourself.

[mandy_2002]

I'm in CA on a high deductible solo plan. My cut is $12/month and my employer pays about $266. I don't think I want to see the cost of regular coverage for 4 here.

[FIRE me]

You don't mention why your employer coverage is ending and why you are going self funded. Are you going self employed, taking a sabbatical, or FIREing?

Anyway, for your situation, keeping your annual income under 200% of the Federal Poverty Level (adjusted for your family size) is the way to get subsidized insurance. And preferablly under 150% of the FPL.

More info here:
http://rootofgood.com/affordable-care-act-subsidy/

[smoghat]

I'm in the same boat. COBRA runs out in October and I'm done working for someone else. The ACA plans are pretty bad in NJ. $2,200 or so for a family of four with a $5000 (or something nearly as absurd) deductible and worse yet no doctors covered outside the state. I wonder if there aren't other plans that would be cheaper or at least have lower deductibles. Is Obamacare really the only game in town?

[jim555]

I'm in the same boat. COBRA runs out in October and I'm done working for someone else. The ACA plans are pretty bad in NJ. $2,200 or so for a family of four with a $5000 (or something nearly as absurd) deductible and worse yet no doctors covered outside the state. I wonder if there aren't other plans that would be cheaper or at least have lower deductibles. Is Obamacare really the only game in town?

Did you factor in the subsidy?  Best to keep MAGI at <=200 FPL, the lower the better.

[FIRE me]

I'm in the same boat. COBRA runs out in October and I'm done working for someone else. The ACA plans are pretty bad in NJ. $2,200 or so for a family of four with a $5000 (or something nearly as absurd) deductible and worse yet no doctors covered outside the state. I wonder if there aren't other plans that would be cheaper or at least have lower deductibles. Is Obamacare really the only game in town?

Did you factor in the subsidy?  Best to keep MAGI at <=200 FPL, the lower the better.

The "the lower the better" part is not true everywhere!

In some states (Mississippi is one example), you can fall off the subsidy cliff if it gets too low, from 100% subsidy to 0% subsidy. Literally, $1 of income can make the difference between full subsidy and zero subsidy. That's why it's called "the cliff".

Additionally, in many states, if you go too low you'll end up on Medicaid (not necessarily a bad thing), but some of those states have very aggressive Medicaid cost recovery rules. In some states the full Medicaid cost of your medical care will come out of your estate.

[jim555]

The OP is in NJ so no worry about falling into the gap since they expanded. 

[FIRE me]

The OP is in NJ so no worry about falling into the gap since they expanded.

New Jersey is an aggressive Medicaid Estate Recovery state.  OP has children so he would presumably want them to eventually inherit, and not leave his money to the state.

http://www.state.nj.us/humanservices/dmahs/clients/The_NJ_Medicaid_Program_and_Estate_Recovery_What_You_Should_Know.pdf

http://www.usatoday.com/story/news/nation/2014/02/16/medicaid-death-bill-homes-assets-at-risk/5534575/

[tooqk4u22]

The OP is in NJ so no worry about falling into the gap since they expanded.

New Jersey is an aggressive Medicaid Estate Recovery state.  OP has children so he would presumably want them to eventually inherit, and not leave his money to the state.

http://www.state.nj.us/humanservices/dmahs/clients/The_NJ_Medicaid_Program_and_Estate_Recovery_What_You_Should_Know.pdf

http://www.usatoday.com/story/news/nation/2014/02/16/medicaid-death-bill-homes-assets-at-risk/5534575/

Yeah but it only comes into play at 55 or older.  OP is 45 so could go Medicaid route for 9 years without worrying about it.

[FIRE me]

The OP is in NJ so no worry about falling into the gap since they expanded.

New Jersey is an aggressive Medicaid Estate Recovery state.  OP has children so he would presumably want them to eventually inherit, and not leave his money to the state.

http://www.state.nj.us/humanservices/dmahs/clients/The_NJ_Medicaid_Program_and_Estate_Recovery_What_You_Should_Know.pdf

http://www.usatoday.com/story/news/nation/2014/02/16/medicaid-death-bill-homes-assets-at-risk/5534575/

Yeah but it only comes into play at 55 or older.  OP is 45 so could go Medicaid route for 9 years without worrying about it.

I didn't notice that, so well read on your part. Assuming that OP keeps an eye out for any changes to the law, he would indeed good on Medicaid.

[smoghat]

Not going to be subsidized given what I expect my level of income will be...

[forummm]

The OP is in NJ so no worry about falling into the gap since they expanded.

New Jersey is an aggressive Medicaid Estate Recovery state.  OP has children so he would presumably want them to eventually inherit, and not leave his money to the state.

http://www.state.nj.us/humanservices/dmahs/clients/The_NJ_Medicaid_Program_and_Estate_Recovery_What_You_Should_Know.pdf

http://www.usatoday.com/story/news/nation/2014/02/16/medicaid-death-bill-homes-assets-at-risk/5534575/

Yeah but it only comes into play at 55 or older.  OP is 45 so could go Medicaid route for 9 years without worrying about it.

I didn't notice that, so well read on your part. Assuming that OP keeps an eye out for any changes to the law, he would indeed good on Medicaid.

And I believe the Medicaid recovery is only for traditional Medicaid (being eligible for the categories of Medicaid that existed before the ACA). Traditional Medicaid is a different program than the ACA's Medicaid expansion variety (based only on income). It's complicated.

[goatmom]

What is problem with medicaid recovery? I guess I don't have a problem with it.  Not so sure why kids should inherit money when parents received low cost medical care at taxpayers expense. Maybe I am missing something here.  It seems pretty fair to me.

[jim555]

What is problem with medicaid recovery? I guess I don't have a problem with it.  Not so sure why kids should inherit money when parents received low cost medical care at taxpayers expense. Maybe I am missing something here.  It seems pretty fair to me.

So you would be ok with estate recovery for ACA subsidies?  How about recovery for the tax break working people get by paying for health insurance with pre-tax money?

It is totally unfair and regressive.  Anything to punish / humiliate the poors.

[seattlecyclone]

What is problem with medicaid recovery? I guess I don't have a problem with it.  Not so sure why kids should inherit money when parents received low cost medical care at taxpayers expense. Maybe I am missing something here.  It seems pretty fair to me.

The unfairness comes into play where someone whose income is low enough that government pays for 100% of their health care has their estate billed for 100% of this cost, but someone earning a little bit more where the government only pays for 90% of their health care has their estate billed for 0% of the cost. Either apply the estate recovery to all health care subsidies or get rid of it entirely. Don't make it be something that only the poorest need to worry about.

[stoaX]

What is problem with medicaid recovery? I guess I don't have a problem with it.  Not so sure why kids should inherit money when parents received low cost medical care at taxpayers expense. Maybe I am missing something here.  It seems pretty fair to me.

So you would be ok with estate recovery for ACA subsidies?  How about recovery for the tax break working people get by paying for health insurance with pre-tax money?

It is totally unfair and regressive.  Anything to punish / humiliate the poors.

Is the regressive aspect of Medicaid recovery an unintended consequence?  My understanding of the origins of Medicaid recovery was to prevent wealthy people from giving away all their wealth to their children near the end of their lives in order to have Medicaid pay for nursing home expenses.  Hence the 5 year lookback rules. The rules that allow some assets to remain unrecoverable are attempt to not "punish the poor".   

The ACA aspect of this is a rather new phenomena since the subsidies have only been in effect a short while.  I wonder if regulations are being reconsidered in some states in light of this.  Changing regulations to adjust to new realities is a slow process in every state I have lived in.   

[jim555]

Some states do not count the new group for recovery, others do.  The old Medicaid was paid for 50%/50% Feds/states.  The new group is 100%/90% paid for by the Feds.  So I don't see why the states would aggressively go after the new group considering the most they will get is 10% of the recovery.  They should move the age from 55 to 65 for recovery, but this would have to be done by the Feds.

[goatmom]

I guess I am assuming poor people don't have estates to pass on to their heirs.  Maybe I am missing the point.  I come from pretty poor background and no one ever had an estate or an inheritance. I remember people having to chip in to pay for the funeral.  That is poor. And yes, I thnk it should be implemented fairly but I still don't see how any recovery punishes poor people.

[jim555]

I guess I am assuming poor people don't have estates to pass on to their heirs.  Maybe I am missing the point.  I come from pretty poor background and no one ever had an estate or an inheritance. I remember people having to chip in to pay for the funeral.  That is poor. And yes, I thnk it should be implemented fairly but I still don't see how any recovery punishes poor people.

Seriously?  So person A makes 137% FPL has to pay back everything.  Person B makes 139% FPL and has to pay back nothing.  Clearly person A is punished for being too poor to get into ACA subsidies.