Obamacare numbers

[Gin1984]

Yeah, I've done an estimate on the numbers for my family.  It's not horrible right now, but I don't trust that the premium won't go up substantially over the years.  Then there's always the chance that the whole ACA gets repealed and then where would we be?  I don't know.  Maybe I'm too pessimistic.

I base my numbers on COBRA, that has been around for longer, so maybe that has less risk?  I don't know, but I have another twenty years so I just go with it, lol.

[WannabeDone]

If COBRA weren't capped at 18-months, that would definitely be doable.

[Gin1984]

If COBRA weren't capped at 18-months, that would definitely be doable.

California has it till 36 months, FYI.

[WannabeDone]

Good point about California.  Would love to be there.  I'll need several years of health insurance though depending on when we finally dare pull the plug on things.

[soccerluvof4]

If COBRA weren't capped at 18-months, that would definitely be doable.

California has it till 36 months, FYI.

But then the cost of living is higher than most areas no?

[WannabeDone]

But then the cost of living is higher than most areas no?

Yeah, but it has warm winters, lots of sun, palm trees, ocean and beaches.  : )

[Gin1984]

If COBRA weren't capped at 18-months, that would definitely be doable.

California has it till 36 months, FYI.

But then the cost of living is higher than most areas no?

Eh, I've only lived in California and NY so I am not sure.  Maybe more than the Midwest, but you might find some cheaper California areas close to Oregon or Central Ca.

[Spartana]

If COBRA weren't capped at 18-months, that would definitely be doable.

California has it till 36 months, FYI.

Wasn't there some kind of pre-requisite to extend the Fed. COBRA an additional 18 months using CAL-COBRA? Seems you had to have some kind of a health issue that meant that (pre-ACA) you would be denied coverage from an insurance company? Seems I read that somewhere.

In any case, I imagine under the ACA COBRA and CAL-COBRA will eventually be abolished (where is the need?) and, if the ACA is ever repealed, might not come back the same.   

[Gin1984]

If COBRA weren't capped at 18-months, that would definitely be doable.

California has it till 36 months, FYI.

Wasn't there some kind of pre-requisite to extend the Fed. COBRA an additional 18 months using CAL-COBRA? Seems you had to have some kind of a health issue that meant that (pre-ACA) you would be denied coverage from an insurance company? Seems I read that somewhere.

In any case, I imagine under the ACA COBRA and CAL-COBRA will eventually be abolished (where is the need?) and, if the ACA is ever repealed, might not come back the same.

Sort of, if you were in a company that was not required to let you COBRA (2-49) CAL-COBRA covered you for the full 36 months, if you were in company over 50 then yes, you used COBRA then CAL-COBRA.  But, no, you did not need a health issue to get access to CAL-COBRA.  However, CA did have a group of plans for those who were in-eligible for health insurance on the open market in which you had to be denied coverage from an insurance company PLUS have used up BOTH COBRA and CAL-COBRA.  I think you are combining the two.  :)

[Spartana]

Thanks for the info - that's probably what I read. I was on COBRA when I first quit my job (expensive!!) but dropped it for a low cost catastrophic policy early on so didn't need to extend it to CAL-COBRA.

[brooklynguy]

This is a disturbing development for people in states that use the federal insurance exchange (rather than their own state-run exchange):

http://www.nytimes.com/2014/07/23/us/court-rules-against-obamacare-exchange-subsidies.html?_r=0

(A federal appeals court ruled that the government cannot subsidize premiums for people in the three dozen states that use the federal insurance exchange.)

[Roland of Gilead]

Really no way that ruling stands.   At minimum the administration will issue an executive order or something to allow the refunds to continue.  If it stood, ACA would collapse.

[brooklynguy]

If it stood, ACA would collapse.

That's exactly why this ruling is so disturbing.  It paves the way for the Supreme Court to resolve the conflict that will inevitably arise when another federal appeals court rules the opposite way.  The last time Obamacare came before the Supreme Court, it passed muster only by the skin of its teeth, and that's when the entire underlying premise of subsidization of premiums was at issue.  This much narrower issue (which, as you said, effectively has the potential to destroy the ACA, since most states opted not to create an exchange) affords another opportunity to dismantle the law for those inclined to do so.  Now that the ACA is already up and running, challenging the law on this basis is an example of cutting off one's nose to spite one's face.  Hopefully cooler heads will prevail.

[randymarsh]

If it stands, it'll be interesting to watch the fall out. The states it would affect most are states that didn't want Obamacare in the first place.

[Tyler]

If it stands, it'll be interesting to watch the fall out. The states it would affect most are states that didn't want Obamacare in the first place.

I'm confident this will affect the healthcare markets in all states. Even if the subsidy doors stay temporarily open for states with their own exchanges, the financial models for the underlying insurance providers will be nuked. And the ability for the IRS to collect and redistribute premiums will also be neutered as the individual mandate is tied to receiving subsidies.  And that's even before you get to the political fallout in an election year that will cause various politicians on every side to knee jerk one way or another.

Just when I was ready to ER this year, healthcare gets another big (potential) upheaval.  All I want is some stability to predict my costs. :/

[Threshkin]

Just when I was ready to ER this year, healthcare gets another big (potential) upheaval.  All I want is some stability to predict my costs. :/

I am also getting ready to ER this year.  To address the uncertainty, I am over budgeting my health insurance expenses.  If I come out ahead it is all gravy.  In my case I am estimating health care at $12,000 per year for two adults.  This is 25% of our entire annual budget! 

I am very conservative regarding money so I tend to over budget expenses and under budget income.  Of course it helps to have the cushion to be able to do this!

[viper155]

"So far this year the federal government has paid out $4.7 billion in subsidies. The Congressional Budget Office and the Joint Committee on Taxation currently estimate that the ACA’s insurance provisions will cost just under 41.1 trillion over 10 years."

I don't seem remember Nancy Pelosi bringing up these numbers back when the ACA was being debated.

It only took one post for an aca thread to turn political. Is that a record?

It's a perfectly legitimate point to make on a subject that is nothing but political.

[seattlecyclone]

Really no way that ruling stands.   At minimum the administration will issue an executive order or something to allow the refunds to continue.  If it stood, ACA would collapse.

This case doesn't have anything to do with the constitutionality of the ACA, it's just a controversy over who the subsidies apply to. The text of the law says that people who buy their insurance from "an exchange established by the state" can be eligible for subsidies. That phrasing doesn't specifically include the federal exchange (for states that failed to create their own exchanges). The court ruled that people who bought their insurance through that exchange were ineligible for subsidies because the part of the ACA establishing the subsidies failed to include the federal exchange. Seems like a reasonable interpretation to me, even if omitting the federal exchange was almost certainly an oversight on Congress's part.

If the ruling is upheld, it doesn't cause the ACA to "collapse" at all. First of all, it changes nothing for people in the 14 states that offer a state exchange. Secondly, nothing is stopping the rest of the states from offering an exchange if they want to keep their citizens from being taxed for subsidies that are only paid to people in other states. Regardless of what happens in this court case, the majority of the act (guaranteed issue health insurance, individual mandate, etc.) will survive. House Republicans may pass yet another ACA repeal bill over this, but the Senate won't pass it and the President won't sign it.

[Tyler]

Just when I was ready to ER this year, healthcare gets another big (potential) upheaval.  All I want is some stability to predict my costs. :/

I am also getting ready to ER this year.  To address the uncertainty, I am over budgeting my health insurance expenses.  If I come out ahead it is all gravy.  In my case I am estimating health care at $12,000 per year for two adults.  This is 25% of our entire annual budget! 

I am very conservative regarding money so I tend to over budget expenses and under budget income.  Of course it helps to have the cushion to be able to do this!

I have a similar approach -- my budget includes the unsubsidized rates.  Luckily they're closer to $500/month rather than $1k/month (I realize they'll rise as we get older).

If the ruling is upheld, it doesn't cause the ACA to "collapse" at all. First of all, it changes nothing for people in the 14 states that offer a state exchange.

The ruling affects not only subsidies but also the mandate to purchase insurance.  Because of that, I'd be surprised if it doesn't also indirectly affect rates for everyone.  The ACA (and insurance market in general) was complex enough as-is without pulling entire states out of the mix.  Insurance companies will have to reevauate their cost models accordingly. 

Of course, nothing is settled by any means (another court found the exact opposite today) and there's a good chance it will end up in the Supreme Court.  Who knows how long it will take to sort out.  Probably a decade, if you look at the big picture.  I'm not gonna wait that long.  ;)

The biggest part of ER is being prepared to roll with the punches.

[Daisy]

This case doesn't have anything to do with the constitutionality of the ACA, it's just a controversy over who the subsidies apply to. The text of the law says that people who buy their insurance from "an exchange established by the state" can be eligible for subsidies. That phrasing doesn't specifically include the federal exchange (for states that failed to create their own exchanges). The court ruled that people who bought their insurance through that exchange were ineligible for subsidies because the part of the ACA establishing the subsidies failed to include the federal exchange. Seems like a reasonable interpretation to me, even if omitting the federal exchange was almost certainly an oversight on Congress's part.

I'm not a lawyer, nor do I play one on TV, but I have a vague reference of "equal protection under the law" being tossed around during the Bush v. Gore days. Does anyone with expertise with this think this could now affect the ACA in that those of us in states on the federal exchange are now being treated differently than other states, even if it's due to the state governments not wanting to set up exchanges?

Oh boy, just what we need. More ambiguity and confusion. I suppose like others above, we cannot rely on these subsidies for our ER calculations. I don't even know what to budget, as I don't want to pay $15k for health insurance as has been tossed around on this thread. That scares me. That's around half of my expenses. I'd rather spend that money on the holistic practictioners I actually do go to, and aren't covered under insurance currently.

I suppose if you're not eligible for subsidies then you can shop on the general market and buy non-ACA plans. Is that true? Just trying to see my options...thanks.

[iris lily]

This case doesn't have anything to do with the constitutionality of the ACA, it's just a controversy over who the subsidies apply to. The text of the law says that people who buy their insurance from "an exchange established by the state" can be eligible for subsidies. That phrasing doesn't specifically include the federal exchange (for states that failed to create their own exchanges). The court ruled that people who bought their insurance through that exchange were ineligible for subsidies because the part of the ACA establishing the subsidies failed to include the federal exchange. Seems like a reasonable interpretation to me, even if omitting the federal exchange was almost certainly an oversight on Congress's part.

I'm not a lawyer, nor do I play one on TV, but I have a vague reference of "equal protection under the law" being tossed around during the Bush v. Gore days. Does anyone with expertise with this think this could now affect the ACA in that those of us in states on the federal exchange are now being treated differently than other states, even if it's due to the state governments not wanting to set up exchanges?

Oh boy, just what we need. More ambiguity and confusion. I suppose like others above, we cannot rely on these subsidies for our ER calculations. I don't even know what to budget, as I don't want to pay $15k for health insurance as has been tossed around on this thread. That scares me. That's around half of my expenses. I'd rather spend that money on the holistic practictioners I actually do go to, and aren't covered under insurance currently.

I suppose if you're not eligible for subsidies then you can shop on the general market and buy non-ACA plans. Is that true? Just trying to see my options...thanks.

Eqal protection under the law as a concept has nothing to do with this.

You will be able to buy ACA compliant policies, just as people making $500,000 annually will be able to buy ACA compliant policies. They don't get a subsidy. You won't get a subsidy.  This ruling today is (apparently, from what I can tell) about subsidies and who gets 'em.

The ACA law is a POS, a cumbersome, idiotic, complex monstrosity. That doesn't mean that I won't use it to my advantage :) but really, what a crock of horsesh*t.

[MoneyCat]

Everybody relax.  The ACA isn't going anywhere and the subsidies are not going to be cut off for people unfortunate enough to live in red states.  There are plenty enough Democratic federal judges in place to prevent the DC Circuit's idiotic opinion from going anywhere.  The 4th circuit already gave the opposite verdict on this issue.  The Tea Party will not succeed in destroying the law just because they hate the idea of millions of people avoiding bankruptcy from medical disasters.

[Gin1984]

This case doesn't have anything to do with the constitutionality of the ACA, it's just a controversy over who the subsidies apply to. The text of the law says that people who buy their insurance from "an exchange established by the state" can be eligible for subsidies. That phrasing doesn't specifically include the federal exchange (for states that failed to create their own exchanges). The court ruled that people who bought their insurance through that exchange were ineligible for subsidies because the part of the ACA establishing the subsidies failed to include the federal exchange. Seems like a reasonable interpretation to me, even if omitting the federal exchange was almost certainly an oversight on Congress's part.

I'm not a lawyer, nor do I play one on TV, but I have a vague reference of "equal protection under the law" being tossed around during the Bush v. Gore days. Does anyone with expertise with this think this could now affect the ACA in that those of us in states on the federal exchange are now being treated differently than other states, even if it's due to the state governments not wanting to set up exchanges?

Oh boy, just what we need. More ambiguity and confusion. I suppose like others above, we cannot rely on these subsidies for our ER calculations. I don't even know what to budget, as I don't want to pay $15k for health insurance as has been tossed around on this thread. That scares me. That's around half of my expenses. I'd rather spend that money on the holistic practictioners I actually do go to, and aren't covered under insurance currently.

I suppose if you're not eligible for subsidies then you can shop on the general market and buy non-ACA plans. Is that true? Just trying to see my options...thanks.

It is my understanding that you will not get a fine if you do not buy off the exchange, just as someone with employer subsidized insurance will not get a fine.  However, yes, that does mean no subsidy and it also means they don't have to take you.

[Daisy]

Everybody relax.  The ACA isn't going anywhere and the subsidies are not going to be cut off for people unfortunate enough to live in red states.  There are plenty enough Democratic federal judges in place to prevent the DC Circuit's idiotic opinion from going anywhere.  The 4th circuit already gave the opposite verdict on this issue.  The Tea Party will not succeed in destroying the law just because they hate the idea of millions of people avoiding bankruptcy from medical disasters.

I don't think it's prudent to rely on these subsidies. As we see, the law has some ambiguities and half the country disagrees with it (rightly or wrongly). Even without this ruling, I was worried that subsidies for high asset people like those of us planning on FIRE-ing were not likely to hold up over time. Best to make plans as if you will get no subsidy. Laws and rules change all of the time.

[iris lily]

I don't think it's prudent to rely on these subsidies. As we see, the law has some ambiguities and half the country disagrees with it. Even without this ruling, I was worried that subsidies for high asset people like those of us planning on FIRE-ing were not likely to hold up over time. Best to make plans as if you will get no subsidy. Laws and rules change all of the time.

yes, this is wise. agreed.

[beltim]

I suppose if you're not eligible for subsidies then you can shop on the general market and buy non-ACA plans. Is that true? Just trying to see my options...thanks.

It is my understanding that you will not get a fine if you do not buy off the exchange, just as someone with employer subsidized insurance will not get a fine.  However, yes, that does mean no subsidy and it also means they don't have to take you.

That's true for two years: http://www.nytimes.com/2014/03/06/us/politics/obama-extends-renewal-period-for-noncompliant-insurance-policies.html?_r=0

However, after that, non-compliant policies purchased off the exchanges will not exempt you from a fine.

[Roland of Gilead]

I don't think it's prudent to rely on these subsidies. As we see, the law has some ambiguities and half the country disagrees with it (rightly or wrongly). Even without this ruling, I was worried that subsidies for high asset people like those of us planning on FIRE-ing were not likely to hold up over time. Best to make plans as if you will get no subsidy. Laws and rules change all of the time.

Disagree here.  Net worth testing is very hard to implement and very expensive/unpopular to implement.  Income testing is easier.   If the subsidy goes away, it goes away for everyone at a certain income level.  If the subsidy goes away for low income, ACA collapses and we can go back to purchasing a cheap catastrophic health plan and self insuring for the smaller stuff.

Based on that, I would plan for paying about 10% of your income for healthcare, no matter how big your stache.

[FireYourJob]

Everybody relax.  The ACA isn't going anywhere and the subsidies are not going to be cut off for people unfortunate enough to live in red states.  There are plenty enough Democratic federal judges in place to prevent the DC Circuit's idiotic opinion from going anywhere.  The 4th circuit already gave the opposite verdict on this issue.  The Tea Party will not succeed in destroying the law just because they hate the idea of millions of people avoiding bankruptcy from medical disasters.

Won that was politically charged.

[rtrnow]

The ACA law is a POS, a cumbersome, idiotic, complex monstrosity. That doesn't mean that I won't use it to my advantage :) but really, what a crock of horsesh*t.

Yeah what a POS, I was just able to purchase reasonable priced (without subsidy) insurance regardless of pre existing conditions. That's so awful. There are no doubt things that could be done better, but that are some really good things too. The general argument I hear around here (and in general) is that people who have work sponsored healthcare or are healthy (therefore could buy insurance cheaply) don't like it. Personally, I think it's just fine for me to pay a bit more so that someone with an unavoidable condition can have care without going bankrupt.

[Daleth]

The ACA law is a POS, a cumbersome, idiotic, complex monstrosity. That doesn't mean that I won't use it to my advantage :) but really, what a crock of horsesh*t.

Yeah what a POS, I was just able to purchase reasonable priced (without subsidy) insurance regardless of pre existing conditions. That's so awful. There are no doubt things that could be done better, but that are some really good things too. The general argument I hear around here (and in general) is that people who have work sponsored healthcare or are healthy (therefore could buy insurance cheaply) don't like it. Personally, I think it's just fine for me to pay a bit more so that someone with an unavoidable condition can have care without going bankrupt.

I'm with you on that.

[Bateaux]

For once I'm glad I'm not planning to FIRE till 2018.  Should shake out by then.

[DoubleDown]

For folks that didn't see, the same day this ruling came out of the District Court in DC, another District Court in Richmond issued the exact opposite ruling in an almost exact case. The Richmond decision was 4-0, all Democrat-nominated judges. In the case of the DC court, it was 2-1 (with the 2 Republicans voting that subsidies were illegal in states without their own exchanges, and the Democrat voting in dissent).

The DC court stayed their opinion allowing the Obama Administration to appeal, or to request an en banc decision (by all 7 members of the court, not just the three in this decision). If the court grants such a request, the decision will likely be overturned as the majority of the 7 judges were appointed by Democrats.

Worst case scenario, because two District Courts reached opposite rulings (on the same day no less!), the case may go to the Supreme Court to decide once and for all. Or, the courts may determine that because the law is ambiguous about this point, then judgment on how to proceed is deferred to the Administration (which would leave the subsidies intact, of course). The DC court should have already deferred, that is the standard protocol in situations like this. It is obvious the intent of Congress in setting up the law was not to give subsidies to people in some states, and not to others. What a ridiculous decision by the DC court.

[Daisy]

Or, the courts may determine that because the law is ambiguous about this point, then judgment on how to proceed is deferred to the Administration (which would leave the subsidies intact, of course).

I don't think it's settled. If it's left up to the administration and not put into law, then the next Republican president can change it and your subsidies are reduced or gone.

I don't want my FIRE plans left up to the whims of politicians and judges. I say the safe thing is to assume no subsidies. If they continue, it's just a bonus.

That probably means I need to work a little longer. :-(

[Gin1984]

Or, the courts may determine that because the law is ambiguous about this point, then judgment on how to proceed is deferred to the Administration (which would leave the subsidies intact, of course).

I don't think it's settled. If it's left up to the administration and not put into law, then the next Republican president can change it and your subsidies are reduced or gone.

I don't want my FIRE plans left up to the whims of politicians and judges. I say the safe thing is to assume no subsidies. If they continue, it's just a bonus.

That probably means I need to work a little longer. :-(

Or have enough to move to a state that has/had non-private plan eligible plans.  California had plans, if you maxed out COBRA and Cal-COBRA and where ineligible for a regular plan.  And honestly they were quite decent.

[Richie Poor]

I have a different perspective on the ACA that I would like to share. Not the politics of ACA but the quality of care you may receive. 

I was hoping the ACA would be beneficial me and wife. I have always been self employed and healthy so I had a catastrophic plan that was very affordable. My wife (29) is a Youth Minister/Church Secretary that has not had insurance since college. We knew she would actually be using her insurance because she has back pain and we were planning on having a baby as soon as we got married in February.

So last December I signed her up for her own BCBS Gold plan at $300/month with a $3500 deductible. That seems like a lot of money for someone so young without any diagnosed conditions but I was alright with amount since it's one of the top tier plans they have. So we are paying this money now so why not use it? She has some bad shoulder pain so she goes to a primary care physician and he is drunk. Not ACA's fault but let's find another and try again. The next doctor we found that accepted her ACA plan was not as bad. His office was run down and it would take 1 hour or so after the appointment before he was ready to see her. But he was interested in her ailment and made a referral for an MRI. My wife gets a call from the lab with good news saying that the MRI would be completely covered by the MRI, which I didn't think was right. We later got a bill for $499 and that was the insurance negotiated rate. Her doctor says her shoulder has bursitis and she needs a steroid shot. He refers her to 2 different pain specialist that don't take her insurance. We call around and finally find someone who will take the insurance but they want to charge $650. It doesn't seem right so my wife decides to postpone that and live with the pain a while longer.

Meanwhile we want to get pregnant but get bad news that she has a condition that prevents her from ovulating. Her OB/GYN (who is also fashionably late to his appointments) prescribes drugs to take for the next 6 months that should help. They didn't. These are most of the road blocks we ran into with her ACA plan but not all  of them. In April I even spoke with a broker about switching plans that might not be "obamacare" plans so that we might see better "negotiated rates" even if the premium goes up. He tells us that all individual plans now are considered "obamacare" plans and doctors are dropping off of all of them. He says we can't change plans anyway without some qualifying life event.

Infuriated with how little health insurance is working for us I canceled our separate policies.  I couldn't handle paying for something and receiving nothing in return. Actually were were getting negative returns. It was hard but after I made the decision our life was more peaceful. I told her to see any doctor she wanted and we would pay cash. She went to a doctor about her shoulder and he gave her a steroid shot right on the spot and said it was included with her $200 doctor visit.  We just saved $450 right there without even counting the monthly premium we didn't spend that month. He wanted an MRI and sent us to a place that only charged us $319 is we paid cash. That is a lot better than our insurance discounted MRI.

She decides she wants a new OB/GYN. This one tells her that her last doctor should have been upping the dosage of her prescription every month to get pregnant and now we have two wait for the drugs to leave the system before we can try again. I double checked on the internet and he was right. So our first OB/GYN wasted 8  months of baby making time.

I realize we may have had just the worst luck with doctors and it isn't what the ACA was hoping for. But based on my own experiences I think the ACA is creating a 2 class system. Those with nice employer sponsored plans will have access to better doctors than those that have ACA plans. My wife says the difference is noticeable as soon as you hit the Doctor's office lobby. The ACA doctors have dirty, crowded waiting rooms that resemble the hospital emergency room and the non ACA doctors office are clean with few people and they see you right on time. So before you take the plunge into your own ACA plan at least investigate to make sure the doctors you trust will accept the plan. I won't be padding the pockets of those insurance companies anytime soon.

Sorry for the long story. I just wanted to rant about my awful experience and maybe see if anyone else thought the ACA had bad quality doctors or if I was just unlucky. I guess it matters less if you are healthy. I hope all of you soon to be retirees have better results.

[Gin1984]

I have a different perspective on the ACA that I would like to share. Not the politics of ACA but the quality of care you may receive. 

I was hoping the ACA would be beneficial me and wife. I have always been self employed and healthy so I had a catastrophic plan that was very affordable. My wife (29) is a Youth Minister/Church Secretary that has not had insurance since college. We knew she would actually be using her insurance because she has back pain and we were planning on having a baby as soon as we got married in February.

So last December I signed her up for her own BCBS Gold plan at $300/month with a $3500 deductible. That seems like a lot of money for someone so young without any diagnosed conditions but I was alright with amount since it's one of the top tier plans they have. So we are paying this money now so why not use it? She has some bad shoulder pain so she goes to a primary care physician and he is drunk. Not ACA's fault but let's find another and try again. The next doctor we found that accepted her ACA plan was not as bad. His office was run down and it would take 1 hour or so after the appointment before he was ready to see her. But he was interested in her ailment and made a referral for an MRI. My wife gets a call from the lab with good news saying that the MRI would be completely covered by the MRI, which I didn't think was right. We later got a bill for $499 and that was the insurance negotiated rate. Her doctor says her shoulder has bursitis and she needs a steroid shot. He refers her to 2 different pain specialist that don't take her insurance. We call around and finally find someone who will take the insurance but they want to charge $650. It doesn't seem right so my wife decides to postpone that and live with the pain a while longer.

Meanwhile we want to get pregnant but get bad news that she has a condition that prevents her from ovulating. Her OB/GYN (who is also fashionably late to his appointments) prescribes drugs to take for the next 6 months that should help. They didn't. These are most of the road blocks we ran into with her ACA plan but not all  of them. In April I even spoke with a broker about switching plans that might not be "obamacare" plans so that we might see better "negotiated rates" even if the premium goes up. He tells us that all individual plans now are considered "obamacare" plans and doctors are dropping off of all of them. He says we can't change plans anyway without some qualifying life event.

Infuriated with how little health insurance is working for us I canceled our separate policies.  I couldn't handle paying for something and receiving nothing in return. Actually were were getting negative returns. It was hard but after I made the decision our life was more peaceful. I told her to see any doctor she wanted and we would pay cash. She went to a doctor about her shoulder and he gave her a steroid shot right on the spot and said it was included with her $200 doctor visit.  We just saved $450 right there without even counting the monthly premium we didn't spend that month. He wanted an MRI and sent us to a place that only charged us $319 is we paid cash. That is a lot better than our insurance discounted MRI.

She decides she wants a new OB/GYN. This one tells her that her last doctor should have been upping the dosage of her prescription every month to get pregnant and now we have two wait for the drugs to leave the system before we can try again. I double checked on the internet and he was right. So our first OB/GYN wasted 8  months of baby making time.

I realize we may have had just the worst luck with doctors and it isn't what the ACA was hoping for. But based on my own experiences I think the ACA is creating a 2 class system. Those with nice employer sponsored plans will have access to better doctors than those that have ACA plans. My wife says the difference is noticeable as soon as you hit the Doctor's office lobby. The ACA doctors have dirty, crowded waiting rooms that resemble the hospital emergency room and the non ACA doctors office are clean with few people and they see you right on time. So before you take the plunge into your own ACA plan at least investigate to make sure the doctors you trust will accept the plan. I won't be padding the pockets of those insurance companies anytime soon.

Sorry for the long story. I just wanted to rant about my awful experience and maybe see if anyone else thought the ACA had bad quality doctors or if I was just unlucky. I guess it matters less if you are healthy. I hope all of you soon to be retirees have better results.

The ACA does not have doctors, your plan has doctors. The kaiser plan on California's exchange has same doctors I had with my mom's amazing plan.   

[Richie Poor]

I know the ACA doesn't have doctors but realize doctors have the choice to accept ACA plans or not. I'm happy to know there are still some quality doctors in CA that still accept ACA plans.

I might have switched my wife over to a company that wasn't BCBS but that isn't allowed until open enrollment.

[Roland of Gilead]

Based on the misinformation in the above story, I think it may be fiction.

Edit:  On further reflection, perhaps not fiction but a testament to how uninformed the public is of their health options.  This is probably Obama's fault.  :-)

[beltim]

Based on the misinformation in the above story, I think it may be fiction.

Edit:  On further reflection, perhaps not fiction but a testament to how uninformed the public is of their health options.  This is probably Obama's fault.  :-)

What misinformation?  I see no factual errors on the part of the poster (the broker, however, did have a factual error: you can still buy individual plans that are not ACA-compliant).  I see some misconceptions on the part of the poster, but they're the same ones people always have when posting about health insurance: that how healthy someone is affects their insurance premium (getting rid of that was one of the points of the ACA), or that $300/month is a lot to pay for insurance (per capital health care costs in the US are $8500 annually, and most of that is insurance).

I think this post is a good illustration of why catastrophic plans would be useful.  The exclusion of catastrophic plans may be my least favorite part of the ACA.  (Yes, I know that there are still plans that the ACA calls "catastrophic," but those still require a lot of first-dollar coverage that is antithetical to their idea of catastrophic plans)

[Daisy]

I have a different perspective on the ACA that I would like to share. Not the politics of ACA but the quality of care you may receive. 

(Warning - health care rant follows)

Some of these issues don’t really have anything to do with the ACA, but more with our conventional medical system, which is a pill-pushing business that many times does not try to find the root cause of a disease. Go into a regular doctor’s office, and they already have their prescription pad out before you can even say one word, and they are rushing to get you through so that they can see the next patient. I realize this is a bit off topic and in some people’s eyes controversial. Our current healthcare system is a mess as it is, and I don’t see how the ACA solves the problems. The good thing about ACA is people with pre-existing conditions can now get insurance coverage.

But I also view insurance companies as the highly paid middle man that doesn’t provide a lot of added value for regular health care (prevention, treating the common cold, flu shots, etc.), but rather skims off a little from each transaction in order to pay for their lavish offices and salaries. Insurance is good for the big stuff like cancer and horrible accidents. I don’t see how the ACA improves this. In fact, it looks like it makes it worse as the insurance companies are now charging exorbitant premiums that are only “affordable” with tax-payer funded subsidies.

I’ve had a lot of good results with holistic practitioners for certain chronic conditions that conventional western medicine does not know how to treat. And I’ve actually “cured” (as in no symptoms) through these holistic practices a couple of things that were bugging me for many years after a lot of consultation with conventional medicine which didn’t work.

So my default is to go holistic unless I get involved in a car or bicycle accident or something where I break a bone or get burned or have other traumatic effects. But for chronic conditions, proper nutrition and holistic care is what I choose – because it has worked remarkably well for me. Most of this is not included in regular insurance coverage. So ACA doesn’t help me there, but honestly neither did the system before. It’s just forcing me to buy a super expensive thing I don’t want. Thankfully I make a good enough salary to afford this. Although in the long run, by fixing my problems, this holistic care was actually cheaper than conventional care (even with having insurance coverage).

I will avoid taking any prescription or over the counter pill as much as I can. Put me down as a hippie, granola-crunching, organic freak. In fact, if I can call this a religion maybe I can exempt myself from purchasing something I don’t want. I identify with the first definition here: http://www.urbandictionary.com/define.php?term=granola%20cruncher

granola cruncher
A person who is not a hippie, but into organic products and cares about the earth. They may wear birkenstocks with wool socks, mostly don't wear makeup, and are a genuinely laid back and cool group. You want tolerance? They won't go through the effort of causing drama - they'd rather be hiking.
A granola cruncher is a a tye-dye wearing, birkenstock wearing, tree hugging, laid back cool person.

You may not agree with me, but that’s the whole point of having health care choice and living in freedom-loving USA. No need to debate with me on whether I am right or wrong on conventional medicine as I already have my opinions based on my experiences and my elderly parents’ experiences in health care.

[Daleth]

But I also view insurance companies as the highly paid middle man that doesn’t provide a lot of added value for regular health care (prevention, treating the common cold, flu shots, etc.), but rather skims off a little from each transaction in order to pay for their lavish offices and salaries. Insurance is good for the big stuff like cancer and horrible accidents. I don’t see how the ACA improves this.

One way it improved that is that the ACA requires all insurance companies (not just ACA exchange plans) to spend 80% of the money they bring in on healthcare for their insurance policy holders. In other words 80% of the premiums you pay have to go right back out the door to cover your and your fellow policyholders' health care costs. That means only 20% is left for everything else: administrative costs, marketing, salaries and bonuses for the insurance company's employees, dividends for shareholders, etc. This also means that the cost of your policy can't go up unless what your insurer pays in health care costs goes up--they can't just decide they want a higher profit margin or bigger bonuses for executives and pass that cost on to you.

That's why millions of people got refunds from their insurance companies last year. Companies that had only spent, say, 78% or whatever (any number less than 80%) on health care costs had to refund the difference to policyholders such that the total amount paid by the insurance company for health care costs equaled 80% of the total amount paid by policyholders for insurance.

[DoubleDown]

Or, the courts may determine that because the law is ambiguous about this point, then judgment on how to proceed is deferred to the Administration (which would leave the subsidies intact, of course).

I don't think it's settled. If it's left up to the administration and not put into law, then the next Republican president can change it and your subsidies are reduced or gone.

I don't want my FIRE plans left up to the whims of politicians and judges. I say the safe thing is to assume no subsidies. If they continue, it's just a bonus.

That probably means I need to work a little longer. :-(

Definitely agree it isn't settled, and I certainly didn't mean to suggest it is. I wanted to let folks know there was a separate and equally important decision that reached the exact opposite conclusion, on the same day, since nothing in this thread had noted that yet. Unfortunately, the decisions come off (to me) as highly political, with all the Democratic judges voting with the ACA and the two Republicans voting against. I think the DC court's opinion with the two Republican majority justices stretches credulity, but that is frequently my opinion of that court's opinions.

I think when it all shakes out, the subsidies will be upheld, but that is definitely an uncertainty. And in the meantime, this decision throws everything (unnecessarily) into disarray for all of us.

[geekette]

As I troll the web trying to plan for this first year of ACA plans, I found a pdf with a lot of info on the form 8962, including how to calculate the percentage of your MAGI that you'll need to pay (I'd only seen ranges before).  Page 8 here - http://www.irs.gov/pub/irs-schema/Form8962SchemaReview.pdf

I haven't dug through it all, but since we did a partial year of COBRA and the rest with an ACA plan, it'll be a bit more complicated.  Whee.

[RunHappy]

I'm also unexcited about the ACA because I think it's the wrong prescription for a chronic ailment. Getting employers out of the business of having to provide health insurance for their employees is where I think we need to be, whether one thinks an individual should purchase independently (like American car insurance) or via a national health system. If the former, I think we have to accept the fact that without subsidies health insurance will be out of reach of too many people. As the world's wealthiest nation and near the top in terms of income per capita, certainly we can do better than this.
[/quote]

Well said.

To add to this, the ACA is very still very new, I think it is too early to make judgements.  There is still a lot of "kicking the tires" that need to happen and longer term data is needed before anyone can say if it is a success or failure.

[TreeTired]

So before you take the plunge into your own ACA plan at least investigate to make sure the doctors you trust will accept the plan.

That is very important!    We moved to NC 6 years ago and found a decent BCBS plan and all of our doctors have been fantastic.  My regular doctor,  my urologist, our dermatologist, my wife's ob/gyn and regular doctor (same woman, I think).   When we switched to a BCBS Obamacare plan I made sure all of our doctors would accept the new plan.  I think my wife's OB/Gyn accepted it, but as a 2nd tier which meant a higher copay.  I figured that was ok for a once a year visit.   Anyway,  that is a very important step -  checking to see which doctors accept the plan,  but if the network is very small and you don't like the doctors that accept the plan, or your current doctor doesn't accept the plan,   I do see that as a problem.   Fortunately, it was not a problem for us.

[randymarsh]

Speaking of in network vs. out of network, is it typically that big of deal? I just started a new job in a new state and my insurance is only in network unless it's an emergency. It's United Healthcare which I assume is a huge network. I'm also still on my parents' even more generous plan so I'm not worried or anything but wanted to know if this type of plan is common.

[geekette]

You'll have to check with UHC to see who your plan covers. Different plans, even within the same insurance company, have different networks, and in/out of network means different coverage.  Generally, the more you (or your employer) pay, the bigger the network. 

It was important to us to keep our primary doctor, so we didn't go with the BCBS "value" plan, but the slightly more expensive "select" plan.

[randymarsh]

My monthly premium is only $20 for medical and a bit more for dental/vision. Overall I think the plan is a pretty good deal, just with a few restrictions.

[firedup]

So any guesses what will happen to the ACA & subsidies now with the election results?

[geekette]

There's not enough change in numbers to override a veto.  I'm up for changes to the ACA, but a wholesale repeal would be a HUGE step back for those of us with no other viable options.