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Old 10-03-2014, 04:03 AM   #41
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The money comes from that vast pile that bails out banks, underwater homeowners, and underfunded public pensions.
I don't understand your comment. The money would have to come from higher premiums and new younger enrollees. I know for a fact my premium tripled with less coverage.
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Old 10-03-2014, 07:12 AM   #42
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I don't understand your comment. The money would have to come from higher premiums and new younger enrollees. I know for a fact my premium tripled with less coverage.
One reason your premium tripled is because you have to cover pregnancy as a 60 year old eunuch and someone can enroll for a reasonable premium who uses $100,000 a year in medicine for a pre-existing condition. Your premium didn't triple because a few of us have figured out how to manage our wealth to qualify for a bit of subsidy.

My comment was also pointing out that there are plenty of other "unfair" examples in our government and the way it transfers wealth.
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Old 10-03-2014, 07:12 AM   #43
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I don't understand your comment. The money would have to come from higher premiums and new younger enrollees. I know for a fact my premium tripled with less coverage.
Joe, Fermion's comment was referring to subsidies (aka advance premium credits) paid by the federal government to insurers, not to premiums.
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Old 10-03-2014, 08:21 AM   #44
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Your premium tripled over what period of time? Premiums do go up with age.

For 3 years I worked in a very small office. My insurance was covered but my DH and DS were not. I had to pay $500/ for the 2 of them. For all 3 it would have been $800/mo. This was 10 years ago. To pay COBRA next year it will be $1500/mo for my high deductible HSA plan, which is the cheapest one offered. New ACA plans have been posted on healthcare.gov and the silver plan I'm thinking of enrolling in next month is $880/mo + $120/mo for a catastrophic plan for DS. This is less than when I looked 4 months ago. So 10 years later I'll be paying not much more for better coverage.

The money for subsidies theoretically will come from decreased need for government support of hospitals for charity care and decreased costs from better preventive care and better chronic disease management. The insurance companies will get more income from previously uninsured healthy young people now paying cheap premiums for insurance that they will use infrequently.

Cost controls are part of the ACA, such as controlling runaway insurance company profits and quality controls. For example, readmissions within 30 days for certain medical conditions and treatment for UTIs due to unnecessary in dwelling urinary catheters are totally in reimbursed by insurance--the hospital has to eat the cost.

I still see the insurance companies trying not to pay the bills-my son had surgery in July and we 're still hassling with the company. First they said DS had other primary insurance which was ridiculous, then they waited another month to send us a 4 page form to fill out stating that the surgery wasn't due to an auto accident, which given the surgery obviously it was not.

It's a complicated system and all the insurance companies, hospitals and office practices have not fully adjusted to the changes.

Look at the healthcare systems in France and Germany, which are both private/public partnerships. They have their drawbacks but they are providing similar and in many ways better care at much less cost than ours.

A lot of reasonable people want to make the ACA work.



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Old 10-03-2014, 09:51 AM   #45
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Im not following your thinking here. Are you equating the lack of guilt ref: the subsidy with your lifestyle and smart money decisions? How's that work?

For those who support the subsidy, I'm curious where you think that money comes from? I mean, philosophically you must view it as your right to get your healthcare subsidized, so the subsidy coming from the US "general fund" is OK?
I was referring to the OP saying that it's odd that we are getting a subsidy even though with our financial position we could easily afford HI without it.
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Old 10-03-2014, 09:21 PM   #46
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Your premium tripled over what period of time? Premiums do go up with age.
In some sense, I'm glad that some form of health insurance reform was passed to at least have a starting point for future refinement.

However, you have to realize that there were some MAJOR increases caused solely by the changes in requirements of the ACA. It's not due to age. People aren't looking at rates from 1995 and comparing it to now.

I'm still on my old grandfathered plan (37 years old, male, Missouri) that doesn't qualify for ACA. I pay $64.55/month for a $5,100 deductible, HSA policy from Anthem.

When my plan expires this year, I'll have to get an ACA-compliant individual policy. The current prices for MO for a Bronze ACA plan are the following:

Choice of just 3 insurers. The cheapest:

$6,300 deductible = $176.47, or 273% higher premiums, PLUS a 23% higher deductible. AND....that doesn't even include comparing the hospital or doctor networks, as many people have commented how there have been some network changes (smaller networks) with the many new ACA plans.
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Old 10-03-2014, 10:13 PM   #47
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The percentage increase is only because you're getting a screaming deal now at $65/month. Even $177/month is a good deal.
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Old 10-03-2014, 11:48 PM   #48
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When I first started working in CA in late 2001 I had to buy my own health insurance on the individual market (I was at a very small company but was reimbursed). This cost me $100/month and after a year or two increased to about $200/month. My plan was through Health.net and unfortunately I don't remember any details other than it was a PPO.

Currently my bronze plan through ACA costs $214/month (no subsidy).
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Old 10-04-2014, 06:56 AM   #49
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Originally Posted by Snidely Whiplash View Post
For those who support the subsidy, I'm curious where you think that money comes from? I mean, philosophically you must view it as your right to get your healthcare subsidized, so the subsidy coming from the US "general fund" is OK?
I have much too high a taxable income to qualify for a subsidy and get my insurance from a retirement plan anyway but I strongly support the subsidy concept and would prefer a single payer system like Medicare for all (with a good faith bipartisan effort to implement improvements). I also understand that I have been and am currently paying a lot more in than I get out since I am in very good health and have a relatively large income. But I also recognize that good health is a bit of a crap shoot and I could be wiped out in a skipped heartbeat if I was responsible for all my costs. I like that little bit of socialism that takes a huge chunk of financial uncertainty out of the equation.
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Old 10-04-2014, 07:12 AM   #50
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I have much too high a taxable income to qualify for a subsidy and get my insurance from a retirement plan anyway but I strongly support the subsidy concept and would prefer a single payer system like Medicare for all (with a good faith bipartisan effort to implement improvements). I also understand that I have been and am currently paying a lot more in than I get out since I am in very good health and have a relatively large income. But I also recognize that good health is a bit of a crap shoot and I could be wiped out in a skipped heartbeat if I was responsible for all my costs. I like that little bit of socialism that takes a huge chunk of financial uncertainty out of the equation.
+1. Well said.
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Old 10-04-2014, 07:27 AM   #51
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+2 We are in a similar situation in that we are relatively healthy and our premiums have exceeded our claims by a longshot. To me, the reasons for carrying health insurance are to gain access to negotiated rates with health care providers and more importantly, insure ourselves from the financial impact of a catastrophic illness or injury. I also support subsidies so that those for who health insurance would be unaffordable can be responsible and buy health insurance and not be bankrupted by a health event. The unfortunate reality is that health care is too expensive and will take up a large chunk of the family budget, particularly for low and middle income families.
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Old 10-04-2014, 07:51 AM   #52
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Your premium tripled over what period of time? Premiums do go up with age.

For 3 years I worked in a very small office. My insurance was covered but my DH and DS were not. I had to pay $500/ for the 2 of them. For all 3 it would have been $800/mo. This was 10 years ago. To pay COBRA next year it will be $1500/mo for my high deductible HSA plan, which is the cheapest one offered. New ACA plans have been posted on healthcare.gov and the silver plan I'm thinking of enrolling in next month is $880/mo + $120/mo for a catastrophic plan for DS. This is less than when I looked 4 months ago. So 10 years later I'll be paying not much more for better coverage.

The money for subsidies theoretically will come from decreased need for government support of hospitals for charity care and decreased costs from better preventive care and better chronic disease management. The insurance companies will get more income from previously uninsured healthy young people now paying cheap premiums for insurance that they will use infrequently.

Cost controls are part of the ACA, such as controlling runaway insurance company profits and quality controls. For example, readmissions within 30 days for certain medical conditions and treatment for UTIs due to unnecessary in dwelling urinary catheters are totally in reimbursed by insurance--the hospital has to eat the cost.

I still see the insurance companies trying not to pay the bills-my son had surgery in July and we 're still hassling with the company. First they said DS had other primary insurance which was ridiculous, then they waited another month to send us a 4 page form to fill out stating that the surgery wasn't due to an auto accident, which given the surgery obviously it was not.

It's a complicated system and all the insurance companies, hospitals and office practices have not fully adjusted to the changes.

Look at the healthcare systems in France and Germany, which are both private/public partnerships. They have their drawbacks but they are providing similar and in many ways better care at much less cost than ours.

A lot of reasonable people want to make the ACA work.



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I'm paying $500.88/mo for a non-aca compliant plan for my wife and I (age 59/61). $10,500 ded/zero copy. I retired and moved from Ohio to Fl so my plan will be transferred from Anthem to Florida Blue Cross Blue Shield(only aca choice in Highlands county Fl). I am being FORCED on an ACA compliant plan. My premium will be $1474.01 in 2015 for a BCBS/1419 comparable plan. My deductible will increase to $12,500/zero copy. By the way, this plan increased 22.1% from 2014 to 2015. My retirement income is a few thousand too much to get a subsidy and I can't control my income as others can. I agree that the aca has helped many get government subsidized insurance who could not afford it in the past. However, it does very little to control healthcare costs and is not fair to all consumers. I know when I retired last year I did not budget for a potential healthcare cost of $30k in premiums and deductibles. That would be nearly 1/2 my retirement income.
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Old 10-04-2014, 08:50 AM   #53
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I also support subsidies so that those for who health insurance would be unaffordable can be responsible and buy health insurance and not be bankrupted by a health event.
Sure, poor folks need a leg up, I get that.

But the vast majority of folks here are not in poverty.

The OP mentioned "It strikes me as a bit odd that you can actually have a substantial amount of money and still get hefty Obamacare subsides."

It does me too. I can't imagine retiring early if it depended on me getting government subsidies. I'd work OMY or two or three until I could afford it.

Maybe I'm stuck in another era, but I still think that anyone who chooses early retirement as a lifestyle choice shouldn't be getting subsidies.
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Old 10-04-2014, 09:00 AM   #54
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Sure, poor folks need a leg up, I get that.

But the vast majority of folks here are not in poverty.

The OP mentioned "It strikes me as a bit odd that you can actually have a substantial amount of money and still get hefty Obamacare subsides."

It does me too. I can't imagine retiring early if it depended on me getting government subsidies. I'd work OMY or two or three until I could afford it.

Maybe I'm stuck in another era, but I still think that anyone who chooses early retirement as a lifestyle choice shouldn't be getting subsidies.
We have discussed this before and many of us acknowledged/agreed that it is a bit much that voluntary ERers with $million+ portfolios get subsidies. On the other hand, the number of ERers under 65 (when Medicare kicks in and makes the whole ACA issue irrelevant) getting questionable subsidies is probably pretty small. Trying to craft legislation to target those few would be difficult and would probably hit more than a few inappropriate targets - e.g. a disabled retiree with a $1M portfolio. In the meantime, it seems sensible for those lucky few who get a tax deal to enjoy it.
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Old 10-04-2014, 09:11 AM   #55
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....The OP mentioned "It strikes me as a bit odd that you can actually have a substantial amount of money and still get hefty Obamacare subsides."

It does me too. I can't imagine retiring early if it depended on me getting government subsidies. I'd work OMY or two or three until I could afford it.

Maybe I'm stuck in another era, but I still think that anyone who chooses early retirement as a lifestyle choice shouldn't be getting subsidies.
I understand your view and debated that myself but disagree with you. You're sitting pretty high in the horse there....

I am prioritizing Roth conversions over Obamacare subsidies so our income will be too high for subsidies. While I concede it is stupid that subsidies are based on income rather than assets that is the way Congress designed it. We could have received subsidies had we structured our income correctly, considered it and decided Roth conversions were preferable. It is well established that citizens are entitled to structure their financial affairs as to minimize taxes and IMO the same principle applies to maximizing benefits. To me, it is no different from adopting a SS claiming strategy to maximize the SS benefits a couple is entitled to or tax efficient placement of your portfolio to minimize income taxes.

Besides, in most cases, if someone has saved enough to retire early, it is likely that they have paid lots of income taxes during their higher earning years and if they end up eligible for health insurance subsidies it is just evening the score a little IMO.
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Old 10-04-2014, 09:20 AM   #56
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You're sitting pretty high in the horse there....
The view's good up here
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Old 10-04-2014, 09:51 AM   #57
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I understand your view and debated that myself but disagree with you. You're sitting pretty high in the horse there....

I am prioritizing Roth conversions over Obamacare subsidies so our income will be too high for subsidies. While I concede it is stupid that subsidies are based on income rather than assets that is the way Congress designed it. We could have received subsidies had we structured our income correctly, considered it and decided Roth conversions were preferable. It is well established that citizens are entitled to structure their financial affairs as to minimize taxes and IMO the same principle applies to maximizing benefits. To me, it is no different from adopting a SS claiming strategy to maximize the SS benefits a couple is entitled to or tax efficient placement of your portfolio to minimize income taxes.

Besides, in most cases, if someone has saved enough to retire early, it is likely that they have paid lots of income taxes during their higher earning years and if they end up eligible for health insurance subsidies it is just evening the score a little IMO.
Thank you. You have a great understanding of the issue and articulated my point much better than I would have.

In my case I was not eligible for private healthcare due to preexisting conditions. I could have gone without insurance for half a year, and tried to get in the states high risk pool. I'd been told by an insurance broker, that my cervical spine and all it's attached to, would be exempt from coverage. ACA made it possible to get insurance.

I guess the folks that see the subsidies as wrong should take it up with their representatives. I'm going to shut up now, before I become pig-headed about the issue........
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Old 10-04-2014, 09:51 AM   #58
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Besides, in most cases, if someone has saved enough to retire early, it is likely that they have paid lots of income taxes during their higher earning years and if they end up eligible for health insurance subsidies it is just evening the score a little IMO.
Exactly! For the past 10 years we have paid $55,000+ in federal tax (no kids, mostly standard deduction) and were ineligible for things other people get like tuition deduction (missed out on many thousands there).

ER with a bit of subsidy is just getting a little back from what we have put in. Zero guilt here. If your state pension pays you so much that you can't arrange finances to get a subsidy yourself, I feel sorry for you.
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Old 10-04-2014, 09:54 AM   #59
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I foundered when I tried to navigate the marketplace website last year, so I called a private insurance broker who was happy to help me fulfill my health insurance needs at the most economical cost.
We did that, too. DH was Medicare-eligible but I'm 61 so needed a private policy. I worked in property-casualty insurance my whole career and still found the process confusing and stressful, so was happy to get expert help. My policy is not through the exchanges and I wouldn't have qualified for a subsidy given our likely income for 2014 (I was paid through July plus unused vacation and we have investment income). I don't think I'll try to "engineer" my taxable income to get a subsidy in future years. We're blessed and we don't need it.

To answer the OP's question: yes, Obamacare helped when I retired. I would have gotten insurance no matter what it cost but would have worried that at some critical point they'd retroactively cancel. I had a benign lump removed from my breast when I was 18; would they use that to deny a future breast cancer claim? I've had a few nasties removed during colonoscopies (non-cancerous); would they use that to deny more serious issues? I'm insanely healthy due to good genes, the grace of God and working at prevention, but now I know I won't lose my insurance if Stuff Happens.
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Old 10-04-2014, 10:18 AM   #60
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We did that, too. DH was Medicare-eligible but I'm 61 so needed a private policy. I worked in property-casualty insurance my whole career and still found the process confusing and stressful, so was happy to get expert help. My policy is not through the exchanges and I wouldn't have qualified for a subsidy given our likely income for 2014 (I was paid through July plus unused vacation and we have investment income). I don't think I'll try to "engineer" my taxable income to get a subsidy in future years. We're blessed and we don't need it.
Just to clarify, the agent helped us enroll in Obamacare. He navigated the healthcare.gov website for us. We chose a subsidized bronze plan with HSA eligibility, and the agent received a commission just like he would have if he had sold us a plan outside the ACA
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