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Old 09-21-2013, 09:39 AM   #321
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But not getting paid for it. Software developers on at least some of the exchange development projects are salaried personnel.
It's a privilege to put in 80 hour weeks for months on end! At the end you might get a pat on the back, or another impossible date.

Yea this retirement stuff, every day I get reminded of how much I miss IT.

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Old 09-21-2013, 11:25 AM   #322
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I have been analyzing the different plans for us at different income points. The best plan for us seems to be the Bronze HSA at an income level that would gives us a little head room to convert some 401K money to Roth IRAs at a low tax bracket.

Our annual premium cost after subsidies would be under $1K. If we don't use any medical care, that would be all we pay for medical costs for the year.

If we hit the family out of pocket max our total costs are still lower than the silver plan because the out of pocket max is the same as the silver, but the silver would have much higher premiums, making a higher total cost.

Our likely total costs health costs would be ~$4K - $5k, based on the average amount of doctors visits and tests we have used in the past as a family in a typical year, which is still less that the silver plan total costs, because of the higher premiums with the silver. And with the HSA, I believe we can use that for glasses and dental costs?

So unless DH finds some flaws in my math, it looks like for us the bronze plan is the clear winner.
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Old 09-21-2013, 11:49 AM   #323
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I have been analyzing the different plans for us at different income points......

If we hit the family out of pocket max our total costs are still lower than the silver plan because the out of pocket max is the same as the silver, but the silver would have much higher premiums, making a higher total cost....

So unless DH finds some flaws in my math, it looks like for us the bronze plan is the clear winner.
Although hard figures are not yet published for my state, it appears your analysis is generally correct. TRUE OOP max includes both HI premiums PLUS published "OOP max". IMHO- It's rather disingenuous for gov't (& insurance carriers) to present "OOP max" in a manner that ignores premium costs.
BTW- I have seen quotes of some states' Gold & Platinum Plans with lower published OOP max figures. For those eligible for significant premium subsidies, it's possible some of those could offer lower actual total annual costs (premiums + published "OOP max").
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Old 09-21-2013, 12:23 PM   #324
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Although hard figures are not yet published for my state, it appears your analysis is generally correct. TRUE OOP max includes both HI premiums PLUS published "OOP max". IMHO- It's rather disingenuous for gov't (& insurance carriers) to present "OOP max" in a manner that ignores premium costs.
BTW- I have seen quotes of some states' Gold & Platinum Plans with lower published OOP max figures. For those eligible for significant premium subsidies, it's possible some of those could offer lower actual total annual costs (premiums + published "OOP max").
The platinum premiums for us, at our optimum MAGI for income tax / Roth conversion purposes, would be 15K a year, which is significantly higher than the total annual premiums ($660) plus OOP max (12.7K) for the bronze plan.

So the platinum plan does not come out ahead for us under low, likely or maximum medical cost scenarios. In a low medical expense year for us, it could cost us over $14K more than we would spend under the bronze plan, because of the fixed premium costs. And in a high medical expense year, the total cost would be ~$10k higher because the OOP max isn't much lower than the bronze plan, but the premiums would be $14K higher.
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Old 09-21-2013, 12:52 PM   #325
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I expect to have about $10K in taxable interest/dividends for 2014. My state calculator says I'm entitled to Medicaid under the new ACA. If I increase that to $20K/yr., my estimated monthly silver plan premium is $85.

Yesterday I got a notice from my HI company that if I stay on a similar plan come January 2014, my unsubsidized premiums for a bronze plan increase from $323 to $530. (Deductible increases from $2,750/$5,500 to $4K/$8K.)
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Old 09-25-2013, 07:40 AM   #326
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Here's a first hint about rates in Texas, Florida and some other states;
Average Obamacare Premiums Will Be Lower Than Projected - Kaiser Health News
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The analysis showed huge variations among states: A family of four making $50,000 in Wyoming, for instance, would pay $1,237 a month on average for a midlevel plan before subsidies, compared to $584 a month on average in Tennessee. After subsidies are added in, however, the cost to both families would be $282 because the amount they pay is linked to their income, not to the cost of coverage...

While experts say premiums vary across the states and even within states, the analysis pegged the national average for an individual at $328 a month for a midlevel policy called a silver plan, before subsidies are factored in. Thatís less than the average $392 projection drawn from earlier data released by the nonpartisan Congressional Budget Office, which will mean savings to families as well as to the federal government for tax credits...

One of the reportís most striking findings is that states like Texas and Florida, where the law has faced fierce opposition despite high rates of uninsured residents, will see rates at or below the national average.
Here's a link to the full report:
ASPE

Unfortunately, the comparative data focuses on 27-year-olds and families of four, two demographics not well represented here at ER.org.

There is a table, on page 15, that lists second-lowest silver plan premiums by state (calculated as a weighted average). My only firm conclusion reviewing the information was that Wyoming is likely to move down many "best places to retire early" lists.

Also available are charts showing the number of plans available in the states' individual "rating areas". ASPE

In Houston, I see that there will be 50 plans offered by 7 carriers: 4 catastrophic plans, 14 bronze, 17 silver, 14 gold and 1 platinum.
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Old 09-25-2013, 07:57 AM   #327
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We just got our non-renewal letter in Fl. According to this preliminary info, we'll have 136 plan choices. I wasn't concerned before this and find myself becoming slightly optimistic.
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Old 09-25-2013, 08:11 AM   #328
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In Houston, I see that there will be 50 plans offered by 7 carriers: 4 catastrophic plans, 14 bronze, 17 silver, 14 gold and 1 platinum.
I'm waiting on the details. It's not clear to me what area Houston is in and are the prices per person or per family. Then, there is the need to check the doctors and hospitals on the plan.

My benchmark based on my personal situation is the Texas High Risk Pool. DW and I would have had to buy individual policies each costing $7,500/yr with a $7,500 deductible. There are no subsidies for these. My COBRA is $830/month but it only runs for 18 months before I would have been forced into the high risk pool.

With health care easily being my largest single budget item in retirement, the ACA will end up reducing my "essential" retirement cost. The subidy will save me even more. Unfortunately, I won't qualify the first year for the subsidy with my SERP payout.
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Old 09-25-2013, 08:32 AM   #329
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It's not clear to me what area Houston is in and are the prices per person or per family.
It takes a bit of page-clicking to determine your rating area.

At the second page I linked, follow a link at "For further information about rating areas, please see:" to view rating area designations by your home county. Then you can go back to the table showing the number of plans available by rating area and see which line applies to you.

I agree the actual prices and plan details are the required information for actual decision-making. Like Michael, however, I feel this first peek through the gate is anything but alarming or surprising.
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Old 09-25-2013, 09:31 AM   #330
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We just got our non-renewal letter in Fl. According to this preliminary info, we'll have 136 plan choices. I wasn't concerned before this and find myself becoming slightly optimistic.
OTOH-----Unfortunately, reading this report has confirmed my worst fears. I'm in one of the highest cost MSA's, and earlier predictions of some massive rate increases turned out to be spot on. After applying ACA's 2.5-3X rate multiplier (my age/nonsmoker vs report's 27yo example), it appears we will see a rather painful rate INcrease once my COBRA runs out. If my math is right, for DW & I (no kids/nonsmokers) it means >50% premium jump PLUS a major rise in our OOP max (from $5k to $12+k).
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Old 09-25-2013, 10:20 AM   #331
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I agree the actual prices and plan details are the required information for actual decision-making. Like Michael, however, I feel this first peek through the gate is anything but alarming or surprising.
I agree that this isn't alarming or surprising. It sounds like we'll get what seemed to be obvious which is the younger people will pay more than now and older people will pay less. The silver plan covers about what the Texas High Risk Pool would and is slightly cheaper (zone 10) if I assume the rates shown are per person. Other than the possible subsidy, this hasn't changed much for me. I'll know more when the details are out.

I think it's interesting that the federal exchange (done for the states that didn't throw billions of their own dollars to create their own exchange) looks to be in pretty good shape. I figured this would happen. Unfortunately, all states didn't do this. The federal exchange will make it easier to allow insurance to be eventually sold across state lines. I never could figure out why any state wanted to do their own. Why reinvent the wheel when it would just be given to you?
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Old 09-25-2013, 10:27 AM   #332
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OTOH-----Unfortunately, reading this report has confirmed my worst fears. I'm in one of the highest cost MSA's, and earlier predictions of some massive rate increases turned out to be spot on. After applying ACA's 2.5-3X rate multiplier (my age/nonsmoker vs report's 27yo example), it appears we will see a rather painful rate INcrease once my COBRA runs out. If my math is right, for DW & I (no kids/nonsmokers) it means >50% premium jump PLUS a major rise in our OOP max (from $5k to $12+k).
You can put different ages into the form and see what the policies are for that age. I'm just not sure if that is for a family or just an individual. The reason the cost will just up over COBRA is that the rate you are paying is the company average. With the ACA, you get the price for your age which is higher if you are over 40 or 45. A younger person would save money by getting off COBRA ASAP.

My COBRA is $830/month for the family plan. With the ACA, my deductible and premium will increase but my copay will stay about the same with the silver plan.

When the real details are available, lots of research will be needed to figure this out. Also, will off-network plans suddenly appear?
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Old 09-25-2013, 10:40 AM   #333
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The updated Kaiser calculator is a big improvement. It calculated within $2 from the average for my area reported.

I also ran the numbers against what I pay now for a bar bones 100% out of pocket for the first $10,400 policy I have now and compared to a bronze plan which is an improvement I would see a 6% increase next year. That would be the lowest increase I have seen since buying my first individual policy in 2006. The calculations are all made at full freight cost without subsidy.

The above comparison is also not apples to apples as the new policy provide better coverage than the current bare bones policy.

I am not surprised at this but I am happy about it.
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Old 09-25-2013, 10:45 AM   #334
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OTOH-----Unfortunately, reading this report has confirmed my worst fears. I'm in one of the highest cost MSA's, and earlier predictions of some massive rate increases turned out to be spot on. (
I guess there many sides to the coin. I am in the 3rd highest cost exchange but I am glad to be able to purchase HI. Most individuals are rejected here regardless of health. Strange thing, even though the exchange numbers are high, compared to what I know some folks in small groups are paying, it's about 25% - 50% less than what they are currently paying and the insurance is better. It's 20% less than what COBRA was a few years ago. This before applying subsidies. It will be interesting to find out more about why the rates are what they are.
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Old 09-25-2013, 10:55 AM   #335
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One of the things that I would want to know is the discount rate that these plans provide to the insured...

IOW, my DW had a knee operation.... the hospital charges were $16K.. the insurance rate was about $3.5K... a cheap plan that does not get that kind of discount is a pretty bad plan IMO.... I do not know if another insurer would have been higher or lower.... but I doubt that all would be the same price....


Now, I did get a nasty surprise.... we have a $5K deductible plan with a $7.5 MOOP... I thought that the first $5K went toward that max.... NOT.... so when I thought that my max would be $7.5, it really if $12.5....
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Old 09-25-2013, 11:16 AM   #336
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Thank you!

The following link was also provided above, but bears repeating since it is extremely helpful. It gives me some idea of what a 60-year-old in Louisiana might be paying for various plans:

http://aspe.hhs.gov/health/reports/2...sheet_home.cfm
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Old 09-25-2013, 11:22 AM   #337
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I'm just glad to get more information. Think I have a better idea of my costs, think I'll save couple hundred a month.

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Old 09-25-2013, 12:50 PM   #338
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I
I think it's interesting that the federal exchange (done for the states that didn't throw billions of their own dollars to create their own exchange) looks to be in pretty good shape. I figured this would happen. Unfortunately, all states didn't do this. The federal exchange will make it easier to allow insurance to be eventually sold across state lines. I never could figure out why any state wanted to do their own. Why reinvent the wheel when it would just be given to you?

Yes, I don't understand that either. I've just used Mediacare.gov (for DW) for first time. Really don't understand why that site wasn't just enhanced for the federal exchange. Seems pretty decent, not sure I've found integration between the plans and providers yet. That may be my ignorance.

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Old 09-25-2013, 07:33 PM   #339
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..... The reason the cost will just up over COBRA is that the rate you are paying is the company average. With the ACA, you get the price for your age which is higher if you are over 40 or 45. A younger person would save money by getting off COBRA ASAP.
Agree COBRA cost is company ave, but COBRA is NOT always cheaper for comparable coverage (inc OOP max) than indiv market even at some arbitrary older age. HI premiums for employers (inc COBRA) depend largely on the specific population mix for specific employer, inc ave age, prevalences of diseases & smoking, usage pattern (e.g. ave freq of provider/hosp visits, expensive testing, etc), etc. Specific COBRA policy may include coverage individuals may not want or need (e.g. maternity, lower deductibles, etc.). And there are still a few employers who simply pick grossly overpriced HI for their market (i.e. poor negotiating skills with the carrier). FWIW- HR folks at my prev employer openly encouraged exiting workers, inc ER's, to shop around for HI before going COBRA. More than a few folks find COBRA is not their best option for HI.

In my case I was comparing a pre-ACA individual policy meeting my needs (HSA-qualifying plan) offered to self-employed (which I still am) for my state of health & completely healthy DW. It is (was?) being offered by an established major carrier which has apparently chosen NOT to offer coverage under the Exchange in my state.
From published info- Under ACA DW & I would/will be paying $14+k/yr for HI premiums (2nd lowest Silver, no subsidy) PLUS facing much higher OOP max of $12,700/yr. So annual HC costs could be >$27,000 per year. Might be better off going uninsured (self-insured) and paying the uninsured tax (official SCOTUS term for it)- or letting IRS try to collect it from my non-existent income tax refund. I could literally pay OOP for ave cost coronary bypass surgery about every 2 yrs and still break even under ACA !!!
Coronary Bypass Surgery Pricing by Healthcare Blue Book

As always YMMV, but my state's high-risk pool (pre-ACA) would have been a MUCH better deal than what ACA has turned out to be.
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Old 09-25-2013, 07:34 PM   #340
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I found a couple of oddities looking at the data.

The first is the minimal number of platinum and catastrophic offerings. Platinum plans aren't even offered in many areas. The number of catastrophic plan offerings is also small: only 2 or 3 for a typical area in my state.

The second is the unexpected relationship between minimum cost catastrophic plans and minimum cost bronze plans as seen in the detailed Excel tables. Using Texas MSA's and my age (53) as a test, the cost of a min. cost catastrophic plan ranges from 20+% less than a bronze plan to 20+% more than a bronze plan.

Taken together, I guess this shows there are weird pricing effects at the margins, where the insurers see the greatest risk of adverse selection and other "fat tail" risks?
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