An actual reporting

[modhatter]

There is so much political bias enveloped in the new ACA plan, by, individuals talking on these forums, to newspaper articles, blogs, TV, it is very difficult to ascertain real numbers. I would really like to see a sampling from the members on this board, as to what the $ difference in their plan has turned out to be for 2014, as all the media has left me scratching my head.

I would expect there had to be increases based on the significant changes to the law regarding guaranteed issuance, elimination of rescission and the new caps placed on policies plus all of the preventative care now included, as well as mental health. But i hear what seems to me on some other forums and of course in certain blogs, newspaper articles and TV shows some pretty what I feel are exaggerated claims.

It appears that a lot of the re-designed plans contain a higher deductible as a means of coping with the added benefits. Would like to hear your experience.

How did your premium and coverage changes with the new law.

1. What kind of deductible you had in 2013 and for how many.
3. What is your new deductible for 2014
4. What was the cost of your plan in 2013
5. What is the cost of your new plan in 2014
6. If you were getting a subsidy, and if your 2014 premium reflects the
subsidy.

I will go first. As I am on traditional medicare, it will not be of much interest, so I will post my son's numbers.

Age 34 (as of Jan) One Person
Individual plan BCBS
2013 No deductible: $412
2014 No deductible $396.98 with max OOP $2,000

Plan looks very similar, except with added ACA stuff. Have not examined and compared all the co-pays for some of the things like major imaging, ambulance etc. I am actually surprised by the reduction when considering the added benefits. But it is a moot point anyway, as we are moving.

 

[Mulligan]

I get a one year extension before I have to enter the exchange...presently I pay under $90 for a $5500 deductible. No copays after deductible. I have an HSA. Closest exchange plan that I will eventually go in is a Bronze HSA with same insurer. Deductible I believe is about $6300 which is worse, and premium is $290. That is the cheapest plan available. I am pushing 50 next year.

 

[modhatter]

I get a one year extension before I have to enter the exchange...presently I pay under $90 for a $5500 deductible. No copays after deductible. I have an HSA. Closest exchange plan that I will eventually go in is a Bronze HSA with same insurer. Deductible I believe is about $6300 which is worse, and premium is $290. That is the cheapest plan available. I am pushing 50 next year.

I didn't know they had anything that cheap for someone around 50. Were there caps on it? Did it cover everything after your deductible?

 

[joe8012]

Wife and I are getting an HSA plan Dec 12 through UHC, 10K ded, 11200 max oop for the two of us(including ded) cost $412 a month. 2014 ACA compliant bronze hsa plan is about $1100 a month for $6350 ded. per person.

 

[Mulligan]

I didn't know they had anything that cheap for someone around 50. Were there caps on it? Did it cover everything after your deductible?

I switched plans last month which only cost $1 more but they guaranteed rate and coverage until Dec. 2014. So I believe it's unlimited under the new rules. The old $87 plan that I had up until September had a $7 million lifetime cap. It's supposed to pay 100% after deductible. Coventry and Anthem were the insurers. I have spent more money in a day shopping at Walmart than I have in medical care, so I have no experience on their claims. They did save me $50 when I got my blood work done though last year. Hospital charged me a $100. Insurer sent a statement showing their discount saved me $50. Of course the hospital wasn't going to pay me back my $50 overpayment until I noticed this. Shame on me...people here are worried about serious health issues and all I am worried about is getting ripped off $50.

 

[pb4uski]

DW and I have had a HDHP for the last two years. $11,900 deductible. Premiums were $556/month in 2012 and $629/month in 2013. Exchange plan for 2014 with $10,000 deductible would be $682/month so probably about the same increase I would have faced absent Obamacare changes. If I can buy a catastrophic plan the deductible would be $12,700 and the premium $475/month.

To put it in perspective, when I retired 2 years ago my HDHP COBRA would have been $900/month with about the same deductible and I budgeted $1,000/month in my retirement budget, so overall the costs have been much less than I expected.

All numbers are for a couple and exclude any subsidies (I don't expect any based on our income)

 

[Major Tom]

I don't currently have a plan, but do have coverage of sorts under my county's system of healthcare for low income folk (luckily for me, it's not asset-tested). As my income is so low, I have no co-pays for doctor visits, ER visits, or surgeries - there is no out-of-pocket for me, except for prescriptions, which cost me a whopping $3. It's a great deal, but I am only covered at my County hospital and within the clinic system in my county. If I get into an accident in another county, I'm on my own.

This plan will automatically convert over to Medicaid under the ACA Medicaid expansion. I'm not sure exactly how the coverage will compare, but it will cover me over a significantly wider area than my county - I'm assuming the entire state (California, in my case).

 

[frank]

I have an hsa plan for my wife. I am on medicare. her premium went from 585. per mo. to 615. with 1600 oop max including drug coverage. we got the same one year extension listed previously in this thread. it was with bcbs. I thought the increase would be higher, but I couldn;t get through the website to check prices with the subsidy. I think we qualify but not sure.

frank

 

[ERhoosier]

Age 34 (as of Jan) One Person
Individual plan BCBS
2013 No deductible: $412
2014 No deductible $396.98 with max OOP $2,000

You don't specify your son's state, '13 OOPmax, or if his 14 HI would be extension of existing HI or new ACA plan.
True zero deductible ACA plans and OOPmax that low are unusual even in Platinum level Plans (where available). In my area the "best" ACA Plans for 34yo non-smoker are ~$400-450/mo with $750 ded & $6k OOPmax. And MUCH smaller provider network than pre-ACA BCBS indiv plans, (at least according to published accounts since ACA provider network info is not yet available from either HC.gov nor indiv carriers).

 

[GLM]

DH & Myself ages 57 & 55.

In March 2013 continuing meagcorp Cobra ( POS- 5k OOPM, 2.5 k individual deductibles , HSA with pervenative care and no lifetime cap) would have been about $760 /month .

We opted to underwrite and buy an individual policy . By buying our own policy he can subtract it off his MAGI “above the line “ as he has 1099 consulting income. It too is a POS plan , higher deductible (joint 10k that drops 2k per year you do not use your deductible until it hits the minimum allowed )in an HSA plan. OOPM $12,600, preventative care , no lifetime limits , coinsurance 70%. Last time I hit the deductible was for an emergency C-section and one week hospital stay for two in 1982. (The whole bill then was 8K!- it cost us $1000)

Our current individual policy is $512/month

Our plan has been extended through 2014 so we will probably keep it as long as we can .

My current insurer is Golden Rule (through United Health Care ).They are not on our exchange. I can only find HMO / HSA plans on the exchange that have the majority of our doctors. Past experience does not make me happy with HMO's . I spent years fighting and old HMO doc to get a referral to an endocrinologist when I knew my thyroid was being under treated. I finally left the plan , found a new doc and saw an endo. Needless years of pain , foggy brain and weight issues. Most but not all of our doctors appear to be on the plan ( My endocrinologist is not on any plan I check . I am working off value penguin so I am not sure ) Closest match given the above is $917 without subsidies . Our new income is in flux but we can easily manage our investments / spending qualify for a subsidy for a net cost of $477 for what I consider an inferior plan. (Wrong doctors HMO, $12,600 deductible , $12,700 MOOP).

Added note – locally the Piedmont hospital group is going to offer individual plans in 2015. No Idea if they will be on the exchange. All our doctors are Piedmont doctors except one specialist DH sees every 6-8 months to monitor eye pressure. We now pay his negotiated rate which is almost list price, so we might do as well offering cash. I am hoping this option works out for us in 2014.

 

[modhatter]

You don't specify your son's state, '13 OOPmax, or if his 14 HI would be extension of existing HI or new ACA plan.
True zero deductible ACA plans and OOPmax that low are unusual even in Platinum level Plans (where available). In my area the "best" ACA Plans for 34yo non-smoker are ~$400-450/mo with $750 ded & $6k OOPmax. And MUCH smaller provider network than pre-ACA BCBS indiv plans, (at least according to published accounts since ACA provider network info is not yet available from either HC.gov nor indiv carriers).

Sorry, the first set of numbers was from Florida, where his current plan which was 0 deductible was switched over to a ACA compliant plan, but with the same type coverage.

The second set of numbers is what i got off of the Nevada Excange site where we have moved. The Platinum Plan I mentioned has a $100 deductible, and a $3,500 Max OOP.

The BCBS Multi State Plan has a $750 Deductible and a $6,000 Max. OOP.
I just looked at it again. I was wrong there are a few co-pays, for primary doctor, urgent care, generics and preferred drugs. But unless you landed in hospital, I would imagine you would have a very hard time reaching Max OOP. Only appeal to me on this plan is the Multi State. These are both HMO's by the way. Not my preferred choice. Only other plan here is a POS plan from a new Co-Op set up. Seems to have a pretty good network, but does not include the hospital near me, which would be my preference.

 

[audreyh1]

Myself, 54. I am choosing a BCBSTX Bronze PPO plan with a 5000 deductible, 6250 Max OOP. HSA eligible, so no copays. The $294/month premium compares to the $549/month I have been paying for the Texas Risk Pool which uses the same BCBSTX network for a $5000 deductible plan with low copays - probably the equivalent of a Silver plan. Don't remember the max OOP, but it's probably higher than the new plan.

My husband, 58, will probably switch to the same BCBSTX Bronze PPO for the $351 premium which is lower than the $478 premium he would be paying next year if he keeps his current BCBSTX "silver-like" PPO plan which has higher deductible and a higher max OOP, and is not HSA eligible.

My husband and I expect to save $382 per month in premiums = saving $4,584 per year, and since both plans are HSA eligible, we expect to save another $2,100 or so in Federal income taxes.

These plans have lower/equivalent deductibles and lower max OOPs than our current plans and use the same PPO network. We will lose the cheap "copays", but due to the premium difference, we will likely be much better off paying for extra doctor visits out of the savings.

And this is with NO subsidies at all.

We will buy our policies directly, and not via the exchange. There are three insurers available to choose from in our county.

This looks like a huge improvement to us!!!!

 

[audreyh1]

Based on a lot of anecdotes I have been reading recently, I suspect the state risk pools are full of people who couldn't get regular due to some extremely minor or obscure "pre-existing condition" that in fact is not chronic and did not create additional future medical expenses at all. So we have been paying out the wazoo, even though we are not more expensive to cover.

Anyone who has had a cesarean? One person who had migraine medicine prescribed one time? I had something odd in one bone in my little toe. I've heard tons of obscure and seemingly innocuous reasons why someone was denied coverage.

I suspect insurance companies have only been accepting people with perfect medical histories, as truly assessing medical risks for individuals is too costly, and it's easier just to say no and force them into the risk pool if they want to keep being covered with pre-existing conditions, or make them accept a waver for any little old thing. And until now, these folks have always been at risk for having coverage denied because the insurance company decided they lied about something in the past.

I just mention this, because I suspect that the huge number of folks, like me, transferring from a risk pool to the new ACA system, include many generally healthy folks with limited medical expenses. As a group, we won't necessarily drive up the expenses.

 

[modhatter]

Wife and I are getting an HSA plan Dec 12 through UHC, 10K ded, 11200 max oop for the two of us(including ded) cost $412 a month. 2014 ACA compliant bronze hsa plan is about $1100 a month for $6350 ded. per person.

Joe, Are you saying your HSA policy went from $412 a month for each of you to $1,100 a month for each of you? $1,100 doesn't seem right for a single person HSA. Did you mean for both of you, meaning your policy went from $412 to $550 each and your max OOP went from $5,600 to $6,350?

 

[modhatter]

Myself, 54. I am choosing a BCBSTX Bronze PPO plan with a 5000 deductible, 6250 Max OOP. HSA eligible, so no copays. The $294/month premium compares to the $549/month I have been paying for the Texas Risk Pool which uses the same BCBSTX network for a $5000 deductible plan with low copays - probably the equivalent of a Silver plan. Don't remember the max OOP, but it's probably higher than the new plan.

My husband, 58, will probably switch to the same BCBSTX Bronze PPO for the $351 premium which is lower than the $478 premium he would be paying next year if he keeps his current BCBSTX "silver-like" PPO plan which has higher deductible and a higher max OOP, and is not HSA eligible.

My husband and I expect to save $382 per month in premiums = saving $4,584 per year, and since both plans are HSA eligible, we expect to save another $2,100 or so in Federal income taxes.

These plans have lower/equivalent deductibles and lower max OOPs than our current plans and use the same PPO network. We will lose the cheap "copays", but due to the premium difference, we will likely be much better off paying for extra doctor visits out of the savings.

And this is with NO subsidies at all.

We will buy our policies directly, and not via the exchange. There are three insurers available to choose from in our county.

This looks like a huge improvement to us!!!!

Looking at your post with your stated age and type of policy you are buying and max OOP cost, I can't help but contrast your cost of $294 and $341 to the post above yours from GLM that state theirs will run $917 for similar plan that is a HMO. I am not sure, but I think that cost is for two. It is hard to say as people seem to use individual figures and then I think they also use combined figures in the same paragraph, so your not sure what numbers they are dealing with individually.

But yours seem low to me for the age bracket, but then I did not look at Bronze plans here, so maybe not. I know it depends on the state your in.
I am in Nevada which is supposed to have high rates.

 

[golftrek]

I am 62. My North Carolina Blue Cross HSA $5000 deductible policy was $240 per month. That policy has been cancelled and the HSA policy I have been offered by Blue Cross of North Carolina has a $5500 deducible (but includes maternity!) and costs $540 per month, more than doubled. I should get a subsidy which actually reduces my premium cost but so far I cannot get the federal exchange site to approve my application.

It is not fair for my policy to be cancelled and then I cannot get approved for the subsidy I qualify for because the site will not work!

Jo Ann

 

[clifp]

2013 plan $337/month Kaiser 0 deductible 3000 max out of pocket
2014 plan grandfathered $378
No drug,maternity coverage and few other minor things.

Closest equivalent
2014 ACA plan Kaiser gold $376
$1500 deductible $6350 max out of pocket.

doctor visits are $25 for both. Generally speaking the existing plan has lower copay than the ACA plan with the exception of lab, xrays.

I can't get verified to look at the other options like HMSA the BCBS in Hawaii..

 

[audreyh1]

Looking at your post with your stated age and type of policy you are buying and max OOP cost, I can't help but contrast your cost of $294 and $341 to the post above yours from GLM that state theirs will run $917 for similar plan that is a HMO. I am not sure, but I think that cost is for two. It is hard to say as people seem to use individual figures and then I think they also use combined figures in the same paragraph, so your not sure what numbers they are dealing with individually.

But yours seem low to me for the age bracket, but then I did not look at Bronze plans here, so maybe not. I know it depends on the state your in.
I am in Nevada which is supposed to have high rates.

People seem to gloss over the Bronze plans.

I see people talking about Silver and even Gold.

Yes, some of these plans may match what people currently have - low doctor visit copays, lower deductibles, etc. But when you look at total annual cost including premiums, you're probably better off saving on premiums and applying the savings to medical expenses IF you need to.

In our case, the Bronze has essentially the same max OOP.

The HMO plans were even cheaper for us - maybe $100/month cheaper for each of us. But we know nothing about that network and don't want to change from PPO. Also, none of them were HSA eligible.

 

[Mr. Paul]

We are both 59 and our 5K deductible BCBS HSA individual policy monthly premium was $1147 in 2012, $1374 this year and next year will be $1696 per month. With the expanded Medicaid rules going into effect in CO next year we will be on Medicaid.

 

[MichaelB]

People seem to gloss over the Bronze plans.

I see people talking about Silver and even Gold.

Yes, some of these plans may match what people currently have - low doctor visit copays, lower deductibles, etc. But when you look at total annual cost including premiums, you're probably better off saving on premiums and applying the savings to medical expenses IF you need to.

In our case, the Bronze has essentially the same max OOP.

The HMO plans were even cheaper for us - maybe $100/month cheaper for each of us. But we know nothing about that network and don't want to change from PPO. Also, none of them were HSA eligible.

We will probably end up with a silver plan even though I would have bet against that a month ago. I expected the higher deductible bronze to always be the best case, but after running the numbers through Animorph's spreadsheet I was surprised that the cost differences did not follow that closely. Among the plans I compared the best silver is better (total less cost) than the best bronze in most cases. It is only more expensive when there is no use at all, and then only by a small amount.

 

[golftrek]

Eureka! I finally got signed up on Healthcare.gov this morning. I started a totally new application with new email, password, etc. I have an HSA policy with Blue Cross of NC (the only real insurance company option in North Carolina.) My 2013 plan with a $5000 deductible was $240. This plan is being terminated and the closest 2014 plan was an HSA plan with a $5500 deductible and a premium if $552. On the exchange I am getting the same plan (Bronze) for $165. Eureka!!!

 

[Rpharmer]

I currently have a high-deductible ($5000), high OOPmax ($7000) policy with BCBS, with a premium of $430/mo. I am grateful to have it, since I've been denied coverage previously, but am now 14 years cancer-free and deemed "insurable" again (albeit with up-rated underwriting, which I understand.) Essentially, I get the benefit of the "discounted" rates when I need care, but that's about it (e.g., if the OV is $120, I only owe the allowable charge of $99, or whatever.) I do have an Rx plan, with $10/$50/$80 tiered copays, so that helps a lot. My oncologist insists on performing rather expensive labs and tests annually, but only owing the "allowable" helps somewhat there, too.

The ACA was written for someone like me. My new policy (also with BCBS) has a $250 deductible, a $500 OOPmax, and the subsidized premium is $160/mo. The Rx tier is $5/$10/$20. There is 10% coinsurance for OVs and hospitalization.

Needless to say, I will be saving thousands of dollars (at least in 2014 -- I'm not allowing myself to look much beyond that yet!) BCBS and I have talked, and I've received my new card (which, BTW, looks exactly like my current card -- even the group number is the same, in reference to some other speculative threads. Quite fire-retardant, if I can say that here!)

Ironically, the bizarre economy we are stuck in, where interest rates on savings remain extraordinarily low, has this one silver lining for me, because most of my (meager) taxable income is CD interest. Back in the days when rates were 5-7%, I would not have qualified for a subsidy (premium or cost-sharing.) But, I'll gratefully forgo the subsidy if/when rates return to 3-4%!

I hope these data points are helpful. I know my situation is atypical.

 

[sheehs1]

We are both 58 years old, have separate individual policies, no access to employer sponsored care and do not qualify for a subsidy. I have a one year extention on old plan. My husband does not.

2013 Anthem BC/BS Premier Plan. Both of our plans have $3,500 deductibles, 0% coinsurance.
Premiums for both= $709/mth = $8,508/yr.
Deductible x2 = $7,000

2014 Anthem BC/BS (Old Premier for me, Silver for husband)
Premiums for both = $12,888/yr
Deductibles x2 = $9,500

2015 Projected
Premiums for both = $16,440/yr (Both Silver)
Deductibles = $12,000

The prices for us are the same on or off exchange. Anthem in Virginia is making them the same. Not sure what we will do, meaning don't know if we will go to Bronze or join a self pay system that has waivers. Am thinking about that but it is so foreign to me, so not sure it has the comfort level I need.
Not sure why our premiums are so high unless it is because we have crossed the 55 year old break. Neither of us have any pre-existing condition that kept us from underwriting before.

 

[audreyh1]

We will probably end up with a silver plan even though I would have bet against that a month ago. I expected the higher deductible bronze to always be the best case, but after running the numbers through Animorph's spreadsheet I was surprised that the cost differences did not follow that closely. Among the plans I compared the best silver is better (total less cost) than the best bronze in most cases. It is only more expensive when there is no use at all, and then only by a small amount.

My spreadsheet software couldn't import Animorph's formulas, so I created my own - a different design.

I analyzed total cost for the following medical expense scenarios:
Essential visits only (free), 4 doctors visits beyond essential, $4000 med bills, $6500 (hits max OOP right away in some plans), $10000, $15000, $20000.

For our scenarios, the Bronze were the winners by far in the lower billing cases, and in the highest expense scenarios were only more expensive by a few hundred dollars, even compared to a Silver plan with half the deductible.

 

[audreyh1]

Eureka! I finally got signed up on Healthcare.gov this morning. I started a totally new application with new email, password, etc. I have an HSA policy with Blue Cross of NC (the only real insurance company option in North Carolina.) My 2013 plan with a $5000 deductible was $240. This plan is being terminated and the closest 2014 plan was an HSA plan with a $5500 deductible and a premium if $552. On the exchange I am getting the same plan (Bronze) for $165. Eureka!!!

Yay for you golftrek - so glad you are past that.