Anyone Signed for ACA for 2016?

[NW-Bound]

After more than 1 week pondering the options and various ACA plans, I just signed up for a Bronze plan with the same insurer I have had.

I will save about $3,600 with this Bronze plan compared to the next Silver plan. The first has a deductible of $5,500 while the latter is $850, but I do not see myself using much health care next year.

 

[Ian S]

I've done all the preliminary work and it's just a matter of selecting a plan. I've whittled the choices down to two. Which one I go with will likely hinge on the results of an endoscopy this Thursday to evaluate my Barrett's condition. If it's stable I'll likely go with the lower cost plan without my GI doc in network for the first seven months in 2016 before I turn 65 and go on Medicare.

 

[lawman3966]

Thanks to some input from this board, I used a broker for this, my first time signing up for an exchange based plan here in Washington state. I'm glad I chose that route, as there were several web site glitches while signing up that I wouldn't have known how to handle on my own.

Based on recommendations both from my broker and from a colleague, I signed up for Grouphealth Silver Plus, starting Jan 1, 2016.

My cost will be $250 a month, fully $400 lower than my current COBRA plan.

 

[Fermion]

I summoned up the courage to log on to the Washington ACA website, changed our income and signed up for a cost sharing silver PPO plan with Premera blue cross (nationwide network).

When presented with the various questions about income sources, I just put a monthly income of $1083 from dividends, interest and capital gains and a monthly income of $834 from IRA distributions. Their little minds are incapable of grasping concepts like budgets and saving, so you need to make things simple and monthly, even if you really do all of this the last month of the year.

Now I have 90 days or so to submit income verification for myself and spouse. My plan is to use Excel to generate some impressive looking spreadsheets that show monthly dividends from our investments and a schedule for selling some SPY where we have quite a bit of capital gains. I am also going to generate a spreadsheet that shows a monthly distribution from my traditional IRA.

In reality, the dividends will happen randomly and I may decide to sell the SPY in December 2015 instead of every month. I will convert the IRA distribution to a Roth and we will live off of already taxed savings. Do they need to know any of this? My guess is no.

 

[teejayevans]

We can not find any insurance for 2016 for under $1100 PM..... I am 53 and my wife is 61...... we are in Florida..... Where do you find affordable insurance

I picked the cheapest bronze plan from Florida Blue, $446/mon...


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[M Paquette]

DW, DD, and I just renewed a Bronze HMO plan with HSA eligibility. Next year's rate is $1466/month, nicely in like with the pre-retirement projection at a 7.5% medical inflation rate that put 2016 health insurance at $17,500.

 

[littleb]

Signed up for Blue Cross of Tennessee Bronze Plan (multi state) for me and DH with a 1350.00 monthly premium and already paid the January premium.


So much unknown for us next year so I stated income about the subsidy level. Hopefully our income will be much less when we retire mid year and we will be eligible for subsidies at tax time.


Funny thing about this multi state plan it includes all drs and hospitals in the state but where you live determines your premium. We live in a small city so the premium is 1350.00. Once we retire and move to another city in our state the same plan with the same drs. and hospitals is 1250.00 month. If we move to a larger city near us with the same plan the premium is 1050.00. It seems like living in smaller cities and rural areas work against you.

 

[Fermion]

Funny thing about this multi state plan it includes all drs and hospitals in the state but where you live determines your premium. We live in a small city so the premium is 1350.00. Once we retire and move to another city in our state the same plan with the same drs. and hospitals is 1250.00 month. If we move to a larger city near us with the same plan the premium is 1050.00. It seems like living in smaller cities and rural areas work against you.

No, it isn't that, it is your proximity to the lowest cost network. If you can find a place in your state that is out of network for the lower cost plans but has the plan you want, then that will be the cheapest place to buy your plan.

Make any sense?

 

[Bamaman]

We're on Medicare and a supplement, but I pay for an individual BCBS policy with medicine and dental coverage for my 28 year old daughter. It went from $253 to $290 for 2016 per month. The deductibles are reasonable, and they lose money on her every month.

 

[Taxman59]

I signed up for the ACA Wednesday and paid for it Friday. $500 for DW, DS and me (53, 19 and 56 respectively) with a $500 deductible per person and max OOP for the family of $1400. I went through BCBSNC and dealt with a broker. They took my projected income and the confirmation shows that they accepted the income without and further info needed. My income in 2015 will be about 250k and in 2016 about 30k. It was easy.


Have the day you deserve, and let Karma sort it out.

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[zedd]

I whittled it down to the "best" of each of the Bronze and Silver plans. Then using out of pocket medical expenses in $1k increments from $2k to 11K plugged in the total cost in terms of total premiums and max OOP.

The way I interpret the results is that the sweet spot for the Silver plan is when OOP is in the $6k to $7k range. Otherwise I might as well go with the Bronze.

However looking at it another way, the Silver plan premium is $1764 higher annually than the Bronze plan. To me there is no instance where the higher Silver plan premium is justified. Does it make financial sense to pay an additional $1764 in premiums for the Silver plan to "insure" against the at most $1036 cost avoidance? I'm thinking probably not.

 

[Fermion]

I whittled it down to the "best" of each of the Bronze and Silver plans. Then using out of pocket medical expenses in $1k increments from $2k to 11K plugged in the total cost in terms of total premiums and max OOP.

The way I interpret the results is that the sweet spot for the Silver plan is when OOP is in the $6k to $7k range. Otherwise I might as well go with the Bronze.

However looking at it another way, the Silver plan premium is $1764 higher annually than the Bronze plan. To me there is no instance where the higher Silver plan premium is justified. Does it make financial sense to pay an additional $1764 in premiums for the Silver plan to "insure" against the at most $1036 cost avoidance? I'm thinking probably not.

Why do you compare the two plans but have a higher MAGI for the silver plan pricing vs the bronze plan?

Also, the advantage to the silver seems reasonable if you usually end up having around $6k of medical expenses per year (saves you over $1000).

The bronze plan max OOP for a couple seems low. You have it as 6,000 where I thought it might be more like $12,000.

 

[Theseus]

Why do you compare the two plans but have a higher MAGI for the silver plan pricing vs the bronze plan?

I understand the MAGI difference all to well. Goes under the category of "If I knew then what I know now" because most of our retirement funds are in pre-tax accounts. In this case taking distributions of another $1,764 means, I'll guess here, another $176 in federal taxes, maybe $80 in state. And pulling that additional income to cover those higher expenses, means MAGI goes up, and that means subsidy goes down, which means more income required, and so on. My spreadsheet modeling had my tax rate somewhere around 33% if accounting for subsidy loss due to income increase, even though we were just tickling the bottom of the 15% rate. For us, in the end I opt to live a little larger and carry the better silver insurance. As my DM puts it, leaving a little bit more for the folks that really need it is a good thing.

 

[zedd]

The devil is in the details. The OMAGI is higher with the Silver plan because the Silver is not HSA-eligable. Contributing to an HSA reduces the OMAGI, increases the subsidy and reduces the premium.

If I knew with certainty that my medical expenses would be $6k then yeah the Silver makes sense. But therein lies the problem. I dont know what they will be.

The OOP is in fact for a 2 person household. But only I am covered by ACA. DW is covered under Medicare.

 

[sansha]

I signed up for a Blue Choice HMO, supposedly HSA eligible, with a 6500 deductible and a 372$ a month charge. Supposedly everything after the 6500$ deductible is covered. I haven't had an HMO in 20 years, and it was not a good experience. OTOH, I'm not really sure that an HMO necessarily means substandard health care any more. I'm in MD, we have some good hospitals here, that supposedly take all plans. I looked at all the plans, and it seems to me the diff financially between a silver and gold plan is a large percentage is covered up front, but that you pay for that in increased premiums so it is a trade off between paying more up front - or paying the deductible in full if you have a major health issue. If you see a doctor a lot or have lots of prescription drugs (not me so far), maybe the other plans are better.

Another thing that bothers me about the other plans is that many have the 80/20 payments, so that you end up paying 20% of the cost, even perhaps after the deductible is met. Perhaps how people go broke with a health emergency even if they thought they had good coverage. At least with an HMO, anything in network is supposedly covered.

I didn't apply for a subsidy (ignored that question), but perhaps next year. My one concern is that though I signed up for health care on the exchange, I haven't received an invoice or notice from the carrier. Hoping to get that soon.

As for if ACA is appealed, I don't see what they are going to do for people who perhaps gave up other plans where they had a history, and throw them to the wolves of no coverage for prior conditions or whatever. That would be enormously unpopular. I can see them curtailing coverage in future, or making plans more expensive. But if they become so catastrophically expensive that an average US income earner can't afford one, well that would be unpopular too. Whatever ACA is replaced with, it's going to have to be reasonably practical/acceptable to both parties or it won't pass. Perhaps it is better to be in on ACA now in some respects, in case it is repealed. It might make one eligible for some future grandfathering.

 

[GTFan]

HMO usually means a much more restricted network, which may not be a big deal if all your local doctors and facilities are part of it but can become a much more expensive deal if you're traveling somewhere and have a medical issue (such as an accident).

Avoid ACA repeal discussion, or take the risk that what some might consider to be reasonable talk about it will lead to quick thread locks.

 

[sengsational]

Another thing that bothers me about the other plans is that many have the 80/20 payments, so that you end up paying 20% of the cost, even perhaps after the deductible is met. Perhaps how people go broke with a health emergency even if they thought they had good coverage. At least with an HMO, anything in network is supposedly covered.

I think that ACA compliant plans have a max out of pocket. After that limit is reached, you're done paying until the next year. You pay $6,850, and after that, it's free. https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/

 

[Theseus]

I felt that the lack of familiarity with HMO's expressed by some might be due to more than just being sheltered from insurance decisions through employer group plan availability, and found some data on the Kaiser family foundation's website that helps shed some light on that subject. Total HMO Enrollment | The Henry J. Kaiser Family Foundation Doing some calcs based on 2014 population estimates from Wikipedia shows the top 10 states for HMO market penetration are:

Hawaii 56.0%
California 51.1%
District of Columbia 44.1%
New Mexico 40.0%
Oregon 37.8%
Massachusetts 35.1%
Michigan 34.6%
New York 34.6%
Maryland 32.9%
Wisconsin 32.1%

And the lowest 10 are:

Mississippi 9.1%
Idaho 7.3%
Connecticut 6.9%
Oklahoma 6.8%
North Carolina 6.3%
Alabama 5.6%
North Dakota 4.2%
Vermont 3.7%
Montana 3.4%
Wyoming 1.8%

I became interested in the idea after finding a map indicating HMO market penetration rates for Wisconsin by county while searching for other insurance info. Even within the state there were very high variations by counties, generally it appeared as if the geographic areas with well established and regarded hospitals had the highest participation rates, 60% in some cases. For us in 2016 it is an HMO, as it was in 2015. Of 47 available marketplace plans in our zip, 33 are HMO, 10 EPO, and 4 EPS. Interesting to look at the data for other areas, as I can see why some are less familiar with HMO's.

 

[FUEGO]

I just signed up my MIL who is 63. She got the cheapest silver plan for $19 per month (with a $798/mo subsidy). Her and her husband draw very minimal SS and it's just a thousand or so above the FPL so they barely qualify in this non-medicaid extension state of ours.

It's HMO with UnitedHealthcare. I took a quick look at the in network providers, saw a ton of PCPs in our ZIP. All the nearest 4-5 local hospitals are in network and tier 1, except the very closest one that's a "tier 2" (whatever that means). Not a big deal since the ambulances haul you to the larger slightly more distant major trauma center anyway (little risk of ending up at the tier 2 hospital where you pay more).

I didn't dive too deep into searching for other providers and specialists but it looked like a fairly broad network from a quick look.

$0 deductible, $500 max out of pocket. Low copays. Just a touch better than her being uninsured like she's been for the past several years.

In her case, she's paying $19 per month for a gold plated silver plan that's way better than the old policy she had pre-ACA for $350-400 per month.

 

[karen1972]

I signed up for a Blue Choice HMO, supposedly HSA eligible, with a 6500 deductible and a 372$ a month charge. Supposedly everything after the 6500$ deductible is covered.

Another thing that bothers me about the other plans is that many have the 80/20 payments, so that you end up paying 20% of the cost, even perhaps after the deductible is met. Perhaps how people go broke with a health emergency even if they thought they had good coverage. At least with an HMO, anything in network is supposedly covered.

.

First, I'd double check if you didn't get paperwork, we had issues and so its your responsibility to ensure its paid for and processed by Jan 1st.

Second, HMO vs PPO is really about size of network, that's it.

Third, the plans all have an out of pocket max with % based on High Deductible. Please note Out of Pocket max is different than deductible. Both are important to pay attention to as I've met my deductible and still owed money up to the max (deductible was $6500 and out of pocket max was $10,000). I had back surgery and therapy so even though I had met my deductible I was still paying all the co-pays for pain killers and therapy and such... so if I had hit my out of pocket max, THEN everything after would have been free.

 

[scrabbler1]

I think that ACA compliant plans have a max out of pocket. After that limit is reached, you're done paying until the next year. You pay $6,850, and after that, it's free. https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/

This is what has happened with me this year. In my Silver plan, I have a max OOP of $6,450 which I reached thanks mainly to a 12-day hospital stay. Since I was released from there back in July, everything within the plan has been free. That includes in-network doctor visits, covered prescription drugs, and in-network labwork. Starting next year, everything gets reset to zero although I am switching to another Silver plan from a different company which has a different set of copays. The max OOP will become $5,900 but if I don't have to spend any more time in the hospital, I won't come anywhere close to $5,900 in OOP medical bills.

 

[Jackanory]

My premium went up by 50%. My silver plan went up $20 per month and my subsidy has gone down by $20 per month with no change in income. Two years to Medicare, where I'll be paying much more!

 

[John Galt III]

I took the cheapest option which was an HMO with $250 deductible and $2,250 max oop. $36 per mo premium. Limited to 8 counties in Pa. Had a much better deal last year but they dropped out. I ought to count my blessings because in 4 years I'll be joining the hammered medicare folks.

 

[Texas Proud]

Just signed up today....

Bronze with a high deductible close to max... $950 per month... about a 17% increase from last year... did not apply income so will be paying premiums out of pocket and getting back the money when filing for taxes... worth over $9 per month back from the CC company.... willing to take that until interest rates get back to normal....


Also signed for dental insurance.... had it last year, but not this year... but DW had a few problems and it cost me.... the net cost to me of the insurance is about $300 ish when you take into account the normal cleanings etc. that we always do... took the high option on this since they pay much more than the low option and it almost pays the difference in premiums for itself when you factor in deductibles....

 

[homestead]

I nixed the ACA exchange healthcare this year, went with a bronze HSA directly from Regence.
I'll save taxes on the hsa plus I can draw out 19k from my IRA tax free.