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Old 04-21-2016, 08:38 AM   #21
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Plan choice is obviously driven by cost. I personally wonder how much needed health care is now deferred due to the potential cost of high deductibles and will become more serious health issues over time.

I've got a $2K deductible, $6K max OOP. This year I'm trying to schedule and address as many things as I can (rotator cuff surgery, neuroma in one foot, basal cell carcinoma requiring MOHS) so that I can reach my deductible in one year and have insurance cover the rest.

Which means in other years I tend to defer care due to the original concerns that drove my decision to choose a particular plan level - the cost beyond premiums. And I may not be the only individual who does that.
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Old 04-21-2016, 08:38 AM   #22
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There is a big cost difference from state to state and region to region for health insurance. When I worked for Motorola - an employer that had campuses all over the country, the insurance was much more expensive in the CA bay area than anywhere else. (Despite the fact that CA has had medical tort reform since they 80's.) My insurance dropped in price when I moved from PA to CA. And when I worked in PA - the folks who lived in NJ were paying much higher rates than us Philly based folks.

When I started planning for retirement I looked at COBRA rates as a gauge of what I'd pay after I was employed... This was pre-ACA... Each year the costs went up dramatically. (And to add salt to the employee wound - the percentage paid by the employee also went up - so the employee's costs were rising at a super rapid rate.). The ACA didn't change that.

When I retired - my ACA compliant plan cost very similar to the COBRA plan.

As for whether workers are paying for the non-workers... I don't agree. I do agree that higher income (pension, cap gains, rental, whatever the source) folks do not get a tax credit, and lower income folks get a subsidy... but it has nothing to do with employment status.
Great points, when I look at insurance quotes they always ask for your zip code upfront so you get appropriate quotes from your area and price. Here in Idaho they even drill down to the specific parts of the state as rates differ.

My current job (FIRE in 10 months) will let me stay on with COBRA for 10% over what they pay now which would run about $900 a month for what is termed a "Cadillac Plan". I can jump over to my DW's plan fro about $710 a month which is also a premium plan or jump into the insurance marketplace for a middle silver plan in the 500's or most bronze plans for even less than that.

All politics aside, this is the single most frustrating part so far is trying to determine future medical costs. I too believe that the insurance costs are driven by the health care costs.

Lets us never forget that there are two very important parts of a successful ER. Your financial health and your physical health and it takes both to really enjoy it all. I make investments in both!
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Old 04-21-2016, 08:40 AM   #23
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Thanks, I have been looking them over and doing side by side comparisons as well. It still amazes me that there are so many different plans out there.
The multitude of options is excessive and very confusing. In reality, there are just a few plans, but each has many different ways to pay. For example, BCBS of Florida has 27 options but really only 3 plans. An HMO, a plan with a local, restricted network of service providers, and a plan with the large, nation-wide network, and they all cover the same health conditions. Each of those plans has many different combinations of premium, deductible, co-pay, co-insurance and out-of-network coverage.

A number of forum members wrote MS Excel spreadsheets to compare the different combinations and estimate the total yearly cost. A tool like this makes is much easier to choose.
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Old 04-21-2016, 08:41 AM   #24
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............As for whether workers are paying for the non-workers... I don't agree. I do agree that higher income (pension, cap gains, rental, whatever the source) folks do not get a tax credit, and lower income folks get a subsidy... but it has nothing to do with employment status.
I never understood why a person with employer paid health insurance got it tax free while a person who bought their own insurance paid for it with after tax dollars. That almost sounds like a subsidy.
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Old 04-21-2016, 11:43 AM   #25
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I originally stated this thread to see if there are differences between Platinum, Gold, Silver and Bronze plans.

I know there are cost differences, and at this point I am not worried about that.

I was worried about having a bronze plan, and then going to the Doctor and having the Dr. say, too bad that isn't covered. If you would have purchased the upgraded plan, it would have been. You purchased the heart friendly plan, not the cancer friendly plan.

It appears that the plan coverage is NOT like an extended automobile warranty. Some auto warranty plans cover electronics, some do not.

I can plan for playing the max out of pocket costs, as it would be a catastrophic event. I would be happy to be alive and pay for what I was provided. If I can plan for something, and all I need is enough planning to tell an ambulance driver to take me to the VA, I am covered.
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Old 04-21-2016, 11:54 AM   #26
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I think the coverage differences have more to do with providers and networks, rather than metal levels. So - using your auto warranty analogy - you have to make sure the warranty covers work done at the dealership you'd like use.
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Old 04-21-2016, 12:08 PM   #27
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I originally stated this thread to see if there are differences between Platinum, Gold, Silver and Bronze plans.

I know there are cost differences, and at this point I am not worried about that.

I was worried about having a bronze plan, and then going to the Doctor and having the Dr. say, too bad that isn't covered. If you would have purchased the upgraded plan, it would have been. You purchased the heart friendly plan, not the cancer friendly plan.

It appears that the plan coverage is NOT like an extended automobile warranty. Some auto warranty plans cover electronics, some do not.
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I think the coverage differences have more to do with providers and networks, rather than metal levels. So - using your auto warranty analogy - you have to make sure the warranty covers work done at the dealership you'd like use.
Right. In other words, there are no differences in what is covered, just how big the provider network is, for all ACA compliant individual insurance plans.

Everything else, and all of the "metals" and such, is about how you will pay your share, which is pretty much the same across all the plans. The premiums, co-pays, deductibles, and co-insurance amounts are all in different combinations but at the end you always pay around the same amount. And if you are willing to take a little risk, with a higher deductible, you'll get a bit of a break in the total cost.
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Old 04-21-2016, 12:35 PM   #28
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I went with a high deductible bronze HSA plan. Already had the HSA from my ex-employer. Pretty cool, you pay all your co-pays with tax advantaged dough and I pay my dentist with it too. As I don't have dental insurance it really helps.
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Old 04-23-2016, 08:03 AM   #29
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Originally Posted by Senator View Post
I originally stated this thread to see if there are differences between Platinum, Gold, Silver and Bronze plans.

I was worried about having a bronze plan, and then going to the Doctor and having the Dr. say, too bad that isn't covered. If you would have purchased the upgraded plan, it would have been. You purchased the heart friendly plan, not the cancer friendly plan.

It appears that the plan coverage is NOT like an extended automobile warranty. Some auto warranty plans cover electronics, some do not.
You do need to stay aware of provider network changes as this article shows.

Quote:
With UnitedHealth already set to end its “Obamacare” health coverage in Louisiana next year, the insurance giant is now pulling the plug early with Ochsner Health System, apparently forcing close to 3,000 patients in south Louisiana to decide between paying hefty out-of-pocket medical expenses or driving more than an hour to visit a doctor.

Taking Ochsner — Louisiana’s largest nonprofit health care system — out of the fold only five months into the 2016 health insurance period is going to be a hassle for UnitedHealth’s members in metro New Orleans, some state and health care industry officials said.

The two companies said Friday they were unable to reach a compromise for Ochsner to continue in UnitedHealth’s public health insurance exchange program. In a statement, UnitedHealth called it a “routine renegotiation” of a contract.

In a letter to its local customers, UnitedHealth said members of its so-called “Compass” program would have in-network care available elsewhere in the state. But the six facilities it listed are all at least an hour’s drive from New Orleans.

State Insurance Commissioner Jim Donelon downplayed the shake-up, saying that providers and insurers are free to make such changes at any time. Some patients, such as someone who is pregnant or undergoing treatment for an acute condition, may be able to remain with Ochsner for an additional three months, he said.

“It’s going to happen more and more, and if negotiations are not on the same contract timeline as open enrollment, you’re going to see this happen in more states across the country.”
Reference: UnitedHealth, Ochsner cutting ties, likely leaving 3,000 in N.O. area without local health provider | The Advocate €” Baton Rouge, Louisiana
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Old 04-24-2016, 09:42 AM   #30
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Originally Posted by Senator View Post
I originally stated this thread to see if there are differences between Platinum, Gold, Silver and Bronze plans.

I know there are cost differences, and at this point I am not worried about that.

I was worried about having a bronze plan, and then going to the Doctor and having the Dr. say, too bad that isn't covered. If you would have purchased the upgraded plan, it would have been. You purchased the heart friendly plan, not the cancer friendly plan.
I have been re-looking at the same things you are. Out where I live it appears that a BC silver plan with a $2K deductible can still come in at $450 a month. I still have until 2017 to nail down an exact plan as that is my FIRE timeframe. COBRA is a joke at 10% over my current plan, and my DW's plan will charge over $700 to join.
It may be a case of having a plan but keep look as you go and as your needs may or may not change. I have multiple expensive testing done every five years to keep watch on a possible hereditary issue which is keeping me from going with too high a deductible (as I would need it), but everyone needs to fit the plan to the person. Best of luck to you, it sounds like you are on solid ground.
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Old 04-24-2016, 11:05 AM   #31
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You obviously have either no or a very skewed understanding of ACA because you are not even in the right ballpark.

Please explain how ACA makes premiums for those who work higher than for those who do not? Premiums for those who work were high before ACA and continue to be high but they didn't spike dramatically. If anything, ACA has reduced increase for group plans because of less cost shifting.

As Michael indicated, the increases in health insurance premiums is a function of increase in the cost of health care services.

Very simple ACA premiums are income based..go to gov healthcare site and put in a fictional family of 4 and incomes of 30, 60 and 100k you'll get three differ sets of prices.


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Old 04-24-2016, 11:13 AM   #32
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Very simple ACA premiums are income based..go to gov healthcare site and put in a fictional family of 4 and incomes of 30, 60 and 100k you'll get three differ sets of prices.


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Yes, but these families presumably "work" to earn their 30, 60 or 100k rather than having it dropped into their laps ..... and you said work vs not work... not that premiums were income sensitive. If you had said that premiums were income sensitive then you would have been factually correct... but you didn't so your post was not factually correct as you asserted it was.

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Sir with respect I beg to differ.. ACA is a tax plan that penalizes those who work for a living by making them pay higher premiums for those who do not or can not. This is not a political comment but simply a statement of fact. .....
emphasis added
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Old 04-24-2016, 11:28 AM   #33
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Let's not be silly.. ACA is income based Those not working will in most cases have the lowest income...



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Old 04-24-2016, 12:24 PM   #34
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Words matter. It not our problem that you can't express your thoughts accurately.

Those not working would most likely be on Medicaid both before and after ACA so ACA didn't change a thing for them. The ACA subsidies benefit people with low income who did not qualify for Medicaid, for whom individual health insurance is unaffordable. In most cases, these are low-income working families.
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Old 04-24-2016, 04:16 PM   #35
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These posts always seem to degrade into arguments over whether the ACA is fair or not. If someone wants to re-argue it, I'd suggest starting another post in the political topics. The OP was asking a specific question about how to evaluate a plan.
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Old 04-24-2016, 09:59 PM   #36
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These posts always seem to degrade into arguments over whether the ACA is fair or not. If someone wants to re-argue it, I'd suggest starting another post in the political topics. The OP was asking a specific question about how to evaluate a plan.
Exactly...

I think I am going to use my VA insurance exclusively for 2016. I will leave my job on 7/5, so I have retro cobra if I need it until ~10/31 or so. I am healthy, only 56.

Anything I can plan for, the VA will provide. Strokes and heart attacks and other ambulance rides are my worry. A bronze plan for 2017 as a backup, maybe. I may stretch it for a couple more years.
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Old 04-25-2016, 06:31 AM   #37
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The individual plans I look at seem just like the plans I saw when working. The obvious, deductibles change. But the focus we had was what is less expensive over all. Worst case was a little surprising at the time and it really depended upon what health care was needed. If you needed little care, the HDHP plan was least expensive. No surprise here. What was more interesting, max out of pocket including premiums... the "better" plan was more expensive (HDHP was better). There were areas between that the higher coverage plans were less expensive.
Some of the higher metal plans switch from deductible to co-insurance and some to co-pays. It is easy to blow through co-insurances with a couple expensive procedures. Co-pays on the other hand charge you per visit and therefore may have some advantages in having a wider center region where it is less expensive.
Note this analysis was for full premiums (no subsidy or cost sharing) and only what I was considering (and same insurer). But this includes employer plans I had in the past where HDHP was offered.
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Old 04-25-2016, 06:43 AM   #38
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My insurer had a neat feature on their website where you entered your info and estimates of the number of well care and specialist visits that you would have in a year, how many prescriptions that you had, etc.

It then showed estimates of the minimum, expected and maximum costs of various plans. The minimum was just the aggregate premiums. The maximum was the premiums and worst case deductibles and co-pays. The expected was premiums plus deductibles and co-pays based on what you provided for expected utilization. It was a nice tool to compare various plans and HDHP seemed to be the winner for us but our utilization is low because we are healthy and have only a few prescriptions.

As previously, one forum member shared a spreadsheet that did a similar analysis.
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