First look at next years rates

[John Galt III]

You're complaining about a $250 deductible and $750 max OOP? I havent seen those numbers since 1990

Thanks. I feel a little better now.

 

[brewer12345]

Interesting info about how it all works, just wondering if you are comfortable having your kids on the state plan. I think in my case I would want all doctors and hospitals available if a kid problem arose. I'm hearing more and more stories about drs not accepting state subsidized plans...I wonder if they are true or urban legend.

In this case, the state sponsored plan is your choice of various HMO offerings. Since our existing plan is already a Kaiser HMO offering, I do not anticipate any issues.

 

[MichaelB]

The Colorado exchange got its stuff sorted out so my broker shot me some quotes. 2016 will be a lower income year for us, so at a hair under 250% FPL we can put the kids on a state-sponsored freebie plan with no deductibles and tiny copays. DW and I would get our own policy with pro rata subsidies. It would be the same high deductible HSA eligible bronze plan we have now, but the premium for the two of us would be $285/month. That is much better than the no-subsidy alternative that would have run us $670/month for the 4 of us.


I am having the broker run quotes to see what the story would be if we had a hair under 150% FPL just to see what I leave on the table by showing more income.

The biggest step up in saving is when you can get your income below 200%, there is another, smaller savings amount when you get below 150%.

This is based on income projection. If you run over, the premium assistance must be partially paid back but the cost sharing is not.

This KFF paper explains cost sharing beginning on page 14 http://www.fas.org/sgp/crs/misc/R41137.pdf but uses the 2014 numbers. This page gives another explanation and has 2016 numbers http://obamacarefacts.com/insurance-exchange/cost-sharing-reduction-subsidies-csr/

 

[pb4uski]

You're complaining about a $250 deductible and $750 max OOP? I havent seen those numbers since 1990

You forgot to mention the $150 premium.

JGIII should not look a gift horse in the mouth.

 

[brewer12345]

The biggest step up in saving is when you can get your income below 200%, there is another, smaller savings amount when you get below 150%.

This is based on income projection. If you run over, the premium assistance must be partially paid back but the cost sharing is not.

This KFF paper explains cost sharing beginning on page 14 http://www.fas.org/sgp/crs/misc/R41137.pdf but uses the 2014 numbers. This page gives another explanation and has 2016 numbers Cost Sharing Reduction Subsidies (CSR) - Obamacare Facts

Understood. We have a structural problem of way too much of our assets being in traditional IRAs rather than Roth or after tax. Either be earning it or converting it from traditional to roth, we need to beef up non-trad IRA assets or face a tax bomb down the road (plus difficulty tapping funds before 59.5). I am also uncomfortable with intentionally cheating (claiming a lower income knowing I can have more and only have to pay back a small amount of what I should not have gotten in the first place). There may be no penalty for doing so currently in place, but I am leery of how it may be viewed in the future especially when my profession requires me to be in a position of trust much of the time.

 

[pb4uski]

I gave up on getting subsidies as the tax benefit of doing Roth conversion now and saving 15% or more in taxes surpassed the benefit of subsidies for us. Our situation might be a bit unusual in that we can buy catastrophic coverage at a 40+% discount compared to a bronze plan.

 

[Fermion]

I gave up on getting subsidies as the tax benefit of doing Roth conversion now and saving 15% or more in taxes surpassed the benefit of subsidies for us. Our situation might be a bit unusual in that we can buy catastrophic coverage at a 40+% discount compared to a bronze plan.

You are a smart man. My cell phone bill trying to deal with ACA is going to be near what the subsidy is this year.

 

[John Galt III]

For the most part, except for serious emergencies, I agree. And in that case, treat me until I'm stable enough to be transported to a hospital in the network. If anything financial keeps me awake at night it's the thought of having a catastrophic emergency and being treated by out-of-network ER docs and others even in an in-network hospital -- and winding up with a large 5- or 6-figure "balance bill".

Makes me think they look for out-of-network people to assign to you since they will be able to gouge, and increase profits. Interestingly, when I was looking at the blurb from the Capital Blue Cross website, the section describing max out of pocket costs actually warned that your in-network doctor could request out-of-network doctors to assist in whatever you are having done, and that the out-of-network doctors' fees would not be covered and also would not apply to the oop max. Good to see the problem actually mentioned up front by an ins co blurb.

 

[karen1972]

Makes me think they look for out-of-network people to assign to you since they will be able to gouge, and increase profits. Interestingly, when I was looking at the blurb from the Capital Blue Cross website, the section describing max out of pocket costs actually warned that your in-network doctor could request out-of-network doctors to assist in whatever you are having done, and that the out-of-network doctors' fees would not be covered and also would not apply to the oop max. Good to see the problem actually mentioned up front by an ins co blurb.

I find its usually the anesthesiologist or people like that where you get hosed by out of network... also over holidays you never know who they brought in to cover. I've had this issue 6 years ago when I had surgery. Its not on purpose, its just rotation and covering vacations.

 

[eytonxav]

If the networks are getting more and more narrow, then whats happening to all the doctors that are no longer in the networks? Nobody can afford to go to a doctor that isnt in their network.

Its near impossible to sort this out. DD was on BCBSTX PPO this year which was discontinued and now they are only offering HMOs for 2016 that are expensive with higher deductibles and OOP max. Whats even more frustrating is trying to determine if your Drs are on the new HMO plans. BCBS has notes on the Dr search that this doctor is either joining or leaving the network. When you call the Dr, they say it depends on what your member ID code is, and some just say that they will not accept exchange plans. What every happened to if you like your plan you can keep it, and this will make healthcare more affordable

 

[ERD50]

I find its usually the anesthesiologist or people like that where you get hosed by out of network... also over holidays you never know who they brought in to cover. I've had this issue 6 years ago when I had surgery. Its not on purpose, its just rotation and covering vacations.

But since they are the business, and they do this everyday, and we are the customers who (hopefully) rarely do any of this - they need to accommodate us. There should be some system in-place to assure you get in-network care if you made an honest attempt at it. If they switch things on us, it should be our problem.

-ERD50

 

[Theseus]

You are a smart man. My cell phone bill trying to deal with ACA is going to be near what the subsidy is this year.

Just got off the phone with them, trying to figure out why I'm getting the "You may lose your financial help" emails again. Had those earlier this year too, called, and was told not to worry about, everything looks good. I'm guessing the rep was empowered enough to click on a checkbox or something, and the emails went away - until now. So this time I called with similar expectations, but had different results. Rep says my income information is OK, but DW's isn't... Uh, it is combined income. Exact same info - IIRC in their process that is submitted before creating 'groups' for insurance plans (we have separate plans in 2015). Questioned that three times, got the same instructions to submit 'her' income info.

 

[homestead]

Anyone know why premiums for bronze hsa's are generally higher than non-hsa plans?

 

[ziggy29]

Anyone know why premiums for bronze hsa's are generally higher than non-hsa plans?

I'd guess because HSA-eligible plans can't have an OOP maximum above $6,550 (single) or $13,100 (family), and some bronze plans have higher OOP maximums than that. So the ones with an OOP max too high to be eligible for an HSA are probably going to be the cheapest.

 

[Sue J]

Anyone know why premiums for bronze hsa's are generally higher than non-hsa plans?

I found this, too. We've had HSA plans for the last 2 years and now they are more expensive than the non-HSA and that makes no sense.

For us this year the HSA plans are all $200-$300 more per month than comparable non-HSA ones.

I've been very happy with the ACA so far but this year our bronze choices are all HMOs and not HSA eligible.

Just shaking my head over how this has all changed in just 2 years.

 

[homestead]

I'd guess because HSA-eligible plans can't have an OOP maximum above $6,550 (single) or $13,100 (family), and some bronze plans have higher OOP maximums than that. So the ones with an OOP max too high to be eligible for an HSA are probably going to be the cheapest.

Thanks, If you have a couple where only one is getting ACA and the other on Medicare which OOP Max would apply single or family? I see a difference depending on the site I use. Healthsherpa vs gov site.

 

[ziggy29]

Thanks, If you have a couple where only one is getting ACA and the other on Medicare which OOP Max would apply single or family? I see a difference depending on the site I use. Healthsherpa vs gov site.

If only one person is going to be covered via Marketplace policy then you are buying a plan for one person, with the single person limits on deductibles and OOP maximums. You have to consider total household income for the purposes of subsidies/tax credits, even if only purchasing coverage for one person.

 

[Texas Proud]

Its near impossible to sort this out. DD was on BCBSTX PPO this year which was discontinued and now they are only offering HMOs for 2016 that are expensive with higher deductibles and OOP max. Whats even more frustrating is trying to determine if your Drs are on the new HMO plans. BCBS has notes on the Dr search that this doctor is either joining or leaving the network. When you call the Dr, they say it depends on what your member ID code is, and some just say that they will not accept exchange plans. What every happened to if you like your plan you can keep it, and this will make healthcare more affordable

Just as an FYI, plans have been changing long before Obamacare... I used to approve the health plan during my last job... every year we would get a new proposal... some years it was almost the same, some there were lots of changes.... so the promise of 'if you like your plan you can keep it' was never going to happen....

Just sayin....


I do agree that finding if a doctor is in plan or not is horrible.... heck, they still list my old PCP as 'in plan' even thought she moved almost two years ago.... we also went to an opthamologist I had been going to for years.... they insisted they were part of my network... so, we went to our PCP to get a referral and lo and behold.... he is NOT in network... so even the Dr's office can give bad info.... and they had my insurance card to check....

 

[homestead]

If only one person is going to be covered via Marketplace policy then you are buying a plan for one person, with the single person limits on deductibles and OOP maximums. You have to consider total household income for the purposes of subsidies/tax credits, even if only purchasing coverage for one person.

Thanks again, Then healhsherpa gets it right and gov site doubles the oop max. That is what I thought too but wasn't sure since it was the gov site.

 

[MBSC]

Thanks, If you have a couple where only one is getting ACA and the other on Medicare which OOP Max would apply single or family? I see a difference depending on the site I use. Healthsherpa vs gov site.

Single. The two sites get to single in different ways.

HC.gov: Enter all family members, check the Medicare box next to "other information" on one to subtract that member, and enter total household income.

HS.com: Enter only members who NEED ACA coverage (one) and enter total household income.

 

[homestead]

Single. The two sites get to single in different ways.

HC.gov: Enter all family members, check the Medicare box next to "other information" on one to subtract that member, and enter total household income.

HS.com: Enter only members who NEED ACA coverage (one) and enter total household income.

This is in the Preview 2016 section.
I did select the medicare box but it also includes, job ...(below in bold)
Forgot to say it doubles the deductible too.
Other information
Eligible for health coverage through a job, Medicare, Medicaid, or CHIP

Healthsherpa does it right it asks for number of people (1) to be insured and then asks family size (2) and it doesn't double the deductables or the oop max.

 

[eytonxav]

Just as an FYI, plans have been changing long before Obamacare... I used to approve the health plan during my last job... every year we would get a new proposal... some years it was almost the same, some there were lots of changes.... so the promise of 'if you like your plan you can keep it' was never going to happen....

Just sayin....

Yes, I realize that having been in a mega corp plan that had been pared back and made more expensive probably every year for the past 20 years or more. Nevertheless, the ACA was supposed change the acceleration in healthcare increases and make coverage more affordable for the masses.

 

[utrecht]

Yes, I realize that having been in a mega corp plan that had been pared back and made more expensive probably every year for the past 20 years or more. Nevertheless, the ACA was supposed change the acceleration in healthcare increases and make coverage more affordable for the masses.

ACA has failed miserably at just abut everything except for making sure you can get insurance even with a pre-existing condition.

 

[Bamaman]

This is my first full year on MegaCorp's retiree PPO Medicare supplement, and my wife and I pay the same $55 per month each.

We still have to purchase Part D medicine coverage in the open market, and it's gone up 100% this year. We'll be going on Medicare.gov's website to see what's the best plan for our state is.

My 28 year old daughter's BCBS Individual Blue healthcare policy (non-O'Bamacare) went from $253 to $290 including dental coverage. She's high maintenance on doctors and medicine so they're really losing $ on her.

I consider our family blessed to have the benefits we have--after reading all the horror stories online.

 

[petershk]

Utrecht: which if you didn't have as an option before could mean the difference between being wiped out financially or not

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