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Old 06-18-2015, 06:34 AM   #41
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One of the issues is that the "cheapest" subsidized ACA plans tend to be HMOs, which IMO are close to garbage. I was on an ACA plan from the beginning until the end of last month, and while I was eligible for some subsidy during that time, I opted not for the cheapest plan, but to pay nearly $100 a month more for a PPO. That tells you what I think of HMOs in general, especially those where out-of-state coverage is iffy at best. (Keep in mind that an HMO usually requires you first see your PCP for everything and they are the "gatekeeper" to specialists and everything else. Makes needing care out of state a lot of "fun".)
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Old 06-18-2015, 08:34 AM   #42
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Originally Posted by ziggy29 View Post
One of the issues is that the "cheapest" subsidized ACA plans tend to be HMOs, which IMO are close to garbage. I was on an ACA plan from the beginning until the end of last month, and while I was eligible for some subsidy during that time, I opted not for the cheapest plan, but to pay nearly $100 a month more for a PPO. That tells you what I think of HMOs in general, especially those where out-of-state coverage is iffy at best. (Keep in mind that an HMO usually requires you first see your PCP for everything and they are the "gatekeeper" to specialists and everything else. Makes needing care out of state a lot of "fun".)
Not a huge HMO fan either, but I would not paint 'em all with the same brush. From available objective measures (member surveys, rate of complaints/suits, etc.) some are good while others.....well not so good. As with most things- YMMV based on your specific circumstances.

Re earlier posts re BCBS- BCBS is not a single insurance co, but (from their website) a "system of 36 independently operated BCBS member companies" and a program for Federal employees. Just because BCBS system operates nationally does not mean every BCBS individual HI plan offers nationwide coverage for non-emergency care.
Health Insurance Companies & Plans | Blue Cross Blue Shield | BCBS.com
AFAIK, each area is handled by only one of these independent BCBS licensee companies. BCBS coverage features can vary widely between states, as well as between individual health plans. Even within BCBS- YMMV.
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Old 06-18-2015, 09:19 AM   #43
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As far as BCBS goes, in my zip code BCBSTX is, and has been, the ONLY "competitor" on the Exchange. No wonder my premium went up 26 percent last year, and I'll bet it will be a lot again this year though I won't likely be on it.
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Old 06-18-2015, 10:02 AM   #44
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Pointing out fact is not "scaremongering". My comments clearly did NOT refer to the situation in all regions or for all ACA plans. Fact is that there are potential pitfalls in HI for FIREs. It is prudent to use due care in understanding the features of any HI plan before signing up. And vast majority of HI options are region specific.
Actually, it is scaremongering. Every time someone asks about ACA you pipe up with unleavened doom and gloom. It does not take a space monkey to figure out that you have an axe to grind. How about instead something along the lines of: "coverage, costs and options vary greatly by location. In some places they are really poor/expensive and in other places they are very good. You will need to see what options are available near you and remember to read policy details and investigate the depth of coverage networks before you buy."
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Old 06-18-2015, 10:36 AM   #45
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.. Snip..

Re earlier posts re BCBS- BCBS is not a single insurance co, but (from their website) a "system of 36 independently operated BCBS member companies" and a program for Federal employees. Just because BCBS system operates nationally does not mean every BCBS individual HI plan offers nationwide coverage for non-emergency care.
Health Insurance Companies & Plans | Blue Cross Blue Shield | BCBS.com
AFAIK, each area is handled by only one of these independent BCBS licensee companies. BCBS coverage features can vary widely between states, as well as between individual health plans. Even within BCBS- YMMV.
True, that is their structure. It's been that way forever. Since the topic is ACA subsidies what's the point? Their structure is the same regardless how you got the insurance.

Guess what, they all use different technology stacks, outsource to different 3rd party providers.... How does the minutiae of their structure impact me as a consumer?
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Old 06-18-2015, 10:46 AM   #46
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This is still a sensitive topic for many members. Hopefully we can express our views and comment on those of others without offending. Let's try to keep it friendly.

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"coverage, costs and options vary greatly by location. In some places they are really poor/expensive and in other places they are very good. You will need to see what options are available near you and remember to read policy details and investigate the depth of coverage networks before you buy."
That's a good way to put it.
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Old 06-18-2015, 10:50 AM   #47
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As far as BCBS goes, in my zip code BCBSTX is, and has been, the ONLY "competitor" on the Exchange. No wonder my premium went up 26 percent last year, and I'll bet it will be a lot again this year though I won't likely be on it.
Florida BCBS also aggressively raised rates on their individual plans last year. I built a spreadsheet that tracked all the individual policies and premiums before and after the increases, as well as the Medigap policies and premiums, for all major insurers. BCBS raised their Medigap policies less than 2% while individual plans were >20%. Perhaps they badly underestimated the individual market. There is no scrutiny (in Fl) of the individual policies, however, so it's also possible they increased the price to cross subsidize their Medigap offerings. What is fascinating is how the same product - their national BlueCard policy with the same coverage - saw such different pricing among the states this past enrollment period. I expected the same policy with the same network to have more pricing consistency around the country.

Health insurance is still very much marketplace that demands a well informed consumer.
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Old 06-18-2015, 01:34 PM   #48
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I have no "axe to grind". I have strived to keep all of my comments factual. All seem to agree that HI options (Exchange, Medicaid, private, employer, whatever) vary significantly by individual circumstances (inc region, finances, health, etc.). We also seem to agree that all should carefully consider their specific HI options before signing up for a health plan (or a specific HI carrier). I have repeated seen the VERY painful consequences (financial and otherwise) to making poor assumptions &/or choices in a HI plan both pre- and post-ACA. The purpose of my comments has not been to "grind an axe" but to hopefully prevent others from suffering such consequences. As MichaelB said, HI is still very much a marketplace favoring the well-informed consumer. And, as in any marketplace, the ill-informed consumer can still suffer.
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Old 06-18-2015, 02:49 PM   #49
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Making poor assumptions/decisions about anything involving money is always painful. Not sure why you are singling out health insurance.
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Old 06-18-2015, 06:31 PM   #50
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It seems that the original poster disappeared two days and thirty posts ago, after posting this:

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I've figured out the answer and will post it (BTW turns out this is a typical forum)
I'm still not sure whether he understands the significance of a Roth conversion or its impact on future tax liabilities.
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Old 06-18-2015, 07:04 PM   #51
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It seems that the original poster disappeared two days and thirty posts ago, after posting this:



I'm still not sure whether he understands the significance of a Roth conversion or its impact on future tax liabilities.
Well, if he comes back, all he has to do is read (and understand) the posts that pointed this out. Doesn't matter to me if he does or not.
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Old 06-18-2015, 08:19 PM   #52
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I know the OP came, called us a "typical forum" and left (lol), but I had a point to make that I didn't see made....I needed to keep above 250% FPL to stay out of Medicaid range. If I fell below that, then in my geography at least, you turn into a second class healthcare citizen (not too many docs accept it), and you need to get approved by the state, and they can reject you. So I would stress to anyone trying to understand this puzzle that managing income is essential for your health, and the health of your bank account.
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Old 06-18-2015, 09:00 PM   #53
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I know the OP came, called us a "typical forum" and left (lol), but I had a point to make that I didn't see made....I needed to keep above 250% FPL to stay out of Medicaid range. If I fell below that, then in my geography at least, you turn into a second class healthcare citizen (not too many docs accept it), and you need to get approved by the state, and they can reject you. So I would stress to anyone trying to understand this puzzle that managing income is essential for your health, and the health of your bank account.
I am puzzled by this. Why would you need >250 FPL to stay out of Medicaid, which is between 0 to 138 FPL? >250 outs you outside of any cost sharing in the Silver plans.
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Old 06-18-2015, 11:47 PM   #54
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Cost sharing is not Medicaid. To the doctor or hospital, your silver plan without cost sharing pays them exactly the same as a silver plan with cost sharing.

Increasing your income just to make sure you don't qualify for cost sharing is...how do I put this nicely? Stupid.
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Old 06-19-2015, 07:32 AM   #55
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I am puzzled by this. Why would you need >250 FPL to stay out of Medicaid, which is between 0 to 138 FPL? >250 outs you outside of any cost sharing in the Silver plans.
I don't know why. It didn't make any sense to me either. The statement "I needed to keep above 250% FPL to stay out of Medicaid range" was my personal experience. That's why I stated it that way, rather than in a general way. To shed more light on my experience...I went through the sign-up process on the federal exchange many, many, MANY times, only to get "snagged" by Medicaid. There's supposed to be a breakpoint at various places, including 230%, I think. I tried them all. And the only way I could keep my family and I out of Medicaid range was to go above 250%.

Folks like to point out how awesome a silver plan with cost sharing is. For me, though, cost sharing doesn't do much since the three of us might have a total of four or five doctor visits a year. Even if these visits were 100% free, that doesn't make up the difference between the cost of a Bronze plan and a Silver. That's not to say I won't revisit the analysis every enrollment period! Basically I'm buying the max out of pocket, and the negotiated rates, and I know that's not true for many that use more health care services.

I think what makes it confusing to talk about is that in different states, with different health insurance needs, there are so many variables that generalization can be problematic.
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Old 06-19-2015, 08:16 AM   #56
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I think I know what happened. Because you have children they qualified for Medicaid/CHIP at a FPL over 138. You would still go into a metal plan.

BTW, the sweet spot on Silvers is <200 FPL, anything more and cost sharing is greatly reduced.
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Old 06-19-2015, 12:02 PM   #57
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I don't know why. It didn't make any sense to me either. The statement "I needed to keep above 250% FPL to stay out of Medicaid range" was my personal experience. That's why I stated it that way, rather than in a general way. To shed more light on my experience...I went through the sign-up process on the federal exchange many, many, MANY times, only to get "snagged" by Medicaid. There's supposed to be a breakpoint at various places, including 230%, I think. I tried them all. And the only way I could keep my family and I out of Medicaid range was to go above 250%.

Folks like to point out how awesome a silver plan with cost sharing is. For me, though, cost sharing doesn't do much since the three of us might have a total of four or five doctor visits a year. Even if these visits were 100% free, that doesn't make up the difference between the cost of a Bronze plan and a Silver. That's not to say I won't revisit the analysis every enrollment period! Basically I'm buying the max out of pocket, and the negotiated rates, and I know that's not true for many that use more health care services.

I think what makes it confusing to talk about is that in different states, with different health insurance needs, there are so many variables that generalization can be problematic.

I did not put any income down on my sign up and will try and get the money back when I file tax returns (with all the caveats of a SC decision)...

But, I agree with you on the difference in cost of a Silver and Bronze... the cost for me and my family is between $400 to over $1000 per month... I can buy a lot of doctor visits for $400 per month...

Now, if thing go 'pear shaped', then it might have been a bad decision.... but that would take two of us hitting max deductible...
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Old 06-19-2015, 02:32 PM   #58
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Very true. Best to study your HI plan options VERY carefully before pulling the FIRE trigger. Since Medicaid is state-based program, most do not generally provide out of state coverage. In many regions most ACA plans, not just the cheaper ones, have limited networks which often do not include out of area coverage except for true emergencies. Main reason I'm still w#rking is for access to decent HI, IOW a reasonably broad network & true nation-wide coverage. Under most any ACA Plan offered in my region, if I were to need urgent but not "emergency" care while traveling/visiting I would be stuck paying 100% of the bill. Almost all ACA plans in my region offer NO out of network coverage, and the few that do have OON OOPmax (HSA family plans) of $40-60K!!! One goal of ACA was to offer a choice of nationwide plans in each region, but that is sadly still not the case for many. Wish that changes in my region for 2016 but I'm not hopeful based on early press from state insurance commission

Are u in Indiana and if so where approximately in the state ?
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Old 06-20-2015, 11:16 AM   #59
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Not even impoverishment will get you care in Texas if you are a childless adult 18-64 (the undeserving poor), since Texas did not expand Medicaid. Texas doesn't even have a "medically needy" exception for this group. So if a 52 year old spends down all assets to $0, Texas will pay nothing for care. The person would have to be deemed "disabled" and have income under 15% FPL with almost no assets to get coverage. In the 30 states that expanded, the only test is a <138 FPL income test for childless adults 18-64.
Not to mention that in many states Medicaid is not accepted by a lot of providers because they're losing money on those patients. In GA (my state) Medicaid is only useful to the truly poor and then only if they also have children because there's no way you're getting it otherwise. Not that you'd want to.

Managing income to stay below 200% FPL and then get a cost-shared Silver is the way to go as you aptly point out, assuming you want the best coverage at the lowest cost. Many folks here are happy with a Bronze or catastrophic plan because they're healthy and want more income from their port, and that's ok too.
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Old 06-23-2015, 07:20 PM   #60
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It seems that the original poster disappeared two days and thirty posts ago, after posting this:
Maybe if any of the posts after that had anything to do with the question I would check more often

And I wasn't interested in discussing Roth IRAs
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