Health Insurance Premiums when FiRED, Pre Medicare, How Much do you Pay?

[kcowan]

I did some Research in British Columbia Canada, as it is the only Provice we would consider moving to. These are directly off their web site:
...Remember No Copays or Deductibles for the most part. Any BC Residents please feel free to comment.
...
When determining premium rates, B.C. residents may claim allowable MSP deductions to their net income to determine their adjusted net income. Individuals may claim $3,000 for every person on their MSP account that is age 65 or older this year, and $3,000 for each child on their account. In addition, if you claimed a disability on your tax return for yourself, spouse or child included on your MSP account, you may claim $3,000 for each disabled person. To determine if you qualify for deductions, please refer to the Application for Regular Premium Assistance Form for more information.

No coverage for drugs. Anything normally covered by Blue Cross not covered. Deductions are subject to a means test i.e. must be below net $30000. 90 days waiting period for coverage for qualified residents.

 

[ShokWaveRider]

No coverage for drugs. Anything normally covered by Blue Cross not covered. Deductions are subject to a means test i.e. must be below net $30000. 90 days waiting period for coverage for qualified residents.

Like the USA you can buy a rider from companies like Blue Cross (Canada) for drugs and better hospital services though right?


Also, Kcowan: what do you do for healthcare at Latitude 20?

 

[Sue J]

For those of us with ACA premium tax credits (whether taken in the form of premium subsidy, or at tax time).... Do you budget for the full cost?

I estimate our income as accurately as possible. Then we budget for the premium amount after our subsidy. Then if something can be sheltered into non-taxable, I decide if it's worth it or not and get the extra subsidy back at tax time.

So for 2014 and 2015 our HSA contribution lowered our income and increased our subsidy at tax time. For 2016 putting all my part time income into a Traditional IRA will do the same thing. For 2017 our income will be the pension, some taxable interest, my part time income and an RMD from an inherited IRA. The only thing that can be sheltered is my part time income unless we have an option for an HSA next year.

I don't know about other ACA users but for us every year has been a different insurance company, premium prices jumping all over the place and deductibles going higher. For 2016 we both had to change doctors as keeping our same plan/same doctors would have more than doubled our cost. My doctor's office dropped the plan I was on, a large local insurer with narrow network, but kept the same insurers plan with the larger network.

So while I hugely appreciate coverage of pre-existing conditions, access to a large choice of plans and generous subsidies at our income level, it's a whole new ball game every year.

We are happy to have the ACA, but it's not perfect.

I'm glad that subsidies are based on taxable income and not assets. I have a little bit of control over that.

 

[scrabbler1]

For those of us with ACA premium tax credits (whether taken in the form of premium subsidy, or at tax time).... Do you budget for the full cost?

In 2014 and 2015, I paid the full cost and took the subsidy at tax time. The subsidy was pretty small, about $220 in 2014 and $450 in 2015. I was expecting to do the same for this year, but when I applied my new insurance company told me my monthly premium would be net of the subsidy, about $480 per ($40 per month). This means, for 2016, that I will have to declare both subsidies as either tax credits or offsets to medical expense deductions.

My annual federal tax bill is pretty low, so I don't make any estimated federal income tax payments (I do make an estimated state income tax payment, though). For 2014 and 2015, I used the tax subsidy as a backhanded income tax withholding, as it partially reduced my federal income tax bill. With my investment income projected to be lower this year than I anticipated, the overall projected subsidy (much higher than the $480) will end up being lower but still higher than the $480, so it will still offset some of my tax bill.

As for how I budget from month to month, I budget whatever premium amount I have to pay. For 2014 and 2015 it was the full cost but for this year it will be reduced by the advanced subsidy ($40 per month).

 

[Fermion]

ACA is not looking like it will change much at all for at least the next four years, so no, we don't budget for the full ACA cost.

 

[MRG]

ACA silver plan costs me $250, $1200 deductible, $1200 oop, first 4 doc visits, of any type, free. One trip to the ER and I'm at oop, sure didn't pay in $1200 either more like 250.

I was unable to buy insurance prior to ACA, five and a half years to Medicare. Maybe CO passes single payer.

 

[socca]

Male, Single, 53

2015 situation:
+ grandfathered non-ACA compliant plan
+ BCBS of FL
+ $174 / mo = $2,088 / yr
+ $12k deductible
+ out-of-network covered at 50%

BCBS of FL terminated this policy, so ...

2016 situation:
+ ACA-compliant Bronze plan
+ Aetna
+ $398 / mo = $4,776 / yr
(the lowest ACA-compliant premium I could find)
+ $6k deductible
+ out-of-network covered at 0%
+ no subsidy

In 2017, it appears that I will have two choices:
(1) sign up for an ACA-compliant plan that is unaffordable according to Obamacare's own definition for what constitutes 'affordable' (annual premium less than 8% of MAGI), or
(2) self-insure and (perhaps) pay the non-participation tax penalty.
I don't like either of these two options.

 

[ivinsfan]

Male, Single, 53

2015 situation:
+ grandfathered non-ACA compliant plan
+ BCBS of FL
+ $174 / mo = $2,088 / yr
+ $12k deductible
+ out-of-network covered at 50%

BCBS of FL terminated this policy, so ...

2016 situation:
+ ACA-compliant Bronze plan
+ Aetna
+ $398 / mo = $4,776 / yr
(the lowest ACA-compliant premium I could find)
+ $6k deductible
+ out-of-network covered at 0%
+ no subsidy

In 2017, it appears that I will have two choices:
(1) sign up for an ACA-compliant plan that is unaffordable according to Obamacare's own definition for what constitutes 'affordable' (annual premium less than 8% of MAGI), or
(2) self-insure and (perhaps) pay the non-participation tax penalty.
I don't like either of these two options.

Those of us in your position, including myself are suffering the most negative outcome of the ACA. ACA incomes limits actually encourage some people to stop working. Every mainstream media report about ACA says premium will rise this year, but the good news is so will the subsidies, forgetting about those of us who don't get one. MY DH is one medicare and I'n 63 so we'll just plod along for a couple of years. someone who is 53 has my complete sympathy,because in my book "self-insure" is not an option.I believe that being charged rack rate for medical procedures is the road to ruin.

 

[ShokWaveRider]

Male, Single, 53

2015 situation:
+ grandfathered non-ACA compliant plan
+ BCBS of FL
+ $174 / mo = $2,088 / yr
+ $12k deductible
+ out-of-network covered at 50%

BCBS of FL terminated this policy, so ...

2016 situation:
+ ACA-compliant Bronze plan
+ Aetna
+ $398 / mo = $4,776 / yr
(the lowest ACA-compliant premium I could find)
+ $6k deductible
+ out-of-network covered at 0%
+ no subsidy

In 2017, it appears that I will have two choices:
(1) sign up for an ACA-compliant plan that is unaffordable according to Obamacare's own definition for what constitutes 'affordable' (annual premium less than 8% of MAGI), or
(2) self-insure and (perhaps) pay the non-participation tax penalty.
I don't like either of these two options.

Another argument for single payer. With such a system EVERYONE will contribute. A Medicare for all would work too. At the moment, although it does not apply to all, those over 65 are "more" prone to use more services as they get older, so it really needs to cover younger people too. It just makes so much sense. Go Figure. Currently Medicare is like a "High risk" Pool for the demographic.

The other thing that just grinds my gears (Thanks Family Guy for the quote), is the amount of people that are against single payer for whatever reason. YET they ALL yearn to be eligible for Medicare.


Seems like all the common sense is going by the wayside in this country. We are actually seeing it being played out real time as I type.

 

[Sojourner]

Single guy here, mid-40s, living in Georgia, paying ~ $330/month for a non-ACA bronze high-deductible plan. Not eligible for ACA cost sharing or premium subsidies, unfortunately (or fortunately, depending on how you look at it). I set up an HSA this year, so that lowers my overall medical costs somewhat. And since I have some self-employment income, I'm able to take the health insurance premium deduction when filing my 1040, which reduces my AGI by nearly $4K. All in all, things could be worse.

 

[explanade]

2016 situation:
+ ACA-compliant Bronze plan
+ Aetna
+ $398 / mo = $4,776 / yr
(the lowest ACA-compliant premium I could find)
+ $6k deductible
+ out-of-network covered at 0%
+ no subsidy

In 2017, it appears that I will have two choices:
(1) sign up for an ACA-compliant plan that is unaffordable according to Obamacare's own definition for what constitutes 'affordable' (annual premium less than 8% of MAGI), or
(2) self-insure and (perhaps) pay the non-participation tax penalty.
I don't like either of these two options.

In a similar situation, my premiums are just over $450.

IIRC, I could have done a Kaiser plan where the premiums were about $100 more a month. But that included a number of doctor visits without meeting the deductible plus there's a new (about 5 years old) Kaiser facility about 3 miles from me.

The Anthem BC plan I have is a pain, because I have to search for network doctors and then they tell me to get the annual exam benefit, I have to make sure the provider uses the correct Diagnosis Codes for the blood tests so that I won't have to pay.

Plus their urgent care facility is like 7 miles away through traffic.

I don't see how I'd qualify for a subsidy. My dividends and cap gains distributions are well over the limit.

 

[kcowan]

Like the USA you can buy a rider from companies like Blue Cross (Canada) for drugs and better hospital services though right?

Yes, although usually drugs are subject to a copay.

Also, Kcowan: what do you do for healthcare at Latitude 20?

We have an agent (Mediquote) who shops around each year based on our age and current medical condition. We end up with 2 policies, one for the 30 day repeat trips and another for the extended stay. Last year, these were different companies because of rates. Claims experiences have been good too.

The main value they add is to ensure that we answer the questionnaire accurately. One of the problems is that snowbirds are putting up with overcharges from local Mexican hospitals. This is increasing the rates for everyone.

 

[burch64]

My wife and I are both on Medicare $2,517 per year, we have supplement plans for our Medicare through my pension fund $5,817 per year for drug and medical supplement. Out of pocket so far this year $1,979 for a total of $10,383, it will go a little higher with more co pays as the year goes.

We do not have dental or vision plans.

 

[ivinsfan]

My wife and I are both on Medicare $2,517 per year, we have supplement plans for our Medicare through my pension fund $5,817 per year for drug and medical supplement. Out of pocket so far this year $1,979 for a total of $10,383, it will go a little higher with more co pays as the year goes.

We do not have dental or vision plans.

So this is an interesting data point for the posters here with ACA subsidy money. When you hit 65 your expenses will go up instead of down.Those of us saying we can't wait to get on medicare are all complete private pay.

Though I have a question about your supplement. MY DH pays about 220 a month for a supplement that pays everything...no out of pocket expenses.How do you pay such a high premium and still have OOP of 2000+ per year.

 

[aja8888]

My wife and I are both on Medicare $2,517 per year, we have supplement plans for our Medicare through my pension fund $5,817 per year for drug and medical supplement. Out of pocket so far this year $1,979 for a total of $10,383, it will go a little higher with more co pays as the year goes.

We do not have dental or vision plans.

In comparison to burch64 above, here's a little more of the breakdown for us. Not much different than an ACA plan. This is NOT a Medicare Advantage enrollment situation.

We are at (on Medicare also):

Combined costs, DW and I:

Medicare premium per year = $2520

Supplemental Plan Premium per year (Me, Plan G, her, Plan F) = $3896

Part D drug plan premium (plus deductible) per year = $1200

Out of pocket costs, if any = Drug costs not covered by Part D = $4000 (est) - Mostly DW as she hits the Donut hole and has some expensive meds.

So our total is roughly = $8,616 per year for both DW and I combined.

We also do not have dental, hearing or vision plans.

 

[ShokWaveRider]

It seems like there is quite a difference all things being equal from one state to another. That does not seem fair really as the numbers are so high. All things being equal shouldn't we all pay the same premiums, OOP Expenses, Drugs etc.?


In Canada there are slight differences between Provinces, but they are quite small.

 

[explanade]

Medicare premiums are high but what about deductibles and OOP costs?

 

[RobbieB]

Medicare looks great! $8616 for 2 people eh?

I'm at $6468 for just me. 4 more years -

 

[aja8888]

Medicare looks great! $8616 for 2 people eh?

I'm at $6468 for just me. 4 more years -

A good chunk of the OOP is for drug costs for DW who has some serious needs (about $4K over normal Plan D costs). But if you are healthy and choose a Medigap Supplemental plan that pays the majority (or all of) the Medicare deductibles, you should be able to be well under $4K per person per year.

This is why Medicare has become the "Holy Grail" of medical insurance now!

 

[burch64]

So this is an interesting data point for the posters here with ACA subsidy money. When you hit 65 your expenses will go up instead of down.Those of us saying we can't wait to get on medicare are all complete private pay.

Though I have a question about your supplement. MY DH pays about 220 a month for a supplement that pays everything...no out of pocket expenses.How do you pay such a high premium and still have OOP of 2000+ per year.

Drug co-pay tiers $15 $50 $70 Also $500 deductible before supplement insurance pays what Medicare does not pay for DW. Lots of health issues and drug co-pays. Me, insurance make $$ from me so far 1 Doctor visit this year
Our drug insurance is $3,224 per year for the 2 of us.

Medical insurance supplement is $2,663 per year for 2 of us (our cost)

Health insurance through AARP United Health Care Drug Insurance through OptumRX

 

[socca]

Single guy here, mid-40s, living in Georgia, paying ~ $330/month for a non-ACA bronze high-deductible plan. Not eligible for ACA cost sharing or premium subsidies, unfortunately (or fortunately, depending on how you look at it). I set up an HSA this year, so that lowers my overall medical costs somewhat. And since I have some self-employment income, I'm able to take the health insurance premium deduction when filing my 1040, which reduces my AGI by nearly $4K. All in all, things could be worse.

"non-ACA bronze" is an oxymoron. Perhaps you mean that you purchased an off-exchange ACA-compliant plan. If your plan is not ACA-compliant, you may have to pay a non-participation tax (AKA the 'shared responsibility payment').

Back when I was looking around for 2016 health insurance, I noticed that the plans available from the major carriers off-exchange and on-exchange were identical, so I went ahead and used healthcare.gov to sign up for a 2016 plan. I figured that I (along with millions of others) paid for this somewhat buggy website, so I might as well use it. In retrospect, this might have been a mistake, since I subsequently got to enjoy occasional recorded nuisance calls from the gov't reminding me to do this or that.

A third option I have for 2017 is to try to convince a reputable carrier to offer me a non-ACA compliant catastrophic coverage policy, and also pay the ACA non-participation tax. However, if the sum of these two costs is greater than or equal to an ACA-compliant policy premium, then this option won't work.

 

[ivinsfan]

Drug co-pay tiers $15 $50 $70 Also $500 deductible before supplement insurance pays what Medicare does not pay for DW. Lots of health issues and drug co-pays. Me, insurance make $$ from me so far 1 Doctor visit this year
Our drug insurance is $3,224 per year for the 2 of us.

Medical insurance supplement is $2,663 per year for 2 of us (our cost)

Health insurance through AARP United Health Care Drug Insurance through OptumRX

Do you ever shop this around,is this the best price for you? You each can have a policy that works for you. You might want to slant the better coverage to your spouse and do less for yourself. Some drug are covered without extra insurance, my DH takes a couple of generic type drugs and his supplemental knocks the 90 day co-pay down to around 10 bucks.Also zero deductible on anything medical.

 

[ivinsfan]

"non-ACA bronze" is an oxymoron. Perhaps you mean that you purchased an off-exchange ACA-compliant plan. If your plan is not ACA-compliant, you may have to pay a non-participation tax (AKA the 'shared responsibility payment').

Back when I was looking around for 2016 health insurance, I noticed that the plans available from the major carriers off-exchange and on-exchange were identical, so I went ahead and used healthcare.gov to sign up for a 2016 plan. I figured that I (along with millions of others) paid for this somewhat buggy website, so I might as well use it. In retrospect, this might have been a mistake, since I subsequently got to enjoy occasional recorded nuisance calls from the gov't reminding me to do this or that.

A third option I have for 2017 is to try convince a reputable carrier to offer me a non-ACA compliant catastrophic coverage policy, and also pay the ACA non-participation tax. However, if the sum of these two costs is greater than or equal to an ACA-compliant policy premium, then this option won't work.

Don't you need to have a waiver to buy the cat policy?

 

[socca]

Don't you need to have a waiver to buy the cat policy?

My understanding is that if I'm willing to pay the ACA non-participation tax, the companies who sell catastrophic coverage policies will be happy to sign me up. However, I've never investigated this option, so I could be wrong.

 

[MBSC]

My understanding is that if I'm willing to pay the ACA non-participation tax, the companies who sell catastrophic coverage policies will be happy to sign me up. However, I've never investigated this option, so I could be wrong.

Catastrophic plans are ACA compliant so the penalty is not applicable. However, to be eligible for a Cat plan you must either be under age 30 or live in an area where the lowest cost Bronze plan is more than 8.13% MAGI.

As explained in posts #38 and #40, the Cat plan premium will not be significantly different from a Bronze plan premium in FL.