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Old 02-17-2018, 07:46 AM   #41
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Originally Posted by pb4uski View Post
Is this alleged $24k in premiums for 2 that you mention based on shopping or just a pre-conceived notion? I selected a couple random MI zip codes (in Detroit and Lansing) and an unsubsidized bronze plan for 2 was less than $1k/month. That my friend, is the price of freedom.... pure and simple.

Have you actually priced health insurance on healthsherpa.com or the ACA site? Or do you just like to rant?
My brother and his wife live in SC and when his previous employer stopped providing retirees coverage as of 1/1/2018 they shopped around and ended up with a policy costing $22K/year for both of them....The OP's numbers look ballpark to me.
The OP stated he is only 54 years old. A Bronze family plan for a couple of 54 year olds in South Carolina is $1225/mo or $14,700/yr before subsidy.
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Old 02-17-2018, 07:50 AM   #42
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Originally Posted by scrabbler1 View Post
This is one of two reasons I have health insurance. The other is to avoid having to pay the huge cost of one of my prescription drugs. I pay $527 per month (net of small ACA subsidy) for a Silver Plan but that plan gives me a $350 reduction per month in the price of the costly drug.
For sure, if we had significant prescription costs, we'd be in a silver plan. DW takes a couple prescription pills, but they're cheap generics.
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Old 02-17-2018, 08:10 AM   #43
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p.s. Passage of the ACA actually helps many to ER. It certainly did in my case. It would have been too risky for me to ER under the pre-2014 rules.
Same here, I would not have considered ER before I took it at the end of 2014 (even though I have unsubsidized, $1k+/mo. MegaCorp retiree HC as an option). With the ACA I get a huge subsidy for a low OOP Silver plan by managing income below 200% of FPL. Pre-subsidy it's something like $1500/mo. for two, after it's less than $100.

Obviously this isn't an option for some here so I agree for them, unsubsidized ACA is basically a big shaft now. But at least you are guaranteed coverage which wasn't the case before 2014.

Biggest ACA uncertainty now is lack of insurers and restricted networks IMO, cost is secondary if you can get subsidies.
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Old 02-17-2018, 08:30 AM   #44
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With the new laws pushed out this year, isn’t the Unsubsidized price going to increase?
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Old 02-17-2018, 08:37 AM   #45
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I'm not sure what your quarrel is with these rules. The VA rules and subsidy issue is the same as the Medicare rule..One spouse on Medicare the younger spouse gets a little less money for her subsidy. That's not a Catch-22 that's common sense.

Now true emergency care WILL be covered by the VA..I've never seen anything to the contrary.. Depending on the situation you might be moved ASAP to a VA hospital. Of course the burden is on the Vet to be sure it's an emergency situation. In exchange for this you get virtually free health care and heavily subsided drugs. And before anyone comments on the last sentence I mean free cost wise. All vets earned their coverage by serving their country.

You already got your cost subsidy baked into the VA coverage, why would you be offered a double dip in the subsidy pool.

If a vet is uncomfortable with the VA rules or location of their providers they have complete freedom to buy a full price policy and go for a subsidy, if they drop completely out of the VA system. It seems you think a belt and suspenders health care coverage should get you a double subsidy.
I've attached a couple of pdfs of the VA's policy on coverage provided from non-VA facilities (the VA mailed the fact sheet to me when the ACA was first implemented). VA does cover service connected issues (injuries/illness that occurred during service) in non-VA facilities, but will not specifically state they will cover non-service connected issues in a non-service facility in an emergency (heart attack, or stroke where the ambulance takes you to the nearest hospital). I called the VA for clarification at the time, and was not successful with getting anything verbal or in writing regarding this issue (was actually told that if it were me, I'd buy the insurance). It's pretty much a judgement call by the VA after the fact - when you've incurred the emergency expense. There are forms one must fill out and submit to the VA for them to evaluate if they will pay your incurred emergency bills. If you have something that addresses this issue in writing - please let me know. I've brought this up here before and a person connected with the VA was looking into this, but never obtained further clarification.

Apologize if you see this as a rant or quarrel with the VA, but I stated I stayed with them (as I am fortunate to be able to afford to pay for an ACA policy w/o subsidy in early retirement). I was just clarifying this from my earlier post for those readers who are veterans covered by the VA that might not be aware of this area of questionable coverage and might not have considered buying additional coverage from the ACA exchange.
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Old 02-17-2018, 08:45 AM   #46
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My actual numbers are similar to what the OP is seeing. I chose a silver PPO plan with cost sharing the 2 previous years. After the current administration's decision regarding cost sharing, a silver plan is now priced higher than a gold plan for this year in my area. I decided to go with a bronze PPO plan this year. It has an annual deductible of $6,550. The monthly premium is $1,386 or $16,632/year. That is for an individual policy. If I keep my MAGI just below 400% of the FPL, I'll get a $661/month subsidy. That still leaves me with an annual premium cost of $8,700 with a $6,650 deductible before the policy begins to pay for anything beyond mandated preventive care.

I'm grateful that the ACA exists, but health insurance and healthcare are completely FUBAR in the USA. I'll hit Medicare age next year. It can't come soon enough.
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Old 02-17-2018, 08:47 AM   #47
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Same here, I would not have considered ER before I took it at the end of 2014 (even though I have unsubsidized, $1k+/mo. MegaCorp retiree HC as an option). With the ACA I get a huge subsidy for a low OOP Silver plan by managing income below 200% of FPL. Pre-subsidy it's something like $1500/mo. for two, after it's less than $100.

Obviously this isn't an option for some here so I agree for them, unsubsidized ACA is basically a big shaft now.
Yep, the subsidy framework could be a lot better for people with upper-middle incomes. Unfortunately for them, the likelihood of improvements to that area seem remote for the foreseeable future.

The system is still deeply flawed, no doubt about it. But it's been a huge boon for early retirees. Moreover, if a 64-YO couple can get high-deductible health insurance without an out-of-pocket cost, I have to assume it's also within reach for a healthy 20-something.

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With the new laws pushed out this year, isn’t the Unsubsidized price going to increase?
Could happen. Our unsubsidized premium rose 50% for 2018, but our available subsidy jumped 100%. We actually left $200/mo in subsidy money on the table. We briefly thought of upgrading to a gold plan, but ultimately decided that the basic bronze was the best fit for us.
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Old 02-17-2018, 08:56 AM   #48
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I understand may people are hyper sensitive about health expenses (because REASONS!), but it seems to me if you are planning ER it's really just another expense that you should check into before pulling the plug.

When I FIREd (2011) we had visited a health insurance broker to get a quote on coverage. Didn't seem like a particular ordeal - we'd done this before when I did various stretches of consulting (self employment) in the past.

When you are preparing for ER, you should understand your expenses and be able to cover them. All of them.
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Old 02-17-2018, 09:00 AM   #49
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I've attached a couple of pdfs of the VA's policy on coverage provided from non-VA facilities (the VA mailed the fact sheet to me when the ACA was first implemented). VA does cover service connected issues (injuries/illness that occurred during service) in non-VA facilities, but will not specifically state they will cover non-service connected issues in a non-service facility in an emergency (heart attack, or stroke where the ambulance takes you to the nearest hospital). I called the VA for clarification at the time, and was not successful with getting anything verbal or in writing regarding this issue (was actually told that if it were me, I'd buy the insurance). It's pretty much a judgement call by the VA after the fact - when you've incurred the emergency expense. There are forms one must fill out and submit to the VA for them to evaluate if they will pay your incurred emergency bills. If you have something that addresses this issue in writing - please let me know. I've brought this up here before and a person connected with the VA was looking into this, but never obtained further clarification.

Apologize if you see this as a rant or quarrel with the VA, but I stated I stayed with them (as I am fortunate to be able to afford to pay for an ACA policy w/o subsidy in early retirement). I was just clarifying this from my earlier post for those readers who are veterans covered by the VA that might not be aware of this area of questionable coverage and might not have considered buying additional coverage from the ACA exchange.
No apology necessary, government language is hard to navigate ..and unfortunately VA employees aren't always clear either. VA is not shy about paying outside charges when warranted. MY DH went to a VA walk in clinic with what turned out to be some cardiac issues. Within 30 minutes he was on his way by ambulance to a non VA cardiac hospital. I had a signed yellow sheet in my hand saying VA would be responsible for 100% of the bill. There was a highly regarded VA hospital an hour and a half away where he could have been treated or moved to after they were satisfied he wasn't in any immediate danger (which he wasn't) but they let him complete all the necessary follow up testing and 4 days in the hospital on the VA's dime in the local hospital.

He ended up needing valve repair surgery and we were so impressed with the care at the hospital the VA sent us to, that we elected to use our standard insurance and just pay the deductible out of pocket for the surgery. But the VA was exemplary in this situation.

I think there is so much abuse of the emergency/non-emergency issue that , the VA deliberately keep it a grey area. In a real emergency you or your family contact the VA ASAP explain what happened and ask how the VA wants to handle it. You can't call 2 weeks later and ask them to pay the bill.
In your situation if you don't have full faith in the VA, paying rack rate for regular insurance seems like a high price. Why wouldn't you just opt out of the system.

This is a little OT here, but that's our VA experience.
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Old 02-17-2018, 09:03 AM   #50
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I understand may people are hyper sensitive about health expenses (because REASONS!), but it seems to me if you are planning ER it's really just another expense that you should check into before pulling the plug.

When I FIREd (2011) we had visited a health insurance broker to get a quote on coverage. Didn't seem like a particular ordeal - we'd done this before when I did various stretches of consulting (self employment) in the past.

When you are preparing for ER, you should understand your expenses and be able to cover them. All of them.
The ordeal isn't getting the quote, it's paying for it..I wonder how much that policy would have gone up in 7 years, both in price and out of pocket number..I'm guessing there is no budget projection that would have covered that number.
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Old 02-17-2018, 10:15 AM   #51
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Is this alleged $24k in premiums for 2 that you mention based on shopping or just a pre-conceived notion? I selected a couple random MI zip codes (in Detroit and Lansing) and an unsubsidized bronze plan for 2 was less than $1k/month. That my friend, is the price of freedom.... pure and simple.

Have you actually priced health insurance on healthsherpa.com or the ACA site? Or do you just like to rant?
Yes, I did price on the ACA website.
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Old 02-17-2018, 10:22 AM   #52
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My approach was to take a part time job that provides good, inexpensive health insurance. (Airline reservations)

Would love to be totally retired, but this is a good compromise for me & I think of it as "my nice little retirement job."

I'm not mobile at this point (elderly Mom who is fairly independent, but don't want to leave her) & in my area (Houston) there are no PPOs on the individual market, at any price. (Last I checked, anyway.)

While I could afford one of the ACA HMO plans, & it would probably be fine for me at this point - no health issues, no Rx - I would not have peace of mind due to the possibility of major health problems arising before Medicare eligibility at age 65 - I want to be able to access a strong network of providers + the limited outside of network coverage if needed.
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Old 02-17-2018, 10:29 AM   #53
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No apology necessary, government language is hard to navigate ..and unfortunately VA employees aren't always clear either. VA is not shy about paying outside charges when warranted. MY DH went to a VA walk in clinic with what turned out to be some cardiac issues. Within 30 minutes he was on his way by ambulance to a non VA cardiac hospital. I had a signed yellow sheet in my hand saying VA would be responsible for 100% of the bill. There was a highly regarded VA hospital an hour and a half away where he could have been treated or moved to after they were satisfied he wasn't in any immediate danger (which he wasn't) but they let him complete all the necessary follow up testing and 4 days in the hospital on the VA's dime in the local hospital.

He ended up needing valve repair surgery and we were so impressed with the care at the hospital the VA sent us to, that we elected to use our standard insurance and just pay the deductible out of pocket for the surgery. But the VA was exemplary in this situation.

I think there is so much abuse of the emergency/non-emergency issue that , the VA deliberately keep it a grey area. In a real emergency you or your family contact the VA ASAP explain what happened and ask how the VA wants to handle it. You can't call 2 weeks later and ask them to pay the bill.
In your situation if you don't have full faith in the VA, paying rack rate for regular insurance seems like a high price. Why wouldn't you just opt out of the system.

This is a little OT here, but that's our VA experience.
Your story is unique with the VA, and the VA isn't any different than any other healthcare system. You state you had gone to the VA Outpatient Care facility in your area. Not sure that you had an appointment, but they usually won't see anyone w/o one. The VA hospital is different and won't turn any veteran away. VA will tell you to go to the VA hospital over a clinic whenever you feel something is critical. Walk in to a clinic with obvious acute chest pain and they'll tell you to get in an ambulance and go to the nearest hospital (I've witnessed this scenario while at my CBOC).

Getting pre-approval paperwork from them (as you did) eliminates the unclear from their documents judgement/approvals after you've incurred some serious hospital emergency bills. A lot of the documents from the Va (and there are many) address everyone connected with the VA. This is veterans of all types of service, from 2 years and out - to career retired and on Tricare. Add to this those who left relatively unscarred to those mentally/physically scarred for life, and you can see why it's so complicated.

I've been with the VA for quite awhile now, and appreciate everything they've done for me over the years at little to no cost out of pocket. When evaluating the ACA and this scenario, I elected to stay with the VA and pay for ACA coverage (with no available subsidy) as a just in case. I figured that it would start paying back to me (financially) on Medicare, staying with the VA and traditional Medicare coverage - and it has...

If one chooses to leave the VA for ACA coverage, there's no guarantee you'll be accepted back when you go on Medicare or just decide to return (they do state that you'll have to reapply and be accepted). If you stay with the VA, you have to really look at this area of concern with their non-service related coverage at non-VA facilities under the age of Medicare coverage. This was the reason I stated it's my catch 22 scenario - staying with VA leaves one vulnerable to emergency coverage judgement, and ACA coverage to insure against this area of concern doesn't allow any subsidy. Getting a subsidy requires a veteran to leave the VA.

FYI - since you are more than 40 miles from your nearest VA hospital, the local CBOC probably has a SOP in place to provide pre-approval paperwork
for the local hospital. The 2014 Veterans Choice Policy allows them to do this along with if you have to wait more than 30 days to see a doctor.
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Old 02-17-2018, 10:50 AM   #54
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Your story is unique with the VA, and the VA isn't any different than any other healthcare system. You state you had gone to the VA Outpatient Care facility in your area. Not sure that you had an appointment, but they usually won't see anyone w/o one. The VA hospital is different and won't turn any veteran away. VA will tell you to go to the VA hospital over a clinic whenever you feel something is critical. Walk in to a clinic with obvious acute chest pain and they'll tell you to get in an ambulance and go to the nearest hospital (I've witnessed this scenario while at my CBOC).

Getting pre-approval paperwork from them (as you did) eliminates the unclear from their documents judgement/approvals after you've incurred some serious hospital emergency bills. A lot of the documents from the Va (and there are many) address everyone connected with the VA. This is veterans of all types of service, from 2 years and out - to career retired and on Tricare. Add to this those who left relatively unscarred to those mentally/physically scarred for life, and you can see why it's so complicated.

I've been with the VA for quite awhile now, and appreciate everything they've done for me over the years at little to no cost out of pocket. When evaluating the ACA and this scenario, I elected to stay with the VA and pay for ACA coverage (with no available subsidy) as a just in case. I figured that it would start paying back to me (financially) on Medicare, staying with the VA and traditional Medicare coverage - and it has...

If one chooses to leave the VA for ACA coverage, there's no guarantee you'll be accepted back when you go on Medicare or just decide to return (they do state that you'll have to reapply and be accepted). If you stay with the VA, you have to really look at this area of concern with their non-service related coverage at non-VA facilities under the age of Medicare coverage. This was the reason I stated it's my catch 22 scenario - staying with VA leaves one vulnerable to emergency coverage judgement, and ACA coverage to insure against this area of concern doesn't allow any subsidy. Getting a subsidy requires a veteran to leave the VA.

FYI - since you are more than 40 miles from your nearest VA hospital, the local CBOC probably has a SOP in place to provide pre-approval paperwork
for the local hospital. The 2014 Veterans Choice Policy allows them to do this along with if you have to wait more than 30 days to see a doctor.
Yes those rules on ACA and VA co-existing insurance are pretty clear and I think fair enough. We all have to make health choices. .it's the catch 22 comparison that causes confusion..in that asking to get double subsidies from the same source isn't realistic. You have already gotten your subsidy by using the VA. A lot of people would be happy having one of those choices open to them.

For any vets out there wondering, my DH did not have an appointment at the urgent care, that's why its urgent care. And the signed paperwork covering the bill was presented to us by the attending doctor before we even had time to ask about coverage.

Don't want to wander too far off topic but the subject of VA healthcare came up early in this thread.
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Old 02-17-2018, 10:52 AM   #55
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Hey, gang.

W*rk has gotten to the point that it's taking years off my life, so it's high past time to RE - at the ripe old age of 54.

I'd RE TOMORROW if I could figure out how to pay for the HC without taking a huge chunk out of my retirement savings.

Curious what approaches the rest of you who have already RE'd (or are thinking of RE) are taking..here's my list..

- Manage income to < 4X FPL; get subsidies (still sucks - HUGE cost even after subsidies for anything that's not a HMO with ridiculous deductibles).

- Health Sharing - scares the bajeebus out of us. BIL is using this for his < 65 DW and I just can't see doing something with no contractual guarantee of reimbursement. Oh, he's saving a bundle monthly over the ACA exchange plans, but what if a major illness hits - are they ever truly going to get reimbursed?

- Something outside of the ACA exchange (is there such a thing any longer? I keep reading about healthcare brokers..does anyone have any good info on that option?)

Really frustrated by the insane costs..it's literally $24K premiums for the 2 of us before subsidies..with $3,500 - $6K pp deductibles. WHO CAN AFFORD THAT?

So, in the meantime..I continue to slog away at a j*b that I absolutely hate and which is probably killing me.

Appreciate any and all suggestions/help.

TIA..
We are in our 50's and we pay $878 per month for a Bronze EPO with OSCAR Health. We get no subsidies so we buy directly from the insurance company. There are lower costs options such as Kaiser HMO but we want access to better doctors and facilities. We only use our coverage for preventive care which is included in the premiums. Neither of us are on any regular prescription medication. My recommendation would be to stay in shape and exercise regularly and go for your annual physicals. If you don't have any chronic health issues, buy a bronze plan. If you are out of shape, buy a bike and go cycling regularly. It's cheaper that the alternative.
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Old 02-17-2018, 10:58 AM   #56
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Hey, gang.

W*rk has gotten to the point that it's taking years off my life, so it's high past time to RE - at the ripe old age of 54.

I'd RE TOMORROW if I could figure out how to pay for the HC without taking a huge chunk out of my retirement savings.

Curious what approaches the rest of you who have already RE'd (or are thinking of RE) are taking..here's my list..

- Manage income to < 4X FPL; get subsidies (still sucks - HUGE cost even after subsidies for anything that's not a HMO with ridiculous deductibles).

- Health Sharing - scares the bajeebus out of us. BIL is using this for his < 65 DW and I just can't see doing something with no contractual guarantee of reimbursement. Oh, he's saving a bundle monthly over the ACA exchange plans, but what if a major illness hits - are they ever truly going to get reimbursed?

- Something outside of the ACA exchange (is there such a thing any longer? I keep reading about healthcare brokers..does anyone have any good info on that option?)

Really frustrated by the insane costs..it's literally $24K premiums for the 2 of us before subsidies..with $3,500 - $6K pp deductibles. WHO CAN AFFORD THAT?

So, in the meantime..I continue to slog away at a j*b that I absolutely hate and which is probably killing me.

Appreciate any and all suggestions/help.

TIA..
Your reality, IMO, is a harsh one. Not only is healthcare expensive, but the longer period of time for which you have to guess how expensive it will be, the bigger risk you take.
When we try to calculate our retirement finances, we make some educated guesses about expenses, inflation, market returns (and risk therein) etc etc but nowhere are our guesses more filled with wild uncertainty than in figuring our healthcare costs.

We seem to be at the mercy of the industry (especially Big Pharm and the Big Insurance), and I don't think I'm taking this thread into the political danger zone by suggesting that whatever happens to ACA, or how such a plan is implemented, it is very likely to be a political football for at least the next 2 or 3 Presidential Terms, and even Medicare won't be immune to being punted back and forth down the field a few times in your lifetime.

If you are scared, you should be.

If I may make a suggestion: if you are even close to thinking you could retire at age 52, from a job that is taking years off of your life, how about some intermediate move? How about a job that you can live with, that at least pays enough for your healthcare costs? Let the nut grow (hopefully) or at least not get smaller as you work your way through your 50s.

Don't despair.
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Old 02-17-2018, 11:25 AM   #57
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I retired this past June, and was able to get a Silver Plan for $468 per month for the wife and I with no deductible and 1500 Out of Pocket.

I could have gotten plans for $200 per month, but not many doctors or specialists would take these plans.

It did go up $100 for 2018
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Old 02-17-2018, 11:52 AM   #58
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My wife and I pay $262/month for a subsidized Silver Plan on the exchange.

Here in Massachusetts we have had RomneyCare/ObamaCare for a long time. I have to say it has worked out extremely well so far. We have a better plan now, with lower deductibles and cheaper than when I paid for the employee portion when I was working.

With what has been done to the ACA over the past year of so that may change down the road. But so far we are very happy with our choices, and expect that will take us to Medicare down the road.

I feel bad for those who don't have options as good as we do. Sadly, I don't see US healthcare changing for the better in the near future, the way things are going. Fortunately, we have planned for far worse cases than we have now and can deal with it financially.

As long as existing conditions continue to be covered, we'll be fine. The cost of my current cancer treatment is over $21k per infusion - that's not something I'd like to pay out of pocket.
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Old 02-17-2018, 12:21 PM   #59
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Yes those rules on ACA and VA co-existing insurance are pretty clear and I think fair enough. We all have to make health choices. .it's the catch 22 comparison that causes confusion..in that asking to get double subsidies from the same source isn't realistic. You have already gotten your subsidy by using the VA. A lot of people would be happy having one of those choices open to them.

For any vets out there wondering, my DH did not have an appointment at the urgent care, that's why its urgent care. And the signed paperwork covering the bill was presented to us by the attending doctor before we even had time to ask about coverage.

Don't want to wander too far off topic but the subject of VA healthcare came up early in this thread.
The reference to my catch-22 was not specifically referring to any subsidy lost with being with the VA (although paying ACA policy full boat was not pretty). It was that being with the VA left me with one of two choices to cover a very unclear potential VA coverage gap as stated in previous posts - and that neither choice was ideal (leave the VA for subsidized ACA with wife, or buy non-subsidized ACA policy and stay).

CBOC (clinic) is not emergency care. I went to one I'm not signed up with while snowbirding in Florida a few years back, and they told me I should bring a book (expect a long day), as I was not in their VA system and an appointment would be further out than my remaining stay. VA hospital (where I would be accepted) was 4 hours away). Other choice was to go to local emergency care clinic w/o coverage - ACA policy didn't pay anything until max out of pocket/deductible $6000.00 was met). Not sure what type of VA facility you have in your area - it may give more care than a normal CBOC since you're so far from your VA hospital.
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Old 02-17-2018, 12:33 PM   #60
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The ordeal isn't getting the quote, it's paying for it..I wonder how much that policy would have gone up in 7 years, both in price and out of pocket number..I'm guessing there is no budget projection that would have covered that number.
I sometimes wonder how expensive my original individual HI policy would be had the ACA's exchanges not come into existence in 2014.

When I first ERed in late 2008, I had found a reasonable HI policy for $469 a month starting in 2009. But when I faced a 20% increase in 2010 and a nearly 25% increase in 2011, I was now paying nearly $700 per month and wondering how expensive HI would be if these big increases continued year after year. In 2 more years I'd be paying $1,000 a month, and 2 years after that I'd be up at $1,500 a month. My whole ER would be in some jeopardy and I was becoming concerned about my budget getting busted if I couldn't get this under control.

But the ACA got passed in 2010 with the exchanges starting in 2014. So, all I had to do was hang in there for the rest of 2011 and all of 2012 and 2013. I was healthy at the time (although my later ailments were being awakened), so I made the decision to be underinsured for 2 1/2 years, until the end of 2013. I chose a cheap, hospital-only plan for under $200 a month. This was effectively a catastrophic plan, as I'd be covered for an expensive hospital stay and little else.

I don't qualify for a big premium subsidy, maybe a few hundred dollars per year, because my MAGI is near the upper limit. (In fact, I an over the ACA premium subsidy cliff for 2017, but I am still getting it for 2018.)

I live in New York, which does not allow age rating, or else I'd be paying a lot more. But the COL is high in NY (I pay $4,000 in SALT) so what I don't pay to the insurance companies I pay to the SALT collectors.
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Retired in late 2008 at age 45. Cashed in company stock, bought a lot of shares in a big bond fund and am living nicely off its dividends. IRA, SS, and a pension await me at age 60 and later. No kids, no debts.

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