Healthcare insurance and retirement - again!

[exnavynuke]

the 3 to 1 rules makes it affordable for you but not for the 25 year old married couple with two kids - they get hammered by it

Maybe I wasn't clear, I was saying that getting rid of the 3 to 1 rule is the key to making it affordable for most people. Hence why I said doing so would likely price-out people with higher risks (like pre-existing conditions). It's a trade off overall. Either low-risk people are forced to pay higher premiums than their risk level would justify without regulations or people with higher risk levels are likely to be priced out of any plan. I'm sure there could be some middle ground, but I don't know what that would be.

 

[bingybear]

I think you can keep the pre-existing coverage thing, IF you already have healthcare. So you do not need to buy insurance, but if you do not have insurance, then the pre-existing exclusion applies.

Switch plans, switch companies, there will be no pre-existing exclusion. Take the gamble, and you really take the gamble...

Before ACA I checked with my insurer (from a work plan) what an individual plan would cost since I had just had a pacemaker installed. Yes, they would insure me. However, the plans were very expensive. But that, it was more expensive than what I can get on exchange plans for both of us now and higher deductible. The noted I would have been denied if I did not already have a plan with them.

From my experience before ACA:
don't think that you can't be denied coverage by a given company.
don't think that you can't get priced out of insurance for a pre-existing condition.

unless there is something in place to make this happen.
I'm curious how this will unfold. Change can be unnerving especially while little to no information is available. This is really a wait and see stance. I have no idea where health insurance is heading right now. I don't know of any information that is trustworthy to base any projections as to where it is headed.

 

[Big_Hitter]

Maybe I wasn't clear, I was saying that getting rid of the 3 to 1 rule is the key to making it affordable for most people. Hence why I said doing so would likely price-out people with higher risks (like pre-existing conditions). It's a trade off overall. Either low-risk people are forced to pay higher premiums than their risk level would justify without regulations or people with higher risk levels are likely to be priced out of any plan. I'm sure there could be some middle ground, but I don't know what that would be.

I"m not sure they would bring back medical underwriting, possible but I'm not sure that would fly at this point

If they nerf the 3 to 1 rule the aging curve will just get really steep for premiums

One of the reasons that premiums have skyrocketed is that we are seeing adverse selection, big time. the healthy people just pay the penalty and self-insure; those that need teh coverage buy it and use it. if the individual mandate is repealed, which I think is highly likely, premiums will go even higher

 

[GTFan]

What I've usually seen off exchange are the same or very similar policies to on exchange. These are usually ACA compliant. I'm not sure why they would stay viable if the ACA was repealed and the others would not.

They have to be ACA compliant, by law which will likely be repealed. Then we'll see what remains.

 

[GTFan]

Individual mandate (penalty) will get repealed
pre-existing conditions and kids to age 26 will remain

You can't have one without the other, the market does not work otherwise.

 

[Big_Hitter]

You can't have one without the other, the market does not work otherwise.

we will see what happens - i'm sure someone is literally drafting legislation as we type

 

[growing_older]

After a recent hospitalization, I am more or less uninsurable. I was concerned about all the talk of repealing ACA and it's protections, so I didn't retire. I've been continuing to work to keep my medical insurance, and it looks like I may continue to need to do that until these issues play out.

 

[bamsphd]

What I've usually seen off exchange are the same or very similar policies to on exchange. These are usually ACA compliant. I'm not sure why they would stay viable if the ACA was repealed and the others would not.

By definition, if the healthcare.gov exchange goes away exchange policies go away. So there is no possibility people with exchange policies can be grandfathered on their existing policy.

In my state, Anthem is offering almost the exact same policies on and off the exchange. The off-exchange versions cost in my case about $3000/year more, have slightly higher deductibles, theoretically a slightly larger network, and of course none of the off-exchange subscribers get a subsidy. If the ACA goes away, I think Anthem would rather hang on to those off-exchange customers, possibly "tweaking" the policy to be less ACA compliant and/or more expensive but encouraging people to renew.

I don't know for certain, but I suspect the off-exchange subscribers as a group are both healthier and wealthier than at least the subsidized subscribers with on-exchange plans. The reality in the US is that wealth to some extent can buy health, and health allows earning greater wealth. So off-exchange subscribers are more desirable health insurance customers.

Of course, all of this depends heavily on what if any "you can keep your policy" rules replace the PPACA.

 

[Corporateburnout]

I'm glad I live in MA as it is the only state that will have affordable healthcare with coverage for pre existing conditions.

When the ACA is repealed the state will revert back to RomneyCare the health care reform act passed into law in 2006. This law is similar to the ACA with some differences such as subsidies end at 300% of poverty level vs 400% for the ACA. That is not an important factor for us as we don't qualify for subsidies but would have a difficult time getting insured with both of us having existing conditions. We planned our early retirement based on that law before the ACA was introduced.

 

[daylatedollarshort]

I'm glad I live in MA as it is the only state that will have affordable healthcare with coverage for pre existing conditions.

When the ACA is repealed the state will revert back to RomneyCare the health care reform act passed into law in 2006. This law is similar to the ACA with some differences such as subsidies end at 300% of poverty level vs 400% for the ACA. That is not an important factor for us as we don't qualify for subsidies but would have a difficult time getting insured with both of us having existing conditions. We planned our early retirement based on that law before the ACA was introduced.

I would prefer moving to MA or some place in the U.S. for 6 months and a day for residency as a plan B if the pre-existing condition clause makes a come back, but I am not as sure that reverting back to Romneycare will be possible. I also hope California would implement some version of Romneycare if the ACA is repealed. But since there is talk about having insurance companies sell across state lines, state laws may get superseded by new federal laws.

 

[Senator]

I"m not sure they would bring back medical underwriting, possible but I'm not sure that would fly at this point

If they nerf the 3 to 1 rule the aging curve will just get really steep for premiums

One of the reasons that premiums have skyrocketed is that we are seeing adverse selection, big time. the healthy people just pay the penalty and self-insure; those that need teh coverage buy it and use it. if the individual mandate is repealed, which I think is highly likely, premiums will go even higher

I suspect that another change may be exempting doctors from malpractice claims if they participate in the national health insurance plan (New ACA).

Any doctor that does not participate, has to pay the large premiums. Any doctor that does, is exempt when working with a national plan patient.

That would save a bunch.

 

[Sarah S]

Do you know this for sure corporate? I live in MA too and am 100 percent uninsurable and terrified to lose guaranteed access. I am hoping we just go back but have not found any confirmation

 

[Sue J]

Loss of Obamacare is one of my major concerns. Our fallback plan is that we can re-enroll in DHs retiree plan next year during open enrollment. The problem with that is that the cost would be 40% of his pension, which would leave us with not very much to live on. Oy Vay!

Trying to find a bright spot.....if our cost of insurance was not based on ACA MAGI, maybe I would start taking my SS before 65 and Medicare. My SS is only $559 at age 62 (Feb 2017) but I really didn't want to have to take it early just to pay for health insurance.

Is it safe to assume that we will have ObamaCare through the end of 2017? They can't just pull the plug on January 21st and dump all these insured folks off of their insurance. Or, would you start getting a bill for the full premium because there is no subsidy anymore?

Can that happen.......?

 

[Pilot2013]

I'm confused... Did no one ER before ACA? Just asking...

 

[exnavynuke]

Here is the summary of the last bill that was passed to repeal parts of the ACA:

The Republicans’ bill, Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015, doesn’t actually repeal Obamacare in its entirety. Instead it goes after some of the key features of Obamacare that are necessary to make the whole system work. It would have:
Restricted the federal government from operating health care exchanges
Phased out funding for subsidies to help lower and middle-income individuals afford insurance through the health care exchanges
Eliminated tax penalties for individuals who do not purchase health insurance and employers with 50 or more employees who do not provide insurance plans
Eliminated taxes on medical devices and the so-called “Cadillac tax” on the most expensive health care plans
Phased out an expansion of Medicaid over a two-year period

I would expect that facing effectively no opposition, this would only be the starting point of the new legislation to repeal/replace the ACA.

 

[exnavynuke]

I suspect that another change may be exempting doctors from malpractice claims if they participate in the national health insurance plan (New ACA).

Any doctor that does not participate, has to pay the large premiums. Any doctor that does, is exempt when working with a national plan patient.

That would save a bunch.

Blanket legislative exemption from tort claims? I don't see that surviving.

 

[Big_Hitter]

I'm confused... Did no one ER before ACA? Just asking...

they did, but getting health insurance was much more problematic

 

[daylatedollarshort]

I'm confused... Did no one ER before ACA? Just asking...

We had a COBRA conversion policy with no pre-existing condition clause, but we gave that up for an ACA plan. So I am not sure where that leaves us now.

 

[euro]

Blanket legislative exemption from tort claims? I don't see that surviving.

I don;t either - nor do I think that would be a smart idea. The middle ground is probably placing caps on tort claims.

 

[euro]

I'm confused... Did no one ER before ACA? Just asking...

Yes, they did, but often folks relied on retiree health benefits (those working for larger companies anyway) from their megas. Over the years, even the megas have been steadily eroding (or cutting) those retiree benefits because they are of course escalating along with the rest of the health care costs, and they are a relatively painless (for the company) to cut.
There is no doubt that the (apparently only perceived) security/certainty provided by Obamacare is/was a significant factor in many ER decisions. Certainly was in MINE even though I have relatively secure (for now) retiree benefits from my megacorp.

 

[scrabbler1]

I am scared if the ACA disappears or if part(s) of it become repealed (i.e. individual mandate) which make the law unworkable or too expensive. As others have written here, you need the individual mandate in return for removing the pre-existing conditions exclusion to keep the coverage affordable. If you want to cover everyone, you need to have everyone paying into the system in some way. Otherwise, you get all of those nasty side effects such as adverse selection and free riders gaming the system.


I worked in the actuarial field for 23 years, specializing in personal auto insurance, and I saw the impact of having a mandatory auto insurance law in all (or nearly all) states. There, you needed all of those safe drivers paying premiums into the system to cover the claims made by the less safe drivers. Those safe drivers are also paying for the possibility of becoming a claimant or on the wrong end of a claim.


The ACA subsidies don't have a big impact on my budget because I am near the top end of the income limit needed to qualify for them. But even without the subsidies, I am paying about half of what I'd be paying had the ACA not exist. I base that on what I was paying in 2009, my first year of ER, through 2011, when I dumped that individual HI policy after its premiums had risen 50% in 2 years. Even assuming modest 10% increases in 2012-2015, I'd be paying at least $900 per month for that policy here in New York, hardly a friendly state for buying HI.


And add to that my being diagnosed with diabetes last year. Thankfully, my medical expenses this year (after insurance) have not been very high, just some doctor visits, labs, and drugs. I have had continuous HI coverage the whole time but would an IC charge me more or try to exclude coverage for anything diabetes-related?

 

[nico08]

what i think will happen:

Cadillac tax will get repealed
Individual mandate (penalty) will get repealed
pre-existing conditions and kids to age 26 will remain
3 to 1 rule may get repealed
individual plans will move to a DC-type approach with HSAs and high-deductible options with a refundable tax credit
minimum essential coverages will be scaled back


ymmv

Hi. Can you explain what a DC-type approach means?

 

[winyaz]

Here is the summary of the last bill that was passed to repeal parts of the ACA:

Originally Posted by https://www.govtrack.us/congress/votes/114-2016/h6
The Republicans’ bill, Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015, doesn’t actually repeal Obamacare in its entirety. Instead it goes after some of the key features of Obamacare that are necessary to make the whole system work. It would have:
Restricted the federal government from operating health care exchanges
Phased out funding for subsidies to help lower and middle-income individuals afford insurance through the health care exchanges
Eliminated tax penalties for individuals who do not purchase health insurance and employers with 50 or more employees who do not provide insurance plans
Eliminated taxes on medical devices and the so-called “Cadillac tax” on the most expensive health care plans
Phased out an expansion of Medicaid over a two-year period

I would expect that facing effectively no opposition, this would only be the starting point of the new legislation to repeal/replace the ACA.

This is helpful. So if they take the same approach, then the requirement to cover those with pre-existing conditions remains, along with children up to age 26. But can they charge people with pre-existing conditions whatever they want? If so that's like not having the requirement to cover these people at all.

I hate not knowing whether I can buy healthcare to retire early or not, and that I may be dependent on working just for healthcare, or moving to someplace that will offer it. I don't want to move but I think retiring is more important than where I live.

 

[audreyh1]

I don't see why Congress wouldn't just repeal the ACA. They've tried over 50 times. Now they can finally do it. They don't even have to bother with a replacement.

Don't you think they will seriously consider this approach? I do. What's stopping them?

 

[Big_Hitter]

I don't see why Congress wouldn't just repeal the ACA. They've tried over 50 times. Now they can finally do it. They don't even have to bother with a replacement.

Don't you think they will seriously consider this approach? I do. What's stopping them?

I don't think the congressional majority thinks the entire law is bad, just parts of it