Help! My health Ins is about to double!

[Katsmeow]

Quote:

Originally Posted by walkinwood Get a bronze plan. If you look around these forums, there was a spreadsheet that someone created that showed what your total cost (premiums + out of pocket) would be for various medical expense totals for the year. For healthy people with low predicted medical needs and no subsidy, the bronze plans always came on top.

It definitely pays to run the numbers. We are buying a plan off exchange (DH's megacorp is subsidizing part of the chost. We don't qualify for an ACA subsidy).

For the network we want there are 3 choices:

Bronze with high deductible with high coinsurance and copays - Lowest premium

Silver with highish deductible ($10,000 for family) with low coinsurance and copays - Lowest premium

Silver with lowish deductible ($5500 for family) with coinsurance and copays between the two plans above - Highest premium

If we need little to no medical care then the Bronze plan works out the best. On the other hand if we had a year where we would max out the $13,400 out of pocket max then the Bronze plan would also end up being the cheapest.

Between those 2 extremes, however, one of the Silver plans works out better. If we had the same health care needs we had in 2014, for example, the highest premium plan ends up with our overall costs the lowest. That would be because that year we would have met the $5500 deductible and would have had several thousand dollars are costs after that where we would have to pay the coinsurance but most of it would be covered. Under the bronze plan, we would have been paying that out of pocket.

There is even a narrow spending band where the middle Silver plan (higher deductible, low co-insurance and copays works). This is mostly where we would have lots of prescriptions (so longer drug copay is great) and saw a lot of physicians (low copays again), but didn't have a lot of other expenses (that is, no hospital charges and no lab/imaging costs).

I was quite surprised to see that I could find a situation where each of the 3 plans would end up being cheapest.

[Texas Proud]

Quote:

Originally Posted by MRG You're are describing my situation. I could not get health insurance at any price because of blood pressure and cervical spine issues. I would be stuck working to medicare age without aca. Health insurance costs have and continue to skyrocket. One thing I know, insurance companies seldom go broke.

But some do.... and some have a plan they lose money, but are covered by other plans..... which is what happened to BCBSTexas..... so now I get a different plan.... but still looking right now..


And I am one who is glad for the pre-existing condition clause in the ACA...


Yes, having just one problem would boot me out, even though the meds I take are less than $20 per month.... and no other complications... so any proposed plan that does not include this is a non starter with me...

[DawgMan]

Quote:

Originally Posted by Mulligan I going to take a guess and say Dawgman was used to underwritten policies. The reason why it was so much cheaper Dawgman was because they didn't accept unhealthy people which kept premiums down. BTW- Mine TRIPLED in price. But there were a lot of games insurance companies could play even with underwritten plans that could have got you eventually in a worse bind than ACA premiums. Sent from my iPad using Tapatalk

Yes! It was an underwritten plan and I understand that there are certain groups (i.e. Pre existing conditions, those who qualify for ACA credits), I just frankly haven't run into anyone yet who is happy about ACA. My frustration lies within the the lies sold to many of us from our President when Obamacare was presented. As a self employed person/family, I have been able to navigate a plan all these years that has been relatively reasonable. Well, now the gig is up and I am just now feeling the pain/frustration! I guess I am not a big fan of Socialism. Ok, it's now out of my system, moving forward. My hope was there might be some more of you out there with a similar profile to mine that have found the best product/angle to minimize cost. So far, Bronze is all I can find, but it still doubles my premium. This will be an issue for me even when I ER in hopefully 4 yrs. Don't get me wrong, I am happy for those of you that are getting a benefit. Just realize there is another group out there who is paying for it by the force of our government. Ok, now I'm really off the soap box....

[jesaco]

I will be retiring this year and have started looking for Health insurance starting Jan 2016 thru ACA plans. Checking available NYS plans, premiums with the deductibles and OOP costs are really sky high. really have to do a lot of research to find the best plan depending on your situation.

Still, It scares the hell out of me to think if something catastrophic happens to me or my family requiring major medical care and having no insurance at all. So I have no choice but to get health insurance.

[rayinpenn]

Quote:

Originally Posted by DawgMan This frankly has me pissed off beyond belief, especially when I think back to Obama's promises on Health Ins. Like many, my policy goes away this year and I need a replacement. The closest policy I can find that is similar to what I had (new policy is actually inferior) is almost double what I have in 2015!! ........

The Who: Me 61, the Mrs 58, Daughter 21, Son16.
The story: Priced cost of similar ACA plan to the one I have with my employer. Roughly $2200 a month or over $26,000 a year. I am grand fathered into a plan at work where they will pay a portion- cost to me $1750 a month or $21,000 per year. I guess it will drop when I hit 65 or daughter graduates and gets a job with her own insurance. When I tell the aforementioned to my younger buddies in the office they say "$2200 a year?" I tell that it is a month. They say OMG.


ACA
the pros
1) Can't turn you down for pre existing condition Huge!
2) low income people can and do have insurance

The cons
1) penalizes people who were thrifty their entire (us) life or those who made big money.
2) deductibles keep people out of the doctors office - a tragedy
3) did nothing to reduce costs. I'm betting my knee surgery will cost $40k - I could fly to Belgium get the surgery a week or 2 of rehab and come back for maybe $12 grand - all in.
Huge!
4) affected part time employment - employers push to keep hours down to avoid mandatory employee insurance.
5) pays for treatments that some might not want to fund.
6) forces religious organizations to fund things contrary to their teachings
7) Many couldn't keep their doctor as promised, savings obviously didn't materialize

The facts
1)As long as Doctor salaries in the US average double other countries don't expect to see improvement soon.

http://www.forbes.com/sites/theapoth...paid-too-much/

I suspect/know the cost of health insurance will keep ER as just a dream for many.

[hotwired]

Didn't read all the answers but just wanted to throw in 2 cents. If you buy the HSA compatible plan, you can put up to $6,600~ in per family. That will reduce your MAGI by that amount which might be enough so that your insurance doesn't double. We are in the same boat. I'm switching now from grandfathered "non obama" plan to a new one, but our income is 3-4k from the line where our premiums will go from $407 to $858. We are also self employed and have SIMPLE retirment plans but will switch to SOLO 401k's if needed to reduce taxable income further.

[Dawg52]

Quote:

Originally Posted by W2R After reading the above posts, I'm just so glad that I qualify for Medicare now. Getting old is not so great, while better than the alternative, but at least we get Medicare.

Yeah, 3.5 more years before I qualify. Until then...$%$#!!!

[travelover]

Quote:

Originally Posted by DawgMan Yes! It was an underwritten plan and I understand that there are certain groups (i.e. Pre existing conditions, those who qualify for ACA credits), I just frankly haven't run into anyone yet who is happy about ACA. My frustration lies within the the lies sold to many of us from our President when Obamacare was presented. As a self employed person/family, I have been able to navigate a plan all these years that has been relatively reasonable. Well, now the gig is up and I am just now feeling the pain/frustration! I guess I am not a big fan of Socialism. Ok, it's now out of my system, moving forward. My hope was there might be some more of you out there with a similar profile to mine that have found the best product/angle to minimize cost. So far, Bronze is all I can find, but it still doubles my premium. This will be an issue for me even when I ER in hopefully 4 yrs. Don't get me wrong, I am happy for those of you that are getting a benefit. Just realize there is another group out there who is paying for it by the force of our government. Ok, now I'm really off the soap box....

Good rant with political slams, but you do realize that you were just one medical incident away from either very high rates or no insurance at all?

And you do realize that Medicare is socialism?

[pb4uski]

Quote:

Originally Posted by DawgMan ........I have always been a catastrophe policy kind of guy, pay for the little stuff, protect on the big stuff, keep premium low. Now it appears my premium will almost double and my policy covers less. I have yet to meet anyone who says Obamacare is a better program for them, but maybe I am just a rich bastard who needs to be taxed more!! Any suggestions??

There is an obscure provision within Obamacare that allows people over age 30 to buy catastrophic coverage if the lowest cost bronze level plan exceeds about 8% of their income. We purchased a cat policy under this provision a couple years ago and have been quite happy with it.

Check with your state exchange as to the process as it varies from state to state. You may need to apply for a hardship exemption from the feds and once you receive an exemption certificate then you can buy the cat policy. But before you do that, find out what the pricing is if you got the exemption certificate because while in my state the savings are substantial (about 42% in 2016) in other states the savings are much more modest so it might not be worth the hassle.

[MichaelB]

DawgMan, many here have felt that same pain, we all understand the desire to let off some steam. Hope the damage isn't more than you can handle.

Folks, let's keep the politics out of the discussion, eh?

[bingybear]

Quote:

Originally Posted by DawgMan Yes! It was an underwritten plan and I understand that there are certain groups (i.e. Pre existing conditions, those who qualify for ACA credits), I just frankly haven't run into anyone yet who is happy about ACA. My frustration lies within the the lies sold to many of us from our President when Obamacare was presented. As a self employed person/family, I have been able to navigate a plan all these years that has been relatively reasonable. Well, now the gig is up and I am just now feeling the pain/frustration! I guess I am not a big fan of Socialism. Ok, it's now out of my system, moving forward. My hope was there might be some more of you out there with a similar profile to mine that have found the best product/angle to minimize cost. So far, Bronze is all I can find, but it still doubles my premium. This will be an issue for me even when I ER in hopefully 4 yrs. Don't get me wrong, I am happy for those of you that are getting a benefit. Just realize there is another group out there who is paying for it by the force of our government. Ok, now I'm really off the soap box....

I was healthy at 51... then I had a couple odd light headed spells lasting about 10 seconds. Ended up with a pacemaker. That happens in the old world, you'd likely not be renewed unless you were with a group/employer.
That said, I'm still on cobra and will switch to ACA or individual mid next year. And for me this will not quite be doubled, but maybe 70% more going from HDHP to ACA HDHP plan with less coverage and more restricted network.
Suggestions. Check independent health insurance brokers. They my have other choices. Check out or create a group... say a group of self employed that create an "employer" like plan with an insurer.
I tend to think of the ACA as defining the groups insurers have to consider. Think what would happen if medicare started denying coverage for those with problems. We will all hit an age we can't afford.

[John Galt III]

I'd like to weigh in as a heavily subsidized user of Obamacare. For 2015 I had a PPO with $100 deductible and $500 max oop, for only $20.50 per month, after subsidy. For 2016, the cheapest similar PPO available to me will be $168 per mo premium with $300 deductible and $2250 max oop. So my premium has increased about 800 percent, and ded and oop get way higher too. I know, still cheap compared to many others who are not as well subsidized! Still everyone, rich and not rich, have the nagging prob lem of the unscrupulous sneaking in of the out-of-network maximum-profit-provider personnel if and when one dares to use the insurance.

[Chuckanut]

ACA has problems and needs to be overhauled. But, going back to the old days of pre-existing conditions, etc. should not be an option.

The big issue is cost. Recent news about generic drug prices skyrocketing when one company takes over production is a great example of what is wrong. Why should Americans pay $8 for a pill that the Canadians get for 50¢? Something smells fishy. Or $50,000+ for a hip replacement that one can get in Europe for under $20,000 Perhaps we need tort reform that eliminates frivolous and time consuming lawsuits while still holding medical professionals accountable for truly negligent and/or malicious behavior.

[daylatedollarshort]

Quote:

Originally Posted by Chuckanut ACA has problems and needs to be overhauled. But, going back to the old days of pre-existing conditions, etc. should not be an option. The big issue is cost. Recent news about generic drug prices skyrocketing when one company takes over production is a great example of what is wrong. Why should Americans pay $8 for a pill that the Canadians get for 50¢? Something smells fishy. Or $50,000+ for a hip replacement that one can get in Europe for under $20,000 Perhaps we need tort reform that eliminates frivolous and time consuming lawsuits while still holding medical professionals accountable for truly negligent and/or malicious behavior.

+1. Health care costs in the U.S. were ridiculously high before the ACA. The ACA may not have fixed this issue very well, but the high costs are not a result of the ACA.

From a 2012 article in the Washington Post:

"The IFHP just released the data for 2012. And yes, once again, the numbers are shocking. This is the fundamental fact of American health care: We pay much, much more than other countries do for the exact same things."

21 Graphs That Show That America's Healthcare Costs are Ludicrous
https://www.washingtonpost.com/news/...are-ludicrous/

[MasterBlaster]

DawgMan:

Take a step back...

We have to charge you more so that we can subsidize others. We need cost shifting (on you and others) to achieve our societal aims.

Thank you for your understanding

[marko]

SIL #1 lives (almost) paycheck to paycheck and just had her HC premium go up 20% for the coming year.

SIL#2 (they're not related--on opposite side of the family) is worth low-7 digits and 'qualifies' for subsidy.

SIL #3 was put on part-time as her employer wanted to "deal with the benefits problem".

I'm not sure we're making progress here. I wonder if the same amount of people are being left out in the cold, we've just rearranged the winners and losers.

[travelover]

Quote:

Originally Posted by MasterBlaster DawgMan: Take a step back... We have to charge you more so that we can subsidize others. We need cost shifting (on you and others) to achieve our societal aims. Thank you for your understanding

There are two sides of this coin. The other is, "we denied insurance coverage to anyone with any health problems in this select group and we will charge you all a low premium as a result. If you develop an expensive problem, you are out".

[MRG]

I recall the "old days" fondly. In 1992 I was diagnosed with hypertension, hospitalized, finally put on meds; my employer provided insurance covered that. My doc had impressed on me how serious this could be by telling me to call his home number if I felt bad. A couple of days later I started feeling bad, numb left arm, pain in chest... A trip to the ER was in order, no heart attack, then. The heart attack came when I received the bill. I'd had a panic attack, my policy had no mental health coverage! Took years to pay that adventure off. No thanks, what we had before didn't work.

[marko]

Quote:

Originally Posted by travelover There are two sides of this coin. The other is, "we denied insurance coverage to anyone with any health problems in this select group and we will charge you all a low premium as a result. If you develop an expensive problem, you are out".

I think we could've done a better job with a lot few pages of paper by just
1) Eliminate the preexisting disqualifier
2) Have the gov't pick up catastrophic coverage for everyone
3) Let everyone decide if they want any other coverage on their own.

[Tandemlovers]

Count us in as thrilled to have been able to purchase insurance on the exchange. We bought a bronze plan that was HSA eligible.$534/month for four adults (two under 26), $12,500 family deductible.

I told my spouse we were going to roll the dice this year by purchasing the least expensive plan, and we ended up having an out of network event in another state resulting in a hospitalization. Long story short, our insurance kicked in, and we were able to negotiate the out of network charges down by 30% just by asking the out of network hospital billing department for relief.

Yes, after twenty five years of employer sponsored health insurance, paying a monthly premium is something of an annoyance, but the emergence of the ACA enabled us to retire relatively early and with the peace of mind that a hospitalization won't bankrupt us.