Help! My health Ins is about to double!

[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]

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]

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]

........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]

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]

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...ow-americas-health-care-prices-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]

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]

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.

 

[Ian S]

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.

Apparently, tort and associated costs represent only a small fraction (2.4%) of healthcare costs: Medical liability costs in U.S. pegged at 2.4 percent of annual health care spending | News | Harvard T.H. Chan School of Public Health

I feel for those who are being stuck with higher insurance bills and the promise that you could keep your doctor and health plan was a foolish one to make in light of the the unfettered ability of insurance companies to exclude doctors from their networks and eliminate plans whenever they wished. In context, I suspect what the President was trying to say was that the ACA itself would not be directly dictating which doctor you could see or not see and of course, there was a provision to grandfather many plans. But ultimately, the insurance companies were always going to dictate which plans they would keep and for how long.

In my case, my pre-ACA plan premiums were slightly less than the closest corresponding ACA plan but the deductible was much higher than that for the ACA plan. But I am older and close to Medicare and so the age surcharge for premiums is less than it would otherwise have been pre-ACA.

I'm firmly convinced that a Medicare for all approach would ultimately be best. Insurance companies would be free to peddle their supplement and Advantage policies and everyone would be covered for the basics. My doctor's office would not need employees whose sole function appears to be shuffling the various insurance paperwork and dealing with the nuances of the myriad different policies. Private companies would not need to spend HR resources trying to figure out what insurance to offer at what cost every year.

 

[zesty]

It works out great for many, but people caught just above the subsidy limit are scrambling to afford it.

They figured that it'll cost about $100k to pay for the next 7 years until they're Medicare eligible, so around 15% of gross income. So they're seriously considering just taking the penalty and chancing those years. If something bad happens and they lose everything, they can come stay with me.

I may just stop saving in taxable for ER and pay for the insurance for them.

 

[zesty]

The pre-existing condition inclusion in ACA is very helpful though. With the surgery I had, I never would have been able to get insurance apart from an employer plan.

 

[razztazz]

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.

That would not have worked because it would have been seen as a "Single Payer" / Government as Insurance Company. The Let 'em Die part would have stomped it. Besides if insurance companies could only charge for selling non-cat polices they wouldn't be able to take in gargantuan amounts of money to "cover" those costs

I did see that exact concept proposed as far back as the 90's to get around the Clinton Plan. There were a couple of Doctor's groups who backed it. The gov is already the backer of all things catastrophic anyway. That's what Gov does in fact. So, add this relatively minor duty to the list and jiu jitsu the whole problem away

 

[NW-Bound]

Our deductible is $10K, out of pocket is $13,900. It's a Bronze HDHP, and it's awful. Nothing even close to what we had with our employer policy. And why? It's the same hospitals, same doctors, same everything. Ugh, makes me absolutely crazy.

We no longer have a health care plan, all we have is a health insurance plan.

True. What you had before with your employer was healthcare, while your Bronze Plan now is health insurance. The difference was your employer subsidized the healthcare part, while you are now on your own. But that has changed with many employers. We have siblings still working, and they complain about their premium going up to several hundreds/month, and their deductible also goes up to a couple of thousands. One can blame that on the cost of healthcare, not on ACA.

By the way, the difference between healthcare and health insurance is the same as the difference between home maintenance and fire insurance. If we want State Farm to also cover our home maintenance cost in addition to the fire hazard, the premium is going to be higher.

 

[bingybear]

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.

One of the things we all really needed... to see what insurance costs. So many people have been paying a small fraction of the insurance cost at their employers plans that most people don't really understand how much is paid in total when the employer's contribution is added to the employee's.
We still need to find out how to make it affordable in general.

 

[travelover]

One of the things we all really needed... to see what insurance costs. So many people have been paying a small fraction of the insurance cost at their employers plans that most people don't really understand how much is paid in total when the employer's contribution is added to the employee's.
We still need to find out how to make it affordable in general.

So true. The way to get the public on board with cost containment is to increase their skin in the game.

 

[sengsational]

One of the things we all really needed... to see what insurance costs. So many people have been paying a small fraction of the insurance cost at their employers plans that most people don't really understand how much is paid in total when the employer's contribution is added to the employee's.

It's now a requirement that the cost of employer sponsored health coverage be disclosed annually on the W-2. Box, 12, code DD.

As long as the negotiated prices (between insurance companies and providers) are secret, and the outcome data is muddled or unavailable, we don't stand a chance of getting prices down.

 

[athena53]

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.

Yeah, this scares the heck out of me. My insurer, Coventry, sent me a letter a month ago saying that my current coverage was no longer available after 1/1/16 but they sent a link to another Coventry policy I "might like". I checked the coverage summary on-line.

ZERO coverage on out-of-network. (Current policy is 50%- not great but not zero, either.)

This morning I met with an agent and got one with BCBS with a 40% co-pay on out-of-network and a $5K deductible instead of $6200 for a little more money. After 1/1, when the new policy is in effect, I'm sending a blistering letter to Coventry.

I wish the ACA had allowed for more cost transparency. DH is on Medicare and has been going to a wound care clinic weekly to treat a leg ulcer. It's healing nicely and he's just about done, but we have no idea what our share of these bills will be because we haven't seen any claim statements. Scary as heck. Whatever our share will be per visit, multiply that by 10. It won't break us, but it makes it impossible for us to determine cost v. benefit in any medical care decisions.

 

[rodi]

As long as the negotiated prices (between insurance companies and providers) are secret, and the outcome data is muddled or unavailable, we don't stand a chance of getting prices down.

It's not secret.... after the fact.

I have a high deductible HSA plan. As I've mentioned many times- this has been a higher than planned medical year for our family with the various broken bones from sports injuries. I get an EOB every month that shows the "full price" and the "negotiated price". Even though I have Kaiser - which is closed network - so only Kaiser customers use Kaiser doctors - there's still a big difference between the full price and the negotiated price. Fortunately, I only pay the negotiated price OOP till the deductible is met.

Here's an example of the xrays done for younger son's broken elbow:
xray full price: $121
discount negotiated: (-$78)
amount I paid $43.

To restate this. I have a HDHP and the deductible had NOT been met - so I was paying 100% of the owed amount... but that amount was $78 less than it would have been if I didn't have insurance.

(Despite these negotiated rates - I still managed to rack up over $8k in OOP for my kids. They are accident prone.)