New HC rates with Obamacare

[MichaelB]

It seems that the new normal is that health insurance will cost you 10+% of your income if you don't work for an employer who more heavily subsidizes the coverage.

Regretfully, the new normal is much higher. The average cost of group healthcare is already >20% of the median household income. See here http://kaiserfamilyfoundation.files...efits-chart-pack-private-insurance-091112.pdf

 

[daylatedollarshort]

Here's what I don't understand:

Does anyone believe that someone making $30K or $40K or $50K a year can come up with $3-4-5K for HC?? These are people who struggle to make the food bill every week, can't qualify for Medicare and will have to get a plan on their own..

HC here in MA is about $10-12K for a bronze family plan...

Our Bronze plan premiums for my family in California at $30K MAGI would be zero (Medicaid) and at $40K they would be $4 a month.

Is MA really that different in cost? If so it would pay to move just based on the health insurance costs alone.

 

[pb4uski]

+1 In Vermont in 2014, a family of 3 with income of $50k could get silver level health insurance for $291/month (after $880 subsidy) so their net cost is ~7% of their gross income.

A single with the same income would pay $417/month (after $0 subsidy) or ~10% of his/her income.

 

[Mulligan]

Regretfully, the new normal is much higher. The average cost of group healthcare is already >20% of the median household income. See here http://kaiserfamilyfoundation.files.wordpress.com/2013/04/2012-employer-health-benefits-chart-pack-private-insurance-091112.pdf

We all have our biases based on our personal experiences, and I can see mine. I find myself complaining about health insurance costs because I never see those people that are consuming the dollars. I base my view on costs based on what I and my friends and family consume which is very little. I just have to realize until cost controls are a focus and not cost shifting, it is what it is, and I guess I should just be happy I have good health.

 

[marko]

Our Bronze plan premiums for my family in California at $30K MAGI would be zero (Medicaid) and at $40K they would be $4 a month.

Is MA really that different in cost? If so it would pay to move just based on the health insurance costs alone.

Well, there's lots of reasons to move from MA, but I stay for the mild winters, low taxes, nice people, courteous drivers and balanced political structure.

As far as I can see, the cheapest bronze plan here in MA is $929 a month for a normal working family making over $47K. To my point, I just don't see how people at that income level, even subsidized, can find another $350 an extra month for HC

 

[MichaelB]

We all have our biases based on our personal experiences, and I can see mine. I find myself complaining about health insurance costs because I never see those people that are consuming the dollars. I base my view on costs based on what I and my friends and family consume which is very little. I just have to realize until cost controls are a focus and not cost shifting, it is what it is, and I guess I should just be happy I have good health.

It's been a real learning experience for me as well. Concern folks have about affordability is well placed and there are no easy or simple answers.

 

[jflynn4]

With no subsidies ... My cost for coverage with effectively the same deductible and lower out of pocket will decrease by more than $1000 per month (you read that right) due to my wife having had breast cancer in 2003 and me suffering from a neck injury in 2010.

 

[daylatedollarshort]

Well, there's lots of reasons to move from MA, but I stay for the mild winters, low taxes, nice people, courteous drivers and balanced political structure.

As far as I can see, the cheapest bronze plan here in MA is $929 a month for a normal working family making over $47K. To my point, I just don't see how people at that income level, even subsidized, can find another $350 an extra month for HC

I used the Kaiser Calculator for my family, with MA as the state, $50K MAGI and got these results for the Bronze plan -

"For example, you could enroll in a Bronze plan for about $1,492 per year (which is 2.98% of your household income, after taking into account $7,581 in subsidies)."

Are you sure you have the correct rates? Are you using a much higher income? I am still not seeing how in either CA or MA a family making $30 - $50K would not get highly subsidized insurance.

The subsidies do not stop until the MAGI for a family of 4 is $92.4K.

See -
Federal Poverty Guidelines

And even unsubsidized, the health exchange rates for us are still much lower than the COBRA conversion plan we are on now.

 

[marko]

I used the Kaiser Calculator for my family, with MA as the state, $50K MAGI and got these results for the Bronze plan -

"For example, you could enroll in a Bronze plan for about $1,492 per year (which is 2.98% of your household income, after taking into account $7,581 in subsidies)."

Are you sure you have the correct rates? Are you using a much higher income? I am still not seeing how in either CA or MA a family making $30 - $50K would not get highly subsidized insurance.

The subsidies do not stop until the MAGI for a family of 4 is $92.4K.

See -
Federal Poverty Guidelines

And even unsubsidized, the health exchange rates for us are still much lower than the COBRA conversion plan we are on now.

I was using a family of two. Maybe that's the difference. My numbers for bronze was $929 a month and a subsidized rate of about $335 a month. Academic at this point for me as I likely won't need to pay for HC for another year.

Having said that, I cannot be the only person out there who's confused. Once again, at a bar last week I overheard someone (obviously well educated and affluent) insisting that ACA will be 'completely free for everyone'.

 

[travelover]

....... at a bar last week I overheard someone (obviously well educated and affluent) insisting that ACA will be 'completely free for everyone'.

After a couple of beers, lots of interesting things get said.

 

[explanade]

Do COBRA plans typically offer the same benefits as the plans you were under when you had employer coverage?

Or do they downgrade to a catastrophic plan?

And it's only good for like 18 months?

 

[teejayevans]

Do COBRA plans typically offer the same benefits as the plans you were under when you had employer coverage?

Or do they downgrade to a catastrophic plan?

And it's only good for like 18 months?

The same, they may give you a option to go to a lower cost plan, yes 18 is max.

 

[daylatedollarshort]

Do COBRA plans typically offer the same benefits as the plans you were under when you had employer coverage?

Or do they downgrade to a catastrophic plan?

And it's only good for like 18 months?

We had the same HI plan choices we had from megacorp on COBRA for 18 months. After that, because of pre-existing conditions we had a choice of HIPAA, conversion or small business plans.

We would get our insurance completely canceled at random times throughout the COBRA period, even when we had the premiums paid well in advance. It was almost like a full time job just staying insured, and calling regularly to get our dental or medical insurance reinstated, sometimes both, each month.

We took the conversion plan when COBRA ended. It cost even more than megacorp plan, but I knew they would try to find a way to not approve even that plan, either through incompetence or malice, and that plan was retroactive to when the COBRA plan ended. The HIPAA plans were not retroactive so it is hard to convert to those without some kind of gap.

The health insurance company didn't approve the conversion plan for whatever lame reason they could think of for weeks but we just kept calling, escalating and fulfilling whatever new hoops they would come up with and finally got it approved. So we called it right to get the retroactive conversion plan.

The small business plans were less per month but had five figure out of pocket maxes and we knew we would go over that this year.

This past year we spent in the neighborhood of $30K alone on health insurance premiums, plus with copays, deductibles and out of pocket max we will be lucky to keep our total medical costs under $50K for the year.

So I say thank goodness for the ACA. There is no way most families in the U.S. would have the financial resources, the time and the management skills to ever stay insured through all of the hoops and roadblocks we had to go through this past year.

 

[Which Roger]

We would get our insurance completely canceled at random times throughout the COBRA period, even when we had the premiums paid well in advance. It was almost like a full time job just staying insured, and calling regularly to get our dental or medical insurance reinstated, sometimes both, each month.

Can you elaborate on this? What were the reasons given for the cancellations, and who triggered the cancellations (former employer, insurance company, other...)? I'm interested since I'm just starting my COBRA coverage and it will help to know about potential landmines.

 

[explanade]

So you expect the ACA plans to offer more and/or cost less than your choices after COBRA expired, daylatedollarshort?

 

[daylatedollarshort]

Can you elaborate on this? What were the reasons given for the cancellations, and who triggered the cancellations (former employer, insurance company, other...)? I'm interested since I'm just starting my COBRA coverage and it will help to know about potential landmines.

Most of the problems seemed to be in issues between a lack of communication, human and batch feeds, between megacorp, the low bid HR COBRA administrator they used, and the health insurance company.

One issue was that the the COBRA admin would not send the batch feed of COBRA participants to the health insurance company until after the start of the month, so if we made doctors appointments the first week of the month our insurance would always show as canceled. Then even after that megacorp had an issue with their feed so we still wouldn't get insurance reinstated. This went on for months on end, never getting any permanent fix.

For every issue that came up HR administrator said it wasn't their problem to call megacorp or health insurance company and they each would tell us to call one of the other two. Many months we would get random premium increases with no warning. We are still trying to get refunds on that. The premiums went up by over $1,400 a month from year one to year two.

The issues just never ended. It took us weeks to find out what HIPAA and conversion policies we could get. Megacorp and health insurance company sent totally different information. One health insurance company rep carefully explained to us that there was no such thing as HIPAA policies at the end of COBRA. There are, of course, and it is federal law that they be offered.

This is just a sample of some of the issues. It was a horrible experience, especially when you have a family with medical needs hanging in the balance.

Once we were off COBRA and on a conversion policy, and megacorp and the COBRA administrator have been out of the picture, all of the issues stopped. The premiums are expensive, but at least we have insurance and it isn't getting cancelled at random times any more.

 

[daylatedollarshort]

So you expect the ACA plans to offer more and/or cost less than your choices after COBRA expired, daylatedollarshort?

For a plan with a lower deductibles and lower out of pocket maximums than our current conversion plan, our Bronze plan premiums may be as low as $4 a month next year, compared to ~$2,300 a month now. And yes we have many more choices of plans under the ACA.

We will save over $27K in premiums alone, and thousands more if we have any major bills next year, because of the caps under the ACA on maximum out of pocket costs.

 

[Malcolm2]

Most 26 year olds do think they are immortal. At least, they think they are not going to get seriously injured or contract some disease and if they do they'll get by. The ones with employer plans take it but those that don't will view it as a discretionary purchase.

True. Most will see this as another entitlement for the old folks. A 'subsidy' is just another entitlement, no matter how you phrase it. To call it anything else is just deceiving yourself and others. The general definition of an entitlement as 'a type of financial help provided by the government for members of a particular group.' Entitlement - Definition and More from the Free Merriam-Webster Dictionary

I am not sure it is right to expect the 26 year old to finance our lifestyle yet again, even if it will save some of us ER folks money.

 

[ERhoosier]

For a plan with a lower deductibles and lower out of pocket maximums than our current conversion plan, our Bronze plan premiums may be as low as $4 a month next year, compared to ~$2,300 a month now. And yes we have many more choices of plans under the ACA.

We will save over $27K in premiums alone, and thousands more if we have any major bills next year, because of the caps under the ACA on maximum out of pocket costs.

For $2300/mo you have a higher deductible &/or OOP max than $12,700 (family)?
That seems high even for the CA HIPAA conversion plans.
HIPAA and Conversion Benefit Summaries, Rates and Health Plan Websites

 

[daylatedollarshort]

For $2300/mo you have a higher deductible &/or OOP max than $12,700 (family)?
That seems high even for the CA HIPAA conversion plans.
HIPAA and Conversion Benefit Summaries, Rates and Health Plan Websites

Sorry, you are right. I made a mistake on the deductibles for the different plan colors. Under the enhanced silver plan our deductibles and out of pocket max would be lower, but not on the $4 a month bronze plan.

If we went with the lowest PPO on the enhanced silver plan, our premiums might still be just over $100 a month and we would have a low deductible and out of pocket max amounts ($500 medical deductible, $2,250 single and $4,500 OOP max family).

It also depends on our MAGI for next year, which we should have a fair bit of control over for 2014.

 

[urn2bfree]

Something I just learned today that might help some on here- it surely will help me- is that COBRA has a 60 day GRACE period. As I am taking ER on December 1, 2013 I thought I was going to have to pay the exorbitant COBRA rate until I could buy one of the new policies effective January 1. But I do not. I can just start shopping for a new policy that will go I into effect by February 1, 2014 and I do not have to pay a dime unless we make a claim in those 60 days. At that point I can say, oops, I meant to have my COBRA coverage paid up, I guess I forgot and it goes into effect. It turns out this feature of COBRA costs companies huge amounts of $$ because most people who take COBRA are likely to make a claim. To make up for this, Insurance companies charge more money for the policies. With the ACA, most people will find the exchanges superior to paying COBRA, thus creating a break for the companies currently having to pay extra to cover the ex employees under these plans.

http://www.stltoday.com/lifestyles/...cle_0f4c3df6-6a40-5f8c-b215-c19862ec480a.html

 

[2retireearly]

Yeah, I am now covered for maternity benefits but will have to get a sex change to use it. Change is good?

My group policy at work,covers men's health...maternity issues...children...all things not related to me. There is a reason for this....GROUP COVERAGE..that is what insurance is all about. Why don't people with group insurance complain?...because they realize what Group Insurance is. Why don't people now know that? It is the Law of Large Numbers.
Shop around for another policy, and hope that competition for business will one day (soon) make the rates 'competitive'.

 

[meierlde]

To show the evolution of plans when I first went to work for a Megacorp in 1976 their HI only covered 50% of pregnancy costs. It got fixed sometime later I can't recall when. Interesting how much has changed in 37 years.

 

[Mulligan]

My group policy at work,covers men's health...maternity issues...children...all things not related to me. There is a reason for this....GROUP COVERAGE..that is what insurance is all about. Why don't people with group insurance complain?...because they realize what Group Insurance is. Why don't people now know that? It is the Law of Large Numbers.
Shop around for another policy, and hope that competition for business will one day (soon) make the rates 'competitive'.

Uhmm, not always.... I left group coverage on purpose to get "INDIVIDUAL COVERAGE". Why? Because it was cheaper! A lot cheaper! Now I am pulled back into "group coverage" again without my consent. Just making a point, that the law of large numbers do not necessarily make it cheaper. Yes, I was underwritten and healthy, but a part of it was because I didn't need/want maternity, drug rehab, or mental health. Ultimately am I upset? Ask me in 15 years, I guess.

 

[Fermion]

Uhmm, not always.... I left group coverage on purpose to get "INDIVIDUAL COVERAGE". Why? Because it was cheaper! A lot cheaper! Now I am pulled back into "group coverage" again without my consent. Just making a point, that the law of large numbers do not necessarily make it cheaper. Yes, I was underwritten and healthy, but a part of it was because I didn't need/want maternity, drug rehab, or mental health. Ultimately am I upset? Ask me in 15 years, I guess.

I got pulled into group retirement (called SS) when I think I could do a much better job with individual retirement using that 14% of my income. Ask me if I am upset in 20 years or so.