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Old 03-30-2013, 08:34 AM   #41
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Originally Posted by Gumby View Post
As I think more about this, the prospect of stepping over the cliff could also affect one's decision to take social security at 62.
the thing i would be more concerned with is subsidies in general.

there is no way based on these prices that the government is going to get enough money to pay for this.

I predict that all the subsidies will be forced downward
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Old 03-30-2013, 08:38 AM   #42
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I am not real up on the ACA, but reading this thread makes me think there is strong justification for a new acronym: UACA (unaffordable care act)
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Old 03-30-2013, 08:44 AM   #43
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there is one more thing that i have forgotten to mention in all my massachusettes health posts.

insurers here can pick what plans they are in.

all the subsidized plans-none of them are from major providers. they are all the same plans that currently supply medicaid members.

the only way to get major providers-at least in mass.-is to buy the non-subsidized plans.

i think whats more important is to find out in california-just what plans will be subsidized.

based on my state(mass.) i would not be able to get the plan i have if subsidised



i'll use an example with an insurance company you've heard of. Blue Cross of mass. is not a subsidized plan provider-so if you go to a doctor in an expensive suburb and he /she does not take a subsidized plan(which because are low reimbursement plans to provider) your choice will be change doctors or get non subsidized plan.
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Old 03-30-2013, 09:04 AM   #44
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As for Obamacare subsidies running out of money see

Obamacare Exchanges To Shed Users After 2018 - Hit & Run : Reason.com

It points out that Obamacare subsidies will get reduced if it cost over 0.5% of GDP as it surely must will. It is not clear how they will get cut. Perhaps subsidies will kick in at 350% versus 400% of the federal poverty level or the 9.5% rule becomes a 10.5% rule.
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Old 03-30-2013, 09:33 AM   #45
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This has mad a mess of my careful FIRE planning

I am 57 and was looking at ER in January.
Megacorp used the ACA as a way to scrape their retirees off the bottom of their shoe by canceling retiree coverage and replacing it with a very paltry sum in a HSA. This is saving them billions. At the same time they were protesting the 2.8% excise tax they had to pay on their healthcare products they sold. I work for one of their healthcare divisions and the amount of profit (margin) they make is really obscene. (See Steven Brill's recent article on why healthcare costs what it does in this country).

Now I am faced with trying to find a way to get at the money I have saved in IRAs/401Ks.
I don't have enough in taxable accounts to cover 8 years until Medicare. Being forced to get our AGI below 62K is a moving mess of balancing capital gains in taxable accounts along with per-tax withdrawals. Looks like we will have to push back SS now. DW and I need about 75k to maintain our standard of living. A 20k premium would push us into an uncomfortable level and would not be sustainable. I have a per-existing condition that is stable but requires us to maintain coverage.

What a mess. It's the only reason I am continuing to work. I am hoping to see some better rate info on plans as we get closer to the end of the year.
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Old 03-30-2013, 09:41 AM   #46
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It sounded so simple when they were trying to sell the legislation. Not to mention the promise of $2500 a year in health insurance premium savings per family.
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Old 03-30-2013, 09:43 AM   #47
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Quote:
Originally Posted by Sittingduck View Post
This has mad a mess of my careful FIRE planning

I am 57 and was looking at ER in January.
Megacorp used the ACA as a way to scrape their retirees off the bottom of their shoe by canceling retiree coverage and replacing it with a very paltry sum in a HSA. This is saving them billions. At the same time they were protesting the 2.8% excise tax they had to pay on their healthcare products they sold. I work for one of their healthcare divisions and the amount of profit (margin) they make is really obscene. (See Steven Brill's recent article on why healthcare costs what it does in this country).

Now I am faced with trying to find a way to get at the money I have saved in IRAs/401Ks.
I don't have enough in taxable accounts to cover 8 years until Medicare. Being forced to get our AGI below 62K is a moving mess of balancing capital gains in taxable accounts along with per-tax withdrawals. Looks like we will have to push back SS now. DW and I need about 75k to maintain our standard of living. A 20k premium would push us into an uncomfortable level and would not be sustainable. I have a per-existing condition that is stable but requires us to maintain coverage.

What a mess. It's the only reason I am continuing to work. I am hoping to see some better rate info on plans as we get closer to the end of the year.
make sure your doctors will take a subsidized plan. all insurers will not be subsidized plan providers
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Old 03-30-2013, 09:46 AM   #48
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It sounded so simple when they were trying to sell the legislation. Not to mention the promise of $2500 a year in health insurance premium savings per family.

Obamacare is strictly a plan to get more lower income people insurance-thats it


and get us to pay for it
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Old 03-30-2013, 09:52 AM   #49
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Sittingduck
Sorry to hear that your plan will be so drastically altered. Maybe your username jinxed you.
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Old 03-30-2013, 09:59 AM   #50
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Obamacare is strictly a plan to get more lower income people insurance-thats it


and get us to pay for it
I could maybe see that if the burden fall to the upper income folks ( which has happened with the tax increase). They will gripe about it bitterly but they are easy enough prey and they will move on. But hitting folks who make $65000 a year, to have them pay 30% of the annual income for health insurance is unconscionable.
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Old 03-30-2013, 10:01 AM   #51
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Originally Posted by gerrym51 View Post
there is one more thing that i have forgotten to mention in all my massachusettes health posts.

insurers here can pick what plans they are in.

all the subsidized plans-none of them are from major providers. they are all the same plans that currently supply medicaid members.

the only way to get major providers-at least in mass.-is to buy the non-subsidized plans.

i think whats more important is to find out in california-just what plans will be subsidized.

based on my state(mass.) i would not be able to get the plan i have if subsidised



i'll use an example with an insurance company you've heard of. Blue Cross of mass. is not a subsidized plan provider-so if you go to a doctor in an expensive suburb and he /she does not take a subsidized plan(which because are low reimbursement plans to provider) your choice will be change doctors or get non subsidized plan.
This sounds very disturbing. If subsidized plans have a low reimbursement plans to provider then why cost should be low which in turn should mean the subsidies should not be that high. What we are seeing the worst of all worlds, a subsidized plan that is expensive to all sides (doctors, government, taxpayers, and patient.)

I hate to sound like the GOP spin machine, but it seems to me the right way to do this is to

a) Tort reform
b) Let insurance companies sell across state borders (like into CA and NY markets) which should lower costs via competition
c) No community rating so the cost of insurance should be a function of the medical condition of the insured so the healthy can get the cheap insurance that they deserve anyway
d) Means test premiums (whatever it is) on an individual basis and then hand out subsidies on an individual basis as needed

We should just let the market work as much as possible and then subsidies comes in at the end. Micromanaging the process with all sort of rules (like 3 vs 1 ratio between the ages, community rating) just messes this already messed up system even worse. Here NY state we already lived what the future under Obamacare might be like, and it is not pretty (I have friends who do have high earnings ($250K+) in their early 40s who are self employed and pay $25K+ for insurance plus another $20K every time they have a kid.)
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Old 03-30-2013, 10:12 AM   #52
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This sounds very disturbing. If subsidized plans have a low reimbursement plans to provider then why cost should be low which in turn should mean the subsidies should not be that high. What we are seeing the worst of all worlds, a subsidized plan that is expensive to all sides (doctors, government, taxpayers, and patient.)

I hate to sound like the GOP spin machine, but it seems to me the right way to do this is to

a) Tort reform
b) Let insurance companies sell across state borders (like into CA and NY markets) which should lower costs via competition
c) No community rating so the cost of insurance should be a function of the medical condition of the insured so the healthy can get the cheap insurance that they deserve anyway
d) Means test premiums (whatever it is) on an individual basis and then hand out subsidies on an individual basis as needed

We should just let the market work as much as possible and then subsidies comes in at the end. Micromanaging the process with all sort of rules (like 3 vs 1 ratio between the ages, community rating) just messes this already messed up system even worse. Here NY state we already lived what the future under Obamacare might be like, and it is not pretty (I have friends who do have high earnings ($250K+) in their early 40s who are self employed and pay $25K+ for insurance plus another $20K every time they have a kid.)
before Romneycare MA. had guarantee issue like NY has now.Insurance plans could not turn you down-but rates were sky high. having priced individual coverage before Romneycare it was actually more expensive. Romneycare brought down the price i would have had to pay but it is still expensive.
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Old 03-30-2013, 10:14 AM   #53
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Some very odd things about that calculator. Let's say a ER couple age 55 with $60K of income. Our premium is $1,723 a month.

But if I add our 25 yo son then the premium is only $861 a month.

If I adopt an 18 year old then the premium is $574 a month (less than what i am paying now for better coverage).

Can't be right.
Maybe they got the input wrong. On the UCberkeley calculator it says "Enter age of policy holder" whereas on the CA calculator it says "Enter age of the youngest adult". Both have age range from 19-64, so you shouldn't enter 18.

I can't believe the numbers jumping to 30%+ of income for premium. Somethings got to be wrong but I don't know where it is.
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Old 03-30-2013, 10:27 AM   #54
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Something seems wrong here. What am I missing?

Health Insurance Calculator | Covered California

Examples:

1 person household; $65K income; youngest age 55:
premium $635 per month, no tax credit


2 person household; $65K income; youngest age 55:
premium $1,723 per month, no tax credit


Why would the 2 person be far more than 2X the 1 person household? I suspect there is an hidden assumption in the calculator that is affecting the numbers?
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Old 03-30-2013, 10:30 AM   #55
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Something seems wrong here. What am I missing?

Health Insurance Calculator | Covered California

Examples:

1 person household; $65K income; youngest age 55:
premium $635 per month, no tax credit


2 person household; $65K income; youngest age 55:
premium $1,723 per month, no tax credit


Why would the 2 person be far more than 2X the 1 person household? I suspect there is an hidden assumption in the calculator that is affecting the numbers?
i think the calculator is giving 65000 income to each person and pricing 2 at 130000

at most 1,270 a month cheaper for 2 people to apply singly
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Old 03-30-2013, 10:30 AM   #56
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The problem with the calculator is that is represents what will happen in the state with the most uninsured population in the United States. According to the California Healthcare Foundation, in 2011 22% of all Californians had no health insurance.

California's Uninsured: Treading Water - CHCF.org

So, the premiums reflect adding 7 million people to the health insurance pool, some who will use subsidies. Initially, because there is no claim experience for these people, the rates will be higher.

They should drop over time as carriers see the claims experience of these other 22%.
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Old 03-30-2013, 10:32 AM   #57
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Thanks for another lively discussion, everyone!

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