Seeking ACA Examples

[clobber]

Not looking for a debate or argument.

I am not subject to ACA and would like to understand how it did or did not benefit people in this forum. Briefly:

1) If you had it, what coverage and cost did you have prior to ACA?
2) How did that change (if it did) with ACA?
3) Do you perceive the change to be better or worse for you specifically?
4) Comments about your specific situation? Difficulties? Successes?

 

[45th Birthday]

Prior to ACA, insurance for our family of four was $8,700 per year. First year of ACA, $15,300. Basically the same coverage but with higher OOP max.

Second year of ACA, costs higher still but not comparable because kids started to go on their own plans. Going out of network has become even more punitive than before (now no OOP max).

However, in Illinois, our previous state of residence, BCBS stopped selling broader network PPO plans. By then we had moved to FL, where those plans are still available thankfully. Had we stayed in Illinois, we would have been stuck with pretty substandard providers, especially hospitals.

Clearly worse for us. Just hopeful this mess will get fixed and that we will still be able to get good coverage.

 

[GTFan]

We pay $36/mo. for two folks in their 50s for a CSR'd BCBS Silver plan ($250 deductible, $750 max OOP per person). That's with keeping MAGI right below 150% of FPL.

My retiree coverage option this year for a much-worse Bronze plan was something like $900/mo., ACA plans were about the same cost.

So as you can see there is no comparison if you can play the MAGI game and live with the network that your plan has (in our area it's very good but we have no coverage out of state, OON coverage is all on us).

 

[scrabbler1]

Prior to the ACA, I was in a group plan through my employer before I reduced my weekly worked hours in 2007 and became ineligible for the program. I went on COBRA for 18 months before I ERed in late 2008. COBRA cost me $392 a month and it included dental.


In 2009, I moved to an individual policy. HI is expensive here in NY and it cost me $469 a month without dental. This was the cheapest comprehensive policy I could find on ehealthinsurance. But in 2010 and 2011 the rate went up nearly 50%, to just under $700 a month. This looked like a death spiral in progress.


I dropped the policy and switched to a bare-bones, hospital-only policy which cost me just under $200 a month. I was healthy at the time, and the ACA had been passed by then. I planned to stay on this policy and be underinsured until the end of 2013, when I could sign up for a much-awaited ACA policy and no longer be underinsured.


I found a Silver plan with Empire BCBS which cost me $384 a month. It didn't include dental but at least I wasn't underinsured any more and wasn't paying $700 a month. My ACA subsidy was pretty small because my MAGI was near the top end to qualify for one.


Good thing the ACA came along because I got sick in 2015 and was in the hospital for nearly 2 weeks. I greatly exceeded my annual OOP max so BCBS picked up everything over the ~$6,200 max.


I dropped BCBS at the start of 2016 because I didn't like how their drug plan worked (I had to use Express Scripts mail-order service and it had become unreliable). I moved to OSCAR and they had a lower rate and I could use a local pharmacy for my drugs which at the time had no copay. All my doctors were in OSCAR, too.


OSCAR's rate rose some in 2017 and will rise some more in 2018. But I am still paying far less than I was paying back in 2009-2010. I am not terribly concerned about the high deductible because, unless I get really sick like I was in 2015, I won't come anywhere near it. The ACA has been a godsend for me. Without it, I'd be either poorer or sicker, or both.

 

[ShokWaveRider]

Prior to ACA I could not get insurance due to High BP but Medicated OK and a Pacemaker.

DW & I $145pm, 0 Deductible, $2 Office Visits, $15 specialist and $2,500 MOOP now for both of us. I think that is a fair price, we may have to change next year, but I hope not.

 

[Fermion]

Prior to ACA we paid about $700 a month for a insurance plan with a $6,000 per person deductible. After ACA we pay $280 a month for a silver plan with a $250 deductible. No contest.

 

[pb4uski]

ACA was beneficial for us and we don't get subsidies.

Prior to ACA our HDHI plan was a small group plan through the state Chamber of Commerce and in 2012 that plan cost $556/month for the two of us. It crept up to $629/month for the two of use for 2013 and the first 3 months of 2014. Under ACA a similar plan increased to $682/month... not bad, just the typical increase. However, in mid 2014 we were able to purchase a catastrophic plan even though we were over 30 under one of the more obscure provisions of ACA because the second lowest cost bronze plan exceeded 8% of our income. We are lucky in that our state is of of the few states in the US where health insurance is not age rated so the premiums were substantially lower than the plan that we were on and dropped from $682/month to $456/month.

Fast forward to 2017... the annual premium increases for our current plan have been more modest than for the regular plans and today we pay $480/month for that same catastrophic plan... a regular plan would be $876/month. Mind you, we essentially pay for all of our medical services because we have been blessed with good health and under the deductible each year... so what we get for the ~$5,800 we pay a year for health insurance is a free annual physical, access to negotiated rates for the little medical services that we do use and the peace of mind that our costs would be covered if we had a health event of some sort.

 

[Fermion]

Pb4, that is what I hope to go with if ACA goes away. A cheap catastrophic plan that does not cover things we don't need (pregnancy, substance abuse, mental health issues). I love the ACA and the cheap policy we have but I would go for that cata plan in a heartbeat if we had to pay full price for the silver platter plan.

 

[MRG]

I can't pass medical underwriting, before ACA, no insurance for you!

My COBRA was $550 monthly for a 'silver' plan. Next year ACA was $200 monthly, now I pay $300 monthly for a silver plan. Deductible of $700, max OOP $1200.

DW has Medicare this is just me. I play the subsidies at < 250%. Without subsidies the plan I'm on is over $1300 monthly.

 

[pb4uski]

Pb4, that is what I hope to go with if ACA goes away. A cheap catastrophic plan that does not cover things we don't need (pregnancy, substance abuse, mental health issues). I love the ACA and the cheap policy we have but I would go for that cata plan in a heartbeat if we had to pay full price for the silver platter plan.

I'm not sure if any of the three items that you list, either individually or combined, have a significant impact on premiums that it would make a difference. My cat plan offers coverage for all of those and is still quite affordable.

 

[shortstop14]

When my wife retired, we used her COBRA plan for 18 months, which cost about $9400 per year. Once the COBRA ran out, we moved to an ACA Silver plan which cost $16,000 per year list price, but $3500 after subsidy. In order to get the subsidy, we reduced Roth conversions in order to keep our income low enough to qualify - that will hurt us a bit down the road in the RMD years, but my calculations showed we net out better taking the subsidy now. Policy cost increased about 15% for this calendar year.

Going on ACA was certainly a useful plan for us - it helped make retiring viable. We've retained the option of using her state employee insurance pool plan, which would cost slightly more than the list price ACA plan. That's our punt position if other options disappear. We've got 4 / 5 years to bridge to Medicare.

 

[sengsational]

I've had high deductible plans throughout.

2013 $4700 + megacorp subsidy (4 people)
2014 $770 + PTC (ACA, 3.5 people)
2015 $1383 + PTC (ACA, 2 people)
2016 $1615 + PTC (ACA, 2 people)
2017 $256 + PTC (ACA, 2 people, if I hit the target MAGI)

 

[jim584672]

Been great for me. I found a Medicaid Managed care plan that has all my doctors from the Megacorp plan. COBRA would have been $600 a month. It is better than what I had while working.

 

[ShokWaveRider]

Seems like only one here is what I would consider outrageous prices. The rest all seem reasonable. The Opposite of what I was expecting based on what we have been hearing.
.

 

[Fermion]

I'm not sure if any of the three items that you list, either individually or combined, have a significant impact on premiums that it would make a difference. My cat plan offers coverage for all of those and is still quite affordable.

Yes but have you ever walked in your bathroom and noticed your cat doing a line of catnip with a rolled up twenty?

 

[Johanson]

I dropped the policy and switched to a bare-bones, hospital-only policy which cost me just under $200 a month. I was healthy at the time, and the ACA had been passed by then. I planned to stay on this policy and be underinsured until the end of 2013, when I could sign up for a much-awaited ACA policy and no longer be underinsured.


I found a Silver plan with Empire BCBS which cost me $384 a month. It didn't include dental but at least I wasn't underinsured any more and wasn't paying $700 a month. My ACA subsidy was pretty small because my MAGI was near the top end to qualify for one.


Good thing the ACA came along because I got sick in 2015 and was in the hospital for nearly 2 weeks. I greatly exceeded my annual OOP max so BCBS picked up everything over the ~$6,200 max.

How much would you have paid if you had stuck with the $200 hospital only plan when you ended up in the hospital for 2 weeks?

 

[aaronc879]

I lost my full time job in 2011. Cobra was too expensive so went without HI. Unable to afford HI without being sponsored by employer, I went without. Unable to find "normal" work, I starting doing self-employed work but continued to go without HI because my income was under $20K/yr and couldn't afford HI. In 2014 I joined the ACA after discovering I could get a big subsidy. With my low income and "young" age of 30-something, I was paying under $100/mo for decent coverage. I continued with that until this year when I finally found full time work and got covered thru employer as of June 1st. Without the ACA subsidies, HI isn't affordable for lower income people or even lower-middle income people with families who don't get insurance from their employer.

 

[Winemaker]

IIRC, last year DW and I paid $16,800 for HI, crappy vision and an okay dental plan.

Just got this years bill, $20,100, and we dropped the crappy vision. I'm on minimal BP meds, DW is asthmatic, but no significant issues.

Income too high for subsidies.

 

[scrabbler1]

How much would you have paid if you had stuck with the $200 hospital only plan when you ended up in the hospital for 2 weeks?

Good question, something I have wondered about since then. Assuming the write-down (discount) between the insurer and the hospital were the same (the Hospital-only plan was also through BCBS), I would have been on the hook for all the non-hospital charges (i.e. doctors, drugs), about $24k. I might have been able to shift some of the outside doctor charges to in-hospital doctors so I could gain insurance coverage for that. Some of the doctor charges were in-hospital charges anyway. Of the $24k, about 93% of it was either discounted by the providers or paid for by BCBS. I was on the hook for only 7% of the total hospital charges, too.

I could not have stuck with the hospital-only plan after 2013 even if I wanted to. That plan was nowhere near ACA-compliant.

 

[HGTVfan]

My company eliminated the health plan for early retirees in 2009 when the business was struggling. I was able to get insurance but paid a 50% premium for a pre-existing condition. The year before ACA took effect I was paying $515 single with a $60 co-pay for a specialist. If I had stayed with the insurance in a grandfathered plan it would have been $629 the first year ACA was in effect. So instead I went with an ACA plan, with subsidy, and paid about $300. For this year I'm paying $424 for an EPO (has out-of-network coverage) with a $2,500 deductible and $20 co-pay for a specialist and a wide network of providers. I live in Florida.

When I first applied for insurance pre-ACA I was taking two Rx, now I take four Rx. So the most important thing for me is the pre-existing condition allowance. I'll be 65 in 2019 and look forward to Medicare.

 

[SecondCor521]

Not looking for a debate or argument.

I am not subject to ACA and would like to understand how it did or did not benefit people in this forum. Briefly:

1) If you had it, what coverage and cost did you have prior to ACA?
2) How did that change (if it did) with ACA?
3) Do you perceive the change to be better or worse for you specifically?
4) Comments about your specific situation? Difficulties? Successes?

1. I had coverage through my employer. My coverage was completely paid for by my employer, but I paid $93 every other week for my three kids, which I think figures out to about $201.50 per month. Since we're mostly healthy I picked a high deductible plan. It looks like I spent about $700 in out of pocket medical the last full year I had this insurance (2015).

2. I retired in February 2016 and started ACA coverage in March 2016. I chose a Silver plan with CSR and subsidies. My subsidized premium for me and my three kids last year was $198.29 and my subsidized premium this year is $219.66. It looks like I spent about $1460 in out of pocket medical in 2016. I also got an additional $350 in premium tax credits on my 2016 taxes. I don't recall the unsubsidized premiums, but I believe last year was $564 and this year it's $7xx.

I need to interject that the above numbers don't account for several things: A, my ex and I share medical expenses according to our divorce decree, so my accounting doesn't include things she paid for because I categorize that differently in Quicken. It also doesn't include the fact that with our kids we probably spent more in 2016 in order to address some elective items with the kids.

3. I'm not sure which change you're referring to: Going from employer coverage to ACA, or from the pre-ACA to the current ACA environment? I guess I will say that when I made my FIRE plan I did count on the ACA being there and expected to have a low income and therefore receive the CSR and subsidies. I like the CSR and subsidies when they benefit me personally. In my state I have lots of choices, and the marketplace website makes it pretty easy to compare policies. I like my insurance policy and the coverage it gets me. They have paid every time I thought they should, except one time when I found out we had a name-brand-prescription-drug-annual-deductible. Overall I am content with my individual situation. I will also add that when I retired, I did contemplate that health insurance and health care was in flux and the relevant laws might change, but I decided that I was optimistic that I would be able to find something that adequately meets my and my children's needs. I remain optimistic today in that regard.

4. No real difficulties except we pay out of pocket for dental expenses now, so I have downgraded our care from luxurious treatment to adequate treatment. It helped me to read a lot on these and other early retirement message boards so I could figure out how best to strategically maneuver. Other than the fact I'm divorced, my situation is pretty easy because I am still relatively young and my kids are all relatively healthy and have lived in the same state. Also, for me personally what works well is a low-premium, high-deductible plan, which is what I've been able to get so far both through my employer and the ACA.

 

[socca]

1) before ACA, $180/mo for a high-deductible plan. I used to complain bitterly about the annual premium increases (about 10 - 15%).
2) after ACA, $400/mo for a plan that was in some respects worse than I had before. For 2017, the only remaining major insurer was asking for $550/mo, which I refused to accept. No subsidy.
3) for me, ACA is an ongoing slow-motion disaster.
4) for 2017, I purchased off-exchange medically-underwritten non-ACA-compliant short-term (11 mo.) HI for $200/mo. Healthcare.gov involuntarily enrolled me in the BCBS of FL plan, and BCBS keeps sending me letters demanding that I pay the 2017 premiums to date despite my best attempts to tell them that I never enrolled & I'm not interested. C'mon folks, it's been 6 months - time to let me go.

Not looking for a debate or argument.

I am not subject to ACA and would like to understand how it did or did not benefit people in this forum. Briefly:

1) If you had it, what coverage and cost did you have prior to ACA?
2) How did that change (if it did) with ACA?
3) Do you perceive the change to be better or worse for you specifically?
4) Comments about your specific situation? Difficulties? Successes?

 

[pgiyer]

OP, thank you for this thread. This is something I have beeon thinking about. What interests me while reading the replies is the couple of posters who said they were not insurable prior to ACA. This is what I dread most since wife has many pre-existing conditions.
So to those posters, would you expand on your experience on being uninsurable? How did you deal with your health problems during that time?

 

[Surewhitey]

DW's coverage (she's part time and pays her own policy) is basic HD plan through Humana...$435 / month last year.
Humana dropped all coverages in TX and told her to go to the ACA website by them. BCBS plan was going to charge $600+ / month just for her.

My plan at work (subsidised and HD plan) went from $200 to $220 (reasonable). Then they upped the benefit by offering an HSA option and now for both of us it will be a pre-tax $606 ($456 effective) / month. Plus we get to put $6,700 into an HSA account and they give us the first $400. We feel like we hit the jackpot since we do not qualify for the ACA subsidies. Never taxed HSA's are awesome!

 

[Scuba]

We are in a pre ACA plan. Concerns we have about going with an ACA plan are:
1. Coverage network- our docs don't accept Covered CA, so we'd have to completely change our doctors. Not appealing.
2. Formulary - we don't want to lose the freedom to get the latest/greatest drugs in case one of us gets a serious medical condition.
3. Coverage when out of state - our current plan has coverage across state lines. ACA plans in our area don't.