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Old 10-31-2013, 05:36 PM   #21
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We just got the premiums next year for DH's retiree coverage:

Unsubsidized:

Regular PPO - per month - $1852 for retiree and spouse; $5370 for retiree and family (this would be a retiree with spouse and children)

HDHP - per month - $1518 for retiree and spouse; $2001 for retiree and family

Thankfully, we get subsidized coverage:


Regular PPO - per month - $2780 for retiree and spouse; $3665 for retiree and family (this would be a retiree with spouse and children)

HDHP - per month - $954 for retiree and spouse; $1256 for retiree and family

I can't imagine anyone choosing to go for the regular PPO which has a $750 deductible versus the HDHP which was a $3000 deductible (these are family deductibles).

In our case, DH is on Medicare so we need coverage for me and kids and that is $780 a month on the subsidized plan. Not horrible - but an increase of $301 a month from this year!


Luckily
Plans that have super low deductibles and max OOP are going to have very high monthly premiums. The Regular PPOs I'm looking at are more like just under $300 Bronze for an individual, mid-50s, if you are willing to handle the $5000 deductible. That's a lot lower than what some of you are posting.

It seems to me that most of us had the equivalent of silver or gold plans: deductible not so high, copays for many services, low coinsurance, etc., and the premiums that we or our employer paid were quite high. These Bronze plans offer something new, I think.
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Old 10-31-2013, 06:33 PM   #22
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Plans that have super low deductibles and max OOP are going to have very high monthly premiums. The Regular PPOs I'm looking at are more like just under $300 Bronze for an individual, mid-50s, if you are willing to handle the $5000 deductible. That's a lot lower than what some of you are posting.

It seems to me that most of us had the equivalent of silver or gold plans: deductible not so high, copays for many services, low coinsurance, etc., and the premiums that we or our employer paid were quite high. These Bronze plans offer something new, I think.
We are sticking with the retiree coverage for at least the next year. The subsidized rate seems to be favorable compared to exchange policies. I can't imagine with the retiree coverage why anyone would go PPO rather than the high deductible plan we are on. The difference in premium cost is $18k a year! And there aren't enough differences in the policies to make to worthwhile.

I did notice while browsing exchange policies that most seemed to have higher premiums than we are currently paying for subsidized coverage and that the deductibles and OOP max were significantly higher.

We will reevaluate it in a year.
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Old 10-31-2013, 06:40 PM   #23
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We are sticking with the retiree coverage for at least the next year. The subsidized rate seems to be favorable compared to exchange policies. I can't imagine with the retiree coverage why anyone would go PPO rather than the high deductible plan we are on. The difference in premium cost is $18k a year! And there aren't enough differences in the policies to make to worthwhile.

I did notice while browsing exchange policies that most seemed to have higher premiums than we are currently paying for subsidized coverage and that the deductibles and OOP max were significantly higher.

We will reevaluate it in a year.
This just really surprises me as I'm not seeing high prices to stay in our PPO and it'll be quite a bit less that I was paying in the high risk pool.

There must be huge discrepancies between states.
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Old 10-31-2013, 07:34 PM   #24
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This just really surprises me as I'm not seeing high prices to stay in our PPO and it'll be quite a bit less that I was paying in the high risk pool.

There must be huge discrepancies between states.
I am in the same state you are.

But I'm not sure you are comparing the same thing I've comparing.

DH is in a group of retirees where Megacorp subsidizes the premium. However, a few years ago they limited the premium increases they would subsidized to 5% per year. When DH retired the cost for the coverage I have now (me and the kids) was about $180 a year for the $3000 deductible PPO plan (this was the high deductible plan). The regular non-high deductible plan (it is $750 a year) was a little over $1000 a month. The big premium increases were last year (up to $479 a month) and then now increased to $780 a month for next year.

I went to ValuePenguin | Insuring Your Decisions With Data to find plans in my area to get an idea of what exchange plans would cost.

There are unsubsidized plans that are about the same as or cheaper than the $780 we are paying now but the deductible is vastly different. The family deductible we have now is $3000 while these call for family deductibles of $12700 a year. Big difference to the $3000 deductible we have now. (It is unclear on the exchange plans if the entire family deductible has to be met before anything is paid even if the individual deductible was met. On our HSA plan nothing is paid until the family deductible is met. Even so the individual deductibles on these exchange plans are higher than our current family deductible).

For example, Aetna bronze PPO plan was $764 a month with $6350 individual deductible and $12700 family deductible. After that most everything is paid for in network ($20 copay for primary visits). Out of network coinsurance is 50% (I have 60% now) with family deductible of $25,400 (now our out of network deductible is $5000).

Cheapest Silver non-HMO plan that was information online is Cigna at $864 a month (almost $100 a month more than we will be paying with DH's retiree coverage) with $2750 individual deductible and $5500 family deductible with 20% coinsurance. Coinsurance is similar to what we have now but the deductible is much higher with the premium higher.

So for us with premiums subsidized by Megacorp we have a better deal currently with retiree coverage. (We are not eligible for exchange subsidies and getting our income to the level to be eligible would be challenging for the next few years while we still have kids in college).

Some retirees of Megacorp, however, get retiree coverage from Megacorp which is unsubsidized. For them, the coverage DH and I would pay $780 for next year would cost them $1242 a month. Exchange coverage could very well be a better deal for them.
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Old 10-31-2013, 08:17 PM   #25
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I see that you have children involved, and that obviously makes a difference.

But for DH and me in our mid and late 50s, a Bronze BCBS PPO with $5000 deductible 20% coinsurance would be around $645 a month together unsubsidized. So I'm scratching my head at these higher numbers.

To get down to a $3000 deductible, doctor visit copays, etc, we would need the Silver PPO and pay $908 a month together, unsubsidized. We would rather apply the premium difference toward the higher deductible, if needed.

This is all less than we are paying now.

My quotes are coming directly from the insurance companies for my county and our birth dates. The deductibles are for each individual.
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Old 10-31-2013, 08:54 PM   #26
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I see that you have children involved, and that obviously makes a difference.

But for DH and I in our mid and late 50s, a Bronze BCBS PPO with $5000 deductible 20% coinsurance would be around $645 a month together unsubsidized. So I'm scratching my head at these higher numbers.
This sounds about right to me, since I can get the cheapest PPO (not HMO) for about $260 a month at age 48, before subsidy, also from BCBS TX. The HMO is just a shade over $200 for me (with $6000 deductible, if it applied to me). I'm trying to figure out where these $1500 per month horror stories are coming from, because I don't see it. Even if you added 50% for tobacco usage per the law or changed the age from 48 to 64, I don't see coming close to that.
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Old 10-31-2013, 08:56 PM   #27
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My current pre-APA PPO policy for the two of us in the 55+ age group is $552/month. That is the new premium that they sent us last month, and will be valid till 10/2014. I assume that they are not going to cancel the whole plan, else they would let me know by now.

The policy is extremely simple. We pay for 100% up to $10,000 a year. After that, the insurer pays 100%. The policy does not cover drugs, and that may make a difference.

When I dropped my 24-yr old son who has his own HI now, the premium was reduced by around $50. Youngsters rarely get sick, but that still surprised us.

Also last month, they reimbursed us for $46 for the premium rebate, which means they did not overcharge.

If I go to an ACA plan, what I have seen so far indicates that I will likely need a subsidy because the premium will be higher.
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Old 10-31-2013, 09:01 PM   #28
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The policy does not cover drugs, and that may make a difference.
Will that even be allowed the next time your policy renews (10/2014)? I thought all ACA-compliant policies had to cover prescriptions?
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Old 10-31-2013, 09:02 PM   #29
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Mine is pre-ACA, so is not ACA-compliant. Does it have to change?

I like my policy because my OOP is very simple. If we are 100% healthy, our expenses will be just the premium of $552X12 = $6624 plus a few hundred for annual exams.

If we are really sick, it will be $16,624 (premium+deductible), plus some prescription drugs which so far are not a whole lot.
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Old 10-31-2013, 09:08 PM   #30
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Mine is pre-ACA, so is not ACA-compliant. Does it have to change?
Not necessarily. But if your plan decides to significantly change (increase) the copayments, deductibles or out of pocket limits, if they change those numbers it *could* lose its grandfathered status. Apparently quite a few people are seeing this happen now.
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Old 10-31-2013, 09:12 PM   #31
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I see that you have children involved, and that obviously makes a difference.

But for DH and me in our mid and late 50s, a Bronze BCBS PPO with $5000 deductible 20% coinsurance would be around $645 a month together unsubsidized. So I'm scratching my head at these higher numbers.

To get down to a $3000 deductible, doctor visit copays, etc, we would need the Silver PPO and pay $908 a month together, unsubsidized. We would rather apply the premium difference toward the higher deductible, if needed.

This is all less than we are paying now.

My quotes are coming directly from the insurance companies for my county and our birth dates. The deductibles are for each individual.
I suspect you also live in a part of Texas that is lower cost. While he aren't in Houston, we are in an adjacent county and premiums are higher.

I'm using the plans on Valuepenguin (link in my past post) where you can put in County and family age and size. In our case, it is just me and 2 teenagers (one over 18). DH is already on medicare.
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Old 10-31-2013, 09:12 PM   #32
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Not necessarily. But if your plan decides to significantly change (increase) the copayments, deductibles or out of pocket limits, if they change those numbers it *could* lose its grandfathered status. Apparently quite a few people are seeing this happen now.
The $10K deductible will eventually get encroached by the rising healthcare cost, and which means the premium will be so high that it is no longer a high-deductible plan, and no longer attractive to people who prefer such a plan. This plan will not last forever.

By the way, we have had this $10K deductible for several years, and the savings in the premium allows us to save up near $40K in an HSA. We have spent $20K of that in 2 consecutive years.

This insurer does not offer any ACA plan in my state. I do not know about its participation in other states.
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Old 10-31-2013, 09:15 PM   #33
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Mine is pre-ACA, so is not ACA-compliant. Does it have to change?

I like my policy because my OOP is very simple. If we are 100% healthy, our expenses will be just the premium of $552X12 = $6624 plus a few hundred for annual exams.

If we are really sick, it will be $16,624 (premium+deductible), plus some prescription drugs which so far are not a whole lot.
The drug thing. If you have to fight cancer, the drugs are incredibly expensive and usually cost way more than anything else. Chemotherapy drugs can run $10K a month.
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Old 10-31-2013, 09:17 PM   #34
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I suspect you also live in a part of Texas that is lower cost. While he aren't in Houston, we are in an adjacent county and premiums are higher.

I'm using the plans on Valuepenguin (link in my past post) where you can put in County and family age and size. In our case, it is just me and 2 teenagers (one over 18). DH is already on medicare.
Our area is not one of the cheapest zones. Not the most expensive, but the next most I think.
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Old 10-31-2013, 09:22 PM   #35
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The drug thing. If you have to fight cancer, the drugs are incredibly expensive and usually cost way more than anything else. Chemotherapy drugs can run $10K a month.
I should have read the fine print a lot more carefully.

However, my son last year and myself this year were treated with drugs under professional care, and we did not have to pay. However, minor prescription drugs we picked up at the pharmarcy, we had to pay.
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Old 10-31-2013, 09:26 PM   #36
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I should have read the fine print a lot more carefully.

However, my son last year and myself this year were treated with drugs under professional care, and we did not have to pay. However, minor prescription drugs we picked up at the pharmarcy, we had to pay.
Drugs administered in office covered - that makes much more sense.
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Old 11-01-2013, 07:07 AM   #37
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This just really surprises me as I'm not seeing high prices to stay in our PPO and it'll be quite a bit less that I was paying in the high risk pool.

There must be huge discrepancies between states.
Yes. There are also huge differences within the states. Florida has one of the highest number of policy offerings. I build a spreadsheet to look at our choices and there are differences of 2.5x among policies for similar coverage. Medical loss ratio limit profits, so I assume the difference is driven by network.

My short list is down to 2 carriers, 2 policies each. Both are national (BCBS & Humana) with national network coverage and there still is a premium difference of almost 30%.
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Old 11-01-2013, 08:21 AM   #38
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Yes. There are also huge differences within the states. Florida has one of the highest number of policy offerings. I build a spreadsheet to look at our choices and there are differences of 2.5x among policies for similar coverage. Medical loss ration limit profits, so I assume the difference is driven by network.

My short list is down to 2 carriers, 2 policies each. Both are national (BCBS & Humana) with national network coverage and there still is a premium difference of almost 30%.
And then there is MS who only has one carrier offered in my county, Magnolia Health. They handle the state's medicaid program. A very limited network for my area too. Of course my doc is not on the list and one of our 2 hospitals not included. Their rates are also well above the national average.

So if you are uninsured it beats nothing. But if you want something half way decent, you will have to go outside the exchange and forget subsidies. Maybe other options will be added for 2015.
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Old 11-01-2013, 09:03 AM   #39
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This sounds about right to me, since I can get the cheapest PPO (not HMO) for about $260 a month at age 48, before subsidy, also from BCBS TX. The HMO is just a shade over $200 for me (with $6000 deductible, if it applied to me). I'm trying to figure out where these $1500 per month horror stories are coming from, because I don't see it. Even if you added 50% for tobacco usage per the law or changed the age from 48 to 64, I don't see coming close to that.

Just to let you know, I have two low quotes from BCBS in the mid $600s.... the next price level is in the mid $800s...

There are many gold plans in the $1400 to $1500 range...

The one platinum plan is over $1800....


I see where the price is high!!!



Edit to add: checking the price for the low cost HMO.... it is in the mid $400s, so the increase is 40ish%....
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Old 11-01-2013, 11:06 AM   #40
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Just to let you know, I have two low quotes from BCBS in the mid $600s.... the next price level is in the mid $800s...

There are many gold plans in the $1400 to $1500 range...

The one platinum plan is over $1800....


I see where the price is high!!!



Edit to add: checking the price for the low cost HMO.... it is in the mid $400s, so the increase is 40ish%....
Is this for two people, or one?

What I am seeing is that a PPO costs about 30% more than the corresponding HMO plan.

Yes, the Gold+ plans are super expensive.
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