Preview of 2018 ACA plans is LIVE

[HGTVfan]

For individual plans there are only 3 options - HMO, restricted network, and expanded network. BlueOptions is the expanded nationwide network. Their tool to see if a provider is in network is not the friendliest. It might be worth a phone call.

Something is wrong with the provider search for all of the FloridaBlue plans on healthcare.gov early preview. Nothing I’ve tried, including all the hospitals, shows as being in network. I’ll wait until Nov. 1 and if it still looks strange I’ll call. But I’m still reeling from the fact that my premium would more than double with my BlueOptions plan. All of the other Florida Blue plans look reasonable.

 

[wrl11]

I understand your frustration and that's a crazy premium, but that last paragraph is not at all accurate. The full amount goes to the insurance company, whether it comes from the insured or insured+govt subsidy. Whether that rate is fair is another question, but you aren't paying the insurance company extra so that someone else can pay them less. The subsidy comes from the government. I'm not sure exactly how that is funded, but it's not from money you are paying directly to the insurance company.

You are right technically, but in reality my statement is accurate. The gov't is funding the subsidies, but they would have to pay more subsidies if people like me didn't pay the full rate on the 80% premium increase. [mod edit]

 

[pb4uski]

I don't think that you are right at all.... your premium is based on expected claims for your cohort and provisions for administration, overhead and contribution to surplus (aka profit) so the premium that you pay is no different than it would be if there were no subsidies at all... that is the construct and if you look at a premium rate filing it is quite clear.... the rest is just a matter of where the premium dollars come from.

 

[zinger1457]

You are right technically, but in reality my statement is accurate. The gov't is funding the subsidies, but they would have to pay more subsidies if people like me didn't pay the full rate on the 80% premium increase.
[mod edit]

If your goal is to get this thread locked you may soon succeed but some of us do find it useful.

 

[wrl11]

I don't think that you are right at all.... your premium is based on expected claims for your cohort and provisions for administration, overhead and contribution to surplus (aka profit) so the premium that you pay is no different than it would be if there were no subsidies at all... that is the construct and if you look at a premium rate filing it is quite clear.... the rest is just a matter of where the premium dollars come from.

You would be correct if the government did not cap certain rates and allowed market pricing. But the government does dictate pricing. Why do you think companies are pulling out of obamacare markets or going bankrupt (like evergreen in maryland)? Do you think they are doing that because the government is allowing free market pricing accross the board? No, they are sticking it to people like myself to pay the bills for others.

 

[ivinsfan]

You would be correct if the government did not cap certain rates and allowed market pricing. But the government does dictate pricing. Why do you think companies are pulling out of obamacare markets or going bankrupt (like evergreen in maryland)? Do you think they are doing that because the government is allowing free market pricing accross the board? No, they are sticking it to people like myself to pay the bills for others.

Come on dude, please stop the political comments they aren't useful. You are not the only person upset about the price of health insurance, but this isn't the time or place for ranting.

 

[MichaelB]

Something is wrong with the provider search for all of the FloridaBlue plans on healthcare.gov early preview. Nothing I’ve tried, including all the hospitals, shows as being in network. I’ll wait until Nov. 1 and if it still looks strange I’ll call. But I’m still reeling from the fact that my premium would more than double with my BlueOptions plan. All of the other Florida Blue plans look reasonable.

Why not check directly with the Florida Blue “find a doctor” tool? It’s here https://providersearch.floridablue.com/providersearch/pub/index.htm

 

[HGTVfan]

Why not check directly with the Florida Blue “find a doctor” tool? It’s here https://providersearch.floridablue.com/providersearch/pub/index.htm

Gee, I thought this thread had been deleted yesterday afternoon. I must have overlooked it.

Yes, I've checked the provider database on FloridaBlue's site and everything looks OK.

Looking at the plans further on healthcare.gov, my best option looks like the BlueOptions Bronze plan which is MUCH less expensive for me - about $275 compared to $975 for Silver. Higher deductibles and co-pays but that is fine.

 

[pb4uski]

You would be correct if the government did not cap certain rates and allowed market pricing. But the government does dictate pricing. Why do you think companies are pulling out of obamacare markets or going bankrupt (like evergreen in maryland)? Do you think they are doing that because the government is allowing free market pricing accross the board? No, they are sticking it to people like myself to pay the bills for others.

There is a backasswards constraint on rates with the 80% medical loss ratio limit, but the reality is that a lot of policies were about that ratio before Obamacare went into effect so Obamacare mostly codified what was common practice at the time... we know this since the magnitude and frequency of rebates was fairly modest.

Companies are not pulling out of Obamacare because of the MLR constraint (which in your parlance "caps" rates), but rather due to other factors.

Ironically, because of the MLR contraint that you loathe, the insurers can't "stick it" to anyone since the MLR effectively caps overhead and profit at 20%.... what is causing the price increase that we are seeing are increases in medical costs driving up claims... since claims are 80% or more of premium costs by law.

 

[Z3Dreamer]

Early 60's couple, subsidy at $64,960 is $2,399, cost of only bronze HSA is $2,178. No other bronze is available. Cost of lowest silver is $2,808. Silver has co-pays of $25 for primary and $75 for specialists, but otherwise deductible and OOP maximum are not too different.

I ran a scenario where I pretended we had a bunch of specialists and primary visits and what the differences would be. Looks like the silver would save us about $2,200 OOP, however, the premiums would cost us a rounded $4,800. Net is that the bronze is about $2,600 cheaper before I consider HSA savings.

I do not see a scenario where the silver makes sense for me. Anyone in a similar situation?

 

[FIREd]

Early 60's couple, subsidy at $64,960 is $2,399, cost of only bronze HSA is $2,178. No other bronze is available. Cost of lowest silver is $2,808. Silver has co-pays of $25 for primary and $75 for specialists, but otherwise deductible and OOP maximum are not too different.

I ran a scenario where I pretended we had a bunch of specialists and primary visits and what the differences would be. Looks like the silver would save us about $2,200 OOP, however, the premiums would cost us a rounded $4,800. Net is that the bronze is about $2,600 cheaper before I consider HSA savings.

I do not see a scenario where the silver makes sense for me. Anyone in a similar situation?

Same situation for me.

My Bronze HSA PPO plan went up 5%, from $830 a month to $870 before subsidy (2 people, age 43). After subsidy, the cost has fallen to $0 all the way to 400% of FPL. I was thinking of upgrading to the Gold Plan for 2018 (cheaper than what I paid for the Bronze HSA plan in 2017, after subsidies) but the Bronze HSA plan remains the cheapest option, even when maxing out of pocket costs. DW and I have been very light consumers of healthcare for over a decade, so we'll probably take the calculated risk to stick with the Bronze HSA plan in 2018.

 

[Blueskies123]

Reporting in... My bronze HSA plan went up, but not as much as expected. The subsidy more than doubled. One bronze plan is being offered for $1.22 a month for DW and I.

This doesn't seem right, so now I have to figure out what is going on between the silver and bronze plans.

It looks like my subsidy exceeds the cost of the bronze plan(cost = 1,033.66) by $300. But they will still charge me $22.00 per month.

So, this means I can get a better plan(cost = 1,399.69) with 1/2 the family deductible for $56 per month.

Comparing 2018 to 2017, I will spend $300 per month less and get a Bronze HSA plan with 1/2 the deductible.

I wonder if the insurance companies are gaming the prices of the silver plans to force the government to spend more on the plan subsidies?

You seem to be saying you are getting a subsidy on a Bronze plan. If I read your post correct I am pretty sure you only get subsidies on silver plans.

 

[Sue J]

Just to clear up what "refundable" means ...

If you pay more taxes than you owe, via withholding or estimates payments, you get a refund of your overpayment.

Some tax credits are called "refundable" because you can get back money that you did not pay in. For example, the Child Tax Credit or the Earned Income Tax Credit.

Other credits are not refundable. You cannot get back more than you put in.

The ACA subsidy in non-refundable. If your premium subsidy was too small all year and then you reconcile at tax time, you can be reimbursed for your insurance premium that you overpaid. But you will not have that reduced to less than zero and get back more than what you paid in premiums.

https://www.irs.gov/pub/irs-pdf/f8962.pdf
Column A (Annual Enrollment Premiums) is compared with Column D (Annual Maximum Premium Assistance) to come up with Column E (Annual Premium Tax Credit Allowed - smaller of Column A or D). So your Annual Premium Tax Credit is limited to the Annual Premium Amount.

I hope I've explained that well enough, if not chime in and clear it up.

Gee, I thought this thread had been deleted yesterday afternoon. I must have overlooked it.

Nice to see this thread is back. It was missing late yesterday.

 

[Blueskies123]

I think something might be weird with the BlueOptions and other FloridaBlue networks. Maybe with this early look. I put in the main hospital I would use and my primary care doctor and neither is in network.

If you are looking for your doctor on the ACA web site I found that their information is woefully lacking. Try checking on the BCBS web site. I found a link on the ACA site to the BCBS provider list. On the ACA site they said none of my doctors were in network. On the BCBS site all my doctors were in network.

 

[scrabbler1]

New York's Marketplace (Exchange) won't open until November 1st, which is when my insurance company's (OSCAR) plan info will become available. I did receive a few months ago an estimate of what the rate for my Silver plan will be. I was considering switching to a Bronze plan but after reviewing their current (2017) benefits, I saw that the prescription drug coverage was lousy, and I have a costly (Tier 2) drug. The Gold plan's drug coverage is the same as the Silver plan's but the premiums are much higher. I can get my drugs locally instead of relying on that terrible Express Scripts mail-order outfit, too.


Finding a plan which has all 3 of my main doctors was very tough 2 years ago when I switched to OSCAR. I nearly lost 2 of them a year ago but they remained in OSCAR's network. Looks like I will stick with the Silver plan assuming I remain with OSCAR.

 

[Texas Proud]

You seem to be saying you are getting a subsidy on a Bronze plan. If I read your post correct I am pretty sure you only get subsidies on silver plans.

You might be confusing subsidy with cost sharing...

Subsidy is based on income and applies to any metal plan...

Cost sharing is also income based, but reduces copays and deductibles and is only on silver...

 

[Mr._Graybeard]

If you are looking for your doctor on the ACA web site I found that their information is woefully lacking. Try checking on the BCBS web site. I found a link on the ACA site to the BCBS provider list. On the ACA site they said none of my doctors were in network. On the BCBS site all my doctors were in network.

I did this the first year of ACA -- relied on the Wisconsin Blue Cross website to check their network rather than Healthcare.gov. After we'd enrolled, I found that the network for the ACA plan was narrower than Blue Cross' network outside the marketplace, and my wife's PCP was out of network. Just my experience.

 

[Z3Dreamer]

Just to clear up what "refundable" means ...

The ACA subsidy in non-refundable.If your end of the year subsidy was too small all year and when you reconcile at tax time, you can be reimbursed for your insurance premium that you overpaid. But you will not have that reduced to less than zero and get back more than what you paid in premiums.

You do point out that you can get money back if you overpaid. I thought I would give an example.

It is refundable to the extent that if you guessed your income too low, you would get a refund. For example, if my premiums were $2,000 a month, my estimated income yielded a premium tax credit of $1,600 a month, but my actual income yielded a premium tax credit of $1,800 a month, I would get a $200 per month refundable credit.

 

[Sue J]

I did this the first year of ACA -- relied on the Wisconsin Blue Cross website to check their network rather than Healthcare.gov. After we'd enrolled, I found that the network for the ACA plan was narrower than Blue Cross' network outside the marketplace, and my wife's PCP was out of network. Just my experience.

Yes, we found that some insurers have a narrow network for the ACA marketplace plans.

One plan was called SummaCare Select and the network was the same as the non-ACA plans. They offered another plan for a lower amount that was called SummaCare Connect. The provider network was much smaller.

 

[Texas Proud]

You do point out that you can get money back if you overpaid. I thought I would give an example.

It is refundable to the extent that if you guessed your income too low, you would get a refund. For example, if my premiums were $2,000 a month, my estimated income yielded a premium tax credit of $1,600 a month, but my actual income yielded a premium tax credit of $1,800 a month, I would get a $200 per month refundable credit.

I guess I should have phrased my original question better...

Can you get a 'refund' for a credit you could use but do not...

IOW, if your qualify for $1500 credit but your insurance only cost $1000... what happens to that $500 you did not pay for insurance?

The answer is nothing... it is not yours no matter what (from the post given)....

 

[ivinsfan]

True so if you pick a bronze plan where you cost is 0, you have left some of your subsidy money on the table.

 

[RunningBum]

I guess I should have phrased my original question better...

Can you get a 'refund' for a credit you could use but do not...

IOW, if your qualify for $1500 credit but your insurance only cost $1000... what happens to that $500 you did not pay for insurance?

The answer is nothing... it is not yours no matter what (from the post given)....

Right, so you could look at a "better" plan with a lower deductible/OOP max, and/or better payments toward care after deductibles, which might cost you the same after a $1500 credit. Or, if you are tweaking income, go ahead and take more income (staying short of the 400% cliff) to where you get a $1000 subsidy rather than $1500, in this example.

 

[Trawler]

Here in Columbus OH the SLSP price sky rocketed so with that so did our estimated subsidy from $937 to $1,348 our Bronze HSA Compatible plan only went $934 to $1180 per month on MAGI of $30K . Yes we pay zero in premium this year and will pay zero in 2018 and will be able to take MAGI to $42K and still get 'free' Bronze plan. We live off our non qualified accounts and cash savings and manage our income from Roth conversions.

 

[golfnut]

Here in Illinois found only one HSA compliant plan - Blue Cross bronze plan.

 

[rodi]

If you want to, post your age and full price of your SLCSP for an individual. It should be interesting to see how they vary by area.

.

Age 56, full price of SLCSP is $719.90. This is for San Diego.

Other oddities... For my insurer... A gold plan is less expensive than the silver.
Kaiser Permanente. Gold HMO 80 is 759.24. Silver is 788.40

My bronze HMO HSA HDHP with Kaiser went up 25% for myself and my teenagers. But it's still $400+ less a month than the gold or silver plan.

This data is for full price. We will get an ACA premium tax credit - but I prefer to pay up front and get any PTC at tax time after last year having my kids forced onto to mediCAL erroneously - and it taking a few months to get this error corrected.