ACA Sticker Shock

[ivinsfan]

Big +1
We are on the other side of the state from SWR.
Like SWR, one of is on Medicare and one on ACA.

Premiums = 119 monthly and that doubled from last year due to allowing a new provider in with the 2nd lowest Silver plan cost.

Max OOP = 2900 Yearly

Most copays are zero or $5.

I have access to all my doctors within a 5 mile radius and no doctor around here has turned it down. (Florida Blue Silver)

MAGI is kept just below 150% of FPL.

The OP asked about the cost of ACA and how it seems to be rising..it would more helpful IMO if posters like you posted rack rate and subsidized rate.

 

[Dtail]

The OP asked about the cost of ACA and how it seems to be rising..it would more helpful IMO if posters like you posted rack rate and subsidized rate.

Fair enough.
Off the top of my head without subsidies, the premiums would go from 1,500 yearly to 13,000 yearly. I don't have the other figures offhand.

 

[pb4uski]

Thought some of you contemplating ER may be interested in my experience just now pricing ACA plans as my COBRA is now ending 18 months after my own ER..

First, I have a grand total of ONE PPO provider (BCBS) to "choose" from in my area. ONE.

Cheapest PPO in my zip code is $652.91, with a (get this) $8,150 (!!!) deductible. Basically, I get to pay almost $8,000 per year ($7,834 in premiums) for ONE mid 50s age person, THEN all of my expenses at 100% until I hit ANOTHER $8,150. Then, and only then, does the plan start to pay.

Obviously, this is nearly $16,000 in cash outlay per year for ONE person, mid 50s, before the plan pays a penny.

Yeah, I'm not even remotely happy. They sure "fixed" our healthcare system, alrighty.

Those of you considering ER should take a very close look at the HC costs before pulling the trigger..

Actually, what you outline is pretty common.

When I retired in 2012 our company COBRA was $450 and that is what I planned on and with inflation would be about the cost that you are looking at. We have ended up paying less than that.

Think of it as wealth insurance, not health insurance. If you have a serious illness that racks up $250k in medical bills your cost is only $16k. Plus, you get access to negotiated rates for health care services.

BTW, we never come close to the full deductible.... we average $1-2k a year for medical services.... so unless you routinely fill up the deductible to assume that you will is foolish.

Think of the excess of what you will pay in ER over what you pay now while working as part of the cost of freedom to do whatever you want everyday.... you're either willing to pay it or not.... if not, then keep on working.

 

[ivinsfan]

Fair enough.
Off the top of my head without subsidies, the premiums would go from 1,500 yearly to 13,000 yearly. I don't have the other figures offhand.

Thanks.. some people are mentioning moving for cheaper HC and you if quote rack rate I don't think there is enough difference in price to offset the hassle of moving...

To me moving would be like the tail waving the dog..wouldn't make sense. Your cost Dtail would be reduced no matter where you live because of your income.

 

[ShokWaveRider]

For DW the Rack is just shy of $1000pm.

 

[ivinsfan]

For DW the Rack is just shy of $1000pm.

IF I remember you guys were one of the couples where the monthly cost did not drop for ACA when you joined Medicare so your costs actually went up.

Something to remember for budgeting purposes.

 

[pb4uski]

Rack/unsubsidized rates for BCBS VT... $545 bronze to $900 Platinum for a single.

https://www.bcbsvt.com/sites/defaul...d-family-plan-comparison-chart-rev10.2019.pdf

 

[ivinsfan]

Rack rates for BCBS VT... $545 bronze to $900 Platinum.

https://www.bcbsvt.com/sites/defaul...d-family-plan-comparison-chart-rev10.2019.pdf

That seems to be a decent rate all things considered.

 

[ShokWaveRider]

IF I remember you guys were one of the couples where the monthly cost did not drop for ACA when you joined Medicare so your costs actually went up.

Something to remember for budgeting purposes.

Yes but that is not the rack, that is from what we were paying after subsidies. My Last ACA Monthly was actually $0 my cost but about $300 for the year 2018 after copays etc. Now I pay $352pm all in with a part G supplement. But I am not complaining at all, as now I know exactly what my costs are and can budget accordingly. One misfortune with ACA and the max OOP + whatever would have been unpredictable. So all good with medicare.

 

[ivinsfan]

Yes but that is not the rack, that is from what we were paying after subsidies. My Last ACA Monthly was actually $0 my cost but about $300 for the year 2018 after copays etc. Now I pay $352pm all in with a part G supplement. But I am not complaining at all, as now I know exactly what my costs are and can budget accordingly. One misfortune with ACA and the max OOP + whatever would have been unpredictable. So all good with medicare.

I don't complain about Medicare costs either, because of the reason you just mentioned no more policy and cost of OOP roulette every year at signup time. And besides it wouldn't help to complain nothing to be done about it.

 

[Dtail]

I don't complain about Medicare costs either, because of the reason you just mentioned no more policy and cost of OOP roulette every year at signup time. And besides it wouldn't help to complain nothing to be done about it.

Yup.
If the ACA generic concept remains in place, I expect my Medicare costs to be higher, which is 4 years from now, but will have more peace of mind.

 

[Dtail]

Thanks.. some people are mentioning moving for cheaper HC and you if quote rack rate I don't think there is enough difference in price to offset the hassle of moving...

To me moving would be like the tail waving the dog..wouldn't make sense. Your cost Dtail would be reduced no matter where you live because of your income.

Agree as a general point. We planned for Florida and the ACA net costs was a bonus.
On the flip side, yes the subsidies would reduce my costs no matter where we lived, but the unsubsidized base in many states starts much higher, plus the access to a wide network is shakier in many counties all over.

 

[daylatedollarshort]

We manage our income for ACA subsidies, and when our kids were in college luckily our state grant program had similar maximum income limits. That was like $30k - $40K a year in savings on tuition and health insurance premiums combined. It has been easier for me to keep our expenses low and stay under the ACA cliff than work part-time in retirement and have to earn the equivalent of $25K - $40K in after tax money.

Before the ACA, we had a $50K medical expense year with a pricey post COBRA plan but that was one of the few plans we qualified for. That included one expensive surgery with out of network and some medical travel costs. Now our premiums with the ACA are only $2 a month plus deductibles. Our deductibles with a bronze plan are are high if we need care, but still our highest ACA year was around $7K, not $50K as it was pre-ACA.

If the ACA hadn't come along we were thinking of moving outside the country. There's first world countries where we could live well on $50K a year in total living expenses, not just pay that amount for medical care alone.

 

[ceciledian]

Thought some of you contemplating ER may be interested in my experience just now pricing ACA plans as my COBRA is now ending 18 months after my own ER..

First, I have a grand total of ONE PPO provider (BCBS) to "choose" from in my area. ONE.

Cheapest PPO in my zip code is $652.91,

You have a PPO? Texas hasn’t offered PPOs since 2015. Even my last employer went with POS/HMO. We’ve been on BCBS Bronze HMO for 2 years now and pay $352/month after subsidy. Decent doctors, referral specialist easy. The subsidy is merely a tax break, i.e. I doubt many people would buy rental property if they couldn’t get all the write-offs.

 

[pb4uski]

Yup.
If the ACA generic concept remains in place, I expect my Medicare costs to be higher, which is 4 years from now, but will have more peace of mind.

Yes, that is the way it will be for us. Medicare all-in is only slightly higher monthly premium cash out than ACA ($286 vs $267) but coverage is far better so deductible and co-pays will be next to nothing on Medicare ($195 I think) vs $8,150 for ACA.

 

[ivinsfan]

You have a PPO? Texas hasn’t offered PPOs since 2015. Even my last employer went with POS/HMO. We’ve been on BCBS Bronze HMO for 2 years now and pay $352/month after subsidy. Decent doctors, referral specialist easy. The subsidy is merely a tax break, i.e. I doubt many people would buy rental property if they couldn’t get all the write-offs.

You really want to compare rental property with HI

 

[youbet]

Health insurance of every type is just very expensive.

Because the costs the health insurers cover are very high! I fully understand that insurance companies have administrative costs and make a profit. But that's all pretty transparent. The real issue is the size of the costs they have to cover.

 

[youbet]

Yes, that is the way it will be for us. Medicare all-in is only slightly higher monthly premium cash out than ACA ($286 vs $267) but coverage is far better so deductible and co-pays will be next to nothing on Medicare ($195 I think) vs $8,150 for ACA.

Medicare co-pays are 20%. That's $20k on a $100k hospital stay.

 

[aja8888]

Medicare co-pays are 20%. That's $20k on a $100k hospital stay.

That's the reason why you buy a Medigap policy.

 

[pb4uski]

Medicare co-pays are 20%. That's $20k on a $100k hospital stay.

No, because the all-in of $286 that I quoted includes Medigap coverage which covers almost all of that.

 

[Gumby]

No question. And that's where we probably should direct our attention. Why are the costs so high and what can we do about it?

Because the costs the health insurers cover are very high! I fully understand that insurance companies have administrative costs and make a profit. But that's all pretty transparent. The real issue is the size of the costs they have to cover.

 

[badatmath]

Last time I checked (couple years ago) we did not have any PPO in my state. One would be nice.

 

[Rainbowdash]

Just like any other insurance I would like to be the one paying and not receive benefits to help the less fortunate, HC is no different, I’m happy to pay the unsubsidized premium, and hope to rarely use it, I’ve been doing this since I retired last year, it was $1140 per month, now $1260 for a family of 3. Deductible and OOP max around $6500 per person.

 

[nobody]

Indeed. I also paid for schools I didn't send children to. I donated 1% of my income to KCMO for 29 years. If I lived there I would have been able to VOTE about the tax but I didn't. I was taxed for a local tax and had zero representation in this matter.

Life and taxes are not always equal or fair.

+1
20 years for me, exact same situation.

 

[Big_Hitter]

Just like any other insurance I would like to be the one paying and not receive benefits to help the less fortunate, HC is no different,

yep, it's insurance so there is a pooling feature - ACA plans are meant to indemnify, not to cover 100% of your costs like a company group plan, for example

for retirement, I just took the premiums plus OP max and used that for my budget