ACA Rate Increases For 2019

[ShokWaveRider]

You probably need to be in zip code 33647.

We are in 32080, but you need to keep that MAGI down for 2 insured people to $30k (for a 2 person household) and for one insured spouse to $22,850 (Again for a 2 person household).

I cannot understand why it differs so when only 1 person is being insured and the other is on Medicare. The amounts above are for a 2 person household income. We will need to shelter some income in 2019, probably with a 3 year MYGA.

 

[ShokWaveRider]

I posted DW's 2019 1443C Plan Summary here for your enjoyment.

http://www.early-retirement.org/forums/f38/share-your-aca-signup-experience-94548.html#post2135719

 

[Dtail]

We are in 32080, but you need to keep that MAGI down for 2 insured people to $30k (for a 2 person household) and for one insured spouse to $22,850 (Again for a 2 person household).

I cannot understand why it differs so when only 1 person is being insured and the other is on Medicare. The amounts above are for a 2 person household income. We will need to shelter some income in 2019, probably with a 3 year MYGA.

Yes agree with your thoughts.
I have an unusual situation in that my brother who lives with us is my dependent from a tax perspective, but I don't need to include my DGF's income as household income, since we aren't married and she is already on Medicare.

 

[bobandsherry]

We are in 32080, but you need to keep that MAGI down for 2 insured people to $30k (for a 2 person household) and for one insured spouse to $22,850 (Again for a 2 person household).

I cannot understand why it differs so when only 1 person is being insured and the other is on Medicare. The amounts above are for a 2 person household income. We will need to shelter some income in 2019, probably with a 3 year MYGA.

I must be misunderstanding what you are saying. In Hillsborough County the $30K MAGI doesn't get you the "C" plan. Just checked by putting in 32080 (St. John) and don't see the "C" plan offered either with the $30K MAGI. Only found that "C" plan offered when I put in $24,500. So is there something you are doing differently?

 

[Dtail]

I must be misunderstanding what you are saying. In Hillsborough County the $30K MAGI doesn't get you the "C" plan. Just checked by putting in 32080 (St. John) and don't see the "C" plan offered either with the $30K MAGI. Only found that "C" plan offered when I put in $24,500. So is there something you are doing differently?

In Hillsborough zip 33647, one does get the "C" plan with $24k. I am guessing that you saw the plan for "1443" when you looked up the info. However when you look into the details (Summary of Benefits), you will see that the plan is actually 1443C. Not sure why it shows this way, but I assure you it is the 1443C plan, as I have this specific plan.

 

[bobandsherry]

In Hillsborough zip 33647, one does get the "C" plan with $24k. I am guessing that you saw the plan for "1443" when you looked up the info. However when you look into the details (Summary of Benefits), you will see that the plan is actually 1443C. Not sure why it shows this way, but I assure you it is the 1443C plan, as I have this specific plan.

As I said I see it for $24,500:

Only found that "C" plan offered when I put in $24,500. So is there something you are doing differently?

But SWR said $30K, or I misunderstood what they were saying:

We are in 32080, but you need to keep that MAGI down for 2 insured people to $30k (for a 2 person household) and for one insured spouse to $22,850 (Again for a 2 person household).

 

[DanP]

Well, this will probably get lost given this thread is 17 pages, but just got the 2019 renewal letter for our Bronze it will cost us $22.8k in premiums alone. High deductible.

Not many options, we used to be Silver way cheaper 2 years ago.

Crazy.

 

[Dtail]

As I said I see it for $24,500:



But SWR said $30K, or I misunderstood what they were saying:

Okay I now see and agree with your statement. When MAGI is less than 150% FPL, the plan is 1443C. When MAGI is at 30k, then it "converts" to a 1443B plan.
The main difference is the change in deductible and maximum OOP.

So I guess SWR can explain why his >150% FPL 1443 plan is the "C" version.

 

[ShokWaveRider]

I must be misunderstanding what you are saying. In Hillsborough County the $30K MAGI doesn't get you the "C" plan. Just checked by putting in 32080 (St. John) and don't see the "C" plan offered either with the $30K MAGI. Only found that "C" plan offered when I put in $24,500. So is there something you are doing differently?

No you are right with that number ($30k) it was a little confusing, it was last last year we had a 1443b, the only difference was the cost sharing. But premiums and deductible were still $0. for BOTH of us. I do not know for this year at $30k as we used the lower MAGI, and Yes $24,600 is the 2019 limit for 1443c. But for a Couple, we had to reduce to $22,850 to get the best rates just for DW as I will be on Medicare.

 

[Mulligan]

I don't know what these are. Where can I find more information on these?

SoReady, thought this may interest you...Earlier post I mentioned my 55 year old friend in Illinois was facing that ridiculous $700 plus premium high deductible ACA plan. Well he just texted me last night. He went to an insurance broker and he found him an underwritten 15 month policy from Cigna. $3000 deductible, with dental and vision riders all for $500 a month. May be worth your time to try. Of course region of state matters. He was in Columbia Ill area.

 

[wmc1000]

Since 2nd Lowest Cost Silver Plan is the basis for subsidies a change in 1 plan from 2018 to 2019 can affect your subsidy significantly even when your plan premium doesn't go up much from the previous year. If a lower cost plan is new to your area it can shift your current plan from the lowest to potentially the 3rd lowest if the previous 2nd lowest drops their rate.

Confusion abounds and subsidy amounts change even when your gross premium may not change much.

 

[ivinsfan]

No you are right with that number ($30k) it was a little confusing, it was last last year we had a 1443b, the only difference was the cost sharing. But premiums and deductible were still $0. for BOTH of us. I do not know for this year at $30k as we used the lower MAGI, and Yes $24,600 is the 2019 limit for 1443c. But for a Couple, we had to reduce to $22,850 to get the best rates just for DW as I will be on Medicare.

You had zero premium and deductible..wow I think this is the first time you have mentioned that... and once again by best rates you mean free.

 

[wmc1000]

Another thing to remember is if your plan has a network mostly local to you it will provide coverage when out of network if an EMERGENCY arises. If you have regular doctor care in your network then your worries about being out of network when travelling is not that much of a concern INHO.

 

[SoReady]

SoReady, thought this may interest you...Earlier post I mentioned my 55 year old friend in Illinois was facing that ridiculous $700 plus premium high deductible ACA plan. Well he just texted me last night. He went to an insurance broker and he found him an underwritten 15 month policy from Cigna. $3000 deductible, with dental and vision riders all for $500 a month. May be worth your time to try. Of course region of state matters. He was in Columbia Ill area.

Thanks Mulligan. I'll have to find an insurance broker to explore this as an option. We are in the Chicagoland area, so I expect prices to be higher.

 

[simple girl]

Another thing to remember is if your plan has a network mostly local to you it will provide coverage when out of network if an EMERGENCY arises. If you have regular doctor care in your network then your worries about being out of network when travelling is not that much of a concern INHO.

True, as long as you are willing to pay out of pocket for regular doc visits if you become ill while traveling (not a big deal considering the high max OOP many of us are used to by now). If you developed a lengthy issue you could just come home for treatment, which most people would do anyways.

My main issue is my local docs that I am established with are not in network with the cheaper BlueSelect plans. I do not want to change doctors.

So, I'm thankful I have the BlueOptions plan to choose from, even if it means we have to pay more.

 

[scrabbler1]

Since 2nd Lowest Cost Silver Plan is the basis for subsidies a change in 1 plan from 2018 to 2019 can affect your subsidy significantly even when your plan premium doesn't go up much from the previous year. If a lower cost plan is new to your area it can shift your current plan from the lowest to potentially the 3rd lowest if the previous 2nd lowest drops their rate.

Confusion abounds and subsidy amounts change even when your gross premium may not change much.

Right. What I found when trying various what-ifs in my spreadsheet is that my MAGI and the SLCSP were the two main variables which determine IF I get a subsidy, and if I do, how much it will be. What I was actually paying for my HI had no impact on the subsidy.

When I went back to try some more what-ifs, from 2017 and 2018 (estimated), I see that going over the cliff cost me about $840 in 2017 (more than I first thought) and going over the cliff will cost me about $980 in 2018. Then again, I will be getting a cap gain distribution at the end of this year which will be as large as all the investment income for the other 51 weeks of this year.

 

[BarbWire]

Another thing to remember is if your plan has a network mostly local to you it will provide coverage when out of network if an EMERGENCY arises. If you have regular doctor care in your network then your worries about being out of network when travelling is not that much of a concern INHO.

Look carefully at the definition of covered emergency. A friend with BCBS-TX took a nasty spill on a mountain bike while in Colorado, resulting in a broken wrist and a facial gash that took many stitches. Went to the ER.

BCBS-TX denied the claim saying that while the injuries certainly required attention they were not “life threatening” and thus he needed to return to Dallas for covered care.

Another friend was told that if she showed symptoms of a detaching retina while traveling — for which she was being monitored quarterly by an ophthalmologist paid by her insurance — an emergency visit to an opthamologist to preserve her sight in that eye would not be covered because it was not a “life-threatening” condition.

Both had HMOs purchased with subsidy from healthcare.gov.

Read the fine print, and consider buying travel medical insurance.

 

[scrabbler1]

Ugh! Not only am I facing a 15% premium increase but I just got a letter from my IC telling me they won't be covering my expensive prescription drug next year. My IC covering nearly 100% of the cost of this drug is the biggest benefit my IC offers. It's as much as the lab fees and my doctor bills combined.


I see three options:


(1) My doctor switches me to a different drug which is covered. There are others available, in all likelihood. No generics for my drug, not until 2022, according to the letter. I see my doctor next week, so the timing on this is good. This drug, for Type 2 Diabetes, I have been taking for about 3 years.


(2) My doctor can request an exception. Not sure how easy it is to get that granted.


(3) I can switch to another insurance company when the ACA's open enrollment starts later this month (in NY). I'd have to see if this drug is covered, and if my current doctors are in their network. And I'd have to see how their premiums and copays compare to what I would have in 2019. I would have a limited time to investigate this during the open enrollment period.


No matter what, I'm going to get screwed to some degree (in the wallet). Will it be a little or a lot?

 

[bobandsherry]

Ugh! Not only am I facing a 15% premium increase but I just got a letter from my IC telling me they won't be covering my expensive prescription drug next year. My IC covering nearly 100% of the cost of this drug is the biggest benefit my IC offers. It's as much as the lab fees and my doctor bills combined.


I see three options:


(1) My doctor switches me to a different drug which is covered. There are others available, in all likelihood. No generics for my drug, not until 2022, according to the letter. I see my doctor next week, so the timing on this is good. This drug, for Type 2 Diabetes, I have been taking for about 3 years.


(2) My doctor can request an exception. Not sure how easy it is to get that granted.


(3) I can switch to another insurance company when the ACA's open enrollment starts later this month (in NY). I'd have to see if this drug is covered, and if my current doctors are in their network. And I'd have to see how their premiums and copays compare to what I would have in 2019. I would have a limited time to investigate this during the open enrollment period.


No matter what, I'm going to get screwed to some degree (in the wallet). Will it be a little or a lot?

Have you checked to see if manufacturer offers discount program? Asking as my wife has a prescription that will change from Tier 4 to Tier 6 next year, so essentially not covered but I found that manufacturer has discount program offer, $0 pay.

 

[scrabbler1]

Have you checked to see if manufacturer offers discount program? Asking as my wife has a prescription that will change from Tier 4 to Tier 6 next year, so essentially not covered but I found that manufacturer has discount program offer, $0 pay.

I went to the manufacturer's website and found an assistance program which applies to this drug. But the maximum income is the same as that to qualify for an ACA subsidy. And as I had written earlier in this thread, I went over that cliff in 2017 and will be going over it again in 2018. What this means is that the ACA cliff for me is now 5 times as high as it was before.

 

[Rianne]

Look carefully at the definition of covered emergency. A friend with BCBS-TX took a nasty spill on a mountain bike while in Colorado, resulting in a broken wrist and a facial gash that took many stitches. Went to the ER.

BCBS-TX denied the claim saying that while the injuries certainly required attention they were not “life threatening” and thus he needed to return to Dallas for covered care.

Another friend was told that if she showed symptoms of a detaching retina while traveling — for which she was being monitored quarterly by an ophthalmologist paid by her insurance — an emergency visit to an opthamologist to preserve her sight in that eye would not be covered because it was not a “life-threatening” condition.



Both had HMOs purchased with subsidy from healthcare.gov.

Read the fine print, and consider buying travel medical insurance.

I would Never get an HMO. PPO plan, they would have been covered. These are the very questions I grilled our HI broker about.

 

[audreyh1]

I would Never get an HMO. PPO plan, they would have been covered. These are the very questions I grilled our HI broker about.

ACA individual PPO plans are simply not available in Texas and many other states.

 

[orchid55]

Yes, we're in Georgia and our only options are HMOs from BCBS, Ambetter and Kaiser. BCBS had PPO plans in 2017, then pulled out of our part of Georgia entirely in 2018. They have returned for 2019 but only with HMOs.

 

[audreyh1]

In Texas we had the experience of BCBSTX dropping individual PPO plans in 2016, and then Humana pulling out of the individual market entirely in 2017. So we were forced into HMO by 2017.

 

[NoMoreJob]

I would Never get an HMO. PPO plan, they would have been covered. These are the very questions I grilled our HI broker about.

Never say never - you may end up in the situation many of the rest of us are in where PPOs are no longer an option.