COBRA or Obamacare?

[karen1972]

Like all things is just about comparing apples and apples... and not clear you have provided enough information for anyone here to actually know which is better for you.

Do you have an HSA?
Do you have an FSA?
Does your COBRA include those?
Does your exchange offer any of those?
What is the Co-pays?
What is the Medical Deductible?
What is the Drug Deductible?
What is the Hospital/ER Co-pay?
What is your likely yearly procedure/drugs/etc?
What doctors/hospitals do you consider a "must have"
Would you be eligible for subsidies but not fall into Medicare?
Are your meds covered at the same Tier level?

Only then can you decide which is better.

When I quit and we lost my insurance we went on ACA because my COBRA premiums were crazy and didn't cover me in my new state.

When he quit and he lost his insurance he kept COBRA because not his monthly script was covered at a $30 co-pay under his cobra plan and was a Tier 4 or $180/month on the BCBS ACA plan... that $150 difference alone made it a no brainer, plus he had his FSA and lower deductible.

 

[big-papa]

About to be faced with the same issue after the end of June (unless I find another job).

My thought process:
- Here in Central TX, the ACA plans premiums are within spitting distance of my Cobra premium and the coverage is nowhere near as good. And because I will have earned quite a bit the first half of the year, no subsidy. Likewise for the cost of ACA compliant plans that aren't on the exchange.

- My daughter has a medication that costs us a $50 copayment per month with my current insurance/Cobra but is $325 per month otherwise since it won't be covered by any ACA Plan available around here unless the very high deductable is first met.

- Unemployment insurance will just about cover my Cobra cost and would would take me to the end of the year anyway, which is when open enrollment would start.

So unless I'm re-employed before then, I'm going the Cobra route at least until the end of the year.

 

[Starsky]

COBRA and the ACA are very different and your choice should depend greatly on - among other things - the policy you have now, where you live and how much income you have.

I chose to stay on my wife's COBRA for 18 months because it was an excellent insurance plan with better coverage than the ACA alternatives.

After 18 months I switched to the ACA [Covered California] with a large HMO. I qualified for an ACA subsidy given our low retirement income that cut my premium in half. The lower monthly cost is offset by the higher co-pays and prescription costs; and it does sometimes feel like insurers will provide more generous care to non-ACA policyholders, but my care has been excellent. I have not had any more problems under the ACA than with our previous insurer.

It is interesting how the ACA can have an impact on work and investment decisions since generating additional income lowers the monthly subsidy. We chose to defer a Roth conversion for this reason. It doesn't cost me to wait.

 

[T-Minus]

I have stopped working, but am still on the payroll 'till mid July. I structured this in order to get 18 months of COBRA coverage...all the way up to the end of 2018. Hopefully, there will be something in place for 2019.

 

[eastnortheast]

Interesting discussion. If/when I retire later this year, I am going to be facing the same dilemma. Looking to probably remain on COBRA initially. Would like to have another 6-18 months to see how any changes to the ACA play out. May be worth it to have a higher income in the COBRA years to minimize income when switching to the ACA to obtain subsidies (if they will still in fact exist).

 

[sakowitzm]

I'm with (what seems like) the majority to stick with COBRA. It's "the devil you know", and having had two immediate family members with cancer, believe me when I tell you the devil can be quite wicked.

 

[Aerides]

I plan to COBRA for at least the remainder of the year (since deductibles don't transfer) and probably the full 18 months, switching to a market plan for 2019.

It's more expensive for premiums, but less for deductibles, with excellent coverage. I don't see other plans comparable for the same price. Added bonus that I don't have to change anything or shop around for doctors during the likely churn in the market we're going to have for at least that long...

 

[jollystomper]

I am also in the same situation. I will take COBRA through 2018. We are not eligible for subsidies so the cost difference is not much. Knowing that we can use the exact same doctors as we do today is worth it. It will give us more time to look at whatever shakes out of the ACA/AHCA.

 

[T-Minus]

...It's more expensive for premiums, but less for deductibles, with excellent coverage...

For DW and I, COBRA is cheaper than the cheapest bronze-level ACA plan ($1,024.96/mo. vs. $1,182.84/mo.), with significantly lower deductibles and much better coverage. These are actual numbers - checked and verified about a week ago. And no, we do not qualify for any subsidies...

 

[NameRedacted]

I'm amazed at all the people that found Cobra better than the ACA.

For my situation retiring in early March of this year the ACA was a much better deal. Cobra would have cost around $1200 a month.

A bronze plan for me only costs $320 - excluding subsidies which I may just qualify for this year and definitely will qualify for next year - if it's still around. I haven't ever needed much healthcare so I'm gambling that bronze coverage will be fine. Even the platinum plan was around $500 or so. The deductibles and copays for the bronze plan are higher but since I haven't used it much that probably won't matter.

My girlfriend, who has type I diabetes, was able to sign up for the NY essentials plan which is an amazing deal. $20/month and no deductible. She has 7 prescriptions and the monthly cost for those is about $70-80 lower. No deductible will save us about $2000/year compared to Cobra. For an extra $26/month she was able to get dental and vision too.

So we were able to save around $1075/month compared to Cobra and if the ACA is around next year even more with the subsidies.

 

[jollystomper]

I'm amazed at all the people that found Cobra better than the ACA..

Perhaps a lot depends on how many you individuals need to cover, as well as the COBRA policy of your employer. My Megacorp offers reasonable COBRA rates (as compared to the employee rate) for the 3 people I need to cover, perhaps because they self-insure.

 

[Carpediem]

It also depends which plans are available in a person's state. For us, we have one choice and it's far from affordable.

 

[2017ish]

I'm amazed at all the people that found Cobra better than the ACA.

For my situation retiring in early March of this year the ACA was a much better deal. Cobra would have cost around $1200 a month.

...

In addition to the factors pointed out by jollystomper, [and as stated by Carpediem while I was typing] it depends upon where you live. In our situation, if unsubsidized ACA were less than 50% the cost of the $2000+ monthly COBRA premium for the last five months of this year, I would not forego DW's employer plan.

Won't know until later in the year if any ACA-compliant plans will be offered here for 2018--much less what providers would actually be covered and at what cost. (In future, will be able to just move state of residence if needed, but travel plans would make that inconvenient this year.)

Keeping options open is key and COBRA enables that for us.

 

[ziggy29]

I would agree with THIS set of numbers I would stick with COBRA. Mostly because you are likely getting a much wider network of providers (I assume this is roughly an apples to apples where deductibles and OOP maximums are concerned?)

But also at this late date while it would seem **very** unlikely that the ACA will be massively changed by legislation in time to take effect in 2018 (IMO), if something does happen and you have declined COBRA, there is no going back if you opt for the Marketplace. The other unknown is the quality of 2018 plans -- each year, in many states, the premiums are going up very quickly (especially unsubsidized), PPOs are being taken away and replaced with HMOs, fewer doctors are taking ACA plans and the choices on the Marketplace are shrinking. Where I live (and many other places), there is only one insurer playing the Marketplace game and they only offer HMO plans.

 

[Aerides]

I could have gotten a bronze plan for about half what Cobra will cost - purely on the basic premiums. I'm mainly staying COBRA to avoid the unknown of changing now, then having to pick another plan for 2018 (because they always seem to change, and because the cost gap may close further).

But I'd have to drop all my doctors, no longer get the Cleveland Clinic in my plan, and have a much higher deductible for that price. Copays and referrals for everything, stuff like that higher too. So a PITA cost.

Even most of the Silver plans weren't close in terms of coverage and benefits. There were some higher end plans that were close, but still over $1k per month for me and DH. But yes every state is different.

 

[RetireAge50]

I'm surprised at how many people have "doctors". What age does this happen? Am I supposed to go to the doctor?

 

[Aerides]

Getting annuals is a good idea. So that's a PCP.

Then most women also have a OB/GYN that they visit at least once a year in addition, and the lovely mammograms. Assume most men visit urologist for the cough test sooner or later as well? Hence "doctors".

 

[ziggy29]

But I'd have to drop all my doctors, no longer get the Cleveland Clinic in my plan, and have a much higher deductible for that price. Copays and referrals for everything, stuff like that higher too. So a PITA cost.

I know what you mean. In particular, here in a lot of Texas the only Marketplace choice is an HMO that does not include MD Anderson (among others), and that is a deal breaker for a lot of folks. In contrast, the employer plan I'm on now (lucky to have one for 20-25 hours a week) not only includes MD Anderson, but treats them as a "cancer center of excellence" so we would pay a 10% copay instead of the usual 15% above the deductible.

It's bizarre how the individual and the employer group models are so different in terms of pricing and motivation.

 

[2017ish]

I'm surprised at how many people have "doctors". What age does this happen? Am I supposed to go to the doctor?

Since our early 40s or thereabouts. I get annual exam; DW gets annual exam (she's been doing it for a lot longer). Two different doctors, as she prefers for personal reasons not to go to our friend for her exams--even though they've cross-referred over the years.

 

[DanP]

Timely topic for me, facing COBRA at ~1,900/month but even a basic search shows closer to 1,400 in the exchange for my particular situation similar coverage. Going to an agent tomorrow to see what makes the most sense, guessing private will win over exchange, and over cobra.

 

[Fedup]

I'm surprised at how many people have "doctors". What age does this happen? Am I supposed to go to the doctor?

Only one doctor here for annual check up. I no longer have an OBGYN.

 

[mamadogmamacat]

only one now also, as my OB/GYN just retired and I have been researching whether one really needs to continue seeing one past menopause. I'm leaning toward not. Will of course continue with having the annual mammogram, or annual pancaking as I called it at work, to the confusion of the mostly male staff and the generally riotous laughter of the few females within earshot

 

[Fedup]

Mine can do all the tests that OBGYN can, hence there is no need to see any OBGYN.

 

[2017ish]

Mine can do all the tests that OBGYN can, hence there is no need to see any OBGYN.

True. DW is an OBG. She doesn't see an OBG any longer (56).

 

[Walt34]

I'm surprised at how many people have "doctors". What age does this happen? Am I supposed to go to the doctor?

Yes, around age 40 you will start to see doctors more often. Other than dental checkups and physical exams required by my job I didn't see any at all until about that age. Then I had a stomach ulcer (long since healed) and I had a gastroenterologist to see a couple times a year. Also around age 40 I had knee surgery and two hernia repairs a year apart. About 45 I had minor surgery for squamous cell cancer on my ear. No recurrence with that but now I had a dermatologist to see a couple times a year.

Through age 60 that was about it, then things started to snowball at 64 when I ended up with two stents in my heart and I had a cardiologist, a couple years later I had a cardiac ablation done for atrial fibrillation so now I have an electrophysiologist to see twice a year. Last December a spot on my arm turned out to be malignant melanoma, so now at 67 I have a dermatologist, a plastic surgeon, and an oncologist in addition to the others. ( The melanoma seems to have been caught early, no issues.)

This "getting old" crap is a pain in the butt but I suppose it's better than the alternative.