Healthcare Choice is only Obamacare?

[Shabby]

I am healthy, 55, live in FL, retired early and still need healthcare. My only option is a plan on Healthcare.gov? They are about $550-$850 for a sub-par United or Blue Cross plan. I can't believe this is my only option? I would need to start another company or get a job to have access to a decent healthcare plan?

Frustrating....

 

[pacergal]

I think the ACA options depends on where you live.
I assisted my DD and SiL last evening to sign up for the 2023 year.
They had numerous options, it depended on which providers they wanted and whether a higher deductible with lower premium or higher premium with lower deductible.
But each one provided comprehensive care.

 

[Aerides]

The ACA is the law that governs all of health insurance.

In 2010 or so when I was shopping pre-ACA to estimate our future retirement budget, a private plan such as United for DH and I was going to run about $700 per month. By the time we retired, we might not have qualified as DH had a pre-existing by then. Plus it would have been more.

All non-employer annual plans are managed via healthcare.gov, but the actual plans vary by provider, region, etc. The law also impacts how employer plans and everything in the health insurance world works. Prior to the ACA, you'd shop around for private insurance, and, assuming you didn't have any pre-existing conditions (or..develop them after you retired, before medicare), you'd buy a plan. In 2010 or so when I was shopping pre-ACA, a private plan such as United for DH and I was going to run about $700 per month. By the time we retired, we might not have qualified as DH had a pre-existing by then.

(There are non-ACA compliant plans that might be cheaper, with 11 month enrollments, call temporary coverage, but these will not come with protections like lifetime caps, ability to stay on your plan if you have a prior illness or condition, or get cancelled for claims, etc.)

 

[PaunchyPirate]

Here in Pennsylvania, I can buy directly from any insurance company that sells private-purchase insurance in my location. There aren't many -- 2, to be exact. I don't have to use Healthcare.gov (or my state's equivalent healthcare exchange pennie.com).

However, the offerings are virtually, but not exactly, the same. But, some of the insurance companies sell a few plans outside of the exchange that aren't offered on the exchange.

However2, you MUST purchase through the healthcare exchange website IF you wish to take advantage of any Affordable Care Act subsidies that you may qualify for. If your purchase outside the exchange, you forfeit any government subsidies.

However3, in my location, the base premium cost is the same on the exchange as it is on the exchange. The rates of off- and on-exchange plans are scrutinized/justified/approved by the State's insurance department each year.

Each state (and even portions of states) is different. Some states are more or and some less friendly toward consumer protections in the insurance arena.

 

[sheehs1]

The only reason to use healthcare.gov is if you qualify for a subsidy. The income limits may have expanded a bit from where they started but as far as I know there is still no sliding income scale for subsidies. Healthcare.gov will tell you if you qualify for a subsidy.

You can purchase from the many private insurers but even they, for the most part, will follow the ACA structure outlined as Bronze, Silver, Gold, etc. There may be some high deductible ones. I went with the Bronze coverage since I was relatively healthy and figured "why pay up front for coverage I may not use".

Since going on Medicare, thankfully I don't have to do this anymore. While I am getting hit with IRMA's on Medicare, it is still cheaper for me than my ACA premiums (1,000/mth with a $5,000 deductible) were. I only went to the doctor for covered preventive and if I had to do so.

 

[aaronc879]

Can you manage your income in a way that will allow you to qualify for subsidies? Most people can with a little planning. If you have so much money that you can't get subsidies then you should be able to afford the insurance on your own. It's a pretty good system, way better than what we had before ACA took effect.

 

[Northforker]

There is a sliding scale that determines the amount of the subsidy. In round numbers it's about 26000 AGI for the max subsidy for a 2 person household and subsidy ends at zero at about 75000 AGI. Last year we engineered our income to be 34000 and our subsidy was 1900, our net premium was 220/mo.

 

[qwerty3656]

There are "cost sharing" options (like medishare), but they won't be any cheaper (and you will not get any subsidy like you can with ACA).

 

[erkevin]

https://www.kff.org/interactive/sub...1][age]=56&adults[1][tobacco]=0&child-count=0

 

[gauss]

The only reason to use healthcare.gov is if you qualify for a subsidy. The income limits may have expanded a bit from where they started but as far as I know there is still no sliding income scale for subsidies. Healthcare.gov will tell you if you qualify for a subsidy.

I agree that the main reason to use healthcare.gov is if you will qualify for a PTC subsidy.

A second, less known reason, is if you are over 30 years old but qualify for a Hardship Exemption that will you allow you to purchase a Catastrophic policy.

On heathcare.gov you can enter the ECN #s of your approved exemption and then see the Catastrophic plans that are offered and purchase one without ever speaking to a person.

If you go to most private insurance company web sites, in their fine print, they tell you to call one of their agents if you would like to purchase a catastrophic plan and are over 30 years old (once you have an approved exemption in hand).

-gauss

 

[foxfirev5]

FWIW I would never retire with no clue about health insurance. That issue was enough to keep me working from age 55 to 60. By the time I figured it out I realized I could have retired at 55. At the time ACA may or may not have been an option. Count yourself lucky and do a little more research.

 

[sheehs1]

There is a sliding scale that determines the amount of the subsidy. In round numbers it's about 26000 AGI for the max subsidy for a 2 person household and subsidy ends at zero at about 75000 AGI. Last year we engineered our income to be 34000 and our subsidy was 1900, our net premium was 220/mo.

What I meant by there being "no sliding scale" on the Exchange (or otherwise) is that once over the income level for any subsidy, which was quite low at first, and I assume is still low, is that someone (single) making $200k a year pays the same for their ACA healthcare as someone (single) making $50,000. Will have to check to see where that limit is today. Back then it was called the "subsidy cliff".

I wasn't talking about the sliding scale within the range of getting a subsidy. Sorry for the confusion.

 

[sheehs1]

I agree that the main reason to use healthcare.gov is if you will qualify for a PTC subsidy.

A second, less known reason, is if you are over 30 years old but qualify for a Hardship Exemption that will you allow you to purchase a Catastrophic policy.

On heathcare.gov you can enter the ECN #s of your approved exemption and then see the Catastrophic plans that are offered and purchase one without ever speaking to a person.

If you go to most private insurance company web sites, in their fine print, they tell you to call one of their agents if you would like to purchase a catastrophic plan and are over 30 years old (once you have an approved exemption in hand).

-gauss

True. And thanks for adding the Catastrophic policy possibility.

 

[TripleLindy]

As others have said, the offerings vary by state, but at least through 2025, annual premiums for ACA plans are capped at 8.5% of your income for the second lowest cost silver plan. That usually results in a number of plans that are even less expensive than the cap.

 

[MichaelB]

I am healthy, 55, live in FL, retired early and still need healthcare. My only option is a plan on Healthcare.gov? They are about $550-$850 for a sub-par United or Blue Cross plan. I can't believe this is my only option? I would need to start another company or get a job to have access to a decent healthcare plan?

Frustrating....

ACA policies have comprehensive coverage, so you’re unlikely to find better coverage elsewhere. They can be expensive, but not sub-par. If anything, the standardized coverage brought about by the ACA was a significant improvement. You might find an employer with better coverage, but they are dwindling fast, and in addition, you would have to work.

Florida BCBS has some of the best range of individual offerings to be found in the US. They typically offer 3 options; an HMO, a PPO with a limited local provider network, and a PPO with their BlueCard national provider network.

As others have pointed out, you need to use healthcare.gov if you want premium assistance. If you don’t qualify for assistance you can deal directly with the insurer.

 

[jim584672]

The 400% FPL subsidy cliff has been gone in 2021 and 2022. That was extended through 2025 by the Inflation Reduction Act.

Don't forget Silver plans (only Silvers) under 250% FPL have cost sharing reductions that can really cut down on out of pocket costs.

 

[Donno]

The only reason to use healthcare.gov is if you qualify for a subsidy. The income limits may have expanded a bit from where they started but as far as I know there is still no sliding income scale for subsidies. Healthcare.gov will tell you if you qualify for a subsidy.

You can purchase from the many private insurers but even they, for the most part, will follow the ACA structure outlined as Bronze, Silver, Gold, etc. There may be some high deductible ones. I went with the Bronze coverage since I was relatively healthy and figured "why pay up front for coverage I may not use".

Since going on Medicare, thankfully I don't have to do this anymore. While I am getting hit with IRMA's on Medicare, it is still cheaper for me than my ACA premiums (1,000/mth with a $5,000 deductible) were. I only went to the doctor for covered preventive and if I had to do so.

I'm sorry, but I used heathcare.gov for the past 4 years and I didn't get a subsidy. The only other choices I had were plans that didn't include drug coverage, and as someone that needs an expensive drug I had to buy an ACA plan. I really hate when people stroke a broad brush and put people into a group without understanding that not everyone lives in the same bubble.

 

[sheehs1]

I'm sorry, but I used heathcare.gov for the past 4 years and I didn't get a subsidy. The only other choices I had were plans that didn't include drug coverage, and as someone that needs an expensive drug I had to buy an ACA plan. I really hate when people stroke a broad brush and put people into a group without understanding that not everyone lives in the same bubble.

You have to do what you have to do. Others said and posted basically the same thing. Yes, there can be extenuating circumstances, variations by state, individual needs are different goes without saying and since the inception of the ACA in 2010, some things have changed. For the most part, if you qualify for a subsidy it's best to use healthcare.gov. If not, one can try to go directly to the private insurers for policy offers in their area. I found the costs of quoted plans on the exchange to be basically the same as those not on the exchange in my state.

 

[Aerides]

One point of clarity:

The ACA is not Healthcare.gov. It's just a component of it. It's a broad set of laws that manage HI. You can shop those same compliant plans with providers directly, in most cases, without using healthcare.gov.

The title of this thread is a bit confusing, vs. if the specific complaint is about the website.

Oh, and PS, if you "start another company" that doesn't open up other options, unless you become a bigger employer. Self-employed folks and small businesses access the same plans as individuals.

 

[sheehs1]

One point of clarity:

The ACA is not Healthcare.gov. It's just a component of it. It's a broad set of laws that manage HI. You can shop those same compliant plans with providers directly, in most cases, without using healthcare.gov.

The title of this thread is a bit confusing, vs. if the specific complaint is about the website.

Oh, and PS, if you "start another company" that doesn't open up other options, unless you become a bigger employer. Self-employed folks and small businesses access the same plans as individuals.

True! Especially the part about self-employed and small business health care options. Plans are the same. First hand knowledge, small family business offering health care to our employees.

 

[orchid55]

Maybe the original poster needs to define what a subpar health plan is. The ACA plans cover mandated benefits, can't be cancelled if you get sick, and are available to most Americans. However, in my state, every single ACA plan is an HMO, most of them very narrow network HMOS. They have no out of state or out of network coverage except for emergency room visits. We felt like we were playing a game of chance every time we went out of state while we had our ACA policies. I can see why the original poster might consider ACA subpar.

 

[qwerty3656]

We felt like we were playing a game of chance every time we went out of state while we had our ACA policies. I can see why the original poster might consider ACA subpar.

Yeah that is my problem with ACA. I live on the boarder of 2 states with the "big city" in the other state. All our doctors/hospitals were in the other state and are now all considered out of network.

 

[HtownRose]

That or move to a state with options you like better.

I'd love to retire & go on the ACA but if I stay in Texas it is only HMOs & EPOs which I'm not comfortable with so I have a "bridge to retirement" job with great employer-sponsored health insurance. At 61.5 I'll be eligible for retiree medical - if nothing changes.

 

[EastWest Gal]

When we started on the ACA there were only a few plans. Now our area has over 40 plans, many are PPOs. One has a national network. We would only use healthcare if out of state for emergencies anyway.

There is no premium cliff until 2026. Go on your state website or healthcare.gov and browse plans. Plug in an income estimate and see what happens. Also compare the plans with employer sponsored plans; you’ll find they are the basically the same. We had worse coverage when we were in my employer sponsored plan in 2018.

You could long for the 1990s, when a solo practitioner friend of mine had to close his practice and join a group because he could not get health insurance, and neither could he get it for his office staff. Why? His insurance company decided to drop him out of the blue-he has Type 1 diabetes then his wife developed scleroderma. No thanks.

 

[Mulligan]

Maybe the original poster needs to define what a subpar health plan is. The ACA plans cover mandated benefits, can't be cancelled if you get sick, and are available to most Americans. However, in my state, every single ACA plan is an HMO, most of them very narrow network HMOS. They have no out of state or out of network coverage except for emergency room visits. We felt like we were playing a game of chance every time we went out of state while we had our ACA policies. I can see why the original poster might consider ACA subpar.

Agree…And its probably relative to what one is used to having. This year, I was able to get off ACA, and was able to get on my GF’s company plan. Definitely night and day, going from a game of who will take the plan and $7k deductible and $700 bucks. Now its $150 a month, $250 annual deductible and includes dental and vision and every network around here takes it… And despite how excellent this is, all my GF did was complain her deductible went up $50 last year. So its all a relative thing I suppose.