nvestysly
Full time employment: Posting here.
- Joined
- Feb 19, 2007
- Messages
- 599
Individual Health Insurance Market vs Exchange
In post #19 on another thread (found here) I indicated non-PPACA premiums are lower than PPACA premiums for a similar policy.
For reference, here are the excerpts from that thread:
As you can see, at least two forum members said my statements were not true. The statements are true for me (and I presume others in similar situations). I realize they may not be true for everyone and I should have identified several caveats that make it true for me. Here are the details:
DW and I have a United Health Care HSA that allows us to see a wide variety of doctors and use a wide variety of services both in and out of network. Our maximum OOP expenses are capped at the deductible. The plan is called HSA100 meaning 100% of expenses are covered after the deductible is met.
In addition, our deductible rolls over on a three-year basis meaning if we don't meet the deductible in year one the amount we paid for year one services decreases the deductible for year two and so on for year three. In year four the process continues as the next year is added the earliest year falls off.
As I said, we have a wide variety of choices to see doctors and use facilities that might normally be considered out of network. Yes, we did have to deal with an exclusion period for pre-existing conditions (so this policy is not for everyone). However, we pay $470.53 per month. The closest policy I can find with PPACA places limits on the provider network and only pays for emergency services out of network. The premium for this PPACA policy is $737.23
It could be agued that my policy and a PPACA are not the same. That's true. However, I don't want coverage for pre-natal care, vision and dentistry for children and several other things PPACA includes that don't suit my needs. So I would argue that I can buy a suitable policy on the open market for less than PPACA policy. I think the same thing would be true for some others.
You might be thinking “hey what about the PPACA subsidy?” Surely that makes PPACA less expensive. I choose to look at the unsubsidized premiums for PPACA policies in order to compare them to non-PPACA policies. Subsidy amounts will vary dramatically so rather than cloud the premium discussion with subsidized amounts I choose to keep it simple.
DW and I may not qualify for a subsidy or if we do it will be relatively small. On the other hand we do itemize our tax return and we receive the equivalent of $100 per month as a tax deduction since we pay for our own medical insurance and contribute to an HSA.
My main reason for making the initial comment was to show that there are some people who are perfectly happy with their existing health insurance policies, we’re paying less than a similar policy via PPACA and we think other people may fall into the same camp. It’s not for everyone, but it’s worth considering.
I didn’t refer to COBRA in my original post so I’m not sure why that subject came up. For comparison, my COBRA rates were over $1200/month. As I said above the UNH HSA100 policy is $470.53/month. So yes, I’m saving quite a bit over COBRA rates too. Much of that savings is because I pay for who I am – 54 YO male with 51 YO spouse – rather than being lumped in with people who are pregnant, who have children, and who are much older.
I know several people who didn’t think they could obtain private health insurance so they didn’t even apply. They heard so many stories from friends of friends about being denied they didn’t think they would be approved. I’m sure there were problems. There is no doubt the medical insurance situation in the USA needed to be tweaked. Unfortunately, some people let all this doom and gloom prevent them from considering individual health insurance. I was almost one of those people until I researched the situation, called an insurance broker and found out that obtaining insurance was not a difficult as many people would lead you to believe. A friend with a significant pre-existing condition said she was approved for individual policy too. I’m only suggesting that there are alternatives to PPACA. Due diligence should be applied.
On Edit:
Thread title was changed from "The Individual Health Insurance Market vs PPACA" to "Individual Health Insurance vs Exchange"
In post #19 on another thread (found here) I indicated non-PPACA premiums are lower than PPACA premiums for a similar policy.
For reference, here are the excerpts from that thread:
For people with unsubsidized premiums PPACA insurance costs more than conventional individual insurance. And for those who receive subsidies don't forget that's somebody else's money paying for your premium.
Not true.
Definitely not true. We're saving a considerable amount over COBRA and even more vs. what we would be paying on the private market based on 2013 ehealthinsurance.com rates. We've had some minor aging joint issues the last two years and we each have a history of prescription drug use, so I'm not even sure we could get coverage privately. We are far from qualifying for a subsidy. I've seen people turned down for some really stupid stuff.
As you can see, at least two forum members said my statements were not true. The statements are true for me (and I presume others in similar situations). I realize they may not be true for everyone and I should have identified several caveats that make it true for me. Here are the details:
DW and I have a United Health Care HSA that allows us to see a wide variety of doctors and use a wide variety of services both in and out of network. Our maximum OOP expenses are capped at the deductible. The plan is called HSA100 meaning 100% of expenses are covered after the deductible is met.
In addition, our deductible rolls over on a three-year basis meaning if we don't meet the deductible in year one the amount we paid for year one services decreases the deductible for year two and so on for year three. In year four the process continues as the next year is added the earliest year falls off.
As I said, we have a wide variety of choices to see doctors and use facilities that might normally be considered out of network. Yes, we did have to deal with an exclusion period for pre-existing conditions (so this policy is not for everyone). However, we pay $470.53 per month. The closest policy I can find with PPACA places limits on the provider network and only pays for emergency services out of network. The premium for this PPACA policy is $737.23
It could be agued that my policy and a PPACA are not the same. That's true. However, I don't want coverage for pre-natal care, vision and dentistry for children and several other things PPACA includes that don't suit my needs. So I would argue that I can buy a suitable policy on the open market for less than PPACA policy. I think the same thing would be true for some others.
You might be thinking “hey what about the PPACA subsidy?” Surely that makes PPACA less expensive. I choose to look at the unsubsidized premiums for PPACA policies in order to compare them to non-PPACA policies. Subsidy amounts will vary dramatically so rather than cloud the premium discussion with subsidized amounts I choose to keep it simple.
DW and I may not qualify for a subsidy or if we do it will be relatively small. On the other hand we do itemize our tax return and we receive the equivalent of $100 per month as a tax deduction since we pay for our own medical insurance and contribute to an HSA.
My main reason for making the initial comment was to show that there are some people who are perfectly happy with their existing health insurance policies, we’re paying less than a similar policy via PPACA and we think other people may fall into the same camp. It’s not for everyone, but it’s worth considering.
I didn’t refer to COBRA in my original post so I’m not sure why that subject came up. For comparison, my COBRA rates were over $1200/month. As I said above the UNH HSA100 policy is $470.53/month. So yes, I’m saving quite a bit over COBRA rates too. Much of that savings is because I pay for who I am – 54 YO male with 51 YO spouse – rather than being lumped in with people who are pregnant, who have children, and who are much older.
I know several people who didn’t think they could obtain private health insurance so they didn’t even apply. They heard so many stories from friends of friends about being denied they didn’t think they would be approved. I’m sure there were problems. There is no doubt the medical insurance situation in the USA needed to be tweaked. Unfortunately, some people let all this doom and gloom prevent them from considering individual health insurance. I was almost one of those people until I researched the situation, called an insurance broker and found out that obtaining insurance was not a difficult as many people would lead you to believe. A friend with a significant pre-existing condition said she was approved for individual policy too. I’m only suggesting that there are alternatives to PPACA. Due diligence should be applied.
On Edit:
Thread title was changed from "The Individual Health Insurance Market vs PPACA" to "Individual Health Insurance vs Exchange"
Last edited: