Preview 2017 ACA plans now active

[HadEnuff]

In NY below 200% FPL the plan is still $20 a month or nothing. Amazed it is still $20.

http://info.nystateofhealth.ny.gov/sites/default/files/Essential Plan Fact Sheet 2017.pdf

is that a PPO plan?

 

[HadEnuff]

What is meant by "rack rate"?

 

[user5027]

What is meant by "rack rate"?

Full price. In the hotel industry...the official or advertised price of a hotel room, on which a discount is usually negotiable.

 

[MooreBonds]

If it's any consolation... I recently had a procedure miscoded, and the hospital claimed I was responsible for the payment. I asked if there was any sort of reduction since I was paying out of pocket. I was told, if I was uninsured, they would reduce the charge by 80%. Since I was insured, they were only allowed by law or contract, I forget which one at the moment, to reduce the charge by 20%.

So, oddly enough, you may pay less for care without insurance, although the premiums aren't high enough yet for me to take that risk.

1) Not all hospitals may be so 'generous'.

2) You were talking to the hospital - there can be multiple additional providers, all of whom bill you independently (doctor, surgeon, anesthetist, radiologist, et. al.), each of which may take different angles on those who don't have insurance...and all of whom are more likely to not negotiate to that level, and instead go after you and/or sell it to a collections firm if you try and negotiate it after the fact, since the small individuals don't have billions in revenue to 'pay for' discounts like this.

 

[MrPotatoChip]

1) Not all hospitals may be so 'generous'.

2) You were talking to the hospital - there can be multiple additional providers, all of whom bill you independently (doctor, surgeon, anesthetist, radiologist, et. al.), each of which may take different angles on those who don't have insurance...and all of whom are more likely to not negotiate to that level, and instead go after you and/or sell it to a collections firm if you try and negotiate it after the fact, since the small individuals don't have billions in revenue to 'pay for' discounts like this.

Then just declare bankruptcy and they get nothing.

 

[Sue J]

For young people with low SLCSP premiums, the sliding scale of subsidies often goes to zero well below 400% FPL.

Yes, that's what I'm seeing when I preview plans for my 29 year old son. His income increased a lot this year (Yay!) as a free lance sound engineer but he won't be able to guesstimate his ACA MAGI until he gets closer to the end of the year. Unfortunately, he didn't inherit my love of detailed spreadsheets so he hasn't been tracking his deductible expenses all year, he just gathers them up at year end.

For his zip code and age the cliff is actually at about $31000 (261% of FPL). His SLCSP is $219/mo. The full cost of the lowest cost Bronze is $197/mo.

 

[MRG]

What is meant by "rack rate"?

It can be a very big difference. A recent ER visit was 15k full price, insurance was 3k.

 

[RunningBum]

When I used the term "rack rate" I meant the unsubsidized premium rate.

 

[niven]

I live in AZ. Luckily I have a grandfathered private insurance plan (as long as it continues to exist). Once it is gone I will have to get Obamacare or a work around. But these facts are grim.

One county in AZ has only one choice -- so much for competition that could drive prices down. And even with more than 1 option, the strictures of an Obamacare policy mean all the policies offered have the same options, so no competition. Let's hope somebody fixes this b/c we have taken a system that 90% of people were happy with and turned it into a disaster. This thing is a rube golberg nightmare and it was more than foreseeable by anyone who could look at it objectively.

Also, when anyone is happy about how subsidies are increasing, let's remember that the taxpayers (we who are working) are paying for all of this. There is no free lunch. Let's hope our inept congress can somehow figure out how to interject competition into this pig and eventually make it affordable. But their usual answer (more taxpayer money for subsidies and insurance company bailouts) will only make the death spiral happen that much sooner.

My advice: If you need or can foresee any type of medical treatment, book your doctor now. In some cases, the wait in AZ is over 6 months to see a qualified doctor. If you are early retired, consider a part-time job at Starbucks or a similar company where you can get work-related healthcare that does not have the huge co-pay, narrow networks and limitations of Obamacare. This is only going to get alot worse before it gets better. Good luck all and God Bless!

I'm not sure what you mean by all policies offered have the same options. Policies vary on premium and how much you can expect to co-pay for doctor visits, prescriptions, etc. and the total deductible and maximum out-of-pocket costs, not to mention what doctors and facilities are in the network. If you mean things like you can't be denied insurance, well I can't say I agree that's a bad thing.

90% were happy with the old system? Hardly - complaining about changes in our company health plan was an annual rite.

I'm sure anyone on pensions and/or social security, investments, etc. will be glad to know you've determined they aren't taxpayers anymore. I guess they can stop worrying about those pesky tax returns.

 

[ivinsfan]

1) Not all hospitals may be so 'generous'.

2) You were talking to the hospital - there can be multiple additional providers, all of whom bill you independently (doctor, surgeon, anesthetist, radiologist, et. al.), each of which may take different angles on those who don't have insurance...and all of whom are more likely to not negotiate to that level, and instead go after you and/or sell it to a collections firm if you try and negotiate it after the fact, since the small individuals don't have billions in revenue to 'pay for' discounts like this.

As more insurance companies switch to HMOS don't count on providers being generous. If and when uncollectibles start to pile up don't be surprised if you get turned away before you can rack up a big bill. If you are not in network you better have your checkbook with you if you want care. They might not let you bleed to death, but the rest is up in the air if they don't feel they are going to get paid.

 

[ivinsfan]

Then just declare bankruptcy and they get nothing.

That's a nice attitude because someone willl pay more because you don't want to pay anything . It will be higher bills for those of us who do pay or more taxes for everyone.

 

[Johnora]

COBRA for 2017

This is a bigger gamble and unknown than where to invest your money...

Retire in 2017 @52, would cost over $700 per month to join DW insurance plan. COBRA will let me stay at $450 a month for up to 18 months but this is turning out to be a game that you need to re-review each year.

No long term planning with healthcare costs anymore just lots of SWAG.

 

[NW-Bound]

As more insurance companies switch to HMOS don't count on providers being generous. If and when uncollectibles start to pile up don't be surprised if you get turned away before you can rack up a big bill. If you are not in network you better have your checkbook with you if you want care. They might not let you bleed to death, but the rest is up in the air if they don't feel they are going to get paid.

I had an out-patient minor surgery at a hospital. They checked with my insurance, and saw that my policy had a $10K deductible that had not been met. They called me at home the night before, telling me to bring money. The next day, at check-in, the receptionist rang up the bill and had me pay before they even let me up to the prep room to put on the airy gown.

The above was pre-ACA, and there's no reason to expect post-ACA would be any different. My policy was a PPO one.

That's a nice attitude because someone willl pay more because you don't want to pay anything . It will be higher bills for those of us who do pay or more taxes for everyone.

More and more of the citizenry is getting this attitude. Eventually, nobody wants to work or do anything. Greece was this way (and still is?).

 

[Big_Hitter]

SWAG.

that in the acronym list?

 

[MichaelB]

More and more of the citizenry is getting this attitude. Greece was this way (and still is?).

Are you sure this is the case? The average cost of healthcare insurance in the US equals around 35% of median pretax household income (IIRC), and that doesn't even cover deductibles or other cost sharing. This is an issue of basic affordability. It only arises in discussions about ACA prices because employer group insurance costs are not made public and Medicare is heavily subsidized.

 

[FUEGO]

It only arises in discussions about ACA prices because employer group insurance costs are not made public and Medicare is heavily subsidized.

Everyone's W-2s now has a box on it that shows what the employer paid for employer provided health insurance. For the past few years of working it was usually $10-15k per year (lower cost being high deductible plan; higher cost being a low-ish deductible 80% co-insurance plan). And that's just the employer's portion.

So all these $1000/month premiums for 2017 don't shock me at all since employers have had guarantee issue insurance for their employees for many many years and have been paying these high premiums. I remember back in 2010 or so our employee's share of family premiums were around $700-900 for a very average plan with moderate deductibles, limited network (major local hospital - where the ambulance would take us - not in network) and high copays.

 

[Looking4Ward]

Everyone's W-2s now has a box on it that shows what the employer paid for employer provided health insurance. For the past few years of working it was usually $10-15k per year (lower cost being high deductible plan; higher cost being a low-ish deductible 80% co-insurance plan). And that's just the employer's portion.

So all these $1000/month premiums for 2017 don't shock me at all since employers have had guarantee issue insurance for their employees for many many years and have been paying these high premiums. I remember back in 2010 or so our employee's share of family premiums were around $700-900 for a very average plan with moderate deductibles, limited network (major local hospital - where the ambulance would take us - not in network) and high copays.

This is true. Although it's been a couple of years now my company would kick in up to $950 a month for coverage, If the employee chose a basic plan and coverage for only themselves they likely didn't have any deductions from their paycheck. But an employee who chose family coverage was most likely having to contribute out of each paycheck as well.

So the annual cost per year was $10K (individual) or more (family). That would certainly be higher today as illustrated by the new ACA rates. The difference, though, is in deductibles and OOP costs. Those were and probably still are much lower for employer sponsored plans because of the lower risk assignment among the groups. What we see in the ACA rates are most likely the upper ranges of the high risk pools.

 

[NW-Bound]

Are you sure this is the case? The average cost of healthcare insurance in the US equals around 35% of median pretax household income (IIRC), and that doesn't even cover deductibles or other cost sharing. This is an issue of basic affordability. It only arises in discussions about ACA prices because employer group insurance costs are not made public and Medicare is heavily subsidized.

I showed earlier that the insurance premium plus the high deductible is almost as high as the median pre-tax income of a couple our age in the county of my 2nd home. It's a whole lot more than 35%.

It should cause an outrage for people to demand to know why it is that high. People should not say "it's OK with me because it is still low after my subsidy". That attitude is what I was talking about.

I have often told the story from more than 35 years ago, when my employer then had a campaign to pass laws in the state to demand transparency in hospital costs, among other things. People voted it down in the election, because the other side said that it was about limiting their healthcare: "How dare people talk about money when it comes to healthcare!" Huh?

My former employer was seeing the writing on the wall very early. Back then, health and dental insurance was free for the employees (PPO too), and for the family it was something like $100/month. The cost was rising though, and my employer knew there was trouble ahead. Still, people didn't care, as they didn't think it was their problem. Let my employer pay. Right!

 

[MichaelB]

It should cause an outrage for people to demand to know why it is that high. People should not say "it's OK with me because it is still low after my subsidy". That attitude is what I was talking about.

I thought you might be making a different point, and agree with this.

Everyone's W-2s now has a box on it that shows what the employer paid for employer provided health insurance.

Good point.

Two sources frequently mentioned that have tracked employer healthcare costs for many years, are KFF and Milliman. Their estimates - KFF reports insurance cost of $18142 (here) and Milliman reports total healthcare cost of $25826 (here). Both 2016, family of 4.

Median household income in the US is only $52K. The reason healthcare costs have reached those levels is because employers are footing the bill, and taxpayers picking up part of that tab. Same holds true, in part, with Medicare.

Making or enabling full transparency in health care prices and costs won't solve any problems but it would probably help get some focus.

 

[NW-Bound]

...Making or enabling full transparency in health care prices and costs won't solve any problems but it would probably help get some focus.

It would show us where the money goes, and what we get in return. It does not solve the problem, but helps us define it.

Maybe after understanding the benefits, we will all say "it's really worth it", and become willing to spend all our own assets (not somebody else's, mind you) down to zero to get "it". But we do not really know what "it" is that costs so much.

Right now, in my area, the health insurance has gone up to more than double in just one year. Per law, insurers have to pay most of it out and not to keep it as profits. So, am I correct in saying that the healthcare cost has doubled? I assume that auditing has been done to see that insurers did not cheat on their books.

What has doubled then? Hospitals have racked up their rates to double? Drugs now cost twice as much? People are now twice as sick?

What is it? Nobody does anything. Just let Uncle Sam keep on paying. He can print more money.

 

[2017ish]

This is a bigger gamble and unknown than where to invest your money...

Retire in 2017 @52, would cost over $700 per month to join DW insurance plan. COBRA will let me stay at $450 a month for up to 18 months but this is turning out to be a game that you need to re-review each year.

No long term planning with healthcare costs anymore just lots of SWAG.

You sum up our situation (retire in 17 at 57/56). Switching our insurance to DW's employer plan despite fact that she will have to pay for it all from her gross revenues (my employer subsidizes--but is too small for COBRA). We'll have choice to do last few months of '17 and all of '18 via COBRA or individual/couple plan off or on the exchange.... Because of deferred comp, won't be eligible for subsidies in either year; will be interesting!

I may have mentioned up thread that my personal SWAG of 2K per month medical in retirement is looking more and more unlikely--at least for the first year or two.

 

[RunningBum]

It would show us where the money goes, and what we get in return. It does not solve the problem, but helps us define it.

Maybe after understanding the benefits, we will all say "it's really worth it", and become willing to spend all our own assets (not somebody else's, mind you) down to zero to get "it". But we do not really know what "it" is that costs so much.

Right now, in my area, the health insurance has gone up to more than double in just one year. Per law, insurers have to pay most of it out and not to keep it as profits. So, am I correct in saying that the healthcare cost has doubled? I assume that auditing has been done to see that insurers did not cheat on their books.

What has doubled then? Hospitals have racked up their rates to double? Drugs now cost twice as much? People are now twice as sick?

What is it? Nobody does anything. Just let Uncle Sam keep on paying. He can print more money.

One explanation is that formerly uninsurable people are now covered, and as a group they use the benefits more. The insurance companies have to charge more to pay out those benefits. IF that's the case, one would hope premiums will somewhat level out, as there shouldn't be another influx of high benefit users coming.

And if you really believe how health insurance is supposed to work, overall costs will drop because formerly uninsurable people are now doing preventative things and not waiting until they are more sick to get treatment.

I've got hope for the first part. Not as confident on the second part.

 

[NW-Bound]

RunningBum, I suspected the same as what you wrote. An earlier poster made the same comment.

BTW, my theory on the price increases is that the insurance companies are still paying for folks who went without insurance for years, joined when coverage first came available and raced to have their pre-existing conditions operated on, etc.

Perhaps some of the cheaper plans are offered by companies who waited to get into the individual state until the "rat moved through the snake" if you will, and do not have the backlog of health problems needing immediate attention.

Healthcare officials have the exact data to shed light on this. So far, nothing comes out of them. The media reports on the premium increase, but the reporters are not smart enough to ask "why" or "how", instead of just "how much".

By the way, looking through the thread I saw that EastWestGal also reported that the premium doubled in her area in PA. Another poster talked of doubling in 2 years.

Even if the cost increase is hopefully temporary as the "snake digests the rat", why is it that some areas have more sick people than the rest of the nation? You would think that some people would raise an eyebrow and look into it.

 

[Blueskies123]

I see many people are saying they can get a silver or bronze plan for just a few hundred dollars a month. I had UHC in Florida but UHC pulled out of ACA. When I looked at the cheaper silver plans NONE of my doctors were in network. The only plans that have my 6 doctors are $2,000 a month before the subsidy. UHC covered all my doctors and was $1200 a month before subsidy.
So my question is to those going for the $200 plans are you finding your doctors in network or you just go the closest doctor in your plan? Are you not worried about the quality of the doctor or the huge backlogs in the waiting rooms?

 

[GTFan]

Heh, most of us going for 'the $200 plans' are doing so because we have little if any choice. My area went from 6 or 7 insurers down to 2 (and the ATL is not a small town). Whole swaths of TN just to the north have just one.

Having said that, I do appreciate that Uncle has jacked my subsidy from $900 to $1100 a month to cover the cost of lesser choices. We're going from a Humana national network PPO to a choice of two local HMOs, Kaiser and BCBS. Right now I'm leaning towards BCBS because there are a bunch of local docs in the plan, although we will have to change PCPs. Plan this year is $160 a month (94% CSR Silver), next year it will be $41 a month. For two people in their early 50s, with a $250 deductible/$750 max OOP per person.

I do agree that this system cannot be maintained as-is, but I intend to take full advantage of it until it implodes.