ACA Rate Increases For 2023

[Wupot2020]

Investment income when married

I see that the application requires that my spouse and I to each provide our income separately. We are both retired and live off of investment income. How doe we enter this info? Do we split it 50/50 or does it even matter since we will note that we file our taxes jointly?

Thanks

 

[Aerides]

I see that the application requires that my spouse and I to each provide our income separately. We are both retired and live off of investment income. How doe we enter this info? Do we split it 50/50 or does it even matter since we will note that we file our taxes jointly?

Thanks

That's what we do. I just kinda fudge it - I split our estimated income in two, then by 12 and put in expected monthly for me, and then repeat for DH.

It doesn't have to be super scientific.

 

[COcheesehead]

Same gold policy ‘23 for Colorado and staying at ‘22’s income, would have went down about $30/ month.
Same policy with ‘23’s income (thank you bonds), would go up almost $600/ month.

So we signed up for a Bronze HSA and save about $60 a month over ‘22’s costs and being able to take advantage of the HSA with an almost 60% increase in our ‘23 income.

 

[GoBears]

Covered California’s rates in my SF Bay Area county will go up an average of 6.1% for 2023. That translates into an extra $180 a month (not taking subsidies into account) for a Blue Shield of CA Silver plan. I decided to switch to Kaiser and save $300 a month for the same Silver Plan coverage. I can’t wait for Medicare in early 2024.

 

[Irishgirlyc58]

Covered California’s rates in my SF Bay Area county will go up an average of 6.1% for 2023. That translates into an extra $180 a month (not taking subsidies into account) for a Blue Shield of CA Silver plan. I decided to switch to Kaiser and save $300 a month for the same Silver Plan coverage. I can’t wait for Medicare in early 2024.

Is that family coverage? A 6.1% increase at $180 means you started at $2950. [emoji15]
Please tell me that’s for several people!
I love Kaiser. Unfortunately I don’t live in an area that they serve.

 

[EastWest Gal]

Can you recheck your work? You say you get a higher subsidy at age 63. This makes sense, since your rate is probably higher. Keep in mind that the subsidy is based on the price of the Second Lowest Cost Silver Plan for your zip code for your age. It is not based on any particular plan you select.

Generally, rates go up with age. In order to see what you say you see, the base rate for age 62 would have to be higher than age 63. In fact, way higher, since the subsidy you indicate is less at age 62. It’s possible, but not typical.

Good point. There are very few silver plans here. And they’re very expensive. I’m sticking with our bronze plan anyway.

 

[DayDreaming]

I got a letter from my current provider saying my monthly premium is going from $381 to $485 next year.
Time to shop around, but I don't have high hopes of finding anything better.

 

[USGrant1962]

Unsubsidized Maryland BC/BS HMO HSA bronze plan +13.2% - ouch!

 

[Murf2]

I went on MediCare mid-year. Our premium was 270 for both of us. The wife’s was 145 after I was off the policy. Just signed up for 2023 last night. 235 instead of 145 for the same BCBSKS.

The only other provider was Ambetter. Very cheap but new to our state & none of our providers seemed to be in network for them.

BCBS service has been great in the past, so what’s another grand a year. [emoji16]

Murf

 

[fh2000]

Covered California website 'Shop and Compare' tool always gives a much higher estimate for DW's plan, so I normally just call their hotline to renew DW's Bronze HSA PPO plan. Her premium for 2022 is $0.

I asked the agent online to do the Shop and Compare estimate for the same plan. He got $260 a month, but when the plan was renewed and finalized for 2023, the premium is back down to $0. He could not explain why such a big difference. But $0 is good.

 

[TripleLindy]

That's what we do. I just kinda fudge it - I split our estimated income in two, then by 12 and put in expected monthly for me, and then repeat for DH.

It doesn't have to be super scientific.

Since I was the only one who had an income for most of our marriage, I just report income under my name and enter $0 for my wife. We also only have investment income, so unless there’s an unusual event, like a significant portfolio rebalance, our income is primarily dividends plus a little interest income. I don’t know why they want to show monthly income, as ours is mainly quarterly, but I just divide the annual amount by 12 and enter that for the monthly amount.

This year, I received a notice that my income didn’t match their records, but no specific info was given. We sold a 2nd home for a profit last year and also had a rebalancing event that resulted in significant income, therefore, last year’s income was higher than usual. Of course, we ended up repaying most of our subsidy. I can only assume that’s the cause of the mismatch. I’ve since submitted a letter explaining that, as well as statements showing 2022 YTD income in line with my 2023 estimate. Hopefully, that will settle the issue.

 

[old medic]

Just got mine... And not happy... Deductable/out of pocket increased $500 and premium up 13.5%.
Can't figure the subsidy yet...

 

[socca]

Completed my annual health insurance song-and-dance - not much change from last year. My options:

(1) [A]CA - no subsidy.

• Lowest-cost bronze plan is $8,772 / yr with $8,600 deductible. Best local hospital is out-of-network.

• Lowest-cost bronze plan with best local hospital in-network is $9,432 / yr with a $9,100 deductible. This plan has increased 13% from last year.

(2) National General "short-term" (364 days) health insurance. Doesn't cover pre-existing conditions.

• in the past I've signed up for the $25k deductible, 100%/0% co-insurance, $1M max coverage plan. This year it's $2,268 / yr, a 31% increase from last year.

• website is even crappier than usual - can't tell whether the best local hospital is in-network

(3) United Health "short-term" (364 days) health insurance. Doesn't cover pre-existing conditions.

• in the past I've signed up for the $15k deductible, 100%/0% co-insurance, $2M max coverage. This year it's $3,696 / yr, a 10% increase from last year.

• the best local hospital is in-network

• better website than National General - can apply entirely online

== this year's choice ==

• same as last year: United Health "short-term" insurance.

• $9.4k for [A]CA vs. $3.7k for UH = $5.7k savings. This is a nice-sized chunk of change.

== additional notes ==

• medical underwriting continues to be amusing. I've been purchasing "private" insurance since 2007 except for a 1.5-year gap when I used the [A]CA, so I've seen how the process has evolved. The height and weight question has always featured prominently in medical underwriting. These health insurance companies are sitting on a vast trove of raw data that indicates that weight matters. I then look around at the overweight/obese Americans swarming everywhere and wonder if they're getting the message.

 

[O2Bfree]

Our premiums will increase next year because of an increase in our income, but now I'm having an issue that I don't understand. The KFF calculator shows $753/month for our premiums, but my state's health plan finder shows $1,025.93/month. The two have agreed the past two years I've used them, and I've checked all my inputs a couple times.

The plan I hope to renew is a baseline Silver plan, and so should have an 8.5% cap. But $1,025.93 is 11.6%. I've called both Molina and health plan finder support lines and neither could give me any answers. The rep for the state agency had never even heard of the KFF calculator or the 8.5% cap! And the rep for Molina knew nothing about their pricing and said to call the state agency! I thought maybe they could tell me if the plan was no longer a baseline plan, but no, they knew less than I do.

So I've messaged Molina about the issue through their website support portal, and also posted a bad review on Google. Molina responded to the review right away—maybe it was a bot response—and gave an email address to use to contact them. They've always responded through their support portal within a couple days, but I'll email them if I don't get a response by then.

 

[Winemaker]

My non ACA plan premium went from $883.56 to $988.86/month.


Can't wait til next year to get on Medicare. Even with IRMAA penalties, I'll save over $350/month. It's been eight years of paying these kind of premiums.

 

[TripleLindy]

Completed my annual health insurance song-and-dance - not much change from last year. My options:

(1) [A]CA - no subsidy.

• Lowest-cost bronze plan is $8,772 / yr with $8,600 deductible. Best local hospital is out-of-network.

• Lowest-cost bronze plan with best local hospital in-network is $9,432 / yr with a $9,100 deductible. This plan has increased 13% from last year.

(2) National General "short-term" (364 days) health insurance. Doesn't cover pre-existing conditions.

• in the past I've signed up for the $25k deductible, 100%/0% co-insurance, $1M max coverage plan. This year it's $2,268 / yr, a 31% increase from last year.

• website is even crappier than usual - can't tell whether the best local hospital is in-network

(3) United Health "short-term" (364 days) health insurance. Doesn't cover pre-existing conditions.

• in the past I've signed up for the $15k deductible, 100%/0% co-insurance, $2M max coverage. This year it's $3,696 / yr, a 10% increase from last year.

• the best local hospital is in-network

• better website than National General - can apply entirely online

== this year's choice ==

• same as last year: United Health "short-term" insurance.

• $9.4k for [A]CA vs. $3.7k for UH = $5.7k savings. This is a nice-sized chunk of change.

== additional notes ==

• medical underwriting continues to be amusing. I've been purchasing "private" insurance since 2007 except for a 1.5-year gap when I used the [A]CA, so I've seen how the process has evolved. The height and weight question has always featured prominently in medical underwriting. These health insurance companies are sitting on a vast trove of raw data that indicates that weight matters. I then look around at the overweight/obese Americans swarming everywhere and wonder if they're getting the message.

That’s a really interesting post and highlights much of what is wrong with healthcare in the U.S., but mostly hidden due to subsidies either from an employer or the government. We focus on what we pay instead of the true cost, which is often more than 2x our cost.

I’m assuming the premiums quoted in point 1 are for 1 person. Consider that the plan with the preferred hospital carries a $9400 premium with a $9100 deductible. That’s a cost of $18,500 before the customer receives a single penny of coverage. The average household income in the U.S. is just under $71,000. The cost of coverage with no care whatsoever is more than 26% of household income. Even if the premium is 100% subsidized, the $9100 deductible represents 13% of income. That’s insane. No other advanced country in the world has costs that high, but the U.S. ranks at or near the bottom in almost all health outcome measures.

Our healthcare insurance has really become disaster insurance. Given the high cost and tightly controlled access, most people would be better off without it, but we’d all be exposed to financial disaster in the event of an auto accident or a cancer diagnosis. High deductibles incentivize people to avoid care, not to mention the difficult to navigate uncoordinated health system and insurance industries.

The short-term insurance, with the pre-existing conditions exclusion, is a subject worth a separate discussion, but one that we shouldn’t require in a country as wealthy as ours.

 

[PaunchyPirate]

Our premiums will increase next year because of an increase in our income, but now I'm having an issue that I don't understand. The KFF calculator shows $753/month for our premiums, but my state's health plan finder shows $1,025.93/month. The two have agreed the past two years I've used them, and I've checked all my inputs a couple times.

The plan I hope to renew is a baseline Silver plan, and so should have an 8.5% cap. But $1,025.93 is 11.6%. I've called both Molina and health plan finder support lines and neither could give me any answers. The rep for the state agency had never even heard of the KFF calculator or the 8.5% cap! And the rep for Molina knew nothing about their pricing and said to call the state agency! I thought maybe they could tell me if the plan was no longer a baseline plan, but no, they knew less than I do.

So I've messaged Molina about the issue through their website support portal, and also posted a bad review on Google. Molina responded to the review right away—maybe it was a bot response—and gave an email address to use to contact them. They've always responded through their support portal within a couple days, but I'll email them if I don't get a response by then.

What is your definition of "a baseline plan"? Perhaps its just a matter of wording, but there is only ONE baseline plan for any one person in one location.

The premium subsidy is based on the Second Lowest Cost Silver Plan (SLCSP) available to you. That is the plan that should not cost you more than 8.5% of your estimated income. Any other silver plan will cost more or less depending on where it sits with respect to your SLCSP. The plan you hope to renew may have been the SLSCP in previous years, which would match it up to the KFF calculator, but it may no longer be the SLCSP this year.

 

[O2Bfree]

What is your definition of "a baseline plan"? Perhaps its just a matter of wording, but there is only ONE baseline plan for any one person in one location.

The premium subsidy is based on the Second Lowest Cost Silver Plan (SLCSP) available to you. That is the plan that should not cost you more than 8.5% of your estimated income. Any other silver plan will cost more or less depending on where it sits with respect to your SLCSP. The plan you hope to renew may have been the SLSCP in previous years, which would match it up to the KFF calculator, but it may no longer be the SLCSP this year.

I meant benchmark plan, as you described. The health plan finder recommended the SLCSP plan by default the past two years, but is apparently not doing that now. So apparently, my old plan's premiums increased by 26.6% for next year.

 

[PaunchyPirate]

I meant benchmark plan, as you described. The health plan finder recommended the SLCSP plan by default the past two years, but is apparently not doing that now. So apparently, my old plan's premiums increased by 26.6% for next year.

You could do a couple things if you're interested in the background of your calculations on your exchange. You could review pricing while NOT logged into your account. I think all exchanges (individual states and the federal exchange) have ways to "browse" without buying. Enter $300,000 as your income so that you would not be getting any subsidy. Then review all the plans that come up. Not just ones that are recommended. I would find the SLCSP and see what the premium is. I would then find the plan that you want and see what it costs.

You are one year older this year than last year, so part of the premium increase you see is because of that. It is not all about inflation. If you want to see the price increase without age impact, pretend that you are one year younger and see what the rate of the plan you hope to keep is. That would be the true apples-to-apples comparison.

 

[O2Bfree]

You could do a couple things if you're interested in the background of your calculations on your exchange. You could review pricing while NOT logged into your account. I think all exchanges (individual states and the federal exchange) have ways to "browse" without buying. Enter $300,000 as your income so that you would not be getting any subsidy. Then review all the plans that come up. Not just ones that are recommended. I would find the SLCSP and see what the premium is. I would then find the plan that you want and see what it costs.

You are one year older this year than last year, so part of the premium increase you see is because of that. It is not all about inflation. If you want to see the price increase without age impact, pretend that you are one year younger and see what the rate of the plan you hope to keep is. That would be the true apples-to-apples comparison.

Thanks for the input. After three years of an easy time selecting a plan that was waaayyyy less expensive than I'd budgeted for, looks like I'll have to put more effort into it for next year.

 

[Rainbowdash]

We are a family of 3, paying $1545 per month, commercial BCBS PPO HSA compatible, $6900 per person and $13800 per family per year deductible, which is the same as OOP max. Since retiring 3 years ago, we have had annual premium increases of around 10-12% per year. There’s no PPO in ACA insurance in our area, therefore we opted for commercial, very expensive and it will only get worse, however we are happy with it as it also covers outside USA

 

[scrabbler1]

That’s a really interesting post and highlights much of what is wrong with healthcare in the U.S., but mostly hidden due to subsidies either from an employer or the government. We focus on what we pay instead of the true cost, which is often more than 2x our cost.

I’m assuming the premiums quoted in point 1 are for 1 person. Consider that the plan with the preferred hospital carries a $9400 premium with a $9100 deductible. That’s a cost of $18,500 before the customer receives a single penny of coverage. The average household income in the U.S. is just under $71,000. The cost of coverage with no care whatsoever is more than 26% of household income. Even if the premium is 100% subsidized, the $9100 deductible represents 13% of income. That’s insane. No other advanced country in the world has costs that high, but the U.S. ranks at or near the bottom in almost all health outcome measures.

Our healthcare insurance has really become disaster insurance. Given the high cost and tightly controlled access, most people would be better off without it, but we’d all be exposed to financial disaster in the event of an auto accident or a cancer diagnosis. High deductibles incentivize people to avoid care, not to mention the difficult to navigate uncoordinated health system and insurance industries.

The short-term insurance, with the pre-existing conditions exclusion, is a subject worth a separate discussion, but one that we shouldn’t require in a country as wealthy as ours.

Back on page 4 of this thread, you made the same statement I bolded above and I refuted it (see post #74), describing 2 reductions in the provider's rate which cause me to pay a lot less than that rate. Some of it is a discount, or write-down. Some of it is what the IC directly pays toward what is left. Each portion is far more than "a penny of coverage" as you incorrectly describe it. What I end up paying, in many cases, is a small copay, such as $50 to see a specialist doctor or a copay for a lab visit.

I didn't mention before but I'll add now is the benefit of having the IC pay for a large portion of my prescription drugs. For the cheaper (Tier 1) drugs, it doesn't matter a whole lot. But for more expensive (Tier 2) drugs, the benefit is huge, as I often pay less for those than I pay for the cheaper, generic-type drugs.

 

[TripleLindy]

Back on page 4 of this thread, you made the same statement I bolded above and I refuted it (see post #74), describing 2 reductions in the provider's rate which cause me to pay a lot less than that rate. Some of it is a discount, or write-down. Some of it is what the IC directly pays toward what is left. Each portion is far more than "a penny of coverage" as you incorrectly describe it. What I end up paying, in many cases, is a small copay, such as $50 to see a specialist doctor or a copay for a lab visit.

I didn't mention before but I'll add now is the benefit of having the IC pay for a large portion of my prescription drugs. For the cheaper (Tier 1) drugs, it doesn't matter a whole lot. But for more expensive (Tier 2) drugs, the benefit is huge, as I often pay less for those than I pay for the cheaper, generic-type drugs.

Oops - I had forgotten that I had already been on this rant earlier in the thread. And I never saw your reply. Sorry about that. But my statement stands and is accurate. Citing a “reduction” in a fee in the form of an insurance discounted rate is fools gold. Those write-offs are standard practice and part of healthcare accounting for tax purposes. You’ll find that you can easily do better by just asking for the cash rate. Give it try, or better, talk to people in the billing office.

As far as drug coverage goes, the plan I cited above would not provide any coverage at all until the deductible is met. If your plan has drug coverage that is not subject to the deductible, that’s great! If you are again referring to the discounted price vs the retail price, you may be right on drug prices. I haven’t had much personal experience in that area, but have been told by many that programs like GoodRX often provide better pricing than the insurance rate.

If you’re happy with the cost of healthcare, fantastic. I’m not and what I’m most disappointed about is that as the most advanced country in the world, we have some of the worst healthcare performance at the highest cost. By a long shot.

 

[scrabbler1]

Oops - I had forgotten that I had already been on this rant earlier in the thread. And I never saw your reply. Sorry about that. But my statement stands and is accurate. Citing a “reduction” in a fee in the form of an insurance discounted rate is fools gold. Those write-offs are standard practice and part of healthcare accounting for tax purposes. You’ll find that you can easily do better by just asking for the cash rate. Give it try, or better, talk to people in the billing office.

As far as drug coverage goes, the plan I cited above would not provide any coverage at all until the deductible is met. If your plan has drug coverage that is not subject to the deductible, that’s great! If you are again referring to the discounted price vs the retail price, you may be right on drug prices. I haven’t had much personal experience in that area, but have been told by many that programs like GoodRX often provide better pricing than the insurance rate.

If you’re happy with the cost of healthcare, fantastic. I’m not and what I’m most disappointed about is that as the most advanced country in the world, we have some of the worst healthcare performance at the highest cost. By a long shot.

I would agree that in some cases, the original provider fee is probably inflated. The lab costs could certainly be, given the huge write-down (~90%) to the IC-allowed charge. For the doctors, the write-down was much lower, on both a percentage and $$ basis. Does this mean the cash rate would simply be the sum of the cash the providers received, or would it be something different (higher or lower)? I'm not sure.

So, let's look at the total amount paid to the providers, adding together what the IC paid directly in cash and what I paid in copays. Overall, I paid 22% of this total. This percentage was pretty consistent among doctors and labs.

As for drugs, there is no write-down for the drug provider. Either the IC paid for the drug, or I did, or some combination. Overall, I paid 4% of the total, driven by the IC paying nearly all the cost for 2 costly drugs while I paid for most of the cost of the very inexpensive ones, a very good deal. I did not have to exceed any deductible first.

I pay just under $4,000 in premiums and copays for my medical (excluding dental, which is outside the insurance system but less than $1,000 total) services and drugs. I'm fine with that, and its outcome. But I can surely see how others are not happy with their own situations - YMMV.

 

[TripleLindy]

I would agree that in some cases, the original provider fee is probably inflated. The lab costs could certainly be, given the huge write-down (~90%) to the IC-allowed charge. For the doctors, the write-down was much lower, on both a percentage and $$ basis. Does this mean the cash rate would simply be the sum of the cash the providers received, or would it be something different (higher or lower)? I'm not sure.

So, let's look at the total amount paid to the providers, adding together what the IC paid directly in cash and what I paid in copays. Overall, I paid 22% of this total. This percentage was pretty consistent among doctors and labs.

As for drugs, there is no write-down for the drug provider. Either the IC paid for the drug, or I did, or some combination. Overall, I paid 4% of the total, driven by the IC paying nearly all the cost for 2 costly drugs while I paid for most of the cost of the very inexpensive ones, a very good deal. I did not have to exceed any deductible first.

I pay just under $4,000 in premiums and copays for my medical (excluding dental, which is outside the insurance system but less than $1,000 total) services and drugs. I'm fine with that, and its outcome. But I can surely see how others are not happy with their own situations - YMMV.

Understood and glad you have good coverage. If you don’t have a deductible and are only paying copays and your low premium, you are definitely in the minority. The example cited above is more indicative of the insurer market, where premiums and deductible are in the $20k range without a subsidy. And that’s what I was highlighting - $20k out of pocket before any coverage. And having worked in the healthcare revenue cycle space, I can assure you that the charge master rate (retail price) is rarely “charged” to anyone. Most cash rates, especially at physician offices, are lower than many insurer rates because the doc gets cash in hand with no wait. Insurers are notoriously slow to pay and often require costly re-filing of claims. Processing payment through an insurer runs in the 4-6% range from a cost perspective.

Congrats on your insurance coverage!