ACA Sticker Shock

[24601NoMore]

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Originally Posted by ivinsfan Well you shouldn't have to move and uproot your entire like for HI. And it's a sketchy plan anyway because moving costs a crap ton of money there is no guarantee insurance would stay cheap and affordable in your area. What the stickers price of your spouse's coverage no way it retails for 65 bucks a month.

Amen to that! I'm always amazed at the suggestions that get made to just uproot your entire life and move elsewhere to get more affordable healthcare, which as we all know is not certain whatsoever to STAY "more affordable".

[wompo]

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Originally Posted by 24601NoMore Thought some of you contemplating ER may be interested in my experience just now pricing ACA plans as my COBRA is now ending 18 months after my own ER.. First, I have a grand total of ONE PPO provider (BCBS) to "choose" from in my area. ONE. Cheapest PPO in my zip code is $652.91, with a (get this) $8,150 (!!!) deductible. Basically, I get to pay almost $8,000 per year ($7,834 in premiums) for ONE mid 50s age person, THEN all of my expenses at 100% until I hit ANOTHER $8,150. Then, and only then, does the plan start to pay. Obviously, this is nearly $16,000 in cash outlay per year for ONE person, mid 50s, before the plan pays a penny. Yeah, I'm not even remotely happy. They sure "fixed" our healthcare system, alrighty. Those of you considering ER should take a very close look at the HC costs before pulling the trigger..

Wish I could get a PPO. Only HMO here in Las Vegas. Cheapest bronze plan with 8250 deductible and OOP per person 16500 total for wife and me (in 50s) is 898.00 per month.

[Bir48die]

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Originally Posted by candrew +1

Sorry, this argument has never flown with me.

[Aerides]

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Originally Posted by 24601NoMore That said, actually having to get to the point where I have to now pay the crazy monthly premiums and have deductibles I'll never satisfy unless I get hit by a train is a whole different matter.

You know it's funny, I would have said the same thing. We each have a $6k deductible.

Year 1: DH had a suspect blood test last year....tl;dr he's fine, but sailed right past the deductible with all the testing and some very mild treatments by July.

Year 2: I started with my first colonoscopy, and a visit to my ortho for a sore knee, a re-up cortizone shot since. Torn Meniscus, simple injury from a twist saving myself from a slippery shower last year. Getting the pre-op clearance required full bloodwork, PCP visit, Cardio/Echo clearance + the actual surgery... I'll hit the $6k this month.

Out of pocket uninsured both these things would have exceeded 20k each so there's that at least.

[Time2]

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Originally Posted by bobandsherry FYI, I get a subsidy and also pay Federal taxes. Also paid in a crap load to fed tax when I was working as well.

And without the subsidy, you couldn't afford health insurance?

[scrabbler1]

Quote:

Originally Posted by 24601NoMore Thought some of you contemplating ER may be interested in my experience just now pricing ACA plans as my COBRA is now ending 18 months after my own ER.. First, I have a grand total of ONE PPO provider (BCBS) to "choose" from in my area. ONE. Cheapest PPO in my zip code is $652.91, with a (get this) $8,150 (!!!) deductible. Basically, I get to pay almost $8,000 per year ($7,834 in premiums) for ONE mid 50s age person, THEN all of my expenses at 100% until I hit ANOTHER $8,150. Then, and only then, does the plan start to pay. Obviously, this is nearly $16,000 in cash outlay per year for ONE person, mid 50s, before the plan pays a penny. Yeah, I'm not even remotely happy. They sure "fixed" our healthcare system, alrighty. Those of you considering ER should take a very close look at the HC costs before pulling the trigger..

In 2019, I paid $648 per month in premiums (no subsidy) for my ACA Silver plan which has a high deductible like yours. But, as BobandSherry wrote, I get a huge benefit from the negotiated rates and reduction in my drug prices, especially for one very costly drug.

Without insurance, I would have had to pay $3,100 for doctor and other medical services, and another $5,000 for drugs. Paying the negotiated rates for the former lowered the cost to $900, and my IC paid nearly $600 of that. So, my share of it was $343, only 11% of the original amount. For my drugs, I paid only $266, or 5% of the original amount. Together, that's $609 out of just over $8,000 of charges, so if my annual deductible had been only $1,000 instead of close to $8,000, it would have made no difference.

I see the annual deductible as a ceiling on what I'd have to pay if something really big and awful (and, very rare, hopefully) happened to me, like what happened to me at this time 5 years ago when I was sick and spent 12 days in the hospital. Yes, I had to pay about $6,400 (the annual deductible in 2015), but the total bill without insurance would have been $88,000.

The labs costs and the one expensive drug are the items where I pay the smallest percentages of the original charges (1.5% overall) and they represent nearly 2/3 of the total original charges. Those alone make insurance worthwhile financially.

I just got back on the subsidy train this year, so I don't pay nearly as much in premiums as I did before, another plus.

[scrabbler1]

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Originally Posted by Aerides Long before we ER'd, back in our early planning days, right before the ACA, we talked with our FA and decided to budget 1k per month for premiums/deductibles. Based on what he was paying at the time for himself+wife, our age (late 40's then), for private insurance for 2, he said that was a good estimate. I remember looking at the time (and this was around 2010-11 ish) that rates for 2 were around $700 plus a hefty deductible. And that is almost 10 years ago. So it's not really the ACA that is giving you sticker shock, but non-employer-subsidized private market insurance. And yeah the ACA never expected to solve the sticker price, other than adding subsidies. But your basic message is true: Understand and plan for these costs in your ER planning, not after you pull the trigger. OP, given how much you agonized over your readiness, I'm sure you ran multiple estimates in your budget planning.

The sticker shock I received was in 2010 and 2011, when, after my COBRA expired at the end of 2008, my pre-ACA premiums rose by 20% from 2009 to 2010 and another 25% from 2010 to 2011. Combined that's a 50% increase in just 2 years, pushing my monthly premium from $469 to $700 and putting a strain on my ER budget. At that rate, I'd be paying $2k per month in 5 or 6 years (for one person, remember)! I did not budget for increases that high in my ER planning.

Thankfully, the ACA had been passed already so all I had to do was hang in there until 2014 when the exchanges were developed.

[bobandsherry]

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Originally Posted by Time2 And without the subsidy, you couldn't afford health insurance?

We'd manage as we did not first year.

[Gumby]

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Originally Posted by Aerides So it's not really the ACA that is giving you sticker shock, but non-employer-subsidized private market insurance. And yeah the ACA never expected to solve the sticker price, other than adding subsidies. .

Indeed. If you look at your last W2 (Box 12 code DD), you'll see the value of your health care insurance. It includes the total of employer and employee contributions, and it is a large number. For our last full year of working, 2018, that was about $20k for the young wife and me. My retirement planning always assumed health insurance would cost at least this much and presumably more.

We are now on my retiree healthcare plan. The yearly premium is $25,200, which is paid by my former employer. I paid 3% of my pay for 10 years while I was working just for this retirement benefit. It is much more valuable than my actual pension.

Health insurance of every type is just very expensive.

[Sue J]

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Originally Posted by 24601NoMore Thought some of you contemplating ER may be interested in my experience just now pricing ACA plans as my COBRA is now ending 18 months after my own ER.. First, I have a grand total of ONE PPO provider (BCBS) to "choose" from in my area. ONE.

Do you have more options of you choose an HMO instead of a PPO? Or is that BCBS PPO the only insurance option in your area?

We were lucky in our area in that we had 6 or 7 insurers but all of them were HMO, we never had a PPO option except maybe in the first few years of ACA.

If you are willing to accept an HMO you may have an option for an HSA plan. That will still have the crazy high deductible but making the HSA contribution lowers your income to get a higher subsidy.

Are you getting any subsidy at all? Your subsidy may be smaller if you are married and only you need the insurance, and your spouse does not. It's the total household income that counts and if you only need insurance for one you lose a lot of subsidy.

[24601NoMore]

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Originally Posted by Sue J Do you have more options of you choose an HMO instead of a PPO? Or is that BCBS PPO the only insurance option in your area? Are you getting any subsidy at all? Your subsidy may be smaller if you are married and only you need the insurance, and your spouse does not. It's the total household income that counts and if you only need insurance for one you lose a lot of subsidy.

We do have a few HMO options that are ~$2-250/mo cheaper. That said, I also have quite a few specialists I see regularly, and the whole "referral" process sounds like a giant PITA. As an example - I have eczema and see a dermatologist regularly. My PCP doesn't know diddly about eczema..so to have to go to the PCP and have her say "yep..that's eczema, here's a referral" every time would get pretty cumbersome AND increase costs - because now I'd need 2 doctors visits every time I need something.

There are two different HMOs that we can pick from that don't need a referral (weird - I thought referrals from a PCP were "always" needed on a HMO..) and they are both more reasonably priced at $4-450/mo for just me. BUT - they both get absolutely awful reviews online. I did call one of them and their customer service was a lot faster to answer the phone and seemed pretty knowledgeable, so you never know..but that does give me pause..

On subsidies - I did a comparison before ER'ing, and it was better financially to maximize income (from CDs and other investments) and not get the subsidy. But then rates went to practically zero, CDs matured, and I may now need to shift to keeping income under 4X FPL just to be able to afford HC. Will need to re-run the comparisons now that my income got hit in 2020 and will get hit further the next couple of years as more CDs mature and due to near zero rates are going to be impossible to replace..

This whole process is definitely a giant PITA..thankfully DW is only a couple years out from Medicare. But I'll have to wrestle with this for almost 10 more years..UGH!!

[ivinsfan]

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Originally Posted by MRG They increased the state reinsurance fund. State wide there's a 18% decrease in premiums more in rural areas where we were paying astronomical premiums.

Does that involve tax money is the point I was getting at or another cute trick is to levy taxes on the insurance companies and we all know where that money comes from.

[ivinsfan]

Quote:

Originally Posted by 24601NoMore We do have a few HMO options that are ~$2-250/mo cheaper. That said, I also have quite a few specialists I see regularly, and the whole "referral" process sounds like a giant PITA. As an example - I have eczema and see a dermatologist regularly. My PCP doesn't know diddly about eczema..so to have to go to the PCP and have her say "yep..that's eczema, here's a referral" every time would get pretty cumbersome AND increase costs - because now I'd need 2 doctors visits every time I need something. There are two different HMOs that we can pick from that don't need a referral (weird - I thought referrals from a PCP were "always" needed on a HMO..) and they are both more reasonably priced at $4-450/mo for just me. BUT - they both get absolutely awful reviews online. I did call one of them and their customer service was a lot faster to answer the phone and seemed pretty knowledgeable, so you never know..but that does give me pause.. On subsidies - I did a comparison before ER'ing, and it was better financially to maximize income (from CDs and other investments) and not get the subsidy. But then rates went to practically zero, CDs matured, and I may now need to shift to keeping income under 4X FPL just to be able to afford HC. Will need to re-run the comparisons now that my income got hit in 2020 and will get hit further the next couple of years as more CDs mature and due to near zero rates are going to be impossible to replace.. This whole process is definitely a giant PITA..thankfully DW is only a couple years out from Medicare. But I'll have to wrestle with this for almost 10 more years..UGH!!

New flash, Coverage from Medicare costs less but can add up and fast..and when your spouse goes on Medicare if you are on the ACA FPL your costs will not go down much if at all.

[SALTedOut]

quote from a few years ago "Healthcare - who in the world knows? It's amazing that HC can be $20K+/yr for 2 people, with $6K+ deductibles - EACH. SERIOUSLY?"

Seems like your current estimate is several thousand less than your prior estimates. You are ahead of the game.

[Sunset]

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Originally Posted by COcheesehead Before I contemplated FIRE, I looked at HC on the exchange so I knew what I was getting into. If you can't cover HC, you can't retire.

And before ACA, it was worse for lots of folks as they had to have a job to have HC.
If a person had serious preconditions, they were not insurable.

Now that there is ACA, the desire to work as a Walmart Greeter dropped a lot

[Sunset]

Quote:

Originally Posted by 24601NoMore We do have a few HMO options that are ~$2-250/mo cheaper. That said, I also have quite a few specialists I see regularly, and the whole "referral" process sounds like a giant PITA. As an example - I have eczema and see a dermatologist regularly. My PCP doesn't know diddly about eczema..so to have to go to the PCP and have her say "yep..that's eczema, here's a referral" every time would get pretty cumbersome AND increase costs - because now I'd need 2 doctors visits every time I need something. There are two different HMOs that we can pick from that don't need a referral (weird - I thought referrals from a PCP were "always" needed on a HMO..) and they are both more reasonably priced at $4-450/mo for just me. BUT - they both get absolutely awful reviews online. I did call one of them and their customer service was a lot faster to answer the phone and seemed pretty knowledgeable, so you never know..but that does give me pause.. On subsidies - I did a comparison before ER'ing, and it was better financially to maximize income (from CDs and other investments) and not get the subsidy. But then rates went to practically zero, CDs matured, and I may now need to shift to keeping income under 4X FPL just to be able to afford HC. Will need to re-run the comparisons now that my income got hit in 2020 and will get hit further the next couple of years as more CDs mature and due to near zero rates are going to be impossible to replace.. This whole process is definitely a giant PITA..thankfully DW is only a couple years out from Medicare. But I'll have to wrestle with this for almost 10 more years..UGH!!

So you do have some cheaper choices.

Are you so sure about the referral of the HMO ?
We have HMO, I get a referral to a specialist, and then continue to see the specialist for the same issue repeatedly without any more referrals needed. So it's not that big of a burden.

[Sarah S]

I would check with my pcp about the way they handle referrals. Mine will approve any reasonable request. I do see my pcp once a year for a physical ( considered preventive so no copay ). Probably if I did not do this they wouldn’t be as willing to refer.

The referrals I get are good for a year and she always approves more visits than I need. I send the information about the doctor I am seeing through the patient portal. Takes less than 5 minutes once a year for my one specialist. YMMV

[MRG]

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Originally Posted by ivinsfan Does that involve tax money is the point I was getting at or another cute trick is to levy taxes on the insurance companies and we all know where that money comes from.

There was no tax increase to support this.

[ivinsfan]

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Originally Posted by MRG There was no tax increase to support this.

Just wondering...cause someone payed for it...unless it was a coincidental rate decrease

[24601NoMore]

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Originally Posted by Sunset So you do have some cheaper choices. Are you so sure about the referral of the HMO ? We have HMO, I get a referral to a specialist, and then continue to see the specialist for the same issue repeatedly without any more referrals needed. So it's not that big of a burden.

Not sure..I called BCBS to ask, and they told me the best they could do is a "global" referral that lasts up to a year. Then you apparently need another referral to renew for the next year.