ACA Sticker Shock

[LiveBelowMeans]

DW and I are paying $23,000 per year for Florida blue hsa ppo bronze plan with a $12,000 deductible. Tough to swallow...

 

[Mr._Graybeard]

DW and I are paying $23,000 per year for Florida blue hsa ppo bronze plan with a $12,000 deductible. Tough to swallow...

That's crazy. What's your income? Have you checked out a rate for an HMO?

 

[GrandmaHoo]

IMO cost-shifting and defensive medicine are the major contributors to health care costs. So much care is written off whether by indigent care, medicaid, medicare, or negotiated prices - all that written off care is factored into the price for the next person. So when you pay your high insurance premiums, you are in effect paying for other people's written off/discounted care. Medicine uses every technology available because they "have to" cover their selves from liability. When my dad saw a specialist, who "charged" $800 and Medicare paid "$65" for that visit - who do you think paid for the difference? I am digressing. When I retired 3 years before Medicare, I socked away money in a HSA to cover my premiums - which were About $1600 a month for myself and husband, with a $4000 deductible and annual $12,000 OOP max per person. ACA didn't help me at all. Socking away money in an HSA pre retirement helped me.

 

[Dtail]

DW and I are paying $23,000 per year for Florida blue hsa ppo bronze plan with a $12,000 deductible. Tough to swallow...

No way to manage MAGI I presume?

 

[Dtail]

That's crazy. What's your income? Have you checked out a rate for an HMO?

That is full freight for FLA, so MAGI must be over 65k.

 

[TEO]

In Pittsburgh its $300/mo for a $8000 plan.

Ive used that full deductable 2 times in my life. Both times while I was racing sportbikes. I've quit now so the deductable is a non issue and I definitely don't include it in my budget as if I will definitely use it.

IMO insurance is for the times when you have a big problem. Not for day to day medical expenses.

I am really happy with my insurance. I'm sure it would have been even better if this admin had not stopped the promised payments to all those insurance companies... that resulted in them backing out.

Btw, my Cobra costs would have been more than double what the ACA plan was... Albeit at a much lower deductable.

 

[davidfin]

ACA has plenty of faults

My own experience. FIRED in 2013. Buyout covered HC in 2013. Best private health insurance I could find cost $1,200 /month for two healthy mid 50s people. Individual deductible was $6500 and $13,000 out of pocket per year. Joined ACA in 2014. By managing AGI, subsidized premiums for both totaled $120/ month for largely the same coverage but HSA qualified. Fast forward to Medicare in 2020. Now annual premiums for both of us total approximately $6000 For much better coverage. The ACA has a lot of warts. To bad the partisan nature of things prevented much needed evolutionary improvements in the ACA. For us, it worked out well.

 

[LiveBelowMeans]

That's crazy. What's your income? Have you checked out a rate for an HMO?

We need a PPO as we travel north for the Summer. Income is obviously above subsidy levels.

 

[samcat]

I checked insurance for us today through Blue Shield. Cheapest plan was $2k per month with $8k deductible each. Minimum PPO plan. Only services covered before deductible are wellness visit and three office visits per year. I think everything else was subject to the deductible. I call this major medical insurance.

For the past three years, we have had Christian Healthcare Ministries. We self insure everything under $500. They cover everything over $500 per incident. No networks, no deductibles.

I've submitted three different claims. All have been paid. No questions asked.

Less than $5k total per year for the best plan with unlimited coverage.

If you don't like the Christian part, I think there are similar companies that don't require religion.

 

[Fermion]

We went over the cliff earlier this year when one of my biotechs got bought out so I said screw it, if we are going over, lets really go over and got aggressive. Now have made $130,000 realized gains on a $100,000 account this year, so I will pay back all of our ACA subsidy and be happy about it.

I mean if you are going over the edge, might as well do it in style.

 

[ImaCheesehead]

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..

So you have one PPO and “a few” HMO’s to choose from? That is more than my husband is able to choose from at his employer, lol. The annual premiums in the group are over 16k for 2 people, of which we pay 2.6k. The difference is an employment benefit. I guess you could go back to work to get that benefit back and not choose ACA at all........ at least you now have a choice. Before ACA you HAD to work to have insurance if you had a pre-existing condition.

 

[Mr._Graybeard]

That is full freight for FLA, so MAGI must be over 65k.

I think our premium for two w/o subsidy was $16000 the last year we were on ACA (2018), now that I think about it. And that's with an HMO.

 

[PointBreeze]

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.

+1

 

[MRG]

The crazy expensive health plans I was forced to buy in California was part of the reason I moved back overseas again. I worked in China many years, retired and relocated to SF Bay Area only to be shocked at the taxes and health insurance costs. I had basically the same plan and deductible - infuriating! Now I pay less than 2k a year for global coverage (USA excluded), zero deductible and even get my glasses covered. For my monthly CA premium I can cover ALL my costs for a month in Vietnam. Where did the USA health care system get derailed so badly?

A system built on the premise of no real prices and no ability to shop and compare because of no price transparency allows exploitation of the consumers of the system.

 

[Perryinva]

Wow. The best thing about this thread (for me) is that I now realize there was no way I could realistically have retired before age 60 and maintained our lifestyle, thanks to a dual edged sword of HC costs for us and reduced pension. I had never realized ACA was that expensive if you have a $100k plus income. I sort of regretted succumbing to FOMO & OMY syndrome for 3 or so years, waiting until 61 to retire, but the reality is I would have been pissed paying those kind of costs for 8 or more years. By my age 60, just our pensions plus DW SS and earnings puts us at better than $80k. At 60, retiree HC is less than 300/mo with a $750ded, PPO, plus we each get a $1k/yr stipend (COLA for life) to be used for premiums until age 65, then it must be used for Supplemental plans with Medicare. I look forward to the reduced premiums once I am 65 (2 1/2 years to go).

 

[jollystomper]

Wow. The best thing about this thread (for me) is that I now realize there was no way I could realistically have retired before age 60 and maintained our lifestyle, thanks to a dual edged sword of HC costs for us and reduced pension. I had never realized ACA was that expensive if you have a $100k plus income.

Very true. When I looking at retirement, the Megacorp financial planners recommended we assume $24K a year for health insurance before Medicare. My pension, with our "basic" investment income, would make us ineligible for ACA subsidiary. This was the biggest hindrance to our desired "extravagant" retirement lifestyle. It was one of the reasons I went into OMY mode, to build up our cash reserves in anticipating that expense.

We were fortunate that, because Megacorp wanted me to work longer I ended up with a retirement package that included COBRA for 18 months at a fraction of the ACA price. When COBRA expired we were able to get Megacorp insurance at a subsidized price that is about half of what ACA rates were, with many more provider options that ACA insurance. For the two of us we are paying $950/month for medical+ dental+vision. There is a $3300 deductible and $8000 maximum out of pocket, and are eligible to contribute to a HSA. Doctor visits before the deductible are discounted close to 50%, lab tests close to 90%, and preventative visits are fully covered. There are other benefits, such as 24/7 access to a nurse free of charge and free nutrition/wellness guidance.

 

[Time2]

As much as I've complained about the premium increases in a policy we had long before the ACA, I'm now glad I never dropped it for the an ACA policy, even though the ACA was much cheaper early on.
In 2010 my $2500 deductible HI premium (family of 4) had an increase that brought the premium up to $9,900. When I got that notice I went shopping and was told several times "just get a BCBS policy" That is what I had. The only way I found to get a lower premium was to get a $10,000 deductible/OOP policy. That lowered the premium from $9,900 to $4,700. Saving me $5,200 a year. (huge decrease) I opened an HSA and fully funded that each year. I was Happy.
Then starting in 2012 I got double digit increases 3 years in a row. Ten years later the $4700 premium is $14,300*. But, it sounds like it is much cheaper than the ACA.


* I started Medicare in Mar, so the $14,300 is the latest increase (12%) on the pre-March premium. Since I dropped off the policy, the premium dropped to $8,772 for my wife and two kids.

 

[meleana]

It’s the one big issue people have to deal with if they retire before being eligible for Medicare (which isn’t so cheap either).

I was covered under my husbands employer and when he retired he could get Medicare but I still have to wait until June, 2021. I was paying $547 per month for COBRA with a high deductible and our FA told me to look into ACA.

I pulled the trigger on a Silver Plan at $40 per month (with all subsidies) , no deductibles, very low copays ( Ex: like $8 per MD visit)

We have no income other than interest and dividends and a small RMD and just have to try to keep income at a certain level so as not to go over and not to go under (where I would be pulled into Medicaid instead)

I am so glad to have done this, especially since I couldn’t even see a MD or had preventative tests the first half of this year due to COVID. Paying that $547 per month would have been such a waste!

 

[ShokWaveRider]

I pulled the trigger on a Silver Plan at $40 per month (with all subsidies) , no deductibles, very low copays ( Ex: like $8 per MD visit)

We have no income other than interest and dividends and a small RMD and just have to try to keep income at a certain level so as not to go over and not to go under (where I would be pulled into Medicaid instead)

I think some folks choose to forget this is EXACTLY what he ACA was intended for, those who are not as affluent as others from an income perspective. Not for those who are high earners or those who have company or Government Worker's HI insurance etc.

Yet, those who seem to voice the most complaints, are those who the ACA was NOT intended for.

Yes, one can argue that in this day and age, the $62k Cliff needs to be adjusted for the reality of family incomes in 21st Century.

I personally think, that even though Medicare with a good supplement is more expensive that the average ACA plan for the intended recipients, it is a fair price for healthcare, with a lot less restrictions and caveats. Other folks should not really have to pay more for inferior coverage. (AKA Universal HC) The Mega Rich and those earning "say" $200k + not withstanding.

 

[Toocold]

Why should saver's be punished for saving? The government should encourage savings and wealth creation, so a sole income test makes sense. Poor people get trapped if an asset test is applied, it means they never escape poverty.

Bingo! But the government benefits when people consume in terms of higher taxes and more economic activity, so their policies reflect this reality.

 

[dawdmorgan]

Healthshare Plan

If you don't have a preexisting condition, don't need maternity care, birth control, substance abuse treatment (or any of the other stuff mandated in ACA) - and are generally in good health, look into a health sharing ministry.

My plan for a family of 4 costs $250/month with a $9,000 deductible. They don't have negotiated rates with as many providers as a BCBS would, but they call and negotiate the rate when the bill is submitted by the provider to them. In many cases for me in AL (ymmv), they negotiate it down to the medicaid rate which is about as good as any major insurer. They also include telemedicine for free and offer other discounts on dental, eyecare, etc... (again, ymmv)

Everything is out of pocket until you hit the $9,000 deductible, then they cover the rest - for approved procedures/care. I consider it catastrophic insurance. They do have a $1M per person lifetime cap, but if I ever get a chronic condition like cancer I will get an ACA plan at open enrollment. We also upped our auto bodily injury to $300k/$500k at minimal cost in case we have a major auto/marine injury that might push towards the cap. If you don't like the $1M cap they have higher priced plans that have unlimited cap - and still way cheaper than ACA.

I'm with Altrua Healthshare, but there are several out there.

We are saving about $14,000 per year vs an unsubsidized ACA plan - with a similar deductible! 4 years in we have saved ~$60k. But it is definitely not for everyone.

 

[scrabbler1]

We went over the cliff earlier this year when one of my biotechs got bought out so I said screw it, if we are going over, lets really go over and got aggressive. Now have made $130,000 realized gains on a $100,000 account this year, so I will pay back all of our ACA subsidy and be happy about it.

I mean if you are going over the edge, might as well do it in style.

This is what happened to me in 2019. I was close to going over the cliff late in the year and tried to take a small loss by selling some higher-priced shares in my main stock fund. But when the estimated CG distribution turned out to be understated just enough to prevent me from being able to remain away from the cliff, I decided to just take the plunge and bail out of the actively managed stock fund. It was, as one forum member here described it, "vomiting" cash. Going over by $2,000 or $50,000 made no difference to my lost subsidy, but going over by $40k will keep me from going over the cliff again.

 

[Earlygirl]

I had nine months to go between my husband's workplace insurance coverage and Medicare. I purchased a short term health insurance plan for $200 a month. Doesn't cover any pre-existing conditions or prescriptions and has a 10K deductible. I was mainly worried about accidents or black swan events. Haven't had to use it, but I am waiting with bated breath; I have 2.5 months to go now til Medicare. So knock on wood for me! Health insurance costs keep a lot of people working longer. I have a friend who went a year without any insurance at all. She lucked out, but too risky in my book.

 

[RetiredAt55.5]

Everything is out of pocket until you hit the $9,000 deductible, then they cover the rest - for approved procedures/care. I consider it catastrophic insurance. They do have a $1M per person lifetime cap, but if I ever get a chronic condition like cancer I will get an ACA plan at open enrollment. We also upped our auto bodily injury to $300k/$500k at minimal cost in case we have a major auto/marine injury that might push towards the cap.

Obviously, there's some risk with relying on jumping on an ACA plan at open enrollment. A lot of cancers must be treated ASAP, so you can't control the timing of expenses. My brother has been in the hospital for 6 weeks (half in the ICU), and was just moved to a live in rehab facility. And it's only July.

 

[Old Microbiologist]

I recommend seriously considering moving to Europe where excellent social medicine can be used which is inexpensive. We don't bother even paying the monthly fee for the National Health plan and pay cash instead. Over the past 10 years we have paid less than $10k (total) and had several serious injuries/medical issues which we paid cash for. I had military Tricare Overseas when I first retired which is a joke. The error rate for claims was over 400% AND now that I am Medicare eligible I am required to pay Medicare Part B. Plus even then thy pay only 60% of allowable fees and there is an annual deductible of $600 per person. Our annual medical expenses are less than even the Part B fee so we declined coverage. Medicare is useless outside the US and we never plan to return to the US. It is a hard decision to make but the US has shown itself to be the worst country on the planet to be sick in.