ACA vs. private plan

[ripper1]

I am currently looking at a private health insurance plan that does not qualify as major medical according to ACA mandate. I guess because it doesn't cover things like mental illness, alcoholism, pregnancy, and wellness. Other than the wellness I will never need these other things covered. But as I understand it the only way the government can make you pay the penalty is through your refunds. They can't garnish your wage or retirement income or put a lien on your home. Any retirees out there using private plans other than obamacare and how has that worked out for you?

[Scuba]

Quote:

Originally Posted by ripper1 I am currently looking at a private health insurance plan that does not qualify as major medical according to ACA mandate. I guess because it doesn't cover things like mental illness, alcoholism, pregnancy, and wellness. Other than the wellness I will never need these other things covered. But as I understand it the only way the government can make you pay the penalty is through your refunds. They can't garnish your wage or retirement income or put a lien on your home. Any retirees out there using private plans other than obamacare and how has that worked out for you?

This may not be relevant to your question, but we have a pre-ACA plan that we are able to maintain because we are grandfathered in. It is a PPO and has worked well for us. Monthly premiums are very reasonable ($736/mo combined). The only problem from my standpoint is that the deductibles and OOP maxes are very high but it's not an HSA compliant plan. We've thought about changing but want to preserve access to docs of our choice. Most of our docs don't accept Covered CA plans.

[Freedom56]

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Originally Posted by ripper1 I am currently looking at a private health insurance plan that does not qualify as major medical according to ACA mandate. I guess because it doesn't cover things like mental illness, alcoholism, pregnancy, and wellness. Other than the wellness I will never need these other things covered. But as I understand it the only way the government can make you pay the penalty is through your refunds. They can't garnish your wage or retirement income or put a lien on your home. Any retirees out there using private plans other than obamacare and how has that worked out for you?

When you find one let me know. I buy directly from the insurance company rather than the exchanges since we are not eligible for an subsidies. The only plans that are offered are those that are ACA compliant. I don't like the idea of paying for mental illness, pregnancy, pediatric dental, but have no choice. We only use preventive care and buy a Bronze EPO that is accepted by our provider. The 2018 monthly rate is $878 per month for both my wife and myself. The best thing you can do to keep your healthcare costs down and improve your quality of life is to stay in shape. Exercise regularly and keep your BMI below 25 and avoid smoking and excessive drinking. The problem with this country is obesity and its impact on healthcare costs. Instead of fixing the problem, the healthcare system is offering maintenance solutions such as cholesterol, high blood pressure, and type 2 diabetes medication and gastric bypass, hip replacement, knee replacement, and back surgery as a solution. Then to top things off, doctors prescribe Opioids to manage pain. So if you have an unhealthy pool of insured people, rates will only keep going up.

[Cessna152]

If the lowest cost Bronze plan available to you exceeds about 9.65% of your household adjusted gross income then you are exempt from the ACA mandate. So if your annual AGI was 60,000 and cheapest plan cost over 5790 a year (482/mo) you would not be subject to the penalty. Of course the mandate may go away, making that exemption moot. I suspect a lot of people actually qualify for it now considering how high premiums have risen.

It is possible to buy non-ACA health insurance on a short-term basis and while the plans are cheaper there are gotchas due to their short-term nature. I contacted a local agent about them (Oregon) but after much humming and hawing over the good and bad, we eventually went with an ACA market plan so as to hopefully qualify (first time) for the premium subsidies.

[socca]

• for 2017, if the lowest cost Bronze plan available to you exceeds 8.16% of MAGI, you are exempt from the Obamacare tax penalty. See health coverage exemptions. This percentage is adjusted for inflation each year. Using the 2017 percentage for 2018 as an estimate, Obamafare delivers unaffordable insurance for me if my 2018 MAGI is between ~$48k and ~$80k.

• the limitation of a short-term health insurance policy to a maximum of 3 months will revert to 364 days after DHHS complies with a recent Executive Order (in late 2016, I purchased an 11-month policy for 2017, the longest then available from my carrier). The 3 month limitation makes short-term insurance less attractive because the deductible resets each 3 month period as each new policy is acquired. The deductible on the short-term policy I recently purchased is a whopping $25k (there are much lower options available, of course). On the positive side, the premiums are remarkably low.

• purchasing short-term health insurance is remarkably similar to what it was like to purchase health insurance back in 2007, when I first began to acquire health insurance on my own. The market was relatively lightly regulated back then, which had both good and bad aspects. There were some incremental regulations enacted before Obamacare which made acquiring and using health insurance less unpleasant. For example, payout maximums were eliminated. The short-term policy I recently purchased has a $1M payout maximum.

Good luck!

[joeea]

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Originally Posted by ripper1 I am currently looking at a private health insurance plan that does not qualify as major medical according to ACA mandate. I guess because it doesn't cover things like mental illness, alcoholism, pregnancy, and wellness. Other than the wellness I will never need these other things covered.

How could you possibly know you won't need mental illness coverage?

[ripper1]

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Originally Posted by joeea How could you possibly know you won't need mental illness coverage?

If I watch another Bears game this year I am going to be admitted.

[ripper1]

I think I am going to end up back in Obamacare. Even though it has gone up substantially. My wife had a kidney removed in 2010 and I have celieac disease. The agent said we have preexisting conditions and they wouldn't be covered the first year but would start to be covered the following year. Even though we have not had any complications from these in the past several years it would be just our luck to have anything happen this year. I don't know ....just might have to bite the bullet. It's too bad also because we had retiree health from city of chicago but they decided they weren't going to pay anymore.

[LARS]

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Originally Posted by joeea How could you possibly know you won't need mental illness coverage?

One might argue just making the claim ought make one’s self nervous on the topic...

[Freedom56]

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Originally Posted by joeea How could you possibly know you won't need mental illness coverage?

Check your family history...

[Rianne]

It's my understanding a private health insurance company can take any previous health issue, one you may not consider pre existing and claim it is a pre existing condition. So, any medical issue you've seen the doctor about can be considered pre existing. For instance, a back ache that might have turned into seeing a chiropractor can be a pre existing condition and the private HI company has a right to refuse payment. If you see a psychologist for any reason, pre existing. Personally, I would not trust any private HI company and am willing to pay extra for the conditions presented in the ACA. I will never get pregnant but I support the ACA coverage.

[ripper1]

Good point, Rianne, which is why I am going to stay with obamacare.

[socca]

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Originally Posted by Rianne It's my understanding...

A health insurance policy is a contract. If you lie on your application, and the issuer later discovers your lie, it can cancel your coverage or deny payment for a claim. Moral: don't lie on your application.

An underwriter can refuse to issue an unrestricted policy to an applicant, or issue a policy with exclusions for the specific pre-existing conditions mentioned on the application. I had an inguinal hernia excluded from coverage quite a few years ago.

BTW: only 4% of Obamacare applicants report themselves as smokers, while around 15% of Americans smoke. Obamacare relies on the honor system for reporting smoking; the results speak for themselves. 😕

[joeea]

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Originally Posted by ripper1 If I watch another Bears game this year I am going to be admitted.

Learn to be a Patriots fan - for your mental health.

[joeea]

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Originally Posted by ripper1 I think I am going to end up back in Obamacare. Even though it has gone up substantially. My wife had a kidney removed in 2010 and I have celieac disease. The agent said we have preexisting conditions and they wouldn't be covered the first year but would start to be covered the following year. Even though we have not had any complications from these in the past several years it would be just our luck to have anything happen this year. I don't know ....just might have to bite the bullet. It's too bad also because we had retiree health from city of chicago but they decided they weren't going to pay anymore.

Until October, we never needed cancer coverage. Never had it, no family history of it.

Now, things are different for me.

When I see the $21,000+ bill for one infusion session, I feel lucky that I have a good ACA plan.

[joeea]

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Originally Posted by Freedom56 Check your family history...

Your family history might indicate that you DO need mental health coverage. But it could never tell you that you DON'T.

[joeea]

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Originally Posted by ripper1 Good point, Rianne, which is why I am going to stay with obamacare.

"ObamaCare is finished. It's dead. It's gone. You shouldn't even mention it, it's gone. There is no such thing as ObamaCare anymore. It is a — and I said this years ago — it's a concept that couldn't have worked."

For good or for bad, what remains of the ACA is all TrumpCare now.

[Rianne]

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Originally Posted by joeea "ObamaCare is finished. It's dead. It's gone. You shouldn't even mention it, it's gone. There is no such thing as ObamaCare anymore. It is a — and I said this years ago — it's a concept that couldn't have worked." For good or for bad, what remains of the ACA is all TrumpCare now.

I will say, because of Trump my monthly premiums for a very good ACA bronze plan that offers an HSA is $7.95/month. We keep our income at $42K and have a cash reserve to cover the rest. For that, I thank you Trump. I'm pretty sure the intelligent FIRE are signing up in droves this year. The foundation of the ACA is still there, I have a pre existing condition and so does DH.

My heart goes out to the middle and upper class who are getting slammed because of the healthcare situation. Just because my brother/wife make over $100K they will pay $30K in health premiums alone. There is a story of a woman in the Kaiser newsletter that reduced her salary from $80K to $55K to get a good ACA plan with subsidies. It was worth it to her. She now has good health insurance that covers her needs and is affordable.

[ripper1]

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Originally Posted by joeea Learn to be a Patriots fan - for your mental health.

Wow, luck you. Are you actually from Boston? It all starts at the top doesn't it? Great leadership and professionals who know what the hell they are doing. Year in and year out they find the best players. Probably the greatest sports franchise of the last 15 or so years. Of course, it doesn't hurt you have Brady over there...lol.

[Alan]

Thanks for the interesting discussion.

https://www.youtube.com/watch?v=gBzJGckMYO4