Another vent on 2018 renewal premium

[RunningBum]

Respectfully since you have been on either employer plans and now the VA,so your empathy isn't very empathic.. in West Central MN we have 2 options a BC HMO that literally doesn't have one specialist in network and a Medica plans with broader coverage. Why don't you float over to the MNSure site and enter some age and income level and see what your premiums and potential OOP would be at your income level?

I've purchase insurance either on the open market or in our small family owned business plan for over 40 years. Your many other cheaper plans that are ACA compliant do not exist. Just challenging those of us buying plans that we want to go cheap or saying it can't be that bad is incorrect.

+1. I've just gone through https://www.healthcare.gov/see-plans/ putting in zip codes of a few places I've lived before or would consider moving to, as well as my own. Some of them, and they aren't really HCOL areas, are very prohibitive if you don't get a subsidy, to the point where I might roll the dice and self-insure. Luckily I should be able to control income to get a subsidy, and one of the two insurers is fairly low cost. The low cost insurer has no doctors I'd use, and I'd have to travel further to use their doctors, but even with a cliff's edge subsidy is well under $100/month, so I've effectively got a catastrophic plan for very little cost. Not the plan I really wanted, but it probably will work out well for me in a typical year. It will work out well for the insurer too, because they'll get my small premium payment plus a $700+ subsidy premium and will almost certainly pay out nothing, not even preventative care since I'll use my own doc.

 

[Senator]

Respectfully since you have been on either employer plans and now the VA,so your empathy isn't very empathic.. in West Central MN we have 2 options a BC HMO that literally doesn't have one specialist in network and a Medica plans with broader coverage. Why don't you float over to the MNSure site and enter some age and income level and see what your premiums and potential OOP would be at your income level?

I've purchase insurance either on the open market or in our small family owned business plan for over 40 years. Your many other cheaper plans that are ACA compliant do not exist. Just challenging those of us buying plans that we want to go cheap or saying it can't be that bad is incorrect.

I did just that, I went to the website and looked at plans. The website is still pretty lame, but is able to produce a list of prices. I filtered by plans with a $3,000 deductible. The premium is a bit higher ($724 vs. $425) than my company plan, but that is to be expected as two plan years have passed.

The maximum OOP is a bit higher than what I had at work ( $6,550 vs. $5,000), but the co-insurance is cheaper. There were plenty of options to choose from.

It appears there are plans. They are expensive, and they are expensive even working at a company. The difference is someone else is paying some of the premium.

Of course, the DGF gets a policy 100% free from the State too. Once she quit her job, she was low income.

 

[ivinsfan]

I did just that, I went to the website and looked at plans. The website is still pretty lame, but is able to produce a list of prices. I filtered by plans with a $3,000 deductible. The premium is a bit higher ($724 vs. $425) than my company plan, but that is to be expected as two plan years have passed.

The maximum OOP is a bit higher than what I had at work ( $6,550 vs. $5,000), but the co-insurance is cheaper. There were plenty of options to choose from.

It appears there are plans. They are expensive, and they are expensive even working at a company. The difference is someone else is paying some of the premium.

Of course, the DGF gets a policy 100% free from the State too. Once she quit her job, she was low income.

So you can see that someone pricing for an entire family is looking at a possible out of pocket of 13k and 2 adults 1450 a month plus whatever children they might need to insure in monthly payments...that's a lot of money.300 dollars higher in 2 plan years is more then a bit..it's 3600 bucks a year.

I see the lowest PPO offering is actually over 800 bucks a month...

 

[aja8888]

Not that it matters to most on this thread, but DW's open heart surgery (Mitral valve replacement) clocked in at just under $160,000 total. But Medicare and our Supplemental (Full F plan) covered it all.

DD is on one of the ACA plans, but fortunately, she has been very healthy and not needed any big event work, just normal female checks for a mid 30's woman.

 

[bingybear]

No, I have a policy and DW has a policy. At the time we bought, deductibles were aggregate, so if we bought one policy for the two of us with a $12k deductble and one of us had a $10k claim then we would have paid the entire $10k. With separate policies with a $6k deductible (same premium since premium for a couple was twice that of a single) and one of us with a $10k claim we would have only paid $6k and the insurer would pick up the $4k excess.

I had an interesting discussion on this with the BCBS CSR because I wanted to make sure that I understood it correctly and they confirmed it... at which point I said I think we'll go with separate policies.. I think the idea was new to the CSR too.

A few years back quite a few plans had aggregate deductibles and it caused a lot of stink. I think this ended the year after it became publicized. Are you implying that this is still going on?

 

[Mo Money]

In the face of an average 41% increase which PA regulators approved for UPMC's exchange plans after recent developments in the funding of cost-sharing reductions, I was surprised to see a "mere" 20% increase in my gold policy off-exchange premium (a one-person ACA policy). It went up from $511/month to $615, with $800 deductible and a murky-and-not-really-disclosed-in-the-premium-letter OOP max (last year OOP was $3500). The same policy premium had gone up a double-digit percentage the year before.

Sadly, the above increase seems like a true bargain compared to the fiscal horrors I have been witnessing in this forum. Truly, I feel for those getting shafted even worse than me.

So I am chucking it. Enter Plan B.

I am establishing myself as the "domestic partner" of my Significant Other. Using my SO's non-UPMC plan from another major insurer, I will save roughly $3K per year, and likely face less-daunting annual increases, given the SO's employer's bargaining power. We will have to cover my SO's imputed income for the fair market value of my coverage, but the $3K savings is the net savings after the tax on imputed income is taken into account.

I am thankful for a Plan B. Not everyone is so lucky, and as stated above, I feel for them. If there was no Plan B, I'd likely be planning to move -- somewhere cheaper, wherever that might be.

 

[kimcdougc]

How are people seeing almost $2K a month? What kind of policies are those? Are people just trying to get a Cadillac plan for the price of a Yugo?

Senator, DH and I already pay over $1,300 a month for a silver PPO plan with no dental or vision. $5,000 deductible each. Insurance informed us by letter they will no longer be on the exchange in 2018.

In Washington state you can't even look at the options for 2018 until November 1st. From the rumors we have heard there aren't many options and the cost will go up at least 50%.

Just one of those things. Guess we could always go back to work for just health insurance. Hmm...don't think so.

Just be a little more empathetic about this situation for some posters here. Every state is different.

The silver plan we had was not good and they didn't want to pay for anything. So, I ended up just negotiating cash prices with several health providers on top of paying $16,000 for a bad medical plan.

Just my 2 cents....or should I say $16,000 dollars plus.

 

[pb4uski]

A few years back quite a few plans had aggregate deductibles and it caused a lot of stink. I think this ended the year after it became publicized. Are you implying that this is still going on?

Not sure... I had thought that aggregate deductibles were prohibited a few years ago but was surprised to see that there were still both aggregate and stacked deductibles for plans in my state for 2018.

 

[ivinsfan]

A few years back quite a few plans had aggregate deductibles and it caused a lot of stink. I think this ended the year after it became publicized. Are you implying that this is still going on?

Yes

 

[Senator]

So you can see that someone pricing for an entire family is looking at a possible out of pocket of 13k and 2 adults 1450 a month plus whatever children they might need to insure in monthly payments...that's a lot of money.300 dollars higher in 2 plan years is more then a bit..it's 3600 bucks a year.

I see the lowest PPO offering is actually over 800 bucks a month...

It is a lot more money. It's more people. Adding an additional person, even if it's in the same family, probably costs 2x in medical care. A PPO would cost more, as you have more choices.

 

[MBSC]

Not sure... I had thought that aggregate deductibles were prohibited a few years ago but was surprised to see that there were still both aggregate and stacked deductibles for plans in my state for 2018.

ACA-compliant family plans must now have an embedded MOOP, not deductible.

But this was changed with the 2016 Notice of Benefit and Payment Parameters. That regulation clarified that starting in 2016 (for plans that are not grandfathered or grandmothered), no individual can be required to pay more than the individual out-of-pocket maximum, even if the individual is enrolled in a family health insurance plan.

Under the new rules, no single member of a family can be required to pay more than $6,850 in out-of-pocket charges in 2016, regardless of whether the rest of the family has incurred any claims. This includes people enrolled in family HDHPs, and HHS has clarified that this does not conflict with HSA and HDHP requirements.

If you’re browsing plans in the exchange, in many states they only show family deductibles and OOPMs on the multi-plan comparison screen if you enter information for more than one family member. So you may need to look a little further to see what the individual OOPM is. In 2016, it won’t exceed $6,850, and in 2017, it won’t exceed $7,150.

But as long as you have an ACA-compliant health plan, you can rest assured that if a only one member of your family needs extensive medical care during the year, your out-of-pocket costs will be capped at no more than $6,850 in 2016, even if your plan has a family OOPM of $13,700.

Reference: https://www.healthinsurance.org/faq...hat-full-deductible-even-for-just-one-person/

 

[ncbill]

It is a lot more money. It's more people. Adding an additional person, even if it's in the same family, probably costs 2x in medical care. A PPO would cost more, as you have more choices.

For 2017 on my DW's employer plan it was only $100/month to add unlimited 'children' (up to age 26 for post-secondary students) so we kept all our kids on her plan, even though the oldest already qualifies (and uses) Tricare.

But it would have been another $1000/month to add me, so I bought a cheaper ACA-compliant plan off the exchange.

Interestingly, her employer dropped the $5000 (family) deductible plan as employees eschewed that one for the plans with lower ($1000/$2000) deductibles, though those come with significantly higher monthly premiums.