Obamacare and me

[Texas Proud]

You probably pay more for housing, food, auto insurance, etc in a more urban area too, based on free market prices. I guess that's the price we pay for choosing to live where we've got all the conveniences.

Actually, some of that is cheaper here than other places in Texas...

But, I do not think that the surcharge is close to 40% (except for maybe auto where there are more accidents than in the country)....

 

[Mulligan]

I didn't see anything to support that statement, and what I have read elsewhere points to the opposite conclusion. Rural and sparsely populated areas are high health care cost while large metropolitan areas are lower cost. Exception to Hawaii and NYC.

I live in a rural area, 15 miles or so from a hospital, and 60 miles from large metro city. I plugged into ehealthinsurance a zip code in a ritzy part of the metro area near all the hospitals and compared it to my location. Oddly enough, it was the exact same quote for both locations.

 

[Texas Proud]

I didn't see anything to support that statement, and what I have read elsewhere points to the opposite conclusion. Rural and sparsely populated areas are high health care cost while large metropolitan areas are lower cost. Exception to Hawaii and NYC.

I can see where it might be true... the Medical Center is huge... it has all the latest high cost machines and also all the high paid doctors... someone is paying for all that stuff...

We also have a lot of smaller hospitals that are part of a bigger network...

 

[ziggy29]

I can see where it might be true... the Medical Center is huge... it has all the latest high cost machines and also all the high paid doctors... someone is paying for all that stuff...

Yet at the same time, living in two different rural areas in Texas myself, I know a lot of folks with serious medical issues are sent from small, less equipped rural hospitals by ambulance or helicopter to hospitals Houston or Austin or DFW or San Antonio. That ain't cheap, and it's a significant cost that is barely (if at all) into play in the big city. Often, the only role of the smaller rural hospitals is to stabilize the patient enough to allow for transport to the city.

 

[MichaelB]

Yet at the same time, living in two different rural areas in Texas myself, I know a lot of folks with serious medical issues are sent from small, less equipped rural hospitals by ambulance or helicopter to hospitals Houston or Austin or DFW or San Antonio. That ain't cheap, and it's a significant cost that is barely (if at all) into play in the big city. Often, the only role of the smaller rural hospitals is to stabilize the patient enough to allow for transport to the city.

+1

In addition, the cost of the world class care in DFW is likely to be more than the cost of average care in the same area, and we are talking about average cost comparisons.

I do find it very frustrating that there is no public information available to let each of us know the cost level where we live.

 

[grasshopper]

In Arizona BCBS rates are higher for everyone (includes Phoenix), but Pima County in which Tucson is part of. Go figure.

 

[Sue J]

Another calculator, posted by Live And Learn in another topic (http://www.early-retirement.org/for...-by-staying-under-the-threshold-65954-10.html) -

National Health Care Calculator

This one allows you to calculate for one person in a couple or both. It looks like the cost to the household remains the same. The insurance cost doubles but the subsidy increases to make up the difference.

 

[frank]

I wonder how much the deductible and max out of pocket are and how smoking or non smoking fits into the calculator? Does anyone know if you pay the premium up front and then get reimbursed at tax time? If that is the case you would be giving someone a pretty hefty loan until you get your money refunded.

 

[bUU]

Does anyone know if you pay the premium up front and then get reimbursed at tax time?

As I understand it, it's a little of both:

For Coverage Year 2014, the subsidy you would be granted would be based on Tax Year 2012 MAGI (because, when you're applying for coverage for 2014, you haven't even done your Tax Year 2013 taxes yet, eh?) Then in 2015, you'd file your Tax Year 2014 taxes, and your 2014 MAGI would be determined, and it would be reconciled so that how much of a subsidy you got in 2014 would be appropriate based on your 2014 MAGI (paying back excess subsidy you received, or receiving a credit for subsidy you should have received but didn't).

 

[Katsmeow]

Another calculator, posted by Live And Learn in another topic (http://www.early-retirement.org/for...-by-staying-under-the-threshold-65954-10.html) -

National Health Care Calculator

This one allows you to calculate for one person in a couple or both. It looks like the cost to the household remains the same. The insurance cost doubles but the subsidy increases to make up the difference.

Not necessarily. DH is on medicare and I'm not. According to this, if I was buying on an exchange just for me, I would pay the single rate but for subsidy persons would get the rate for a 2 person household.

In reality, we still have kids at home and our income is above subsidy rates. It did go up with 1 child and then up again with 2 child so this is a more fine-grained calculator that those where it makes no difference if there is one child or more children.

Right now we are still on DH's retiree insurance but I am concerned that sometime this fall we will find out that they are doing away with it...

 

[2B]

+1

In addition, the cost of the world class care in DFW is likely to be more than the cost of average care in the same area, and we are talking about average cost comparisons.

I do find it very frustrating that there is no public information available to let each of us know the cost level where we live.

This reference only applies to Texas but it probably reflects insurance company thinking across the nation. The Texas High Risk Pool rates are broken out by zip code. As an example, the lowest rates are for Area 1. Zip code 76620 is in Area 1 and it is for Lufkin which is a smaller city. Area 6 (the highest rate code) includes zip code 77020 which is in Houston. The difference in cost for a 60 year old male in Plan II ($2500 deductible) is $357/mo between the two areas.

I'll try to post the link but I frequently don't get it in where it works right.

http://www.txhealthpool.org/Regular%20Rate%20Tables%20080112.pdf?bcsi_scan_94b52927ec029860=0&bcsi_scan_filename=Regular%20Rate%20Tables%20080112.pdf

What I am waiting for is the ACA Fed exchange to come out with rates that will effectively eliminate the Texas High Risk Pool. The people paying these rates are mostly older since I've discovered being over 50 pretty much disqualifies anyone from any other insurance policy in Texas. Health insurance companies know everyone in this plan will sign up for anything cheaper and they really don't won't these people in their "normal" risk pool.

 

[Malcolm2]

We've been getting hosed for years due to all the free loaders we end up subsidizing here in TX, which I suspect will not change anytime soon even with ACA.

My subsidized mega corp benefit costs me more than 2x what an equivalent retiree pays in the Northeast

And who will pay for all those subsidies??
Best I can tell from the websites in my area is a average family of four will pay $19K. Sure is an incentive to not sign up until a major event comes along. I suspect many will do just that, which will push the cost up further for us. Human nature.

 

[pb4uski]

And who will pay for all those subsidies??
Best I can tell from the websites in my area is a average family of four will pay $19K. Sure is an incentive to not sign up until a major event comes along. I suspect many will do just that, which will push the cost up further for us. Human nature.

My understanding is that you can't just sign up if a major event comes along. There will be windows of time that you can sign up. If the major event occurs outside those windows, you're screwed until the next window opens.

So if you have a cardiac event outside a window and are uninsured, you're screwed until you spend all your resources and become eligible for Medicaid.

I guess if you have little saved then it is probably worth the risk - you pay medical providers what little you have and then go on medicaid. But if you have substantial savings, then probably not.

 

[rbmrtn]

And who will pay for all those subsidies??
Best I can tell from the websites in my area is a average family of four will pay $19K. Sure is an incentive to not sign up until a major event comes along. I suspect many will do just that, which will push the cost up further for us. Human nature.

One could also ask who is paying for them now. Basically employer provided health care is being subsidized because they already disallow preexisting condition per FED regulations and they get a tax break because the premiums are treated as a business expense.

I would hope there would be some type of penalty such that if you do not sign up during the enrollment period and something happens, then you get stuck with the whole bill plus a penalty.

 

[bUU]

Sure is an incentive to not sign up until a major event comes along. I suspect many will do just that, which will push the cost up further for us. Human nature.

If it becomes a problem, then hopefully people will do the right thing and close the loophole.

 

[meierlde]

I didn't see anything to support that statement, and what I have read elsewhere points to the opposite conclusion. Rural and sparsely populated areas are high health care cost while large metropolitan areas are lower cost. Exception to Hawaii and NYC.

As an illustration if you look at the premiums for the Texas High Risk Pool you find that the premiums for Houston are much higher than San Antonio and then less again further west. (Partly that may be because unskilled labor pays less in the boonies) The list goes by zip codes. For the 3k deductable plan for those 60-64 the rates are in The highest cost areas (Houston and Dallas) for a guy 1198/month, in Fort Worth a bit less and In San Antonio 951 and in the boonies 841. Now the table is some what irrational in that those with a Bellaire Tx zip code pay $100 less all be it that Bellaire is surrounded by Houston on all sides.
So yes the regional disparities exist. (Note also that Dallas Suburbs pay less than Dallas city again the folks in the suburbs might be a bit healthier)