Seeking ACA Examples

[Mr._Graybeard]

I retired in July 2013 with a severance package that included six months of free health insurance comparable to a silver ACA plan. As soon as that coverage lapsed, we went with a high-deductible Bronze plan with HSA from the marketplace. The first year the premium was $298 a month; the following year it was $221; last year it was $190 a month; and this year the premium for two adults in their early 60s is $106 a month. Yep.

We've learned to play the MAGI game, and the deductible has gone up slightly every year. This year we're looking at $13000 max OOP. I don't care about that -- my two must-haves are zero co-pay above the deductible and an HSA so I can shelter income.

If we have $13K in medical expenses in a year, so be it -- we just want to be protected from a catastrophic medical situation. My thinking always goes back to a friend who suffered a brain anyeurism at age 56 and spent a couple months in the ICU because he was too tough to give up without a fight. When he finally died, he left well over $1 million in medical bills, which exceeded the lifetime benefits cap on his group coverage.

 

[Sarah S]

I went on ACA from a Cobra plan. The premiums were similar a little over 600 a month. ACA had a higher deductible ( 2000) but a better network. That was 2014. This year the same ACA plan in 687 a month. No subsidy. Very satisfied

Without ACA or Romney care type protections I could not get insurance due to a pre existing condition. So far the insurance company has made money from me each year but potentially I could become expensive ETA my condition is genetic and there are no interventions known to mitigate risk

 

[MBSC]

...I would have been on the hook for all the non-hospital charges (i.e. doctors, drugs), about $24k.... Of the $24k, about 93% of it was either discounted by the providers or paid for by BCBS.

A relative recently had his gallbladder removed at an Ambulatory Surgery Center. Before surgery, he asked how much it would cost. The ASC said his insurance would be billed $12k. He told them he doesn't have insurance (2 years until Medicare) and they charged him $5k (58% discount by the provider).

 

[AllDone]

Prior to ACA we were paying $1500 COBRA monthly for two, post ACA first year was $1100 with $5000 higher OOP. We used no medical care that year and pocketed the $4800 savings. This year our ACA premiums are $1400. We are not eligible for subsidies. I just had my knee replaced due to an old injury at the fancy hospital by the super-specialist. I also have a genetic form of early osteoarthritis. My husband has reflux currently controlled with diet and a history of benign but large colon polyps. We selected a more expensive ACA policy that is a wide-network PPO. We (me) currently take only one drug, but because of a manufacturing problem I can't buy the covered brand. My doctor could probably do the paperwork to get the alternative covered, but instead I buy it from Canada for $200/6 month supply which is cheaper than my copay for branded drugs. The US cost is $200/month.

My BIL has a successful small business. He is extremely healthy, but was born with a mild, common congenital heart defect (genetic) which sometimes requires a valve replacement. He receives an annual echocardiogram and evaluation by a cardiologist and currently has no need of further treatment. My sister provided his insurance through a corporate job. She retired to start a small business and they moved to another state where he was only able to get insurance through a high-risk pool which cost $1700/month (IIRC) for himself. I don't know what they currently pay, but I'm sure it's less!

We all need the ACA and worry that at ages 56-60 with various injuries and genetic conditions we would not be able to purchase underwritten insurance. We have no lifestyle related issues.

 

[LARS]

My thinking always goes back to a friend who suffered a brain anyeurism at age 56 and spent a couple months in the ICU because he was too tough to give up without a fight. When he finally died, he left well over $1 million in medical bills, which exceeded the lifetime benefits cap on his group coverage.

Not to sound totally uncaring, but this is an example of why healthcare costs are through the roof. Million dollars to extend "life" (if you can call last days spent in an ICU life) for a couple of months.

Don't know how you compassionately solve this issue, but it is one of the elephants in the healthcare room...

 

[ShokWaveRider]

OP, thank you for this thread. This is something I have beeon thinking about. What interests me while reading the replies is the couple of posters who said they were not insurable prior to ACA. This is what I dread most since wife has many pre-existing conditions.
So to those posters, would you expand on your experience on being uninsurable? How did you deal with your health problems during that time?

I went back to work for HI till ACA Then retired again.

 

[MildlyEccentric]

The ACA was perhaps the most important factor in my retirement decision. In retirement, I could afford heath insurance premiums, but I couldn't pass medical underwriting, so obtaining any insurance was problematic. COBRA helped, but left a gap between the time COBRA ran out and Medicare began. Under the ACA, I was able to obtain insurance for the years I needed and ultimately switched to Medicare this year. If I was in the same position today, I'm not sure if I would retire owing to the uncertainty surrounding the availability of insurance.

 

[AllDone]

Not to sound totally uncaring, but this is an example of why healthcare costs are through the roof. Million dollars to extend "life" (if you can call last days spent in an ICU life) for a couple of months.

Don't know how you compassionately solve this issue, but it is one of the elephants in the healthcare room...

How do you tell in advance who's going to get better and who will die?

My mom missed a flu shot one year, caught the flu, got ARDS and shock, had less than a 10% of survival, spent two weeks on a ventilator, and recovered with nothing worse than a paralyzed vocal cord which made her voice extremely faint for a year. She's still healthy 16 years later. Odds were that she was going to die, though.

 

[clobber]

Thanks everyone for the responses.

 

[FUEGO]

1) If you had it, what coverage and cost did you have prior to ACA?
Family coverage through DW's work (then she retired and we went on ACA coverage). It was $80/month IIRC for a $3500-5000 deductible plan that covered 80% after that. Heavy subsidy from the employer - roughly $10,000-15,000/yr from my recollection of amounts stated on W-2.

2) How did that change (if it did) with ACA?
When we got on the ACA plan, it was $0 deductible and $500 max out of pocket on our first plan, and our cost per month went up slightly to $125/month (with a similar $10,000/yr subsidy from the government, plus an unspecified value of the Cost Sharing Reduction subsidy that allowed us to have $0 deductibles). Currently on a new plan with $100 deductible but cost dropped to $16/month (with an even larger subsidy from the govt). On the previous ACA plan, our kids also got dental coverage with no deductible (we pay 20% co-insurance though).

3) Do you perceive the change to be better or worse for you specifically?
Coverage under ACA plan seems to be better than previous plan - pretty much everything is covered, even preventative prescriptions. Copays lower, deductibles lower. Only downside is a more limited network (but we had significant limits with previous plan from employer, too - only one hospital network available with old employer plan and with new HMO plan).

Overall the ACA plan is better - lower costs while keeping reasonable access to medical care. I would take the ACA plan over the old employer plan for sure. If we had significant medical needs that required certain specialists, this might change my mind.

4) Comments about your specific situation? Difficulties? Successes?
ACA works exceedingly well for us. We manage income to hit around $40,000 AGI (roth conversions to bring us to that limit). We pay virtually nothing out of pocket, monthly premiums are next to nothing. We really don't consume hardly any healthcare at this point in our lives (both still in our 30's and none of us have medical conditions requiring anything beyond a $40/yr prescription plus paying attention to health and lifestyle).

I really don't mind paying more, even a lot more, as long as I can get some certainty over health care costs for the next 25 years till we hit medicare age. I'd hate to have to go back to work just to get health insurance (if, for example, we develop a pre-existing condition and insurance is no longer available or $200,000/yr).

 

[DayDreaming]

2011: $248/mo (pre ACA)
2012: $319/mo (pre ACA)
2013: $399/mo (pre ACA)
2014: $279/mo (ACA bronze)
2015: $146/mo (ACA bronze)
2016: $134/mo (ACA silver)
2017: $100/mo (ACA silver, $500 deductible)

This is coverage for a single person in good health.

Each year listed here is with BCBS - the plan name changed a few times due to changes at BCBS, but the coverage I had was pretty similar each year. The costs listed are after the ACA subsidy, so the actual cost might be higher or lower after I do my income taxes, but not significantly different.

My HI costs were never high, but they're lower under the ACA, and other than that I've really noticed no difference (other than making my income taxes more complicated).

Note that my monthly costs for HI have gone down in the past few years because my MAGI has gone down each year.

 

[Mr._Graybeard]

deleted

 

[LARS]

How do you tell in advance who's going to get better and who will die?



My mom missed a flu shot one year, caught the flu, got ARDS and shock, had less than a 10% of survival, spent two weeks on a ventilator, and recovered with nothing worse than a paralyzed vocal cord which made her voice extremely faint for a year. She's still healthy 16 years later. Odds were that she was going to die, though.

And therein lies the problem...

 

[gauss]

Your final year of life is almost always your most expensive healthcare wise.

-gauss

 

[LARS]

Your final year of life is almost always your most expensive healthcare wise.

-gauss

I've usually heard that expressed as last six months, but... yes.

The "million" dollar question becomes balancing the competing goals of quality v. quantity in those final months. Too often, I suspect that quantity wins out over quality: leaving a few extra miserable final months for the dying and a large medical bill for society.

How you solve this is a conundrum. Personally, I do not see, or want, to take personal choice out of this equation. So what you're left with is educating society, and the medical profession, on end of life decisions and on how to "best" manage the process.

But this has strayed from the OP, which was my fault. Sorry.

 

[FUEGO]

How do you tell in advance who's going to get better and who will die?

My mom missed a flu shot one year, caught the flu, got ARDS and shock, had less than a 10% of survival, spent two weeks on a ventilator, and recovered with nothing worse than a paralyzed vocal cord which made her voice extremely faint for a year. She's still healthy 16 years later. Odds were that she was going to die, though.

Same story here with my FIL. Passes out one day, goes to the hospital, and they decided it was something in the GI tract causing internal bleeding. Down for surgery and 6 weeks later he wakes up after a long hard fight (plus several more weeks in an inpatient rehab facility). Doctors weren't optimistic for the first several weeks post-surgery.

I handled the insurance claims and medical bills for them. Just over a half million dollars claimed (Medicare paid $45,000 or so IIRC, plus $2-3k from FIL, so it's not really a half million dollar hospital visit).

 

[Alan]

Thanks for the interesting discussion, the thread has now gone well off course but had many on topic posts.