So grateful for the ACA

[marko]

So here's what I don't understand: It seems every other day there's something on the local TV news or in the paper about someone needing a Crowdfunding or other way of visibility because they've had some accident or ailment and can't afford health insurance. The complaint is that insurance is too expensive.

I thought ACA was supposed to take care of that or, in default Medicaid. Or is there some gap that one makes too much for Medicaid but not enough to pay for ACA?

I'm always mystified.

 

[pb4uski]

Required underwriting: YES

Extremely expensive: NO

Rewind the clock to 2007. My medical insurance premiums were about $80 / month (that's not a typo ). The coverage was comparable to what I was getting from a mega-corp plan the year before.

Skyrocketing premiums began (for non-subsidized folks) when the [A]CA was enacted. I was only on the [A]CA for 1.5 years before I went back to purchasing non-[A]CA medical insurance. My premium for a non-[A]CA policy today is $360 / month. For an [A]CA policy it would be over $900 / month.

I'm interested only in data. I'm not going to squabble about the politics associated with the [A]CA.

Yup. If you are a health insurer and can underwrite and reject applicants then you can offer a much lower premium. Perceptive glimpse of the obvious.

But if you can't pass underwriting, then you're screwed.

 

[MichaelB]

So here's what I don't understand: It seems every other day there's something on the local TV news or in the paper about someone needing a Crowdfunding or other way of visibility because they've had some accident or ailment and can't afford health insurance. The complaint is that insurance is too expensive.

I thought ACA was supposed to take care of that or, in default Medicaid. Or is there some gap that one makes too much for Medicaid but not enough to pay for ACA?

I'm always mystified.

There are likely many causes, but one is the coverage gap. This is where some states chose to not increase Medicaid eligibility, so some people earn too much to qualify for Medicaid but not enough to qualify for ACA assistance. See here https://www.kff.org/medicaid/issue-...if-all-states-adopted-the-medicaid-expansion/

 

[GenXguy]

So here's what I don't understand: It seems every other day there's something on the local TV news or in the paper about someone needing a Crowdfunding or other way of visibility because they've had some accident or ailment and can't afford health insurance. The complaint is that insurance is too expensive.

I thought ACA was supposed to take care of that or, in default Medicaid. Or is there some gap that one makes too much for Medicaid but not enough to pay for ACA?

I'm always mystified.

The ACA can still be very expensive. It was lower for me to stay on $1000/mo COBRA last year than switch to ACA, and the ACA was even worse when factoring in the deductible and max out of pocket vs. my COBRA. And if you have to go out of network for care, it can be a lot worse.

Another thing is that the Medicaid Expansion, which is actually part of the ACA, wasn't adopted in all states, so that isn't always an option depending on what state you live, even if your income is very low.

 

[Onda]

Required underwriting: YES

Extremely expensive: NO

Rewind the clock to 2007. My medical insurance premiums were about $80 / month (that's not a typo ). The coverage was comparable to what I was getting from a mega-corp plan the year before.

Skyrocketing premiums began (for non-subsidized folks) when the [A]CA was enacted. I was only on the [A]CA for 1.5 years before I went back to purchasing non-[A]CA medical insurance. My premium for a non-[A]CA policy today is $360 / month. For an [A]CA policy it would be over $900 / month.

I'm interested only in data. I'm not going to squabble about the politics associated with the [A]CA.

Depends on which state you live in. Some very high income and high cost of living states have cheap ACA and some very low income states have expensive ACA.

 

[big-papa]

The ACA can still be very expensive. It was lower for me to stay on $1000/mo COBRA last year than switch to ACA, and the ACA was even worse when factoring in the deductible and max out of pocket vs. my COBRA. And if you have to go out of network for care, it can be a lot worse.

Another thing is that the Medicaid Expansion, which is actually part of the ACA, wasn't adopted in all states, so that isn't always an option depending on what state you live, even if your income is very low.

I believe it. There are so many variables involved like one's MAGI, the plans actually available in your area and their coverage area, as well as in-network providers. I spent several weeks at the end of last year comparing ACA plans against each other as well as comparing to staying on COBRA for another year before deciding on our ACA plan. So far so good 3 months in.

Cheers.

 

[ncbill]

Yup. If you are a health insurer and can underwrite and reject applicants then you can offer a much lower premium. Perceptive glimpse of the obvious.

But if you can't pass underwriting, then you're screwed.

Also don't forget those insurers practicing rescission at will.

 

[audreyh1]

Also don't forget those insurers practicing rescission at will.

Yeah that was always the sword hanging over our heads.

 

[jimbee]

Also don't forget those insurers practicing rescission at will.

That's a good point, the ACA made rescission illegal.
https://www.healthcare.gov/glossary/rescission/

 

[athena53]

Also don't forget those insurers practicing rescission at will.

Oh, that was awful. If you developed an expensive condition they'd go through your entire medical history with a fine-toothed comb and look for things that might have made them turn you down. In one sad story, a woman whose little boy developed cancer had the policy rescinded because she'd neglected to mention she'd once been on anti-depressants. At a small consulting firm where I worked pre-ACA we kept shopping our coverage around every year as the premiums increased. One insurer said they'd cover the 3 of us who were relatively healthy but not one guy because he was Old and not a 40-ish guy because he'd been on anti-depressants.

 

[badatmath]

I recall my (job bound) health insurance going up with ACA as they mandated more coverage. Before my plan had some lifetime limit of a couple million (don't remember the number). Other than that I haven't needed ACA yet as I have retiree health (knock on wood it lasts).

It has been some years since I checked in my state but the ACA options did not look desirable. Mostly HMOs (not for me thanks).

 

[disneysteve]

Agreed. ACA coverage is what is allowing me to retire this year at 59. Having an affordable option to carry us until Medicare was a must. Without that I’d still have to work 5+ more years.

 

[F.I.R.E User]

I just hit a milestone - I paid my last ACA health insurance premium; I start Medicare May 1st.

The ACA allowed me to retire early (2017), which has given me the opportunity to take much better care of my elderly parents and spend much more quality time with my significantly-older-than-me partner than I would have if I were still working.

In 2018 one of my brothers was diagnosed with stage 4 pancreatic cancer. He lived in Arizona and my parents and I live in Pennsylvania. I was able to take my parents out to visit my brother several times and then back out for the funeral in late 2019. I am so grateful I was retired and could do that for my parents, for my brother, and for me.

Both of my parents have had extended hospitalizations in the past three years, and I was able to spend all day every day with them in the hospital, which gave all of us a lot of peace of mind.

How much do you pay for ACA and deductibles?

 

[jeffmete]

ACA quoted me 2,200/month when I retired at 62.5 (for my wife and I), ended up going with a Christian medical sharing (Medishare) which was less than half the ACA. It’s not for everyone, but worked out for us till Medicare kicked in.

 

[F.I.R.E User]

ACA quoted me 2,200/month when I retired at 62.5 (for my wife and I), ended up going with a Christian medical sharing (Medishare) which was less than half the ACA. It’s not for everyone, but worked out for us till Medicare kicked in.

I see people getting it for $500 a month.

 

[RetiredHappy]

I see people getting it for $500 a month.

It depends on your income. I am 61 yo and paying $1,300 per month on a silver plan without subsidies.

 

[ERhoosier]

Most do not realize how much ACA options vary across the country, especially for folks with serious ongoing pre-existing conditions. I was on ACA (after exhausting COBRA) when I tried to ER some years back. ALL ACA options in my area (regardless of high (no subsidy) premiums) included high out-of-pocket max'es, NO out-of-area non-emergency coverage, and literally more limited provider networks than Medicaid. When my wife lost access to her eye specialist (literally no ACA participating subspecialist ophthalmologists in my area- even tho I worked in local health care with local connections) it scared us so much I went back to w@rk to get access to employer health insurance until I could COBRA again to Medicare. The promises of ACA turned out empty for DW & I.

 

[scrabbler1]

The ACA has been a godsend for me. When I first ERed in late 2008, there was no ACA. In 2009, I had found a decent individual policy which cost $470 a month. But by 2011, the premium had risen to nearly $700 a month, just under 50% in 2 years. At least the ACA had been passed by then, so there was hope.

I ditched that plan and bought a bare-bones, hospital-only plan just to get me to the end of 2013, so in 2014 I would sign onto an ACA exchange plan and get a broader policy again, at hopefully a better price than the $700 per month.

I did get an ACA Silver plan and qualified for a small subsidy, with a monthly premium just under $400 per month. I was no longer underinsured and was paying less than I was in 2009, two good improvements.

Good thing I got a better plan because in 2015 I had some health issues which landed me in the hospital for 11 days. I hit my max OOP so an $80k hospital bill cost me only about $4k. I had to change plans in 2016 because the old plan made me use the terrible Express Scripts to get my new drugs.

Starting in 2017, I was over the premium cliff so I lost the subsidy. With the annual rate increases increasing from year to year, not qualifying for the subsidy was costing me more and more. So, in late 2019, when I was about to go over the cliff for the third straight year (due to big, unneeded, year-end CG distributions), I change the stock portion of my portfolio from an actively managed fund I had been in since the mid-1990s to a comparable index fund. This got me back on the subsidy train in a big way.

Then, just this year, New York State (which, like pb4uski's Vermont, doesn't age-rate) raised its income limit to qualify for its Essential Plan. Thanks to what I did in late 2019, I now qualified for the Essential Plan and have just started this month with a new insurer (because my old one didn't offer an EP). I can keep all my doctors, pharmacy, and other providers and will have lower copays along with no premiums. (If I stayed with my old plan, I would lose the entire subsidy.)

I turn 61 in a few weeks so I will be in this plan for the next 4 years.

 

[meleana]

Yup. I was forced out of my job at age 62. I stayed on my husband’s employer plan but he wanted to retire a year later. He’s 2 years older than me and would be on Medicare With the help of our FA I was only on $500 per month COBRA for one month. Straight to Silver ACA plan for $34 per month HMO with the help of a broker/ navigator . We had barely any income as were living on cash and delaying SS until age 70. No monthly pensions.

Never even had a copay all the time on it.

Was on the ACA plan for a year and a half. Second year was $50 per month. Then went on Medicare.

Here’s the amazing part: the following year I got a letter from that insurance company and a check for almost $1000 and the following year same thing, but a smaller check for a few hundred! Something about having to reimburse premiums because they didn’t pay out as many claims or something like that! Required by the state!

Meanwhile I no where near laid out that much money in premiums! That’s the government for ya!

 

[walkinwood]

We were in NJ when we ER'd so guaranteed issue even before ACA, but the community rating premiums were very high.


We applied for insurance in CO before finalizing our move. If we were denied, we would have had to change plans, but luckily, we were approved. We moved and ACA came around a couple of years later.


Even without the subsidy, the lack of anxiety over possibly losing coverage (or having it be unaffordable) made ACA a huge win for us.

 

[AlmostThere35]

ACA wasn't useful for me

The ACA was ultimately useless for me, b/c not all (including the best) cancer centers will accept ACA compliant plans (eg. MD Anderson).

I've always been the picture of perfect health. I took care of myself and it showed. I retired early at 35 and I'm very glad I did b/c less than 10 years later it turns out I have incurable brain cancer.

Basically, I ended up going back to work 30+ hrs/wk with my old company (they love me and I've been occasionally consulting for them since retiring to keep my toes in the water hence they were happy to help me) so I could get on a group policy to get the best care and still leave my nest egg to my family. You can say I just wasn't willing to compromise, and you're not wrong, but I just think it's kind of screwy that the system is such that for working age adults, you more or less have to be working (or your spouse has to be) to get the best care.

To get the best treatment asap without spending excessively, I went back to more or less full time employment, I ditched ACA, shelled out cash for the pre-surgery stuff like MRIs, etc. (less than 1/20th the price in cash at outpatient facilities), and scheduled surgery and etc. for after the 1st of the next month when my company's group policy medical insurance became effective for me. Here I am working again and while on chemo and radiation treatments.

Luckily, my wife likes her job and still works. I can get on her group policy in a few more months. I might quit and pay cash for a bit again before then since this'll be it for treatment anyway aside from limited chemo going forward (the stats say I have a couple years give or take).

ACA didn't end up saving me any money in any case. There is more to complain about concerning ACA and our healthcare system in the US in general, but I'm familiar enough with systems in other countries at either end of the spectrum to know that no one has a solution without pros/cons.

 

[RetiredHappy]

What I have is an off-exchange private individual health insurance which has better coverage than ACA health insurance. It costs about 20% more but still has fairly high deductible and max out of pocket. I go to UCLA to see a specialist even though it is out of state for me and UCLA is considered within the EPO network. I just want the best health insurance plan that money can buy.

 

[I am He]

The ACA isn't just something to use for a marketplace plan. It's a law that also affects private insurance, Medicaid, and Medicare.


The ACA is NOT insurance.

Probably most thankful for the mandate re: pre-existing conditions.

 

[HI Bill]

One thing that might be interesting is if there is a specific aspect of the ACA that people found most helpful. For me, hands down, it was guaranteed access.

For me, it was the prohibition of excluding clients' pre-existing conditions. If I had to pay for private insurance before ACA, they could have excluded my condition, which requires 10 (ten) to 12 $3,000 shots a year. It would have made ER much less feasible, or at least much later.

 

[ArmchairMillionaire23]

<mod note> this is not a discussion on public debt or other support programs. Posts have been removed that were off topic

I will be turning 55 near the end of next year so DW & I were looking forward to retiring in 2025 and using ACA and subsidies to hopefully help keep us insured for the 10+ years until Medicare is available. I'm not looking to get my post deleted, but we worry that there's a chance that the ACA might be eliminated or severely cut back next year depending on how the 2024 election turns out (not just Presidential, but the House & Senate along with state & local governments)

We were originally looking into possibly retiring in June, at the end of the school year (DW is a teacher) but I'm seriously considering applying for insurance through the ACA and starting it right after the first of the year before the politicians start trying to make changes (if there are any - again, I'm not trying to turn this into an overtly political rant)

I've been looking into Silver plans on the Marketplace website. I have to figure out how much we're going to start withdrawing from my 401(k) and/or Roth IRA so we know our income so we can calculate how much of our income is going to go towards insurance.

Has anyone started an ACA plan right after the first of a new year? How far in advance do you have to set things in motion?

Thanks in advance for any advice and/or suggestions.