Preview 2017 ACA plans now active

[Mulligan]

adverse selection - healthy people pay the penalty and unhealthy people use the insurance

If premium gets too much that a healthy person such as I will not pay the premium, the government can pound sand collecting my penalty. The law is set up for people to exploit premium subsidy by controlling reported income. Well I can exploit the law concerning penalty. No refund...No govt collection of penalty. They set the law up that way. If I get priced out of insurance market, I sure as hell ain't paying the penalty that they are allowing me not to pay.

 

[NW-Bound]

But without health insurance, will you do self-administered health care like the tough guy I mentioned in a post earlier, who self-amputated several toes?

 

[Mulligan]

Im not at the point, yet. But eventually a point comes for some people where the breaking point is reached...The bottom line is 5% of people consume 50% of healthcare costs and 20% consume 80%... Insurance companies knew that. That is why my insurance from 2010 to Dec. 2014 went from $73 to $85 with a $5500 deductible... And thanks to Obamacare booting me off my underwritten plan, I went to $325 with $6500 deductible and an in-network plan that consists basically of the local veterinary clinics. My $85 was subsidizing other healthy people. Now I am subsidizing the 20% thus my premiums have sky rocketed and medicare facilities options compromised. Not everybody gets sick. In fact most dont. John Adams drank like a fish, spent 7% of his presidential salary on personal alcohol consumption, had whiskey and leeches as medical options and lived to be 91, without insurance. I have decided I will be like him!

 

[NW-Bound]

...I went to $325 with $6500 deductible and an in-network plan that consists basically of the local veterinary clinics...

But they do have anesthetic at the local vet clinics, compared to your having to chop off fingers and toes with just a few shots of whiskey. No?

... Not everybody gets sick. In fact most dont...

Eventually, most do. It happens with old age. The difference is that some die cheaply, while some linger on for a very looong time, costing a lot of money.

My pre-ACA policy had a lifetime limit of $1M, and that did not bother me any. I thought, and still think, that if I got so sick that $1M could not cure me, I would not want to live anyway with that quality of life. But one cannot get a policy like that anymore. It's illegal. So, the premium has to go up (though there's something else that causes it to go up that much!).

Insurers have to pay out 85% (the so-called MLR or Medical Loss Ratio). Their profit is contained in the remaining 15%, which includes the operating cost. Now, even the government Medicaid program has a 10% operating cost or overhead, as I recently saw elsewhere. And people still call insurance companies names.

PS. The $1M limit was more than 10 years ago. If adjusted for inflation, I would like it even more now.

 

[Mulligan]

Mine had a $7 million limit. Im not worth 7 million. If I had hit that limit, throw me in the trash can. Old age to me is 65. Once you hit that point, its Medicare and that is cheap compared to this crap plan I am getting. The costs go down. I will just write a list of things to repair when I am 65 and take care of it then!

 

[NW-Bound]

I am not sure if I would want to go through $1M worth of pain and suffering, let alone $7M. Put me down, please.

 

[RetireAge50]

Mine had a $7 million limit. Im not worth 7 million. If I had hit that limit, throw me in the trash can. Old age to me is 65. Once you hit that point, its Medicare and that is cheap compared to this crap plan I am getting. The costs go down. I will just write a list of things to repair when I am 65 and take care of it then!

Thanks Mulligan for telling it like it is. It is about time someone got in the fighting mode.

 

[Mulligan]

Well remember NW, we are talking about medical billing dollars not real world dollars. A million dollars in healthcare costs equates to buying a Toyota Corolla in real world bucks, lol.

 

[Mulligan]

Thanks Mulligan for telling it like it is. It is about time someone got in the fighting mode.

I cant help myself, Retire, lol. Im actually not opposed to single payer. Just make it a VAT tax on things so the local lazy beggar has to contribute also to his healthcare costs when he goes and buys his cigs and booze. Im tired of all this cross subsidization in 10 different ways and directions so that many people never feel the financial pain of healthcare. We need everybody mad to overhaul the system, just not the 1 million getting hosed with the full rate hikes and everybody else not noticing it. And IMHP it isnt the insurance companies most at fault. They are just the people we write the check to so they bear the brunt.
I cant tell you how dumb some people are....Many friends I have who work get their insurance mostly free. And I cant get it through their thick heads, their paycheck increases are minimized because of the "free insurance" costs employers are paying.

 

[NW-Bound]

Well remember NW, we are talking about medical billing dollars not real world dollars. A million dollars in healthcare costs equates to buying a Toyota Corolla in real world bucks, lol.

Medical billing dollars are highly inflated. Insurance-negotiated costs are less so.

As I have often talked about, I was faced with a life-threatening illness 4 years ago. After 2 major surgeries, 2 minor ones, and extensive 18-month treatment, I cost the insurer around $180K, I think. My wife kept track, and still has the exact number somewhere.

With what I went through, I did not see how I would want 6x that, let alone 39x. In fact, many older patients would drop out and said they'd rather died. And they did.

 

[zinger1457]

Just checked ACA, only one insurer (BCBS) to select from in southeast AZ. They do offer a bronze HSA plan very similar to what I currently have but the plan cost is ~75% more. Not sure if there is a miscalculation somewhere but if I use the same income for 2017 that I used for 2016 my subsidy increases from $320/month to $949/month.

 

[Texas Proud]

Medical billing dollars are highly inflated. Insurance-negotiated costs are less so.

As I have often talked about, I was faced with a life-threatening illness 4 years ago. After 2 major surgeries, 2 minor ones, and extensive 18-month treatment, I cost the insurer around $180K, I think. My wife kept track, and still has the exact number somewhere.

With what I went through, I did not see how I would want 6x that, let alone 39x. In fact, many older patients would drop out and said they'd rather died. And they did.

Well, when you hear the cost of many procedures when you go to Thailand or some other place I would say that even insurance costs are highly inflated....

And I am not talking third world care.... but top of the line care...

Our system is broken and moving deck chairs on the Titanic will not help... single payer will not help... it is actually the cost that is the problem, not who pays for it...

I hope I have not crossed the line.... just stating an opinion that is not blaming any political party....


Edit... Decided to put something down to show my point... well, not so good.... here is a link... http://www.medretreat.com/procedures/pricing.html





This chart will provide you with a basic comparison of common procedure pricing between the U.S. and overseas hospitals. As pricing will vary depending on where you originate from, and which country you choose to receive your procedure, we have provided a price range for comparison purposes.

PROCEDURE COST IN U.S. COST ABROAD Orthopedic Hip Replacement $40,000 - $65,000 $7,000 - $13,000 Hip Resurfacing $50,000 - $60,000 $8,000 - $12,000 Knee Replacement $45,000 - $60,000 $7,500 - $12,000 Neurology Spinal Fusion $80,000 - $100,000 $6,000 - $10,000 Total Spinal Disc Replacement $100,000 - $150,000 $8,000 - $12,000 Discectomy $20,000 - $24,000 $5000 - $7,000 Cardiology Angioplasty $50,000 - $65,000 $5,000 - $7,000 Heart Bypass $90,000 - $120,000 $10,000 - $18,000 Heart Valve Replacement $125,000 - $175,000 $13,000 - $18,000 Gynecology Hysterectomy $18,000 - $25,000 $4,000 - $7,000 Cosmetic Face & Neck Lift $8,000 - $15,000 $2,500 – $4,000 Breast Augmentation $6,000 - $12,000 $3,500 - $5,000 Tummy Tuck $6,000 - $12,000 $3,800 - $5,200 Liposuction/Area $2,000 - $3,000 $800 - $1,200 Dental Dental Implants/Tooth $3,000 - $5,000 $800 – $2,000 Dental Crowns $800 – $1,200 $200 – $600

 

[Mulligan]

Medical billing dollars are highly inflated. Insurance-negotiated costs are less so.

As I have often talked about, I was faced with a life-threatening illness 4 years ago. After 2 major surgeries, 2 minor ones, and extensive 18-month treatment, I cost the insurer around $180K, I think. My wife kept track, and still has the exact number somewhere.

With what I went through, I did not see how I would want 6x that, let alone 39x. In fact, many older patients would drop out and said they'd rather died. And they did.

And we are glad you came through strong and enjoying life! These plans are becoming useless. If I go into a hospital Dec. 30 for a few days, I am out over $20,000 before I get a penny assistance. Great insurance! I think I want to by twice as much as it is such a great deal.
There is another way people game it. A friend on mine told me he knows several people who have large hospital bills, and brag they just pay $20 a month to them to keep them off their backs. Maybe that will be my gaming plan, lol.

 

[NW-Bound]

Well, it's all about ACA plan availability and premium increases we talk about, yes?

It does not bother me that much that the healthcare cost is higher here than in Thailand. Heh, when working I got paid a lot more than a Thai engineer did in his country, so why should I ask an American doctor or nurse to be paid in Thai baht? Everybody gets paid more here than his counterpart in Thailand.

The question should not be whether it should be higher here in the US, but how much higher it should be.

 

[Mulligan]

Well, it's all about ACA plan availability and premium increases we talk about, yes?

It does not bother me that much that the healthcare cost is higher here than in Thailand. Heh, when working I got paid a lot more than a Thai engineer did in his country, so why should I ask an American doctor or nurse to be paid in Thai baht?

The question should not be whether it should be higher here in the US, but how much higher it should be.

Medical providers salaries are a zit on the face of medical costs. They deserve their bucks. Ok, Im done complaining. I cant solve anything. I will write my check....until I dont. And I aint paying no "penalty" if it ever comes to that!

 

[Hiredgun]

AZ 116% Increase in some cases, over 50% increase in most

I live in AZ. Luckily I have a grandfathered private insurance plan (as long as it continues to exist). Once it is gone I will have to get Obamacare or a work around. But these facts are grim.

One county in AZ has only one choice -- so much for competition that could drive prices down. And even with more than 1 option, the strictures of an Obamacare policy mean all the policies offered have the same options, so no competition. Let's hope somebody fixes this b/c we have taken a system that 90% of people were happy with and turned it into a disaster. This thing is a rube golberg nightmare and it was more than foreseeable by anyone who could look at it objectively.

Also, when anyone is happy about how subsidies are increasing, let's remember that the taxpayers (we who are working) are paying for all of this. There is no free lunch. Let's hope our inept congress can somehow figure out how to interject competition into this pig and eventually make it affordable. But their usual answer (more taxpayer money for subsidies and insurance company bailouts) will only make the death spiral happen that much sooner.

My advice: If you need or can foresee any type of medical treatment, book your doctor now. In some cases, the wait in AZ is over 6 months to see a qualified doctor. If you are early retired, consider a part-time job at Starbucks or a similar company where you can get work-related healthcare that does not have the huge co-pay, narrow networks and limitations of Obamacare. This is only going to get alot worse before it gets better. Good luck all and God Bless!

 

[bob boag]

Just from the point of view of clarity, I wonder if at some point they'll memory-hole the moniker "Affordable Care Act".

 

[eta2020]

Well, it's all about ACA plan availability and premium increases we talk about, yes?

It does not bother me that much that the healthcare cost is higher here than in Thailand. Heh, when working I got paid a lot more than a Thai engineer did in his country, so why should I ask an American doctor or nurse to be paid in Thai baht? Everybody gets paid more here than his counterpart in Thailand.

The question should not be whether it should be higher here in the US, but how much higher it should be.

The cost is also much higher then in Switzerland or France and on average very far from Swiss or French quality.

BTW you most likely got paid much less then you would if you did same job in Switzerland just as you are most likely collecting much smaller pension for that work then Swiss citizen.

It is meaningful to compare USA to France and not all that meaningful to compare it to Thailand or Zimbabwe.

 

[xdafly]

Our (MFJ, retired for a year) monthly Silver Plan premium will drop to under 33.

Nice!

 

[NW-Bound]

The cost is also much higher then in Switzerland or France and on average very far from Swiss or French quality.

BTW you most likely got paid much less then you would if you did same job in Switzerland just as you are most likely collecting much smaller pension for that work then Swiss citizen.

It is meaningful to compare USA to France and not all that meaningful to compare it to Thailand or Zimbabwe.

The cost of living varies between countries, so it is common to look at healthcare cost as a percentage of GNP. And indeed, the US is highest among developed countries.

For personal finance, where I am, when the premium for a Silver Plan along with the high deductible consume the entire median before-tax income of a couple, something is extremely wrong. See an earlier post of mine (#107).

Having the government picking up the tab is not the solution. This cannot go on forever. Are we becoming another Greece?

 

[John Galt III]

I'm in eastern Pa. I have 3 Silver plans to choose from. Will probably go with Geisinger HMO which will be $0 (zero) per month premium after subsidy. $300 deductible. $2,350 max oop. Based on income of $16,500.

 

[MBSC]

With the premium so high, undoubtedly more people will qualify for a subsidy.

The premium rate doesn't have anything to do with whether you get a subsidy, does it?

For young people with low SLCSP premiums, the sliding scale of subsidies often goes to zero well below 400% FPL. As their SLCSP premiums rise, more young people in the 300%-400% FPL range become eligible for subsidies.

On a different note, as SLCSP premiums rise 50 year olds will begin to experience "the cliff" currently seen by 60 year olds. The 60 year olds will see a bigger cliff.

 

[eta2020]

The cost of living varies between countries, so it is common to look at healthcare cost as a percentage of GNP. And indeed, the US is highest among developed countries.

For personal finance, where I am, when the premium for a Silver Plan along with the high deductible consume the entire median before-tax income of a couple, something is extremely wrong. See an earlier post of mine (#107).

Having the government picking up the tab is not the solution. This cannot go on forever. Are we becoming another Greece?

Well I am just mentioning it because immigration to place like Portugal is another option to bridge FIRE age to age 65 . I don't want to get into political discussion of broken Health System in US since that will be blocked by admins.

One can get 10 years tax free stay in Portugal. That is just an example.....

 

[ShokWaveRider]

For those who are getting the subsidy, it is still better than paying the full unsubsidized amount. At least I think so. It does pay to try and control your income. No SS for us till 66.

We do talk about the money a lot because that is also we are concerned about.

BUT Pre-Existing Condition Coverage, No Payout Caps, Women's Health, Wellness Health, and Diagnostic services are PRICELESS.

 

[jkern]

the plan may have an employer cost cap

You are exactly correct. My former employer changed their retiree medical benefit rules some time ago and I missed being grandfathered by two years.