2022 ACA Exchange Experiences

[USGrant1962]

Isn't it so affordable because someone else is paying for your insurance? My wife and I are about to retire but are not feeling great about having others subsidize our health insurance.

Since it seems most people on this site have enough money to retire early it sure seems probable that they could also buy their own insurance without needing others to subsidize it for them.

What am I missing or is this just the way it is in order avoid paying $2,500 a month for an off the marketplace plan?

You really shouldn't worry about getting a health insurance subsidy. There is only a tiny segment of the population that is NOT subsidized and that is not based on income/wealth. Basically only those who are upper income and retired and under 65; and maybe those who stay on unsubsidized COBRA between jobs. I guesstimated one time it is maybe 1% of the population, though probably less now with the elimination of the subsidy cliff. About 11 million are on ACA plans, or 3% of the population, and I've seen somewhere that 85% of those are subsidized.

Everyone else is subsidized in one way or another. Examples:

• Warren Buffet, Charlie Munger, Bill Gates, Steve Ballmer, Michael Bloomberg and 61 million others - 65+ on Medicare, subsidized
• Elon Musk, Mark Zuckerberg, and 156 million others - employer provided, business expense deduction and not taxed on personal income taxes, subsidized
• Small business owners/self-employed - business expense deduction and not taxed on personal income taxes, subsidized
• The poor - Medicaid, subsidized
• Me - can deduct health insurance against my consulting income on Schedule C, subsidized

The whinging that people under 65, unemployed, and with assets should be the only ones to pay full freight is silly, especially because it is a rounding error in the nation's health insurance bill.

 

[connor77]

Thanks BubbaChris and USGrant for the different perspectives.

 

[RetiredAndLovingIt]

What income are you inputting? Poverty level is $21,960 for a family of three this year. I get $29,280 for 133% of that (although maybe I don’t know how to calculate that correctly). So, yes, that amount would be forced to Medicare.

Using $35,000 for a fictitious 3 person family in Wayne county, Michigan, I see Silver plans as low as $9.69 per month and they have Cost Sharing enhancements to lower deductibles and copays.

I got similar when I checked. zip 48103, 33K 2 x 60 YO and 1 -18 YO
Kid would be put on Medicaid or CHIP and silver premiums starting at 0. Tax credit is $1356 and I sorted by lowest premium which was 0. and 33 plans available. Obviously we have no idea what doctors and hospitals that they would want which would change their choice but the point being that they can get plans at no or very low cost with 0 deductable

 

[scrabbler1]

Just to expand on one of USGrant's items in his fine list, an employee covered under his or her employer's group health plan pays for HI in 2 ways, the way I did when I was working. (1) employer subsidy, which is tax-free, and (2) pretax payroll deductions. In both instances, the tax benefit rises as income rises, exactly the opposite of the fairer ACA subsidies which decrease as income rises.

 

[Rainbowdash]

Disagree with most of USGrant list.
People on Medicare have spent their entire working life paying into the system, after 65 they still need to pay premium into it, not subsidized
People who are working where part of their HI is paid by their employer is because that’s part of their pay, not subsidized
People who can deduct their HI premium because they own a business, that’s the benefit of providing jobs to others, and improve our entire economy, not subsidized
People on Medicaid, I agree, subsidized

 

[qwerty3656]

What income are you inputting? Poverty level is $21,960 for a family of three this year. I get $29,280 for 133% of that (although maybe I don’t know how to calculate that correctly). So, yes, that amount would be forced to Medicare.

Using $35,000 for a fictitious 3 person family in Wayne county, Michigan, I see Silver plans as low as $9.69 per month and they have Cost Sharing enhancements to lower deductibles and copays.

It looks like its PPO vs HMO. Plenty of cheap HMOs, but the cheapest PPO I could find was over $700 a month. We live right on the border of Ohio (basically a suburb of Toledo) and all our doctors/hospitals are in OHIO. I think I need a PPO if I want any hope of getting approved to use those doctors/hospitals.

 

[DayDreaming]

I applied for coverage on my state exchange - GetCovered.nj.gov - and it tells me that I am deceased. How sad, there were still things I wanted to do before I died! I wish I had blown some more dough!

Their first suggestion was that I contact Social Security to correct the problem. I contacted SS and they said there is no record of me being deceased, so the problem is not there. I contacted getcovered.nj.gov and they said to just write a letter stating that I am alive, sign & date it, and upload an image of it to their website. I did that and got another notice saying that I need to provide proof, so I'm back to square one. Arrgh!

In case this helps anyone else: they did finally accept my signed and date letter stating that I am not deceased. I did not have to provide any other information.

 

[FLSUnFIRE]

I applied for coverage on my state exchange - GetCovered.nj.gov - and it tells me that I am deceased. How sad, there were still things I wanted to do before I died! I wish I had blown some more dough!

Their first suggestion was that I contact Social Security to correct the problem. I contacted SS and they said there is no record of me being deceased, so the problem is not there. I contacted getcovered.nj.gov and they said to just write a letter stating that I am alive, sign & date it, and upload an image of it to their website. I did that and got another notice saying that I need to provide proof, so I'm back to square one. Arrgh!

I'd have been tempted to call back and threaten to haunt them until they revive you in their system!

 

[scrabbler1]

DayDreaming, you remind me of a 1973 "All in the Family" episode when Archie is mistakenly declared dead by the VA. He and Edith got the VA office to clear things up and the VA agent shows them a punch card (egads!) with one of its holes indicating that. Archie's quick response: "Fill that in!"

A different man, Archie Binker, was supposed to be declared dead, but at the end of the episode, Archie mentions that the other man (deceased) is waiting for the VA to declare him dead LOL!

https://www.imdb.com/title/tt0509805/?ref_=fn_al_tt_1

(note: the Storyline mistakenly refers to a different episode)

 

[PaunchyPirate]

It looks like its PPO vs HMO. Plenty of cheap HMOs, but the cheapest PPO I could find was over $700 a month. We live right on the border of Ohio (basically a suburb of Toledo) and all our doctors/hospitals are in OHIO. I think I need a PPO if I want any hope of getting approved to use those doctors/hospitals.

So that's a different story than your original post on the topic. For what it's worth, the max 8.5% of your income is set up to set a baseline price for the Second Lowest Cost Silver Plan (SLCSP) in your location. Nothing more. For 2022, You will be given a subsidy to ensure you pay no more than 8.5% of your income to get the SLCSP. If you choose to use that subsidy on a different plan (better or worse), you are permitted to do that, but you will pay the difference in cost if it's higher.

By the way, at an income of $35,000, you won't even be paying 8.5% for that SLCSP. It's a graduated scale that maxes out at 8.5% in 2022. I don't know the percentage for $35,000, but I think it's in the 6% arena.

 

[jimbee]

Disagree with most of USGrant list.
People on Medicare have spent their entire working life paying into the system, after 65 they still need to pay premium into it, not subsidized
People who are working where part of their HI is paid by their employer is because that’s part of their pay, not subsidized
People who can deduct their HI premium because they own a business, that’s the benefit of providing jobs to others, and improve our entire economy, not subsidized
People on Medicaid, I agree, subsidized

Most people on Medicare have a subsidized premium for parts B and D. The portion of payroll tax applied to Medicare pays for part A.

 

[jim584672]

In Michigan, even if I put my income right at 133% of poverty, I would still pay over $700 a month for insurance (for 3 people) for lowest silver plan - way more than 8.5%?

Edit: Assuming anything under $30k and you are forced onto medicare.

It is technically 133%, but they disregard 5%, so it is effectively 138%, for MedicAID.

 

[BubbaChris]

Disagree with most of USGrant list.
People on Medicare have spent their entire working life paying into the system, after 65 they still need to pay premium into it, not subsidized

If you paid into Medicare for 30 quarters or more, Medicare Part A has no premium. And just like with Social Security, while you were paying into it through payroll deductions those funds were used to pay the expenses for the then-current enrollees. Your deductions were not being put aside into an account with your name on it.

With the other Medicare parts there are subsidies that make your premium smaller than what it would be if you were paying for the full cost of health insurance.

Best regards,
Chris

 

[Rainbowdash]

You are right that Medicare payroll deduction will not cover the whole Medicare expenditures, the rest comes from federal income tax collection. Named differently, same meaning. When everybody needs to pay into the system and everybody can enjoy the benefits later on, it is definately not a subsidy

 

[Rainbowdash]

#USGrant top 1% pays for 40% of the federal income tax which is the subsidy you are referring to. Do you still think the Bill Gates, Buffet, Bloomberg, etc are getting their Medicare subsidized?

On the other hand, early retiree multimillionaires managing their income to get ACA subsidy are no different than all the multi billion dollar companies utilizing different loop holes to avoid taxes, this is completely wrong and I wish Congress can change this soon.

 

[connor77]

#USGrant top 1% pays for 40% of the federal income tax which is the subsidy you are referring to. Do you still think the Bill Gates, Buffet, Bloomberg, etc are getting their Medicare subsidized?

On the other hand, early retiree multimillionaires managing their income to get ACA subsidy are no different than all the multi billion dollar companies utilizing different loop holes to avoid taxes, this is completely wrong and I wish Congress can change this soon.

This is exactly the reason I posted my question in the first place. Just because one can legally get a subsidy by reporting a very low income doesn't make it right in my opinion.

I'm in a similar situation to another poster who responded where my wife and I have no children but our property taxes go mostly to local schools but it still doesn't feel right to me to get a subsidy. I'm well aware that what people are doing is well within the law.

I won't hold my breath that the way we are all taxed is going to become fair any time soon.

Still exploring my healthcare options. I called Anthem BCBS yesterday and none of the individual plans I'd have available to me don't list my doctors as accepting any of the plans...even gold level. I have more work to do...

 

[Aerides]

<Mod Note>

Justification for the ACA and its subsidies has been argued many times over the past decade on ER.org. It is not the point of this thread, and will only serve to derail it. Knock it off.

 

[GTFan]

Thank you.

 

[dixter]

Got a letter from the company and they said after 2022 they will not be offering BCBS as the prices the company has to pay is over the limit... so 2023 no more BCBS...

so I guess its good that in 2023 medicare kicks in for us....

 

[GATime]

Planned retirement next year so decided to check out the GA ASA options. In GA, we use the national program. As with this year, the GA plans are terrible. Not a single PPO offered and the HMO plans are very restrictive. Was hoping things would change in GA for 2022 but no chance. Looks like I'll be opting into Cobra next year.

 

[COcheesehead]

Got a gold plan for $827. Was on COBRA at $1910. MAGI $105,000. Pretty happy with that.

 

[ERhoosier]

I was on ACA plan a few years ago until being forced back to w@rk for decent health insurance (to support our health issues). Unfortunately, like GATime related, ACA options in my area are also poor for 2022. Networks narrower than state Medicaid, and our specialists are not in ACA network. NO non-emergency out of area coverage available PERIOD (even in the highest cost plans). This can be a BIG issue if you travel a lot. And deductibles/OOP Max remain high ($5+k per person). All of which are no issue....as long as you are not sick or seriously injured. So ACA in 2022 remains no help to us. I retired (again) a few months ago & see no viable option but to COBRA until Medicare.

 

[GTFan]

Planned retirement next year so decided to check out the GA ASA options. In GA, we use the national program. As with this year, the GA plans are terrible. Not a single PPO offered and the HMO plans are very restrictive. Was hoping things would change in GA for 2022 but no chance. Looks like I'll be opting into Cobra next year.

We've been on GA ACA plans for 6 years now, I wouldn't call them terrible or restrictive. Currently on Ambetter in Cobb which has Wellstar in-network along with a number of other practices, and generally we've had good luck dealing with them. A few minor issues here and there, CSRs are not all that helpful etc. which is about what I'd expect with these plans. But no referrals needed, go see who you want even though it's an 'HMO' plan.

You can certainly go on Cobra if you want to pay thousands more than we're paying for Ambetter. That's the real kicker - keep your income below 250% FPL, get a cost-shared Silver plan with a decent network, save a ton of money. Of course YMMV if you have a lot of health issues, want to keep docs that are not in any ACA network etc. But there are more providers than ever now offering ACA plans in GA, so just because it says 'HMO' it doesn't mean you're stuck with crappy networks.

 

[bltkmt]

Subsidized cost of our bronze plan (in CT) remains cheap (<$20 per month for three people). Deductibles and OOP costs raised slightly.

 

[sengsational]

There seem to be many more choices this year for me here in NC. There were many years where there were just two companies offering policies on the exchange. This year, it looks like 6 companies, and there's many offerings. Confusing too, because the pricing doesn't make sense when you only look at what aspects of the policy are shown on the main list. Digging in, you might discover differences in network or drug coverage or something. It's so random which doctors are in which networks. In years past, I'd never bothered shopping too much since all I was buying was the max out of pocket that I never got close to. It looks like the limited networks are where they're looking to get you nowadays. There's often no max out of pocket on out of network providers, and the reality is that if you have any significant medical services where you want choice for who you use, you will probably not find a full complement of providers that are all in network. For instance, you might get in network facility and doctor, but imaging, pathology, etc is out of network.