ACA Alternatives

[Pluperfect]

Then use that as a base for international travel, also buying travel insurance for the countries I'd visit.

I'm guessing that the people who are advocating for keeping the subsidies won't use this in their campaign.

 

[RetiredHappy]

As I mentioned on another thread where a single person was facing a ~$3,000/month unsubsidized premium and was only a couple of years from Medicare, in that situation I'd domicile outside the USA and buy inexpensive coverage there (my example, Mexico) as catastrophic insurance.

Then use that as a base for international travel, also buying travel insurance for the countries I'd visit.

You don't need to buy a gold plan. I buy unsubsized high deductible Bronze plan for $1,100 per month and I am 2 years away from Medicare.

 

[TripleLindy]

You don't need to buy a gold plan. I buy unsubsized high deductible Bronze plan for $900 per month and I am 2 years away from Medicare.

I wish I could find a plan with that premium. I subscribed to the lowest cost Bronze plan and it is $2800/month unsubsidized for 2 people. I’m also 2 years from Medicare.

 

[RetiredHappy]

I wish I could find a plan with that premium. I subscribed to the lowest cost Bronze plan and it is $2800/month unsubsidized for 2 people. I’m also 2 years from Medicare.

I lied. I was thinking of last year's. My next year's is $1,100 per month. I am going to correct my post.

 

[COcheesehead]

You don't need to buy a gold plan. I buy unsubsized high deductible Bronze plan for $1,100 per month and I am 2 years away from Medicare.

Same. My DW goes on Medicare in 2026 so my individual bronze policy is $907/month.

 

[Stormy Kromer]

I wish I could find a plan with that premium. I subscribed to the lowest cost Bronze plan and it is $2800/month unsubsidized for 2 people. I’m also 2 years from Medicare.

Me too.

 

[big-papa]

Same. My DW goes on Medicare in 2026 so my individual bronze policy is $907/month.

Similar. We were both on a bronze policy for 3 months this year until my wife went on medicare. About a $150 jump in the ACA premium when she did that and I lost the subsidy. Next year it's just me and a little more than $1K per month. Fortunately, it's only for 5 months, then I go on medicare.

Cheers.

 

[Sorcerer]

From what I understand, the ACA is simply returning to its original form. There were never massive subsidies when it started. That only came about when the pandemic happened. Is this correct? If so, why is everyone so upset? This is how it always should have been, if the information I gathered is correct.

 

[RetiredHappy]

From what I understand, the ACA is simply returning to its original form. There were never massive subsidies when it started. That only came about when the pandemic happened. Is this correct? If so, why is everyone so upset? This is how it always should have been, if the information I gathered is correct.

Once given, it is difficult to take back...

 

[sengsational]

This would be a best option for us too.

Having said that, we could use medical tourism for things that allow air travel and a few days wait time like knee/hip replacement, cancer, planned surgeries, etc. Only thing we would be vulnerable would be heart/brain related emergencies where we may not have time to travel outside the country. Roll the dice? We will reevaluate when I actually retire

FWIW I would be OK to spend $100K-$200K for a time-critical medical emergencies.

It would be disruptive, but you could move your residence if you were confronted with some number of months of treatments before open enrollment. Moving allows a special enrollment period.

It it weren't for the insane "chargemaster" rates, the scare stories with multi-million dollar hospital bills would evaporate into hundreds of thousands

 

[MBSC]

It would be disruptive, but you could move your residence if you were confronted with some number of months of treatments before open enrollment. Moving allows a special enrollment period.

To clarify, moving within the US creates a SEP to change ACA plans. Moving back to the US from another country allows you to enroll in an ACA plan.

Changes in residence

You must prove you had qualifying health coverage for one or more days during the 60 days before your move. You don't need to provide proof if you’re moving from a foreign country or United States territory.

Qualifying health coverage: Any plan that meets the PPACA minimum requirements for comprehensive health coverage, such as Marketplace plans, Medicare, Medicaid, CHIP or some job-based plans.

Reference: Getting health coverage outside Open Enrollment

 

[MichaelB]

From what I understand, the ACA is simply returning to its original form. There were never massive subsidies when it started. That only came about when the pandemic happened. Is this correct? If so, why is everyone so upset? This is how it always should have been, if the information I gathered is correct.

There was financial assistance from day 1 for people at 4x the poverty level. There also was the subsidy cliff for people at 4x +$1 at the federal poverty level.

 

[big-papa]

There was financial assistance from day 1 for people at 4x the poverty level. There also was the subsidy cliff for people at 4x +$1 at the federal poverty level.

Exactly - it was less about the size of the subsidies (tax credits), but more about extending the availability of the tax credits by removing the cliff. There was still a ramp down with increasing MAGI, just no cliff.

Cheers.

 

[TripleLindy]

From what I understand, the ACA is simply returning to its original form. There were never massive subsidies when it started. That only came about when the pandemic happened. Is this correct? If so, why is everyone so upset? This is how it always should have been, if the information I gathered is correct.

There are multiple factors in play. As others have stated, it’s the $1 over 400% of the FPL that’s the primary source of angst. Since ‘21, premiums have been capped at 8.5% of income and that cap has expired, meaning those earning more than 400% of the FPL are on the hook for the full premium. The additional factor is the sticker shock of the full premium. It has more than doubled since ‘21. We were paying around $15k annually before the enhanced subsidies were enacted. Our premium this year with a higher deductible is now more than $34k.

 

[RetiredHappy]

There are multiple factors in play. As others have stated, it’s the $1 over 400% of the FPL that’s the primary source of angst. Since ‘21, premiums have been capped at 8.5% of income and that cap has expired, meaning those earning more than 400% of the FPL are on the hook for the full premium. The additional factor is the sticker shock of the full premium. It has more than doubled since ‘21. We were paying around $15k annually before the enhanced subsidies were enacted. Our premium this year with a higher deductible is now more than $34k.

Age is also a factor in the increase.

 

[TripleLindy]

Age is also a factor in the increase.

Yep and understood. But not to that extent. People much younger than us are experiencing similar increases.

 

[RetiredHappy]

Yep and understood. But not to that extent. People much younger than us are experiencing similar increases.

Hence I said a factor.

 

[pb4uski]

To me, the bigger factor in solving our health care/health insurance crisis is finding a way to control health care services costs. Many conservatives advocate using competition to rein in costs but WADR, that isn't going to work. To begin with for emergency and urgent services it isn't practicable to "shop" for a better price... for example, no one is going to shop care needed for a heart attack. Even when available, pricing isn't transparent enough and "junk" fees like $$$ for an aspirin provided in a hosptal setting happen. Also, the consolidation of medical services in large hospital and doctor groups a lot of pricing power in their markets and make individual consumers shopping for price unrealistic, especially where your health insurance is network limited. Health care services are close to monopolistic and IMO competition will never rein in costs. While as a fan of capitalism, I think the only solution is regulation of medical services pricing simiiar to Medicare. Have a long list of services and what wil be paid for each service and service providers need to live with that pricing. At the same time, the prices that are dictated need to be fair. Medicare services are not fair so the prices would need to be higher.

I believe that it can be done and would be better, but we would just need to jettison the irrational belief that the problem can be solved by competition.

We need to blow it up.

 

[TripleLindy]

To me, the bigger factor in solving our health care/health insurance crisis is finding a way to control health care services costs. Many conservatives advocate using competition to rein in costs but WADR, that isn't going to work. To begin with for emergency and urgent services it isn't practicable to "shop" for a better price... for example, no one is going to shop care needed for a heart attack. Even when available, pricing isn't transparent enough and "junk" fees like $$$ for an aspirin provided in a hosptal setting happen. Also, the consolidation of medical services in large hospital and doctor groups a lot of pricing power in their markets and make individual consumers shopping for price unrealistic, especially where your health insurance is network limited. Health care services are close to monopolistic and IMO competition will never rein in costs. While as a fan of capitalism, I think the only solution is regulation of medical services pricing simiiar to Medicare. Have a long list of services and what wil be paid for each service and service providers need to live with that pricing. At the same time, the prices that are dictated need to be fair. Medicare services are not fair so the prices would need to be higher.

I believe that it can be done and would be better, but we would just need to jettison the irrational belief that the problem can be solved by competition.

We need to blow it up.

I agree with you regarding the cost of care being out of control. I also believe that as long as healthcare is treated as a business, costs will continue to rise. When viewed purely through the lens of capitalism, the goal is to charge as much as the client will pay. When the product is health, there’s no limit to the amount one is willing to pay. And for those who can’t afford to pay, it’s not like asking them to do without a car and find other means of transportation.

I was under the impression that the calls for competition were about competing insurance companies, not competing healthcare service providers. At least that’s what I’ve heard when listening to some of the interviews. However, unless new products are created, the claims of politicians that consumers can spend some kind of government payment on less expensive insurance (non-ACA) is nothing but hot air. Those plans don’t exist, unless you consider garbage indemnity plans as a viable alternative.

 

[TripleLindy]

Medicare services are not fair so the prices would need to be higher.

I’m not convinced of this. If we could weed out all of the non-care related expenses, like onerous claims processes, private equity’s enrichment, administrative management, etc., I think that Medicare reimbursement rates start to make much more sense because more money would flow to actual care providers.

 

[pb4uski]

... I was under the impression that the calls for competition were about competing insurance companies, not competing healthcare service providers. At least that’s what I’ve heard when listening to some of the interviews. However, unless new products are created, the claims of politicians that consumers can spend some kind of government payment on less expensive insurance (non-ACA) is nothing but hot air. Those plans don’t exist, unless you consider garbage indemnity plans as a viable alternative.

I don't think the calls for competition were for health insurance pricing. Health insurance pricing is already competitive and you can see that by the range of premiums for each level of ACA plan where the coverage and benefits are essentially the same or very similiar. Besides, health insurers are limited to 25% of claim costs for overhead, taxes and profits.

Totally agree on the hot air thing. It is a sleight of hand to replace $5,000-10,000 or more of PTC a year with $1,500 deposited to a HSA and think that is a solution. It's a cruel joke.

 

[SecretlyFI]

While as a fan of capitalism, I think the only solution is regulation of medical services pricing simiiar to Medicare. Have a long list of services and what wil be paid for each service and service providers need to live with that pricing. At the same time, the prices that are dictated need to be fair.

Isn't this the way it works now, if you have insurance (pre-medicare, either through employer or ACA)?
There's a rack rate for a service and then when you look at the EOB, you see it reduced down to the negotiated/agreed-upon amount that you & the insurance company pay.

 

[pb4uski]

Isn't this the way it works now, if you have insurance (pre-medicare, either through employer or ACA)?
There's a rack rate for a service and then when you look at the EOB, you see it reduced down to the negotiated/agreed-upon amount that you & the insurance company pay.

No, it is not the way it works now.

The amount paid for medical services under Medicare is decided by CMS and not a negotiation with health care providers like employer provided and ACA individual health insurance. While reimbursement rates are not decided in a vacuum, it is dictated by CMS.

And for Medicaid, payout rates are decided by the states since Medicaid is a joint federal/state program, but often Medicaid payouts are defined as a percentage of Medicare payout rates.

For other insurance it is negotiation between insurers and health care providers who through consolidation and vertical integration have little competition and significant pricing power in many markets.

 

[Flieger]

There was financial assistance from day 1 for people at 4x the poverty level. There also was the subsidy cliff for people at 4x +$1 at the federal poverty level.

Yes. But isn't this what we went back to? I think that's the point the Person was trying to make.

Flieger

 

[SecondCor521]

Yes. But isn't this what we went back to? I think that's the point the Person was trying to make.

Flieger

There were two additional changes made by the new tax law this year (HSA eligibility was expanded to all Bronze and Catastrophic plans, and repayment limitations were removed), but yes, in terms of the subsidies and the cliff we are generally back to where we were pre-COVID.