ACA costs by county in state

[Tetto]

Good Morning from CT.

I was hoping someone can explain to me how the per month cost can wildly vary within a county/state. For instance, I live in New London county in CT. My projected costs for my DW and I are $70/month where I live(me 59 DW 62). If I move 40 miles to New Haven county, it jumps $300/month for the same BCBS Gold plan. Does this make sense to anyone? Thanks, Tetto.

 

[MichaelB]

The provider networks are probably different, with the New Haven county policy offering a much broader provider network, and the additional providers are high cost. Yale Health System might be one example.

 

[disneysteve]

Zip code plays into health care more than you might think. A town about 6-8 miles from me has drastically different health care outcomes than my town. It’s a very poor area relative to my town. I’m sure insurance costs reflect that.

 

[cathy63]

I assume your $70/mo and $300/mo are the subsidized rates. The actual plan premiums are probably not that different.

What happens is the subsidy is based on the premium for the second lowest cost silver plan. If you look at the SLCSPs in the two areas, you'll probably find that there's a low cost provider in the $300/mo area so people there don't get as much subsidy to use on higher plans. If you signed up for the SLCSP in each county, your monthly out-of-pocket premium cost would be the same.

 

[Tetto]

I assume your $70/mo and $300/mo are the subsidized rates. The actual plan premiums are probably not that different.

What happens is the subsidy is based on the premium for the second lowest cost silver plan. If you look at the SLCSPs in the two areas, you'll probably find that there's a low cost provider in the $300/mo area so people there don't get as much subsidy to use on higher plans. If you signed up for the SLCSP in each county, your monthly out-of-pocket premium cost would be the same.

Interesting. By playing with the website AGI function is how I was gauging our cost. If I kept our AGI around $55k/year, we qualified for gold plan as above , vision and dental included for about $11.29 per month. It’s crazy how there can be this much variation.

 

[PaunchyPirate]

They have to set up geographic regions of some sort in which to define medical costs. They chose zip codes as the data point which maps to a county. From that point on it is free-market medicine. Providers set their prices. Insurance companies negotiate discounts. States (may) regulate premiums. Whatever the market dictates. Places where costs are higher charge higher rates. They may have to average those out over a county geographically. I live 7 miles from a county border. That other county has a higher cost of living and therefore higher medical costs than I do in my county. Free market baby.

The alternative is pricing set by the government. This country's population has made it clear it doesn't like that. For one reason or another.

 

[Koolau]

Zip code plays into health care more than you might think. A town about 6-8 miles from me has drastically different health care outcomes than my town. It’s a very poor area relative to my town. I’m sure insurance costs reflect that.

What about actual care and outcomes? Do they report outcomes anywhere?

 

[W2R]

It makes no sense to me, but then what do I know? (nothing). I worked for years at a boring, low paying federal job so that I could get federal retiree insurance in my old age. That seems to be working out for me. If not, I don't want to hear about it!

 

[Tetto]

What about actual care and outcomes? Do they report outcomes anywhere?

What’s interesting is that my doctor is in a different county than where I live. I would pay X for the insurance and then cost is Y in different county! I’m sure in Hartford county where he is it’s much more expensive, but I still pay cheap price. Works for me(when I actually do it…)

 

[Koolau]

What’s interesting is that my doctor is in a different county than where I live. I would pay X for the insurance and then cost is Y in different county! I’m sure in Hartford county where he is it’s much more expensive, but I still pay cheap price. Works for me(when I actually do it…)

I wonder if people "borrow" addresses to get lower ACA costs.

For the month or so our daughter must live in a rented house, she's borrowing her dad's address so her kids can get established in the school they will attend when they move to their newly finished house. I don't see that as gaming the system very much as their house is almost finished. Moving schools after a month would have been a major issue to the grands. They've already moved from another state. That's a lot of trauma for kids. YMMV

 

[MichaelB]

I wonder if people "borrow" addresses to get lower ACA costs.

For the month or so our daughter must live in a rented house, she's borrowing her dad's address so her kids can get established in the school they will attend when they move to their newly finished house. I don't see that as gaming the system very much as their house is almost finished. Moving schools after a month would have been a major issue to the grands. They've already moved from another state. That's a lot of trauma for kids. YMMV

That might work if the plan has a broad provider network that covers both the “borrowed” and the permanent locations. So many of the comments in our forum health insurance discussions complain of plans with limited local or regional provider networks. I know in our case, having a second home and wanting / needing multi-state coverage, the additional cost for a broad network plan was substantial.

 

[Koolau]

That might work if the plan has a broad provider network that covers both the “borrowed” and the permanent locations. So many of the comments in our forum health insurance discussions complain of plans with limited local or regional provider networks. I know in our case, having a second home and wanting / needing multi-state coverage, the additional cost for a broad network plan was substantial.

I'm sorry for you. I had no idea your insurance with ACA was not portable. I've never used ACA as I've been on Medicare and it's good in any state. I see that I'm completely ignorant of ACA.

 

[MichaelB]

I'm sorry for you. I had no idea your insurance with ACA was not portable. I've never used ACA as I've been on Medicare and it's good in any state. I see that I'm completely ignorant of ACA.

We were fortunate, Florida BCBS offered an option that included their “Blue Card” provider network, which is about as big and broad as it gets. It was also breathtakingly expensive, but we paid because we had to. Most ACA policies apparently have more limited networks. I have little knowledge of this but suspect the Florida insurance regulator did a better job than her counterparts in other states.

It’s not ACA. Better said, not just ACA. Both my daughters have employer provided insurance and the plans are bare bones, with limited provider networks and long wait times.

 

[Koolau]

We were fortunate, Florida BCBS offered an option that included their “Blue Card” provider network, which is about as big and broad as it gets. It was also breathtakingly expensive, but we paid because we had to. Most ACA policies apparently have more limited networks. I have little knowledge of this but suspect the Florida insurance regulator did a better job than her counterparts in other states.

It’s not ACA. Better said, not just ACA. Both my daughters have employer provided insurance and the plans are bare bones, with limited provider networks and long wait times.

Clearly I've been spoiled. First, spoiled by Megcorp's relatively excellent heath insurance (and very affordable) followed by MC with supplement. BOTH are good anywhere doctors accept them. I am blessed.

 

[aja8888]

Clearly I've been spoiled. First, spoiled by Megcorp's relatively excellent heath insurance (and very affordable) followed by MC with supplement. BOTH are good anywhere doctors accept them. I am blessed.

I wouldn't call it "blessed". You are just like everybody on Medicare that buys a supplemental plan. I have several friends on Medicare Advantage PPO plans and they see the SAME doctors I do, but they have a small copay where I pay a few hundred dollars a month for the coverage beyond medicare.

The ACA is a completely different animal. My son-in-law works for a very large corporation and when the ACA came out, employers were told they had to meet the minimum requirements of the ACA plans, so many corporations did, in fact, do that. The family deductible in his plan is something like $12,000/yr. Pretty crappy coverage from a company that employs 100's of thousands of people.

 

[Koolau]

I wouldn't call it "blessed". You are just like everybody on Medicare that buys a supplemental plan. I have several friends on Medicare Advantage PPO plans and they see the SAME doctors I do, but they have a small copay where I pay a few hundred dollars a month for the coverage beyond medicare.

The ACA is a completely different animal. My son-in-law works for a very large corporation and when the ACA came out, employers were told they had to meet the minimum requirements of the ACA plans, so many corporations did, in fact, do that. The family deductible in his plan is something like $12,000/yr. Pretty crappy coverage from a company that employs 100's of thousands of people.

Yeah, I think "blessed" is a good word - especially as I find out more about ACA. I never needed to use ACA so reained ignorant of its provisions and restrictions.

 

[RetiredHappy]

ACA plans are not horrible, but many of them are "HMO" plans which suck. Even with the ACA PPO ones, many top doctors don't take them. I think it has something to do with lower reimbursement rates. Hence I buy an off exchange private individual insurance plan. My health is too important to save a few dollars.

 

[teej1985]

ACA plans are not horrible, but many of them are "HMO" plans which suck. Even with the ACA PPO ones, many top doctors don't take them. I think it has something to do with lower reimbursement rates. Hence I buy an off exchange private individual insurance plan. My health is too important to save a few dollars.

That's not even an option in some states., Some states don't have PPO's at all on the individual market.

 

[Koolau]

ACA plans are not horrible, but many of them are "HMO" plans which suck. Even with the ACA PPO ones, many top doctors don't take them. I think it has something to do with lower reimbursement rates. Hence I buy an off exchange private individual insurance plan. My health is too important to save a few dollars.

Too important to save a LOT of dollars for that matter. I often think health care is probably the best use of resources there is. I love saving money and hate spending a fortune on meds/dr visits, but living longer/in better health: - "PRICELESS" - though YMMV.

 

[RetiredHappy]

Too important to save a LOT of dollars for that matter. I often think health care is probably the best use of resources there is. I love saving money and hate spending a fortune on meds/dr visits, but living longer/in better health: - "PRICELESS" - though YMMV.

Well said. Yes, it is costly. My premium is $16K this year and it will continue to go up for another 3 years until I reach Medicare age. I am very healthy but supported by a ton of drugs. One doctor said to me "For someone so healthy, you take alot of drugs." She got it backwards. If I don't take the drugs, I would be dead.

 

[Murf2]

I think ACA plans work very well for the lower income people they were intended to help. I know I never could have retired without it.

 

[RetiredHappy]

I think ACA plans work very well for the lower income people they were intended to help. I know I never could have retired without it.

You do know that many FIRE'ed folks here have high assets but manage to "low income" to get ACA subsidies. Unfortunately, it is not an option for us as our income could not be managed since my spouse got on SS at 70 and RMD at 70.5 yo. My taxable account also generates a ton of capital gains and dividends.

 

[jim584672]

Since my state has a pure community rating and no age rating the 60 somethings get a great deal while the 20 somethings pay up. If you are outside the subsidy zone it matters, inside it doesn't matter since the cost is capped as a percentage of MAGI for the Silver benchmark.

 

[Koolau]

You do know that many FIRE'ed folks here have high assets but manage to "low income" to get ACA subsidies. Unfortunately, it is not an option for us as our income could not be managed since my spouse got on SS at 70 and RMD at 70.5 yo. My taxable account also generates a ton of capital gains and dividends.

Yet another aspect of my financial life that I failed to plan adequately for. Still, I prefer my Megacorp sponsored retiree assistance with my medical insurance (with MC.) YMMV

 

[Murf2]

You do know that many FIRE'ed folks here have high assets but manage to "low income" to get ACA subsidies. Unfortunately, it is not an option for us as our income could not be managed since my spouse got on SS at 70 and RMD at 70.5 yo. My taxable account also generates a ton of capital gains and dividends.

Of course I do. It seems to me that most of the complaints come from people the program wasn’t really intended to help.
It’s there so anyone can do as they please with it. Not judging anyone else.