ACA plans for 2015

[W2R]

Since this is the first time a person could just "look in" on premium costs this is also the first time I have actually looked at the website. A low level bronze is less than $200 difference than a gold plan. This is just my musing but the government's definition of gold is different than mine as the differences all things considered are minimal. My definition of gold is my girlfriend's plan. A $150 yearly max deductible. And I could have it also for just $200 a month. The trouble is I would have to get married to get it!

AAAGH!! Nonononono! Look out! (Just kidding!)

Frank has been studying the available PPACA plans for him here in Louisiana, a state where Medicaid has not been expanded. He has pretty much made up his mind not to get one, though. He plans to go with his own retiree medical insurance, and to move from their most expensive plan to the next one down, which still isn't cheap. He has so many worries and concerns about PPACA, subsidies, and more. He is an intelligent man who understands these things much better than I do so I refuse to advise him one way or another.

He could get my federal health insurance if we married, but it's just not worth it to us. What we have going works so well for us, why mess with it. Besides, marriage should be motivated by other reasons than insurance, IMO.

 

[Looking4Ward]

Looks like my monthly premium is going up by 12.5%

 

[MBSC]

My 2015 individual bronze non-subsidy premium will be increasing 0.7% including the age adjustment. It would have dropped 3.1% if I had managed to stay the same age. The health coverage and network provider directory are unchanged. The plan is adding one free vision exam for adults.

The premium for the second lowest cost silver plan that subsidies are based on increased $2 per month including the age adjustment.

 

[Sue J]

I've been digging in the plan details and specifics for 2 insurers that we would consider. Both have the "family deductible" issue where you have to meet the deductible for both of you if it's a family plan.

In this topic -
http://www.early-retirement.org/forums/f38/bronze-silver-and-coinsurance-copay-68965-10.html
we discussed that you should be able to buy individual plans, each with their own deductible and that the subsidy would be divided in proportion.

If anyone finds out how to get individual policies for a married couple, please post about it. So far in the preview I don't see a place that would offer that and I'm hoping that it becomes evident on Nov 15th when you can actually apply.

Last year I learned that all HSA plans have the aggregate deductible for a family plan. Now I'm seeing that even non-HSA plans are describing the deductible as being for the whole family, which is double the individual deductible. Here's the description for a silver plan with co-pays -

Deductible the Member Pays
With a family plan, your family must meet the entire family deductible before we provide benefits. This applies to all members on the contract.

For the maximum out-of-pocket there's this note -

Maximum Out of Pocket Costs the Member Pays (includes deductibles, medical and prescription drug copays and coinsurance)
With a family plan, your family must meet the entire family maximum out-of-pocket before we pay benefits at 100 percent.

This is for a silver plan deductible 2000 single/4000 family and MOOP of 6600 single/13200 family. I checked a very expensive Gold plan and the deductible and MOOP are described the same way.

Last year these plans were described as having an embedded deductible that applied to each individual.

So some things have changed for 2015.

So, if anyone figures out how a married couple can get individual policies with the subsidy, please post about it. We are considering an HSA plan, would like to get individual policies even if it means going with 2 different insurers.

 

[gbstack]

Unless the subsidies are just an estimate they seem to be lower compared to 2014!

 

[gozer]

Unless the subsidies are just an estimate they seem to be lower compared to 2014!

If everything else is the same for you, this means the 2nd cheapest silver plan is cheaper this year than the 2nd cheapest silver plan was last year. (full price, not subsidized price)

 

[brewer12345]

I was able to browse the basics of plans on the Colorado exchange. Looks like we can get an HSA-eligible bronze plan for a bit over $600/month with our chosen insurer. The unsubsidized cost for our current silver plan was close to $800/month. Since we will not qualify for subsidies in 2015 and use very little healthcare services in general, this looks more than acceptable.

 

[MichaelB]

So, if anyone figures out how a married couple can get individual policies with the subsidy, please post about it. We are considering an HSA plan, would like to get individual policies even if it means going with 2 different insurers.

Just a guess, but each spouse could have an individual account on the exchange, then apply separately.

 

[ziggy29]

Because of the reported income on my tax return in 2013 (including 3+ months of my Megacorp w*rk plus 6 months severance pay), I have to reaffirm my expected 2015 income in an updated application in order to keep any subsidies and cost sharing in place.

Still no clue what the plans or premiums are here, or if anyone other than BCBSTX will enter the local market based on my zip code.

 

[ziggy29]

So, if anyone figures out how a married couple can get individual policies with the subsidy, please post about it. We are considering an HSA plan, would like to get individual policies even if it means going with 2 different insurers.

When I did some "what ifs" a year ago when I wasn't sure whether my wife's church was going to sponsor her for health insurance (they did), I ran a few scenarios and all of them had us in two separate plans applying together as a couple with a shared subsidy. Ours had to be different because I was eligible for zero cost sharing as an American Indian (if we kept income below 300% of FPL) whereas my wife wasn't. So we *had* to be on two separate plans. Our quotes were given combined, with a subsidy essentially shared among the two of us.

The policies can be separate, but you need to file jointly.

 

[Sue J]

Just a guess, but each spouse could have an individual account on the exchange, then apply separately.

But how would you split the household income?

Last year they told me that MFJ couples had to apply together to get the subsidy.

I'm sure we're not the only ones looking to avoid the 2X deductible issue caused by having a family plan vs individual. I'm hoping that when it comes to actually applying for plans after Nov 15th that there is an option to shop for insurance for just one spouse and then shop for a plan for the other spouse. Wishful thinking.....

It's the internets, someone somewhere will have an answer, I'm just looking for the info ahead of time.

 

[Mulligan]

AAAGH!! Nonononono! Look out! (Just kidding!)

Frank has been studying the available PPACA plans for him here in Louisiana, a state where Medicaid has not been expanded. He has pretty much made up his mind not to get one, though. He plans to go with his own retiree medical insurance, and to move from their most expensive plan to the next one down, which still isn't cheap. He has so many worries and concerns about PPACA, subsidies, and more. He is an intelligent man who understands these things much better than I do so I refuse to advise him one way or another.

He could get my federal health insurance if we married, but it's just not worth it to us. What we have going works so well for us, why mess with it. Besides, marriage should be motivated by other reasons than insurance, IMO.

Ya like procreation....and I am way past that as a reason!


Sent from my iPad using Tapatalk

 

[ziggy29]

But how would you split the household income?

Last year they told me that MFJ couples had to apply together to get the subsidy.

I'm sure we're not the only ones looking to avoid the 2X deductible issue caused by having a family plan vs individual. I'm hoping that when it comes to actually applying for plans after Nov 15th that there is an option to shop for insurance for just one spouse and then shop for a plan for the other spouse. Wishful thinking.....

Well, that's what I remember -- you can get separate policies but you have to file jointly. If it's two people, usually the family deductibles are 2x the individual deductible, BUT (I could be wrong) I think individual deductibles still apply. For example, there may be a $6000 deductible on a Bronze HDHP and a $12000 deductible on a family plan, but even in the family plan the deductible for any individual won't exceed $6000. I could be wrong and misremembering stuff, but I think that's how it went when I was exploring last year.

 

[ERhoosier]

IIRC-The family deductible issue only applies to HSA-eligible plans. Not all plans with high deductibles at/above HSA thresholds are necessarily HSA-compliant. IOW- In most regions, you can buy plans with 'high' deductibles (>$1300 indiv/$3000 family for 2015) that are NOT HSA-eligible.

Understanding How Your Deductible Works « Health Insurance

Health Savings Account - HSA 2015 Rules & Requirements

http://www.irs.gov/pub/irs-drop/rp-14-30.pdf

 

[EastWest Gal]

I have been checking healthcare.gov and it seems to be working fine. I am intending to enroll this month, as I will be off my company health insurance Jan 2015. My state (PA) doesn't have an exchange. Good news-- the premiums have gone up but more significantly, so has the income level that one is eligible for a subsidy. I have estimated my income in full retirement next year and I am eligible for a ~30% subsidy. I checked last year and that wasn't the case.

I would like to here why I should look at ehealthinsurance.com as an alternative. My doctor will accept ACA insurance. And other than my husband's allergies and very well-controlled cholesterol, we have no healthcare issues. I could save ~$5K/yr.

Politics--will the SCOTUS gut the ACA? Will Congress try to repeal it (of course the POTUS will veto). What would you do?

Let me know what you think. Thanks for any and all opinions.

 

[M Paquette]

Politics--will the SCOTUS gut the ACA? Will Congress try to repeal it (of course the POTUS will veto). What would you do?

Ignore the politics. The Supreme Court case hasn't even started yet, and the earliest they could possibly rule would be in June 2015. Internally the various political factions do not expect any legislative change to be done before 2017. (That is, real, non-showboat legislation is being planned for that session of Congress, not the upcoming one.)

Note to others: Please, please do not turn this into a political thread.

If you may be eligible for a subsidy, I suggest going through the official exchange.

 

[EastWest Gal]

Thanks for the reassurance. I, too, don't want this to be political. My mind and emotions say: save the money.

Please can anyone give a rational reason not to go for ACA insurance?


Sent from my iPhone using Early Retirement Forum

 

[ERhoosier]

Ignore the politics. The Supreme Court case hasn't even started yet, and the earliest they could possibly rule would be in June 2015. Internally the various political factions do not expect any legislative change to be done before 2017. (That is, real, non-showboat legislation is being planned for that session of Congress, not the upcoming one.)

Note to others: Please, please do not turn this into a political thread.

If you may be eligible for a subsidy, I suggest going through the official exchange.

With all due respect, you were "political" by using term "showboat" re-possible legislation. One legislator's "showboat" is another's advocacy of a deeply held cause .
Given that many of the senators voting for ACA passage in 2010 are no longer in office and control of the senate changed parties, most pundits feel some ACA changes will pass this next Congress ('15-16). Certain provisions (e.g. medical device tax,30hr workweek HI mandate, IPAB, etc.) have much bipartisan support for repeal.
Republican Wave Put Obamacare In Surgery, And These Parts Could Be Amputated - Forbes
Much of ACA funding is "discretionary" and subject to the normal budgetary process. Most believe that some of that "discretionary" funding will be cut (since discretionary funds require passage of legislation to continue). That said, short of (very UNlikely) full ACA repeal subsidies will continue as these are part of "mandatory" ACA funding. According to Congressional Research Service, major ACA provisions like Exchange & subsidies would continue even during a gov't budgetary shut down.
http://www.coburn.senate.gov/public...&File_id=1933ce98-a8cf-48bc-af5c-b222c18fcb1d

Bottom line is I 100% agree most should ignore the current politics. Any 2015 ACA legislative changes are unlikely to alter the big picture for most folks. I would make 2015 HI decisions based on present situation and not what SCOTUS/Congress might or might not do in the coming months.

 

[Mulligan]

Thanks for the reassurance. I, too, don't want this to be political. My mind and emotions say: save the money.

Please can anyone give a rational reason not to go for ACA insurance?


Sent from my iPhone using Early Retirement Forum

I would if I was getting a 30% discount. I was offered an "off exchange" plan to replace the plan they are dropping me from. I found a cheaper one on exchange from same carrier. I will just call them after 11/15 and have them change it. So in essence I am going to an exchange plan without the hassle of signing up through the exchange.


Sent from my iPad using Tapatalk

 

[tomz]

I just browsed healthcare.gov to see what my options for 2015 in Florida are. Unsubsidized premiums went from $1296 to $1641 (26% increase). Subsidy is basically unchanged from 2014. However, the $345 premium increase means my subsidized premium increase is 170% (from $182 to $493). The plan is basically identical to the 2014 plan with a few tweaks. Despite the changes, I will still be paying about half of what I paid before the ACA for a barebones catastrophic policy.

 

[rbmrtn]

Some changes for my state, last year only one issuer and the premiums were way on the high side. This year this issuer has cut premiums by ~40%. Two additional issuers have joined, both now have higher premiums than the original issuer. One is in the ballpark while the other entered with much higher premiums ( unless things change when the real numbers are posted ). There are now some HSA plans but the premium is higher compared to similar plans. Given the premium cut I'll likely stay with the original issuer, but need to revisit the HSA option.

 

[rbmrtn]

Subsidy is basically unchanged from 2014. However, the $345 premium increase means my subsidized premium increase is 170% (from $182 to $493).

I would think your subsidy would increase as well. Your total premium is limited to 9.5% of your income. Your subisidy is then calculated using the second least expensive silver plan. If the premiums go up, your subsidy should as well.

 

[tomz]

I would think your subsidy would increase as well. Your total premium is limited to 9.5% of your income. Your subisidy is then calculated using the second least expensive silver plan. If the premiums go up, your subsidy should as well.

There are more plans this year - mostly HMOs. The 2nd least expensive plan is about the same cost as last year's and is from a company that didn't participate in the exchange last year. The healthcare.gov browse option didn't show all the different versions of the plan (based on % of poverty level). It only showed the basic silver plan. Maybe when I apply the subsidy will be larger.

 

[ERhoosier]

I would if I was getting a 30% discount. I was offered an "off exchange" plan to replace the plan they are dropping me from. I found a cheaper one on exchange from same carrier. I will just call them after 11/15 and have them change it. So in essence I am going to an exchange plan without the hassle of signing up through the exchange.

Hassle factor can certainly be a reason to buy off-Exchange. In some areas, more choice in individual plans is available off-Exchange. And some folks are eligible for decent group plans (via professional societies, etc.). Provider networks can be another big factor. Networks can be very different between Exchange and non-Exchange plans even for same insurance company.
Whether or not these outweigh the possibility of getting a subsidy is a personal decision. A lot of unforeseen things can happen during a year to cut MAGI (j#b loss, stock market downturn, etc.).

 

[Mulligan]

Hassle factor can certainly be a reason to buy off-Exchange. In some areas, more choice in individual plans is available off-Exchange. And some folks are eligible for decent group plans (via professional societies, etc.). Provider networks can be another big factor. Networks can be very different between Exchange and non-Exchange plans even for same insurance company.
Whether or not these outweigh the possibility of getting a subsidy is a personal decision. A lot of unforeseen things can happen during a year to cut MAGI (j#b loss, stock market downturn, etc.).

I will try to get as much info as possible before selecting, but nothing short of driving 200 miles to find a provider and the medical facility is not an open air tent, I will go cheapest route possible. With insurance, ultimately you are paying for someone else's health issues or someone is paying for yours. As long as I am paying for others (and hopefully that will continue for an extended period) I will attempt to pay as little as possible in premiums.


Sent from my iPad using Tapatalk