ACA Rate Increases For 2023

[Aerides]

I guess there’s only a small percentage of people that don’t have either employer sponsored healthcare or Medicare, so it never rises to the point of being addressed.

roughly 30M people are on the ACA, easily half of them had no option at all for insurance before it - had to stay working or go with a short term plan, or always worry that a pre-existing condition would cause them to be dropped.

A significant majority of those on the ACA (not including Medicaid) receive some form of subsidy. Full freight means rather high income, especially with the current caps.

However you look at it, the gap is far smaller than it used to be, but there's a long way to go before everyone is happy.

 

[orchid55]

We had the opposite experience with insurance company payouts to providers. We had ACA for 6 years. My husband wanted to stay with his primary care physician whether or not he was in network. I saved the EOBs and found that when the doc was in-network for our Blue Cross plan we got a 60% discount on his charges. When the doc was out of network the charges were submitted as if we were uninsured and we received a 70% discount.

We regarded the ACA policies as bankruptcy insurance. We didn't want to be responsible for an enormous hospital bill, even with a 70% discount.

The reason that the deductibles are so high is because the bronze, silver and gold plans are meant to cover only 60, 70 or 80 percent of your medical bills on average. As medical costs sincrease(MRIs, increased medical salaries, etc.) the deductibles must be raised or the plans become too generous.

 

[TripleLindy]

I and others here have posted about another benefit to having health insurance, one far less obvious than subsidies or exceeding one's annual deductible: Simply having insurance allows the insured to pay a lower amount than the provider's fee had there been no insurance.

Unless I’m fairly confident that I’m going to hit my deductible, which is rare, I ask the office for the cash, uninsured rate when scheduling. It’s often less than the insurer’s negotiated rate, which is pretty irritating. Their role is to negotiate rates on behalf of a large group but I can do better as an individual??

A few comments have referred to healthcare insurance as bankruptcy insurance. That’s so true. It’s the only reason we carry the insurance. My wife and I are relatively healthy with no current chronic conditions. Since we rarely meet the deductible, we’d be better off without insurance, but have to protect against an accident or something like cancer.

 

[Rainbowdash]

Unless I’m fairly confident that I’m going to hit my deductible, which is rare, I ask the office for the cash, uninsured rate when scheduling. It’s often less than the insurer’s negotiated rate, which is pretty irritating. Their role is to negotiate rates on behalf of a large group but I can do better as an individual??



A few comments have referred to healthcare insurance as bankruptcy insurance. That’s so true. It’s the only reason we carry the insurance. My wife and I are relatively healthy with no current chronic conditions. Since we rarely meet the deductible, we’d be better off without insurance, but have to protect against an accident or something like cancer.

Some doctors will keep the cash payers fee low because they don’t even report this as income, they don’t get a 1099 unlike payments from insurance companies, saving them easily 40% in taxes

 

[SecondCor521]

Some doctors will keep the cash payers fee low because they don’t even report this as income, they don’t get a 1099 unlike payments from insurance companies, saving them easily 40% in taxes

Cite?

They should report it as income, and pay the associated taxes.

Any that don't are playing a risky game, as they probably have accounting staff receiving the payments who could turn them in for an IRS bounty.

https://www.irs.gov/about-irs/whistleblower-office-at-a-glance

 

[Rainbowdash]

Cite?



They should report it as income, and pay the associated taxes.



Any that don't are playing a risky game, as they probably have accounting staff receiving the payments who could turn them in for an IRS bounty.



https://www.irs.gov/about-irs/whistleblower-office-at-a-glance

I agree with you, they should report as income and pay taxes like everybody else, but in reality, it’s very hard for anybody to notice this especially in small practices where the doctor is the one taking the cash everyday and “deposit” in the bank. Chances are they don’t have an accounting staff, they usually just hire an accountant to do their taxes and book keeping.

 

[SecondCor521]

I agree with you, they should report as income and pay taxes like everybody else, but in reality, it’s very hard for anybody to notice this especially in small practices where the doctor is the one taking the cash everyday and “deposit” in the bank. Chances are they don’t have an accounting staff, they usually just hire an accountant to do their taxes and book keeping.

I don't think single doctors accepting cash from patients happens in the US anywhere any more. My PCP is a solo practitioner I think, and he's got a staff of 10 or so.

Again, are you actually aware of any doctors who take cash and don't report the income? If so, and if it bothers you, I suggest the IRS whistleblower program.

 

[ownyourfuture]

I don't think single doctors accepting cash from patients happens in the US anywhere any more.

I wouldn't doubt there's many doctors accepting cash and not reporting it.
At least in certain parts of the country. Maybe those practicing in poor areas & specializing in treating undocumented patients. Corruption is everywhere.

 

[SecondCor521]

I wouldn't doubt there's many doctors accepting cash and not reporting it.
At least in certain parts of the country. Maybe those practicing in poor areas & specializing in treating undocumented patients. Corruption is everywhere.

Do you know of any?

 

[ownyourfuture]

Do you know of any?

No I don't.
That being said, it's my understanding that the undocumented aren't eligible for Medicare, Medicaid, or an ACA plan. It's estimated that approximately 12 million of these people reside in the US. They go somewhere for their healthcare needs, & I doubt it's always an emergency room.


You believe what you want to believe, & I'll do the same,
BTW: I didn't say I know for a fact doctors take cash payments & don't report it.
I stated "I wouldn't doubt this happens"

There's a difference.

 

[Rainbowdash]

Do you know of any?

There are some doctors in my area primary care doctors targeting cash payers, the ones that don’t have insurance, they charge $50 per patient, and will spend 5 min with the patient. I doubt they report everything. Also, doctors take cash all the time, copays for example, they don’t get 1099 for that. Again I’m not saying every doctor under report their cash payments, but I would not be surprised that a significant amount of them do.

 

[MBSC]

2023 plans are on HealthCare.gov.

You may need to clear browser cache if you visited the site recently and don't see the updated page.

 

[Rainbowdash]

There are some doctors in my area primary care doctors targeting cash payers, the ones that don’t have insurance, they charge $50 per patient, and will spend 5 min with the patient. I doubt they report everything. Also, doctors take cash all the time, copays for example, they don’t get 1099 for that. Again I’m not saying every doctor under report their cash payments, but I would not be surprised that a significant amount of them do.

Correction $50-$100 per patient.

 

[Dtail]

2023 plans are on HealthCare.gov.

You may need to clear browser cache if you visited the site recently and don't see the updated page.

Thanks for the notice. Looks like my medical and dental are within dollars of last years premium with same income levels. OOP went up $800.
That would be a winner for my family. Last year for my brother and one more year for me.

 

[TripleLindy]

Some doctors will keep the cash payers fee low because they don’t even report this as income, they don’t get a 1099 unlike payments from insurance companies, saving them easily 40% in taxes

While I don’t doubt that this may occur with unethical people, that applies to any profession and I believe it is so rare as to not even register statistically, especially in healthcare. All of the docs I see are in professionally run practices, some affiliated with large health systems, and I’m sure all payments are properly reported. Even those docs will offer a “cash” rate. I pay with a credit card, not actual cash.

 

[TripleLindy]

2023 plans are on HealthCare.gov.

You may need to clear browser cache if you visited the site recently and don't see the updated page.

Thanks for that! I thought I would need to wait for open enrollment next week to see the plans and pricing.

Does anyone know what the “Easy Pricing” designation means? Some plans have the designation right under the plan name. Google didn’t give me anything, nor did a search on healthcare.gov.

 

[ShokWaveRider]

DW's ACA Silver plan went up $91 a month. There are more $0 premium plans on the ACA this year but none of our local docs take them. How does that work?

 

[PaunchyPirate]

DW's ACA Silver plan went up $91 a month. There are more $0 premium plans on the ACA this year but none of our local docs take them. How does that work?

I’m not sure if I’m answering what you meant, but if you go to a doctor who doesn’t accept a plan you signed up for, you probably need to pay cash before the service.

In our wonderful world of healthcare in the US, it’s a free for all. Docs don’t have to take your insurance if they don’t want to.

 

[Dtail]

DW's ACA Silver plan went up $91 a month. There are more $0 premium plans on the ACA this year but none of our local docs take them. How does that work?

Are you using the BCBS 1443C plan, as our premiums are just about the same as last year?

 

[MBSC]

Does anyone know what the “Easy Pricing” designation means? Some plans have the designation right under the plan name.

They are the new 'standardized plans' for each metal level.

With standardized maximum out-of-pocket limitations, deductibles, and cost-sharing features, consumers will be able to more directly compare other important plan attributes, such as premiums, provider networks, prescription drug coverage, and quality ratings when choosing a plan.

...Issuers offering Qualified Health Plans on HealthCare.gov will be required to offer standardized plan options at every network type, at every metal level (Bronze, Silver, Gold, and Platinum), and throughout every service area where non-standardized options are offered [by that issuer] starting in 2023. These plans will be differentially displayed on HealthCare.gov to help consumers make more informed choices about their coverage.

Source: https://www.cms.gov/newsroom/press-...ssible-and-affordable-millions-americans-2023

More detailed article: https://www.healthaffairs.org/do/10.1377/forefront.20220430.953129/

 

[scrabbler1]

While I haven't yet received a letter from my IC telling me what my new monthly rate will be, I did receive a letter from my state's (NY) exchange telling me what my monthly premium's subsidy will be. This is a good sign because in prior years, I had various problems with enrollment, renewal, and income verification which sometimes delayed my receiving the subsidy at the very start of the year. Looks like there won't be any problem for 2023.

 

[Donno]

Even though I start on Medicare in December, I decided to check the ACA website to see what it would have cost next year vs this year. The good news is there are now 93 plans to choose from in my zip code compared to 4 years ago when I first went on the ACA when there were only a handful. The bad news is my current plan (bronze through BCBSTN) was now down to the 3rd page of offerings and was the first to cover my doctors and medicines. The price has gone from $856 this year to $954 next year and the deductible has gone from $8700 to $9100.

 

[FLSUnFIRE]

2023 plans are on HealthCare.gov.

You may need to clear browser cache if you visited the site recently and don't see the updated page.

My plan went up 7% (~5% of the 7% was due to me being a year older). Subsidy increased more so my OOP will be $9 less each month. With everything else going up at least there is that!

 

[bobandsherry]

Just looked at costs for my plan, Florida blue, using HealthSherpa. I guess good news is my plan overall premium went up from $1889 to only $1907, so about a 1% increase. The increase in subsidies increased by 1%, so overall my net premium is a reduction of 8%.

 

[audreyh1]

I’m shocked and delighted to report that my monthly premium is going down 9.38% for 2023. I expect there will be a hefty rebate for 2022 as well since they dropped the premium so much in spite of being 1 year older.

I’m very surprised because I’m getting quite close to Medicare age (in 2024) and usually the premiums really go up those last few years.