ACA Sticker Shock

[24601NoMore]

Thought some of you contemplating ER may be interested in my experience just now pricing ACA plans as my COBRA is now ending 18 months after my own ER..

First, I have a grand total of ONE PPO provider (BCBS) to "choose" from in my area. ONE.

Cheapest PPO in my zip code is $652.91, with a (get this) $8,150 (!!!) deductible. Basically, I get to pay almost $8,000 per year ($7,834 in premiums) for ONE mid 50s age person, THEN all of my expenses at 100% until I hit ANOTHER $8,150. Then, and only then, does the plan start to pay.

Obviously, this is nearly $16,000 in cash outlay per year for ONE person, mid 50s, before the plan pays a penny.

Yeah, I'm not even remotely happy. They sure "fixed" our healthcare system, alrighty.

Those of you considering ER should take a very close look at the HC costs before pulling the trigger..

 

[jim584672]

You should move to NY. About $600 for a Silver (SLCSP) plan, any age. If your income is 2x poverty or lower, $20 a month, or free under 1.5x poverty.

Have you looked into whether you can get a subsidy?

 

[bobandsherry]

Another view is you get negotiated rates, that can be big savings vs not having coverage. Example we pay $65 to see specialist, last visit the specialist would have charged $800+. In office procedures also covered by co-pay. I saw specialist last year, had procedure done in office, paid $65 for the visit, the procedure would have been almost $2k.

And some things are paid before deductible, annual exams, some prescriptions (such as diabetes). Routine lab tests also included. Last lab visit would have been several hundred dollars even with negotiated rates, but fully covered.

Yeah, it does suck what they charge but unless you have to go for surgery and hospital stay chances are you won't make a dent towards the deductible. I view health coverage as disaster coverage with a sprinkling of cost savings.

All that said, I try to manage income so that we stay below the upper income threshold and qualify for subsidy. [emoji41]

 

[Willers]

We're in our 5th year of the ACA and it has been an obsession to stay under the cliff. We are in CO so it is $25K+ and a $7-8K deductible (for a couple) in our state if you miss the limit by a dollar or more. Luckily we've stayed under so far. Welcome to affordable health care!

 

[ShokWaveRider]

$65 a month here for DW in NE FLA for 2020. We have NEVER found a provider that does not take it, it is Florida Blue. Some of the best HC providers all within 5 mile radius including all the specialists we will ever need. $2400 Max OOP, $5/10 Copays with 5 free Doc visits (No Copays). Any drugs she has had have $0 Copays. Never paid more than the Monthly premium.

OP Needs to find or move to a state with better healthcare access. This was a MAJOR issue when we retired.

 

[Time2]

You should move to NY. About $600 for a Silver (SLCSP) plan, any age. If your income is 2x poverty or lower, $20 a month, or free under 1.5x poverty.

Have you looked into whether you can get a subsidy?

I have never liked this idea of it's cheaper if you get the subsidy.
Somebody is paying that subsidy, it's the 51% that pay Federal taxes.
My wife and two kids have a grandfathered BCBS policy. It was in effect before the ACA, it has a $10,000 deductible. This month the bill came with a 12% premium increase and is now $8,772. That's not great, but better than the 19.4%, 21% and 18.8% increases I got in the 3 years after the ACA regulations went into effect.

 

[MRG]

Thought some of you contemplating ER may be interested in my experience just now pricing ACA plans as my COBRA is now ending 18 months after my own ER..

First, I have a grand total of ONE PPO provider (BCBS) to "choose" from in my area. ONE.

Cheapest PPO in my zip code is $652.91, with a (get this) $8,150 (!!!) deductible. Basically, I get to pay almost $8,000 per year ($7,834 in premiums) for ONE mid 50s age person, THEN all of my expenses at 100% until I hit ANOTHER $8,150. Then, and only then, does the plan start to pay.

Obviously, this is nearly $16,000 in cash outlay per year for ONE person, mid 50s, before the plan pays a penny.

Yeah, I'm not even remotely happy. They sure "fixed" our healthcare system, alrighty.

Those of you considering ER should take a very close look at the HC costs before pulling the trigger..

ACA never was never intended to "fix the healthcare system", it's a way to buy insurance for folks who don't have employer subsidized healthcare insurance.

Before ACA many people couldn't get insurance for any price. I'm one of those people. Yes our current for profit system has issues, healthcare is expensive. Is this news? When I first went on ACA it was comparable to the current COBRA costs, it's gone up every year except last year, so has COBRA. My premiums went down 50%, thanks to actions our state took. Perhaps you should vote for representatives to help reduce healthcare costs? I do.

 

[COcheesehead]

Before I contemplated FIRE, I looked at HC on the exchange so I knew what I was getting into. If you can't cover HC, you can't retire.

 

[MichaelB]

Thought some of you contemplating ER may be interested in my experience just now pricing ACA plans as my COBRA is now ending 18 months after my own ER..

First, I have a grand total of ONE PPO provider (BCBS) to "choose" from in my area. ONE.

Cheapest PPO in my zip code is $652.91, with a (get this) $8,150 (!!!) deductible. Basically, I get to pay almost $8,000 per year ($7,834 in premiums) for ONE mid 50s age person, THEN all of my expenses at 100% until I hit ANOTHER $8,150. Then, and only then, does the plan start to pay.

Obviously, this is nearly $16,000 in cash outlay per year for ONE person, mid 50s, before the plan pays a penny.

Yeah, I'm not even remotely happy. They sure "fixed" our healthcare system, alrighty.

Those of you considering ER should take a very close look at the HC costs before pulling the trigger..

That premium looks to be in line with what major employers are paying for large group coverage, based on the annual KFF employer survey (2019 here) That survey shows 2019 premiums to be a bit over $7k.

People who have enjoyed employer provided health insurance, for the most part, have not seen the eye watering costs of insurance and health care their employers have paid for the benefit.

 

[bobandsherry]

I have never liked this idea of it's cheaper if you get the subsidy.
Somebody is paying that subsidy, it's the 51% that pay Federal taxes.

FYI, I get a subsidy and also pay Federal taxes. Also paid in a crap load to fed tax when I was working as well.

 

[MRG]

FYI, I get a subsidy and also pay Federal taxes. Also paid in a crap load to fed tax when I was working as well.

Indeed. I also paid for schools I didn't send children to. I donated 1% of my income to KCMO for 29 years. If I lived there I would have been able to VOTE about the tax but I didn't. I was taxed for a local tax and had zero representation in this matter.

Life and taxes are not always equal or fair.

 

[pacergal]

Yes, this is the primary reason I worked 5 more years, so that I could qualify for retiree premium benefit until age 65.

 

[candrew]

FYI, I get a subsidy and also pay Federal taxes. Also paid in a crap load to fed tax when I was working as well.

+1

 

[ivinsfan]

I have never liked this idea of it's cheaper if you get the subsidy.
Somebody is paying that subsidy, it's the 51% that pay Federal taxes.
My wife and two kids have a grandfathered BCBS policy. It was in effect before the ACA, it has a $10,000 deductible. This month the bill came with a 12% premium increase and is now $8,772. That's not great, but better than the 19.4%, 21% and 18.8% increases I got in the 3 years after the ACA regulations went into effect.

No one likes the cost of HI! and yes some get it cheaper then others..a lot of people liken it to tax code but it's not nearly the same since everyone needs to have coverage.

 

[ivinsfan]

ACA never was never intended to "fix the healthcare system", it's a way to buy insurance for folks who don't have employer subsidized healthcare insurance.

Before ACA many people couldn't get insurance for any price. I'm one of those people. Yes our current for profit system has issues, healthcare is expensive. Is this news? When I first went on ACA it was comparable to the current COBRA costs, it's gone up every year except last year, so has COBRA. My premiums went down 50%, thanks to actions our state took. Perhaps you should vote for representatives to help reduce healthcare costs? I do.

What actions did your state actually take? Because in my mind the only thing they can do is cost shift it from one group to another.

 

[RetiredAt55.5]

Thought some of you contemplating ER may be interested in my experience just now pricing ACA plans as my COBRA is now ending 18 months after my own ER..

First, I have a grand total of ONE PPO provider (BCBS) to "choose" from in my area. ONE.

Cheapest PPO in my zip code is $652.91, with a (get this) $8,150 (!!!) deductible. Basically, I get to pay almost $8,000 per year ($7,834 in premiums) for ONE mid 50s age person, THEN all of my expenses at 100% until I hit ANOTHER $8,150. Then, and only then, does the plan start to pay.

Obviously, this is nearly $16,000 in cash outlay per year for ONE person, mid 50s, before the plan pays a penny.

Yeah, I'm not even remotely happy. They sure "fixed" our healthcare system, alrighty.

Those of you considering ER should take a very close look at the HC costs before pulling the trigger..

PPO's are going to cost more. Fortunately, in my area we have HMO options and many doctors/specialists accept them. Yes, it's a hassle to deal with the HMO rules, such as referrals, but the cost savings are worth it (to us).

 

[Aerides]

Long before we ER'd, back in our early planning days, right before the ACA, we talked with our FA and decided to budget 1k per month for premiums/deductibles. Based on what he was paying at the time for himself+wife, our age (late 40's then), for private insurance for 2, he said that was a good estimate. I remember looking at the time (and this was around 2010-11 ish) that rates for 2 were around $700 plus a hefty deductible. And that is almost 10 years ago.

So it's not really the ACA that is giving you sticker shock, but non-employer-subsidized private market insurance. And yeah the ACA never expected to solve the sticker price, other than adding subsidies.

But your basic message is true: Understand and plan for these costs in your ER planning, not after you pull the trigger. OP, given how much you agonized over your readiness, I'm sure you ran multiple estimates in your budget planning.

 

[ivinsfan]

$65 a month here for DW in NE FLA for 2020. We have NEVER found a provider that does not take it, it is Florida Blue. Some of the best HC providers all within 5 mile radius including all the specialists we will ever need. $2400 Max OOP, $5/10 Copays with 5 free Doc visits (No Copays). Any drugs she has had have $0 Copays. Never paid more than the Monthly premium.

OP Needs to find or move to a state with better healthcare access. This was a MAJOR issue when we retired.

Well you shouldn't have to move and uproot your entire life for HI. And it's a sketchy plan anyway because moving costs a crap ton of money there is no guarantee insurance would stay cheap and affordable in your area. What the stickers price of your spouse's coverage no way it retails for 65 bucks a month.

 

[MRG]

What actions did your state actually take? Because in my mind the only thing they can do is cost shift it from one group to another.

They increased the state reinsurance fund. State wide there's a 18% decrease in premiums more in rural areas where we were paying astronomical premiums.

 

[24601NoMore]

OP, given how much you agonized over your readiness, I'm sure you ran multiple estimates in your budget planning.

Yep..I did run multiple estimates, and they were within this range.

That said, actually having to get to the point where I have to now pay the crazy monthly premiums and have deductibles I'll never satisfy unless I get hit by a train is a whole different matter. And much different now that we have the economic realities we're all experiencing due to COVID..plus, we're back looking at buying our retirement house (with a big capital outlay needed beyond the equity in our current home) so costs are feeling much more "amplified" at the moment..

 

[24601NoMore]

Well you shouldn't have to move and uproot your entire like for HI. And it's a sketchy plan anyway because moving costs a crap ton of money there is no guarantee insurance would stay cheap and affordable in your area. What the stickers price of your spouse's coverage no way it retails for 65 bucks a month.

Amen to that! I'm always amazed at the suggestions that get made to just uproot your entire life and move elsewhere to get more affordable healthcare, which as we all know is not certain whatsoever to STAY "more affordable".

 

[wompo]

Thought some of you contemplating ER may be interested in my experience just now pricing ACA plans as my COBRA is now ending 18 months after my own ER..

First, I have a grand total of ONE PPO provider (BCBS) to "choose" from in my area. ONE.

Cheapest PPO in my zip code is $652.91, with a (get this) $8,150 (!!!) deductible. Basically, I get to pay almost $8,000 per year ($7,834 in premiums) for ONE mid 50s age person, THEN all of my expenses at 100% until I hit ANOTHER $8,150. Then, and only then, does the plan start to pay.

Obviously, this is nearly $16,000 in cash outlay per year for ONE person, mid 50s, before the plan pays a penny.

Yeah, I'm not even remotely happy. They sure "fixed" our healthcare system, alrighty.

Those of you considering ER should take a very close look at the HC costs before pulling the trigger..

Wish I could get a PPO. Only HMO here in Las Vegas. Cheapest bronze plan with 8250 deductible and OOP per person 16500 total for wife and me (in 50s) is 898.00 per month.

 

[Bir48die]

+1

Sorry, this argument has never flown with me.

 

[Aerides]

That said, actually having to get to the point where I have to now pay the crazy monthly premiums and have deductibles I'll never satisfy unless I get hit by a train is a whole different matter.

You know it's funny, I would have said the same thing. We each have a $6k deductible.

Year 1: DH had a suspect blood test last year....tl;dr he's fine, but sailed right past the deductible with all the testing and some very mild treatments by July.

Year 2: I started with my first colonoscopy, and a visit to my ortho for a sore knee, a re-up cortizone shot since. Torn Meniscus, simple injury from a twist saving myself from a slippery shower last year. Getting the pre-op clearance required full bloodwork, PCP visit, Cardio/Echo clearance + the actual surgery... I'll hit the $6k this month.

Out of pocket uninsured both these things would have exceeded 20k each so there's that at least.

 

[Time2]

FYI, I get a subsidy and also pay Federal taxes. Also paid in a crap load to fed tax when I was working as well.

And without the subsidy, you couldn't afford health insurance?