Did You Have Health Insurance Prior to Signing Up With an Exchange?

[Hamlet]

I suspect that your state was subsidizing their high risk pool rates.

Most likely you were paying rates that the state set, not the full cost of providing insurance to the people in the pool.

DH (52) was paying $350/mo on HIRSP for a 3K deductible with IIRC a $4700 OOPmax. On our new plan, his portion is about $400 or so and our deductible is $11K and OOPmax almost $13K.

I thought it was pretty strange when the news started coming out about the rates for ACA and that his rates would be GOING UP. I thought, How can that be? He was in the 'high risk' pool with supposedly sickly people and now, with a mixture of everyone, the rates are more. Just kind of negates the argument that this is 'affordable' for those with pre-existing conditions when compared to HIRSP. I guess the only way it's 'affordable' is if the person is in the category of getting a subsidy and/or cost-sharing.

But at least it's EASY to apply now and to shop around. I'm thankful for that! Those old insurance applications were about as fun as walking through glass.

** I know I compared indiv deductibles to family above - but even for an individ plan for him, his rates would go up. And at the VERY least (since HIRSP may have gone up next year, too) they stay the same (are no more affordable) for like coverage.

 

[MichaelB]

I'm glad to hear that.

As a matter of fact, DW and I never had individual policies either. We both switched directly from being covered on our parents' employer-based policies to being covered by our own employer-based insurance. But we were always covered.

It appears that the vast majority of poll responders here did have coverage prior to the ACA, but as others have said, I doubt this group would be a typical sample of the population as a whole.

Yes, beginning early retirememt with employer based ínsurance is a world of help. Employer policies can be continued using COBRA, then rolled over into conversion policies. The policies themselves can still be cancelled (for entire groups) but individuals cannot be dropped. My case, my employer was not a US company and the insurance coverage we had was a type of self-insurance, so it was not subject to COBRA regs, which I discovered after leaving. As agents have pointed out to me many times, the key to health insurance is getting into a group.

Since my retirement I have always kept open the possibility of returning to work, and others that are close have done the same with me, not for money but for the health insurance. That's been like an itch I can't scratch. While I don't expect any big immediate change in the US either in insurance or employment marketplaces, I do think this will "loosen up" the job market in an important way that is helpful to small businesses and people that want to change their employment.

 

[REWahoo]

I suspect that your state was subsidizing their high risk pool rates.

Most likely you were paying rates that the state set, not the full cost of providing insurance to the people in the pool.

+1

DH (52) was paying $350/mo on HIRSP for a 3K deductible with IIRC a $4700 OOPmax.

Compare his $350/mo pool premium to the Texas pool where 2013 rates for a similar ($2,500 deductible) policy range from $578 to $824 per month depending on county of residence.

 

[REWahoo]

Since my retirement I have always kept open the possibility of returning to work, and others that are close have done the same with me, not for money but for the health insurance.

+1

From the time I lost COBRA eligibility until age 65 I had a health insurance contingency plan. It involved acquiring a concealed carry permit then taking a part-time job driving a school bus...

 

[jflynn4]

Yes ... Had insurance.

Employer provided for many years prior to ER then COBRA and then the hell of private coverage for 10 months where my premiums skyrocketed to over $1900 per month due to pre existing conditions (DW had breast cancer in 2003 and I suffered a neck injury in 2009).

New coverage thru the exchange is significantly better than I've had and is saving me $1300 per month.

 

[aaronc879]

I've been without health insurance since Aug 2011 when I became unemployed. Since i'm 34 and have no health problems, I forgot about the ACA deadline until a couple days ago and now it's too late to get coverage so I guess i'll continue to be uncovered for now. I don't have the assets that most people on this forum have so not too worried about being uncovered. Little stuff I can pay out-of-pocket. If i'm in a major accident, my finances will be the least of my worries.

 

[AllDone]

I've been without health insurance since Aug 2011 when I became unemployed. Since i'm 34 and have no health problems, I forgot about the ACA deadline until a couple days ago and now it's too late to get coverage so I guess i'll continue to be uncovered for now. I don't have the assets that most people on this forum have so not too worried about being uncovered. Little stuff I can pay out-of-pocket. If i'm in a major accident, my finances will be the least of my worries.

It's too late to get insurance that starts January 1, however you can still sign up for insurance that starts February 1, 2014.

 

[aaronc879]

It's too late to get insurance that starts January 1, however you can still sign up for insurance that starts February 1, 2014.

How does the subsidy work? Say I get the lowest cost plan for $200/mo and get a $100/mo subsidy. Do I just pay $100/mo or do I pay the full $200/mo and get reimbursed after filing taxes?

 

[audreyh1]

How does the subsidy work? Say I get the lowest cost plan for $200/mo and get a $100/mo subsidy. Do I just pay $100/mo or do I pay the full $200/mo and get reimbursed after filing taxes?

AFAIK you pay the $100, and the insurance company gets reimbursed from the govt.

 

[AllDone]

How does the subsidy work? Say I get the lowest cost plan for $200/mo and get a $100/mo subsidy. Do I just pay $100/mo or do I pay the full $200/mo and get reimbursed after filing taxes?

You can set it up either way.

 

[oldtrig]

Neither DW not I were able to buy individual health insurance until now.

Why? didn't you have insurance? Just curious

 

[aja8888]

Why?

Probably for the same reasons my wife was rejected several times at age 62: pre-existing conditions and no disclosure of the fact that she was "old".

 

[oldtrig]

I don't mean to sound mean in this reply but I just wonder if someone could not get insurance could not they do exactly do what I did when I almost 50. My son had a condition that no insurance company would write a policy that covered it. I took a job that supplied group insurance. I had to do it. I did not really like closing a business I had enjoyed for over 20 years but I had no choice in the matter. Oh I could have took the gamble but it was not worth it at the time. When in a group everybody get covered with no questioned asked. I always thought that was unfair but so is life sometimes. It just seemed crazy in 1996 to pay $400 per month and my son's condition would not be covered. No way am I for this government insurance. Somebody has to pay for it and its scary where they are going to come up with the money. Like I mentioned before something had to be done to stop these every rising costs in the medical field but our government puts their hands in it, come on. oldtrig

 

[Hamlet]

Do you understand that the group insurance that you get through a large employer is already "government insurance" in the same way that the new individual insurance is going to be "government insurance"?

The large group insurance market works the way it does because the government set rules saying that insurance companies weren't allowed to charge different rates to individuals working at a large company.

When you work for a big company, the young health folks subsidize the older sicker folks' insurance costs. That isn't the free market at work-- the government wrote the rules forcing that to occur. Without government involvement, it is unlikely that people would get insurance through their employers at all.

The large group market works so well because it already has the rules that the ACA is trying to put in place for the individual and small business market.

I don't mean to sound mean in this reply but I just wonder if someone could not get insurance could not they do exactly do what I did when I almost 50. My son had a condition that no insurance company would write a policy that covered it. I took a job that supplied group insurance. I had to do it. I did not really like closing a business I had enjoyed for over 20 years but I had no choice in the matter. Oh I could have took the gamble but it was not worth it at the time. When in a group everybody get covered with no questioned asked. I always thought that was unfair but so is life sometimes. It just seemed crazy in 1996 to pay $400 per month and my son's condition would not be covered. No way am I for this government insurance. Somebody has to pay for it and its scary where they are going to come up with the money. Like I mentioned before something had to be done to stop these every rising costs in the medical field but our government puts their hands in it, come on. oldtrig

 

[AllDone]

Oldtrig: Hamlet +1

When you went to work for that big company, you got a subsidy from the other, healthy employees, a subsidy from your employer, and a subsidy from the government. The ACA effectively extends the healthy-to-unhealthy subsidy to everyone and the government subsidy to some people who don't work for a large employer. The ACA doesn't level the playing field completely, but it does make it possible for everybody to get access to insurance.

The other stuff is just the hyperbole of politics. Most of the people being brought into the system are working poor and people who were willing to risk leaving the corporate world without insurance. They're not sick, they're generally healthy and unlikely to be wildly expensive to cover. The subsidies are not as generous as people get in the corporate world. The other stuff like "security breeches" and "death panels" is just made up to get people spun up about voting and contributing. There are a lot of people who have spent their lives studying health care economics, health care delivery, etc. and who say that system, while not optimal, will work.

 

[scrabbler1]

Hamlet, +1(+2). AllDone, also +1.

When I went from employer coverage to having to buy my own HI 5 years ago, I was dismayed at how the tax code treats employer-based HI so much more favorably than it does in the individual market.

Employer-based coverage provides a tax-free subsidy of the premiums while the tax code allows the workers to fully deduct their portion of the premiums regardless of income. It does not matter if the worker can itemize his deductions on Schedule A, his portion can be made with pretax dollars.

Now look at the tax code when someone loses those two big benefits, as I did starting in 2009. I had no employer subsidy, of course. But I could not even deduct the entire premiums I paid because I had to exclude 7.5% of my AGI first (since raised to 10%). So some of my premiums were made with after-tax dollars while some were made using pretax dollars, quite a bit worse than those in group health plans.

Add to that the higher cost of an individual policy versus being part of a group health policy. The ACA provides a subsidy like the employer-based one but it is not nearly as big as what I would get from an employer because the ACA's subsidy is based on income. And I am still stuck with the 10%-of-AGI exclusion for the rest of the premium, assuming I can always itemize. To me, that should be separate from Schedule A the way IRA deductions and other above-the-line ones are so they can always be deductible.

 

[NoMoreJob]

Yes, my wife and I purchased individual coverage since ER in 2003. I went to a policy though our state exchange for 2014 because otherwise the cost of the HSA policy that would have replaced our old one would have doubled in cost from $7,000 to $14,000.

 

[Malcolm2]

Do you understand that the group insurance that you get through a large employer is already "government insurance" in the same way that the new individual insurance is going to be "government insurance"?

The large group insurance market works the way it does because the government set rules saying that insurance companies weren't allowed to charge different rates to individuals working at a large company.

When you work for a big company, the young health folks subsidize the older sicker folks' insurance costs. .

Of course the large elephant in the room (the government) did not normally force people in private companies to pay for others if they don't want or need coverage. Big difference.

I'm with Oldtrig, even though I will extend an old policy as long as able I am not for everyone trying to grab a subsidy, especially those with significant assets. I just don't want our kids to pay for yet another entitlement for us older folks. Perhaps if the entitlement was means tested, but not through income engineering while sitting on large retirement assets as some try.

 

[NoMoreJob]

Of course the large elephant in the room (the government) did not normally force people in private companies to pay for others if they don't want or need coverage. Big difference.

I'm with Oldtrig, even though I will extend an old policy as long as able I am not for everyone trying to grab a subsidy, especially those with significant assets. I just don't want our kids to pay for yet another entitlement for us older folks. Perhaps if the entitlement was means tested, but not through income engineering while sitting on large retirement assets as some try.

Many (like us) were not given the option to extend existing policies. Our choice was to pay significantly more (double in our case) or take a subsidy. Yes, we currently have 'significant' assets but it's my responsibility to protect those assets as they represent the basis for our retirement income, hopefully for the next 30+ years. We have no pensions or other income other than eventual social security. Would it be responsible of me to prematurely draw down our assets in order to stand on principle especially when in all likelihood it will be my wife who will suffer if there's not enough left in 30 years (I'll likely be gone)? This is the question I wrestle with.

 

[AllDone]

Of course the large elephant in the room (the government) did not normally force people in private companies to pay for others if they don't want or need coverage. Big difference.

I'm with Oldtrig, even though I will extend an old policy as long as able I am not for everyone trying to grab a subsidy, especially those with significant assets. I just don't want our kids to pay for yet another entitlement for us older folks. Perhaps if the entitlement was means tested, but not through income engineering while sitting on large retirement assets as some try.

But what if you think of the "subsidy" as a "tax break"? Would that be more acceptable to you? Right now about 2/3 of the country pays for their insurance with pre-tax dollars through their employer while those of us in the individual market pay in post-tax dollars. Does that seem fair to you? We could extend the tax savings to everybody, but how do we get coverage to people with "pre-existing conditions? (My BIL is uninsurable due to a condition he was born with, but is extremely healthy. His condition would have been undetectable without modern medical technology.). Additionally, wealthier people pay mostly income taxes while poorer people pay a higher percentage of Their income in the form of FICA and sales tax. (I paid 5% of my income in FICA, my nurse paid 7.5% of her income in FICA). The current system that subsidizes the health insurance of only those people who are employed by large employers and who have higher incomes doesn't seem all that fair to me. Yet, those subsidies provide the same drag on your kids (if subsidies provide any drag at all -- I don't believe that is true.) Any way, that's problem number one.

The other problem that bothers you is the mandate. I don't like being told what to do, either. However, I don't want to get hit by an uninsured driver or pay for an uninsured person's ER visit, so I like other people to be told what to do. Megacorp is required to provide insurance to all of it's employees at the same price regardless of age or health history, if it provides insurance to any employee. I suppose that there are people who are mean enough that they would forego insurance rather than contribute to their coworkers' expenses, but those people are secure in the knowledge that if their own health situation deteriorates, they can jump into the pool. They are acting as free-riders. If everybody did that, then the whole system would collapse. That's why the Heritage Foundation called the individual mandate "personal responsibility", back when they were still in favor of an ACA like plan.

In any system you find a few people who work the system and bend the rules a little. Sorry. In this case, though, a lot of hard working people are getting a more fair system that has previously been denied to them.

 

[scrabbler1]

Another good post there, AllDone, +1.

I worked for 23 years in the insurance industry, specializing in the actuarial area of personal auto. While it is not the same as health insurance, there are some similarities. First, the industry and government have worked hard to minimize the level of "free riders" who game the system to burden everyone else with the costs of their not buying insurance. States over the years (1980s and 1990s) strengthened their mandatory insurance laws to make it tougher for drivers to own cars without proper insurance. This, in turn, keeps the cost of Uninsured Motorists (UM) coverage low. UM is basically what insured drivers pay to compensate for the many drivers who choose to go without insurance, a "free rider" subsidy. States with stronger mandatory auto insurance laws tended to have the lowest UM rates.

Another thing insurers are allowed to do (and this is more for homeowners, not auto; I did work on HO a few times) is to not allow people to buy HO insurance within a certain number of days (at least 30, but it may be more) before a major weather event approaches, such as a hurricane. This prevents people from choosing to go without HO insurance until they see a big storm approaching, then being able to collect if their home gets damaged or destroyed. This is akin to those in the HI arena who wait until they get sick before they start buying insurance, also gaming the system by not paying into the system while they were healthy.

And remember what I wrote in Post #41 about the unequal tax treatment of those in group health plans versus those of us in the individual market and how those of us in the latter are at a disadvantage when it comes to taxes.

 

[unclemick]

Too old for ACA.

However as noted in previous posts went from 1993 to 2006 without any health insurance - couldn't afford it. Post Katrina and early SS bought BC/BS up north aka MO - way cheaper than LA.

heh heh heh - I absolutely DO NOT recommend anyone follow my example.

 

[Calico]

But what if you think of the "subsidy" as a "tax break"? Would that be more acceptable to you? Right now about 2/3 of the country pays for their insurance with pre-tax dollars through their employer while those of us in the individual market pay in post-tax dollars. Does that seem fair to you? We could extend the tax savings to everybody, but how do we get coverage to people with "pre-existing conditions? (My BIL is uninsurable due to a condition he was born with, but is extremely healthy. His condition would have been undetectable without modern medical technology.). Additionally, wealthier people pay mostly income taxes while poorer people pay a higher percentage of Their income in the form of FICA and sales tax. (I paid 5% of my income in FICA, my nurse paid 7.5% of her income in FICA). The current system that subsidizes the health insurance of only those people who are employed by large employers and who have higher incomes doesn't seem all that fair to me. Yet, those subsidies provide the same drag on your kids (if subsidies provide any drag at all -- I don't believe that is true.) Any way, that's problem number one.

The other problem that bothers you is the mandate. I don't like being told what to do, either. However, I don't want to get hit by an uninsured driver or pay for an uninsured person's ER visit, so I like other people to be told what to do. Megacorp is required to provide insurance to all of it's employees at the same price regardless of age or health history, if it provides insurance to any employee. I suppose that there are people who are mean enough that they would forego insurance rather than contribute to their coworkers' expenses, but those people are secure in the knowledge that if their own health situation deteriorates, they can jump into the pool. They are acting as free-riders. If everybody did that, then the whole system would collapse. That's why the Heritage Foundation called the individual mandate "personal responsibility", back when they were still in favor of an ACA like plan.

In any system you find a few people who work the system and bend the rules a little. Sorry. In this case, though, a lot of hard working people are getting a more fair system that has previously been denied to them.

+100

I receive health insurance from my employer, and I pay for it with tax free dollars as you describe. I feel very fortunate to have this benefit. I am equally glad that folks like your brother-in-law (one example among millions) now have affordable access to health insurance too. It is not perfect, by a long shot, but it is an improvement over the old system.

 

[MichaelB]

In the year 2022, once the ACA is fully implemented, the CBO projects the total gross outlay for exchange subsidies, new Medicaid and Chip participants will cost around $250B.

The taxpayer cost of employer based health care (tax expenditure) in 2013 is around $248B. The CBO projects that to rise to around $450B in the year 2022.

 

[Malcolm2]

But what if you think of the "subsidy" as a "tax break"? Would that be more acceptable to you? Right now about 2/3 of the country pays for their insurance with pre-tax dollars through their employer while those of us in the individual market pay in post-tax dollars. Does that seem fair to you? We could extend the tax savings to everybody, but how do we get coverage to people with "pre-existing conditions?

The ACA subsidy is a government entitlement payment paid direct to the insurance company on the persons behalf. Websters defines Entitlement as:
a type of financial help provided by the government for members of a particular group. That money was never the rightful property of the entitlement receiver and comes from someone else, far different from an situation of an employee of mega corp. In the megacorp example the government is only _taking_ less of the employees income. Those two are only the same if you subscribe to the belief that government is entitled _first_ to all of your income and "allows" you to keep some. I don't accept that premise, and I doubt most people do.

Actually most of the retired folks who are buying insurance at market prices are also paying for it after after tax.

It is good that those that those with medical conditions can get health care easier, nobody would deny that and it is good it helps folks in your case. My only issue is to have my kids generation pay for those getting a new entitlement payment that they did not work for while sitting on significant assets. Does that seem right? Just seems wrong to add yet another burden. That is why Medicaid requires personal assets to be used, perhaps carried too far to the extreme with LTC. Many people who decide to buy a ACA policy, if it works, will pay their full way, and then some. Talking points of ACA formal or informal navigators aside I think we must be clear.