Cheapest plan we can get in our state is $1,304 for DH, 18-year-old daughter, and myself. D’s psychiatrist is not in network. $6,000/person deductible Nothing paid for primary doctor or specialists until deductible is met. Generic drugs - $15 co-pay. So realistically, our $1,304/month means we will get meds for a reasonable cost. No other benefit.
Why am I paying over $1,300/month for what is effectively catastrophic coverage?
This sucks.
Before ACA, we had better coverage at lower prices. Our two-person firm could get group coverage. Now we can’t, since DH and I are the only two employees. Doesn’t matter that we are both professional engineers.
It is good in covering folks with pre-existing illness/injury. Previously, those of us with such issues could only get insurance IF we had an employer who happened to provide insurance. One of the reasons there are so many problems with it is that so many folks tinkered with it, watering down the requirement that EVERYONE have it (especially young healthy folks who don’t use many medical services), not just folks who are old, ill, hurt or have chronic conditions. Our group plan (through H’s former employer) is essential for us, covering me, H, and D at very reasonable rates with excellent coverage.
HI has a requirement that all employers who had employees working at least 20 hours/week for at least 3 weeks had to have employer offer medical insurance. To skirt that, many employers called their staff “independent contractors,” or had them work under 20 hours/week, requiring many to have multiple jobs since no one will hire full-time or 20+ hour/week workers. That requirement has existed for many, many years and many have skirted it, including our State when it hires on-call staff or less than full-time employees it doesn’t give them more than 17 hours/week most of the time, so no benefits.
“Nothing paid for primary doctor or specialists until deductible is met.”
@MaineLonghorn I’d suggest taking a closer look at your plan options again. My guess is the $6,000 deductible is per FAMILY not per person and that your annual physical exams/tests would be paid without meeting the deductible.
One physical exam is covered each year. Tests are NOT included. And if you bring up specific issues with your doctor during your annual, you are charged for that part of the visit. Each year, we get a mailed notice from the PCP reminding us of this fact. I tell DH, “Don’t bring up anything that’s not urgent, because you’ll get charged.”
That supposed one free wellness visit or physical per year is a joke. Our doctor’s office put up a sign that says in essence, if you ask any questions, if you mention any ache or pain, then your visit will be billed at regular office visit charges. It is no longer the ‘free’ physical.
Knowing your state but not knowing your specifics of course (although I can make educated guesses) I can visit healthcare.gov and find plans with lower deductibles than your post above. Have you looked at all the options?
My guess is you are looking at a bronze plan? Often silver plans have lower deductibles and though they have a little higher premiums, they can make sense for some scenarios.
@TatinG We use several PCPs amongst are family members. None of them have that policy or follow that kind of billing procedure. Granted if you have a complaint, it may lead to follow up care and subsequent appointments which will be billed separately. But just because I or a family member mention a complaint at our annual checkup, it isn’t billed differently and it is still free. Sounds more like a complaint with your PCP than ACA.
My husband is 62, I am 54, and my daughter is 18. I looked through all the plans.
Cheapest silver plan is $1,476. $4,650/person deductible. PCP would be $35/visit. Specialists not covered until deductible met. $172/month more than bronze plan. So if we saw our PCP more than once a month, every month of the year, this plan would make sense. We don’t go that often.
DD got her letter too. Her insurance which is an individual policy from Anthem…not eligible for a subsidy, and we don’t want Medicaid for her…went up $100 a month for 2017. We will be looking for a less expensive individual plan with a higher deductible, and higher out of pocket costs for her.
It would be $375 a month for this healthy 28 year old’s individual plan.
Not exactly. His subsidy depends on what his salary is compared to the federal poverty level ($11880) and what the reference/benchmark Silver plan costs. Most likely, his subsidy will go up this year. But it might not.
He should definitely shop around and check out the different plans.
@“Cardinal Fang” I’m not sure there will be much shopping around for him. He lives in Arizona where almost everyone has pulled out of the individual exchange market in his area.
In HI, I don’t think there are many ACA plans left either, but haven’t followed it closely because I and most folks I know have insurance from our or spouse’s employer of former employer (if retired). The plans need to be read carefully for what is covered, excluded, etc. Also, Rx formularies are subject to change at any time with little or no notice, which can be very tiugh for folks on maintenance Rx.
S has a subsidized silver policy. His premium is going to increase by 16%. His subsidy didn’t change by more than a couple of bucks. That’s not peanuts and he’s certainly feeling the hit.
I went to healthcare.gov to get an idea what I will be paying next year. I must have done something wrong the first time because it showed my subsidy decreasing drastically resulting in an increase of 68%. I did it again and my subsidy about doubled from last year. My same plan (with a $500 increase in deductible) will actually cost me about $50 a month less.
Patsmom, I urge your son to shop around on the exchanges. He doesn’t have to buy the same policy this year as last year. There may be-- probably there is-- a cheaper Silver plan for him.
