We mostly have 2 insurers in our state–BCBS and Kaiser. Fortunately they mostly seem to do a decent job.
One of the things that make some states particularly badly hit is Medicaid expansion. Or, to be more precise, lack of Medicaid expansion. In general, expansion states are better off than non-expansion states. But that doesn’t explain Arizona, which is an expansion state but which now has only one insurance provider for many residents.
The insurers that are thriving in the Obamacare marketplace are little-known insurers that previously ran Medicaid systems. They know how to set up lean, narrow network operations that they can offer for low cost. People grumble about narrow networks, but these insurers get plenty of customers who want to save money on their insurance.
Some providers will not serve patients covered by certain insurers in our state because the insurers are too hard to work with. It is worth asking your providers whether they will still serve you if you switch to insurer xxxxxx if you’re thinking of switching and want to keep your provider. That would matter to me, as it’s taken time and energy to develop relationships with my MDs.
All of this varies by state. Sometimes within larger states. We can share our details, but they may not hold for other posters. So before blaming the program, we can also look at how well things are managed (or, frequently, not) within our own states. Make that noise, if you need.
Looks like my premiums would not go up. What I can’t see yet is the “second lowest Silver” benefit to deductible. What shows is double this year’s.
But I go on Medicare 11/1.
Tweet from Larry Levitt, Senior VP of the Kaiser Family Foundation, my go-to source for health policy statistics:
ACA benchmark premiums are rising by 22% in 2017. That means the subsidies available to consumers also rise by 22%, cushioning the impact.
You’re become my go-to source, @“Cardinal Fang”. 
Thanks for sharing your knowledge. I think there is still a lot of confusion about ACA and how it works.
That is subsidy eligible. For an individual, the subidies don’t cut out until roughly $47K in annual income. (Somewhat more because it is AGI, not straight income – so can be reduced somewhat by various income adjustments).
The percentage of subsidy will change as his income increases, but overall eligibility doesn’t cut off until 4x poverty level. (Roughly $12k/year for one person)
The insurance company can’t calculate subsidy – so they are simply going by past records – but the subsidy won’t be the same. If the person’s income increases, the subsidy goes down; but that is counter-balanced by the rise in the benchmark rate. But only the exchange can collect the financial information needed to calculate the subsidy. Your son will know his actual rate after entering info at the exchange. He may not need to do much other than check a few boxes, if he expects his income to remain stable.
There are some really interesting charts of info in this link: http://kff.org/health-reform/issue-brief/2017-premium-changes-and-insurer-participation-in-the-affordable-care-acts-health-insurance-marketplaces/
It breaks down the ACA increase by state for a given scenario and then shows how with subsidies there is no increase for that scenario. It also shows change in number of insurers by state.
The landscape really varies across the country.
http://www.vox.com/2016/10/24/13394258/obamacare-premiums-hike-explained
The subsidized are protected. Those covered by employers are somewhat protected. In the end it’s
the small business people getting hit. As was to be expected.
I work with a single woman who is 61, uses tobacco, and makes about $50,000. She does not qualify for a subsidy because she is just barely over the income limit. She cannot afford the premium which is about $900-$1000 a month. Luckily, she does not have to pay the penalty since the cost of insurance is way more than 8% of her income, but she is also uninsured. She has several medical issues that, so far, have not cost her more than the out-of-pocket limit on the cheapest policy, but she lives in worry that she’ll have to go to the hospital and will not be able to pay for it. She had employer-paid group insurance until Obamacare came along and the group policy was discontinued. The employer pays a monthly amount for health insurance, but it only serves to increase her income over the subsidy limit and yet is not nearly enough to cover the premium. I feel for her.
I am in Ca and have a Anthem bronze plan with no subsidies. My info from the insurer is that my rate will go up 4%. What they neglect to point out till you read more closely is that I’m getting less. Dedudible is going up to $6600 for each of us. We insure 3 people and our premium is going up to $1331 a month. The network is fairly narrow where I live for those on individual plans. I don’t have an option to pay more for a wider network. I need to check if I have any other options new to my area.
My D does not get health insurance through her job and her Anthem also in Ca is going up 18%. She makes too much for a subsidy. Her primary care physician who she loved recently sent out a letter she is leaving private practice and going to work for the local UC. The letter basically said she doesn’t know who to refer them to. If you are on Medicare the other physician in the practice will take new patients but not for anyone else.
My family has experienced both the pros and cons of the ACA. H and I have not had group insurance since our 20’s. We have always bought individual insurance through Blue Cross. We had a high deductible but we could see any Dr in our area and they were a preferred provider. We could go to any large medical center in the US for treatment. No longer the case. Anthem groups individual policies with California Care policies and the network is very narrow.
Yet our D has a whole range of pre-existing conditions. Before the ACA she would not have been able to buy individual insurance at any price. She would have been stuck in a job that provided group coverage. Thanks to the ACA she can work a job she enjoys.
just saw a renewal for a friend price up 200.00 per month , co pays, deductibles up.(value down) almost not affordable. she is just above threshold for taxpayer subsidy. looked at other plans available …they cost even more for less value.
Subsidies go up to match premium increases, so my monthly cost will not go up. But looking at these numbers, the program cannot be sustainable. I looked at married couples (no dependents) of different ages and different income. Plugged these into the Healthcare.gov website for my area (North Carolina). A 30 year old couple making $30k gets a monthly subsidy of $869. A 64 year old couple making the same $30k gets a monthly subsidy of $2538 !! That’s $30,456 per year, Captain Obvious notes that is more than their annual income. It’s wonderful that the federal government is providing these generous subsidies, and I know there are income sources, but I don’t see how it can possibly be sustainable. The cliff, where subsidies go to zero is somewhere between $60k and $65k for a couple regardless of age. At age 30, subsidy is $531 at $60k income. At age 64, monthly subsidy is $2,199 with $60k annual income. Drops to zero at $65k. So making $5,000 more in income will eliminate a $26,388 tax credit…er… welfare payment.
@NJres while your monthly cost might not go up, I suspect your out of pocket expenses will. Like you, I am also in NC. Last year an ER visit cost an co-pay of a couple of hundred dollars. Next year, BCBS changed the policy so you are responsible for the full cost off the ER visit until you satisfy your deductible. So an ER visit could cost $6000 next year. They are also modifying the drug coverage and how blood work is covered.
I understand that they are trying to get people to stop using the ER for issues that can be handle in a doctor’s visit. That makes perfect sense but it will be painful if you truly have an problem that requires an ER. A simple accident requiring medical attention after office hours will be very expensive. Most clinics around where I live close at 8.
If a person is close to the cliff on subsipdies, they could do an HSA plan and put the maximum amount into their HSA account, also a traditional IRA or even a SEP contribution all come off the front page. The key number is AGI on the bottom of page 1 of the 1040, so a person close to the limits can climb back up the cliff with some tax advice.
Some people in North Carolina and other high-cost areas get huge subsidies. I don’t see why that would make the ACA unsustainable. The federal government has a lot of money, and there aren’t many older people getting subsidies.
I can think of reasons why the ACA would be unsustainable, but that’s not one of them. The worry is not the people getting subsidies, but the people not getting subsidies-- will they decide to stop buying individual insurance? Data point of two, here: Mr. Fang and I got hit with a whopping increase on top of our already huge premium. We’re staying, because we have to have insurance. Again we thought of going to Kaiser, which would still be expensive but not as expensive. Again we decided to stay with the doctor we’ve had for 30 years, but one more big increase and it’s Kaiser for us.
To me, the interesting thing about these price increases is that some insurers raised rates, and other insurers just dropped out. That shows that insurers, however much you hate them, were not predatory greedy bloodsuckers who were profiteering in the exchanges. They might well be predatory greedy bloodsuckers, but if they had been making money in the individual market, let alone making boatloads of money, they would have stayed. Companies don’t drop profitable businesses en masse. Healthcare in the US costs a lot of money even if you ignore whatever profit insurers are making.
Our PCP is exploring dropping insurance and going to an annual fee that would cover xx visits and would allow him to spend more time with patients. I forget the particulars because we aren’t going to opt in for it. While we like him, we can’t afford to do that. If doctors bypass health insurance altogether, it won’t matter about deductibles, ACA, or anything else.
That’s frequently called Concierge medicine and seems to be increasing lately but there is a limit to how many doctors can do that. There are only so many consumers who can afford it, spending on the fees, and one still needs insurance for hospital, specialist, lab, and drug expenses.
“At age 64, monthly subsidy is $2,199 with $60k annual incomeI”
I just ran this for my state and the subsidy is about $750.
30k income and it’s just under $1100.
Two at age 30 and $30k total gets about $320
It’s an example why it’s so difficult to compare across the board, all states.
Don’t compare the subsidy across states. It makes no sense. If you want to compare premiums for benchmark Silver plans, compare premiums directly. If you want to compare what the age 64 couple with the $60K income actually has to pay for benchmark Silver plans-- it is the same in all states. It is the same last year as this year. It’s $483/month.
If we want to know what that couple’s subsidy is, we make a simple calculation. We take the unsubsidized premium for the second lowest Silver plan. We take what they have to pay, $483/month. We subtract. Simple–the couple pays what they have to pay, $483/month, and the government pays the rest, provided they buy that benchmark Silver plan. Because the government is nice, we let that couple use their same subsidy on a different plan if they want to.