ACA individual health insurance: people will still get premium subsidies and deductible subsidies

Parent Cafe
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I don’t want to sound harsh or snide but how many doctors do these young people have that the network is so important? My son (age 24) doesn’t even have a doctor where he lives and comes home to see his internist here for his yearly physical. If he gets a virus or bad sore throat he just goes to to an urgent care. Most young people don’t have a plethora of chronic conditions that require a multitude of specialists. Guys usually have a PCP and women a PCP and an gynecologist.

Of course that doesn’t apply to all young people but the majority are pretty healthy until they get much older (like us!)

Young people also move around a lot and I’ve never heard one say they can’t take a new job in another city because they’d have to leave their doctors.

But if it’s so important your kids be in a specific network perhaps the parents can chip in some money to help pay their kid(s) premium.

If they had something major where 100% of initial cost would have to be covered by the deductible, would any parent here not pay that for their kid if they couldn’t afford it themselves?

JMHO

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I think I’m up to about a dozen specialists :slight_smile:

Even before I got sick, I wanted to keep my doctor. I’d switched doctors every few years growing up because of legitimate reasons. Once I found a good one, I held on for dear life.

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^I understand your situation Romani, but most young people aren’t in your situation. Your issues does, however, speak directly to the importance of having health Insurance even if one is young and healthy - because no one is immune from getting serious illnesses, regardless of their age or present health status.

Also, eventually after you finish your PhD, you might have to move to where you get a job and will have to find new doctors.

Even many of the parents on this board are moving away and settling somewhere else for retirement. I haven’t heard one person mention, in all the treads about moving, not moving because they would have to leave their doctors.

I also wonder when the cheap slim plans become legal what doctors and hospitals are going to accept that insurance? Something tells me there are going to be very few doctors or hospitals that will accept that insurance - yet I bet we don’t hear any complaints from those that have been complaining they were taken away after ACA about lousy networks.

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My healthcare will actually be cheaper next year for the same level of benefits I have this year. Go figure. Happily surprised.

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Well, you kinda do. My kid does happen to have several doctors - 3 specialists and a PCP - due to his health issues… It’s not that he loves these particular docs so much that he can’t leave them. It’s that the ones in the other network are basically the bottom of the barrel. I’ve asked a couple of my own trusted physicians to look over the provider list and suggest some of the specialists on there and they couldn’t come up with anyone they would send their own kids to.

We’ve been doing that for years and will continue to do it as long as he needs our help. Please don’t make assumptions when you don’t have all the facts.

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I remember as a 20-something I went for stretches with no health insurance, and my parents were appalled. One job didn’t offer it and another had a several-month waiting period, and I never needed to go to a doctor during those periods.

On the other hand, my DD, 20, broke her spine this summer in a car accident. She has numerous specialists now. Typical of a young adult? No. But you just never know what unlikely but unfortunate circumstances will occur.

Her BCBS insurance is almost doubling in premium cost (and raising its out of pocket maximum by $2,000). And since she’s a dependent, I have to cover the full cost since I make too much for subsidies. At the same time, I have to remember that before the ACA she might not have been insurable at all or her premium might have risen 500%.

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emilybee- I thought your post was very snide. You have NO idea what someone’s situation might be. Medical care issues can be just as complicated and important for young people as for anyone else. Good for your kid that it’s a cakewalk! I think our kids’ issues with insurance and medical providers are as concerning for us as parents as are our own, because we wouldn’t let them suffer or flounder and might wind up with considerable expense to help them in a medical emergency or if there is a need for a certain specialist or provider.

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The “want to keep one’s physician” thing may be that if someone has a physician who is at least acceptable, one may not want to leave the known-acceptable physician to take the risk of getting a worse physician, even if most other physicians around are acceptable or better. Also, if the physicians are not in the same medical group (likely if the change is made for insurance network reasons), then keeping track of medical records across multiple physicians is more hassle.

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As I said, I was speaking as a young person who wanted to keep my pcp- BEFORE I was sick. I had had really really bad ones before and didn’t want to start all over trying to find a new one.

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Look, I’m certainly fully fledged, want to move, but the first thing that comes to mind is my docs and local hospitals, which are great. I didn’t have a network issue on ACA, here.

But I smh because it’s silly to assume there won’t be any competent care for me. And despite a few things we’re watching, I don’t need these docs to be the one and only team.

Emily’s point was YMMV. My D1 doesn’t particularly like her doc, but trusts her (with me, as the 2nd opinion.) D2 likes her doc for the social support. Either could change docs. Not all of you may be in that position. Right. But many are, many young folks with no specific needs that ground them to one team. In fact, for many, if they got the big bucks/prestige job offer, they’d probably go.

That’s not insensitive. The whole point of this thread is making the best choices for you.

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I would force my young adult kids to have insurance, even if I had to pay for it out of pocket on my own. Because, as @Barbalot’s post states, anything could happen at any time. (Hope your daughter is on the mend!)

As my kids’ financial backstop at this point in life, I know that we as parents would be stepping up to provide for care if they were uninsured.

One benefit to ACA is that with the elimination of pre-existing conditions, a young healthy person who only needs an annual check-up and such, which represents the vast majority, can sign up for a low cost plan. Yes, the deductibles will likely be high but preventative care is covered. Should something catastrophic happen, you know you have a max OOP limit so your expenditures for the year are capped at that. Should something happen where you find you would ideally like a broader array of specialists, you can always trade up in the coming year to a more comprehensive plan. That option didn’t even exist prior to ACA unless you were covered by a great employer plan.

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“As I said, I was speaking as a young person who wanted to keep my pcp- BEFORE I was sick. I had had really really bad ones before and didn’t want to start all over trying”

But what happens if you get a job offer in Des Moines or Kanas City or Phoenix after finishing school. Are you going to turn down a Professorship so you don’t have to ever switch doctors?

I specifically said, some young adults have issues where they need specialists, but the vast majority of young people do not - which is why it’s so much less expensive to insure young people than older people. If I’m wrong about that then maybe they should be paying just as much as people in their 50’s and 60’s too.

I loved both my PCP and OBGYN but when H got a job in another city we moved and I had to get new doctors. It never crossed my mind that we can’t move because I’d have to give up my doctors.

My mention of parents helping out with premiums wasn’t directed at anyone in particular. Many of us help our kids out to make things easier for them as they are first starting out. I still pay my adult kid’s car insurance, for instance.

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The problem is- just as with adults- it’s all a gamble. Who knows when you will have a car accident or an athletic accident and require a lot of medical care. It might not be the level of a catastrophic diagnosis like cancer, but the bills can be quite high. Will you need PT? Even if you are young, these things happen. My son is a top amateur athlete in a dangerous sport. Stuff happens! He needs solid insurance. I am extremely healthy (although I’m certainly not young) but who knew I would have a detached retina with no warning and have immediate surgery? …

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Yes, stuff happens which is why anyone who chooses to forego health insurance no matter ones age is just dumb, IMO. Solid insurance is a separate issue from “I want to keep my doctor(s).”

I had a temporary crown put in last week after breaking a tooth and I’ve ended up with dental trismus (aka lockjaw) and muscle relaxant isn’t working so I’m now also on a antibiotic steroid and may need physical therapy.

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Michigan’s health plans are up. They look pretty good- I’m thankful. I’m helping a friend pick out a plan (27 yo female, Detroit area) and there’s a BCBS Silver plan for $272 BEFORE the subsidy. 600 deductible, 1500 OOP max.

Virtually no out of network coverage but that’s not necessary IMO.

ETA: The most important thing she wanted was a plan that covered her existing therapist. The first one she looked at (the one mentioned above) did.

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But the point is, some doctors and hospitals charge a lot more than others, and somebody has to pay.

It would be nice for patients if there were no for-profit hospitals and no for-profit insurance companies, and they all had to charge the same rates for the same services – but that’s not the system we have.

So if you want the choice of what you consider the best hospitals and doctors … you pay more. You either pay more directly out of pocket if you have the financial ability to do so, or you buy insurance that will cover your needs – but the fact that insurance for the pricier health care options is going to cost more is not surprising.

That’s the way thngs work. Just like it was free for me to send my kids to public school, but I would have had to pay money out of pocket, they went to private schools. My kids had a legal right to a free public education, but not any education at any school with any teachers that I chose. We had options, but the options were limited.

So yes, it’s a drag if the plan you want with the doctors you want has premiums you can’t afford. But the reason the premiums are higher is that it costs insurance companies a lot more to provide access to those doctors.

So that’s the choice.

And while I understand the frustration, I think there is a disconnect between complaining about having to pay more for what essentially are luxury goods within the market. We all have to make adjustments in life based on what we can afford, whether it is the house or apartment we live in, the mode of transportation we use to get to work, the clothes we wear.

I don’t think the CSR subsidies were ever meant to provide low-wage earners with access to 5-star facilities. Those qualifiers are one tier above Medicaid. So they are expected to pay a little bit into the system … but the point of the system and of the financial help they are given is to insure access to a basic level of care, so that no one suffers or dies because they can’t afford to see a doctor. And it makes a lot of sense for insurers to set up cost-controlled, limited network plans to provide the care in a way that can also minimized premium costs.

But that’s very different than someone deciding that one set of doctors or providers are not good enough. Everyone has a right to make that determination, but people who want that choice should reasonably expect to pay more.

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To be clear, I did pay extra to keep my doctor. When I was on the exchange, I opted for BCBS which cost close to double the cheaper one (Aetna? I can’t remember now) because it had U of M and my doctor in-network. I’m fine with that- it’s a choice I made.

All I was trying to convey was that there are reasons why someone young and healthy would chose a plan to keep their doctors. I’m not saying that that means they’re entitled to the cheapest plan AND their preferred doctors.

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I guess I didn’t make my original post clear. What I was upset about was the fact that the premium more than doubled. We always expected that he would have to pay more for the better network and we have no problem with that. It was the size of the increase that stunned me. I was expecting something like a 15-20% rate increase, not 100%.

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The problem is people who buy plans that include expensive doctors and hospitals then end up using those expensive doctors and hospitals, and they’re expensive, and that makes premiums skyrocket for those plans. This is why in some places, plans have stopped even including the expensive doctors and hospitals. I mentioned upthread that in my area, no individual plan includes price-gouging Stanford Hospital and price-gouging Lucille Packard Children’s Hospital, because they price gouge.

The premiums doubled for your son’s plan but not other plans because your son’s plan includes expensive doctors and the other plans don’t. The right place to complain is to the expensive doctors and hospitals for being expensive.

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We live in VA, a non-medicaid expansion state. DD barely made enough for the subsidy last year and her income stayed the same this year. She went on the preview website and it looks like the floor for the subsidy went up. So she is stuggling with making too much for medicaid and not enough for the subsidy. Did anyone else see the floor go up? Her premium for her current BCBS silver plan doubled, too.