I hope you’re right, CF, although 20-25% increase is more than I’d like to pay. We’d still be looking at paying $3000-3500 more next year. I guess I’ll find out for sure in 2 weeks.
I guess my number one kid is in the hole…he earns $42000 a year. So…guessing he needs to look at Gold plans…and see the costs.
I think he will have an increase anyway.
Kid 2…with no income will be buying from the company directly. Her situation sort of stinks.
At $42K, he would still qualify for a small subsidy.
@thumper1 What is the Medicaid option for Kid 2 in her state of residence?
I believe @thumper said Kid 2 is in Georgia, which is not an expansion state.
If Kid 1 was getting a subsidy, and he has the same income this year, his price for the reference Silver plan is the same this year as it was last year. Since the reference Silver will be more expensive this year, his subsidy will also be bigger if he had one last year.
@shellfell, a 25% premium hike is pretty awful, I’d say. But there we are.
I had to pick up a couple of prescriptions today, so I decided to investigate what my costs would be if we get a plan that doesn’t cover prescriptions (well, they’re covered, but they’d be part of the deductible, which is pretty much useless). The pharmacy said there’s no way to tell! The “cash” price is listed on each receipt, but the cost the pharmacy can charge varies on the insurance company, and they don’t know what that will be until they ring it up. 
She said that theoretically you can call each insurance company to get the information, but she’s had customers who have done that and then the price rings up differently later. This is ridiculous.
Remember that if you don’t get a subsidy, you can buy directly from the insurance companies. Their direct plans (for next year at least) still have to include the same basic coverages under the ACA that they have since it was passed. Sometimes they sell plans with some variations from what they are offering on the exchange.
You may find that they have extra rules, though (like requiring proof of residence in the state – I got hassled last year about D1’s residence when I put that she was an OOS college student with home residence in my state, but in the end they sold us the insurance – but I needed to get evidence of her enrollment from the school). In general I’d buy through the exchange if you can, but there are other options if you aren’t getting the subsidy anyway.
@MaineLonghorn --very true about lack of transparency in RX drug pricing. I have been enrolled in high deductible plans in the past, and the pharmacist cannot tell me how much I had to pay until running the RX through, as if it were actually processed. I now have a tiered copay plan, but am surprised from month to month at how much I will pay for each RX.
Mail Order Drug copay for 90 day supply is not always lower than three copays at retail. Retail can take advantage of coupon promos offered my manufacturers, whereas MOD cannot. It is a mess.
@CT1417, I know what you mean. Supposedly I have a “$15.00"copay”, but the amount is different every month, for every med! So maddening.
The whole healthcare marketplace is rife with lack of transparency on pricing. The pricing of healthcare policies, especially with ACA, where you know you are getting a minimum of mandated coverage, and the exchanges, where you can at least see side by side comparisons and quotes and pull up detailed coverage policies, is much more transparent then the provider end.
I suggest the opposite. If you are getting subsidies, or you might get subsidies, buy through the exchange. If you are definitely not getting subsidies, be safe and buy off exchange, directly from the insurance company. Insurance brokers will be happy to help you buy, and you will not pay any commission.
I was just looking at Pennsylvania prices. For two 60-year-olds buying Silver, the difference between on-exchange and off-exchange prices was around $18000/year. Not a typo, eighteen thousand dollars a year. (Pennsylvania, like California, loaded all of the CSR surcharge onto Silver on-exchange plans.)
If you buy insurance directly from the insurance company, not a short-term plan but a regular insurance plan, you get the same protections you get if you buy on the exchange. All policies are required to charge the same price to everyone of the same age (community rating), they can’t ask you about your health conditions (pre-existing condition protection), and they have to cover the essential benefits.
(Post edited. I did my math wrong.)
@“Cardinal Fang” thank you for starting this thread and sharing your knowledge. I am in the process of either renewing our individual insurance or shopping to see if we can get better value as a group (we own a small business). We are in WI and rates don’t seem to be available yet, however I did run into something you may have input on - a healthshare company called Aliera. We do not qualify for any subsidies and our bronze plan has exceeded our mortgage already for two years, not including deductible. Do you have any input on a healthshare organization?
We used to buy off-exchange since we don’t get subsidies until our 2017 premium went up 40% over our 2016
premium, and that was still the least expensive off-exchange plan we could get. Our 2017 exchange plan, with the same benefits, etc, was only 10% greater than what we paid off-exchange in 2016. I don’t think you can say that buying directly from the insurance company is less expensive than buying on the exchange.
Aliera sells regular insurance, but they also operate a health sharing ministry, Unity. Their website is remarkably uninformative about it, which I find suspicious. However, I found the rules, which are similar to rules I’ve seen for other health sharing ministries.
Health sharing ministries are faith-based organizations where members pay a fixed fee every month (just like a premium) and it goes to pay other members’ health costs (just like a premium). Members have to sign a statement of faith, and have to agree to abide by certain restrictions, including:
Praying and going to religious services
Not smoking
Not abusing alcohol (they are not specific about this)
Not using of illegal drugs
Not abusing of prescription drugs
Exercising regularly
Eating a healthy diet
If you get sick and the organization discovers that you didn’t do these things, it doesn’t have to pay your medical bills and it can throw you out without refunding your money.
They don’t cover ongoing prescription drugs. They pay for 45 days of a prescription only.
If you get expensive, they can take over management of your health care and dictate what providers you go to and what services you get. This is “voluntary” but if you don’t agree, they won’t pay.
They can reject applicants who have pre-existing conditions, and in any event, they don’t pay for treatment for pre-existing conditions if you’ve gotten treatment for them in the previous 2 years. If you are treated for something expensive in the first 90 days of membership, they will investigate to see if it was pre-existing; if they decide it was, they can throw you out.
Mental health services are not covered. Obviously, addiction services in particular are not covered, since they involve drug abuse.
If you want a hysterectomy, their investigators have to determine it wasn’t for birth control before they pay for it.
They don’t cover childbirth for the first 10 months of your membership, and after that, they’ll pay only $5000 for a vaginal birth and $8000 for a c-section that was necessary according to them. They have a limit of $50,000 for newborn care, so someone whose baby is in the NICU is on the hook for a pile of bucks.
If too many members have expensive health needs, they can raise your premium at any time.
After you have been a member for two months, you pay your “premium” directly to the person whose bills it will pay. They are not clear about what that person does if you don’t pay promptly.
A child born to you can be put on your insurance plan. A child adopted by you can be rejected if they’re too expensive.
Hospital expenses have to be “pre-notified” or they might not pay; this includes emergency admissions to the hospital. Even if you notify them in advance according to their guidelines and they give you the go-ahead, they still might not pay. You have to keep notifying them when you’re in the hospital, and if they determine you don’t need to be there any more, they can stop paying.
You get a max of six appointments a year for physical therapy, speech therapy, respiratory therapy and occupational therapy. That’s six total, not six each.
They pay “reasonable” charges. They decide what is reasonable.
There is a “shared responsibility” amount-- that is, a deductible.
Health sharing ministries count as insurance for purposes of the individual mandate.
These ministries pretend they are saving money by only covering the Godly, but actually they’re saving money the usual way: by not covering people who need health care. They don’t allow sick people to join, and if someone gets sick after joining, they have all sorts of ways of not paying for them. In addition, they don’t cover ongoing drug prescription, they don’t cover mental health, they pay a pittance for labor and delivery and they don’t cover expensive newborn care. They have a loophole about not paying for anything resulting from an illegal act, although I don’t know how seriously they enforce it. One could imagine them denying treatment for someone who was driving 10 mph above the speed limit and was T-boned by a drunk.
I don’t say that. I say that in some cases it is very very very much less expensive than buying on exchange.
So how much less expensive are the health sharing ministries? I’d love to join one without the religion part, ha. The no-smoking, no excess drinking, no drugs part would suit me fine. Maybe a Healthy Living plan.
There’s some plan like this that advertises frequently on Sirius. Can’t recall the name.
Senators Lamar Alexander and Patty Murray have just reached a deal to continue the cost sharing subsidies for two years in return for giving states “more flexibility in the variety of choices they can give to consumers.”
https://www.nytimes.com/2017/10/17/us/politics/alexander-murray-deal-obamacare-subsidies.html
“Health sharing ministries count as insurance for purposes of the individual mandate.”
But these aren’t ACA compliant, right?
They’re a lot less expensive (but then, they don’t cover prescription drugs). Alas, there are none without the religion part.
My take is that you should LOOK at both the exchange and individual companies if you aren’t eligible for a subsidy. You may find a better price off the exchange. BUT… there are situations where the simpler rules of the exchange are helpful.
Example: 2 years ago we were moving to a new state. Was trying to purchase a plan in November for D2 starting Jan. 1 in the new state (our official “move” wasn’t until end of December from our old state, so she had coverage there). D2 was away at college in a 3rd state, and did not have any proof she lived in the new state. She didn’t have a driver’s license there, and my apartment complex cut me a break and didn’t list her on the lease (they would have had to charge more) because she is really only home a couple of months out of the year. She was not going to be “boots on the ground” until the last week of December, when she applied for her driver’s license within 24 hours of getting home from college.
The insurance company in the new state (one of the Blues) would not sell her a plan via their regular company process/website because she couldn’t provide that proof of residence. BUT, the very helpful customer service person I worked with said (when her application was rejected), “Go buy on the exchange, they don’t ask for that proof there. Here is the plan that is the closest equivalent.” It was priced the same, too. So we did end up having the exchange work better for us than a direct purchase, at least that year.
Health sharing ministries are ACA compliant in the sense that they count as insurance. However, they don’t cover the essential benefits. Moreover, there are stories about how they evade paying expensive claims, and they are not regulated like insurance companies. For example, they don’t have to have reserves to pay big claims, like an insurance company would have to have.