<p>“If you made 115,000 for same family of 5, no subsidies and its 1607 a month. Before deductibles.”</p>
<p>Who, in their right mind, would want to pay $1,607 per month for a silver plan, that only covers 70% of your health care costs? That stinks! Why would anyone think this is a good deal? Even if you were to get subsidized for it, you’d have to have an extremely heavy subsidy to make it a decent plan. Terrible.</p>
<p>“As for people making $115,000 in Washington State, they can afford health care - the problem has been that, in many cases, no one would sell it to them. That problem has been solved.”</p>
<p>Seriously? If you make 115K, you can afford $19,200 for health insurance? At that rate, people would prefer to go uninsured, or only purchase a catastrophic plan. The only people who would purchase this are those who have an extremely desperate need for insurance, and couldn’t get it anywhere else. And then they’d be paying 30% of their health care costs, probably unsubsidized. That could bankrupt you.</p>
<p>"And this age group does want insurance… How many people here dont want their grown up kids to have insurance?</p>
<p>Many parents are going to chip in and help…
If your kid is going to grad school or med school or law school or doing low paid work…you aren’t going to help your kid if you can?"</p>
<p>Yes, mom and dad will help by allowing them to stay on the family insurance plan until they are 26. They are not going to get many young, healthy people to sign up under the age of 26. May as well count those kids out.</p>
<p>Busdriver, no, the exchange isn’t built for someone at 115k. Best I figure, they don’t use the exchange, which better suits moderate and low income. They shop around or stay on an employer plan.</p>
<p>“Busdriver, no, the exchange isn’t built for someone at 115k. Best I figure, they don’t use the exchange, which better suits moderate and low income. They shop around or stay on an employer plan.”</p>
<p>But how does this plan sustain itself if only the people who get the highly discounted rates sign up for it? If the only people it is a good deal for (through getting very heavy subsidies) sign up, who pays for it? The states have no money, they’ve already raised taxes, both state and federal. Where do they get the money?</p>
<p>The patient pays 30% up to a maximum of $12,700 for the family. So if you are in a financially more secure position-- or you know that you have high medical expenses-- you can opt for the Bronze plan (lower premiums).</p>
<p>Do the math: create a spreadsheet and look at total premiums and compare with different health care scenarios. Then look at what your family’s history of health spending has been. </p>
<p>I am curious as to how you have been buying health care in the past, because I never was able to afford to pay for family coverage. Even back when I was still married, we had 4 separate individual plans: my husband’s, mine, and one for each of the kids -that originally was assembled with the help of a knowledgeable agent. That was still cheaper than putting us all on one policy. </p>
<p>
The subsidy leaves the the family paying $871/month – that is WAY, WAY better than anything that was ever available to me for family coverage – I know many people who have been paying that much for individual coverage.</p>
<p>This year in California, several insurers are basically not going to write any new policies for individuals. They will still stay in the employer-based market, but self-employed individuals will be out of luck. One example is Aetna. A co-worker who buys her own individual plan (we do not get insurance at our jobs) paid 250/month for a high deductible policy last year. This year it went up to 454 per month. Last week she received a letter saying they are terminating her policy. </p>
<p>But she is welcome to buy the insurance through the exchange. If she can afford it. </p>
<p>It’s only mid-July and we have lost three major health insurance providers for this market. </p>
<p>The concern I have is that many of us who wouldn’t NEED to use the exchange will have to default to the exchange when more insurers jump ship.</p>
<p>I went to the NJ State website and looked at all the plans that are available for people in my county, and I chose one that looked like the best coverage for me. I’m not sure I made the right choice since I didn’t have anyone to help me wade through the options.</p>
<p>Like I said, I have a complicated situation. I used to work and paid 100% of my health insurance premium through the group plan. Then I stopped working due to disability. I do not have COBRA. I’m on SSDI, but in the middle of the 2-year waiting period before I become eligible for Medicare. Since I stopped working, I have been private paying for an individual plan (around $650/month). There are less expensive plans, but I need one with an OOP maximum, given my medical situation.</p>
<p>My husband has been disabled for about a decade, and he has Medicare. Luckily, he also has SSDI plus income from a disability policy that just barely cover the cost of his nursing home.</p>
<p>It’s a good thing my children are covered by their father’s (my ex’s) insurance since there is no Medicare “family plan”. The spouses and children of people on Medicare need to fend for themselves.</p>
Mathematically, that leaves the family with almost $96K left over. That’s about twice what I have every year of my life.</p>
<p>I know they have taxes to pay – but so do we all. </p>
<p>Don’t just compare the $115K earners with the $110K earners (right at the cut off) - look at how they compare with the family earning $90K - ($713 premium after subsidy; $8556/year). So that $90k family pays less, but in the end they’ve also got less than the $115K family. </p>
<hr>
<p>What are you doing now for insurance? Are you on the private market? What do you pay?</p>
<p>In my experience, family medical plans were always more comprehensive and would be less out of pocket expense in terms of deductibles if multiple family members had any kind of costly medical issues throughout the year. </p>
<p>We have been individual-insured, employer-insured with employer contributions, and COBRA insured. Back in the mid-1990’s with the youngest child, we had a CIGNA HMO, paid around $350 a month for the whole family. Covered nearly everything with a small copayment for prescriptions. Once I had my own insurance for a brief period of time with the rest of the family on one plan. </p>
<p>Our employer picks up 60% of our health care, we pick up the other 40% for premiums. Have a great HMO plan. It was more expensive than the PPO’s, but we knew that surgery was inevitable. Our co-pay for the surgery - $100. I spent more in the parking garage and cafeteria while waiting for patient to get out of the hospital.</p>
<p>The rub is that we have a compromise plan that relies on private insurers rather than a single government plan - which in some countries is then run through private insurers. The idea, as has been stated, is that you need younger healthier people to sign up for insurance to make the pool large enough that it can insure the risks at a rational cost for everyone else in the pool. That means the people who make upper middle class livings get squeezed; there has to be a phase-out of subsidies somewhere. </p>
<p>The pool idea is no different than pools of mortgages or other obligations - like car loans or other consumer debt - that is evaluated, rated and sold. An insurance pool is rated. The problem has always been that without a mandate - something Heritage Foundation focused on very early - the people who are the healthiest don’t pay for insurance. NY, for example, tried to increase coverage by eliminating rules against pre-existing conditions but the cost of insurance for individuals remained too high because the pool wasn’t large enough and didn’t contain enough healthy people. </p>
<p>So the pool sustains itself if losses are less than expenses … which include g&a and marketing not merely medical costs. The point of the mandate is to get the pool to that point. But to answer the question of cost as directly as I can: I don’t think there is a good reason for premiums to go up by that much. I think the insurers feel they can charge this because they think they can charge this. They look at what they make if they charge x or x + or - given probable sign up rates, drop rates, etc. and they pick one. They may - who really knows - pick the one that maximizes income to them or they may pick something lower - especially if pressured by state government (as has happened, particularly in CA) - but I don’t imagine they pick the rate that keeps the pool afloat plus a small fudge factor.</p>
<p>As some have noted, there are winners and losers in every game … except if we had a single, Medicare-like program for all. </p>
<p>I’ve been talking about this with my brother, a doctor. He has persuaded me the problem is the insurers themselves, that their vast administrative processes and marketing expenses create a veritable wave of paper that eats up his profit margins - requiring whole staff people to process paper to get paid. He hates insurers.</p>
<p>BTW, private insure g&a plus marketing is generally described as over 20% of revenue, sometimes pegged around 30%. Makes sense business-wise: they pay out claims, have staff, real estate costs, g&a, marketing and profit margins. They also have earnings from investments - and other business lines though I have no idea how that is factored in. They aren’t going to have profit margins of 40%.</p>
<p>“I am curious as to how you have been buying health care in the past, because I never was able to afford to pay for family coverage. Even back when I was still married, we had 4 separate individual plans: my husband’s, mine, and one for each of the kids -that originally was assembled with the help of a knowledgeable agent. That was still cheaper than putting us all on one policy.”</p>
<p>For us, we’ve always had family plans paid for by our employer, though they made my husband go on a separate employer plan a few years ago. Between the two of us, we’ve never paid more than $200 per month for premiums, thanks to our union negotiators. Should we retire before age 65, we have to pay the full cost of our plan without company help, but right now it is only about 14-15K/yr for an excellent, low out of pocket, high coverage plan. </p>
<p>“The subsidy leaves the the family paying $871/month – that is WAY, WAY better than anything that was ever available to me for family coverage – I know many people who have been paying that much for individual coverage.”</p>
<p>Depends upon which family you’re talking about. Apparently after you make 115K in Washington state, there is no subsidy, so you pay the full boat. Nobody would pay that unless they were otherwise uninsurable.</p>
<p>“Don’t just compare the $115K earners with the $110K earners (right at the cut off) - look at how they compare with the family earning $90K - ($713 premium after subsidy; $8556/year). So that $90k family pays less, but in the end they’ve also got less than the $115K family.”</p>
<p>It doesn’t work like that. People aren’t going to say, “Hey, look how much more I make than the other guy, so it’s just fine if I pay outrageous prices.” They are going to comparison shop, regardless of what anyone else pays, they will look at what they will pay. And higher earners won’t go on these plans if they can find a better deal in the private market.</p>
<p>Samurai, I’m not a fan of insurance companies in general, but one reason I’ve stuck with Blue Shield for many years is that Blue Shield California is nonprofit. “Nonprofit” doesn’t meant that my rates never go up, but it does mean that my rates aren’t going up to benefit investors, and they aren’t going up in order to subsidize some gargantuan salary of a CEO. AFAIK, Blue Shield is still writing policies for individuals – I never had any problem finding an individual policy from them in California, though I did have to opt for a higher deductible to keep the premium affordable. </p>
<p>My kids have had Aetna policies through their respective employers, in two different states, and neither one of them was particularly happy with their coverage. I don’t really know – they looked like good plans on paper to me – but I think my kids were dealing with the day-to-day issues of finding health care providers who accepted the plan. </p>
<p>The companies that are pulling out of California are doing so because they don’t want to compete in the market --but that doesn’t mean that there won’t be coverage. Others will come in to fill the gap left by their withdrawal. If the finances don’t work out so that the companies can pay their employees and break even, then I guess a nonprofit like Blue Shield will have to raise rates --but I think they will still be hear and happy to fill whatever gap is left when the profit-seekers go off to try to find different ways to make money.</p>
<p>Here’s a link so you can see how tough life has been for Aetna and its suffering stockholders over the past year: [Aetna</a> Inc: NYSE:AET quotes & news - Google Finance](<a href=“http://■■■■■■/ih8T8]Aetna”>http://■■■■■■/ih8T8)</p>
<p>This is a college board. How many families are paying $10K, $20K or $30,000 or even full pay per year on their child’s college education? I know we are paying a bunch plus PLUS loans for my other kids. I work with families all the time that make around that amount. They also do not get a ton of financial aid but assume loans, as do the parents. If say $100K is AGI, what is left to use on housing, food, medical, auto and yes, even things like tuition/housing and books? </p>
<p>For us, we pay about $600 a month for our family plan, with H’s employer picking up almost 800, which is a perk. This is a premium plan with no deductibles, as long as we stay in network. Our co-pays are not expensive. </p>
<p>Previously our COBRA for PPO was $1200, unsubsidized. </p>
<p>Yes, everyone pays taxes. Yes, we can leave California. Which is the plan. It’s killing us.</p>
<p>“The idea, as has been stated, is that you need younger healthier people to sign up for insurance to make the pool large enough that it can insure the risks at a rational cost for everyone else in the pool.”</p>
<p>That all sounds great, but if those young, healthy people aren’t making much money and getting heavily subsidized…but using those health benefits for preventive care because now they have them, these plans could go negative quickly, even if they aren’t trying to make a profit. If only the people who are getting the cheap deals, or the ones who have a higher income but have a high need sign up…with upper middle class people walking away, this could turn out badly.</p>
<p>“And that’s a problem because…
(The median household income in California is $61k.)”</p>
<p>That’s a problem because somebody has to pay. You can’t just offer a huge amount of cheap medical coverage without someone one paying for it, or the program will go bust. Unless of course, that’s the intention.</p>
<p>But you will still have that. Your insurance hasn’t been costing $200/month – that is just the SHARE you paid, while your insurance was picking up the bulk. The way you find out what it is really has been costing is to ask your HR department for the COBRA number.</p>
<p>I think you would be really surprised at what these policies really cost. You are getting a large employer subsidy now and you probably will continue to get that subsidy. The exchanges are designed to help out those of us who have been buying on the private market – I can assure you, we are used to seeing plans that cost a lot and barely cover anything. No sticker shock really. I pay $400/month for a plan with a $3500 deductible, $5000 maximum out of pocket; the online calculator for the Silver plan says that it will cost $600/month - but that’s probably without the huge deductible-- so mathematically it’s probably close to the same.</p>
<p>I am not against the idea of ACA. We were pretty financially desperate for a long time. I am grateful he has a job with insurance but we were looking to move for financial reasons and now I see these premiums and wonder if we shouldn’t stay put and keep employer coverage in the foreseeable future, especially until we know what happens in October. </p>
<p>My worry is that we will be priced right out of the market with less insurers charging more than they even were.</p>
<p>Like many, we are all one job loss away from financial ruin. For our family, we are getting by with a lot less than we used to and with staggering bills that remain from extended unemployment but with the same bills as before. Even cutting back on household expenses and asking for Professional Review with kids in colleges, colleges still expected a good chunk of change…so did our bank, the Franchise Tax Board, County Assessor, etc.</p>
<p>Grateful to have insurance and coverage for my twenty-something adult kids. Just wondering how this is going to all fall out. Like most of us.</p>