Affordable Care Act Scene 2 - Insurance Premiums

Parent Cafe
3041

<p>Emilybee, as I said, I’m in the clover. The concern was before we knew the numbers for ACA and how they would impact what my son’s premim cost when he goes off our insurance which will be very soon. In September, I got the COBRA numbers by request and they were very high, as were our choices pre ACA, with some plans that were not comprehensive as well. Not good which meant our son who is now covered for no cost would incur cost of about $5K which he could not swing on his own. That, by the way, is just the premium cost and if he did have need of health care, the deductibles and copays would come into play. With ACA, the max cost would be $6K and only if he had medical expenses that went that high, as that is the deductible for the catastophic plan, and actually it would put money back into his pocket through tax credits if he chose that. For less than $1200, he will be able to get very good plan, with out of pocket maximus of about $3K if he hits a bad stretch in terms of injuries, ailments, which we hope he does not. The tax credits actually pay for most of that so that means, we pay zippo unless he needs medical care, and then we’ll see what we have to cover up to that deductible. It’s nearly as good as staying on our plan. So I’m happy for now. </p>

<p>But I do want to know what is on the exchange for us, if DH should leave his employer. Yes , we can get COBRA, but what would we have to pay on the exchange? These are questions I had about this whole thing. Is this a good thing for our family specifically if our circumstances were different? What about families like ours who are buying their own insurance? It appears that in NY, cutting of premium prices due to the competition from the market, and the shoring up of the policies that ACA requires, makes it a bit easier to shop policies, but I think we would pay more, due to our income. Other areas in the country, ummm, jury is still out. As other have posted on this thread, the cost will go up.for some people. Makes sense. The money has to come from somewhere to pay for people like my son, and it ain’t gonna come from him, because he doesn’t have it. Getting even any payment from that population is better than the way it has been working, because they tend not to pay throw up their hands if they need health care and we all pay for it. So anything they pay is better than nothing. </p>

<p>There will be a lot of upset folks as there will a lot of them who will be paying more some a lot more. Because they can. Can’t squeeze it out of the stones. </p>

<p>For us ACA, so far seems to have kept every promise given. I realize it will not, for a lot of people. and I had no idea until this month whether we would be in the group who benefits, stays the same or ends up paying more.</p>

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<p>CF, I think you might have misunderstood Cptofthehouse – I think she was saying that she and her husband are part of the “richer people” who need to subsidize “poor people” like her starving artist son. It happens that she will benefit from ACA because she plans to pay her son’s premium for him either way-- but the son is an adult so I think she was just saying that she can see the big picture.</p>

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<p>Cardinal Fang, my son is so income poor, that he is being subsidized,not subsidizing. Yes, if he were earning a living wage, he would be subsidizing the older folks, but as it stands, if he stays healthy, he’ll have extra money in his pocket as he gets a tax credit because of what his income is likely to be this year. His expected income is $16K, he will be 26, with no prexists. Look at what he will have to pay and what subsidies he gets for which plans. Now if he made $60K, it would be a whole other story. In fact, if my son does not make the $16K mark, he will be eligible for Medicaid as that has been expanded. He narrowly misses it, if things go as projected for the next two months.</p>

<p>We are proud, happy, feel blessed and am thankful that for most years our family has subsidized the health industry, as we have not met our deductibles even. We’ve paid in far more than what the companies have paid in health care costs for us. But once upon a time, one of our children was diagnosed with acute lymphocythic leukemia, and those years of treatment were when we were the ones subsidized. We’d be paying for those years still, had we not had good health insurance. And that son would have had a heck of time getting individual health care due to prexisiting conditions, if he ever would have to get his own insurance, if he could even get it. No more. So another win for another family member due to ACA! </p>

<p>Emilybee, at least for 18 months due to COBRA premium limitiations, we would still have done better without ACA as our costs would be higher even with the reductions in premiums that NY insurance companies have put into place. So, ACA did not save us any money if we had to go on the open market this year for a while.</p>

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<p>I’m very skeptical about the doctors who claim they will retire rather than accept smaller reimbursements. Naturally, no one wants their income to drop. But people are bad at saying how they will actually react when something happens. Are any of you sports fans? Have you ever said, or heard other fans of your favorite team say, “I’ll stop being a fan of Favo Team if they ever trade for Evil Player We Hate”? Yeah. Me too. And the minute Evil Player We Hate puts on the uniform of their team, suddenly they see things differently. “I’ll quit being a Sharks fan if they ever sign that headhunter Raffi Torres!” Yeah, right, and then when Torres puts on the teal jersey and scores a playoff OT goal, fans love him. </p>

<p>Same with specialists saying they’ll retire rather than getting a smaller, but still very large, income. I’ll believe it when I see it. I’m not going to cry if orthopedic surgeons have to scrape by on less than half a million dollars a year, and I don’t think they’re going to retire rather than have to accept that meager compensation.</p>

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<p>“But I do want to know what is on the exchange for us, if DH should leave his employer. Yes , we can get COBRA, but what would we have to pay on the exchange?”</p>

<p>I completely understand wanting to know what is out there if one were to leave their employer. </p>

<p>I think almost everyone who has insurance though large employer groups will pay more on the individual market if they don’t qualify for a gov’t subsidy, because we would lose our employer subsidy. It is not that our employer plans are less expensive - in fact - most of them are more expensive in total - then plans on the individual marker - it’s just that the employer is picking up the lions share of the cost.</p>

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<p>He is, oddly, doing both. He is getting a subsidy to pay for his insurance premiums. But that subsidy is not coming from the other people on his insurance plan. It is coming from taxpayers.</p>

<p>From the point of view of the insurance company, which doesn’t care whether a premium is subsidized or not as long as they see the money, he, or his premium, is subsidizing older, sicker people. His premium will be (we hope) more than the cost of his health care during the year. It will also be more than the average health care costs of everyone his age paying premiums in his plan. Younger people’s health care premiums will be higher, so older people’s can be lower. In that way, younger insurance-buyers are subsidizing older insurance-buyers.</p>

<p>Your insurance premium is not higher to cover subsidies. Subsidies don’t come out of insurance premiums. They come out of taxes.</p>

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<p>CardinalFang, as I stated earlier, when managed care hit, a lot of doctors were outraged and claimed they would rather retire. Some did. not just because of the lower pay, but because of the stipulations and monitoring that came with managed care contracts. Doctors lost a lot of freedom and were subject to inquiries if they went over certain quotas for certain procedures. That was not always to the benefit of the patient either, and many doctors did throw up their hands and found other jobs. Some who could went the concierge route. A number simply refused for a while to sign any managed care contracts, but when it hit their bottom lines and it came right down to either toe the line or taking a cut in pay, quitting the medical profession and finding other work, the vast, vast majority came around. Not happy, and still not happy and many blaming every and anything on these restrictions, and sometimes rightfully, but they had to come on board if they wanted to pay those mortgages, their school tuitions,and for some, their own student loans. Not that easy to find jobs that pay as much as what most doctors make,and it’s tough to switch fields anyways. Some did, but most did not. </p>

<p>My prediction is that the same will happen with ACA. I agree fully with you on that one Cardinal Fang.</p>

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<p>I am skeptical too. Nobody wants his/her income cut. We are speculating. I dont think there is going to be a bunch of doctors quitting en masse. There are also plenty of young people that would like to become doctors. </p>

<p>Texaspg provided a link about students matriculating to medical schools in state and out of state. In that link there were percentages of medical school applicants that did not get in anywhere. Looks like the percentage is in the high 50’s for students that did not get into any schools. Maybe that was md schools, but anyway, there isnt a shortage of applicants. </p>

<p>I dont know too many professions that have the security and pay of doctors.
I just visited Manhattan and I was surprised to see how many residences had doctor offices in them. Visiting NY was like revisiting the Cosby show.</p>

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<p>Cardinal Fang, well, you can do the numbers at $16K a year. There were some years he got EIC for NY State. Pretty pathetic. It think for this year he may have to pay some taxes, but not much, and his subisdy for the premiums means even less in taxes, maybe will zero him out. His tax credit due to ACA will exceed the annual premium he needs to pay for most plans leading to money in his pocket that he can use towards any health care costs which I hope will be minimal or none which has been the case for a number of years, especially as he has skipped physicals and other entitlements built into the health insurance. The one year he cost the health insurance company was for his hand injury, and the deductible meant I paid for that as he could not. I likely could have negotiated payment lower than I did in that instance, as the hospital fund was willing to pay about 90% of the cost of that incident. But over his lifetime, he has so far been low cost in terms of health care cost. But even what ended up being a non serous injury, no ramifiacations once the ER doctors treated him, just one follow up for stitches removal and take a look was big bucks in cost Ambulance, ER doctor, Xrays and other scans for glass particles, and then surgeon, follow up, local anesthesa for the hand during repair. Had the glass from the mirror that fell–he automatically tried to save it, cut anything major in the hand, it could have amounted to a veritable fortune in medical procedures to get as much function back as possible. That’s why one wants to have health insurance. Not a hospital in the country would likely let him bleed to death from the injury in their ER-they took him immediately, but getting a hand specialist to reconstruct might well have been a problem if the injury were more extensive. As it was, the cost was shockingly high for about an hour in the ER and a quick follow up check up. Yes, ER had to address his problem immediately due to the profuse bleeding so he beat the usual 3-12 hour wait.</p>

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<p>A friend of mine has employer based insurance and the insurer is Anthem… Same as me. His insurance is better. We were talking and my friend says he pays 350 a month and his company pays 350 a month. I think he thought I paid 700 a month. I said no. Next year I am going to pay close 1400 a month.</p>

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<p>I wish those in the individual market were free to sign up with either the federal government plans or the state plan in the state they live just as if they were a government employee. Even paying the entire premium would give them better plans at less cost.</p>

<p>It creates the option to join a very large group.</p>

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<p>dstark, you’re going to pay $1,400 a month? For how many people?</p>

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<p>cpt, I’m just saying that your premiums are not paying for his insurance subsidies. That’s not where the money comes from to pay his insurance subsidies. You are not subsidizing his health insurance. You do not have a higher insurance premium because he is getting a subsidy.</p>

<p>When his insurance premiums are paid (insurance premiums that are subsidized by the federal government, paid for by taxpayers) those insurance premiums go to pay for health care for older people.</p>

<p>This is not a value judgment. This is the mathematics of on the one hand, subsidizing insurance premiums, and on the other hand, not letting the premiums for older people be more than three times the premiums for younger people.</p>

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<p>Tom1944, that would help. </p>

<p>I could spend a few more days in NY every year. I promise I would spend the money. :)</p>

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<p>tom1944, I totally agree with you. Allow us to have the plans offered to state employees. I would take that in a NY minute.</p>

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<p>What are the typical total premiums for those policies, and why are they cheaper? How is the state of California getting a better deal than people on the individual market?</p>

3057

<p>4 people GP. Two parents. Two kids in their 20’s. Bronze plan.</p>

<p>My friend with employer matched insurance has 2 parents. 2 kids covered.</p>

3058

<p>dstark, for some reason I thought you were getting Kaiser, not Anthem.</p>

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<p>CF- they are very large groups. I will link NJ’s very large selection of plans.</p>

3060

<p>dstark, are any of your doctors going to participate in the network for the Anthem bronze plan next year? Have you asked any of them yet?</p>