<p>That doesnt really answer my question though… </p>
<p>I read that people under age 30 and low income people can buy catastrophic insurance. What is the definition of low income?</p>
<p>Re chiropractic: It is now a state-by-state determination whether it will be covered. This is somewhat amusing to me, because my current (2013) Blue Shield policy does cover chiropractic, but California is one of a handful of states that does not require it under ACA, so my new policy will pay for acupuncture but us eliminating coverage for chiropractic.</p>
<p>The reason I say it’s amusing is that I had not been to a chiropractor in more than 20 years, but I need one now. Turns out that there is a very popular chiropractor a few blocks from me, so I made an appointment and he fixed me right up. I did have them run my current insurance card but as I have not used my deductible, they told me that they would charge me less if I simply worked with them on a cash basis.</p>
<p>So the one medical expense that I know that I will use won’t be covered in the future. Not a big problem – but it’s one more reason I like my HSA. (I double checked the law - it is definitely OK for me to pay for the chiropractic visits with the HSA. Though I am thinking that it would NOT be OK to pay for the massage therapist at the yoga studio down the road from him out of HSA money, even though the reason for the visit would essentially be the same.)</p>
<p>I think you misunderstood what you read. (or whatever you read failed to explain it).</p>
<p>If the lowest Bronze level premium in a region would cost more than 8% of household income, the person is eligible to buy catastrophic. So it is a matter of the relationship of income to premium cost.</p>
<p>I think this is more likely to impact older, middle income people whose income is too high to qualify for subsidies, and who are also facing high premiums. So perhaps a 62 year old who earns $52,000 in a high cost area who is faced with a $600 premium for the Bronze policy might want to save a few premium dollars and go with catastrophic.</p>
<p>The catastrophic would never be a good option for the low income person – because that person would be eligible for Medicaid or a subsidy. If the person is below poverty line and lives in a state that didn’t expand medicaid, I think they’d do better to skip the insurance altogether than pay for the catastrophic, which is just spending money he doesn’t have on a policy that won’t pay for what he needs. He’s not going to be able to afford to meet the deductible in any case, so buying a catastrophic policy doesn’t really help him.</p>
<p>So people who get no subsidies whose premiums exceed 8% of AGI are eligible for Catastrophic?</p>
<p>A family of 4 with 100k AGI whose premiums are 8100, should be eligible?</p>
<p>“they told me that they would charge me less if I simply worked with them on a cash basis”</p>
<p>Do they know Flossy? :p</p>
<p>“If the lowest Bronze level premium in a region would cost more than 8% of household income, the person is eligible to buy catastrophic. So it is a matter of the relationship of income to premium cost.”</p>
<p>Ok…so we read that people think their insurance premiums are too high and they want catastrophic insurance.</p>
<p>I think this is more likely to impact older, middle income people whose income is too high for subsidies"</p>
<p>Yes.</p>
<p>So… What are the premiums for catastrophic coverage in Ca for somebody that is age 60 and premiums in the bronze plan are 12 percent of their income?</p>
<p>I realize premiums vary by region.</p>
<p>How would selling one’s house for a $30,000 gain change the subsidy amount? A gain of that amount of the sale of a residence wouldn’t appear on a 1040. Therefore, it’s not included in MAGI, correct?</p>
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</p>
<p>[Sticker</a> Shock Often Follows Insurance Cancellation - ABC News](<a href=“http://abcnews.go.com/US/wireStory/sticker-shock-insurance-cancellation-20764181]Sticker”>http://abcnews.go.com/US/wireStory/sticker-shock-insurance-cancellation-20764181)</p>
<p>This means until this family spends more than $28,000 in a year on its health costs, the insurance is worthless. I just don’t see why anyone would buy this insurance.</p>
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<p>Yeah, he couldn’t possibly use the insurance, because no healthy 64-year-old ever has an expensive condition. Oh, come on.</p>
<p>I’m also kind of confused about the policy he is talking about. The article says it’s a Bronze plan, but then describes what sounds to me like a catastrophic plan: a $12,700 deductible where nothing is paid for until the deductible is reached. Even for a 64-year-old couple, $1275 a month for a catastrophic plan sounds pricey.</p>
<p>When they’re 65, they’ll get public insurance – Medicare.</p>
<p>I am under 50. My monthly oremiums in gold were going to be $524 a month. I assume they would go up each year. </p>
<p>It all depends in what plan , what tier, what state you live in. </p>
<p>And your age. And your deductible.</p>
<p>But why are you even looking at Gold? The system is built around the assumptions that most people will want the Silver plans. The maximum out-of-pocket is no different between Gold & Silver, so if you are looking at the California policies, the primary difference is that Silver has a $2000 deductible, and Gold has no deductible and higher premiums which amount to roughly 80% of the deductible you no longer have.</p>
<p>If you had to buy on the individual market and you were eligible for subsidies, you’d probably opt for Silver. If you knew that you would not be eligible for subsidies, in most cases you’d go for Bronze.</p>
<p>Because Calmom, the plan I currently have (and liked) was a gold plan. I wanted to see an apples to apples comparison. </p>
<p>It would be crazy to sign up with Kaiser and negotiate the BS that goes with it, if I didn’t have full coverage. </p>
<p>That gold plan was $1666 per month, $19,992 per year, with a possible subsidy brining it lower. But essentially everything is covered, minus small co-pays with no deductibles. </p>
<p>The Bronze Kaiser with my stats looks like this:</p>
<p>1090 monthly, family of five. Possibly could get a subsidy bringing it down to 800. So far, so good. </p>
<p>$5000 individual, $10,000 family deductible.
30% negotiated hospital stay
Max out of pocket one $6300
Max out of pocket $12700</p>
<p>The silver Kaiser with my stats looks like this:
$1462 monthly, family of five
Possibly could get subsidy, bringing it down to $1126 monthly</p>
<p>$2000 individual deductible, $4000 family deductible
$250 individual, $500 brand name family deductible
20% negotiated medical stay
Max out of pocket $6350 individual, $12700 family </p>
<p>Kaiser is great, if you need care such as hospitalization. It is a huge hassle to get it, though. Took 18 months for family member to get surgery for a chronic condition. I waited a nearly month to see a podiatrist on the plan, thinking a bone might be broken in my foot. I could have gone to urgent care. I finally did. They didn’t take the correct kind of xrays, waited a few more weeks, finally saw a specialist. It is all gatekeeper medicine. </p>
<p>So let’s say I think my family has an outside chance requiring surgery that year. Does it make more sense to pay $13,512 in monthly premiums to get essentially 1 free preventative visit per family member? I would have to rack up $2000 more in costs before they paid one dime. If two fam members had problems, well we get to do that again, up to $4000 total before tgey pay. </p>
<p>So my net cost outlay could be between $15,512 to $17,512 before Kaiser picks up stuff beyond that ine preventative care visit per fam member. </p>
<p>This is highly illogical. </p>
<p>I chose Kaiser a few years ago, knowing that as an HMO, they would make certain rules, you follow them and medical care coverage is there and relatively cheap.</p>
<p>If I have to pay deductibles and 20% hospital or 30% hospital, I would go back to flexibility of a PPO. </p>
<p>I still haven’t met my primary care doc at Kaiser. Last time I was in, she was out and I saw someone else. The first one I had there was good, but her office was a hassle to get to and with little parking. I moved to another office. Back when we had PPO’s we could make a call to office, figure out if we needed to come in and sometimes get advice over the phone. </p>
<p>Kaiser wears you out a little. Getting an appt, getting nurse advice - it is all tech based. Log in. Easy as pie. Except when you think you have ordered your prescription and it says so online, but no followup with doc’s office to say they cannot fill without being seen again. Who would have known? We waited ten days for prescription to arrive, thinking it was on it’s way. </p>
<p>We chose Kaiser because we needed no more financial surprises for a few years.</p>
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<p>The law says that everybody has to buy insurance, that rates are determined by age and region, and that for each policy offered in a region, everyone of the same age gets charged the same rate.</p>
<p>I don’t think there’s any way for a market to be structured that is more fair than that.</p>
<p>The ACA will be judged on whether the increases in costs are smaller on average for the average person, not on whether there are any increases, or if relatively few have increased costs. </p>
<p>You’re right. </p>
<p>The problem here is simply that there is no average person. One-size-fits-all is ridiculous IMHO.</p>
<p>
But that is an employer-provided, employer-subsidized plans. The employer plans have always been better than plans on the individual market, and they still are better. So you should be grateful that you are eligible for employer-provided insurance. Now what you have, that you didn’t have before, is the knowledge that you could still get insurance even if you lost eligibility for employer-provided insurance. </p>
<p>The gulf between employer-provided and individually purchased insurance has narrowed somewhat because of the essential benefits requirement, and there is also now a tax subsidy which fills the affordability gap for those on the lower end of the economic spectrum who don’t have an employer willing to pay the lion’s share of their insurance premium – but no one ever promised that Obamacare would match the best employer plans. </p>
<p>The difference now is that you are assured of getting coverage. Even if you could have opted for COBRA before, the COBRA would eventually run out and you would have had to go to the individual market, where your premium would have been rated by both your age and health history.</p>
<p>I’m sorry you aren’t all that fond of your experience with Kaiser. I’ve never used Kaiser – do you know why? Because there NEVER has been a Kaiser plan that was even remotely affordable to me as a buyer on the individual market. Whatever Kaiser offered, it was always significantly more for premiums than what I could get from Blue Shield or another PPO-based insurer. And yes, I have always had deductibles and they have gone up, and up, and up for the last two decades. That is simply what life is like when you buy on the individual market.</p>
<p>
Good thing that accidents and expensive illnesses like cancer are so highly predictable, right?</p>
<p>We did have individual plans that we were rated on in 2010 and 2011, after COBRA ran out. </p>
<p>That plan we had with individual Kaiser was nearly identical to the employer plan we have now. In fact, when we signed up with new employer package, it was exciting to realize we would not lose this plan. We only had very small co-pays, no deductible to meet before getting care. Yes, preventative has always been included in Kaiser. </p>
<p>Only now, that same plan will cost $500 more per month, after ACA if we buy on exchange. Some will get subsidies, some will not. It all depends on family MAGI. For us, that varies from year to year. </p>
<p>Sure, I take comfort we cannot get cancelled. </p>
<p>That we can get underwritten. </p>
<p>Still, it is a lot more money.</p>
<p>Ok… I am disappointed. </p>
<p>I cant find out what catastrophic plans cost when people are older than 30.</p>
<p>This info would be more valuable than reading about some couple that doesnt understand their insurance.</p>
<p>The cost would depend on the specific insurance company and region. The plans are sold off-exchange – why don’t you try running a quote at ehealthinsurance.com?</p>
<p>ehealthinsurance isn’t giving me quotes for catastrophic plans. I tried, to figure out what would be going on with the Pennsylvania couple, but ehealthinsurance showed me no catastrophic plans.</p>