<p>I will probably call them this week. Since I am going to take the 3-month extension, there is no rush.</p>
<p>You know the whole notion of whether you can afford something is very subjective. Two people may have the same income and one buys a Mercedes because he thinks it is affordable and the other doesn’t because he can’t afford it. Either one of them is right or maybe they are both right.</p>
<p>GP, I have no idea about the drug formularies, because I really am clueless about prescription drugs. (I don’t take regularly take anything that isn’t available OTC).</p>
<p>There is some subjectivity…</p>
<p>I was going to call Anthem tomorrow, ask them a question, and sign up but after spending time posting here, I forget what i was going to ask. Maybe the question will come to me. :)</p>
<p>Paying an extra $5,000 a year does stink. I dont want to pay $4200 more but I will.</p>
<p>Calmom, as much as anything, I was looking for some clarity. I have no idea what GP is basing his statements on. I get that, in the end, what can matter most to us, as families, is how it impacts us, as families. But the thread still keeps cycling back to generalities-</p>
<p>Not going to check 2nd Silver, since it would need a full re-do.</p>
<p>$63k- no subs
Age 45 619
Age 58 1092
Age 60 1163 </p>
<p>Yes, this is tougher as one gets older. We’re looking at 62 or 63k, assuming no kids as dependents. We don’t know about financial strength. I’m not comfortable with how it is tiered- but I can understand they had to come up with some framework…</p>
<p>Note how, for this exchange, their prices before subs and the BC costs are roughly equal.</p>
<p>One last thought about affordability:</p>
<p>If my wife or I come down with a chronic condition and I have to pay $20,000 to $25,000 a year between deductibles and premiums for a number of years, I may change my mind about whether I can afford this.</p>
<p>“You know the whole notion of whether you can afford something is very subjective.”</p>
<p>The letters that really get me are those addressed to my kid for financial aid telling her that her parents can afford every dime on the bill. :D</p>
<p>Lookingfoward, the $1,110 a month is for a bronze blue shield plan. It would cost a lot more for a silverplan. I haven’t looked in a while but I think it would jump to over $1,400 a month or $17,000 a year.</p>
<p>texaspg, I got those same letters from my son’s school.</p>
<p>“The letters that really get me are those addressed to my kid for financial aid telling her that her parents can afford every dime on the bill.” :)</p>
<p>Of course events can change what is affordable.
Why do you think I am so nice to my wife? </p>
<p>I’m kidding. :)</p>
<p>Callmom, I am going to ask about drug formularies, although I am sure the agent will have no idea. Given how expensive some brand drugs are these days, this could be worth a lot of money if you’re on a plan or with an insurance company with a limited drug formulary.</p>
<p>dstark, it is obvious you married far above yourself. :)</p>
<p>GP, I would think that the drug formulary question would be very specific to individuals who happen to rely on expensive drugs – so it would be an important question to ask if you knew that you needed a particular, expensive, unusual, non-generic drug.</p>
<p>“dstark, it is obvious you married far above yourself.”</p>
<p>Lol.</p>
<p>
</p>
<p>But this isn’t an ACA thing - insurance rates on the individual market have always been tiered by age, and if anything ACA caps that. Before ACA, most insurers had a 5:1 ratio between highest(oldest) and lowest (youngest) rates – ACA restricts that to 3:1.</p>
<p>Lookingforward, I’m confused by your question in post #5531.</p>
<p>
</p>
<p>Anyone can buy through the exchange. Anyone. There are no restrictions at all on who can buy and pay the full premiums for policies listed there. (Except maybe undocumented aliens).</p>
<p>But only people who are not eligible for employer insurance or another insurance program such as Medicaid or Tricare, and who have incomes between 100%-400% of the Federal poverty line can qualify for a tax credit to be applied against the cost of insurance.</p>
<p>The insurance companies are free to offer different ACA-compliant policies off exchange – perhaps with a different network, or slightly different structure of benefits. So people who are certain that they are not eligible for the tax credits might choose to buy off-exchange because they find a policy they like better off the exchange; or they just don’t want to hassle with the exchange web site – or maybe they don’t care. My insurance company sent me a letter and said that my old policy would be terminated and if I did nothing, they automatically would roll me over into a new policy. My premiums are high enough for me to spend the time to look into the subsidy – but if I was younger and looking at a premium that was staying close to what it had been – I might not have bothered.</p>
<p>We’re on the same page. At the time, it seemed GP would buy off-exchange and had brought in the example of a couple at just over 62k paying 25%. I had no idea what age he meant and wondered why they wouldn’t take advantage of a subsidy that does exist. Etc, etc. And yes, my exchange plans do offer some better aspects than straight BCBS. </p>
<p>Same here about receiving info about the rollover and new pricing. I can imagine some could assume that was that- and wouldn’t realize they could go to another source to compare pricing and plans. Although the exchange made a decent effort to get the word out, nothing, nada, zip came up into my broader neighborhood, which ranges from wealth down to students, young families and the people still trying to get a toehold. (Contrast that with political talks, transportation and zoning meetings, etc, at the local churches or temples.)</p>
<p>lookingforward, when I said over 62K, I was referring to plans without subsidies for a couple. Also, the 25% applies to the cheapest silver plan. The bronze plan is around 22%.</p>
<p>Calmom, the drug formularies can be important if at some point in the future you need an expensive brand name drug. If it is not on the formulary, it could cost thousands of dollars for which the insurance company would not reimburse you. So I wonder if the insurance companies have limited the formularies, just like the networks, to reduce their costs. It would be a very sneaky way of making these ACA-plans more affordable because no one would even think to inquire about the formulary. Hopefully, they haven’t changed the formularies.</p>
<p>The list that Anthem sent me for 2013 has more drugs listed than the ones online.</p>
<p>Dont know about 2014. , Anthem uses tiers with generics in tier 1 and the cheapest. My daughter is using a birth control pill that is not on the list. It is not a generic. Anthem told me they would cover the drug if the doctor asked them to do that. Instead, the nurse just gave me a ton of free samples…</p>
<p>.</p>
<p>
No, his hypothetical is of a couple who makes slightly too much to qualify for a subsidy. </p>
<p>Basically we’ve gone from a system where nobody got any subsidies to one in which probably about half of insurance buyers on the individual market are eligible for subsidies and the other half are envious. Kind of reminds me of some of the CC financial aid discussions – you know, those threads where someone with $200K a year income is distraught over their FAFSA EFC. </p>
<p>
I think that most of the letters that went out from the insurance companies also contained text mentioning that financial assistance was a possibility. The consumer advocates did not like the presentation; i.e., the text was unclear and placed near the bottom of the page. But I figure that most people when confronted with a huge jump would tend to call around and ask – so the ones who might tend to just accept the bump without inquiry would more likely be situations where the increase in cost was not high enough to trigger a reaction, or perhaps where the new rate was lower than the old – a real possibility for some, especially for people who had been paying a higher rate due to pre-existing conditions.</p>
<p>dstark, since you’re calling tomorrow ask if the Anthem formulary has changed for 2014. I doubt you will get answer, but who knows. Also, ask one more time about having UCSF in network, even though it is in a region with an EPO network. Can someone who lives in a region with a PPO network go to a provider in an EPO region and stay in network? San Francisco and Los Angeles are both EPO regions.</p>
<p>Edit: Ask them when the provider search tool will be running on their website.</p>