<p>When I ran my exchange costs for the family, for each of us individually, and poked further, age, family and MAGI indeed made a difference. And yes, of course, my state’s particular offerings. Our premiums will drop precipitously, for non-HSA Silver. Had we not encountered what we did, in 2013, yes, they would have gone up, (again, the word is “precipitously,”) if we had to purchase independently.</p>
<p>I’ll be 60 in 2014 and am in Maryland. A bronze plan for me will cost $354 a month and the silver will be $482 a month. These are not the lowest deductible or the highest deductible plans so there are cheaper ones and more expensive ones available.</p>
<p>Ah yes, you did, dstark. </p>
<p>I guess my point is, at what point will the premium be unaffordable? At 7.5% a year, that adds up quick. We have seen uncontrolled rate increases for premiums from insurance companies, but honestly I am having a hard time wrapping my head around this. Why would insurance companies drop their premiums to lower amounts in years to come? Doctors and hospitals will renegotiate their terms of compensation, and we will be paying more. </p>
<p>Yes, if I hit that magic 9.5% mark, I will not have to purchase a policy, but I still need insurance, right? Because I am not an idiot and will not risk the what-if scenario.</p>
<p>With such range of ranges from states, will there be an exodus of people moving to where they can find affordable rates? I would leave California and head to a no income tax state or low sales tax state to save there . Okay, easy choice, there. But what happens to California when more people on Medicaid and less buying insurance? It will cost more, no? </p>
<p>Then what? </p>
<p>If my family premium is 19,000 a year before subsidies in 2014. And you project up to 7.5% increases each year:
in 2015 that is an extra $1425 - $20,425
in 2016 that is an increase of $1531 - $21,956
In 2017 that is an extra $1646 - $23,602
In 2018, that is an extra $1770 - $25,352</p>
<p>I am not a financial planner, but isn’t there a rule of 7 or is it 8 in terms of investments? </p>
<p>I am thinking long term. In terms of premiums, a number that I would want to consider is how much premium can I afford this year and next and the year after that. </p>
<p>I would be careful to plot out my income so if eligible for subsidies or tax breaks, I would get them. I won’t expand my business because of increasing costs to insure, but will scale back. I will have to see what my opportunities are as a sole proprietor for any tax savings. </p>
<p>Still also wondering how the FAFSA and CSS Profile formulas will work themselves out in next few years.</p>
<p>I am in mid-40’s and my rate for the plan I want would be in mid-550’s before getting a subsidy. Same for husband. Kids rates were in $225 a month range.</p>
<p>^^^ At 60 in my area, one person, mid-Silver, if bought direct at straight BCBS rates: $630</p>
<p>In contrast, SL, age 45 would be about $340. Kids under 21, about $150 each. I don’t know what plan you’re looking at, but family of four, before any subsidies, could be $980. If the kids are up to 24, about $1150.</p>
<p>SL, there is a 72 rule. Divide your return into 72 and that will tell you how ling it takes fir your investment to double. </p>
<p>So 7.5 percent is 72 / 7.5…</p>
<p>Your premiums will double in less than 10 years.</p>
<p>You are incredibly young.</p>
<p>Wow, lookingforward. Amazing. What a difference. </p>
<p>I was looking at same plan our family bought on individual market in 2010-11, which is according to tiers a gold plan. Kaiser. </p>
<p>Young is a state of mind. Some days I feel really old, dstark. </p>
<p>Doubled premiums in ten years scares me silly.</p>
<p>SL, our best Gold doesn’t come near $550 til age 52. Good example of how states can vary. Then on the exchange, MAGI can bring a subsidy.</p>
<p>I’m not an economist, but as prices grow, people will start looking for alternatives. Our experience will shape our views- eg, doing a cost-benefit analysis, we may not need a “best Gold,” with a $500 deductible and its particular scheme of co-pays and co-insurance. Wanting insurance may be an inelastic need, but we may very well find ways to make things more feasible than they seem when calculating 7.5% increases.</p>
<p>Supposedly we are past the window for paper applications</p>
<p>
</p>
<p>[APNewsBreak:</a> Feds balk at paper health application](<a href=“http://bigstory.ap.org/article/apnewsbreak-feds-balk-paper-health-application]APNewsBreak:”>http://bigstory.ap.org/article/apnewsbreak-feds-balk-paper-health-application)</p>
<p>Sure, we could go Bronze. </p>
<p>$11957 yearly premiums no subsidy @1188 month
Or
9552 yearly premiums with subsidy @796 month</p>
<p>$5000 person deductible, $10000 family deductible
$6350 max out of pocket person, $12700 family</p>
<p>$60 copays reg doctor
$70 copay specialist</p>
<p>30% lab tests copay after deductible
30% xrays copay after deductible
30% coinsurance hospital after deductible
30% coinsurance doctor after deductible
$19 generic prescription</p>
<p>30% pregnancy hospital & 30% doctor copay</p>
<p>HMO</p>
<p>So, the way Kaiser goes is if you have an issue that needs to see a specialist, you need to see primary doc gatekeeper, first. </p>
<p>So to get to a specialist, I would have a $130 in, two visits, plus labs and xrays or imaging. </p>
<p>I would have to spend the $11,957 in monthly premiums plus an additional $5000 deductible before I get any services at no pay from Kaiser. Unless it was a preventative visit. </p>
<p>And remember this is all in-network with their docs. </p>
<p>Nearly $17,000 a year at at least for 2014 and I am still on hook for at least another $6350 if I need real care. And that is just me, not any other family member needing medical help. </p>
<p>Sorry. I don’t think that sounds like a good deal for an HMO. </p>
<p>Sure I get a wellness checkup each year, but I could have done that for $250 plus labs. </p>
<p>If I buy on or off exchange, I would never settle for Bronze for Kaiser. It would be good that mental health would be covered, because you would have to be slightly out of your mind to choose a lower tier Kaiser plan. The benefits to having the HMO plan would be negated, IMO.</p>
<p>Interesting article about self insuring in small to medium size companies. </p>
<p>Article doesn’t say how many large companies self insure - just that 59% of all private sector workers were in self insured plans. </p>
<p><a href=“Allure of Self-Insurance Draws Concern Over Costs - The New York Times”>Allure of Self-Insurance Draws Concern Over Costs - The New York Times;
<p>
</p>
<p>But what is different from the past? Without ACA, I would still be seeing a 10% increase in insurance next year - much more, actually, when my age increase is factored in – and historically it seems that BS has raised rates in California on the individual market about 10-15% each year. But California rates were far lower than what was available in New York – no one fled our states in the past looking for cheaper insurance. (I admit that I am tempted by the NY exchange rates these days, where I would benefit tremendously from the lack of age rating for premiums – but once I factor in housing costs to rent in NY, any savings fly right out the window. )</p>
<p>The only “exodus” I see would be individuals and families moving to Medicaid expansion states. Under ACA, the premiums for those eligible for subsidies will essentially stay level, with subsidies growing over time. If they get too high for those who are unsubsidized, then there will be a problem that I assume would have to be addressed sooner or later through additional tax credits or subsidies-- but I don’t see people moving from one state to another because of it. Of course, it might be a factor that will be considered by young people in deciding where they want to settle in the first place. </p>
<p>Though I never noticed my daughter or her friends being deterred by the high cost and past sky-high health care premiums in NYC – I think that some states are just a draw for other reasons. I think that people in the income tiers that are not subsidy eligible are probably considering quality of life issues over cost of living, and are often quite willing to take on a lot of expense to live wherever they happen to choose. Health insurance is just one additional element to consider on top of tax rates and housing costs.</p>
<p>There has been an exodus of low to middle income folks leaving California. You might think those who had the most would leave due to tax burden, but it appears it is those with lower incomes leaving state. </p>
<p>3.4 million have left state in last 20 years. </p>
<p>Households with inome over 200,000 a year moving to CA have increased in last decade. </p>
<p>[Allysia</a> Finley: The Reverse-Joads of California - WSJ.com](<a href=“http://online.wsj.com/news/articles/SB10001424127887324338604578326402863024028]Allysia”>Allysia Finley: The Reverse-Joads of California - WSJ)</p>
<p>SL, the deductible is part of you out of pocket maximum. You are double counting. :)</p>
<p>“Nearly $17,000 a year at at least for 2014 and I am still on hook for at least another $6350 if I need real care. And that is just me, not any other family member needing medical help.”</p>
<p>Emilybee… The link looks interesting. I will check it out when I get home.</p>
<p>Really, dstark? I was under impression it was hospital, copays and labs, not initial deductible. </p>
<p>If I am mistaken, that is…better.</p>
<p>The deductible is part of your out of packet max on every plan I’ve ever been on.</p>
<p>Really!!! :)</p>
<p>[Is</a> deductible included in maximum out of pocket](<a href=“Answers - The Most Trusted Place for Answering Life's Questions”>Is deductible included in maximum out of pocket? - Answers)</p>
<p>I expect a good attitude from you SL. ;)</p>
<p>You may want to think about what you want to do…</p>
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</p>
<p>But that is past, not future (you were speculating about the impact of future rises in insurance rates) – and it is probably driven largely by other cost-of-living factors, with housing costs probably being at the top of the list. </p>
<p>Obviously increased insurance premium levels are a factor, but do keep in mind that the majority of working people will still have employer coverage. If anything, I see the current subsidy structure as putting added pressure on individuals who earn at around the cut-off mark (~$45K for an individual) to seek out jobs with employer-provided health care.</p>
<p>Dstark, </p>
<p>That is the best news I have heard in a long time. 
Thanks! </p>
<p>I remember old EOB statements from insurance companies in past that did not count everything. Some items, counted towards max, some thingsdid not. Like when kid broke wrist out of network, even though emergency. </p>
<p>See how even after reading this thread for months, there is still a good amount of confusion?</p>
<p>
People are fundamentally honest and even if not, they tend to to worry about their credit rating.</p>
<p>It’s pretty easy to skip out of a busy restaurant after eating without paying the bill, yet only a small fraction of customers try that. It’s easy for tenants to live a couple of months rent free in an apartment before the eviction process winds down to its inevitable result - and yet most tenants don’t try that. Nothing could be easier than shoplifting at the supermarket – especially at one of those markets with self-serve checkouts… and yet the vast majority of customers pay for what they select and take home.</p>
<p>Given that Healthcare.gov has partnered with Equifax for identity-verification - and the tie-in with IRS for the subsidies - I don’t see skipping out on premiums as being an effective long-term strategy. It will certainly be easy for the insurance companies to flag those customers, and I think a fairly easy legislative fix if it becomes a problem. (Just amend the part of the law that sets up the subsidies that reduces or eliminates subsidy eligibility for anyone whose exchange-purchased policy was cancelled for nonpayment the previous year.)</p>