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</p>
<p>The first part of that statement is correct: everyone of a certain age pays the same, so the currently sick are paying the expenses of the currently healthy. </p>
<p>The second part might be misleading. Under the ACA, younger people are subsidizing people in their sixties. As you get older, your premiums will increase each year, but they won’t increase as much as they would have pre-ACA. In California, they go up a set percentage for every year of age. </p>
<p>OK – I understand – you are in an unfortunate coverage-gap/ loophole because the ACA didn’t really consider the problem that arises in the situation where employers don’t cover spouses. However. you do have some benefits coming to you because you are self-employed, and I have some advice/suggestions.</p>
<ol>
<li><p>The cost of your premium is probably fully deductible, as an above-the-line, income-reducing writeoff – as “self employed health insurance deduction” . (Based on your statement that the premiums represent 1/3 or less of your “salary” - though it is unclear to me from your wording whether you are a sole proprietor or are doing business under some other from). So when you file your taxes, you will likely be able to subtract the full cost of your premiums from your income – which gives you an effective subsidy equivalent to your marginal tax rate. That is, if you pay $7200 in insurance premiums and have a 25% marginal tax rate, you are getting 25% of your premium back in reduced income taxes. </p></li>
<li><p>In your health situation, you might want to look into getting an HSA-eligible bronze plan; setting up an HSA account; and depositing the maximum allowed for an individual into the HSA bank account. You can use that money to pay for any medical bills, or you can simply bank it or investment - but you get to write off the entire amount you deposit the same as you might an IRA contribution. So that’s an additional tax reduction, with the added benefit of a tax sheltered savings account for you. The money can be withdrawn from an HSA without penalty once you turn age 65, and until then it can be used for a variety of medical expenses typically not covered by insurance, such as optometry and dental, or, for example, a prescription drug that’s not on the insurance company formulary. So definitely worth having, especially if you’ve already opted for an insurance plan with a higher deductible. </p></li>
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<p>Great suggestion Calmom! I knew I should now be able to deduct the premiums, but had not considered the HSA benefit. I will definitely look into those options, especially as the open enrollment period is coming soon. Supposedly I could not change plans until then because I’m now covered, and do not have a qualified changing event. Very helpful.</p>
<p>A small step in the right direction.</p>
<p><a href=“Price Tags On Health Care? Only In Massachusetts | KFF Health News”>http://www.kaiserhealthnews.org/Stories/2014/October/09/Price-Tags-For-Health-Care-In-Mass.aspx</a></p>
<p>“Anyone with private health insurance in the state can now go to his or her health insurer’s website and find the price of everything from an office visit to an MRI to a Cesarean section. For the first time, health care prices are public.”</p>
<p>Last I mentioned, My wife cancelled her cataract operation. Except…The operation was not cancelled because the doctor’s office said to my wife that they took my wife’s plan and everything was a go. The doctor’s office called Anthem and everything was given the ok.</p>
<p>So… I called Anthem and it turns out the doctor’s office contract to take covered california plans expired a month ago and the doctor’s office did not renew the contract. The doctor is out of network. We could have been out thousands if the operation occured. We may be out $400 because my wife had an office visit after the contract expired. She will probably fight that.</p>
<p>My wife has another surgeon who takes her plan and his office says if the anesthesiologist is not in the plan, the one thing we don’t know, the office will pick up any cost above in network costs. </p>
<p>So everything is a go. My wife is happy with the new surgeon and his office. </p>
<p>She is looking forward to seeing better. Going to have both eyes done this year so there will be some out of pocket savings because the out of pocket maximum is going to be hit. Going with the multi focal lens (which is not covered). </p>
<p>Great news,DStark!</p>
<p>I got a notice from Covered Cal. that it will be possible to renew plans as of tomorrow. Technically open enrollment doesn’t begin until Nov. 15, but Covered Cal is essentially set up to take pre-orders. Probably a good idea to spread out the server load somewhat, though I’m sure there are going to be as many wait-to-the-last-possible-moment procrastinators in 2015 as there were in 2014. Rates are posted though technically not final. </p>
<p>Calmom, thanks. Interesting info on Covered Calif. </p>
<p>Dstark, I wonder what the other office would have done had the surgery proceeded and you were billed due to the expiration of their contract. This would be why I’d like to see some kind of document the performing office signs off on warranting their representations about coverage are true ;)</p>
<p>Having “lost” the work, I wonder if the former office will also renew their contract. I’m curious because the reality may be that an informed consumer and natural consequences could just clean up some of the access issues that seem to have been wrought by the implementation of ACA.</p>
<p>At any rate, I’m glad its worked out for your wife, and I’m doubly glad an office sloppy about its contracts didn’t get the work. It might be worth bringing to the doc’s attention that your own due diligence prevented what might have been an actionable misrepresentation and motivate him to clean up the practice’s organization a little ;)</p>
<p>Kmcmom13, do you know what I find amusing? At one point the surgeon and my wife were talking and the surgeon asked what plan my wife had. My wife showed the surgeon her insurance card. The surgeon said she had the same plan. :)</p>
<p>I think when my wife gets the last office visit bill, the surgeon will be notified. :)</p>
<p>Get it in writing. When I had my procedure last spring, the anesthesiologist actually sent me written info. Then you have something to bounce off if there’s a billing issue. Not everything can be anticipated, there’s always some fine print. But when there seems to be this sort of confusion think about it.</p>
<p>Anthem emailed my wife a list of every opthamologist in our area that is in her plan.</p>
<p>I’m about to try it out: I’m leaving my job and will look to our state’s version of Obamacare for insurance. Very intrigued. Any tips for a novice? Or should I read through all one thousand+ pages on this thread? </p>
<p>We live in NJ, and I was very disappointed to see no plans other than epo (exclusive provider) available throught the exchange for individuals. Although we can get a ppo with out of network benefits through our group plan, we were considering retiring before we are eligible for medicare. I am very disappointed that after a lifetime of caring for other people’s health, H and I will have limited ability to see doctors covered by our insurance. Additionally, many of the companies that we are used to doing business with are not offering plans through the exchange. If I go to my current insurer to see if they have any private plan for individuals, they are also epo plans. I think we will have to move to another state to get the coverage we want.</p>
<p>anothermom2: California has very similar problems. The only exchange options in my county are EPO’s. The one insurer that had offered a PPO last year has dropped that plan. One, and only one PPO option is available in the individual off exchange market and I suspect this too will disappear next year. </p>
<p>While the ACA has allowed movement for some people, it has restricted it for others - as you exemplify. </p>
<p>Katliamom, can you tell us your state, in case one of us has experience with it? And imo, no, don’t read the thread history- just ask your questions and we’ll see if we can help. Some of us have had positive experiences, some not. It seems to mostly vary by state. </p>
<p>I guess my first tip would be to try to anticipate what you need, rather than a one-to-one comparison with what you have today. Then see which plans best line up. Depending on the state, you may have to be vigilant about which of your docs are covered. </p>
<p>Dstark, great news. </p>
<p>I’m surprised about a contract ending mid-year. Seems like everything having to do with insurance goes January to December. </p>
<p>@anothermom2 - I also live in NJ and the plan we currently have will end at the end of this month as it’s not ACA complient (damn!). So, I went to the Marketplace to find a new plan. I was able to purchase a POS+ plan. I saw several POS plans, so maybe you need to look some more or speak to a different person. There are plans besides EPO plans. </p>
<p>katliamom, good grief, whatever you do, do NOT read the 1000 pages of this thread! 
</p>
<p>lookingforward is right; if you’re willing to tell us your state, that’ll help. But even if not, we can give you some tips.</p>
<p>Small starter tip for @katliamom – YMMV but I chose a premium silver PPO coupled with an HSA for the following reasons:</p>
<ol>
<li><p>If you’re on a silver plan but not qualifying for subsidies (I don’t) but something catastrophic should occur income-wise, it can convert to a subsidized plan most readily. Eg. If you were eligible for the level of subsidy wherein you have a much smaller deductible and out-of-pocket max, you’re only eligible on a silver plan.</p></li>
<li><p>I chose the PPO so that I’m rarely, if ever, out of network. In my state, that works. (MI). It costs more, but to my mind, simplifies the process a little, as its maximum access.</p></li>
<li><p>I love the HSA for many reasons that include the tax advantage, the fact once funded of having my deductible covered, and the fact that it can be used (within reason) for many complementary or alternative health procedures that often aren’t covered by regular insurance, eg. Prescribed medical massage, acupuncture, pt sessions, etc. I have facet joint syndrome in my spine and manage it without a lot of medical intervention. Before the HSA, I wasn’t great about keeping receipts, etc. The HSA kind of “forces me” or encourages me to be more organized about my health expenses.</p></li>
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<p>Lastly, if you don’t exhaust it, you can rollover the money you’ve saved tax-deferred on retirement just like any other registered instrument.</p>
<p>Good luck in your search. Marketplace shopping is a PITA but you will get the hang of it ;)</p>
<p>You guys rock! I’m in Colorado and so far I’ve heard positive reports about the system here. kcmom - fabulous information, thank you so much. </p>