Affordable Care Act Scene 2 - Insurance Premiums

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You might want to check the numbers in some of the states that do have their exchanges up and running. </p>

<p>In my region in California, the subsidy is keyed to a Kaiser plan, which would be $1643 a month for a married couple age 60. A $60K income would entitle that hypothetical couple would be entitled to an $1168/month premium, for a net monthly premium of $475.</p>

<p>I think these numbers are on the high end – from what I can tell, I am in one of the more costly regions in my state for insurance – but I think that if you look at the prices for states like California and New York, you are unlikely to experience as much sticker shock in your own state. (It won’t make NC any cheaper, but at least you will be looking at the numbers in a different context). </p>

<p>If you are subsidy-eligible, then it really doesn’t matter what the plan costs-- you’re minimum payment is going to be keyed to your income, and there will be a Silver plan that fits that. </p>

<p>If not, then you are going to want to look seriously at the bronze plans, as well as plans outside the exchange. The private policies will still have to comply with ACA requirements so they will also cost more, but there may be ways that plans can be packaged to be more attractive to some. (For example, I think it would be possible for a company to come up with something that falls between the Bronze and Silver levels – for regulatory purposes it would meet the actuarial requirements of a Bronze policy, but to attract customers, it might offer a few Silver-type perks, such as lower deductible or lower co-pay on some but not all types of medical expenses). I can see some niche markets developing for private insurers seeking out non-subsidy eligible clientele.</p>

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<p>Totally ignorant here, even before ACA I threw my hands up in the air whenever health insurance came up. If we are covered by an emplyer, what changes should we expect if any?</p>

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<p>None, other than the same types of changes you might have seen in the past. That is, rates can still go up, your employer can still make changes to what is offered to employees in order to deal with the rising rates. If your employer’s plan is extremely generous, they might cut back to avoid the “Cadillac” tax, but that tax is something the employer pays and doesn’t go into effect for several years.</p>

<p>The whole point of ACA is to provide a way for people who do not have employer-provided insurance to get insured.</p>

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<p>A guide to new exchanges:</p>

<p><a href=“A Guide to the New Exchanges for Health Insurance - The New York Times”>A Guide to the New Exchanges for Health Insurance - The New York Times;

<p>Article also has a link to Heathcare.com which is how they suggest one get into all marketplaces (there are links to each state’s at that site.) There is also an 800 number listed.</p>

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<p>Wrong link – you want to go to healthcare.gov - <a href=“http://www.healthcare.gov%5B/url%5D”>http://www.healthcare.gov</a></p>

<p>The .com site is a privately owned site probably set up as a way to generate ad revenue. It’s not a scam, but it could lead to wrong info and frustration. </p>

<p>I think it is VERY important to rely on the .gov site or the site maintained by your state’s exchange, or sources that are known to be very reliable such as the Kaiser Foundation. There is a LOT of misinformation floating around, including some from private insurance agents. I have several very specific examples already, including misinformation I have been given by my own insurance company…</p>

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<p>Calmom, Thank you for the reply. What make it Cadillac plan?</p>

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<p>I thought it was to insure the 30m without insurance? Many without employer provided insurance were satisfied with their insurance.</p>

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<p>Yes, if you already had insurance you are satisfied with, and if your insurance company still offers the same plan, then you can keep your existing plan. (This goes for plans that were in existence before passage of the ACA in 2010.)</p>

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<p>^ right…just pay a whole lot more in most cases</p>

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<p>geeps, the point of ACA is to get millions of people into one big risk pool. You cannot expect to be rewarded for wanting to remain a risk pool of 1 or 2, or whatever you family size. Mini-risk pools are one factor which has led to our ridiculous insurance rates. </p>

<p>Have you looked at the ACA exchange for your state? Every plan offered is required to have the same health benefits which have generally been available on employer-sponsored plans. The tradeoff is out-of-pocket versus premium. If you want to keep your premium lower, then there are plans which have higher deductibles and co-pays, and vice versa. </p>

<p>What is it about your current plan which you don’t want to give up?</p>

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<p>my plan will not change at all…except for the 50% premium increase.</p>

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<p>That doesn’t answer the questions. What is it about that particular plan which is so attractive to you? And have you checked out your state’s exchange?</p>

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<p>Probably not in “most” cases – not if you factor in what people in the harder-to-insure category was paying. I mean – I’m one of those people whose rates are going up for a plan that is significantly weaker than what I had. Unfortunately, my ex-husband is one of those people who has been uninsured, because his premiums were triple what mine were, and he ended up simply unable to pay. We’re the same age, but he has had more health problems. So he’ll be able to get insurance again, and at a lower rate than what he was paying. </p>

<p>If we average it all out – and factor in the people who wanted insurance but were completely shut out of the market because of their health histories – then I think the numbers are probably roughly the same. </p>

<p>“Fair” does not always mean that everyone gets better than what they already had. Fair sometimes means the haves get a little less in order to enable the have-nots to have more.</p>

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<p>Just to clarify, I’m sure you meant “to enable the have-nots to have something.” Have-nots aren’t getting more than haves. They’re getting more than they were able to get prior to ACA.</p>

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<p>Yes, that’s what I meant. </p>

<p>If life were fair, then 3 years ago I would have been paying $600 a month for insurance instead of $350, and my ex husband would have been paying $600 instead of $850. Now we can go onto the exchange and shop for the same policies and be quoted essentially the same rates. I’ll end up paying 60% more than I was paying, he’ll be paying substantially less than he would have been paying if he had been able to get insurance.</p>

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<p>Geeps, I want to make it clear that I understand how you are feeling. I am in the same boat as you are: I am losing a plan that was much better in terms in coverage and had a significantly lower premium than the closest equivalent on the exchange. I may qualify for a subsidy, and if so that will make a big difference for me, but because I am self employed with unpredictable income, it will be very hard for me to know from year to year whether or not I am going to get that subsidy or not. </p>

<p>But the point is that I also know that I got that deal precisely because my insurance company was able to exclude others from a similar deal or price them out of the market.</p>

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<p>I just want to update my own comparison of the various metal plans, now that I have exact premium amounts and information about deductibles in my area. Basically I selected one insurer (the one that I am currently with), and created a spreadsheet to look at total costs for various plans at different medical expense levels, based on an **unsubsidized<a href=“full%20cost”>/b</a> premium.</p>

<p>Here is what I am looking at roughly – my single person premiums are based on my current age, 59. </p>

<p>Bronze: $4500 deductible, 40% copay after the deductible, $7800 annual premium, $6350 maximum out-of-pocket</p>

<p>Silver: $2000 deductible, 30% copay after the deductible, $9700 annual premium, $6350 maximum out of pocket</p>

<p>Gold: No deductible, 20% copay, $11,400 annual premium, $6350 maximum out of pocket</p>

<p>Platinum: No deductible, 10% copay, $13,000 annual premium, $4000 maximum out of pocket</p>

<p>Obviously these specific numbers will be different for each person – I’m just listing mine so people can understand my math.</p>

<p>All of the plans provide basic preventive care for free - so that part is a non-issue. The issue is what I’ll pay assuming various medical needs each year.</p>

<p>So I start by adding the deductible to the premium – that tells me how much money I pay out before the insurance company starts picking up at least some of the tab. So for the 4 plans, that is:</p>

<p>Bronze: $12,300
Silver: $11,700
Gold: $11,400
Platinum: $13,000</p>

<p>So basically, with the Bronze plan, I would have to pay $3600 in unreimbursed out of pocket medical costs before I even reach the cost of a Gold level premium. </p>

<p>For me, that’s the end of the inquiry: I haven’t incurred anything close to that in 25 years. </p>

<p>On the high end (true catastrophic), I’m protected by that out-of-pocket max. </p>

<p>I did create a spreadsheet to look at various scenarios. For my situation, I come out ahead financially as long as my medical costs remain low or if they are very high. There is a zone of about $7500-$10,000 in medical costs where the Silver plan becomes more cost effective than the Bronze, but within that particular zone of costs the Gold plan is actually even better. (Because of the low copay and no deductible, Gold would be better for me than Bronze from about $4000-$12000 in medical out-of-pocket costs) But after $14,000 in out of pocket, the Bronze is the better choice overall because of the annual out-of-pocket max. </p>

<p>I do think that the math is going to come out differently for others – but I do think that this underscores the importance of factoring in your past medical costs and anticipated future costs.</p>

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<p>It looks like you’re doing a great job of meshing your past experience and projected future bills to decide the best plan for you. Thanks for explaining your reasoning.</p>

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<p>“Wrong link – you want to go to healthcare.gov”</p>

<p>Sorry, just a typo on my part. The article did link healthcare.gov.</p>

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<p>What are others seeing for exchange premiums vs the regular carrier premiums? In RI, they are basically the same.</p>