Check the alternate plan, how would a car accident & ER visit be paid? How would a cancer Dx be treated and paid? How would a heart attack be treated and paid? How would a badly broken leg be treated and paid? What about a Dx of A-fib where you need ablation and it does not work and then you need frequent med management? Dx of Diabetes?
As a prior poster said, you are in excellent health until you are not and many people who have historically been in great shape end up with something seriously wrong.
For many people, there were no individual plans available pre-ACA because they had pre-existing conditions (e.g. asthma). For others in the individual market, it was a minefield of medical underwriting, since many of the insurance companies would try to rescind policies for accidental omissions of non-relevant long-past medical events that you may not have remembered, doing so only when a big claim was presented.
ACA obviously is not ideal, but (a) the pre-ACA situation that some want to go back to was worse for lots of people, and (b) no matter how you look at it, medical care and therefore medical insurance is expensive and keeps getting more so, meaning that either you will be paying quite a bit directly for medical care and insurance, or someone else like your employer or the government will be.
Our family is also self-insured (Dh runs his own business) and we are paying the high rates like you and have for 13 years. Every few years I shop around and can often find better plans. We’ve been happy with United/Golden Rule for about the last 6 years. While it takes a really long time to shop around, with each insurer having it’s own application and medical forms, it can be worth the time to shop.
It sounds like you are thinking of making the switch just for one year, to save premium costs. If this is the case, you do lower your risk (if you’re like me, you can put off nagging aches and pains for a few months; of course this doesn’t help you in the case of an accident or major medical event), but I think you run a risk of having even higher premiums when you rejoin your current plan. Also, I’m not sure what the rates are for college insurance plans, but it might not be a savings.
There are health insurance agents still around, I think, who could give you an idea of what else might be involved in this decision. I have one, but he’s semi retired and his daughter has taken over the business. Ohio, if you are interested PM me.
IDK, worse for lots of people or worse for everybody? As for costs, none of it makes any sense. I cover 16 employees at about $500/month each. Deductible is $3000 ($6000 for family). 80% co-insurance until out of pocket max of $6000 (12,000 for family). Covers pre-existing conditions, no lifetime cap, etc. Not cheap, but not as ridiculous as some of the ACA rates I have compared to. How can my small group of 50+ year olds be less expensive than everyone in the ACA? Something is broke.
The policy you’re describing is an ACA compliant policy. Maybe by ACA you mean the individual exchanges? Group insurance has always been ridiculously cheaper than individual.
Yes…having a group plan reduces overall costs. Individually purchased policies have always been more costly…per person. And with less rich benefits as well.
Sample of one here…one family member had two very serious medical issues within three years. Let’s just say, we would be living in a homeless shelter if she hadn’t had good insurance. You can PM me for the specifics if you really want to know. But let’s just say…even $15,000 per year for insurance would only have put a very small dent in these medical bills. Yes, we had to pay the $5000 deductible…in addition to the premium costs. But all of that was a very small drop in the bucket related to total costs.
Oh…and this was a very healthy under 25 year old.
You are healthy…until you are not.
Group plans based on employment have less individual adverse selection (the tendency for people to want to buy insurance only when they know they have an expensive medical issue) than individual plans (although the demographics of employees affects the cost). Hence all of the pre-existing condition restrictions on individual policies pre-ACA. ACA had a weak individual mandate ($695 tax penalty for tax years before 2019) that will be effectively no individual mandate for 2019.
People want it all (coverage of pre-existing conditions with no individual mandate), but adverse selection will destroy any individual market for individually purchased medical insurance where both of these are the case.
Our premium is going up “only” 6.7%, whoo hoo! This will mark the year, however, that our monthly premium is more than our mortgage payment on a large house with attached office.
@MaineLonghorn - this makes me wish there were a “dislike” button.
@Hoggirl, I forgot! The good news is that DH turns 65 in March, so he’ll be on Medicare! That should save us a good bit.
I would never go without insurance. When my husband was 27, he opted for the cheap plan at work, then got Hodgkin’s disease. Our out of pocket costs were insane.
Two years ago, our healthy, athletic 21 year old daughter had a DVT, requiring multiple procedures. I shudder to think of what this would have cost if we hadn’t had insurance.
I can see going without dental insurance. But medical insurance? No way.
Our premiums went down 7% for next year. Pre-ACA, it was a 25% bump every year. I pay half as much for better insurance for myself and my kid as I did for just myself in 2002. Full premium cost in both cases, so not a difference in what an employer paid. Through a professional association, so technically group insurance, in both cases.
I was healthy (except for mild intermittent asthma), until one day I was diagnosed with a serious chronic progressive condition. My kids have had health issues from early childhood. H has had asthma as far back as he can remember.
We have exceeded our annual maximum out of pocket several years. I would never contemplate not having very good medical insurance but am sad to read how very expensive it is!
I know folks who exceed their out of pocket max in January each year!
My brother owns a business. Pre ACA he was very happy with a $400 per month premium and did have a major surgery on it. After ACA, his policy was discontinued and the only policy he could find was $1200 per month with a huge deductible. I figured out he’d have very little coverage until he paid over $20k in premiums, co-pays, and deductibles. He paid the tax penalty instead. He’s still looking for a policy, and a Kaiser one is 'only $700 per month with a $6k deductible.
One thing I did notice is that the cost of screening lab done for instance was $1400, the BC/BS PPO approved $400 and I owed the small deductible. If I did not have insurance, I would have been responsible for the $1400. Going without just does not make sense.
RE; Group insurance plans. Prior to the ACA a H and W business, a sole proprietor an all family member business would qualify for group coverage. Post ACA…nope…those are the folks who were chosen to pay for the free and subsidized care given to the previously disenfranchised group.
Why would the ACA destroy a small group system that worked? Because someone needed to pay for those who were brought into the system. If you are subsidized - or receiving free insurance, if you are receiving deductible assistance - heck the ACA is great!!! If on the other hand you are among the chosen who gets to pay for free…eh…ACA not so good.
Maybe the thought was the paying group - which includes full pay individual policy holders - was too small to matter, maybe the thought was if the premiums rose ‘slowly’ over the years, the paying group wouldn’t notice.
Guess the payers are noticing, and they realize what’s available is anything but affordable.
Why not bring back the group option - and make it available to everyone who doesn’t qualify for a freebie and who isn’t covered by an employer? In our case, take ALL of CA’s over charged folks forced into the individual market and offer them a couple of group policies?
Oh, and after the ACA, if you still choose to be uninsured, your actual treatment options should be extremely limited -IMO.
That’s exactly what happened to us. DH was a sole proprietor and our insurance had better benefits for what we paid when we could still get a small business plan. When that changed in 2014, we starting seeing much higher deductibles, ridiculous premium increases every year, and fewer choices.
Yes, just this year, my husband has developed kidney stones. He is VERY healthy. Nobody believes me when I say he’s almost 65. “55, you mean?” people will respond.
He had one stone removed already. A day procedure at the hospital. JUST THE HOSPITAL portion of the bill was $16,000! We have a “real” policy, ha, and our OOP cost will still be over $7,000. Hate to think what it would have been with a cheap policy.
And now he has to have another stone removed, since they take out just one at a time. I’m glad he’s already reached his OOP max.
Another cautionary tale here. I am healthy, low 50s. At a routine exam this year an issue was found that required pretty invasive surgery and several days in the hospital. I have a high deductible plan but thank goodness I had it. I maxed out the policy and it’s been rough (with 2 kids in college this year also) but without that plan I’d likely have to file for bankruptcy. The hospital and doctor and all of the other charges were insane.
Quick question - I just looked at the Marketplace for a policy for my 23-year-old son. He will be visiting at Christmas. I can’t get him travel insurance because he’s coming home from out of the country (I checked). I also can’t get him a short-term policy because of his pre-existing condition.
When I typed in his age and income (only $5,000), I get a message that he’s not eligible for a discount in premium price. Why would that be? Because he’s under 26? 
I hate to pay $270 for one month of coverage.