My spouse and I have ACA plans. Eligibility is not income-dependent, only any potential subsidy.
In my state there are NO PPO plans available on the exchange, they are all HMOs. Most doctors accept the bigger HMOs here so it hasn’t been a big restriction. You might be able to get something privately that is a PPO but these don’t have subsidies.
Prices vary a lot depending on what level plan (bronze, silver, gold, platinum) you get. Our plan (which is also HSA-eligible, and is the only one that is IIRC) is a bronze level plan, costs about $21K/year in premiums for the two of us, with a $3500 deductible/$7500 OOP each, and higher co-pays than a higher-level plan. Plans with lower deductibles, co-pays, and OOP maxes can cost up the $4k/month for two people.
For one person it would be half of that.
You should be able to look at plans and prices on your state’s exchange, assuming your state has one.
One caveat with these plans (at least in my state) is that many/most of the lowest cost plans have VERY restrictive hospital networks, and not all doctors will accept the less well known insurers. I’m in MA and to be able to utilize the Boston hospitals like Mass General or Brigham or Dana Farber required us to get a plan that cost about $250/month more than a plan with a more restricted network.
What income level is that? I haven’t looked into it. When I read “an income level that is more of a challenge to remain below” I always wonder whether that’s a cc standard or a real America standard.
Scroll down to see 24 rates. $47K for single filers.
Oops–editing b/c I realized you were asking about ACA cliff, not zero percent capital gains bracket.
The ACA subsidy level varies with size of household. IIRC, a two person household could earn up to the mid-high 60’s and after that, entire subsidy disappeared.
One more edit…that figure indexed with inflation (or something) so it may be higher by the time the current subsidies reset, assuming they do.
For the ACA, MAGI is used whereas for the zero percent capital gains bracket, you look at income after the standard deduction (or itemized, if that is the case).
To qualify for an ACA subsidy, you have to make at least 100% of the Federal Poverty Level (FPL). Subsidies used to end at 400% of the FPL (the dreaded subsidy cliff) but the Inflation Reduction Act removed the cliff and lets it tail off to infinity at costs above 8.5% of your income. From 100% to 400% the percentage varies from 0 to 8.5% as your income increases.
Useful article and much more helpful than my estimated recall!
While the subsidy no longer has an upper income limit, it does disappear around $200K for a single person. I think that is b/c the 8.5% surcharge would be more than the total cost of insurance. There is probably a more technical explanation than that.
We are doing this - to bridge time between early retirement and Medicare age. We have been living since 2021 on our non -retirement savings and our only income is interest income (from already taxed savings - not 401 K) and the money I make from a part-time job. Family of 2, our health insurance premiums are much lower than COBRA would have been at the time. We have done this now in both NJ and MA. In NJ we got better rates. In MA, we are paying higher premiums than we did in NJ to be on a better plan (more widely accepted - so includes the Boston hospitals mentioned by the other poster - Dana, Brigham, etc.)
Yes, I wonder how much the growth of FIRE has been boosted by ACA subsidies. Certainly early retirement is much more common in places like Europe where healthcare is free.
This is for a platinum level BCBS plan with basically no deductibles and no or very low co-pays, even for drugs.
I think this plan makes no sense for anyone, it’s crazy expensive. I guess some people just don’t want the hassle of making co-pays and paying a deductible, and are willing to pay for it.
But even on a bronze plan, worse case where you meet your deductibles and out of pocket maximums, the total cost can reach $35K+.
Although it is very hard to reach the OOP max unless you are on a crazy amount of drugs or have a hundred doctor appointments/year.
When we budgeted, we planned for premiums + deductibles, and didn’t worry about co-pays since we don’t use that much in the way of medical resources. Cost for that can run $25-27K depending on the plan.
Premiums are affected by age, as well. They go up a lot as you get into your 60’s.
I wondering if anyone can answer this question about drugs covered under Medicare drug plans. I’m on Medicare and have a supplemental plan through Blue Cross Blue Shield and a Blue Cross Blue Shield Medex drug plan. The drug plan has a deductible ($500) for drugs that fall into Tiers 3 and 4; drugs in Tiers 1 and 2 have no deductible. I only take 2 drugs (eye drops) and, of course, one of them is in the group where it’s not covered until I meet the deductible. Is it Medicare or BCBS who categorizes drugs like this and what are the criteria for putting drugs in various categories?
It’s bcbs that puts the drugs into different tiers
Their criteria will usually fall into a few categories. Is there a cheaper generic that does a similar thing? Is the insurance getting rebates from the manufacturer to place the drug in preferred category? Is it highly expensive? Is there a similar medication that has been proven to be more effective and better results?
Every Part D provider makes their own decisions regarding which drugs are in which tier, as well as how much they will charge. The good thing is that you can switch drug plans annually if necessary … of course, the plans also can change annually! My H has a drug that falls into a more expensive tier, so he pays cash at Costco for it (their price is even more inexpensive than the GoodRx price, which is also quite a bit less expensive than the price through the Part D plan)
If you are self-employed you can deduct premiums. It’s harder to deduct large out of pocket costs. That makes it better to pick a plan where you pay more in premiums.
Thanks, notrichenough. That’s a more manageable figure. Still soooo expensive. My ideal would be either hub or I gets part time job with benefits if we want to scale back from full-time work not use so much savings on healthcare for those pre-Medicare years.