I have no idea what your risk factors are.
I quoted what the average was and my family quote was for two 55 year old parents which is significantly more expensive than average, and their kids.
For 5, I pay about $1300 a month and it is a good plan.
Remember how this impacts you has to do with your state. That’s who manages- or doesn’t- your insurers and the options presented to you.
Exchange net pricing will vary based on your income. So two adults may pay X while another couple pays Y (even same state.) So some here are talking post-subsidy, while others are talking about the base price. And remember that your plan’s deductible and max out of pocket may be different than the next guy’s, when quoting and comparing prices on a thread. And that, depending on what happens to you, your plan’s co-insurance percent can affect how you reach your max out of pocket.
Apples to apples is hard to do with other families. And if you are looking to (or have to) change the specific plan, you have to weigh all the components: monthly, deductible, co-insurance and then maybe office visits, Rx costs and whether your doc is included. In 2015, my price went up, but my deductible went way down. (I thought there might be some major expenses, so this worked for us.)
OP, just FYI, “Obamacare” doesn’t set prices. Private for-profit health insurers set the prices.
Our increase is 13%. We’ll be meeting with our agent to see what else is available. This was not something we could do before Obamacare, because of preexisting conditions.
How does risk factors don’t play into Obamacare? I know age risk does. When I applied there were no health questions asked. Only age. Is there a database they access before quoting on the exchange. I thought it was pooled insurance where they looked at the total cost of coverage by everyone in the pool and based the rate on that. Wasn’t that suppose to be one of the advantages of Obamacare that it gives an individual access to pooled insurance of both low and high risk people. Unfortunately not enough low risk people signed up. Which may explain the high rate increases this year. The costs were greater then the estimates.
Cardinal Fang, I agree completely agree that is how it works but how effective is it if there are only two insurers on the exchange? One a giant and another a small player. Also for drug prices, if you have a patent there is no competition to drive lower prices. I fully understand the need to recoup development cost and the need to fund future costs. However, they are willing to sell the same medicines in other countries for MUCH lower costs. Partly because other governments won’t include them on their plans unless the cost is lower. We don’t have that benefit.
I don’t think he meant risk as in health status. Rather, your particulars. No database for your individual healthcare usage history, to be used for costs. That was a pre-ACA hurdle.
It’s not so effective with only two insurers, unless your state is on top of managing what they offer and how they operate. Also, some states have rollout plans for how they will be adding to the competition, over the first years.
Btw, on CC, we are not supposed to compare with other countries or what we think is ideal. Just what is and how we can make our best decisions. If a family is dependent on certain Rx, you want to see how your insurer covers those- and what alternatives you may already have.
I absolutely agree with you that this is a problem, and that’s the reason for the individual mandate. Without it, there’s little incentive for healthy people to jump into the risk pool and pay money for a service they believe they won’t need (though they can be catastrophically wrong about that). And of course, there cannot be affordable health insurance without lots of people in the pool who are healthy this year.
Many people, especially young people, have made the calculation that the penalty is cheaper than insurance premiums, and that was most assuredly true the first year when it was under $100. But the penalty was designed to start small and then rise steeply over the first few years. In 2017, a family could be on the hook for $2K or more if they opt out. Still cheaper than insurance, but I think that as the penalty rises, and the differential between the penalty and the cost of insurance drops, the thought process should change for many people: “If I’m going to pay all that money, I might as well get something for it.”
ACA is being rolled out over a number a years, and it will be a while before the dust settles. For example, a family which incurs a $2K penalty for the 2017 tax year won’t feel it until they file their taxes in April 2018. At that point it will be too late to get coverage for 2018. That family will have to wait until late 2018, for the 2019 tax/coverage year, and insurers won’t know the state of play, healthy vs unhealthy subscribers, until the 2020 plan year. This year’s premiums are only a snapshot, and we won’t have the full picture about how this is working for some time to come. In the meantime, I’m darn glad that my D and my DH, who have preexisting conditions, are able to get insurance at a price they can afford.
The pre-exisiting conditions will kill this whole thing off. It’s great that those with these conditions can get coverage, and I am sure they love that they can’t be charged more than healthy individuals. However, at that point, it is not insurance. It becomes welfare. Insurance is designed to balance risk vs. premiums paid. Higher risk, higher premiums. That’s not what we have. Higher risk people with guaranteed large payouts for medical care pay nothing more than healthy individuals, and that is not sustainable.
It’s been sustainable for decades when companies do it. If you got insurance through your employer, you didn’t have to pay more if you were a diabetic asthmatic heart patient than if you were a marathon runner.
The companies paid the majority of that cost(and in some cases, all of that cost). It’s not the same.
Some companies paid the majority of the costs. Others, especially small businesses, did not.
@Parent1337 What an odd thing to say, welfare. My pre-existing condition happened when I was 15 years old and I have been uninsurable, except through a company all of my adult life, more than 30 years. My husband is self employed and I am home with my homeschooler, so no way for me to buy insurance before Obamacare. Insurance has been a nightmare. The thing is, I very rarely see a doctor for my condition. I take several generic medications and go in once every 3 months for a 15 minute medication check. That is only 4 doctor appts a year. Nothing more. For years, I actually didn’t see a doctor or take medications. Yet, I am uninsurable.
It takes very little to end up with a pre-existing condition. Just one illness that can become chronic, even if you barely receive treatment. Many of us don’t cost much but we will have a label that we cannot shake, forever! How is that welfare?
Im not a fan of obamacare yet at the same time people who paid in to insurance for their entire life to be dropped suddenly when an illness set in is not insurance either. It came to the point every illness however minor became a prerxisting. Treating headaches, perspiring too much, or high cholesterol became enough to deny medical insurance. Everyone has got something whether its a mole, seasonal allergies, asthma or a family history and if you dont one day an illness can set in. I think the problems are the regulatory costs, the monopolization of healthcare, lack of transparency with costs, and obamacare is trying to cover everything from soup to nuts, while implementing the movement away from medicine as an art to an assembly line with strict rules where the approach of one size fits all does not work. Why on earth does acne medicine and birth control meds require preauthorization? Why every month do i have to drive down to doc office to pick ip prescription for ADD meds. Why every month doc has to call in acne medicine? When the drug that is prescribed by doc gets denied why does a bureaucrat overrule the doctors decision so parient gets sicker and more healthcare is used ie hospitals and er’s. Why is it when you need surgery and you cant afford to pay deductible upfront require you to have surgery inpatient to pay over time? This is the lunacy of the system. And why doesnt our government enforce antitrust laws with pharmaceuticals?
The main reasons that normal market mechanisms works poorly for medical insurance are:
a. From an individual standpoint, medical care is often expensive and not predictable enough on an individual basis, so individuals would like the buy insurance for it, rather than saving up for possible heart attack or cancer treatment like they do for planned purchases of houses, kids’ college, etc…
b. But from an insurance point of view, some risks are predictable enough on an individual basis, and costs can be scheduled to some extent, that adverse selection is a serious problem with respect to pre-existing conditions. I.e. there will be people who will try to go without insurance but then try to buy insurance as soon as a physician says “you need expensive treatment for ____ within the next month”.
What shielded most people from the poor functioning of the medical insurance market in the pre-ACA days was that most people were either covered by employers or the government. In both cases, their plans covered people with pre-existing conditions but also covered all in pools which were not selected for health or sickness. But that also meant that going into self-employment or retiring before Medicare age was not much of an option for those who had pre-existing conditions the shut them out of the pre-ACA individual medical insurance market.
In the pre-ACA days, pre-existing conditions included common things like asthma and any kind of diabetes.
Obamacare mostly affects the individual insurance market, not group insurance. Also, the amount which the employee contributes is a decision made by each individual business, and has no bearing on the amount of the premium. Although lots of businesses have used the general confusion about Obamacare as a golden opportunity to stick it to their employees.
Like @LKnomad , we are veterans of the individual insurance market, and before ACA, it was a harsh place to be. Before ACA, my D could not get insurance at any price. I know that was OK with some people, but it was a bit of a problem for us.
Our insurance has gone down to next to nothing. We are insured through my husbands company’s group insurance and choose the high deductible plan. His company even pays the first $1500 of the deductible if we actually go to the doctor. This is a great deal for low maintenance people like us.
@walkinghome, have a look at your husband’s W-2. I think it’s line 12DD, something like that. Anyway, it’s the line that says how much your insurance costs. I’m willing to bet that number is not “next to nothing.” It’s probably a five digit number. Your insurance doesn’t cost next to nothing; it’s just that you’re not paying for it.
@LASMA starting 2018 it will affect group insurance with a 40% “Cadillac Tax” if employers don’t reduce coverage and increase deductibles. We already have a $5K deductible before our insurance kicks in, I shudder to think what it’s going to be when this new tax kicks in in 2018.
http://www.cnbc.com/2015/10/01/obamacare-cadillac-tax-who-wants-it-and-who-wont-pay.html
We pay $1200 per month with a $5,000 deductible. It’s crazy! That’s obviously way more than the penalty. But if you have assets for a hospital to go after in the event of serious illness or injury, it still makes sense to have insurance. If you have no liquid assets there is much less incentive.
@“Cardinal Fang” , I misstated that, I guess, but it’s not coming directly out of our pockets any more.
Let’s be accurate about the Cadillac tax. It affects only those companies who offer group insurance that costs over $10,200 per year per employee, or family insurance that costs over $27,500 per year per employee. That’s expensive insurance, much more expensive than most companies offer. If you make the rough guess that employees at a company average 40 years of age, that’s equivalent to individual insurance for a 60 year old that costs $15,000 per year or $1250 per month, a lot of money.
Also, the Cadillac tax is only levied on the portion of the premium that exceeds the threshold. It’s not 40% of the entire premium, but 40% of the excess.