Sally Redux

It is fundamentally flawed, that's for sure.

scrubbedexpat099

Lack of cost control plus cross generational subsidy will not help.

nun

Yeah, let's get rid of Medicare too...that's subsidized by all those young working people.

Pulaski

It would be easier just to get rid of the old people.

OnwardandUpward

It's hard to predict what will happen, it's all a bit messed-up. I'm just taking it one year at a time, this year if I earn $25 000 it's @ $200-$538 a month premiums plus $1500-$2000 out-of-pocket, then I'm still reading the small print on what other charges, that's a Platinum policy in Texas. That's as cheap as I can get it from what I can see- and way cheaper than the other policies advertised as bronze and gold.
The website says you don't know the final charge until you apply, so hopefully it's fairly accurate.
I don't want to spend too long earning $25 000 a year though, it's not enough to save for retirement.
I feel like I don't quite know what I'm doing any more!

nun

At least Obamacare has death panels, that should help to keep costs down.

nun

Try this site to estimate your cost and subsidy

Texas Health Insurance Exchange | Healthcare.gov

a18ion

Yes, well, neverminding that the actuarial figures behind it may be bunk, the idea of Medicare is more like the NHS, but for OAPs only. Heath care paid from universal taxation. So you have to wonder how Americans miss the connection to a fully universal system...

The con, of course, is that your FICA contributions will pay for your health care in old age. Rubbish. This is no different than the con involved in every country's pay-as-you-go pension scheme, including the UK. It's bollocks.

There's nothing wrong with promising people health care or pensions from general taxation. But the idea their own NIC or FICA contributions are being set aside for them is fantastic (in the old sense of the word). The sooner there's more honesty by politicians, the better discussions we might have.

Michael

Please provide a little more information since without it, no one understands what you are talking about. Are you single, married, have children? What are the ages? What is your zip code?

Why do you need the most expensive plan? Do you have major health conditions? Are the prices you are quoting after the federal subsidy?

Pulaski

As premiums rise, more and more people will realise that they are better off, or no worse off, with a high deductible plan, and will largely take themselves out of the insurance system by paying their own medical expenses from their HSA, and rarely having reason to claim on their insurance. ..... I haven't had a claim due to illness or injury to make since I went over a HD policy five years ago. (preventative treatments and check-ups are covered, and small charges are processed, but are settled entirely out of my HSA).
Ah ha! As we suspected all along!

OnwardandUpward

The website itself, which someone just posted a link to, is quite hard to follow I think, keeps taking you off to the insurance company websites to read all the small print/ providers etc.

This icoverage s just for me, no-smoker, based on $25 000 income pre-tax for 2015 in Texas- you don't need to know my zip code! This is the best value plan from what I can see- a bronze plan has $5000-$6500 out-of-pocket.

I will definitely be using the coverage extensively in 2015 as yes, I now have health problems.

*

"manners maketh man"

nun

I think the most complex and worrying aspect of Obamacare is the subsidy and trying to estimate your Modified Adjusted Gross Income.

For me I'm a 53 year old male living in MA. I retired earlier this year just as the Obamacare websites crashed......I decided to buy insurance from my ex-employer.

This year my MAGI would have been too high to get the subsidy and the cheapest Silver plan with a $2k deductible would have cost me $400/month....the same as my ex-employer's plan that has a $250 deductible and far lower co-pays.

In 2015 my income will be far less and I might get a $300/month subsidy, but I'm going to stay with my ex-employer's plan because in 2016 I'll be 55 and qualify for a lower premium of $100/month.....so I'm going to pay the higher premium up to then to maintain continuity and the high level of coverage. I figure it's worth the few thousand dollars difference to avoid uncertainty.

OnwardandUpward

It's hard to know what to do but your rationale sounds reasonable.

I bought COBRA for three years after my divorce, which was $400 or so a month plus $1500 out-of-pocket, this was 2008, and people were saying then how terribly expensive that was, no inkling of the higher costs to come which are the norm now; it was worth it to me for the reassurance while I started over, like you say- avoid uncertainty.

a18ion

Our policies were also HSA high deductible policies. We hadn't expected to make claims, but that's not how it turned out... Actually, if you do the maths, it's never more advantageous to by anything above Bronze (if you're not getting a subsidy).

We view our policy much as you describe, except that paying the premiums is kind of like membership dues to a "buying club" where I get the "contracted rate my club has negotiated" for the heath care I expect to pay for out of my own pocket.

In figures, while we paid $25,800 in premiums, the list price for the services we received was $80,000, but the contracted rate was $56,800, so our premiums and the "member discount" were very close. So, making it a wash, which is okay, because I still have insurance in the bargain, in case things don't go well.

In our case, they didn't go well and the insurance "value" of the club membership was quite good. Of the contracted costs of $56,800, we paid $18,200 in deductibles, and the insurance "club" paid $38,600.

So these High Deductible policies are closer to catastrophic coverage. For the most part your premiums give you access to cheaper "contracted" care prices, but all your care is paid for yourself in years when you don't have any major illness. But in years when you have big bills, there's a payback.

Anyway, that's how I try and wrap my brain around it...

Pulaski

That's essentially it, in nut shell.

We realised that with our more traditional policies, with lower deductibles, that we still weren't reaching the threshold where the insurance kicked in, so we getting no value from the extra premiums we were paying over and above the premiums for HD policies. In other words, if our medical expenses are only a few hundred dollars, it makes no difference if the deductible is $2,000 or $9,000, but by choosing a HD policy we had the same OoP cost, but only about 20% of the premium cost. And the "OoP" payments actually come from our HSA.