2017 ACA plan previews

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tbradnc
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Re: 2017 ACA plan previews

Post by tbradnc »

cricket49 wrote:
DetroitRick wrote:
Hayden wrote:This is something I never considered when thinking about where to early retire. For early retirees who need to purchase individual insurance, where are the good locations, i.e., places where it is possible to purchase a plan with a large network?
Hayden, it's a great question. But any answers you get today, based on recent trends, will become meaningless in a year anyway. Many locales are experiencing shrinking policy options and shrinking provider networks. And then there is the potentially unpredictable impact of tax credits.

For example, as an early retiree in Southeast Michigan, we appear to have lots of plans (in our age brackets, 55-60, healthcare.gov shows 41 Silver plans). Sounds stellar, but most of this are minor derivations of identical plans. 8 different HMO policies from the same insurer in that 41 number are identical, except for size of provider network and small out of pocket limitations. There are only 3 PPO policies available for 2017 here, and those are virtually identical. Personally, 2017 changes have pushed us to switch from PPO to HMO (otherwise our net of credit costs would be up 40% for 2017). Even calling doctors offices to confirm accuracy of provider listings is rough - lots of errors and changes in getting these simple lists. We'll work through it, but I'm just saying that trying to pick an area that is likely to have a large network 3 years in the future is going to be worse than predicting market returns for the same period. Much worse. And believe me, I would love to be proven wrong. :D I would start packing the moving van next year.

The other thing that makes comparisons difficult, occurs when the tax credit is used (our case). That credit is determined on expected total medical expenses using the benchmark plan (2nd lowest Silver Plan). In theory, ACA will help defray large increases by higher credits. That is what our local newspapers are incorrectly saying this week. But in actual practice, our market has continually seen a single bottom-feeder type insurer offering a single low-priced "benchmark" policy for a given year. Then they leave the marketplace after 1 year, and somebody else comes in to do the exact same thing. The result - there is no accurate way to predict tax credit impact from year-to-year, at least until the insurer market gets past its learning curve and these benchmark rates stabilize.

I'm really interested in how others answer your question, but I think this whole process is too transitional to bank on any particular answers. At least for a while.
We are in Tennessee which is one of the states where the premiums went up over 50% but you cannot really compare apples to apples because for 2016 we had an option of 30+ health plans to choose from. In 2017 we have 4 plans offered and our plan was discontinued. Only plans available BCBS are 1 Bronze, 2 Silver and 1 Gold with premiums ranging from 1757/month to 3258/month for 2 people. Not too bad huh? 15,000 deductible and all plans NOW pay at 50% after the deductible is met except the Gold plan which is 3258/month. Not only are the premiums not affordable but the benefits have been cut to the bone.

It gets better. BCBS has managed to cut benefits where this is more like an HMO instead of a PPO plan. The main hospital in our area is not covered and only 2 out of 6 of our doctors are in the ACA for 2017. The mammogram facility is not covered. The only drug prescribed is not covered.

Until I read DetroitRick's post I assumed we would have access to the same hospitals and doctors that are currently under the ACA for 2016. His post made me research the ACA health plans fine details. Many of the Dr's and hospitals are running from Obamacare just like the insurance companies.

We don't know what we are going to do since paying an annual premium of 21,000 is outrageous for very limited care. We were planning to retire this year but now are looking at other options. :annoyed
We're in TN too but I think that there are county-by-county differences within each state. We're in Unicoi and our plan (BC/BS B07S) is still available in 2017 but the rate is almost 100% higher. We qualify for a subsidy which will drop the monthly premium to $249.xx if I use 100% of the subsidy to offset the full rate.

I could get a cost sharing Silver plan for about the same amount but my spouse and I are in good health and rarely access the medical system so I'm going to roll the dice and stay with a HDHP so I can fund our HSA 100% again
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JDCarpenter
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Re: 2017 ACA plan previews

Post by JDCarpenter »

cricket49 wrote:...

We are in Tennessee which is one of the states where the premiums went up over 50% but you cannot really compare apples to apples because for 2016 we had an option of 30+ health plans to choose from. In 2017 we have 4 plans offered and our plan was discontinued. Only plans available BCBS are 1 Bronze, 2 Silver and 1 Gold with premiums ranging from 1757/month to 3258/month for 2 people. Not too bad huh? 15,000 deductible and all plans NOW pay at 50% after the deductible is met except the Gold plan which is 3258/month. Not only are the premiums not affordable but the benefits have been cut to the bone.

It gets better. BCBS has ...
Look at the bright side--you still have BCBS as an individual option in your part of Tennessee!

FWIW, we are retiring either 6/30 or 7/31; at end of this year, will probably be switching employer coverage to relatively expensive and uninspiring plan (but with HSA) offered by DW's employer, rather than my very nice plan--my employer is too small to come under COBRA, while hers is easily big enough. By biting that bullet, we'll at least have another option for the first 6, and likely 18, months of retirement...
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Kat2809
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Re: 2017 ACA plan previews

Post by Kat2809 »

In RTP area the premiums went up about 12%
Female 44: $450->$505
Male 46: $495->$555

However, with several companies dropping out and changes to the plans, the big difference I noticed is that all the new plans actually include 60-80% out of network coverage, no HSA but all have very low co-pays including a $600 Emergency visit and they include Duke and Wake so that covers everywhere I'd likely go. So I'm ok with the changes as if I had the same issues as 2015/2016 I'd actually save $2200 out of pocket costs.
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susa
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Re: 2017 ACA plan previews

Post by susa »

For those with currently 2016 Silver Plans and planning on getting another 2017 SP, have you easily figured out the differences when you have multiple SP's available from same provider ?

Case in point, we just estimated a Blue Cross (BCBS) SP where the only discernible difference is monthly premium, out of pocket max but same doctor(s), same hospital(s), much is same and more of the same. When clicking on Compare, even then, not easily obvious.

Now, if the difference is just $10 or $20,.... but often the difference is double, yet not easy to spot what I purchase for $100 more / month
snowman
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Re: 2017 ACA plan previews

Post by snowman »

susa wrote:For those with currently 2016 Silver Plans and planning on getting another 2017 SP, have you easily figured out the differences when you have multiple SP's available from same provider ?

Case in point, we just estimated a Blue Cross (BCBS) SP where the only discernible difference is monthly premium, out of pocket max but same doctor(s), same hospital(s), much is same and more of the same. When clicking on Compare, even then, not easily obvious.

Now, if the difference is just $10 or $20,.... but often the difference is double, yet not easy to spot what I purchase for $100 more / month
Call the provider directly, they will offer detailed explanation. Don't call the exchange, that's a waste of time. We went through the same exercise 2 years ago.
snowman
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Re: 2017 ACA plan previews

Post by snowman »

For us, ACA has been a godsend. Our silver plan went up 26% for 2017, after similar hikes over the past 3 years, yet we still pay less now for better coverage (even before subsidies) than we did in 2013 (last year before ACA). However, I agree with other posters that this is a race to the bottom and it is not sustainable in the long run.
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Hayden
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Re: 2017 ACA plan previews

Post by Hayden »

The WA plans won't be on the state website until Nov 1. I know what is going to happen to my current plan, because the company told me. But I don't know what other options I have.

Anyone in WA found a way to see the 2017 options now?
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Hub
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Re: 2017 ACA plan previews

Post by Hub »

BruDude wrote:RE: Provider networks - I have a number of clients in Houston. None of the plans available on the individual market allow access to Texas Children's Hospital, MD Anderson, or Houston Methodist, which are the three major hospitals in the city. I am seeing this more and more every year. The networks are changing so much that I have just started telling clients they need to verify providers on their own, I simply don't have the time to do it anymore for every client.
This is my issue more than the money. I can reconcile the fact that this stuff is ridiculously expensive, but along with that needs to come good in-network options and out-of-network coverage that has a maximum out of pocket. I couldn't imagine paying all this money and then not being covered for special care that one time catastrophe did strike.
eog
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Re: 2017 ACA plan previews

Post by eog »

Does anybody have any idea what is causing the spike in these prices? Is it basically because the pool of people that the insurers have to insure now include those with pre-existing conditions and the fact that insurers cant just drop clients?
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munemaker
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Re: 2017 ACA plan previews

Post by munemaker »

eog wrote:Does anybody have any idea what is causing the spike in these prices? Is it basically because the pool of people that the insurers have to insure now include those with pre-existing conditions and the fact that insurers cant just drop clients?
Several factors:
1) People with health problems sign up for sure.
2) People with serious pre-existing conditions pay the same price as an olympic athlete. Risk is being considered based only on age and tobacco use.
3) Young are being overcharged by a factor of 3X to make premiums more affordable for the old. Obviously if you are asked to pay 3 times the value for anything, you are going to resist buying it, to the degree that you can. Hence, a lot of young, healthy people are not signing up.
4) Insurance companies calculate their rates from history, and there was no history for a system like this. Government built a provision in the system to help reimburse insurance companies for losses in the first few years. This enabled insurance companies to price more aggressively at first, but now their actual experience is driving the increases.
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Don Christy
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Re: 2017 ACA plan previews

Post by Don Christy »

eog wrote:Does anybody have any idea what is causing the spike in these prices? Is it basically because the pool of people that the insurers have to insure now include those with pre-existing conditions and the fact that insurers cant just drop clients?
First, the rate "spike" impacts only a tiny portion of the insurance market (albeit likely a higher portion of bogleheads).

Only a small percentage of the insured are in individual ACA exchange and large (83%) number of those are subsidized so that the rate increases won't be felt by them (though they may have fewer plans and narrower networks).

Here's an analysis of the health coverage market for the entire US population:
http://acasignups.net/16/10/26/reminder ... r-coverage

So while this is a BIG issue for a few, it's not an issue for many.

Also, the average premium for the benchmark plan in 2017 is right where it was projected to be when ACA was being passed. The rates were lower the first couple of years, probably a mistake by insurers.

my read is that there are a number of factors driving the spike in rates in this small slice of the market:
- low penalties for not signing up have kept many young healthy folks out
- insurers mispricing plans
- adverse selection where sick people signed up for richer plans and healthy folks went with cheapest or stayed out altogether. So risk pooling didn't work out for insurers.
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eog
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Re: 2017 ACA plan previews

Post by eog »

Don Christy wrote:
First, the rate "spike" impacts only a tiny portion of the insurance market (albeit likely a higher portion of bogleheads).
I don't think this is the case. My last 2 employers have both gone to high deductible plans that have higher premiums and worse coverage. I am not sure if that is completely due to ACA or not but the publications I have received from our benefits department called out ACA as one of the reasons for my company dropping all non high deductible plans. I have no idea what how comparable the price increases have been for those that are not using ACA plans vs those that are.
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Hub
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Re: 2017 ACA plan previews

Post by Hub »

While companies seem to have heavily shifted toward HDHPs, the ACA exchange has fewer HDHP options for me than "normal" plans and fewer than a year ago.
Tanelorn
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Re: 2017 ACA plan previews

Post by Tanelorn »

Don Christy wrote:Only a small percentage of the insured are in individual ACA exchange and large (83%) number of those are subsidized so that the rate increases won't be felt by them (though they may have fewer plans and narrower networks).

Here's an analysis of the health coverage market for the entire US population:
http://acasignups.net/16/10/26/reminder ... r-coverage

So while this is a BIG issue for a few, it's not an issue for many.
It is a BIG issue for many. Those stats only count the 11M people on the exchange, not the 6M people who buy off-exchange individual policies because they don't qualify for subsidies (there's more choice off-exchange, even if it's small variations) and the 7M people who paid penalties to not buy insurance because it was too expensive, and that's not even counting the other 25M people who are still uninsured but have some excuse not to pay the tax penalty for not having insurance.

Even of those who buy insurance, the subsidies only cover slightly more than half - 9M of the exchange group, out of 17M who bought individual insurance last year (11M on, 6M off exchange). That's just about half the people who are paying full sticker price for these increasingly poor plans, and of course many people who get some subsidy, ie families in the $50-100k income range, won't get a very large one. And everyone who isn't on a cost sharing silver plan, where eligibly caps out at 250% FPL, is facing $6k deductibles for most things, so even after you pay most or all of the premiums, you may well still pay thousands more before you get any relief.
Also, the average premium for the benchmark plan in 2017 is right where it was projected to be when ACA was being passed. The rates were lower the first couple of years, probably a mistake by insurers.

my read is that there are a number of factors driving the spike in rates in this small slice of the market:
- low penalties for not signing up have kept many young healthy folks out
- insurers mispricing plans
- adverse selection where sick people signed up for richer plans and healthy folks went with cheapest or stayed out altogether. So risk pooling didn't work out for insurers.
Don't forget the risk corridors provisions designed to funnel billions of taxpayer money to insurers so they could keep prices artificially low for the first three years to make it apparently more palatable and economic than it actually is. Now that those subsidies to the insurance companies are gone, we should see the "real" prices going forward starting with 2017. I don't see a lot of enthusiasm for them.
BruDude
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Re: 2017 ACA plan previews

Post by BruDude »

Just got a renewal notice for a client that went from $600/mo to $1100/mo for same plan, pretty ridiculous.

For those in extremely high cost of insurance areas - one option you may want to look into is to see if you can buy an 11-month or 12-month short term policy. If the lowest-priced plan on the exchange costs more than 8.13% of your income, you can get an exemption from the mandate penalty. Short-term policies don't cover pre-ex conditions and will expire at the end of the term, but are going to be a lot less expensive than unsubsidized plans in most areas. These will become more prevalent for young/healthy families that don't qualify for subsidies.
Planner
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Re: 2017 ACA plan previews

Post by Planner »

Hey, if anyone religious is looking for cheaper coverage, I'd recommend a health care sharing ministry. My wife has been on chministries.org's gold plan ($150/mo) and liked it. You're a self-pay patient (uninsured) in the eyes of the health care provider, but you're exempt from ACA penalties and just have to explain to providers that you have financial support from a group of people, in a similar manner to health insurance. I think each of the ministries have their own requirements to join, but you just have to look at the statement of belief and decide whether or not you can agree or not.
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knpstr
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Re: 2017 ACA plan previews

Post by knpstr »

20% increase in the bronze plan.

Health insurance is now a bigger payment than my mortgage payment.
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rob
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Re: 2017 ACA plan previews

Post by rob »

knpstr wrote:Health insurance is now a bigger payment than my mortgage payment.
Yup.... same here - I'm looking to stop been self-employed mostly due to health "care"... talk about the tail wagging the dog :oops:
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snowman
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Re: 2017 ACA plan previews

Post by snowman »

Don Christy wrote:
eog wrote:Does anybody have any idea what is causing the spike in these prices? Is it basically because the pool of people that the insurers have to insure now include those with pre-existing conditions and the fact that insurers cant just drop clients?
First, the rate "spike" impacts only a tiny portion of the insurance market (albeit likely a higher portion of bogleheads).

Only a small percentage of the insured are in individual ACA exchange and large (83%) number of those are subsidized so that the rate increases won't be felt by them (though they may have fewer plans and narrower networks).

Here's an analysis of the health coverage market for the entire US population:
http://acasignups.net/16/10/26/reminder ... r-coverage

So while this is a BIG issue for a few, it's not an issue for many.

Also, the average premium for the benchmark plan in 2017 is right where it was projected to be when ACA was being passed. The rates were lower the first couple of years, probably a mistake by insurers.

my read is that there are a number of factors driving the spike in rates in this small slice of the market:
- low penalties for not signing up have kept many young healthy folks out
- insurers mispricing plans
- adverse selection where sick people signed up for richer plans and healthy folks went with cheapest or stayed out altogether. So risk pooling didn't work out for insurers.
Thanks for the link, very informative, especially the chart. Puts things in perspective.
furnace
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Re: 2017 ACA plan previews

Post by furnace »

rob wrote:
knpstr wrote:Health insurance is now a bigger payment than my mortgage payment.
Yup.... same here - I'm looking to stop been self-employed mostly due to health "care"... talk about the tail wagging the dog :oops:
We don't need a house; we all can just live in the hospital :mrgreen:
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JDCarpenter
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Re: 2017 ACA plan previews

Post by JDCarpenter »

Planner wrote:Hey, if anyone religious is looking for cheaper coverage, I'd recommend a health care sharing ministry. My wife has been on chministries.org's gold plan ($150/mo) and liked it. You're a self-pay patient (uninsured) in the eyes of the health care provider, but you're exempt from ACA penalties and just have to explain to providers that you have financial support from a group of people, in a similar manner to health insurance. I think each of the ministries have their own requirements to join, but you just have to look at the statement of belief and decide whether or not you can agree or not.
Don't necessarily need to be that religious. I've been looking at one that, although close, would be comfortable for this secular humanist/agnostic (employing an expansive interpretation of the deity). Liberty Health Share (see its statements of belief here: https://www.libertyhealthshare.org/do-i-qualify ). From my initial look at these options, however, this is the only one that I could in good faith apply for. (And, I suspect that some of the others would require pastor's attestation and the like.)

For all of these ministries, I believe pre-existing conditions come into play. They also are not technically insurance and are subject to even less regulatory oversight than insurers. Most have lifetime expenditure caps.
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nirm
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Re: 2017 ACA plan previews

Post by nirm »

For those seeing ridiculous premium costs on top of high deductibles and subpar coverage, wouldn't it make more sense to pay the tax penalty, and self insure with the savings?

I know it's not ideal, but that's what I would be considering at that point.
Tanelorn
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Re: 2017 ACA plan previews

Post by Tanelorn »

nirm wrote:For those seeing ridiculous premium costs on top of high deductibles and subpar coverage, wouldn't it make more sense to pay the tax penalty, and self insure with the savings?

I know it's not ideal, but that's what I would be considering at that point.
It's worth considering. Here is a current thread discussing that topic:

viewtopic.php?f=2&t=201714

It would be nice, even if self-insuring most of the expected costs, to get some aspect of either pre-negotiated rates or catastrophic coverage.
BruDude
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Re: 2017 ACA plan previews

Post by BruDude »

Planner wrote:Hey, if anyone religious is looking for cheaper coverage, I'd recommend a health care sharing ministry. My wife has been on chministries.org's gold plan ($150/mo) and liked it. You're a self-pay patient (uninsured) in the eyes of the health care provider, but you're exempt from ACA penalties and just have to explain to providers that you have financial support from a group of people, in a similar manner to health insurance. I think each of the ministries have their own requirements to join, but you just have to look at the statement of belief and decide whether or not you can agree or not.
Anyone considering this should note that a sharing ministry is NOT an insurance company and they have no obligation to pay your claims. There's also a number of exemptions on what they will cover.
cricket49
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Re: 2017 ACA plan previews

Post by cricket49 »

nirm wrote:For those seeing ridiculous premium costs on top of high deductibles and subpar coverage, wouldn't it make more sense to pay the tax penalty, and self insure with the savings?

I know it's not ideal, but that's what I would be considering at that point.
I would if I had no assets. Also, would not be willing to be hit with a 200,000 hospital bill.
Expect the best. Prepare for the worst.
talzara
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Re: 2017 ACA plan previews

Post by talzara »

Tanelorn wrote:
mcfroggin wrote:i am seriously considering starting a business with someone in the same boat as me, so that we could qualify for the better corporate policies. The purpose of the business would not be to make money, but to obtain quality insurance. Either that or my wife may need to get a job merely to get us decent insurance.
I would happily pay your business overhead costs to join your company if you figure this out (seriously! I'm healthy too :)). I am also looking into this. Feel free to PM me if you want to share experiences.
It doesn't matter how healthy you are. Small businesses up to 100 employees are community-rated.

Self-insurance has become an option for businesses above about 30 employees. It won't work for 2 employees, because you will not find anyone to sell you stop-loss insurance.
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bottlecap
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Re: 2017 ACA plan previews

Post by bottlecap »

nirm wrote:For those seeing ridiculous premium costs on top of high deductibles and subpar coverage, wouldn't it make more sense to pay the tax penalty, and self insure with the savings?

I know it's not ideal, but that's what I would be considering at that point.
That's what we're doing in six days.

My only concern is having to wait for the enrollment period to get back on should something terrible happen, but that that's a risk we are forced to take.

It will save nearly $10k per year, which dwarfs our typical yearly medical expenses. I give up the preventative syphilis screening under the ACA, but again, that's just another risk I'll have to self-insure against...

JT
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bottlecap
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Re: 2017 ACA plan previews

Post by bottlecap »

BruDude wrote:
Planner wrote:Hey, if anyone religious is looking for cheaper coverage, I'd recommend a health care sharing ministry. My wife has been on chministries.org's gold plan ($150/mo) and liked it. You're a self-pay patient (uninsured) in the eyes of the health care provider, but you're exempt from ACA penalties and just have to explain to providers that you have financial support from a group of people, in a similar manner to health insurance. I think each of the ministries have their own requirements to join, but you just have to look at the statement of belief and decide whether or not you can agree or not.
Anyone considering this should note that a sharing ministry is NOT an insurance company and they have no obligation to pay your claims. There's also a number of exemptions on what they will cover.
Why do they have exemptions if there is no obligation to pay claims? Seems like a waste of attorney fees.
BruDude
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Re: 2017 ACA plan previews

Post by BruDude »

bottlecap wrote:
BruDude wrote:
Planner wrote:Hey, if anyone religious is looking for cheaper coverage, I'd recommend a health care sharing ministry. My wife has been on chministries.org's gold plan ($150/mo) and liked it. You're a self-pay patient (uninsured) in the eyes of the health care provider, but you're exempt from ACA penalties and just have to explain to providers that you have financial support from a group of people, in a similar manner to health insurance. I think each of the ministries have their own requirements to join, but you just have to look at the statement of belief and decide whether or not you can agree or not.
Anyone considering this should note that a sharing ministry is NOT an insurance company and they have no obligation to pay your claims. There's also a number of exemptions on what they will cover.
Why do they have exemptions if there is no obligation to pay claims? Seems like a waste of attorney fees.
Exemptions from covered benefits...i.e. they will not cover certain benefits/drugs/procedures.
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dm200
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Re: 2017 ACA plan previews

Post by dm200 »

One factor to consider if YOUR ACA premium went up from previous year:

In evaluating or forming an opinion about the magnitude of ACA premium increases, it is very common (depending on your age) to separate the portion (if any) of YOUR increase that is due to YOUR age being one year older and the overall provider increase.

So, just as a hypothetical, if your 2016 monthly premium is $500.00 per month and your 2017 monthly premium will be $600 per month, that is a total increase of 20.00%. However, if the premium for the 2017 would be $550 for someone one year younger than you, then that is a 10.00% increase in plan premiums and the rest is attributable to your being one year older. My wife, for example, was in the initial ACA enrollment and during the first few years, overall premiums for her coverage did not increase much at all each year -- BUT her premium increased because she was one year older each year.
talzara
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Re: 2017 ACA plan previews

Post by talzara »

munemaker wrote: 3) Young are being overcharged by a factor of 3X to make premiums more affordable for the old. Obviously if you are asked to pay 3 times the value for anything, you are going to resist buying it, to the degree that you can. Hence, a lot of young, healthy people are not signing up.
Only in New York and Vermont, which disallow age rating.

In the other 48 states, Obamacare has a 3-to-1 age spread. A 64-year-old pays 3 times as much as a 21-year-old. The actuarially-correct age spread is 5-to-1.

Therefore, 21-year-olds in other states are overcharged by 30%, not by 200%. The penalty for not carrying insurance was set to be about equal to this 30%.

The full penalty did not kick in until 2015. Many people would not have learned of the increased penalty until they filed their tax returns in 2016. This enrollment period is the first one in which people are deciding with full knowledge of what the penalty is.

This does not apply to areas that are in a death spiral, or for New York or Vermont. The penalty is not adjusted by ZIP code.
talzara
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Re: 2017 ACA plan previews

Post by talzara »

rob wrote:
knpstr wrote:Health insurance is now a bigger payment than my mortgage payment.
Yup.... same here - I'm looking to stop been self-employed mostly due to health "care"... talk about the tail wagging the dog :oops:
The United States currently spends 17.5% of its GDP on healthcare. Historically, it has spent 17-20% of its GDP on housing.

On average, healthcare will cost about the same as your mortgage.
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Don Christy
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Re: 2017 ACA plan previews

Post by Don Christy »

Tanelorn wrote:
Don Christy wrote:Only a small percentage of the insured are in individual ACA exchange and large (83%) number of those are subsidized so that the rate increases won't be felt by them (though they may have fewer plans and narrower networks).

Here's an analysis of the health coverage market for the entire US population:
http://acasignups.net/16/10/26/reminder ... r-coverage

So while this is a BIG issue for a few, it's not an issue for many.
It is a BIG issue for many. Those stats only count the 11M people on the exchange, not the 6M people who buy off-exchange individual policies because they don't qualify for subsidies (there's more choice off-exchange, even if it's small variations) and the 7M people who paid penalties to not buy insurance because it was too expensive, and that's not even counting the other 25M people who are still uninsured but have some excuse not to pay the tax penalty for not having insurance.
I believe the 6M off-exchange without subsidies is slice 16, representing less than 2% of covered market. I still agree with you that it's a big problem for these folks, and those on-exchange without subsidy, but that represents only about 3-4% of the total covered market.

For the largest population who are covered in large group plans, the National Business Group on Health did a survey and large group Employers’ costs are expected to go up by about 6% next year, with employees seeing average of 5% increase.

And of course the analysis doesn't include those who didn't take insurance, it's an analaysis of the covered market.
Even of those who buy insurance, the subsidies only cover slightly more than half - 9M of the exchange group, out of 17M who bought individual insurance last year (11M on, 6M off exchange). That's just about half the people who are paying full sticker price for these increasingly poor plans, and of course many people who get some subsidy, ie families in the $50-100k income range, won't get a very large one. And everyone who isn't on a cost sharing silver plan, where eligibly caps out at 250% FPL, is facing $6k deductibles for most things, so even after you pay most or all of the premiums, you may well still pay thousands more before you get any relief.
Fair points, but these people would either be uninsured or stuck in really crappy plans otherwise. So there are 2-3% of covered people who are seeing large increases and less options, but have access to quality healthcare, and a large number of folks who were previously uninsured who have subsidized access or access through expanded Medicaid coverage who would not be covered otherwise.

The market has to get larger before these issues will stabilize and resolve, but discussing what it would take to do this starts getting political so will avoid.
Also, the average premium for the benchmark plan in 2017 is right where it was projected to be when ACA was being passed. The rates were lower the first couple of years, probably a mistake by insurers.

my read is that there are a number of factors driving the spike in rates in this small slice of the market:
- low penalties for not signing up have kept many young healthy folks out
- insurers mispricing plans
- adverse selection where sick people signed up for richer plans and healthy folks went with cheapest or stayed out altogether. So risk pooling didn't work out for insurers.
Don't forget the risk corridors provisions designed to funnel billions of taxpayer money to insurers so they could keep prices artificially low for the first three years to make it apparently more palatable and economic than it actually is. Now that those subsidies to the insurance companies are gone, we should see the "real" prices going forward starting with 2017. I don't see a lot of enthusiasm for them.
Agree with this point.
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dm200
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Re: 2017 ACA plan previews

Post by dm200 »

3) Young are being overcharged by a factor of 3X to make premiums more affordable for the old. Obviously if you are asked to pay 3 times the value for anything, you are going to resist buying it, to the degree that you can. Hence, a lot of young, healthy people are not signing up.
How do you get "3 times"? Triple the "value"? I don't get it.

"once upon a time" (as best I understand), many area of the country did not age rate or risk rate the insured. It then became a cycle of charging more for older insured and risky insured, and the more that happened, the more the discrepancies widened.
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Re: 2017 ACA plan previews

Post by fpr4 »

Conch55 wrote:My apologies if someone already posted this but 2017 ACA plans can now be previewed on healthcare.gov.

https://www.healthcare.gov/see-plans/
If accurate, ours is going up 74%.
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Re: 2017 ACA plan previews

Post by munemaker »

dm200 wrote:
3) Young are being overcharged by a factor of 3X to make premiums more affordable for the old. Obviously if you are asked to pay 3 times the value for anything, you are going to resist buying it, to the degree that you can. Hence, a lot of young, healthy people are not signing up.
How do you get "3 times"? Triple the "value"?
I was going by memory which apparently isn't too good. Looks like the young are only being overcharged by 44% to reduce cost for the older enrollees. Sorry about that. REFERENCE: http://dailysignal.com/2016/10/24/obama ... l-problem/

The Affordable Care Act prevents insurance companies from charging their oldest customers more than three times in premiums what they charge their youngest customers. The measure works to prevent insurance companies from charging older customers unaffordable premiums.

However, some policy analysts have expressed concern that this raises the premiums of young Americans. According to an analysis by Heritage Foundation researchers, this could drive many out of the market and raise costs for those who remain—including the elderly. The analysis suggested that young enrollees are paying 44 percent more than they otherwise would as a result of the Obamacare regulations.
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Re: 2017 ACA plan previews

Post by Tycoon »

knpstr wrote:20% increase in the bronze plan.

Health insurance is now a bigger payment than my mortgage payment.
Same here. My mega corp employer plan now costs me more than my mortgage did when I had a mortgage.
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Re: 2017 ACA plan previews

Post by fpr4 »

talzara wrote:
rob wrote:
knpstr wrote:Health insurance is now a bigger payment than my mortgage payment.
Yup.... same here - I'm looking to stop been self-employed mostly due to health "care"... talk about the tail wagging the dog :oops:
The United States currently spends 17.5% of its GDP on healthcare. Historically, it has spent 17-20% of its GDP on housing.

On average, healthcare will cost about the same as your mortgage.
Between premiums and doctor's bills I am projecting to pay 2x in medical costs what I did for my mortgage.

17.5% of GDP is not a historically accurate rate. It is the "whacked out - insurance companies, big pharma, and hospital boards silently control our lives" rate.

Has life expectancy changed that dramatically in the period that per capita healthcare spending has skyrocketed? No. No it hasnt.

Healthcare costs have gone up about 600% (inflation adjusted) since 1970, while life expectancy has gone up 5%. We are lining the pockets of a select few with costs that are largely hidden from the consumer (because their employer or the government covers most of it).
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Re: 2017 ACA plan previews

Post by danaht »

JDCarpenter wrote: For all of these ministries, I believe pre-existing conditions come into play. They also are not technically insurance and are subject to even less regulatory oversight than insurers. Most have lifetime expenditure caps.
It's still a little step up from having no insurance at all. The only thing I don't like about these cost sharing ministries is the fact that you won't be able to fund a HSA with one. There was some legislation recently to try to make these HSA compatible - but it will probably never pass. Also, I am not sure if you can expense the cost of the premiums for these if you are self employed. Fortunately. I won't have to worry about these questions until my current HDHP becomes un-affordable or is canceled.
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Re: 2017 ACA plan previews

Post by dm200 »

munemaker wrote:
dm200 wrote:
3) Young are being overcharged by a factor of 3X to make premiums more affordable for the old. Obviously if you are asked to pay 3 times the value for anything, you are going to resist buying it, to the degree that you can. Hence, a lot of young, healthy people are not signing up.
How do you get "3 times"? Triple the "value"?
I was going by memory which apparently isn't too good. Looks like the young are only being overcharged by 44% to reduce cost for the older enrollees. Sorry about that. REFERENCE: http://dailysignal.com/2016/10/24/obama ... l-problem/
The Affordable Care Act prevents insurance companies from charging their oldest customers more than three times in premiums what they charge their youngest customers. The measure works to prevent insurance companies from charging older customers unaffordable premiums.
However, some policy analysts have expressed concern that this raises the premiums of young Americans. According to an analysis by Heritage Foundation researchers, this could drive many out of the market and raise costs for those who remain—including the elderly. The analysis suggested that young enrollees are paying 44 percent more than they otherwise would as a result of the Obamacare regulations.
OK, that number makes more sense. I suspect that the analysis is complex as well. The degree of "overcharging" or "undercharging", I believe, differs greatly between males and females as well. Since (ignoring the infrequent high tech exceptions) younger women have babies vs older women not, the young/old percentage may be quite different between males and females. While you can make the case that the young are "overcharged", nonetheless their ACA premiums are less or much less than mid to older folks' premiums.
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Re: 2017 ACA plan previews

Post by dm200 »

danaht wrote:
JDCarpenter wrote: For all of these ministries, I believe pre-existing conditions come into play. They also are not technically insurance and are subject to even less regulatory oversight than insurers. Most have lifetime expenditure caps.
It's still a little step up from having no insurance at all. The only thing I don't like about these cost sharing ministries is the fact that you won't be able to fund a HSA with one. There was some legislation recently to try to make these HSA compatible - but it will probably never pass. Also, I am not sure if you can expense the cost of the premiums for these if you are self employed. Fortunately. I won't have to worry about these questions until my current HDHP becomes un-affordable or is canceled.
With these "ministries", how do they actually or claim to cost less than health insurance?
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Re: 2017 ACA plan previews

Post by bottlecap »

BruDude wrote:
bottlecap wrote:
BruDude wrote:
Planner wrote:Hey, if anyone religious is looking for cheaper coverage, I'd recommend a health care sharing ministry. My wife has been on chministries.org's gold plan ($150/mo) and liked it. You're a self-pay patient (uninsured) in the eyes of the health care provider, but you're exempt from ACA penalties and just have to explain to providers that you have financial support from a group of people, in a similar manner to health insurance. I think each of the ministries have their own requirements to join, but you just have to look at the statement of belief and decide whether or not you can agree or not.
Anyone considering this should note that a sharing ministry is NOT an insurance company and they have no obligation to pay your claims. There's also a number of exemptions on what they will cover.
Why do they have exemptions if there is no obligation to pay claims? Seems like a waste of attorney fees.
Exemptions from covered benefits...i.e. they will not cover certain benefits/drugs/procedures.
I guess my confusion stems from your previous statement that the "ministry" or whatever it is has no obligation to pay any claims - which means covered or otherwise. You are in the industry. Is that true? If so, I won't consider them. But if it's true, there is also doesn't make sense that there are any exemptions.

Can these entities take your monthly payments and them claim no obligation to pay claims?

JT
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Re: 2017 ACA plan previews

Post by dodecahedron »

bottlecap wrote:
Can these entities take your monthly payments and them claim no obligation to pay claims?
As far as I can tell (from looking at the paperwork and discussing with a relative who has been happy with her family's experience in the plan), the ministry is not the entity paying claims. The ministry simply assigns specific members to send money to other specific members who have incurred health expenses the ministry deems worthy of assistance. So my relative is not sending money to a faceless anonymous insurance company but rather to a family whose identity is known to her. And the family is mindful that when it incurs costs, those will be borne not by a faceless anonymous company but by a family whose identity has been made known to them.

At least in my relative's ministry, the family assigned to assist another family is expected to send prayers and emotional support as well as financial support.

I gather there is some fairly nominal membership fee ($40/yr) that goes to the ministry for its administrative costs but the bulk of the money goes directly from family to family. It is not insurance in the usual sense of the word. The ministry does not maintain "reserves" or capital as regular insurance companies do. It is a 501c3 and there are probably some volunteers involved in administration on a pro bono basis.

Not my kind of arrangement but my relative has been happy with it.
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Re: 2017 ACA plan previews

Post by talltodd »

Be aware that if you have kids and are reviewing family plans & prices and are in the range to get a subsidy that the prices shown may not be including the kids because they "might" be able to be covered by Medicaid or CHIP. This is not readily apparent and really caught me off guard.
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Re: 2017 ACA plan previews

Post by BruDude »

bottlecap wrote:
BruDude wrote:
bottlecap wrote:
BruDude wrote:
Planner wrote:Hey, if anyone religious is looking for cheaper coverage, I'd recommend a health care sharing ministry. My wife has been on chministries.org's gold plan ($150/mo) and liked it. You're a self-pay patient (uninsured) in the eyes of the health care provider, but you're exempt from ACA penalties and just have to explain to providers that you have financial support from a group of people, in a similar manner to health insurance. I think each of the ministries have their own requirements to join, but you just have to look at the statement of belief and decide whether or not you can agree or not.
Anyone considering this should note that a sharing ministry is NOT an insurance company and they have no obligation to pay your claims. There's also a number of exemptions on what they will cover.
Why do they have exemptions if there is no obligation to pay claims? Seems like a waste of attorney fees.
Exemptions from covered benefits...i.e. they will not cover certain benefits/drugs/procedures.
I guess my confusion stems from your previous statement that the "ministry" or whatever it is has no obligation to pay any claims - which means covered or otherwise. You are in the industry. Is that true? If so, I won't consider them. But if it's true, there is also doesn't make sense that there are any exemptions.

Can these entities take your monthly payments and them claim no obligation to pay claims?

JT
There are some benefits that the costs are not shared for, they are just excluded from being covered altogether. For example, they may not cover birth control or mental health treatment. However, for the items they do "cover" they are not obligated to pay the claims and you could be stuck holding the bag with a really large claim. Who in this type of arrangement is going to pay the bills for someone like this Iowa patient that has over $12 million a year in claims? Link - http://www.desmoinesregister.com/story/ ... /84277758/
She said about 10 percentage points of the increase stem from the costs of a single, extremely complicated patient who is receiving $1 million per month worth of care for a severe genetic disorder.
Since they are not legally filed as an insurance company, they do not have any legal obligation to pay claims or adhere to the rules and regulations that insurance companies do. Generally speaking, those rules and regulations are in place for a reason.

People are attracted to these plans because they are "cheap" relative to health insurance. Well, they didn't pull the "free" money out of thin air and just cut the cost of healthcare by 60%, it has to come from somewhere.
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Re: 2017 ACA plan previews

Post by bottlecap »

BruDude wrote: There are some benefits that the costs are not shared for, they are just excluded from being covered altogether. For example, they may not cover birth control or mental health treatment. However, for the items they do "cover" they are not obligated to pay the claims and you could be stuck holding the bag with a really large claim. Who in this type of arrangement is going to pay the bills for someone like this Iowa patient that has over $12 million a year in claims? Link - http://www.desmoinesregister.com/story/ ... /84277758/
So it sounds like there is an obligation to pay, but that large claims could put the ministry under. That is a risk.

However, no one needs to insure for birth control and, even if you are struck by lighting with a huge, recurring, yearly claim and decide not to end things, you can always get regulated insurance.

The problem is that the "real" health insurance companies have priced themselves out of the market. I understand that these ministries aren't insurance companies, but if I can get some benefit from them, and for less than the penalty I will otherwise pay (which may or may not be the case), then I don't have anything to lose. A regulated insurance is not really an option for the typical person who is self employed anymore.

JT
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Re: 2017 ACA plan previews

Post by dm200 »

I believe this is allowed here, since it does not relate (directly) to proposed legislation.

I saw an article about these large increases in ACA premiums. The opinion was that the major factor in this is that insurance companies are only now getting the data from experience with ACA plans that the believe shows losing money. This increase would, then, be a one time bump and not a HUGE flaw in the ACA. Another factor cited (again perhaps a one time bump) is the end of the reinsurance for very sick people. [do not understand this]. The "penalty" for being uninsured is also only now amounting to significant dollar amounts.
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Re: 2017 ACA plan previews

Post by dm200 »

The problem is that the "real" health insurance companies have priced themselves out of the market
There are, in my opinion, many reasons for high health insurance premiums. I believe the major factor is the high cost, per insured person, for the healthcare expenses paid by insurance companies. The "blame", I believe, is shared at many levels - from insured individuals who "overuse" the system, to defensive medicine by providers, to government that bends to unreasonable voter uproar, to politicians who jump on whatever bandwagon can get them elected, to drug companies, and so on.

High premium health insurance will pay for all kinds of expensive tests, treatments, surgery, etc., but not very much at all for keeping you healthy and not needing much of such treatments. Sometimes it is even difficult for a patient to avoid expensive tests, etc. I have experienced that. A few years ago, for example, I got healthy and have since gotten off 4 preseciption drugs. This is in concurrence with the prescribing physicians. HOWEVER, I initiated the request to get off (or phase off). No Physician even hinted at my getting off the drugs. I asked, and they concurred (perhaps after some interim blood tests). At a followup physical, my doctor receive "guidance" from a cardiologist that I should have a CT scan every 2 years. I "pushed back" because I did not want to be bombarded with more X-Ray radiation. Because I resisted, I was authorized for an in person Cardiology appt and that Cardiologist was in 100% agreement with me that I did not need the CT scan. My Primary Care Physician commented that in her experience younger doctors tend to want and order more tests.
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Re: 2017 ACA plan previews

Post by BruDude »

bottlecap wrote:
BruDude wrote: There are some benefits that the costs are not shared for, they are just excluded from being covered altogether. For example, they may not cover birth control or mental health treatment. However, for the items they do "cover" they are not obligated to pay the claims and you could be stuck holding the bag with a really large claim. Who in this type of arrangement is going to pay the bills for someone like this Iowa patient that has over $12 million a year in claims? Link - http://www.desmoinesregister.com/story/ ... /84277758/
So it sounds like there is an obligation to pay, but that large claims could put the ministry under. That is a risk.

However, no one needs to insure for birth control and, even if you are struck by lighting with a huge, recurring, yearly claim and decide not to end things, you can always get regulated insurance.

The problem is that the "real" health insurance companies have priced themselves out of the market. I understand that these ministries aren't insurance companies, but if I can get some benefit from them, and for less than the penalty I will otherwise pay (which may or may not be the case), then I don't have anything to lose. A regulated insurance is not really an option for the typical person who is self employed anymore.

JT
They are not an insurance company, therefore there is no obligation to pay for anything. If the ministry can't find families willing to support the sick member, well, the ministry itself isn't going to pay for it either.
dm200 wrote:I believe this is allowed here, since it does not relate (directly) to proposed legislation.

I saw an article about these large increases in ACA premiums. The opinion was that the major factor in this is that insurance companies are only now getting the data from experience with ACA plans that the believe shows losing money. This increase would, then, be a one time bump and not a HUGE flaw in the ACA. Another factor cited (again perhaps a one time bump) is the end of the reinsurance for very sick people. [do not understand this]. The "penalty" for being uninsured is also only now amounting to significant dollar amounts.
The news articles largely have no idea what they're talking about. Agents have been seeing these increases for three years now. The higher the rates get, the less likely healthy people will be to purchase the policies. This is truly the first year where a lot of my clients are seriously considering paying the penalty and opting out because the policies have gotten so expensive for what is basically garbage coverage ($7k deductible, very small provider network, no access to their current doctors and/or hospitals). Keep in mind that these rate increases are a compounding effect - if rates go up 15% next year, it's 15% of the much higher premium than was there the year before. I would find it very, very hard to believe that there is any chance of enrollment among younger/healthier people in 2017 being an improvement over 2016 at these prices. Prediction - in 2018, there will be less insurance companies selling, more large rate increases, and instead of having 30% of the country with one insurance company, you'll have 30% of the country with no insurance company. What happens then? I have no idea.
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Re: 2017 ACA plan previews

Post by dm200 »

Article/opinion on the ACA in the Washington Post: https://www.washingtonpost.com/opinions ... de28d7490f
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