ObamaCare 2018

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munemaker
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ObamaCare 2018

Post by munemaker » Thu Aug 10, 2017 9:10 am

If you are on ObamaCare or thinking about going on ObamaCare, here is an informative and timely report from Kaiser Family Foundation that you should read:

An Early Look at 2018 Premium Changes and Insurer Participation on ACA Exchanges
http://www.kff.org/health-reform/issue- ... exchanges/

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Hayden
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Re: ObamaCare 2018

Post by Hayden » Thu Aug 10, 2017 10:42 am

This is interesting; thanks for posting. Of course, insurance is local, so unless one lives in the major cities cited, the numbers will be different.

I am early retired and health insurance is a factor in where I move for retirement. From this article, Seattle looks attractive.

mrsbetsy
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Re: ObamaCare 2018

Post by mrsbetsy » Thu Aug 10, 2017 12:07 pm

Thanks for posting this information. It's good news for us!

munemaker
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Re: ObamaCare 2018

Post by munemaker » Thu Aug 10, 2017 12:09 pm

Hayden wrote:This is interesting; thanks for posting. Of course, insurance is local, so unless one lives in the major cities cited, the numbers will be different.

I am early retired and health insurance is a factor in where I move for retirement. From this article, Seattle looks attractive.
You can get quick, fairly accurate Obamacare 2017 estimates by location at http://www.kff.org/interactive/subsidy-calculator/ . Eventually they will update to include 2018 when info becomes available.

furwut
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Re: ObamaCare 2018

Post by furwut » Thu Aug 10, 2017 12:15 pm

And don’t forget if your MAGI income is under 400% of the Federal Poverty Level your premium* is a function of your income and not what the insurance company charges.

* Based on a Silver tier plan.

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Hayden
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Re: ObamaCare 2018

Post by Hayden » Fri Aug 11, 2017 10:21 am

munemaker wrote:
Hayden wrote:This is interesting; thanks for posting. Of course, insurance is local, so unless one lives in the major cities cited, the numbers will be different.

I am early retired and health insurance is a factor in where I move for retirement. From this article, Seattle looks attractive.
You can get quick, fairly accurate Obamacare 2017 estimates by location at http://www.kff.org/interactive/subsidy-calculator/ . Eventually they will update to include 2018 when info becomes available.
That's a nice calculator. But.. the price I am actually paying is $150/month higher than what they show. They show cost for a low cost Silver plan. I bought a Bronze HSA plan with the widest available network.

rkhusky
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Re: ObamaCare 2018

Post by rkhusky » Fri Aug 11, 2017 12:40 pm

Hayden wrote: I am early retired and health insurance is a factor in where I move for retirement. From this article, Seattle looks attractive.
Detroit looks good too. And you can get a really cheap house there.

DetroitRick
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Re: ObamaCare 2018

Post by DetroitRick » Fri Aug 11, 2017 1:31 pm

There's an interesting twist in these 2018 rate filings. Michigan, as some other states have also just done, required insurers to submit 2 different premium sets for approval this year on all Silver policies - one assuming cost sharing subsidies continue, another assuming they do not. This relates to the ACA Silver Policy feature where out-of-pocket maximums get reduced when income (MAGI, specifically) is under 250% of federal poverty level. Since the insurers have to offer the feature in their ACA policies regardless, it makes premium determination difficult since they don't know if they will continue receiving the subsidy on their side. Thus the two simultaneous rate submissions for these policies here in Michigan.

Kaiser Family Foundation has estimated a national average additional Silver premium impact from this one issue of 19%:
http://www.kff.org/health-reform/issue- ... -payments/

For the largest insurer in my county, the specific increase presumed if these cost-sharing subsidies stop is 13% higher than if they continue as currently. Their competitors have done the same, many with larger increases and some with smaller ones. To clarify, that is 13% on top of all other yearly increases. Because we have public access here to all these filings, I have to marvel at the sheer magnitude of info involved in rate setting and submission. On the brighter side, it seems that we still have lots of insurers participating in the larger metropolitan area here.

And just to clarify, the final net premium to consumers for Silver is a function of 3 things (not just income): your own family income, the benchmark premium rate (Second Lowest SIlver Plan for your specific area), AND any spread between your own insurer and that benchmark rate. So gross premiums do matter. Thanks for posting the link, OP! It's interesting to compare.

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Re: ObamaCare 2018

Post by LadyGeek » Fri Aug 11, 2017 10:03 pm

This thread is now in the Personal Finance (Not Investing) forum (insurance).
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michaeljc70
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Re: ObamaCare 2018

Post by michaeljc70 » Sat Aug 12, 2017 10:04 am

After changing plans every year for the last 3 years and big price increases, I am not sure what I am going to do for 2018. Being pretty healthy, I am considering something drastic. I won't go totally uninsured, and it seems catastrophic plans aren't allowed (though deductibles are getting so high, some of these are really catastrophic plans). I might take a full time job with insurance for the first time in 25 years until the dust settles. I have also been exploring these medical share type programs.

Oddly, Illinois isn't in any of the tables in the document in the OP.

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Re: ObamaCare 2018

Post by michaeljc70 » Sat Aug 12, 2017 10:08 am

furwut wrote:
Thu Aug 10, 2017 12:15 pm
And don’t forget if your MAGI income is under 400% of the Federal Poverty Level your premium* is a function of your income and not what the insurance company charges.

* Based on a Silver tier plan.
That's not entirely true. It is based on your income and what the premium is, which varies by area. You can definitely make under 400% of poverty and be on a silver plan and get no subsidy. The poverty levels are also very low. $12k for an individual!

munemaker
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Re: ObamaCare 2018

Post by munemaker » Mon Aug 14, 2017 2:31 pm

michaeljc70 wrote:
Sat Aug 12, 2017 10:08 am
furwut wrote:
Thu Aug 10, 2017 12:15 pm
And don’t forget if your MAGI income is under 400% of the Federal Poverty Level your premium* is a function of your income and not what the insurance company charges.

* Based on a Silver tier plan.
You can definitely make under 400% of poverty and be on a silver plan and get no subsidy.
Thanks

I didn't know that!

Tanelorn
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Re: ObamaCare 2018

Post by Tanelorn » Mon Aug 14, 2017 4:09 pm

Eyeballing the first table, it looks like 2018 premiums are about 10-20% higher than 2017.

kjvmartin
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Re: ObamaCare 2018

Post by kjvmartin » Mon Aug 14, 2017 4:35 pm

rkhusky wrote:
Fri Aug 11, 2017 12:40 pm
Hayden wrote: I am early retired and health insurance is a factor in where I move for retirement. From this article, Seattle looks attractive.
Detroit looks good too. And you can get a really cheap house there.
There's a reason... well several reasons for that!

user76586
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Re: ObamaCare 2018

Post by user76586 » Mon Aug 14, 2017 5:06 pm

michaeljc70 wrote:
Sat Aug 12, 2017 10:08 am
furwut wrote:
Thu Aug 10, 2017 12:15 pm
And don’t forget if your MAGI income is under 400% of the Federal Poverty Level your premium* is a function of your income and not what the insurance company charges.

* Based on a Silver tier plan.
That's not entirely true. It is based on your income and what the premium is, which varies by area. You can definitely make under 400% of poverty and be on a silver plan and get no subsidy. The poverty levels are also very low. $12k for an individual!
You can also get a subsidy for a bronze (or gold) plan. Silver is only required for the cost sharing subsidies that reduce the deductible/out of pocket costs not the premium tax credit.

Also, the income is based on your modified AGI. Your traditional IRA/401(k) contributions get subtracted. If you have legit business expenses, especially a home office deduction or standard mileage rate on a cheaper to operate car, you can get it down even more. Rough math on $80k self-employment net income maxing a solo 401k says 80*0.8-18=46, in subsidy range for a single person. If you're working for the man and only get the $18k you can still be in subsidy range if you're single and in the $60s. Married/family poverty levels are higher. Don't forget to subtract your HSA, student loan interest, etc.

munemaker
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Re: ObamaCare 2018

Post by munemaker » Mon Aug 14, 2017 7:55 pm

user76586 wrote:
Mon Aug 14, 2017 5:06 pm
michaeljc70 wrote:
Sat Aug 12, 2017 10:08 am
furwut wrote:
Thu Aug 10, 2017 12:15 pm
And don’t forget if your MAGI income is under 400% of the Federal Poverty Level your premium* is a function of your income and not what the insurance company charges.

* Based on a Silver tier plan.
That's not entirely true. It is based on your income and what the premium is, which varies by area. You can definitely make under 400% of poverty and be on a silver plan and get no subsidy. The poverty levels are also very low. $12k for an individual!
You can also get a subsidy for a bronze (or gold) plan. Silver is only required for the cost sharing subsidies that reduce the deductible/out of pocket costs not the premium tax credit.

Also, the income is based on your modified AGI. Your traditional IRA/401(k) contributions get subtracted. If you have legit business expenses, especially a home office deduction or standard mileage rate on a cheaper to operate car, you can get it down even more. Rough math on $80k self-employment net income maxing a solo 401k says 80*0.8-18=46, in subsidy range for a single person. If you're working for the man and only get the $18k you can still be in subsidy range if you're single and in the $60s. Married/family poverty levels are higher. Don't forget to subtract your HSA, student loan interest, etc.
401k and traditional (deductible) IRA also reduce MAGI, thereby potentially helping to qualify for OBAMACARE subsidy.

J295
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Re: ObamaCare 2018

Post by J295 » Mon Aug 14, 2017 9:12 pm

And HSA contributions also reduce MAGI

michaeljc70
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Re: ObamaCare 2018

Post by michaeljc70 » Tue Aug 15, 2017 12:16 pm

Of course self employment deductions reduce your income. My point is the subsidy is not based just on income as many believe. You can go here to play around with different variables:

http://www.kff.org/interactive/subsidy-calculator/

For example:
Using Zip 60126, 1 adult, single, $30k MAGI
Age 21: Subsidy is $63 a month.
Age 60: Subsidy is $525 a month.

As you can see, 2 people with the same income in the same location are eligible for vastly different subsidies. The premium and income are taken into account and the premium obviously varies by location and age.

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Re: ACA 2018

Post by nisiprius » Tue Aug 15, 2017 4:38 pm

We used to be pretty punctilious in this forum about calling it "ACA" and that's probably still a good idea....
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Re: ObamaCare 2018

Post by Valuethinker » Tue Aug 15, 2017 4:39 pm

kjvmartin wrote:
Mon Aug 14, 2017 4:35 pm
rkhusky wrote:
Fri Aug 11, 2017 12:40 pm
Hayden wrote: I am early retired and health insurance is a factor in where I move for retirement. From this article, Seattle looks attractive.
Detroit looks good too. And you can get a really cheap house there.
There's a reason... well several reasons for that!
Uninsured health costs can of course wipe out all financial planning.

I am sure there are places in greater Detroit and perhaps even in the city proper which are safe to live in?

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Re: ACA 2018

Post by Valuethinker » Tue Aug 15, 2017 4:40 pm

nisiprius wrote:
Tue Aug 15, 2017 4:38 pm
We used to be pretty punctilious in this forum about calling it "ACA" and that's probably still a good idea....
Who was this Obama guy anyways? ;-)

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HueyLD
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Re: ACA 2018

Post by HueyLD » Tue Aug 15, 2017 5:19 pm

Valuethinker wrote:
Tue Aug 15, 2017 4:40 pm
nisiprius wrote:
Tue Aug 15, 2017 4:38 pm
We used to be pretty punctilious in this forum about calling it "ACA" and that's probably still a good idea....
Who was this Obama guy anyways? ;-)
I no longer use the term ACA because virtually nobody seems to know what ACA means.

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Re: ObamaCare 2018

Post by BruDude » Tue Aug 15, 2017 5:38 pm

It's going to be a race to the bottom in most states this year. Which company can provide the worst network at a price that people still find halfway reasonable? Anthem BCBS just announced they're leaving VA, and Aetna and United Healthcare already did the same. Something like 80-90% of my clients in VA have either Anthem or Aetna. Anthem had the best network by far, which wasn't even good. Now most people will be stuck with a choice of Kaiser and possibly Cigna in Northern VA, CareFirst BCBS priced themselves out of the market, and the rest of the state will have Optima which doesn't even have a network that extends past the Chesapeake area last time I checked.

Feels like everyone is about to get royally screwed, I feel bad for my clients. This may also be the year I stop being able to help them if the remaining companies decide they don't want to pay agents any compensation, which is a very likely possibility. CareFirst BCBS already notified us that they will be paying us exactly $0 this year. What a mess.

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Re: ObamaCare 2018

Post by blueberry » Tue Aug 15, 2017 6:16 pm

As someone who at times looked for individual health coverage before ACA existed and discovered it wasn't even available in my state (previously in WA individual health has been available off and on), ACA has been great. My deductible went way up last year but it felt closer to real costs and I've had no gripes. I certainly have more choices than with the health insurance I've had through employers and I've appreciated knowing for instance that basic preventative care is free, no life time cap, etc.

I thought no one really knows what 2018 will bring.

-bb

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Re: ACA 2018

Post by gkaplan » Tue Aug 15, 2017 7:32 pm

nisiprius wrote:
Tue Aug 15, 2017 4:38 pm
We used to be pretty punctilious in this forum about calling it "ACA" and that's probably still a good idea....

It's a losing battle, not that I've accepted it. I reported one of the threads a number of years ago, but Mel essentially said that nearly everyone uses the term "Obamacare" and thus has become an acceptable alternative to "ACA." (I can't remember his exact words.)
Gordon

Tanelorn
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Re: ObamaCare 2018

Post by Tanelorn » Wed Aug 16, 2017 8:21 am

BruDude wrote:
Tue Aug 15, 2017 5:38 pm
It's going to be a race to the bottom in most states this year. Which company can provide the worst network at a price that people still find halfway reasonable?
Maybe the adverse selection effects of the guaranteed issuance are turning out to be bad enough that they don't want to have a reasonable price? The government subsidized customers don't care and maybe as an insurance company you just don't want anyone else since the unsubsidized risk pool is too toxic. At least for low income people, you get a lot of people to sign up regardless of their health since it's very close to free.
Feels like everyone is about to get royally screwed, I feel bad for my clients. This may also be the year I stop being able to help them if the remaining companies decide they don't want to pay agents any compensation, which is a very likely possibility. CareFirst BCBS already notified us that they will be paying us exactly $0 this year. What a mess.
This is really short sighted. If the government is trying to get people covered in this complex mess of a system, you'd think they'd at least budget a little to pay agents to help them get appropriate coverage. My state has this problem too - cutting costs on their very good low income options so there is no referral fees and hence nearly nobody who qualifies is able to find out about it. I guess it cuts costs by cutting down on the number of heavily subsidized people in the program, but presumably the point of the program was to cover people who qualified.

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Re: ObamaCare 2018

Post by BruDude » Wed Aug 16, 2017 8:53 am

Tanelorn wrote:
Wed Aug 16, 2017 8:21 am
BruDude wrote:
Tue Aug 15, 2017 5:38 pm
It's going to be a race to the bottom in most states this year. Which company can provide the worst network at a price that people still find halfway reasonable?
Maybe the adverse selection effects of the guaranteed issuance are turning out to be bad enough that they don't want to have a reasonable price? The government subsidized customers don't care and maybe as an insurance company you just don't want anyone else since the unsubsidized risk pool is too toxic. At least for low income people, you get a lot of people to sign up regardless of their health since it's very close to free.
Feels like everyone is about to get royally screwed, I feel bad for my clients. This may also be the year I stop being able to help them if the remaining companies decide they don't want to pay agents any compensation, which is a very likely possibility. CareFirst BCBS already notified us that they will be paying us exactly $0 this year. What a mess.
This is really short sighted. If the government is trying to get people covered in this complex mess of a system, you'd think they'd at least budget a little to pay agents to help them get appropriate coverage. My state has this problem too - cutting costs on their very good low income options so there is no referral fees and hence nearly nobody who qualifies is able to find out about it. I guess it cuts costs by cutting down on the number of heavily subsidized people in the program, but presumably the point of the program was to cover people who qualified.
Insurance companies have done just about everything they can to stop people from buying ACA policies. I have seen companies remove online applications from their websites, hide the rates so that you have to call them to get a quote (which means waiting on hold for 1-2 hours during the open enrollment period), require paper applications instead of online applications (just to make everyone's life a little more difficult), lose the paper applications that they now require, reduce agent compensation to $0 or close to it, "forget" to pay agents in a timely manner (I received some commissions this year from 2015 and 2016!), screw up bank draft payments causing termination of coverage which then has to be reinstated, lose people in the system, being unresponsive to customer messages and emails, and on and on. They really do not want to sell these policies. The only companies expanding are those like Centene which have an awful Medicaid-like provider network and they will be the only choice for a lot of counties. So what happens when you have a tiny provider network, the company with 50% market share exits the market altogether (BCBS), and now everyone in that area/state has to join the same company with the same tiny provider network?

I have said from the beginning that as soon as the BCBS companies start jumping ship, we've all got a major problem. Well, here we are.

munemaker
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Re: ACA 2018

Post by munemaker » Wed Aug 16, 2017 5:55 pm

nisiprius wrote:
Tue Aug 15, 2017 4:38 pm
We used to be pretty punctilious in this forum about calling it "ACA" and that's probably still a good idea....
OP here. Can't we just keep the discussion about healthcare and leave the politics out?

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Tycoon
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Re: ObamaCare 2018

Post by Tycoon » Wed Aug 16, 2017 6:04 pm

BruDude wrote:
Tue Aug 15, 2017 5:38 pm
What a mess.
Yep, that about sums it up.
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Re: ObamaCare 2018

Post by LadyGeek » Wed Aug 16, 2017 6:24 pm

Please stay on-topic, which is about ACA rates for 2018.

To remain actionable, please focus on your own situation and state your concerns in a factual manner.
To some, the glass is half full. To others, the glass is half empty. To an engineer, it's twice the size it needs to be.

Bigbonds
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Re: ObamaCare 2018

Post by Bigbonds » Wed Aug 16, 2017 6:57 pm

Valuethinker wrote:
Tue Aug 15, 2017 4:39 pm
kjvmartin wrote:
Mon Aug 14, 2017 4:35 pm
rkhusky wrote:
Fri Aug 11, 2017 12:40 pm
Hayden wrote: I am early retired and health insurance is a factor in where I move for retirement. From this article, Seattle looks attractive.
Detroit looks good too. And you can get a really cheap house there.
There's a reason... well several reasons for that!
Uninsured health costs can of course wipe out all financial planning.

I am sure there are places in greater Detroit and perhaps even in the city proper which are safe to live in?
Yes and no on healthcare cost wiping out finical planning. Most states have good enough homestead laws they can't take your house. 401k and iras are all protected from bankruptcy which is where most people have the bulk of their savings. The important thing to remember is bogleheads forum is an economic echo chamber that is completely detached from reality. Over 50% of Americans make less than 30k a year and then there are about 100 million that can work but don't. Somehow all these people are making it.

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Re: ObamaCare 2018

Post by blueberry » Wed Aug 16, 2017 7:04 pm

Bigbonds wrote:
Wed Aug 16, 2017 6:57 pm
Valuethinker wrote:
Tue Aug 15, 2017 4:39 pm
kjvmartin wrote:
Mon Aug 14, 2017 4:35 pm
rkhusky wrote:
Fri Aug 11, 2017 12:40 pm
Hayden wrote: I am early retired and health insurance is a factor in where I move for retirement. From this article, Seattle looks attractive.
Detroit looks good too. And you can get a really cheap house there.
There's a reason... well several reasons for that!
Uninsured health costs can of course wipe out all financial planning.

I am sure there are places in greater Detroit and perhaps even in the city proper which are safe to live in?
... Most states have good enough homestead laws they can't take your house.
I believe WA state homestead law protects only up to 125k primary home value. I don't know if that is typical.

-bb

FinanceGeek
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Re: ObamaCare 2018

Post by FinanceGeek » Wed Aug 16, 2017 7:15 pm

BruDude wrote:
Tue Aug 15, 2017 5:38 pm
It's going to be a race to the bottom in most states this year. Which company can provide the worst network at a price that people still find halfway reasonable?
Exactly. What's missing from the KFF's otherwise excellent article is a discussion of the range of provider network sizes and out of network benefits in each state. There is emerging a strongly delineated 2 tier HI system: group and individual. By and large, PPO plans with out of network benefits aren't available to individuals at any price - on or off the exchanges - but are readily available to groups.

Key takeaway - maintaining access to group HI can easily be a life or death decision for anybody with pre-existing conditions. At least where I live, individual health insurance (on or off exchange no longer matters) means paying big $$ to buy into medicaid-class networks and care. The future of FIRE might be to decide which small business to invest in to buy a no-show job that qualifies for a group policy.

Bigbonds
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Re: ObamaCare 2018

Post by Bigbonds » Wed Aug 16, 2017 8:54 pm

blueberry wrote:
Wed Aug 16, 2017 7:04 pm
Bigbonds wrote:
Wed Aug 16, 2017 6:57 pm
Valuethinker wrote:
Tue Aug 15, 2017 4:39 pm
kjvmartin wrote:
Mon Aug 14, 2017 4:35 pm
rkhusky wrote:
Fri Aug 11, 2017 12:40 pm

Detroit looks good too. And you can get a really cheap house there.
There's a reason... well several reasons for that!
Uninsured health costs can of course wipe out all financial planning.

I am sure there are places in greater Detroit and perhaps even in the city proper which are safe to live in?
... Most states have good enough homestead laws they can't take your house.
I believe WA state homestead law protects only up to 125k primary home value. I don't know if that is typical.

-bb
In Texas it's unlimited. It varies by state.

munemaker
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Re: ObamaCare 2018

Post by munemaker » Wed Aug 16, 2017 9:32 pm

Pretty fortunate here in NW PA. I retired in March 2017 and was facing $12,000 COBRA premiums for my DW and me (good plan though). I am planning to take my small defined benefit pensions at age 65 and postponed SS (hopefully to age 70). Most of our investments are in tax deferred accounts. I have a wad of cash to live off of for the next 2 years until we reach Medicare age and cash does not throw off much income these days. This very low taxable income positions us for the ObamaCare subsidies.

ObamaCare rates in our area are expected to go up 9 to 10% in 2018. However, if you are in subsidy range, you are insulated from the rate increase.

We have a really good ObamaCare policy with very low premiums and low deductibles. There is no out of network coverage (except emergencies) but the in network capabilities are extremely good. I had physical exam and a few minor claims this year and everything was handled professionally. Doctor's office visits are only $10 (physicals free, of course). So far, we are very pleased with our insurance and health care system. We have not had a major medical problem though.

As far as insurance companies discouraging people to sign up with ObamaCare subsidies, that is definitely not true with our provider. They were and continue to be very helpful. I compared my insurance card to a friend's (same insurance) who does not use ObamaCare and they are identical. The medical professionals treating us have no idea we are on ObamaCare. The insurance company's customer service is outstanding, and you do not have to wait to have your call answered by a person. They take a survey after every single call (optional) so if a policyholder is not being treated right, they find out immediately.

A local newspaper articles says we are expecting to have one more ObamaCare plan to pick from next year, and the two providers from 2017 are expected to remain. It is not a done deal yet and they still have time to pull out.

We seem to be the exception, but ObamaCare was a godsend for us. Otherwise we would be paying out the wazoo for health insurance. Hopefully our positive experience continues until we are on Medicare.
Last edited by munemaker on Wed Aug 16, 2017 9:50 pm, edited 2 times in total.

curmudgeon
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Re: ObamaCare 2018

Post by curmudgeon » Wed Aug 16, 2017 9:39 pm

FinanceGeek wrote:
Wed Aug 16, 2017 7:15 pm
BruDude wrote:
Tue Aug 15, 2017 5:38 pm
It's going to be a race to the bottom in most states this year. Which company can provide the worst network at a price that people still find halfway reasonable?
Exactly. What's missing from the KFF's otherwise excellent article is a discussion of the range of provider network sizes and out of network benefits in each state. There is emerging a strongly delineated 2 tier HI system: group and individual. By and large, PPO plans with out of network benefits aren't available to individuals at any price - on or off the exchanges - but are readily available to groups.

Key takeaway - maintaining access to group HI can easily be a life or death decision for anybody with pre-existing conditions. At least where I live, individual health insurance (on or off exchange no longer matters) means paying big $$ to buy into medicaid-class networks and care. The future of FIRE might be to decide which small business to invest in to buy a no-show job that qualifies for a group policy.
My (very limited) picture of small business plans has been that they are far more similar to individual plans than to large group plans. This is because the group size is so small (and the insurance often optional).

I consider myself quite fortunate that once I battled my way through the CoveredCA state marketplace, there is a reasonable amount of competition in my area and an acceptable (to me) HMO available. I don't consider the overall system to be sustainable other than by increasingly massive taxpayer subsidies, but I'm just riding with it for now.

Saving$
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Re: ObamaCare 2018

Post by Saving$ » Wed Aug 16, 2017 10:21 pm

My state has about 5 providers, who together offer about 60 plans [edited to add: that are available in my particular urban county]. When I started looking at the networks, I was appalled. There is a major university hospital system 3 miles from me, and although some plans included certain doctors in that system, the only hospital in some plans was a rural regional hospital about an hour away...hope you never get sick...

- In 2016, I was able to find only one PPO plan eligible for an HSA that had a decent provider network that I could buy off the exchange midyear. That insurer pulled out of my state for 2017.

- For 2017, no PPO plan [edited to add: was available on the exchange], and no other plan eligible for an HSA that had a decent provider network was available on the exchange. However, I found ONE ACA compliant policy off exchange, directly from the insurer, a well known national company, via an online insurance site (NOT the exchange). I assume it was not eligible for tax credits since it was not listed on the exchange, but I did not care because I did not qualify for the credits.

- For 2018, the well known national company announced they will not offer 2018 plans in my market...

Do the exchange listed plans in other states also have these odd and limited networks? Most of the plans were not PPO and indicated $0 coverage for out of network care. What do people do if they get sick or have an accident when out of town?
Last edited by Saving$ on Wed Aug 16, 2017 11:15 pm, edited 1 time in total.

Tanelorn
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Re: ObamaCare 2018

Post by Tanelorn » Wed Aug 16, 2017 10:41 pm

Saving$ wrote:
Wed Aug 16, 2017 10:21 pm
My state has about 5 providers, who together offer about 60 plans. When I started looking at the networks, I was appalled. There is a major university hospital system 3 miles from me, and although some plans included certain doctors in that system, the only hospital in some plans was a rural regional hospital about an hour away...hope you never get sick...

- In 2016, I was able to find only one PPO plan eligible for an HSA that had a decent provider network that I could buy off the exchange midyear. That insurer pulled out of my state for 2017.

- For 2017, no PPO plan eligible for an HSA that had a decent provider network was available on the exchange. However, I found ONE ACA compliant policy off exchange, directly from the insurer, a well known national company, via an online insurance site (NOT the exchange). I assume it was not eligible for tax credits since it was not listed on the exchange, but I did not care because I did not qualify for the credits.

- For 2018, the well known national company announced they will not offer 2018 plans in my market...

Do the exchange listed plans in other states also have these odd and limited networks? Most of the plans were not PPO and indicated $0 coverage for out of network care. What do people do if they get sick or have an accident when out of town?
My experience mirrors yours - the insurers with good networks keep quitting the state and/or slashing their network size. Every year you have to switch insurance companies and hope it's not that much worse, while you pay 20% more in premiums for the privilege. One or two more years like this and either 1) there won't be any plans left, or 2) they'll be so bad it won't be worth buying health insurance at all. It's already expected something like 1/3 of the counties across the country will have a single "choice" of insurer for 2018, and a few dozen where residents will presumably be fined for not moving since there's no one selling any at all.

The non-coverage while traveling is also quite annoying... You shouldn't have to buy one of those ripoff trip insurance policies for every road trip, but the way things have been going, those are probably better quality care than the Obamacare plans at this point (group-style nationwide PPO, just with preexisting exclusions). Apparently you aren't supposed to have time for vacation unless you work for a big company or until you're 65 :annoyed.

wassabi
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Re: ObamaCare 2018

Post by wassabi » Thu Aug 17, 2017 4:35 am

BruDude wrote:
Tue Aug 15, 2017 5:38 pm
It's going to be a race to the bottom in most states this year. Which company can provide the worst network at a price that people still find halfway reasonable? Anthem BCBS just announced they're leaving VA, and Aetna and United Healthcare already did the same. Something like 80-90% of my clients in VA have either Anthem or Aetna. Anthem had the best network by far, which wasn't even good. Now most people will be stuck with a choice of Kaiser and possibly Cigna in Northern VA, CareFirst BCBS priced themselves out of the market, and the rest of the state will have Optima which doesn't even have a network that extends past the Chesapeake area last time I checked.

Feels like everyone is about to get royally screwed, I feel bad for my clients. This may also be the year I stop being able to help them if the remaining companies decide they don't want to pay agents any compensation, which is a very likely possibility. CareFirst BCBS already notified us that they will be paying us exactly $0 this year. What a mess.
So where do people get health insurance if their job doesn't offer it and there is essentially no network in their state through ACA? Are people still able to apply directly to the providers or is it a requirement to use the ACA market if one needs insurance?

Da5id
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Re: ObamaCare 2018

Post by Da5id » Thu Aug 17, 2017 7:37 am

wassabi wrote:
Thu Aug 17, 2017 4:35 am
So where do people get health insurance if their job doesn't offer it and there is essentially no network in their state through ACA? Are people still able to apply directly to the providers or is it a requirement to use the ACA market if one needs insurance?
I believe you only need to use the ACA marketplace if you want a subsidy. You can apply directly to any insurer who chooses to offer individual policies in your state. But selection/price, who knows...

danaht
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Re: ObamaCare 2018

Post by danaht » Thu Aug 17, 2017 7:59 am

michaeljc70 wrote:
Sat Aug 12, 2017 10:04 am
After changing plans every year for the last 3 years and big price increases, I am not sure what I am going to do for 2018. Being pretty healthy, I am considering something drastic. I won't go totally uninsured, and it seems catastrophic plans aren't allowed (though deductibles are getting so high, some of these are really catastrophic plans). I might take a full time job with insurance for the first time in 25 years until the dust settles. I have also been exploring these medical share type programs.

Oddly, Illinois isn't in any of the tables in the document in the OP.
I am taking a chance now. My insurance was canceled this year - so I switched to a Health Care Sharing Ministry instead of going with the cheapest ACA HSA qualified bronze plan. I am now paying ~$70 (for the HC ministry) instead of ~$460 (for the new ACA HSA plan) a month. The only thing I regret is not being able to contribute to a HSA. But, I figure why pay $460 a month just so I can contribute $283 a month to a HSA. If insurance becomes affordable again in the future - I'll switch back then. Affordable for me is ~$300 a month for the highest premium HSA plan.

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Re: ObamaCare 2018

Post by michaeljc70 » Thu Aug 17, 2017 8:16 am

danaht wrote:
Thu Aug 17, 2017 7:59 am
michaeljc70 wrote:
Sat Aug 12, 2017 10:04 am
After changing plans every year for the last 3 years and big price increases, I am not sure what I am going to do for 2018. Being pretty healthy, I am considering something drastic. I won't go totally uninsured, and it seems catastrophic plans aren't allowed (though deductibles are getting so high, some of these are really catastrophic plans). I might take a full time job with insurance for the first time in 25 years until the dust settles. I have also been exploring these medical share type programs.

Oddly, Illinois isn't in any of the tables in the document in the OP.
I am taking a chance now. My insurance was canceled this year - so I switched to a Health Care Sharing Ministry instead of going with the cheapest ACA HSA qualified bronze plan. I am now paying ~$70 (for the HC ministry) instead of ~$460 (for the new ACA HSA plan) a month. The only thing I regret is not being able to contribute to a HSA. But, I figure why pay $460 a month just so I can contribute $283 a month to a HSA. If insurance becomes affordable again in the future - I'll switch back then. Affordable for me is ~$300 a month for the highest premium HSA plan.
I am thinking of doing the Sharing thing for a while. As I understand it though, you get no discounts for medical services. With my insurance, even though the deductible doesn't kick in until $7500, I typically get 30-90% off. Doctors tend to be on the lower end, but blood work and CT scans tend to be closer to 90% off. That makes a huge difference. As an example, a CT scan was $2300, which is a lot to pay out of pocket. After the insurance discount, it was $210. EDIT: I guess some sharers do negotiate bills with providers.

The other option is to just get the cheapest ACA plan I can find, but last I looked, it wasn't that cheap.

FinanceGeek
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Re: ObamaCare 2018

Post by FinanceGeek » Thu Aug 17, 2017 9:24 am

michaeljc70 wrote:
Thu Aug 17, 2017 8:16 am
With my insurance, even though the deductible doesn't kick in until $7500, I typically get 30-90% off. Doctors tend to be on the lower end, but blood work and CT scans tend to be closer to 90% off.
I've always wondered why the insurance companies don't sell "membership" in their negotiated pricing networks - as a separate product from selling you insurance. That way folks who had to self-pay could at least pay a smaller amount.

wassabi
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Re: ObamaCare 2018

Post by wassabi » Thu Aug 17, 2017 9:55 am

Interesting points about negotiated rates. I didn't think about this previously, but if a person has a $5,000 deductible and a medical visit normally costs $300 but the negotiated rate is $100 then the insured person is only responsible for paying the $100 (provided the deductible has not been met). Is that right?

Da5id
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Re: ObamaCare 2018

Post by Da5id » Thu Aug 17, 2017 9:56 am

wassabi wrote:
Thu Aug 17, 2017 9:55 am
Interesting points about negotiated rates. I didn't think about this previously, but if a person has a $5,000 deductible and a medical visit normally costs $300 but the negotiated rate is $100 then the insured person is only responsible for paying the $100 (provided the deductible has not been met). Is that right?
Yes.

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Re: ObamaCare 2018

Post by BruDude » Thu Aug 17, 2017 11:09 am

wassabi wrote:
Thu Aug 17, 2017 9:55 am
Interesting points about negotiated rates. I didn't think about this previously, but if a person has a $5,000 deductible and a medical visit normally costs $300 but the negotiated rate is $100 then the insured person is only responsible for paying the $100 (provided the deductible has not been met). Is that right?
I had surgery a couple months ago and the facility charge before insurance discount was $16,302. The negotiated price was $691.

Tanelorn
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Re: ObamaCare 2018

Post by Tanelorn » Thu Aug 17, 2017 11:34 am

wassabi wrote:
Thu Aug 17, 2017 4:35 am
So where do people get health insurance if their job doesn't offer it and there is essentially no network in their state through ACA? Are people still able to apply directly to the providers or is it a requirement to use the ACA market if one needs insurance?
The plans in my state aren't that different between the ACA exchange and the off-exchange policies direct from the insurance companies. There are small tweaks, like better drug benefits or cheaper labs or variations on copay vs deductible, but broadly the companies available and the the networks and the general costs/benefits are basically the same. For example, there are no PPO plans available on or off the exchange, regardless of how much you might want to pay.

wassabi
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Re: ObamaCare 2018

Post by wassabi » Thu Aug 17, 2017 12:11 pm

Tanelorn wrote:
Thu Aug 17, 2017 11:34 am
wassabi wrote:
Thu Aug 17, 2017 4:35 am
So where do people get health insurance if their job doesn't offer it and there is essentially no network in their state through ACA? Are people still able to apply directly to the providers or is it a requirement to use the ACA market if one needs insurance?
The plans in my state aren't that different between the ACA exchange and the off-exchange policies direct from the insurance companies. There are small tweaks, like better drug benefits or cheaper labs or variations on copay vs deductible, but broadly the companies available and the the networks and the general costs/benefits are basically the same. For example, there are no PPO plans available on or off the exchange, regardless of how much you might want to pay.

So when people are concerned about insurance companies dropping from the exchange, that should only affect those who would benefit from a tax subsidy. For those who don't qualify for a tax credit though, they would be fine using an agent and/or going directly to the insurance company. Sound right?

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chickadee
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Re: ObamaCare 2018

Post by chickadee » Thu Aug 17, 2017 12:41 pm

No, not always right. At least in my state, insurance companies have left the individual market entirely. So you can't go buy a plan direct from Aetna or Humana or United or Cigna, nor can you buy one through the exchange.

They have all chosen to exit this un-profitable personal health insurance market entirely and only sell insurance to companies.

And, the only plans left to individuals are HMOs, as insurance companies lost millions in the first few years of Obamacare when offering PPO plans.

So individuals in my area can now choose a BCBS HMO plan, or a Scott and White HMO plan, and a couple of "no name" lesser players. These plans offer a limited network of doctors. In a city of over 1 million people, there are 8 urologists on the BCBS HMO plan, as an example.

That's it. Them's the "choices."

michaeljc70
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Re: ObamaCare 2018

Post by michaeljc70 » Thu Aug 17, 2017 3:23 pm

My insurer was on the exchange for 2016, left it in 2017 but we're still in the individual market, and in 2018 they are not offering any individual plans.

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