What do ERE-ers pay for health insurance in 2016?

[Allagash]

From my understanding though pre ACA insurance companies couldn't just drop you if you got sick. The issue was if you were sick and had no insurance, it could be then harder to get it depending on what you had.

Semantics I suppose. They couldn't drop you during the year, but they could choose not to renew you for the next year. Even not for profits like BCBS did that.

I never heard about refusing to renew people who already had insurance because they were sick. My understanding was once you were approved you were approved, you didn't have to get re-approved annually or anything. It was only if you were uninsured and had a pre-existing condition and were trying to get insurance or switch insurance where it could be the issue.

[George the original one]

I never heard about refusing to renew people who already had insurance because they were sick. My understanding was once you were approved you were approved, you didn't have to get re-approved annually or anything. It was only if you were uninsured and had a pre-existing condition and were trying to get insurance or switch insurance where it could be the issue.

Something that was common in states like Texas (this happened to my brother), that an insurer would leave the marketplace, so if you had a pre-existing condition that was being treated, then suddenly you were left out in the cold. The pre-existing condition totally prevented you from finding new insurance (or the rates offered by other companies were extortionate). The insurer would wait a couple years and then re-enter the market and not have to carry their former clients!

Now that you're approaching age 50, you should also remember that annual colonoscopies are always covered. Colon cancer WILL touch your life at some point. I've had one friend die of colon cancer at age 48 (technically it was the treatment of stage 3 cancers in the brain & liver that killed him, but colon cancer was the source) and a former girlfriend who got early detection this summer but lost 18" of her intestine at age 54.

[George the original one]

On rates... Oregon is one of the +30-35% states this year. However, for the past two years there was no rate increase, so it is really averaging out to 10%-12% per year.

Our silver plan is going from ~$1000/mo in 2016 to ~$1300/mo in 2017 for covering husband & wife age 54, no dependents. Our income is engineered to be no more than 15-20% above the minimum Obamacare threshold, so we'll get as maximum of a subsidy as possible and thus knock the cost down to about $300/mo.

[Allagash]

I never heard about refusing to renew people who already had insurance because they were sick. My understanding was once you were approved you were approved, you didn't have to get re-approved annually or anything. It was only if you were uninsured and had a pre-existing condition and were trying to get insurance or switch insurance where it could be the issue.

Something that was common in states like Texas (this happened to my brother), that an insurer would leave the marketplace, so if you had a pre-existing condition that was being treated, then suddenly you were left out in the cold. The pre-existing condition totally prevented you from finding new insurance (or the rates offered by other companies were extortionate). The insurer would wait a couple years and then re-enter the market and not have to carry their former clients!

Why couldn't they just have made a law that prohibited insurance companies from denying people for pre-existing conditions and eliminated the caps on coverage and be done with it? Why did we have to get this cluster **** called ACA where middle class and lower middle class people are now getting their premiums jacked through the roof for basically the same health insurance as they had before?

[Allagash]

On rates... Oregon is one of the +30-35% states this year. However, for the past two years there was no rate increase, so it is really averaging out to 10%-12% per year.

Our silver plan is going from ~$1000/mo in 2016 to ~$1300/mo in 2017 for covering husband & wife age 54, no dependents. Our income is engineered to be no more than 15-20% above the minimum Obamacare threshold, so we'll get as maximum of a subsidy as possible and thus knock the cost down to about $300/mo.

What is the minimum OC threshhold?

[George the original one]

What is the minimum OC threshhold?

This is all spelled out on Healthcare.gov and you can play with the calculator...

MAGI of 100% of Federal poverty guideline if your state does not have expanded Medicaid or else you get nothing. For states with expanded Medicaid (like Oregon), then the minimum is MAGI of 138% of Federal poverty guideline and if you're under, then you can get Medicaid.

2017 Federal poverty guidline (annual income) for lower 48 states (Hawaii & Alaska are higher):
$11,880 1 person household
$16,020 2 people household
$20,160 3 people household

BTY, the reason we have such a ridiculous system is that the insurance industry, the healthcare industry, and Republican party all opposed single-payer as is available in reasonable countries.

[jennypenny]

I didn't think pre-existing conditions mattered anymore? They used to, but I thought ACA did away that.

I ran the 2017 calc for 3 people in PA (couple, 14yo child) and the silver PPO (what I'd choose) was $468/month with a $11,400 OOP max. I didn't check to see if our doctors were included. I listed an income of $50K since that's how much we'd need to pull/earn to cover expenses with our current medical costs. We currently pay @$235/month for a 90% HDHP with a $10k OOP max through an employer.

[jacob]

So Jacob would probably be paying about $220/mo in IL for health insurance right now if he was single (possibly a lot more next year). That would constitute 37% of the $7,000 a year he spent when he was single! Marrying a lady with a decent W-2 job with health insurance can be part of a smart ERE plan

No need to be flippant. I think you meant a smart health care plan. If I was single or DW's benefits didn't cover me or the benefits weren't a good deal for "+1", I would have at least two choices under the current regime.

1) Cut my income to under 100% or 133% of the federal poverty level, which is over 2x as much as I spend now. In that case, since IL is part of the medicaid expansion, I would be on medicaid which would be free (with certain provisions).
2) Cut my income to $1 over the 1.33*FPL or 1.33*$11700+1=$15562. In that case, the maximum I can pay for health insurance under ACA is 3.05% of the cost of the second lowest cost silver plan from the exchange (SLCSP is a keynumber), see (https://www.irs.gov/instructions/i8962/ ... ml#d0e1027 for the 3.05% in table two; the first number is the ratio between your MAGI and the FPL). I'm too lazy to look up what my SLCSP is, but $220 sounds reasonable, so lets go with that, so my maximum health care cost would be $220*12*0.0305 = $81 for the year. I'd get the rest (12*$220-$81=$2559) back in the form of a premium tax credit. Thanks Obama!
3) Deduct health insurance as a business expense on Sched C. And so on ...

This was a fairly rough overview, but the key here is to observe that the subsidy percentage is determined by the same number for all states whereas the SLCSP is not. Therefore it makes sense not to live in states where health care costs are supremely high. It also makes sense not to exceed 400% of FPL, but that should be really easy as one can just dial in income by dividends and not take capital gains, e.g. go for lower yielders. Being in control of one's income, relocating one's state if need be, and living well at $7k/year (or $15562 as it may be) are all part of a smart ERE plan

For more detail, see here http://www.gocurrycracker.com/obamacare ... etirement/

[Tyler9000]

I'm a relatively decent case study for Texas. Just the two of us, high 30's, no dependents.

In 2015 we went completely off the work grid and engineered our investment income to maximize subsidies. An HSA-eligible silver plan ended up costing us about $70/month with a $100 deductible. In 2016 we both put in some part time work with difficult-to-estimate income, so we elected to keep the exact same plan but pay the full rate (knowing we'll get a big tax refund once they reconcile the premium subsidy they owe us). It worked out to $570/month with a $6k total deductible.

This year our provider pulled out of the exchange, so we'll be shopping for a new one. It looks like the most similar silver plan with a $6k deductible is about $670/month with no subsidy, and the least expensive bronze plan with a $12k deductible is about $500/month. If I were to similarly engineer our income again, there are several options that are <$100/month with <$1k deductible.

I'm mildly irritated that no available plans have my preferred doctor, but I suppose that's not too surprising.

[OTCW]

BTY, the reason we have such a ridiculous system is that the insurance industry, the healthcare industry, and Republican party all opposed single-payer as is available in reasonable countries.

That is one avenue to level things, but I think our biggest problem is that we've confused health insurance with health care. Our country is just unhealthy (obesity), and over medicated as the first option of treatment.

I wish the health care reform under obama care could have done more to address that aspect.

[Tyler9000]

I didn't think pre-existing conditions mattered anymore? They used to, but I thought ACA did away that.

Correct. And honestly, it was a necessary change. The previous system was built for insurance companies to extract payments from healthy people and find creative ways to dump them as soon as they became sick and unprofitable.

Now whether the current system was the best solution to that problem is an entirely different issue.

[cmonkey]

We currently pay about $160/month for a HDHP from my employer. We currently exceed the 400% FPL and so the ACA is out for us.

After I am done working our household size will be 4 and so I'm planning to engineer our income to 133% + $1 of the FPL (~$32,300 in 2017). The cheapest HSA eligible plan on healthcare.gov is currently ~$1133/month for my projected family. That's a lot!

With the subsidies we'd actually only pay 1133*12*.0305 = $414.68 yearly / $34.56 monthly.


We'd also have the option of staying under the FPL and getting on Medicaid, but I haven't done the research on that yet.

[7Wannabe5]

My net cost of insurance with $400 deductible = $0. My use of medical services/prescriptions thus far 2016 =$0. Of course, my $0 expense is partially due to my avoidance of some theoretically preventative procedures such as mammograms, colonoscopy, gum tissue torture/massage etc. etc. etc. I did fork out a bit of cash for ibuprofen, menthol lozenges, sunscreen etc. etc. etc.

[workathome]

We're paying ~12k/year for a family of four with no subsidy qualifications and a 7k deductible!

If the income goes away, that drops by 50% plus the deductible drops to 1k.

[chicago81]

I just received information from my employer about the choice of plans for 2017. There are 3 different tiers I can choose from... However, by putting them into a simple spreadsheet, it is clear that one of the plans is economically better than the others in every single healthcare cost spending scenario. I guess the two other plans are just sucker-bets for those who are too lazy to put this stuff into a spreadsheet. Anyway, here is the "best" plan my employer is offering for next year. (Numbers are for an individual, nonsmoker.)

High deductible HSA Compatible plan
Biweekly payroll cost: $40 ($1040/yr)
Deductible: $1750
Co-insurance after deductible: 20%
Out of pocket annual max: $3750
Employer contribution to HSA: $600

Prescriptions are subject to the deductible, and dental & vision are not included (but can be paid for separately with even more payroll deductions.)

I estimate ACA Exchange plans for someone my age with a similar doctor network would cost approximately $350/mo, so considering the employer contribution to the HSA and the payroll costs, this insurance benefit from my employer is worth to me about $313/mo.

[wheatstate]

Thanks for starting a great thread. I like seeing the solutions you have found.

I didn't like the idea of paying ~$200/month for an unsubsidized ACA plan with a $6k deductible that would probably go unused.
I decided to go with a health care shared ministry.
https://en.wikipedia.org/wiki/Health_ca ... g_ministry

The good:
$200/month + $125 annual membership. Same rate for most ages 30-60ish. Under 30 is $149.
No income limits / subsidies / or checks
$500 "unshared" amount / year -> Once this amount is spent on qualifying healthcare, other qualifying healthcare is covered 100%.
Qualifies as an acceptable plan for ACA, so no penalty

The Bad:
Not technically insurance, so not held to the same legal responsibilities as an insurance company
Doesn't cover high risk activities like rock climbing, sky diving.
They don't cover health issues from too much smoking, drinking....

My Plan:
Health Care Sharing Ministry, Liberty Direct
http://www.libertydirect.org

As an added bonus, $60/month can go to your Direct Primary Care (DPC) physician. These DPC doctors serve as a cross between primary care physician, light urgent care and overall health adviser. Typically, they do not accept traditional insurance, operate on a membership model (similar to a gym) and operate on a low-overhead, no-bureaucracy model.
Summary: $200 my monthly cost = $60 to my DPC doctor + $140 to Liberty Direct

Disclaimer: I have had the plan for a year. My DPC has handled a couple small issues conveniently. I have been healthy, so have not spent the $500 unshared amount, so have not tried to share larger expenses. I share this to give another option. Only you can decide on a program fit for you.

[Riggerjack]

What is the minimum OC threshhold?

This is all spelled out on Healthcare.gov and you can play with the calculator...

MAGI of 100% of Federal poverty guideline if your state does not have expanded Medicaid or else you get nothing. For states with expanded Medicaid (like Oregon), then the minimum is MAGI of 138% of Federal poverty guideline and if you're under, then you can get Medicaid.

2017 Federal poverty guidline (annual income) for lower 48 states (Hawaii & Alaska are higher):
$11,880 1 person household
$16,020 2 people household
$20,160 3 people household

BTY, the reason we have such a ridiculous system is that the insurance industry, the healthcare industry, and Republican party all opposed single-payer as is available in reasonable countries.

At the time, Democrats controlled the House, Senate, and the White House. The vote broke down:
12/24/2009 Status: Senate bill passed

More: select a member to see his or her other key health care votes.
Yes (60)
Our
Pick
D Mark Begich AK
D Blanche Lincoln AR
D Mark Pryor AR
D Barbara Boxer CA
D Dianne Feinstein CA
D Michael Bennet CO
D Mark Udall CO
D Christopher Dodd CT
I Joseph Lieberman CT
D Thomas Carper DE
D Edward Kaufman DE
D Bill Nelson FL
D Daniel Akaka HI
D Daniel Inouye HI
D Thomas Harkin IA
D Roland Burris IL
D Richard Durbin IL
D Evan Bayh IN
D Mary Landrieu LA
D John Kerry MA
D Paul Kirk MA
D Benjamin Cardin MD
D Barbara Mikulski MD
D Carl Levin MI
D Debbie Stabenow MI
D Alan Franken MN
D Amy Klobuchar MN
D Claire McCaskill MO
D Max Baucus MT
D Jon Tester MT
D Kay Hagan NC
D Kent Conrad ND
D Byron Dorgan ND
D Ben Nelson NE
D Jeanne Shaheen NH
D Frank Lautenberg NJ
D Robert Menéndez NJ
D Jeff Bingaman NM
D Tom Udall NM
D Harry Reid NV
D Kirsten Gillibrand NY
D Charles Schumer NY
D Sherrod Brown OH
D Jeff Merkley OR
D Ron Wyden OR
D Robert Casey PA
D Arlen Specter PA
D John Reed RI
D Sheldon Whitehouse RI
D Tim Johnson SD
D Mark Warner VA
D Jim Webb VA
D Patrick Leahy VT
I Bernard Sanders VT
D Maria Cantwell WA
D Patty Murray WA
D Russell Feingold WI
D Herbert Kohl WI
D Robert Byrd WV
D John Rockefeller WV
No (39)
R Lisa Murkowski AK
R Jefferson Sessions AL
R Richard Shelby AL
R Jon Kyl AZ
R John McCain AZ
R George LeMieux FL
R Saxby Chambliss GA
R John Isakson GA
R Charles Grassley IA
R Michael Crapo ID
R James Risch ID
R Richard Lugar IN
R Samuel Brownback KS
R Pat Roberts KS
R Mitch McConnell KY
R David Vitter LA
R Susan Collins ME
R Olympia Snowe ME
R Christopher Bond MO
R Thad Cochran MS
R Roger Wicker MS
R Richard Burr NC
R Mike Johanns NE
R Judd Gregg NH
R John Ensign NV
R George Voinovich OH
R Thomas Coburn OK
R James Inhofe OK
R Jim DeMint SC
R Lindsey Graham SC
R John Thune SD
R Lamar Alexander TN
R Bob Corker TN
R John Cornyn TX
R Kay Hutchison TX
R Robert Bennett UT
R Orrin Hatch UT
R John Barrasso WY
R Michael Enzi WY
Not Voting (1)
R Jim Bunning KY

What does it take for Democrats to be responsible for their actions? This was, if I remember right, a bill that needed "to be passed to be read", per Pelosi.

There is no part of ACA today that wasn't an objection, at the time. Rates going up was part of the package.

Though, I do think SOMETHING had to be done about preexisting conditions.

[Allagash]

What is the minimum OC threshhold?

BTY, the reason we have such a ridiculous system is that the insurance industry, the healthcare industry, and Republican party all opposed single-payer as is available in reasonable countries.

How much would single payer cost and who would pay for it? Our country has $20 trillion in debt and as it is right now entitlements such as medicare and social security are underfunded and will require tax increases or cutting of benefits to not go bankrupt. And single payer is basically "medicare for all".

Not saying single payer is not the right way to go, it might be. I would just like to see the numbers broken down on that and how it would all work. Today if someone lives in a high income tax state like CA or OR and are in the top tax bracket, their federal taxes are 39% and state taxes in CA are another 13% so that is 52% of their taxable income is goes towards income taxes. Then you have property taxes, sales taxes, capital gains taxes, etc... Who is going to get their taxes increased to pay for single payer?

[Allagash]

What is the minimum OC threshhold?

This is all spelled out on Healthcare.gov and you can play with the calculator...

MAGI of 100% of Federal poverty guideline if your state does not have expanded Medicaid or else you get nothing. For states with expanded Medicaid (like Oregon), then the minimum is MAGI of 138% of Federal poverty guideline and if you're under, then you can get Medicaid.

2017 Federal poverty guidline (annual income) for lower 48 states (Hawaii & Alaska are higher):
$11,880 1 person household
$16,020 2 people household
$20,160 3 people household

BTY, the reason we have such a ridiculous system is that the insurance industry, the healthcare industry, and Republican party all opposed single-payer as is available in reasonable countries.

George, so by my calculations you keep your total income for two people under about $24k a year to get the deal of $300/mo? What is the deductible with that?

[Riggerjack]

Well, the single payer theory is based on removing the profit from insurance companies making up for the inefficiency of government run programs.

It makes sense, if you have no experience in government inefficiency, or just think corporation is just another word for evil (honestly, this is starting to seem reasonable).

I believe, as I said at the time, the solution is high deductible insurance, HSAs, and requiring equal pricing.

In today's America, you have two skyrocketing costs. Health care and education. In both cases, every customer pays different costs for the same services, and the costs are offset by 3rd parties. The only effective cost control is a cost conscious customer. In medicine, cost is determined after service is provided. No other business works like that. If you take a car to get worked on, because it sputters sometimes, you don't know how much it will cost, but you know the shop rate, and the approximate cost once a diagnosis is made. This is not at all the way pricing of medical care works.

Until patients have strong economic incentive to cut costs, cost will continue to expand as they have. Insurance works on a cost plus model, so higher costs work out to higher profits, in aggregate. Don't expect a solution from that quarter.