My son had a catastrophic plan for awhile, even though he had a high income, however it was limited in term. Really cheap, though. The exchange says these people are eligible for catastrophic:
I would think the crazy prices that Nrdsb4 is being quoted would allow an affordability exemption, even for someone with a high income. Job-based insurance appears unavailable. I wonder if an insurance broker might be helpful in this situation. Otherwise people in that area only have two choices…pay 40K+ for health insurance or have nothing. There just has to be another option.
^Isn’t that what all policies are that are purchased by individuals in the open market - 12 month policies? No guarantee they can continue to purchase from the same provider from year to year.
I am following any and all health insurance posts with great interest since we will be on our own come September. Definitely eager to learn about any and all options!
I checked the ACA plans here, and it came up with various plans from two companies. For two 63-year-old people, the cheapest bronze plan was ~$1600 per month with a $12,000 deductible (Kaiser). The other company’s cheapest bronze plan was ~$2,000 per month with a $12,000 deductible. Gold level plans ranged from ~$2,400 to ~$3,200 per month.
Unless you have plutocrat-level money (where you can self-insure any medical bills, but then you probably are not concerned with anything discussed in this thread), a retirement budget for those who are too young to get the socialized medical insurance (Medicare) must include a substantial budget for medical insurance if your income is outside of the ACA subsidy or Medicaid ranges.
I got my renewal notice in the mail - ACA plan from Anthem BCBS. Rate is going down, deductible is up a little, copay is down a little. I haven’t looked online at the exchange yet to shop around for other plans. Every year we usually wind up switching to another exchange plan. I think everyone should shop around.
Options - or lack there of - can really vary from state to state. How your state chooses to work with ACA will impact options/affordability in your state.
I’m not a MA resident but someone up thread mentioned the wide choice of plans available in MA. MA had its own version of mandatory healthcare before ACA existed, proof that when government and insurance companies work together, the outcomes are better.
Yes, but short-term plans do not have to be ACA-compliant. So they have pre-existing condition exclusions, don’t cover maternity or preventative care, lots of other exclusions for specific treatments like joint replacement, may not cover prescriptions, etc. But they are substantially cheaper.
Our non-subsidized ACA bronze plan from BCBS will keep the same benefits/deductables/max out of pocket wth a slightly lower premium next year. If we keep it, it will be ~ 1300/mo (before dental) with a $6000 deductable, $13,100 max out of pocket. No out of netowrk benefits and our closest hospital is Tier 2 which drives up all of the prices/deductibles. I thought this was high until I started reading these threads!
An associated issue is that our area doctors are going consierge!
Just got back from a bike ride. I will look into this more closely, but will say that this kind of thing seems to be even related to the county one lives in. DH has a history of stage 3 colon cancer. Anything that has anything to do with pre-existing conditions doesn’t work well for him.
We do have an insurance broker. He presented us with basically two options last year. Haven’t heard from him yet, since we just got this letter.
I should mention that we have in the past excluded HMOs because they have so many restrictions. We’ve always gone with PPOs, but last year none were offered. We ended up choosing an EPO, which was less restrictive than the HMOs, but certainly so very expensive.
Will need to spend the next few weeks researching to see if we can do better.
@thumper1: Last we checked, BCBS is one of the two or three options now available. If we did not have DH’s retirement HC extension, we would not live here.
All 42 exchange plans on the MA exchange are HMO plans. IME most doctors around here will take all the HMO plans, but not all the hospitals will take all the HMOs, or some may cost more. It’s one of the details you have to check before you pick a plan.
When we lived in CT we could get a PPO plan on the exchange. Now that we’re in VA, the only plans on the exchange are HMO & EPO, but I can’t tell the difference between the EPO plan we have (which is the lowest premium plan) and any of the HMO plans. I’ll also be checking off-exchange plans since we don’t qualify for subsidies anyway.
@notrichenough - what happens if you are in a car accident and unconscious and the ambulance takes you to a hospital that doesn’t take your HMO?
I’d also like to know about out of network issues with travel. Are emergencies covered if you are traveling out of state? What is the definition of an “emergency”?
The health insurance issue really does have a big impact on early retirement!
@Nrdsb4, is this someone you trust? Is it possible he presented you with only two options because they benefit him in some way? Could there be other options available that he will not get a commission from? I am not very trusting that people are looking out for you, if it is in conflict with their own interests.
For ACA plans, my understanding is that your insurance company can’t charge you higher co-payments or co-insurance, or not cover you, for emergency room care for emergencies.
One thing to watch out for is that some insurers are refusing to cover any emergency room costs if they deem your visit to not be an emergency after the fact. This can cost you 10’s of thousands and leave you with a large fight on your hands as you try to make medical decisions without any medical training.
My understanding is that out of state emergencies would be covered. Very few if any plans will have in-network coverage outside of your state, so anything that’s not an emergency would be considered out of network. Since HMOs generally do not cover out of network care at all, you would be on the hook for 100% of it.
The definition of “emergency” is probably up to the insurance company, but I wouldn’t be surprised if it includes being admitted.
I’m no expert, these are good questions to ask.
If you live half the year in one place and half in the other, I don’t know what you do if all you can get is an HMO plan.
If you haven’t belonged to an HMO in a long time, they are not like they were 25+ years ago, where belonging to an HMO literally meant you picked from a handful of doctors who were employed by the HMO and worked in a building owned by the HMO, and getting referrals to specialists was limited to those in the HMO as well for most things.
These days, around my area at least, most doctors accept all the major HMOs in addition to PPO insurance. Doctors aren’t employed by HMOs directly any more. So you might be surprised to find that your doctors are covered by your HMO. It’s worth checking out before you commit to a $45,000/year plan just so you can have a PPO.
The biggest differences between HMOs and PPOs seem to be that HMOs don’t pay for out of network care at all, and may have a smaller hospital network, and in return for these limitations the premiums and deductibles can be significantly smaller.
Kaiser uses this model, but Kaiser (where it exists) has big buildings with lots of physicians and full ranges of medical services available, rather than a “handful”. That model actually makes it easier to see what is and is not covered by the HMO plan, unlike with network HMOs where you may have to check every provider, sub-provider (e.g. anesthesiologist in a surgery), and facility that you may possibly have medical contact with to verify that it is in-network.
Traditional Medicare has some HMO and PPO aspects. It is like an HMO in that you need to find physicians at accept Medicare (like “in network” for an HMO). But 78% to 97% of physicians do (varies by state), so it is a very large “HMO network”. But, within the range of physicians who accept Medicare, some accept “assignment” and some do not. Those that accept “assignment” will have lower costs to the patient (like “in network” for a PPO).
and our closest hospital is Tier 2 which drives up all of the prices/deductibles. I thought this was high until I started reading these threads!