It's That Time of Year...Health Insurance Enrollment

[AlmiraGulch]

My children and I are covered by my employer.  I enrolled today in basically the same high-deductible plan with HSA that I had last year.  I increased the amount I'm putting into the HSA, and my premium is the same (about $67 a month, total, for the three of us), but the individual deductible did go down by $1000 to $7000 while the co-pay after deductible went from 100% to 90%. Family OOP max is $12,000, I think.  Anyway, I know the deductible is high, but we had other options and this is the one that I choose for my family.  It works for us.

 

My husband's employer pays for all of his premiums.

 

My sister posted on FB today that her premiums for next year are going up by 199%, for worse coverage.  I'm not sure what that means, but she did say that premiums and out of pocket max, combined, for three of them (they cover their adult son), comes in just shy of $24,000. She does not work outside the home and her husband is self-employed.  He retired from a Fortune 500 company after 30 years 2 or 3 years ago, so spent most of her adult life with very good, corporate coverage.

 

She is blaming ACA for this increase.   Since i am now, and have almost always been, covered by my employer, I've not looked in the open market for health insurance in many years.  I that premiums went up considerably for my employer, and for my husbands, but they chose not to pass that on to their employees.   

 

My question:  I recognize that a 199% increase in premiums just sucks, but is it really different now than it ever was, or than it would have been had ACA not been enacted?  It just seems like increases in insurance premiums, and lesser coverage, have been the story for as long as I can remember.  Many of us have just sometimes been lucky enough to not bear the burden of most of the increase.  

 

Is this really an ACA thing, or just the burden of buying health insurance without the purchasing power of an employer?

 

[mom2att]

The problem I see is that it is no longer possible to have a catastrophic-only policy, and it used to be. In prior years we were able to purchase a plan with a high deductible that didn't cover things like maternity, birth control, office visits, etc. For a reasonable amount each month our insurance provided a plan for emergencies, but as a young, healthy family, we opted were able to skip the options that raised the rate and pay those costs out of pocket, which amounted to significant savings.

 

It seems that this option went away with the new insurance regulations. Well-visits are covered, maternity is covered, B/C is covered, but as a result the monthly cost has increased significantly. Meanwhile, the deductible just got higher.

 

When our insurance costs approached $1,000 per month, we said enough. We're with a health share plan now. It does make a tremendous difference cost-wise when you don't have an employer chipping in, but it used to at least be possible to choose a less costly option for those who didn't need all the extras.

 

On the flip side, providers are now required to provide insurance to those they were formerly able to reject, so there's a winner for every loser when it comes to issues like this, I suppose.

 

ETA--just re-read the OP. $67 per month for a family of three? I can't even imagine. Even the "low cost" options I mentioned were never lower than $200/month. And that was with a $10,000 deductible. Your employer is footing the bill, big time.

[Guest]

The rate increases for the comparable coverage are absolutely worse than they have been since the middle of the last century. Even adjusted for inflation.

 

I'm with her on this.

[Guest]

The problem I see is that it is no longer possible to have a catastrophic-only policy, and it used to be. In prior years we were able to purchase a plan with a high deductible that didn't cover things like maternity, birth control, office visits, etc. For a reasonable amount each month our insurance provided a plan for emergencies, but as a young, healthy family, we opted were able to skip the options that raised the rate and pay those costs out of pocket, which amounted to significant savings.

 

It seems that this option went away with the new insurance regulations. Well-visits are covered, maternity is covered, B/C is covered, but as a result the monthly cost has increased significantly. Meanwhile, the deductible just got higher.

 

When our insurance costs approached $1,000 per month, we said enough. We're with a health share plan now. It does make a tremendous difference cost-wise when you don't have an employer chipping in, but it used to at least be possible to choose a less costly option for those who didn't need all the extras.

 

On the flip side, providers are now required to provide insurance to those they were formerly able to reject, so there's a winner for every loser when it comes to issues like this, I suppose.

 

ETA--just re-read the OP. $67 per month for a family of three? I can't even imagine. Even the "low cost" options I mentioned were never lower than $200/month. And that was with a $10,000 deductible. Your employer is footing the bill, big time.

Yes, exactly this. Our policy that was destroyed by this horrid law was one that we chose ourselves, out of our own pocket as self insurers, appropriate for our risk level and what hit our budget could take in an emergency as well as monthly. No longer.

[monstermama]

Call me cynical, as I'm sure some things are worse (particularly for small companies), but I also think some companies are taking advantage and blaming ACA when they're just interested in cutting costs and getting away with it.  The company I worked for before I became a SAHM had worse and worse healthcare coverage every year even before ACA - at one point, when asked point blank why they had gotten rid of a popular PPO plan, the CEO actually said they were "readjusting" the healthcare plans because it was "too much" compared to other companies in our sector.  We'd seen similar rises in DH's insurance as the company culture changed.

 

We're lucky that DH switched jobs this year to a company that truly cares about its employees and offers an amazing healthcare plan.

[Spryte]

My children and I are covered by my employer. I enrolled today in basically the same high-deductible plan with HSA that I had last year. I increased the amount I'm putting into the HSA, and my premium is the same (about $67 a month, total, for the three of us), but the individual deductible did go down by $1000 to $7000 while the co-pay after deductible went from 100% to 90%. Family OOP max is $12,000, I think. Anyway, I know the deductible is high, but we had other options and this is the one that I choose for my family. It works for us.

 

My husband's employer pays for all of his premiums.

 

My sister posted on FB today that her premiums for next year are going up by 199%, for worse coverage. I'm not sure what that means, but she did say that premiums and out of pocket max, combined, for three of them (they cover their adult son), comes in just shy of $24,000. She does not work outside the home and her husband is self-employed. He retired from a Fortune 500 company after 30 years 2 or 3 years ago, so spent most of her adult life with very good, corporate coverage.

 

She is blaming ACA for this increase. Since i am now, and have almost always been, covered by my employer, I've not looked in the open market for health insurance in many years. I that premiums went up considerably for my employer, and for my husbands, but they chose not to pass that on to their employees.

 

My question: I recognize that a 199% increase in premiums just sucks, but is it really different now than it ever was, or than it would have been had ACA not been enacted? It just seems like increases in insurance premiums, and lesser coverage, have been the story for as long as I can remember. Many of us have just sometimes been lucky enough to not bear the burden of most of the increase.

 

Is this really an ACA thing, or just the burden of buying health insurance without the purchasing power of an employer?

I'm not convinced it's only an ACA thing, based on my own personal experience. I had private insurance, that I planned (and was advised by ins agent) to keep forever, as my secondary. I purchased it in the mid-90s, and it was a very basic plan with no Rx coverage at all. It started out at $80. From 2000 to 2004 my rates went from $180 to $2,700. That's not a typo. I dropped it. They increased each quarter as much as they were legally allowed to increase. Fortunately, I could get coverage through DH's employer. Going without is not an option for me.

 

So whether one saw it pre-ACA or not, things certainly were not rosy for everyone. Something needs to be fixed here.

[GoVanGogh]

Call me cynical, as I'm sure some things are worse (particularly for small companies), but I also think some companies are taking advantage and blaming ACA when they're just interested in cutting costs and getting away with it.  The company I worked for before I became a SAHM had worse and worse healthcare coverage every year even before ACA - at one point, when asked point blank why they had gotten rid of a popular PPO plan, the CEO actually said they were "readjusting" the healthcare plans because it was "too much" compared to other companies in our sector.  We'd seen similar rises in DH's insurance as the company culture changed.

 

We're lucky that DH switched jobs this year to a company that truly cares about its employees and offers an amazing healthcare plan.

I agree with this.

 

We have a child with special needs which require an insane amount of therapy. My husband's company switched insurance providers back in July, citing ACA. I really doubt ACA had anything to do with it.

 

They went from (what we were told was) a premium policy that covered nearly all of our child's therapy to a very basic policy that doesn't cover any pediatric therapies. (Unless needed for accident rehab.)

 

I know we were costing them a fortune, but - if hospitals are going to save the lives of premature babies - there has to be assistance available for the families. Don't get me wrong. I am forever thankful that our hospital had the medical knowledge and technology to save our child. But it does come with a very, very high price tag. My DH says prematurity is the gift that just keeps giving. Our child will have lifelong issues (physical and speech related, not cognitive) related to prematurity.

 

Our out-of-pockets expenses - with great insurance - cost us almost $1,000 a month. Now - with a basic policy - our out-of-pocket expenses have been over $2,000 a month - since July. It is no wonder that medical expenses lead many to bankruptcy.

 

 

One benefit of ACA - for us - is that our child's pre-existing condition will no longer prevent them from getting insurance.

[NoPlaceLikeHome]

Actually insurance premiums were increasing often by 20 to 50% every year and coverage was getting less and less every year even back in the early 1990s. The hospital CEO where I worked explained every year how the health insurance premiums were raised an average of 20 to 50% per year every year I worked there and our coverage became less and less and we paid more and more. This is why Hillary made proposals for health care reform way back then and was pilloried for it:(

 

Also, the early 2000s before ACA became law, our family had to buy health insurance on the private market and the only insurance we were approved for was $1300/month for family coverage! And my son and I were turned down for coverage by other health care plans for ridiculous reasons since we were fairly healthy and always had health care coverage.

 

As for catastrophic care plans only, they often mean no care since most folks cannot afford to pay for medical care. So I am glad that basic coverage like check-ups, pregnancy, and birth control are covered.

 

Honestly, we need universal health care like medicare for all. It would not only benefit all of us but would also benefit businesses since they would not be burdened with covering health insurance and be able to better compete against foreign companies who do not have to provide health care insurance.

[PinkyandtheBrains.]

I'm not convinced it's only an ACA thing, based on my own personal experience. I had private insurance, that I planned (and was advised by ins agent) to keep forever, as my secondary. I purchased it in the mid-90s, and it was a very basic plan with no Rx coverage at all. It started out at $80. From 2000 to 2004 my rates went from $180 to $2,700. That's not a typo. I dropped it. They increased each quarter as much as they were legally allowed to increase. Fortunately, I could get coverage through DH's employer. Going without is not an option for me.

 

So whether one saw it pre-ACA or not, things certainly were not rosy for everyone. Something needs to be fixed here.

 

I don't think it's an ACA thing.

 

And still many are benefitting.

 

Single payer system would've been great.

[AlmiraGulch]

Call me cynical, as I'm sure some things are worse (particularly for small companies), but I also think some companies are taking advantage and blaming ACA when they're just interested in cutting costs and getting away with it.  The company I worked for before I became a SAHM had worse and worse healthcare coverage every year even before ACA - at one point, when asked point blank why they had gotten rid of a popular PPO plan, the CEO actually said they were "readjusting" the healthcare plans because it was "too much" compared to other companies in our sector.  We'd seen similar rises in DH's insurance as the company culture changed.

 

We're lucky that DH switched jobs this year to a company that truly cares about its employees and offers an amazing healthcare plan.

 

Part of it depends on the size of the company, I'd think.  A very large company is less likely to be impacted than a smaller one.  Economies of scale and all.

 

Regardless, this doesn't apply to my sister's family, since they're self-employed.  

[AlmiraGulch]

Yes, exactly this. Our policy that was destroyed by this horrid law was one that we chose ourselves, out of our own pocket as self insurers, appropriate for our risk level and what hit our budget could take in an emergency as well as monthly. No longer.

 

I know an equal number of people who feel the way you do as believe the opposite.  

 

I suppose it depends on what side you land in.  

 

(Again...no personal experience here...)

[AlmiraGulch]

Actually insurance premiums were increasing often by 20 to 50% every year and coverage was getting less and less every year even back in the early 1990s. The hospital CEO where I worked explained every year how the health insurance premiums were raised an average of 20 to 50% per year every year I worked there and our coverage became less and less and we paid more and more. This is why Hillary made proposals for health care reform way back then and was pilloried for it:(

 

Also, the early 2000s before ACA became law, our family had to buy health insurance on the private market and the only insurance we were approved for was $1300/month for family coverage! And my son and I were turned down for coverage by other health care plans for ridiculous reasons since we were fairly healthy and always had health care coverage.

 

As for catastrophic care plans only, they often mean no care since most folks cannot afford to pay for medical care. So I am glad that basic coverage like check-ups, pregnancy, and birth control are covered.

 

Honestly, we need universal health care like medicare for all. It would not only benefit all of us but would also benefit businesses since they would not be burdened with covering health insurance and be able to better compete against foreign companies who do not have to provide health care insurance.

 

I agree with you.  My sister (the one who was ranting, from my iniital post) definitely would not agree, even though she's paying what she's paying. 

 

I'm not sure what would make her happy.  I suspect it would be for people like her (whatever that means) have the best coverage, paying what she felt comfortable paying, even if millions go without.  They should just get jobs, you know....

[Joker]

We only pay $100/month for four of us. Our out of pocket maximum for the year is $12K. Half of that OOP max is on our HSA card and half of that is supplied by dh's employer. We are well aware that we don't feel the pinch, though, because his employer is very large and pays so much of the cost for their employees. My siblings are teachers and have horrible insurance because the state doesn't really help them at all.

[AlmiraGulch]

 

ETA--just re-read the OP. $67 per month for a family of three? I can't even imagine. Even the "low cost" options I mentioned were never lower than $200/month. And that was with a $10,000 deductible. Your employer is footing the bill, big time.

 

You read correctly.  $67/month for the plan I described, for three of us.  I am not complaining.  

 

There were options with much higher premiums, I just didn't choose them.  I prefer to put the money into HSA and pay the money when we need it, rather than paying up front for something we may not use in a particular year.

[HRAAB]

I cannot sanely discuss health insurance right now, but I'm with your sister except our increases aren't that high.

 

I wish they would let me get a catastrophic plan, and I would gladly cover the routine stuff out of my own pocket.

 

And I want to make it clear I wasn't opposed to the ACA. I really don't know what to think or do.

[AlmiraGulch]

I cannot sanely discuss health insurance right now, but I'm with your sister except our increases aren't that high.

 

I wish they would let me get a catastrophic plan, and I would gladly cover the routine stuff out of my own pocket.

 

And I want to make it clear I wasn't opposed to the ACA. I really don't know what to think or do.

 

So I think I'm hearing that the biggest difference between ACA and pre-ACA is that you can no longer purchase a catastrophic policy?  

 

I think there are also differences of opinion where people qualify or not for subsidies, and, for certain income brackets, whether or not their state chose to expand Medicare.  

[Guest]

I cannot sanely discuss health insurance right now, but I'm with your sister except our increases aren't that high.

 

I wish they would let me get a catastrophic plan, and I would gladly cover the routine stuff out of my own pocket.

 

And I want to make it clear I wasn't opposed to the ACA. I really don't know what to think or do.

I wasn't bothered by 10-50% increases. It happens. 240% increases on a plan that was selected precisely because it fit us as is, without us having any say, is what drives me up the wall. Ours was a catastrophic plan with an affordable monthly fee and an HSA component. That was what they killed. They changed the HSA contribution laws that made the plan work and reduced the coverage we had while increasing it in all the wrong areas. My maternity, for example, still wasn't covered but my premiums tripled. So our out of pocket cost was what we expected but we were bleeding money to the tune of several hundred PER WEEK to pay for sh*t coverage. And a bronze plan was worse.

 

I can't sanely discuss this either. I'm self censoring heeeeavily.

 

I'm as republican as they come and do NOT oppose medical insurance reforms. This wasn't it. At all.

[mom2scouts]

Before the ACA, we were uninsured. We are all pretty healthy and we paid out of pocket for truly necessary care while praying that nothing major happened. We are the people that the ACA was supposed to save.  We didn't have employer paid health insurance, made a little too much for Medicaid, and couldn't afford a private policy. The discussion about ACA was all about health CARE, but the ACA wasn't about health care. It was about health INSURANCE. We weren't convinced it was going to do what it was intended to do.

 

With Medicaid expansion, we were eligible for that. Unfortunately, finding a doctor who will take Medicaid in my area is almost impossible. Even is you do find a doctor, they may not be taking any more Medicaid patients or they may drop it next month. It's a full time job trying to find someone who will take it and we can only see the doctor listed on our card. When we need a doctor, it's likely that the doctor listed won't take us. The ACA did NOT improve access to medical care. I haven't seen a doctor in nine years. Our longtime pediatrician was willing to see us,but he retired last year and I haven't found anyone to see my children yet. On top of that, when it came time to renew my coverage, I did it by mail. Apparently they didn't receive it and I got a reminder letter. I tried again to renew it online, but that didn't work either and our coverage was dropped. I reapplied and it's been "pending" for seven weeks. I have college degrees and can't figure out how to navigate this government program. Guess what? That means that, once again, we are uninsured. The ACA made things worse for people I know who were happy with their health insurance and didn't do much to help those of us who didn't have insurance. I don't know anyone who's happy with the results of the ACA.

[NicksMama-Zack's Mama Too]

My best friend is a small-business owner. Her premiums have increased 75% since ACA. Her deductibles and out-of-pocket expenses have increased as well. She used to cover 100% of her employees' premiums, but now she just contributes a fixed amount and they have to make up the difference if they want it. The business could not continue to absorb the increases.

 

Her premiums are 1800/mo.

[Guest]

My best friend is a small-business owner. Her premiums have increased 75% since ACA. Her deductibles and out-of-pocket expenses have increased as well. She used to cover 100% of her employees' premiums, but now she just contributes a fixed amount and they have to make up the difference if they want it. The business could not continue to absorb the increases.

 

Her premiums are 1800/mo.

Wow, she even beats us. Ours only topped out at $1700 and some change. Poor thing :(

 

CHM is so great in comparison, and they even (wrongly) denied some bills of mine I need to contest. Even if we have to eat it we are still paying less.

[umsami]

Ours did increase.... higher copay.... higher deductible.... higher max out of payment.... but I live in a state which shunned the Medicaid expansion and there are only two companies to choose from.  Before, we had three...but the company we went with dropped our state.

 

My premiums did not increase 199%, though.  That means they basically doubled.  For similar coverage (well, as close as I can get), we're paying about $200 more per month for a family of six.  Kaiser Family Foundation is a good source for tracking health insurance, rate increases, etc.  http://kff.org

 

I think people blame the AHCA for everything, when in reality it's a lot of factors including companies wanting to maximize profits (both insurance companies and employers).  That's the problem with for-profit insurance companies.  

 

I'll also add that I believe the state government has a right to deny those increases.  (All articles I read say that the plans are seeking a so-and-so percentage increase.)  So, it could be in the interest of some to approve such increases for political gains.  

[Roadrunner]

I can't even talk about. We were quoted $2,200 a month. That's with $15,000 deductible.

[Guest]

I can't even talk about. We were quoted $2,200 a month. That's with $15,000 deductible.

I don't like this post, but I get it. Hugs :(

[Tsuga]

We were offered some new choices but stuck w/ the policy which is the best we've had in years. The worst I had was when self employed.

[Guest]

I can't even talk about. We were quoted $2,200 a month. That's with $15,000 deductible.

Why the huge disparity? We pay $1000/month for 7 people with a $10k deductible.

 

I'm thrilled that they have gotten rid of pre-existing conditions because that kept us locked into a VERY expensive plan offered through DH's office.

 

It sucks that some states are better than others.

[Roadrunner]

Why the huge disparity? We pay $1000/month for 7 people with a $10k deductible.

 

I'm thrilled that they have gotten rid of pre-existing conditions because that kept us locked into a VERY expensive plan offered through DH's office.

 

It sucks that some states are better than others.

I don't know. We are in CA. 

We will keep trying. There are options through work instead of self pay, but the nearest hospital will be 2 hours away and the doc 1.5 hours away. Basically we will be paying about that but for insurance we aren't realistically going to be unable to use due to the distance. 

[ChocolateReignRemix]

The rate increases for the comparable coverage are absolutely worse than they have been since the middle of the last century. Even adjusted for inflation.

 

I'm with her on this.

Source?

[kewb]

Nothing new here. I have been watching my coverage get worse since I started my first job after college in the 80's.

ACA is a convenient scapegoat.

I live in a state with 3 choices for healthcare in the exchange. Technically, 5 but 2 of them are newer and have no track record. My premiums are not increasing 199%.

[Sk8ermaiden]

Our healthcare costs were skyrocketing. They have stabilized since the ACA. Small business owners seem to get the short end of the stick, though that is not new. I remember how horrifically high healthcare costs were when my stepfather started his own business 15 years ago. 

 

Costco has started offering health insurance. Honestly, with how Costco is run, I would not be surprised if they turn out to be a good choice. 

[Lanny]

<snip>

 

I'll also add that I believe the state government has a right to deny those increases.  (All articles I read say that the plans are seeking a so-and-so percentage increase.)  So, it could be in the interest of some to approve such increases for political gains.  

 

 

Yes. Each state has a State Insurance Commission or a department with a different name, that regulates Insurance companies licensed to sell insurance within the borders of their state.

 

In the case of the sister of the OP with the 199% increase, I wonder if the sister has contacted her State Insurance Commission, to verify that they approved a 199% rate increase for her policy?

 

With regard to typical increases for 2016, to people who purchase their insurance on an ACA Exchange, there was something about that on the 6 P.M. (E.S.T.) TV news I watch every night, about 1 or 2 months ago. It varies by state. I seem to recall the increases typically were about 15 - 20 percent, but some were as low as 5% and one or 2 I believe were up about 40 or 50%.   Each state is different.

 

One of the things with ACA is that there are now many more people with severe and expensive medical problems getting coverage and as the insurance companies see what their actual out of pocket costs are, to provide coverage, they request rate increases.  Which is not to say that when I had an Individual Major Medical policy in the states, for many years, that my premiums did not increase every year or so. As they increased the premium, I increased my deductible, to try to keep the premium I paid about the same. The rate increases have been going on for MANY years and that is not something unique to policies affected by ACA regulations.

[BlsdMama]

Our insurance options changed this year (gasp) for the better.  Now, granted, our premiums went up 150%, however, our individual deductibles went down.  Our out of pocket max is $8k (an improvement) not counting premiums, of course.

 

Our insurance was NOTHING like this a few years ago.  I know DH's employer is still absorbing a large majority of the costs.

 

It *is* definitely affecting our medical care.  We think twice before going to the doctor for anything minor.  I have my cerclage surgery coming up.  Normally it would be done at 14 weeks pregnant.  I'm going to ask if we can safely move it to January 2nd.

 

It is the difference between paying the first $4500 (this year's deductible - 100% mine plus 20%) and 2015's deductible of $2,000.  And, of course, if we do it in late December ($4,500 + 20%) the I'm still responsible for the 2015 deductible plus 20% of our costs of the delivery, etc.

 

I'm hoping pharmacy has also changed.  I need weekly progesterone / Makena.   Those shots are dreadfully expensive on the years the courts have decided we can't use a generic.  ($1,000+ per week.)

[Lolly]

Why the huge disparity? We pay $1000/month for 7 people with a $10k deductible.

 

I'm thrilled that they have gotten rid of pre-existing conditions because that kept us locked into a VERY expensive plan offered through DH's office.

 

It sucks that some states are better than others.

Are you paying the full price? Is this through an employer who is paying a large portion for you? Are you using the tax credit through the Marketplace?

Edited November 20, 2015 by Lolly

[Guest]

Are you paying the full price? Is this through an employer who is paying a large portion for you? Are you using the tax credit through the Marketplace?

 

Our bronze07S level plan for 2016 is $1145.54 per month for 5 non-smoking people in good health. It has a deductible of $10,400 and out of pocket max of $12800. We pay everything until we reach the deductible, then 50%. I consider it catastrophic coverage.

Yes, that plan is purchased through the Marketplace. That is the basic price without any tax credit.

[Lolly]

Yes, that plan is purchased through the Marketplace. That is the basic price without any tax credit.

For 2016 or 2015?

[MyThreeSons]

We went 15 years with zero coverage for me. We simply couldn't afford it. Our sons had Medicaid for several years, but when dh retired, we became ineligible, so we went a few years with no coverage for anyone except dh, who has both Medicare and VA coverage. 

 

The first year of the ACA, I enrolled in the cheapest possible plan for me, but only used it to cover a few prescriptions, written by our family doctor who was not in the plan. Youngest ds was caught in the gap because of his age -- the feds said he needed to be on the state medicaid plan, but the state said he didn't qualify. He aged out of the state plan before any appeal to them could be processed, This year, we have been very pleased with the plan we have for the two of us, and I planned to continue it for next year. 

 

My early research is showing that our portion of the subsidized premiums will go up almost 50%, while our deductibles will double. It is likely that we will still go with this plan, although it will be tough. I am still paying off several medical bills from this year. 

[Guest]

For 2016 or 2015?

2015. I don't have the exact 2016 numbers but our agent says they are similar. That reminds me, I need to call him today.

[Scarlett]

Part of it depends on the size of the company, I'd think. A very large company is less likely to be impacted than a smaller one. Economies of scale and all.

 

Regardless, this doesn't apply to my sister's family, since they're self-employed.

Family max is 12k so she is paying 1000 a month for premiums. Not bad for a family. I am paying $287 for a 6k deductible plan for just me. It was 200 last year.

 

Insurance companies have been raising rates for a long time. Even back in the 90s the company I worked for faced an increase every year.

 

It is just a cost that has to be factors into our lives now. Thankfully now there are options if we become unemployed or disabled.

[AlmiraGulch]

Family max is 12k so she is paying 1000 a month for premiums. Not bad for a family. I am paying $287 for a 6k deductible plan for just me. It was 200 last year.

 

Insurance companies have been raising rates for a long time. Even back in the 90s the company I worked for faced an increase every year.

 

It is just a cost that has to be factors into our lives now. Thankfully now there are options if we become unemployed or disabled.

 

Her max is just shy of $24,000.  My family max is $12,000.   

 

Also, I was wrong about who this is covering.  The amounts I quoted are just for her and her husband. Her son is on his own separate plan, although it's cheap.  I think it went up from $17 to $75 (or something like that) per month.  Quite an increase, but still not a lot of money.  

[Scarlett]

Her max is just shy of $24,000. My family max is $12,000.

 

Also, I was wrong about who this is covering. The amounts I quoted are just for her and her husband. Her son is on his own separate plan, although it's cheap. I think it went up from $17 to $75 (or something like that) per month. Quite an increase, but still not a lot of money.

Well yours can't compare because your employer is paying most of the premium right?

 

What are the ages of your sister and husband? I am 50 and my premium is $287 for 2016. I am dreading an increase every year.

[ScoutTN]

At best, it was a problematic scenario before, but ACA definitely made it worse. Government telling people what they must do and limiting options is rarely a good thing, imo. 

 

My DH does not like his job but the health insurance is very affordable compared to most and that alone makes it worth staying. With his health issues (lifelong condition - vascular malformations throughout his nervous system, brain surgery 3 months ago), our premiums and costs for care would bankrupt us in months. 

 

 

 

 

[shawthorne44]

The problem I see is that it is no longer possible to have a catastrophic-only policy, and it used to be. In prior years we were able to purchase a plan with a high deductible that didn't cover things like maternity, birth control, office visits, etc. For a reasonable amount each month our insurance provided a plan for emergencies, but as a young, healthy family, we opted were able to skip the options that raised the rate and pay those costs out of pocket, which amounted to significant savings.

...

 

And they knew that was going to happen.  When it was asked who is going to pay for the ACA coverage for all these people that can't afford it now the answer was "Young people that don't have full coverage now".  

[Lolly]

2015. I don't have the exact 2016 numbers but our agent says they are similar. That reminds me, I need to call him today.

Ah. Be interesting to see how similar. We dropped coverage significantly for next year (numbers I gave). We had a silver plan, still with a pretty high deductible, but better. Its cost to us would have been twice what we were paying. We are paying the same amount this year for far less coverage. It should work for us though, because we never go to the doctor. Dd's plan from last year would have gone from about $350 to $530.You really can't compare the 2015 rates with 2016 in my experience.

Edited November 20, 2015 by Lolly

[AlmiraGulch]

Well yours can't compare because your employer is paying most of the premium right?

 

What are the ages of your sister and husband? I am 50 and my premium is $287 for 2016. I am dreading an increase every year.

 

Yes, you're correct about my employer paying.  I was just saying that I thought maybe I'd misrepresented her out of pocket as $12k, when actual that's mine, and theirs is much higher. 

 

They are both about the same age as you (she's slightly younger, he's slightly older).

[Scarlett]

Yes, you're correct about my employer paying. I was just saying that I thought maybe I'd misrepresented her out of pocket as $12k, when actual that's mine, and theirs is much higher.

 

They are both about the same age as you (she's slightly younger, he's slightly older).

Well what I was saying is that the out of pocket is a set amount.....can't be higher for a family than 12k...maybe 12800. So that means her premiums are 1000 per month. At least I think that is how it would work.

[Guest]

At best, it was a problematic scenario before, but ACA definitely made it worse. Government telling people what they must do and limiting options is rarely a good thing, imo.

 

My DH does not like his job but the health insurance is very affordable compared to most and that alone makes it worth staying. With his health issues (lifelong condition - vascular malformations throughout his nervous system, brain surgery 3 months ago), our premiums and costs for care would bankrupt us in months.

We've had the opposite experience. Under the ACA, there are no pre-existing conditions. The only questions they ask are age and SSN. My DH couldn't buy coverage before the ACA due to his health issues. He was locked into a job with coverage that we paid 100% of but at least we could get it. Our ACA policy is not great coverage but it costs us half what we paid last year.

[Lolly]

Well what I was saying is that the out of pocket is a set amount.....can't be higher for a family than 12k...maybe 12800. So that means her premiums are 1000 per month. At least I think that is how it would work.

 

Premiums do not count towards the deductible or out of pocket costs. If premiums are $1000 per month and out of pocket is $12000, the family pays $24000 ($1200 in premiums and $12000 out of pocket) before they stop paying for medical costs. Out of pocket is in addition to premiums.

Edited November 19, 2015 by Lolly

[Scarlett]

Premiums do not count towards the deductible or out of pocket costs. If premiums are $1000 per month and out of pocket is $12000, the family pays $24000 before they stop paying for medical costs. Out of pocket is in addition to premiums.

Ok then I am really confused because I thought there was a cap on out of pocket.

[Lolly]

Ok then I am really confused because I thought there was a cap on out of pocket.

 

There is a cap. It is just in addition to the premiums.

 

 

 

 

Edited November 20, 2015 by Lolly

[Scarlett]

There is a cap. It is just in addition to the premiums.

 

Our monthly premium is $1145.54 x12= $13,746.48 in premiums for the year. Once we pay $10,400 (deductible= we pay 100% of any medical fees) of payments to doctors (not including premiums to insurance) we start paying 50% of the medical fees. Once we have paid out $12,800 (out of pocket which=deductible + $2400 paid at 50% of actual cost), we no longer have to pay. So, we pay $13,746.48 in premiums + $12,800 to medical offices = $26,546.48 in payments if we reach the out of pocket. Add in my dd's plan at $386 x12=$4632 premiums+2100 out of pocket= $6720; and we have a total possible of $33,266.48 of medical expenses for the year. Which is why we don't ever seek medical treatment other than dd. So much for affordable care!

Ok that is how I understood it but I must be seeing the OP wrong somehow.

[Lolly]

Ok that is how I understood it but I must be seeing the OP wrong somehow.

 

ah. Then, yes, if their total for the year can come up to being $24000, and they have a $12000 max out of pocket, then their monthly premium would be $1000.

Edited November 19, 2015 by Lolly