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AlmiraGulch

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

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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.

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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.

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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.

 

That's not true.  Out of pocket for her family, on her policy, is nearly $24,000. 

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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.

 

Yes, he can not be refused coverage, but we would be priced out of effective coverage. To get what we have through his employer in the marketplace would cost over 40% of his after tax pay. Right now we pay $350 a month. If we had had the coverage we could afford through the ACA, his brain surgery this summer would have bankrupted us. Over $200K in medical bills. 

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Yes, he can not be refused coverage, but we would be priced out of effective coverage. To get what we have through his employer in the marketplace would cost over 40% of his after tax pay. Right now we pay $350 a month. If we had had the coverage we could afford through the ACA, his brain surgery this summer would have bankrupted us. Over $200K in medical bills.

I know I sound like a salesperson for the ACA, I promise, I'm not! Our current policy is $1000/month. There is a $10k deductible but it pays 100% after that. Our old policy was an 80/20. I feel really good knowing that the biggest hit we could take is $10k (and my DH has heart surgery every 10 years so I get expensive procedures!!). The ACA has been good for our family.

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I know nothing about health care except what I pay through my employer for Anthem. I was exceedingly pleased that my premiums went down by about 30% this year!! I doublechecked with the person who handles this and annually compares hundreds of policies to choose which one is best for our 75-person company. She said it was because all the bureaucracy associated with newly implementing ACA has been reduced, and this is the more 'normal' amount we should expect from now on. She said it's very age-specific, so folks 40 and below are getting a big reduction, and there will be a steady (but not drastic) increase as folks age.

 

 

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Yes, he can not be refused coverage, but we would be priced out of effective coverage. To get what we have through his employer in the marketplace would cost over 40% of his after tax pay. Right now we pay $350 a month. If we had had the coverage we could afford through the ACA, his brain surgery this summer would have bankrupted us. Over $200K in medical bills.

Is the employer paying part of the premium?

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I know nothing about health care except what I pay through my employer for Anthem. I was exceedingly pleased that my premiums went down by about 30% this year!! I doublechecked with the person who handles this and annually compares hundreds of policies to choose which one is best for our 75-person company. She said it was because all the bureaucracy associated with newly implementing ACA has been reduced, and this is the more 'normal' amount we should expect from now on. She said it's very age-specific, so folks 40 and below are getting a big reduction, and there will be a steady (but not drastic) increase as folks age.

My premium went from $200 to 287 per month this year. I thought that was significant.

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I know I sound like a salesperson for the ACA, I promise, I'm not! Our current policy is $1000/month. There is a $10k deductible but it pays 100% after that. Our old policy was an 80/20. I feel really good knowing that the biggest hit we could take is $10k (and my DH has heart surgery every 10 years so I get expensive procedures!!). The ACA has been good for our family.

This is great for people who have an extra $22,000/year to spend on health care with premiums and OOP max combined. Most Americans would spend the rest of their lives paying for the $10,000 medical bills in addition to keep paying $12,000 for premiums annually + what medical bills occur in subsequent years.

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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. 

Talk to a good agent, they don't increase your rates at all and they know what they are doing.  If you don't know one, let me know and I'll message you a recommendation for a very good one I know here in California.  Licensing is by state, so that will work.

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