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You dont have to buy a policy off the marketplace(ACA or state exchange) if you aren't getting a subsidy. You can go through an insurance broker that sells health insurance policies or go directly to the health insurance carrier to buy a policy (such as through blue cross blue shield to buy a policy). As of now, these policies meet ACA rules for pre-existing condition, free preventative visits, can't cancel if you get sick, kids under 26, etc). Of course, this appears to be going away very soon.
Lots of self employed and such avoid the ACA web site if they aren't getting a subsidy and go direct to the health insurer or insurance agent to buy a policy. I think people over 30 can get a catastrophic plan via an insurance agent or direct through the carrier (not sure of this).
I do buy it directly from the insurance company. They consider it to be the same pool as those who buy from the exchange. The policies are identical: identical costs, lumped into the same pool.
Center on Budget and Priorities: Medicare is not "Bankrupt": Medicare Is Not
Yes, Medicare is bankrupt, it is highly subsidized by outside funds, only 15% of the program is paid for out of premiums collected. The original Medicare model was that it would be a self sustaining program, never has been, and not to mention is was a HUGE flop in the early years when it only covered 80% of costs leaving the elderly saddled with 20% of the costs and while 20% of a $100 office visit wasn't that much, 20% of a $400,000 heart surgery certainly was, thus the introduction of the Supplement plans and later the Medical Advantage plans.
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Originally Posted by NSHL10
To me, the individual market still has the main problem of a bad applicant pool. It is primarily poor, old and sick. So basically we have 3 choices:
1. Do what we always did, privatize the gains socialize the losses which would be putting the subsidized onto medicaid and raise taxes to cover the expense
2. Expand the pool by forcing everyone to buy a plan via eliminating employer provided insurance
3 Medicare for all
The problem with all of these is that people think they will get these for the same low costs as today. If we have Medicare for all, costs will quadruple, at least. If employers don't subsidize insurance costs, like over 85% of people in this country have access to now, costs are going to more than double. Look at what is happening with exchange/individual plans now and the whining that goes on just on this forum about how expensive the plans are. The exchange/individual plans already have a larger risk pool than any employer sponsored plan does now.
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Originally Posted by Jo48
Yep, my older daughter might just lose her insurance. She has one of those HSA type plans where she works, but she cannot afford to put anything into. Her wife, yes she is a married gay, covers her under her own better insurance plan.
This opens up another can of worms. Married gays. Right now, companies giving health benefits must also cover married gay spouses, not just straight married couples. I read somewhere that Trump wants to eliminate this and leave it up to individual companies to decide for themselves. Gay married spouses will lose their coverage too.
Your daughter can't contribute to an HSA if she is covered under another policy anyway. In the past, individual plans did decide if they were going to give coverage to domestic partners, which not only addressed gay relationships but also hetero relationships were people were not married. It was the gay marriage laws in the various states that changed this practice, not the ACA. If gay marriage is recognized in the state in which her policy was written, it would be illegal to deny coverage to married gay couples if the policy covers hetero married couples. Now, there are some plans out there that do not offer any kind of family coverage, in that case, no, they would not cover your daughter or any other spouse.
As for "one of those" HSA plans, they are the lowest cost plan on the market and there is no law that they have to contribute to the HSA, it's an option, an excellent option at that, to have tax free money to pay your medical bills. She has the option to just pay her bills as they come too.
If ACA is dropped will the plan cost come down? Without a subsidy we would have a hard time paying the premiums. If I recall correctly the cost of insurance shot up when ACA started. I assume the pre-existing clause is what created part of the jump. What else made the costs jump up?
If ACA is dropped will the plan cost come down? Without a subsidy we would have a hard time paying the premiums. If I recall correctly the cost of insurance shot up when ACA started. I assume the pre-existing clause is what created part of the jump. What else made the costs jump up?
According lot of things were covered that raised costs: the "free" preventative doctor visits, vaccines, physical exam, colonoscopies, etc. Some plans offered free visits to your primary doctor which knocked out HSA compatbility.
Max out of pocket limits also raised costs.
Not saying any of the above is bad, just showing where the expenses came from.
If ACA is dropped will the plan cost come down? Without a subsidy we would have a hard time paying the premiums. If I recall correctly the cost of insurance shot up when ACA started. I assume the pre-existing clause is what created part of the jump. What else made the costs jump up?
Costs for the plans has not increased much at all since the ACA, and those increases are far less on average than annual increases were before the ACA. Most of the people you hear complaining about higher premiums had bare bones policies with deductibles in the $20,000+ range that offered limited services with very low lifetime maximums and now they have to buy a real health insurance plan so their premiums have gone up. Several years ago we were moving and switching jobs and took out individual plans to cover the gap our changes would have created. Our family coverage was $675/month but we EACH had a $10,000 deductibles with a $20,000 out of pocket max. If we were in a car accident, and all ended up with major injuries, that would have cost us $100,000. Today, if we still had an individual plan, the MOST it would have cost would be $13,700. The preexisting condition clause did not add that much to the overall costs. The states that the ACA was modeled after, MA and MN already had that prevision and they continue to have the the lowest overall premiums. They also had free preventive care, women's health care and most of the other provisions in the ACA. The real issue is that people just don't understand how insurance works, they had plans that covered nothing in the past and now they are buying a real insurance plan .
Now, in 2017 there have been higher prices mainly because of the losses companies have taken on these plans and that the reinsurance provision has been eliminated (which is a secondary insurance that insurance companies or employers have to pay out high value claims--say someone with cancer, taking the burden off of the base plan). Also realized, most markets saw no increases and many saw reductions in premiums.
Of course not. People with health insurance coverage will be paying for all those who have none, but use the ER when they are sick, have accidents, don't maintain their meds, etc. Just as it was before the ACA.
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If I recall correctly the cost of insurance shot up when ACA started. I assume the pre-existing clause is what created part of the jump. What else made the costs jump up?
The cost of health insurance has been rising since 2000, long before the ACA was in place. What's contributed to the cost? Outrageous liability insurance, hospital advertising, state of the art imaging machines, etc.
Yes, Medicare is bankrupt, it is highly subsidized by outside funds, only 15% of the program is paid for out of premiums collected. The original Medicare model was that it would be a self sustaining program, never has been, and not to mention is was a HUGE flop in the early years
Of course it had problems in 1965 when it was created. What new program, including the ACA, does not? What other suggestions do you have for those over 65, who, until this program was created, found it virtually impossible to obtain private health insurance due to their age?
Of course it had problems in 1965 when it was created. What new program, including the ACA, does not? What other suggestions do you have for those over 65, who, until this program was created, found it virtually impossible to obtain private health insurance due to their age?
Exactly my point, people keep saying "Medicare for all" without realizing the true state of the program and the difficulties that program had at the start, now just a couple years into the full ACA program, all the doom and gloom when people need to give the market time to stabilize, which is a couple years away still. Putting everyone into Medicare is not going to achieve what people think it will because they are NOT going to get that coverage for the low price people pay now, even though most people suggest Medicare for all because they THINK it will be more affordable. Maybe the better solution is ACA for all, including those over 65...I know I'd see a huge pay increase if I didn't have to keep paying for Medicare out of each paycheck. With the pre-existing condition clause removed, everyone can find coverage now and with the advent of the HSA, people could pre-fund their retirement health care through their HSA's...like they were designed to do from the onset 20 years ago...but people don't understand that....
Someone upthreads stated that Medicare is heavily subsidized and does not pay its own way, and then went on to say they would experience a "huge" increase in their paycheck if they didn't have to pay for Medicare.
The first part of that statement is true, the second is false.
The Medicare tax to the individual is a relatively small 1.45% of pay. Total FICA is 7.65% which includes SS at 6.2%. FICA at 7.65% can possibly be described as "huge" - but certainly not the Medicare portion of that which is 1.45%.
If one earns $100,000, their Medicare tax is $1,450, which translates to $120.83/mo. Even assuming normal deductions - worst case one takes home $6,000 - $120.83/mo. is hardly "huge."
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