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Well, the plan you have is pretty amazing to cover two people, in their 60's. You wont find better on the exchange. At least in my state you wont. If your income is that low, especially if your husband is not working, you may qualify for additional financial help to cover your medical costs though on the exchange. Or maybe even Medicaid. You would need to do some calculations to try to figure out which route would be cheaper, based on what medicines you take, how frequently you have doctor's appointments etc.... I encourage you to try to find a non-profit organization in your area that helps people choose health insurance options. If you are native american, maybe check with any organizations in your area that help with resources for native americans and maybe they can direct you to one of these health insurance "navigators".
Just for comparison, I have an Obamacare plan in my state.
I am in my early 50's - so younger than you guys.
The insurance is only for me.
I have no major medical problems.
The cheapest bronze plan in my area + dental insurance costs me almost $900 per month. $900.
To see if I qualify for one of the greatest subsidies that helps reduce not only your monthly premium but also reduces your co-pays/co-insurance, you have to get the cheapest silver type plan. Those are almost $1000 per month for my age in my state. Yours would be much more expensive if you are in your 60's, in my state.
And the coverage is still terrible. It only covers only 50% of the bill. I have a deductible of $2300 per year before it pays for that 50%! Co-pays are ok for generic medications at $5-25 per month. But name brand coverage is terrible - I have to pay a percentage of the actual cost of the medicine which is 35-40%. My max out of pocket for the year is over $9000 dollars. I don't qualify for those extra subsidizes this year. But my higher income is slashed by these crazy expensive medical costs. If I even step into an ER, they charge me $1000 on top of all of bills that I accumulate in the ER. And the $1000 doesn't even count towards my deductible.
My medical costs are higher than my rent. Substantially higher. And I'm lucky enough to be healthy. Our system is insane.
I have been buying my own health insurance for the past 12 years. It went from $250 per month to almost $1000 per month and the coverage is worse each year.
Each year the plans on the exchange reduce the amount they pay in small ways that you don't even realize at first. They make you pay more of the drug costs, and move cheap drugs to higher tiers. Or they change from a plan with co-pays to one where you pay a percentage of costs. Or they decrease the percentage they cover - it was 80% years ago... now its only 50%. Or they add more prior authorizations to things that used to be covered, or reject claims simply hoping you wont go to the trouble of fighting or appealing. Even rejecting claims that they know should be covered, because most people wont figure it out or will give up and pay anyway. It is fraud. Truly. They add new co-pays that never existed before, that do not apply to your deductible, so you wind up paying more and more out of pocket. I even had an example where the hospital overcharged for a service dramatically --- an error (or another example of fraud, really....). But the health insurance company didn't care, because they didn't have to pay for it! I told them that the mistake, suggested they should re-process the claim, told them the coding overbilling error or they could call the hospital and have it corrected - but they didn't care. They wouldn't fix it or try to pursue it. Because they knew they wouldn't have to pay it anyway! They just applied it to my deductible, and said.... "Sorry... it's your responsibility".
Finally I will be able to get employer funded health insurance this year. I am ecstatic.
Anyway.... sorry for the rant!
So talk to a health care navigator and investigate your options. But I suspect you may want to hang on to that employer health insurance afterall!
Well, the plan you have is pretty amazing to cover two people, in their 60's. You wont find better on the exchange. At least in my state you wont. If your income is that low, especially if your husband is not working, you may qualify for additional financial help to cover your medical costs though on the exchange. Or maybe even Medicaid. You would need to do some calculations to try to figure out which route would be cheaper, based on what medicines you take, how frequently you have doctor's appointments etc.... I encourage you to try to find a non-profit organization in your area that helps people choose health insurance options. If you are native american, maybe check with any organizations in your area that help with resources for native americans and maybe they can direct you to one of these health insurance "navigators".
Just for comparison, I have an Obamacare plan in my state.
I am in my early 50's - so younger than you guys.
The insurance is only for me.
I have no major medical problems.
The cheapest bronze plan in my area + dental insurance costs me almost $900 per month. $900.
To see if I qualify for one of the greatest subsidies that helps reduce not only your monthly premium but also reduces your co-pays/co-insurance, you have to get the cheapest silver type plan. Those are almost $1000 per month for my age in my state. Yours would be much more expensive if you are in your 60's, in my state.
And the coverage is still terrible. It only covers only 50% of the bill. I have a deductible of $2300 per year before it pays for that 50%! Co-pays are ok for generic medications at $5-25 per month. But name brand coverage is terrible - I have to pay a percentage of the actual cost of the medicine which is 35-40%. My max out of pocket for the year is over $9000 dollars. I don't qualify for those extra subsidizes this year. But my higher income is slashed by these crazy expensive medical costs. If I even step into an ER, they charge me $1000 on top of all of bills that I accumulate in the ER. And the $1000 doesn't even count towards my deductible.
My medical costs are higher than my rent. Substantially higher. And I'm lucky enough to be healthy. Our system is insane.
I have been buying my own health insurance for the past 12 years. It went from $250 per month to almost $1000 per month and the coverage is worse each year.
Each year the plans on the exchange reduce the amount they pay in small ways that you don't even realize at first. They make you pay more of the drug costs, and move cheap drugs to higher tiers. Or they change from a plan with co-pays to one where you pay a percentage of costs. Or they decrease the percentage they cover - it was 80% years ago... now its only 50%. Or they add more prior authorizations to things that used to be covered, or reject claims simply hoping you wont go to the trouble of fighting or appealing. Even rejecting claims that they know should be covered, because most people wont figure it out or will give up and pay anyway. It is fraud. Truly. They add new co-pays that never existed before, that do not apply to your deductible, so you wind up paying more and more out of pocket. I even had an example where the hospital overcharged for a service dramatically --- an error (or another example of fraud, really....). But the health insurance company didn't care, because they didn't have to pay for it! I told them that the mistake, suggested they should re-process the claim, told them the coding overbilling error or they could call the hospital and have it corrected - but they didn't care. They wouldn't fix it or try to pursue it. Because they knew they wouldn't have to pay it anyway! They just applied it to my deductible, and said.... "Sorry... it's your responsibility".
Finally I will be able to get employer funded health insurance this year. I am ecstatic.
Anyway.... sorry for the rant!
So talk to a health care navigator and investigate your options. But I suspect you may want to hang on to that employer health insurance afterall!
Thank you. Sorry to hear you had to pay out so much $$ all those years and even while the Exchange plans got worse, yet so exciting you have employer funded insurance finally. Good for you. Hoping we both stay healthy this year
My last job I made $$ off of the health insurance. This crappy plan shocked me, I expected part of my compensation to come from an HSA match.
He is 61, I am 54 yrs old.
He's choosing to go without health insurance for another 9 months until he qualifies under my plan for $20 per mo.
Despite the GOOD Exchange plan offered for only $26 per month, he isn't going for it. It charges the taxpayer hundreds per month which he wants to avoid. As we know, this is whether he uses the insurance or not. It's not like Traditional Medicaid which is fee for service. We both don't feel right about charging the taxpayer that much $$. I do not see us ever qualifying for Medicaid under any circumstances
We eat organic whole foods. We are not around crowds, as over half of my shift is outside either pushing carts or delivering groceries to cars. He works on Vacation Homes in a HUGE subdivision where work is endless in the most expensive tourist town in Northern Calif where we both work. Problem is, he works just half the year. We are going into the Summertime when he's going to start work
I am not against low income programs if people are smart about it. I signed up for the Indian Health Clinic some time ago after getting laid off during COVID just to avoid the IRS penalty for not having health insurance. This charges the taxpayer $50 a month to be on the doles which is vastly different than many hundreds of dollars thru the exchanges. I visited the Indian Clinic for dental but my dental insurance covered it fully.
When you live remotely and are not around people, that is the best health insurance you can have considering you are fit and eat right without an serious health issues. He has high BP and some breathing issues using a BPAP so he is a bit high risk but we are going to take that chance fo the next 9 months. He eats right, is in shape enough, it should be okay. Thanks for al that information and your experience and perspective
Last edited by Pip-Squeak; 03-31-2023 at 02:47 PM..
Good luck you you. Make sure your husband still takes his blood pressure medicine and uses his CPAP every night - especially if he isn't seeing the doctor. If he gets sick, you are right that sometimes the local clinics are still cheaper than having insurance. And if something very bad happens, you can probably get him signed up for insurance quickly if he is Native American as well.
But honestly - I don't mind paying extra on my insurance premiums so that your husband can get health insurance. I only mind that the health insurance companies are making all that extra money. Don't give up getting what you are eligible to get when you deserve it. Your husband deserves it.
Good luck you you. Make sure your husband still takes his blood pressure medicine and uses his CPAP every night - especially if he isn't seeing the doctor. If he gets sick, you are right that sometimes the local clinics are still cheaper than having insurance. And if something very bad happens, you can probably get him signed up for insurance quickly if he is Native American as well.
But honestly - I don't mind paying extra on my insurance premiums so that your husband can get health insurance. I only mind that the health insurance companies are making all that extra money. Don't give up getting what you are eligible to get when you deserve it. Your husband deserves it.
Thanks, you shouldn't be paying extra on your premiums as my employer will cover him. We just have to wait. Its $297 a week right now, in 9-10 months, it will be $20 a month. Yes he takes his BP meds and uses his BPAP at night. We should be okay until then. He also gets a fairly good amount of exercise and is not overweight.
Thanks, you shouldn't be paying extra on your premiums as my employer will cover him. We just have to wait. It’s $297 a week right now, in 9-10 months, it will be $20 a month. Yes he takes his BP meds and uses his BPAP at night. We should be okay until then. He also gets a fairly good amount of exercise and is not overweight.
Check the silver level plan on health insurance market/ ACA exchange- these type plans offer some additional benefits if you are low income.
Has to be silver plan, not bronze, etc.
it could be better for your family in some circumstances
Check the silver level plan on health insurance market/ ACA exchange- these type plans offer some additional benefits if you are low income.
Has to be silver plan, not bronze, etc.
it could be better for your family in some circumstances
Thank you. We will just wait another 8 months for him to qualify under my plan for $20 per month.
Again, I was just shocked there was no HSA plan and Match. Prior we had an Indemnity Plan and an HSA Plan.
So I made about $200 a month on the health insurance alone.
Still good news he doesn't need to sign up for Medicare in 3 yrs. This plan will suffice.
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