Obamacare or Keep My Plan

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Ravenvalor

Senior Member
Hello,

Can anyone recommend a good site that will help me decide whether or not I should keep my existing health insurance plan or not? I would rather be dragged kicking and screaming to Obamacare and am wondering if my new premium rates are just the catalyst.
I would rather holdout at least one more year in order to see if the Republicans can reverse this 'Titanic'.

Thanks,
 

iwire

Moderator
Staff member
Location
Massachusetts
Just a heads up guys.

The only way posts will remain or this thread stays open is to keep it to pure insurance facts.

Any political commentary or opinion will be removed.

We just do not do politics here at this forum.
 

PetrosA

Senior Member
When we first went through the process, we had a list of options to consider. We ended up calling the insurance company to talk with someone there who could explain the differences between the plans offered. That was most helpful and we ended up with a plan that we were really happy with. This year after renewal we ended up getting moved to the state Medicaid plan (which will probably change again after I file my return) and that was a nightmare since neither the healthcare.gov or the state people knew what the heck was going on and my stepson has lost his insurance in the meantime because of that. The "Obamacare" system worked great for us. It was only when we got re-qualified that things went south.
 

kwired

Electron manager
Location
NE Nebraska
Open enrollment is over for 2015 so even if you want to get in to the Affordable Health Care Program you may need to wait until next year. I believe open enrollment starts in November (possibly the 15th)and ends Feb 15. If you wish for coverage to begin Jan 1 you must enroll before Dec 15, otherwise in general you must enroll by 15th of prior month of when coverage begins.

Whether or not it is worth while varies quite a bit and your income level does make a difference in how much you need to contribute and how much the program contributes for you. You will find actual insurance premiums are still in similar price ranges as they were before - it is just who pays what percentage is one big change. Also your health history may be a factor in whether you can afford private insurance or if AHCP is a better option. If you have a serious condition - you may have a hard time getting your own insurance at an affordable rate - but the AHCP plans still have to cover you.

If you have children or other dependents under 19 - they will not be covered by AHCP - unless they fail to qualify for medicaid or CHIP (childrens health insurance program which is under state medicare programs AFAIK) but you must try to enroll them in those programs first.

If you go to open enrollment site (may have to wait until november to do this since open enrollment is done for 2015) you can put in some of your information, doesn't even need be totally accurate just in the ballpark, and you get a list of policies and what it is estimated they will cost you out of pocket immediately, and you can easily start to see what your options are. You may find policies as low as $20 a month up to several hundred a month - they all have different deductibles, limitations, copays, types of services that are covered, etc.

If you submit the information with estimated income or other figures you still likely get the insurance at the rates that were quoted, but if you were way off with your estimated income or other figures, you may owe some extra money after the year and you file your tax return. You may also end up with more credits then you used - that can be applied to the next year or possibly even refunded to you (I'd need to verify this information), but I know it works somewhat similar to paying your income tax - if you don't pay enough during the year you will owe the balance when you file, if you pay too much you will have a credit, and if you don't want to have to pay a large bill at the end of the period you need to keep track of where you are and have adjustments made, which in this case essentially changes what your out of pocket insurance premium is each month.

Right or wrong (this starts to get political so I will not say much other then a few basic facts) - insurance companies still get to sell policies though they may have more restrictions on who or what they must cover in some instances where they could refuse to cover some of those in the past, people that could not afford or even get insurance before can have insurance, uncle Sam is paying a portion of their premium depending on income and other factors. Some users are very happy with what they have, some not so happy. It is hard to develop such a plan that would make everyone happy, but you do not have to use this plan either.

I enrolled this year, went from paying about $800 monthly for a high deductible plan, no copays, no prescription coverages and even some limitations on what services are covered to a plan that only costs about $120 from my pocket monthly, has lower deductible, does have copays and some prescription coverages. Looks much better then what I had now, but we will see how it turns out after the entire year is over before I will say much more on how good or bad it is for me.
 

GoldDigger

Moderator
Staff member
Location
Placerville, CA, USA
Occupation
Retired PV System Designer
Even after the open enrollment period is over, a "qualifying event", which includes losing other insurance, allows you to enroll at that time. You simply cannot make a decision to change at any time without an external event.
 

petersonra

Senior Member
Location
Northern illinois
Occupation
engineer
It seems to vary wildly by state. Some people are experiencing huge premium increases and benefit changes (usually not in one's favor), others seem to be more stable.

One thing that is sure is that a lot of people who got insurance cheap will be paying for it at tax time. The difference between the estimated subsidy price for Obamacare plans and the real price will be made up through the income tax system. There is another form you have to fill out and it will calculate how much extra you owe of you got too much of a subsidy or how much you get back if you got too little. There are some very scary estimates of the total amount of extra subsidies paid out.
 

Barbqranch

Senior Member
Location
Arcata, CA
Occupation
Plant maintenance electrician Semi-retired
Here in rural northern CA, there are very few doctors that will take the ACA insurance. Even some of the big companies here sell ACA as well as non-ACA policies, and the doctors only take the non-ACE flavors. Check w/ your doctor before jumping ship.
 

petersonra

Senior Member
Location
Northern illinois
Occupation
engineer
Here in rural northern CA, there are very few doctors that will take the ACA insurance. Even some of the big companies here sell ACA as well as non-ACA policies, and the doctors only take the non-ACE flavors. Check w/ your doctor before jumping ship.

There are some very strange rules that come with Obamacare policies.

One of them is that the insurance company is only on the hook for 30 days of bills if someone who signs up does not actually pay their premiums. The providers are actually responsible for services rendered after 30 days, even though it can take 90 days or so for them to get notified that the insurance is not valid.

Another issue for providers is that most of the Obamacare plans come with very high deductibles. The fear ( a very legitimate fear in my opinion) is that people who can barely pay the Obamacare premiums are not going to be able to come up with the average $5000 deductible that most Obamacare plans come with. That means the providers are going to be stuck paying the deductible because you can't get blood out of a turnip. Doctors are exposed to this huge financial risk more than other providers because they see the patient first so that is where the deductible is.

I can't say I blame them a lot for not wanting to take on unknowable risks like these.
 

jimman

Member
Location
North Carolina
NC - ACA policies are thru Blue Cross and Blue Shield. BCBS writes 90+% of insurance policies in NC. I found a great policy (myself only) with $500.00 deductable, office copays, and 80% payments and a prescription plan for about $125.00/month.(subsidized amount of $379.00) I only had the policy for 4 months, and then accepted a position with a local company with insurance benefits. Great policy, but I am now on the hook for the subsidized amount.

In summary, in NC, you can get a good plan for a reasonable amount. Since most or all are BCBS, it is accepted everywhere.

Go to the healthcare.gov and see if you qualify, try this link https://www.healthcare.gov/lower-costs/
It shows the income limits, then check out the plans available. I think the one I got above was a gold plan, and I felt it was actually better than the platnum plan. Bronze plans have HIGH deductables, and you will find yourself as being insured but not able to actually afford to use it.

Also, remember that NC did not expand Medicaid, so if your income is below the minimum limits, you don't get any assistance at all.
 

kwired

Electron manager
Location
NE Nebraska
It seems to vary wildly by state. Some people are experiencing huge premium increases and benefit changes (usually not in one's favor), others seem to be more stable.

One thing that is sure is that a lot of people who got insurance cheap will be paying for it at tax time. The difference between the estimated subsidy price for Obamacare plans and the real price will be made up through the income tax system. There is another form you have to fill out and it will calculate how much extra you owe of you got too much of a subsidy or how much you get back if you got too little. There are some very scary estimates of the total amount of extra subsidies paid out.
It is just like paying your income taxes to some extent, if you end up making more income then you estimated when signing up for your plan you very well may owe some money at the end of the year, but if at some point during the year you realize you will earn more you can change your information and as a result your out of pocket premium amount will go up - either way you pay the same thing - just one way is spread out via monthly payments the other way entire difference is due immediately.

There are some very strange rules that come with Obamacare policies.

One of them is that the insurance company is only on the hook for 30 days of bills if someone who signs up does not actually pay their premiums. The providers are actually responsible for services rendered after 30 days, even though it can take 90 days or so for them to get notified that the insurance is not valid.

Another issue for providers is that most of the Obamacare plans come with very high deductibles. The fear ( a very legitimate fear in my opinion) is that people who can barely pay the Obamacare premiums are not going to be able to come up with the average $5000 deductible that most Obamacare plans come with. That means the providers are going to be stuck paying the deductible because you can't get blood out of a turnip. Doctors are exposed to this huge financial risk more than other providers because they see the patient first so that is where the deductible is.

I can't say I blame them a lot for not wanting to take on unknowable risks like these.

I can't say I know how it may work in some states, but when I signed up I had choices of fairly low deductibles maybe even some plans as low as $500, as well as plans with high deductibles. Lower deductible the higher premium generally is. The trick even without Obamacare is to know what kind of health conditions you may have and expect to pay for services and find a plan that has the right balance for you. If you are young and healthy why not take a high deductible and low premium plan, makes no sense to pay a high premium if you never are going to use much if any of the benefits of the plan, though you will end up paying for all your incurred medical expenses out of pocket if you do become sick or injured as minor injuries or illnesses likely do not get you to your high deductible.

If you are older or maybe have health issues then lower deductible policy is probably what you are more interested in. You will have higher premium though, but you can calculate what premiums plus deductible is and know roughly how much of your budget will be needed for medical expenses - and insurance hopefully covers anything above that amount.
 

iwire

Moderator
Staff member
Location
Massachusetts
I just want to say thank you to everyone for staying away from the politics of this. :)


I understand that it is very difficult and some (most) have strong feelings about this subject.
 

PetrosA

Senior Member
Depending on your income, you also have to consider that aside from deductibles, certain plans qualify for much larger refunding from the government. So in our case, there were about eight plans available, but one of them qualified for nearly 100% in refunding. So instead of $12,000 in maximum copays it was reduced to about $600 per year in copays. It all depends on where the funding is going among those plans that are available to you and this is why I recommend calling the provider since they can best answer those questions.
 
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