Do you know how health insurance really works?

[LivingAlmostLarge]

Amen !
There are only two ACA providers in our state. Since we make over $67,000 annually and aren't eligible for discounts, my spouse and I (58 & 61) pay $1450 per month for our ACA insurance coverage. Prior to ACA when you could buy health insurance on a more competitive open market, we could have purchased the same coverage for about half that amount. The ACA sure aint "affordable".

I have heard of people with sizeable net worth cheating the system by manipulating their "visible" income to a level below the threshold so they get discounts, etc. and much cheaper ACA coverage.

This is why Mr MM (Which I agree only sees life through the lens of a privileged white guy) is not buying insurance. But when you opt out by not buying you are unfortunately shrinking the pool so people like Fishingdude, why aren't you going without? He would argue you have assets to cover yourself and pay OOP for everything. Why not buy concierge medicine dr visits? It's much more affordable because what you are spending you can just pay completely out of pocket?

That being said I don't think most of us are as savvy as Texashusker to know even how the game works. To understand that coding and billing stuff. To see how dr and hospitals are billing and charging anyone. I still texas don't think it's the government. I think a bigger player is the coupling of insurance to employment. That decouples people's awareness because the bulk of people are covered by employers and BUY employer plans even when bad. And most employer plans are subsidized like the government.

Imagine what would happen if we decoupled insurance with working and made everyone either choose to BUY or NOT buy insurance. That would make the market completely free including dismantling medicare and instead saying we can rescontruct a public option if people want it. Thus everyone would be forced to gamble if they want insurance and want to pay for it and participate in the pool or end up like MMM choosing he's 40 and healthy and rich so why not skip insurance? He figures he'll come out ahead.

But then we might see only people who are sick or pre-exisiting conditions buying insurance. And everyone else whose young and healthy opting out of buying insurance. And see how the insurance pool holds up then without any outside intervention. I would have to guess that Fishingdude would be paying even more if people were allowed to opt out.

[disneysteve]

I have heard of people with sizeable net worth cheating the system by manipulating their "visible" income to a level below the threshold so they get discounts, etc. and much cheaper ACA coverage.

What are they cheating exactly? The law says if your AGI is $68,960 or less, you qualify for the subsidy. If you are able to keep your AGI below that level, you are eligible. As long as you aren't doing anything illegal in the process, good for you.

It isn't about net worth. It's about taxable income. Those are two very, very different things.

When I retire, I think we should be able to do this without any difficulty. I can't do it while I have W2 income but once that stops it shouldn't be an issue.

[Fishindude77]

I would be curious to know more about your $1450 per month plan. Deductibles, coinsurance, max. out of pocket. You are paying $17,400 a year for "affordable" coverage - it will be interesting to know what you actually get for that.

Pretty lousy, basic health insurance coverage ...... I believe max out of pocket is $7k, no dental or vision coverage.
Will keep you from going broke if something major pops up.

[disneysteve]

I would be curious to know more about your $1450 per month plan. Deductibles, coinsurance, max. out of pocket. You are paying $17,400 a year for "affordable" coverage - it will be interesting to know what you actually get for that.

I recently priced out ACA plans.

Silver: Starts at $1,565/month with $2,500 deductible and $8,550 max out of pocket.
Gold: Starts at $3,120/month with $950 deductible and $4,500 max out of pocket.

With the subsidy, those rates drop to $500 for Silver and $2,055 for Gold.

[Fishindude77]

What are they cheating exactly? The law says if your AGI is $68,960 or less, you qualify for the subsidy. If you are able to keep your AGI below that level, you are eligible. As long as you aren't doing anything illegal in the process, good for you.

It isn't about net worth. It's about taxable income. Those are two very, very different things.

When I retire, I think we should be able to do this without any difficulty. I can't do it while I have W2 income but once that stops it shouldn't be an issue.

I realize it's not about net worth. Point is you have people out there that operate on several hundred grand per year or more manipulating their finances to show sub $68,960 AGI.
They could well afford the full premium expense, but play games to work the system. I'm not sure it's worth the effort?

Might be a different story if your AGI was just slightly above the threshold where the savings would significantly help your financial situation.

Just like everything else the government gets involved in. Uncle Sam try's to get in our pocket and we figure ways around it.

[disneysteve]

Might be a different story if your AGI was just slightly above the threshold where the savings would significantly help your financial situation.

Yeah, that will be us in a couple of years. We'll be close enough that staying under the cap shouldn't be difficult while still maintaining our desired spending level and it will save us around $12,000/year on health insurance costs.

[kork13]

This doesn't add to the conversation at all, but it was a hilarious insurance thing & I had to share... DW & I got some great news today -- lab work came back, and DW is pregnant!! Due date: next week.

So apparently DW's medical records don't reflect the fact that she's pregnant, because she got her pregnancy test done at another base (while I was in training), where they didn't have her records. So the test never made it into her medical records. Now last week her PCM's nurse called & asked DW to come in to do the official blood work to confirm the pregnancy, in order for Tricare to cover all of the prenatal care she's been receiving since ~July. Gratefully they caught it BEFORE the baby shows up in the next week or two, so that we aren't on the hook for all of the prenatal/delivery costs... But YIKES!!! That is some kind of oversight! Shocking that it was only now that the insurance realized the confirmation test was never in her record.

[disneysteve]

So apparently DW's medical records don't reflect the fact that she's pregnant, because she got her pregnancy test done at another base (while I was in training), where they didn't have her records. So the test never made it into her medical records.

Does the military not have electronic medical records? That would be pretty ironic since the whole reason the rest of us all do is because the government forces us to.

[kork13]

Does the military not have electronic medical records? That would be pretty ironic since the whole reason the rest of us all do is because the government forces us to.

They do, but a medical facility only has access to an individual's digital records after on-boarding them into the local database (or that's my understanding). We were only there for 2 months, and I guess they did DW's test as what I'll call a "non-patient." Maybe they didn't want to bring her records in, go through assigning a PCM, etc. only to have us leave weeks later.

[TexasHusker]

I recently priced out ACA plans.

Silver: Starts at $1,565/month with $2,500 deductible and $8,550 max out of pocket.
Gold: Starts at $3,120/month with $950 deductible and $4,500 max out of pocket.

With the subsidy, those rates drop to $500 for Silver and $2,055 for Gold.

Is this per member? A couple? A family? Age? What are the coinsurance percentages and copays for PCPs and specialists?

[Like2Plan]

This doesn't add to the conversation at all, but it was a hilarious insurance thing & I had to share... DW & I got some great news today -- lab work came back, and DW is pregnant!! Due date: next week.

Holy Toledo!

[disneysteve]

Is this per member? A couple? A family? Age? What are the coinsurance percentages and copays for PCPs and specialists?

That's for my wife and I, ages 56 and 57.

Silver: $2,500 deductible, $25 doctor visits, $10 generic meds
Gold: $950 deductible, $10 doctor visits, $20 generic meds

[LivingAlmostLarge]

I recently priced out ACA plans.

Silver: Starts at $1,565/month with $2,500 deductible and $8,550 max out of pocket.
Gold: Starts at $3,120/month with $950 deductible and $4,500 max out of pocket.

With the subsidy, those rates drop to $500 for Silver and $2,055 for Gold.

That is a serious discount with the subsidy. I can see why people "live" on $68k. I mean without it you are looking at $18k/year and $36k/year. Kinda hard to be "mustachian and live on $18k if that's the cost of your medical premium. Actually it's probably hard to live on $65k and pay nearly half or $36k for medical.

I got DH's first paystub this week and I saw what it looks like. We are paying $128/per pay period for our family medical. About the same as before for similar coverage.

[Fishindude77]

That is a serious discount with the subsidy. I can see why people "live" on $68k. I mean without it you are looking at $18k/year and $36k/year. Kinda hard to be "mustachian and live on $18k if that's the cost of your medical premium. Actually it's probably hard to live on $65k and pay nearly half or $36k for medical.

Pretty nuts, isn't it?
A person making $69,000 pays almost $37,000 for a gold plan
A person making $67,000 gets same plan for $24,000

Incentive to not earn.

[disneysteve]

Pretty nuts, isn't it?
A person making $69,000 pays almost $37,000 for a gold plan
A person making $67,000 gets same plan for $24,000

Incentive to not earn.

Exactly. And it's really not that hard to adjust your income to get under the cap in most cases, especially if you're close.