Do you know how health insurance really works?

[LivingAlmostLarge]

What would be interesting to see is what is the employer contribution to your medical is.

Employer contribution is 800.29/pay period for medical for family of 4. So (800*26)/12 = $1733/month in medical premiums.

[disneysteve]

What are you coinsurance percentages? Is that deductible and max out of pocket per person, or household?

I'm not sure. That's the only info I saw on the HealthSherpa quotes. I have to dig in deeper to get more details.

ETA: Deductible and OOP Max is per person
Labwork is free
Imaging is 50% after deductible
Hospital is 20% after deductible

[disneysteve]

Hopefully, no unexpected capital gains. Or, you decide to sell your house and you have big gains.....you'd have to time your big financial moves correctly.

When you get into Medicare territory, you another set of hoops to avoid triggering IRMAA.

For sure. There are many sites devoted to just these topics. The early retirement forums are filled with these discussions.

[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.

What are you coinsurance percentages? Is that deductible and max out of pocket per person, or household?

[Like2Plan]

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.

Hopefully, no unexpected capital gains. Or, you decide to sell your house and you have big gains.....you'd have to time your big financial moves correctly.

When you get into Medicare territory, you another set of hoops to avoid triggering IRMAA.

[Like2Plan]

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.

What would be interesting to see is what is the employer contribution to your medical is.

[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.

[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.

[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.

[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

[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!

[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?

[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.

[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]

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.