Do you know how health insurance really works?

[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.

[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]

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]

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 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.

[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.

[Like2Plan]

Even with Medicare (and even though medicare reimbursements may not be enough to cover expenses at Dr. offices), the individual has to have additional insurance because Medicare doesn't cover the entire cost. Additional coverage is needed for prescription drugs (which may have additional co-pays). And, then not everything is covered by Medicare.

I figure those folks who sell medicare supplemental insurance must make a ton of money. They are always second payers and they only pay a percentage of the claim that is capped at predetermined rates. I received a ton of mail and literally thousands of phone calls from folks soliciting medicare supplemental insurance.

[TexasHusker]

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.

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.

[Fishindude77]

No, this is not the system that we already have. The government has forced itself into every orifice of healthcare finance, public and private. Look at the volumes of requirements for "private" ACA plans as an example. So onerous and cumbersome that the vast majority of individual health insurers pulled up the stakes and left town. There are many markets in the U.S. with only one insurer remaining that offers an ACA compliant plan. There is no such thing as "affordable" private health insurance, unless you are poor enough to receive subsidies, or rich enough that any amount doesn't matter. Go to healthcare.gov and get some sample pricing for a family of four. Then add up all of the coinsurances and deductibles before anything gets paid. It is an eye-opener.

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.

[disneysteve]

Retirees should be on Medicare once they reach 62, which is fully government run.

Lowering the enrollment age for Medicare to 60 is one proposal that the President has supported to help expand coverage.

[TexasHusker]

There are plenty of people who are far from poor who are able to manage their taxable income to qualify for the subsidy. Many retirees do just that even though they may have multi-million dollar portfolios.

There may not be blatant rationing going on, but the inequalities in the system amount to just that. Somebody on Medicaid certainly isn't getting the same level of care as someone on private insurance. Access to care is very variable based on where you live, how much money you have, what insurance you have, etc.

You make my point. Health insurance requires government subsidies to become affordable. Playing games with income so that we qualify for handouts is a big chunk of our quagmire.

Retirees should be on Medicare once they reach 62, which is fully government run.

[disneysteve]

There is no such thing as "affordable" private health insurance, unless you are poor enough to receive subsidies

There are plenty of people who are far from poor who are able to manage their taxable income to qualify for the subsidy. Many retirees do just that even though they may have multi-million dollar portfolios.

There may not be blatant rationing going on, but the inequalities in the system amount to just that. Somebody on Medicaid certainly isn't getting the same level of care as someone on private insurance. Access to care is very variable based on where you live, how much money you have, what insurance you have, etc.

[TexasHusker]

This is the system we already have, is it not? The only difference is right now there's a gap between affordable private health insurance and medicaid eligibility. Those in upper incomes just pay the deductible or out of network costs, out of pocket costs to get the care they want, where they want it, from private health systems.

No, this is not the system that we already have. The government has forced itself into every orifice of healthcare finance, public and private. Look at the volumes of requirements for "private" ACA plans as an example. So onerous and cumbersome that the vast majority of individual health insurers pulled up the stakes and left town. There are many markets in the U.S. with only one insurer remaining that offers an ACA compliant plan. There is no such thing as "affordable" private health insurance, unless you are poor enough to receive subsidies, or rich enough that any amount doesn't matter. Go to healthcare.gov and get some sample pricing for a family of four. Then add up all of the coinsurances and deductibles before anything gets paid. It is an eye-opener.

[HundredK]

I agree because people who are rich afford like Mr Money Mustache is NO insurance and concierge medicine. He even discussed how paying for a private dr was more affordable than insurance. I mean great if you can afford it and for most of us here, we'd probably afford it and probably scrimp and save to do it. But for the majority of people they couldn't.

Also the gap between affordable to middle class and the rich is huge.

Agreed - MMM irritates me so much because a lot of what he says is just through the lens of a wealthy white guy. I stopped reading anything from him for just that reason, it just gets tiring, his arrogance. I can definitely see how he ended up divorced, heh, who could live with that?

[LivingAlmostLarge]

Even if you do have some money- I am wondering how that would hold up to some really serious expenses? Like how about an aortic aneurysm or a stroke that requires a life flight for care/rehabilitation?

That's not common. But 6 figures cancer treatment or surgery? He makes like a million a year so I think he's fine. He said he's tired of paying $20k or something a year for health insurance he doesn't use. He said it was worthless. But he never acknowledge that people like him are part of the problem. Health people refusing to buy into insurance means the insurance pool is only poor risk people. Thus why it's so expensive. But that's why pushing everyone to "have" insurance is supposed to increase pools and spread risk around. Why socialized system works.

Texas I agree we'd have to ration care. But we ration care already. We ration based on who is wealthy enough to afford care. Who is rich enough to afford to know how to use insurance. Who can take time from work and go to dr. Who can pay for medications and stuff prescribed by dr. There already is a divide about those we have good insurance and those who don't. Unfortunately it goes hand in hand with jobs. We need to decouple it and make everyone buy it. I think that would make it cheaper from a perspective. NO medicare even or make it medicare for all.

More than the government stepping in, it's EMPLOYMENT. I mean a lot of what you mentioned happened from when employment was not tied to health insurance. Before people paid the dr. But when the "middle" class rose so did this thing where employers provided health insurance. If we all had to shop around and watch costs it would be different. We'd probably all call for reform.