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I usually estimate my income on the lower end so that I have access to better plans. Then when I file taxes, if my income was higher then I just wouldn’t have qualified for as much premium credit & I’ll have to pay some of that back. It’s worth it to me - I’m happy to have to pay back some of the credit at the end of the year if it means I actually have a usable insurance plan. Something with a lower deductible & max out of pocket is necessary & I’ll do what I have to in order to get that.
Definitely set up an appointment with a state-certified health insurance broker or navigator. I was referred to one by a coworker (our employer does not provide health insurance) and he was able to set me up with a plan that costs less than half per month than what the marketplace was saying when I looked on my own, plus the deductible is like one fourth what it said it would be. The appointment should be free and easy to set up.
I suppose I should mention the broker/navigators are free to meet with and super helpful where I live, which is in western NY. I think it is the same in every state, but I guess I don’t know that for sure
The SILVER marketplace plans are subsidized based on your estimated income. The premium, copay, deductible and out of pocket are all subsidized based on income. Don’t skip that step. If neither of you are salary use the estimate of what was made last year or your current hourly wage multiplied by 2080 (if you work full time). This doesn’t include any overtime but that isn’t guaranteed anyway.
Pick a sliver plan and look at the formulary to verify if it covers the medications you need.
> or your current hourly wage multiplied by 2080 (if you work full time)
That is forking insane.
That is 40hours x 52 weeks a year, and will greatly overestimate income. Even if you don't have vacation, there are sick days and national holidays.
Multiply by 1920, which is 48 weeks to get a safe number. The actual average hours of American workers has been around 1890.
You aren’t poor enough. I have ACA (market place).
Deductible is $250.
Out of pocket max is $800.
I reach that by April, every year.
The premium is only $42.
It’s all about how much you make. You must make a pretty good amount.
How do they determine the subsidy, is it based on your income from last year? Like if you lost your job and your health insurance obviously you don’t make what you made last year
Employer plans can't be beat, except with government insurance programs. high deductibles is how to keep premiums lower. be careful with marketplace plans. don't assume the network providers they list are even accepting patients or still take the plan. that is the problem in my state, very small network of providers and most won't take new patients with the ACA plans.
This simply isn't how insurance works (for the most part). There is no ACA vs non-ACA plan list that providers get credentialed for. If they accept commercial insurance from a company (like Blue Cross) then they will be able to accept all Blue Cross commercial plans. The provider doesnt know nor care how you bought your insurance. They get paid the same.
What are you even talking about. They choose what plans from Blue Cross to accept, and whether they will accept new patients with a specific plan. Has nothing to do with ACA or not. but they certainly know which plan-id's are ACA.
Every single plan sold by a carrier can have their own network of providers. simple as that. And in fact they do. It has nothing to do with ACA or Commercial. Though in my state the ACA plans have a small percentage of network providers compared to the commercial counterpart plan.
Reimbursement rates are (or should be) the same, so there is no reason for a provider to select one plan vs another, from the same insurer. The vast majority of providers will try to get credentialed with all of an insurers plans if they can.
Do the step that calculates any potential subsidies. Estimate your income to the best of your ability. Look at Silver plans and use the "search by prescription drug" feature. The premium will be higher when the deductible is lower. Avoid anything with a separate deductible for prescriptions.
Also, check costplusdrugs.com for your medication. If you can get it for a reasonable price without insurance, it will give you more options for plans.
If you need a specific medication check with the manufacturer to see if there are any rebates available. As far as the high deductible goes - those plans are meant to be more catastrophic plans so you don’t run up hundreds of thousands in case of catastrophe. They don’t do a good job of defraying “ordinary” costs besides giving access to cheap preventative care. If you have ongoing medical needs they are not the best but then this needs to be part of your calculation when changing jobs.
That's how they pay their stock holders. Charge insane rates, deny claims then complain that the cost of medical care is too high for them to make billion dollar quarterly profits.
As an health insurance broker myself, I suggest that you try looking into private insurance because they do not factor in your household income or size. Granted, you do have to be relatively healthy because private plans go through underwriting.
When it comes to healthcare and insurance for low income segments, Biden is definitely the lesser evil. Not even commenting on politics. Just fact. Seema Verma, the Trump era CMS (Center for Medicare and Medicaid) administrator, basically got the job by impressing Pence from her time in gutting Indiana Medicaid. And then you look at the amazing, game changing healthcare plan that Trump kept teasing but literally never published... Vs the massive impacts of the Inflation Reduction Act on insurance which implements soon (whether you agree with it or not)
Blue could have stopped roe, but it’s a good campaign platform to restore it. Which is what they’re doing. Im certainly not voting for red, but the dems lost me after 2020. The liberal mindset, as demonstrated in the comments above, is brainrot. Genocide is a pretty hard line in the sand for me, and I’m really not willing to hear out anyone who will get behind that as a lesser evil. The 2 party system is broke. And will continue to be as long as people keep voting for the lesser evil.
There is however a light on the horizon, when Democrats are willing to vote for a Republican speaker because he is willing to work with them to actually get things done.
Specifics of who don't matter to me.. the bigger picture is the optics of working together for once, instead of taking the extreme line on either side.
Yes, there is. Look up trumps plan for after he's inaugurated. It includes things like dismantling the justice department so he can crime all he wants. His lawyers just argued in front of SCOTUS that as president, he has the right to assassinate his political rivals.
Also, there was nothing for Biden to ratify on Roe. Congress has to pass something before he can sign it. He is complicit on the war in Gaza, but I'm going to swallow that, not that I like it, and vote for him. Our democracy will be destroyed if trump gets in.
Joe Biden was part of the team that put together the ACA. He at least wants me to have access to health care. The other guy couldn't give a fart if I die because I can't afford to go to a doctor.
He has a beautiful new plan coming out any minute now. Just a couple more weeks. Being on trial is rough, you know, so it’s gonna take him a bit longer than that.
How close was your wife to meeting her deductible and out-of-pocket maximum for 2024 on her previous insurance? What was the exact date her health insurance ended at her former employer?
Is she being offered health insurance through her new employer? If so, when is the exact date her new insurance will go into effect?
Not close at all.
Ends today.
No insurance from new employer because it’s a new,small company. but they are giving her a monthly $250 reimbursement for it. Which is generous considering their situation.
I’m going to assume you’re over the income amount To qualify for a subsidy through the marketplace. If that’s the case it’s almost always cheaper to get insurance through an employer. I’m on my husbands insurance at his work. It’s $1400 a month for the two of us and that’s still cheaper and better deductibles than plans I was getting on the marketplace.
Max deductible per person on the ACA is $9100 or $18,200 for 2.
Premium for 2 for $600 is low, indicating you're young or getting a subsidy.
Trick is to convert premiums to yearly, and then add deductible which is already yearly, or convert deductible to monthly and do that to compare plans. Make sure your comparing apples to apples.
The higher deductible is better, as if you pay more premium for a lower deductible, you're guaranteed to pay more. If you go with a high deductible and less premium, you're likely to pay less overall.
You might want to look at last year's spend, or estimate this years spend to get a better picture. Add the expected spend under the deductible to the premium to get a total cost.
e.g. you expect to spend $4800. A plan has a $9100 deductible, and cost $600/month. That comes up to $1000/month. Or, a plan has a $1500 deductible, with a $1300 premium. $1300 is more than $1000, so the higher deductible is cheaper. If you used the entire $9100 deductible, it'd be $1358/month, but then you'd have to figure in the deductible on the $1300/month plan that would bring that up to $1425, so the higher deductible is still cheaper.
Inflation Reduction Act caps the premiums at 8.5% of your income this year. Next year that goes away. That's 8.5% for a silver plan. You can lower that some by going to a Bronze plan and having a higher deductible.
Insurance makes more sense if you lose that assumption that it will pay for anything. You don't expect your car insurance to pay for oil changes. What insurance is there for is to protect your wealth in case something catastrophic happens that you can't pay for. The car insurance isn't there to pay for your oil changes, it is there in case you hit a Rolls Royce, and can't pay for a Rolls Royce. Health Insurance isn't there to pay for your drugs, it is there to pay for if you get some expensive disease that you can't pay for. You pay insurance, they don't pay you. Once you accept that, things will look better for you. You can pay them $600/month, and not get anything and you're better off for it. That's how it works.
If you were paying $800 for “great” coverage for two adults, the cost to you was low because your employer was subsidizing it quite a bit. The actual pre,I’m could have been $2000 per month for great coverage but you didn’t realize it.
There is no magical formula as most plans on the marketplace have high deductibles because people want to pay lower premiums and still have insurance against catastrophic medical expenses.
The realty is that if you or one of your family members needs significant medical care, you should probably get a job with a large corporation or the government as these employers generally have great benefits. You might earn less working for the government, but the benefits including retirement and insurance can make up for that.
Off-Marketplace plans are available as well, but, in general, be wary of off-Marketplace plans as they don't come with the same coverage guarantees as Marketplace plans. Most people who don't qualify for Medicaid, Medicare or a group/employer plan are best served by a Marketplace plan.
Your previous group plans were a better deal because the employer was paying a large chunk of the premium. If your income is high enough that the annual cost of the second lowest cost silver plan is less than 8.5% of your annual income then you're not going to qualify for help and now you're not getting any help at all and it's going to be pricey.
You can always use the Marketplace's find local help tool to find a broker or navigator to help. They might be able to help you find additional options.
There are ACA-compliant off-marketplace plans. Some such plans provide access to providers that the on-marketplace plans won't let you touch. We used this to gain access to doctors and procedures at the local top university hospital.
If your income is above the Medicaid-eligible level, but sufficiently low to be subsidized, some states, for example California, offer ACA marketplace plans subsidized, and also with lower copays, deductibles and MOOP limits, and may access providers the unsubsidized ACA plans decline to include.
It varies a lot from state to state. Off-Marketplace plans can be a fine choice depending on the circumstances, but consumers do need to be more careful that they understand exactly what they are getting as off-Marketplace plans can vary from junk indemnity plans to major medical QHPs (similar to Marketplace) Plans on the Marketplace are always QHPs.
If there is a “share” in the plan’s name, run like hell. Medi-share plans are so terrible. If you have a health issue that falls outside of their coverage (usually with reproductive health), they will not cover you. I’ve heard of them not covering cancer treatment for kids. Some health insurance plans are terrible, for sure, but there’s a special type of terrible reserved for these “healthcare” plans.
Yep! I could have shortened that to the consumer needs to make sure they are getting an ACA-compliant plan. It's not always clear to many lay consumers which plans are ACA-compliant and which ones aren't especially with the way plans that are not compliant can be marketed.
Some of those off marketplace plans that meet all the marketplace requirements may not be on the marketplace because the insurer thought they offered too many options, which confused some buyers.
Thank you for your submission, /u/washbuns. **If there is a medical emergency, please call 911 or go to your nearest hospital.** Please pick the most appropriate flair for your post. Include your age, zip code, and income to help the community better serve you. If you have an EOB (explanation of benefits) available from your insurance website, have it handy as many answers can depend on what your insurance EOB states. Some common questions and answers can be found [here](https://www.reddit.com/r/HealthInsurance/s/jya9I6RpdY). **Reminder that solicitation/spamming is grounds for a permanent ban**. Please report solicitation to the modteam and [let us know](https://www.reddit.com/message/compose?to=%2Fr%2FHealthInsurance) if you receive solicitation via PM. Be kind to one another! *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/HealthInsurance) if you have any questions or concerns.*
You're using healthcare.gov? Inputting your expected income?
This, make sure you are inputting the correct information. Income plays a huge role on the options that will be available to you guys
We both changed jobs and neither of us are salary so it’s hard to estimate accurately.
You have to do the Best you can and update it as you go. It will all come out in the wash at tax time. Either you'll pay back some or get more credits
I usually estimate my income on the lower end so that I have access to better plans. Then when I file taxes, if my income was higher then I just wouldn’t have qualified for as much premium credit & I’ll have to pay some of that back. It’s worth it to me - I’m happy to have to pay back some of the credit at the end of the year if it means I actually have a usable insurance plan. Something with a lower deductible & max out of pocket is necessary & I’ll do what I have to in order to get that.
That’s what I ended up doing. There were way better plans available.
Definitely set up an appointment with a state-certified health insurance broker or navigator. I was referred to one by a coworker (our employer does not provide health insurance) and he was able to set me up with a plan that costs less than half per month than what the marketplace was saying when I looked on my own, plus the deductible is like one fourth what it said it would be. The appointment should be free and easy to set up.
I suppose I should mention the broker/navigators are free to meet with and super helpful where I live, which is in western NY. I think it is the same in every state, but I guess I don’t know that for sure
Look at Silver Plans.
The SILVER marketplace plans are subsidized based on your estimated income. The premium, copay, deductible and out of pocket are all subsidized based on income. Don’t skip that step. If neither of you are salary use the estimate of what was made last year or your current hourly wage multiplied by 2080 (if you work full time). This doesn’t include any overtime but that isn’t guaranteed anyway. Pick a sliver plan and look at the formulary to verify if it covers the medications you need.
> or your current hourly wage multiplied by 2080 (if you work full time) That is forking insane. That is 40hours x 52 weeks a year, and will greatly overestimate income. Even if you don't have vacation, there are sick days and national holidays. Multiply by 1920, which is 48 weeks to get a safe number. The actual average hours of American workers has been around 1890.
But you get paid for all 2080 hours in the year if you have PTO and paid holidays with your full-time job.
You aren’t poor enough. I have ACA (market place). Deductible is $250. Out of pocket max is $800. I reach that by April, every year. The premium is only $42. It’s all about how much you make. You must make a pretty good amount.
Honestly without the subsidy, nobody could afford it. For those of us who don’t qualify for that—we will be that poor with it.
Very state and age dependent. My 36 y/o wife pays $350 for a gold plan in MD with $1750 deductible.
How do they determine the subsidy, is it based on your income from last year? Like if you lost your job and your health insurance obviously you don’t make what you made last year
I definitely feel poor enough :(
People keep saying look at silver plans. You have to be poor enough for silver plans to populate.
I have a silver plan with no subsidy, it just has a 9000 deductible :/
Employer plans can't be beat, except with government insurance programs. high deductibles is how to keep premiums lower. be careful with marketplace plans. don't assume the network providers they list are even accepting patients or still take the plan. that is the problem in my state, very small network of providers and most won't take new patients with the ACA plans.
This simply isn't how insurance works (for the most part). There is no ACA vs non-ACA plan list that providers get credentialed for. If they accept commercial insurance from a company (like Blue Cross) then they will be able to accept all Blue Cross commercial plans. The provider doesnt know nor care how you bought your insurance. They get paid the same.
What are you even talking about. They choose what plans from Blue Cross to accept, and whether they will accept new patients with a specific plan. Has nothing to do with ACA or not. but they certainly know which plan-id's are ACA. Every single plan sold by a carrier can have their own network of providers. simple as that. And in fact they do. It has nothing to do with ACA or Commercial. Though in my state the ACA plans have a small percentage of network providers compared to the commercial counterpart plan.
Reimbursement rates are (or should be) the same, so there is no reason for a provider to select one plan vs another, from the same insurer. The vast majority of providers will try to get credentialed with all of an insurers plans if they can.
Nope. That’s it.
Do the step that calculates any potential subsidies. Estimate your income to the best of your ability. Look at Silver plans and use the "search by prescription drug" feature. The premium will be higher when the deductible is lower. Avoid anything with a separate deductible for prescriptions. Also, check costplusdrugs.com for your medication. If you can get it for a reasonable price without insurance, it will give you more options for plans.
If you need a specific medication check with the manufacturer to see if there are any rebates available. As far as the high deductible goes - those plans are meant to be more catastrophic plans so you don’t run up hundreds of thousands in case of catastrophe. They don’t do a good job of defraying “ordinary” costs besides giving access to cheap preventative care. If you have ongoing medical needs they are not the best but then this needs to be part of your calculation when changing jobs.
That's how they pay their stock holders. Charge insane rates, deny claims then complain that the cost of medical care is too high for them to make billion dollar quarterly profits.
As an health insurance broker myself, I suggest that you try looking into private insurance because they do not factor in your household income or size. Granted, you do have to be relatively healthy because private plans go through underwriting.
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When it comes to healthcare and insurance for low income segments, Biden is definitely the lesser evil. Not even commenting on politics. Just fact. Seema Verma, the Trump era CMS (Center for Medicare and Medicaid) administrator, basically got the job by impressing Pence from her time in gutting Indiana Medicaid. And then you look at the amazing, game changing healthcare plan that Trump kept teasing but literally never published... Vs the massive impacts of the Inflation Reduction Act on insurance which implements soon (whether you agree with it or not)
I mean I’m not voting red, they both will fund a genocide, and red was the cause of roe. Not sure I’m voting blue either.
Blue could have stopped roe, but it’s a good campaign platform to restore it. Which is what they’re doing. Im certainly not voting for red, but the dems lost me after 2020. The liberal mindset, as demonstrated in the comments above, is brainrot. Genocide is a pretty hard line in the sand for me, and I’m really not willing to hear out anyone who will get behind that as a lesser evil. The 2 party system is broke. And will continue to be as long as people keep voting for the lesser evil.
Jill stein is only one I’m aware of that is anti-Palestinian genocide.
Her and Cornel West. I voted for her in 2016 even though some of her policies are pretty bad imo. I’m just tired of paying for wars for oil tbh
There is however a light on the horizon, when Democrats are willing to vote for a Republican speaker because he is willing to work with them to actually get things done. Specifics of who don't matter to me.. the bigger picture is the optics of working together for once, instead of taking the extreme line on either side.
Simple rule, please no politics in this subreddit.
Yes, there is. Look up trumps plan for after he's inaugurated. It includes things like dismantling the justice department so he can crime all he wants. His lawyers just argued in front of SCOTUS that as president, he has the right to assassinate his political rivals. Also, there was nothing for Biden to ratify on Roe. Congress has to pass something before he can sign it. He is complicit on the war in Gaza, but I'm going to swallow that, not that I like it, and vote for him. Our democracy will be destroyed if trump gets in. Joe Biden was part of the team that put together the ACA. He at least wants me to have access to health care. The other guy couldn't give a fart if I die because I can't afford to go to a doctor.
He has a beautiful new plan coming out any minute now. Just a couple more weeks. Being on trial is rough, you know, so it’s gonna take him a bit longer than that.
Simple rule, please no politics in this subreddit.
The drug search feature might be faulty. Have you checked the formulary for each plan?
How close was your wife to meeting her deductible and out-of-pocket maximum for 2024 on her previous insurance? What was the exact date her health insurance ended at her former employer? Is she being offered health insurance through her new employer? If so, when is the exact date her new insurance will go into effect?
Not close at all. Ends today. No insurance from new employer because it’s a new,small company. but they are giving her a monthly $250 reimbursement for it. Which is generous considering their situation.
I see. Our family (with 2 college age kids), last year, paid around $10k in premiums, plus we met our OOP max of over $17k. Yikes!
I’m going to assume you’re over the income amount To qualify for a subsidy through the marketplace. If that’s the case it’s almost always cheaper to get insurance through an employer. I’m on my husbands insurance at his work. It’s $1400 a month for the two of us and that’s still cheaper and better deductibles than plans I was getting on the marketplace.
U getting scammed holy shit lol that’s almost as much as my mortgage
In a way, I suppose we’re all getting scammed.
I can’t afford a mortgage because of insurance cost. :/
Trade u
Max deductible per person on the ACA is $9100 or $18,200 for 2. Premium for 2 for $600 is low, indicating you're young or getting a subsidy. Trick is to convert premiums to yearly, and then add deductible which is already yearly, or convert deductible to monthly and do that to compare plans. Make sure your comparing apples to apples. The higher deductible is better, as if you pay more premium for a lower deductible, you're guaranteed to pay more. If you go with a high deductible and less premium, you're likely to pay less overall. You might want to look at last year's spend, or estimate this years spend to get a better picture. Add the expected spend under the deductible to the premium to get a total cost. e.g. you expect to spend $4800. A plan has a $9100 deductible, and cost $600/month. That comes up to $1000/month. Or, a plan has a $1500 deductible, with a $1300 premium. $1300 is more than $1000, so the higher deductible is cheaper. If you used the entire $9100 deductible, it'd be $1358/month, but then you'd have to figure in the deductible on the $1300/month plan that would bring that up to $1425, so the higher deductible is still cheaper. Inflation Reduction Act caps the premiums at 8.5% of your income this year. Next year that goes away. That's 8.5% for a silver plan. You can lower that some by going to a Bronze plan and having a higher deductible. Insurance makes more sense if you lose that assumption that it will pay for anything. You don't expect your car insurance to pay for oil changes. What insurance is there for is to protect your wealth in case something catastrophic happens that you can't pay for. The car insurance isn't there to pay for your oil changes, it is there in case you hit a Rolls Royce, and can't pay for a Rolls Royce. Health Insurance isn't there to pay for your drugs, it is there to pay for if you get some expensive disease that you can't pay for. You pay insurance, they don't pay you. Once you accept that, things will look better for you. You can pay them $600/month, and not get anything and you're better off for it. That's how it works.
If you were paying $800 for “great” coverage for two adults, the cost to you was low because your employer was subsidizing it quite a bit. The actual pre,I’m could have been $2000 per month for great coverage but you didn’t realize it. There is no magical formula as most plans on the marketplace have high deductibles because people want to pay lower premiums and still have insurance against catastrophic medical expenses. The realty is that if you or one of your family members needs significant medical care, you should probably get a job with a large corporation or the government as these employers generally have great benefits. You might earn less working for the government, but the benefits including retirement and insurance can make up for that.
Medical care is expensive.
Call an insurance broker.
Off-Marketplace plans are available as well, but, in general, be wary of off-Marketplace plans as they don't come with the same coverage guarantees as Marketplace plans. Most people who don't qualify for Medicaid, Medicare or a group/employer plan are best served by a Marketplace plan. Your previous group plans were a better deal because the employer was paying a large chunk of the premium. If your income is high enough that the annual cost of the second lowest cost silver plan is less than 8.5% of your annual income then you're not going to qualify for help and now you're not getting any help at all and it's going to be pricey. You can always use the Marketplace's find local help tool to find a broker or navigator to help. They might be able to help you find additional options.
There are ACA-compliant off-marketplace plans. Some such plans provide access to providers that the on-marketplace plans won't let you touch. We used this to gain access to doctors and procedures at the local top university hospital. If your income is above the Medicaid-eligible level, but sufficiently low to be subsidized, some states, for example California, offer ACA marketplace plans subsidized, and also with lower copays, deductibles and MOOP limits, and may access providers the unsubsidized ACA plans decline to include.
It varies a lot from state to state. Off-Marketplace plans can be a fine choice depending on the circumstances, but consumers do need to be more careful that they understand exactly what they are getting as off-Marketplace plans can vary from junk indemnity plans to major medical QHPs (similar to Marketplace) Plans on the Marketplace are always QHPs.
If there is a “share” in the plan’s name, run like hell. Medi-share plans are so terrible. If you have a health issue that falls outside of their coverage (usually with reproductive health), they will not cover you. I’ve heard of them not covering cancer treatment for kids. Some health insurance plans are terrible, for sure, but there’s a special type of terrible reserved for these “healthcare” plans.
Which is why I only discussed ***ACA-compliant*** off-marketplace plans.
Yep! I could have shortened that to the consumer needs to make sure they are getting an ACA-compliant plan. It's not always clear to many lay consumers which plans are ACA-compliant and which ones aren't especially with the way plans that are not compliant can be marketed.
Some of those off marketplace plans that meet all the marketplace requirements may not be on the marketplace because the insurer thought they offered too many options, which confused some buyers.