Anecdotal Feedback on ACA Exchange Health Insurance
January 23, 2016 3:11 PM Subscribe
Thinking of dropping spouses' employee-sponsored health insurance for an exchange plan due to high monthly premium cost. For people who have switched, were you happy in doing so? Were there issues to be aware of in switching?
Hello! Being between jobs, I am currently on my wife's employer-sponsored insurance. It's good coverage, but in order for the institution to afford/offer coverage to spouses/dependents, they offset the cost by jacking up the premium on the dependent coverage. Because of this, I have been considering switching to an exchange policy, and I was wondering if anyone who had done so would share their experiences (don't violate HIPPA, just give me some indication if this is a good idea and what to watch out for).
Hello! Being between jobs, I am currently on my wife's employer-sponsored insurance. It's good coverage, but in order for the institution to afford/offer coverage to spouses/dependents, they offset the cost by jacking up the premium on the dependent coverage. Because of this, I have been considering switching to an exchange policy, and I was wondering if anyone who had done so would share their experiences (don't violate HIPPA, just give me some indication if this is a good idea and what to watch out for).
Plans available via state exchanges vary as widely as employer-provided plans, and are often offered by the same insurance companies. Be sure to consider all the costs of health care (deductibles, copays, provider availability), not just premium cost. If you're not ordinarily spending anything on health care other than premium payments, do the math using the proverbial hit-by-a-truck scenario. How much will you be out in a year when you've got to pay the full deductible? If you have a serious problem, you might have to come up with the whole sum at once.
If you have doctors you see regularly or want to see again, check to make sure they're covered by whatever plan you choose. If you haven't already got that kind of relationship, you might be a good candidate for one of the insurance plans run by a hospital (if available locally) -- that avoids a lot of hassle with worrying about whether every provider that sees you is actually in-network. (Those vary pretty widely, too. Health insurance is not easy to figure out.)
posted by asperity at 3:32 PM on January 23, 2016 [1 favorite]
If you have doctors you see regularly or want to see again, check to make sure they're covered by whatever plan you choose. If you haven't already got that kind of relationship, you might be a good candidate for one of the insurance plans run by a hospital (if available locally) -- that avoids a lot of hassle with worrying about whether every provider that sees you is actually in-network. (Those vary pretty widely, too. Health insurance is not easy to figure out.)
posted by asperity at 3:32 PM on January 23, 2016 [1 favorite]
Make sure you read and understand the plan terms. I didn't (assuming that for hundreds of dollars per month, even the bronze plans would be better than the catastrophic plans I'd previously paid $60-80/mo for), and got hit with a several thousand dollar ER bill when I went in for chest pain, even though they ultimately gave me an ibuprofen and sent me home after running some tests.
posted by ktkt at 4:04 PM on January 23, 2016 [1 favorite]
posted by ktkt at 4:04 PM on January 23, 2016 [1 favorite]
No one here can tell you which option is going to be the best for you financially. In fact, you yourself have no way of knowing. That is the point of insurance: it is a hedge against potentially large, unpredictable future costs.
IF. And let me stress again. IF. you were able to know that on December 31, 2016, your only interaction with the medical system would be a standard yearly checkup (which is free in all Marketplace plans) -- then it would be easy. You'd go to the Health Insurance Marketplace for your state, check out the premium cost for the cheapest Bronze plan available, and see if that was less than the cost for you to be added on to your spouse's employer-offered plan.
However, there is uncertainty (risk) involved. And in the event that you do need medical attention (whether for something as trivial as a doctor's visit due to a bad cold, or for some terrifying thing like a heart attack or a car accident), your spouse's insurance is almost certainly going to have: lower deductibles (the amount of money you have to pay in yourself before the insurance picks up a portion of the bill); lower costs for medication; and lower copays.
With a lot of the Bronze plans, you have to meet a high deductible (usually thousands of dollars) before the insurance will help out with medical bills. If you want to go a step up to the Silver plans, your premiums are going to go up and your deductibles and copays will go down -- but then you're looking at monthly premium costs that may not be much lower than you would've been paying to stay with your spouse's insurance in the first place.
(If you didn't have coverage offered through your spouse, the government would subsidize these costs -- but since you have another way to get reasonably affordable coverage, you probably can't get any help from Uncle Sam.)
What you can do if you want hard numbers is to go to healthcare.gov/see-plans, put in your zipcode, age & tobacco-use-status and check the "compare plans" box for:
--Cheapest Bronze plan
--Cheapest Silver plan
and compare those to the coverage offered through your spouse's employer.
What are your monthly costs going to be if you have NO medical needs? (=$Premium)
What are your monthly costs when taking into account your medications, if any?
What are your monthly costs going to be if you need to see the doctor 3 times in a year?
What are your monthly costs going to be if you end up in the hospital and get a $10,000 bill?
Again, this all varies based on your current medical situation, and based on unforeseeable events. So part of the formula has to be your tolerance for risk. If you've got a chunk of money that you could afford to part with in the event of major medical bills -- maybe you decide to throw the dice, take a cheaper Bronze plan and pocket the savings if you don't end up needing any medical stuff this year. (In that case, I'd recommend looking into plans that have an Health Savings Account option or similar; or automatically having some chunk of money set aside each month to cover your doctor's visit for when you get a nasty ear infection in October or whatever.)
I'm a professional health insurance counselor; send me a MeMail if you have other questions or don't want to disclose things publicly.
posted by tivalasvegas at 4:23 PM on January 23, 2016 [12 favorites]
IF. And let me stress again. IF. you were able to know that on December 31, 2016, your only interaction with the medical system would be a standard yearly checkup (which is free in all Marketplace plans) -- then it would be easy. You'd go to the Health Insurance Marketplace for your state, check out the premium cost for the cheapest Bronze plan available, and see if that was less than the cost for you to be added on to your spouse's employer-offered plan.
However, there is uncertainty (risk) involved. And in the event that you do need medical attention (whether for something as trivial as a doctor's visit due to a bad cold, or for some terrifying thing like a heart attack or a car accident), your spouse's insurance is almost certainly going to have: lower deductibles (the amount of money you have to pay in yourself before the insurance picks up a portion of the bill); lower costs for medication; and lower copays.
With a lot of the Bronze plans, you have to meet a high deductible (usually thousands of dollars) before the insurance will help out with medical bills. If you want to go a step up to the Silver plans, your premiums are going to go up and your deductibles and copays will go down -- but then you're looking at monthly premium costs that may not be much lower than you would've been paying to stay with your spouse's insurance in the first place.
(If you didn't have coverage offered through your spouse, the government would subsidize these costs -- but since you have another way to get reasonably affordable coverage, you probably can't get any help from Uncle Sam.)
What you can do if you want hard numbers is to go to healthcare.gov/see-plans, put in your zipcode, age & tobacco-use-status and check the "compare plans" box for:
--Cheapest Bronze plan
--Cheapest Silver plan
and compare those to the coverage offered through your spouse's employer.
What are your monthly costs going to be if you have NO medical needs? (=$Premium)
What are your monthly costs when taking into account your medications, if any?
What are your monthly costs going to be if you need to see the doctor 3 times in a year?
What are your monthly costs going to be if you end up in the hospital and get a $10,000 bill?
Again, this all varies based on your current medical situation, and based on unforeseeable events. So part of the formula has to be your tolerance for risk. If you've got a chunk of money that you could afford to part with in the event of major medical bills -- maybe you decide to throw the dice, take a cheaper Bronze plan and pocket the savings if you don't end up needing any medical stuff this year. (In that case, I'd recommend looking into plans that have an Health Savings Account option or similar; or automatically having some chunk of money set aside each month to cover your doctor's visit for when you get a nasty ear infection in October or whatever.)
I'm a professional health insurance counselor; send me a MeMail if you have other questions or don't want to disclose things publicly.
posted by tivalasvegas at 4:23 PM on January 23, 2016 [12 favorites]
Make sure you can. If it's not the open enrollment period, you may not be able to switch unless you have a qualifying life event.
posted by chesty_a_arthur at 5:22 PM on January 23, 2016
posted by chesty_a_arthur at 5:22 PM on January 23, 2016
Your costs are going to fluctuate widely depending on what state you live in (to determine available plans), what your income is (to determine your level of subsidy), and what kind of coverage you're looking for.
Fortunately, healthcare.gov has a tool that can help you estimate healthcare costs using all of these things:
https://www.healthcare.gov/see-plans/
The only real thing you should be mindful of that's not obvious at first is that if you have low household income, sometimes silver plans can cost less than bronze plans while also giving more coverage (this is due to something called cost reduction, which is different from the subsidy).
posted by Ndwright at 5:23 PM on January 23, 2016
Fortunately, healthcare.gov has a tool that can help you estimate healthcare costs using all of these things:
https://www.healthcare.gov/see-plans/
The only real thing you should be mindful of that's not obvious at first is that if you have low household income, sometimes silver plans can cost less than bronze plans while also giving more coverage (this is due to something called cost reduction, which is different from the subsidy).
posted by Ndwright at 5:23 PM on January 23, 2016
Make sure you can. If it's not the open enrollment period, you may not be able to switch unless you have a qualifying life event.
Open enrollment lasts until the end of January. At this point, enrolling will only get you coverage that starts in March, though.
posted by asterix at 6:04 PM on January 23, 2016
Open enrollment lasts until the end of January. At this point, enrolling will only get you coverage that starts in March, though.
posted by asterix at 6:04 PM on January 23, 2016
I'm not sure if it also applies to spouses, but, if an employer offers insurance and the employee opts to forego the employer-based plan and go to the Exchange, they will not qualify for any subsidy.
posted by Thorzdad at 6:17 AM on January 24, 2016
posted by Thorzdad at 6:17 AM on January 24, 2016
Thorzdad is correct -- in most cases you are ineligible for help with premiums and deductible/copays if you are (or were) able to get coverage through some other source, including government programs (Medicare or Medicaid) and employer coverage from your or your spouse's employer.
The idea behind this is that through the Affordable Care Act, the federal government is committed to ensuring that you can get reasonably affordable insurance*, so they will subsidize coverage to people who have no other way to get it. But if you do have another route to coverage, you have to take that or else opt to buy insurance at full price through the Marketplace.
*I would like to see substantially lower thresholds for determining affordability. That's unlikely to happen though with the current gridlock in Washington.
posted by tivalasvegas at 5:51 AM on January 26, 2016
The idea behind this is that through the Affordable Care Act, the federal government is committed to ensuring that you can get reasonably affordable insurance*, so they will subsidize coverage to people who have no other way to get it. But if you do have another route to coverage, you have to take that or else opt to buy insurance at full price through the Marketplace.
*I would like to see substantially lower thresholds for determining affordability. That's unlikely to happen though with the current gridlock in Washington.
posted by tivalasvegas at 5:51 AM on January 26, 2016
Last year we looked into exchange options for my husband but he was ineligible because insurance was available from my employer. We did get quotes for private insurance that were not a ton higher than exchange, and you should definitely look into that option, but don't assume you can get the subsidized rates if you have a choice of other sources.
posted by Lyn Never at 6:11 PM on January 26, 2016
posted by Lyn Never at 6:11 PM on January 26, 2016
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