Health insurance deductibles - ouch

[disneysteve]

We haven't had to deal with a deductible on our health insurance for many years. Those days are over now. We're now on an exchange plan with a $4,700 deductible. I got two bills this week for recent medical services and it all went to our deductible for a total of $1,700 that we need to pay. Of course, our monthly premium is $1,000 less than we were paying before on COBRA so it's fine, but just a big change from what we've been used to all these years. $3,000 more and the deductible will be satisfied. Hopefully we don't get there but at least I know there's an end point if we do.

[Fishindude77]

Aint nuthin affordable about the Affordable Care Act if you make a decent income.

[disneysteve]

Aint nuthin affordable about the Affordable Care Act if you make a decent income.

I'm not complaining at all. I'm very happy to have the ACA coverage. Without that, there's no way I could have retired now. It's given us a good affordable option. We were spoiled with me working for a major healthcare provider and having the coverage we had. I realize that most people don't have it that good with their employer plans. I'm active in an early retirement forum and the vast majority of those people would tell you the same thing - they couldn't possibly have retired early without the ACA.

[ua_guy]

Insurance plans have been leaning towards higher patient responsibility and coinsurance for years, basically hollowing out everything but moderate and catastrophic coverage. Thankfully the ACA put the lid on some of that. Free enterprise will free enterprise and leave you high and dry.

[FrostedMoose]

Insurance plans have been leaning towards higher patient responsibility and coinsurance for years, basically hollowing out everything but moderate and catastrophic coverage. Thankfully the ACA put the lid on some of that. Free enterprise will free enterprise and leave you high and dry.

That's a bunch of crap.

ACA only made things a lot worse. Before ACA, there were 11 insurers in my market for individual plans. I know because I shopped them every year. John Alden, Fortis, Humana, Blue Cross, Aetna, Cigna, United, and a couple of local insurers. Our family rate was around $900 a month with a $1500 deductible. When ACA got passed, all of those insurers left the market except for Blue Cross and one local insurer. Their policies were deemed illegal. So we had to buy Blue Cross. It's now almost $3000 a month, and I believe our deductible is around $10,000 before insurance pays a dime. My "cost share" is almost $20,000!

Another thing - Blue Cross is now the only ACA insurer in our market. When my grand daughter got pregnant, there was no OB/GYN here taking ACA. The only in-network OB/GYN was 60 miles away in a town of around 12,000. Foreign medical graduate. She would have had to given birth at that tiny hospital with very marginal care. She had a miscarriage so we didn't have to endure all of that.

ACA stuck responsible self-employed people with expensive, crap insurance. No one without some weird agenda likes ACA.

[LivingAlmostLarge]

That's a bunch of crap.

ACA only made things a lot worse. Before ACA, there were 11 insurers in my market for individual plans. I know because I shopped them every year. John Alden, Fortis, Humana, Blue Cross, Aetna, Cigna, United, and a couple of local insurers. Our family rate was around $900 a month with a $1500 deductible. When ACA got passed, all of those insurers left the market except for Blue Cross and one local insurer. Their policies were deemed illegal. So we had to buy Blue Cross. It's now almost $3000 a month, and I believe our deductible is around $10,000 before insurance pays a dime. My "cost share" is almost $20,000!

Another thing - Blue Cross is now the only ACA insurer in our market. When my grand daughter got pregnant, there was no OB/GYN here taking ACA. The only in-network OB/GYN was 60 miles away in a town of around 12,000. Foreign medical graduate. She would have had to given birth at that tiny hospital with very marginal care. She had a miscarriage so we didn't have to endure all of that.

ACA stuck responsible self-employed people with expensive, crap insurance. No one without some weird agenda likes ACA.

Actually ACA gave people who were uninsurable a chance to BUY insurance. How do I know? My husband is one that couldn't get insurance before and can now. Now with the situation we are in with DK2 I am betting she'd be uninsurable as well. I know he's uninsurable because we were turned down recently for whole life insurance plus LT care rider. So he's pretty much uninsurable. Bets are my youngest will deal with the same. I should add they are priceless but insurance companies say they aren't worth the risk.

[ua_guy]

That's a bunch of crap.

ACA only made things a lot worse. Before ACA, there were 11 insurers in my market for individual plans. I know because I shopped them every year. John Alden, Fortis, Humana, Blue Cross, Aetna, Cigna, United, and a couple of local insurers. Our family rate was around $900 a month with a $1500 deductible. When ACA got passed, all of those insurers left the market except for Blue Cross and one local insurer. Their policies were deemed illegal. So we had to buy Blue Cross. It's now almost $3000 a month, and I believe our deductible is around $10,000 before insurance pays a dime. My "cost share" is almost $20,000!

Another thing - Blue Cross is now the only ACA insurer in our market. When my grand daughter got pregnant, there was no OB/GYN here taking ACA. The only in-network OB/GYN was 60 miles away in a town of around 12,000. Foreign medical graduate. She would have had to given birth at that tiny hospital with very marginal care. She had a miscarriage so we didn't have to endure all of that.

ACA stuck responsible self-employed people with expensive, crap insurance. No one without some weird agenda likes ACA.

What's interesting is you can't seem to explain why those plans were "illegal" (actually, they just didn't meet the coverage requirements of the new ACA laws). You can only talk about cost, but, when discussing INSURANCE we all know it depends on coverages, what, and how much is covered. The rest amounts to whining.

You also can't seem to discuss the impact it had on healthcare providers. People look at me sideways when I mention this. You mean, people actually have to pay for their care? Amazing. ACA helps providers get paid for the care they provide. MORE people are insured and their coverages under ACA have to meet a bare minimum of adequacy. This part you won't argue with me because I actually work on the business side of healthcare and ACA helps us get paid for the care our doctors provide.

[disneysteve]

ACA only made things a lot worse.

Tell that to the millions of people who were finally able to get insurance, sometimes for the first time in their lives.

Tell that to all of the people (like me) who were able to retire early (pre-Medicare age) because there was finally an affordable healthcare option.

Tell that to all of the people who were finally able to get out of awful jobs that they were keeping only for the insurance. They were able to get better jobs or start their own businesses without the fear of losing health insurance for themselves and their families.

The ACA has made things immeasurably better for tens of million of people.

[FrostedMoose]

Tell that to the millions of people who were finally able to get insurance, sometimes for the first time in their lives.

Tell that to all of the people (like me) who were able to retire early (pre-Medicare age) because there was finally an affordable healthcare option.

Tell that to all of the people who were finally able to get out of awful jobs that they were keeping only for the insurance. They were able to get better jobs or start their own businesses without the fear of losing health insurance for themselves and their families.

The ACA has made things immeasurably better for tens of million of people.

Your first point I agree with.

Your second point, if it is affordable to you, it's because other people like me are paying for yours, along with mine. I'm spending $27,000 a year for no insurance until I spend yet another $19,400. How would anyone call that affordable?

Your third point, perhaps ACA did provide at least some measure of reassurance, although again, you'd have to spend tens of $ thousands before anything is paid by the insurer.

The ACA may have made things better for a few million, but it's certainly not in the tens of millions. There are only 15 million self-employed people in the U.S. to begin with. Many were affected very negatively, like me.

[FrostedMoose]

What's interesting is you can't seem to explain why those plans were "illegal" (actually, they just didn't meet the coverage requirements of the new ACA laws). You can only talk about cost, but, when discussing INSURANCE we all know it depends on coverages, what, and how much is covered. The rest amounts to whining.

You also can't seem to discuss the impact it had on healthcare providers. People look at me sideways when I mention this. You mean, people actually have to pay for their care? Amazing. ACA helps providers get paid for the care they provide. MORE people are insured and their coverages under ACA have to meet a bare minimum of adequacy. This part you won't argue with me because I actually work on the business side of healthcare and ACA helps us get paid for the care our doctors provide.

My benefit plans previous to ACA were far more generous than the ACA plan I have now. I have no reason to lie about that.

As to your second point, ACA is so popular with doctors that only one third of doctors in the U.S. accept ACA. In many markets, it is below 20 percent. This is according to a survey conducted by The Physicians Foundation. Furthermore, of the 20,000 physicians that responded, 46 percent gave ACA a grade of D or F.

[Fishindude77]

Pre ACA we could buy private health coverage for myself and spouse for $6-700 per month with many companies to choose from.
When we were forced onto the ACA plan several years ago my rates were $1800 per month. That has gone down some due to raising the allowable income thresholds during Covid, but still not to private coverage cost levels. There are only 2-3 companies in our state that offer ACA coverage so you are stuck with one of them.

It's true anyone can get health insurance now with ACA but they accomplished this by eliminating most of the competition in the industry, and those that earn a decent income are basically paying the premiums for the low income earners who pay nearly nothing for the same coverage.
You are also now required by law to carry health insurance. I'm not suggesting it's a great idea to go without, but if you are in great health and have high enough worth to cover medical bills it shouldn't be forced on you.

Just another one of those areas the government should have kept it's nose out of.

[ua_guy]

My benefit plans previous to ACA were far more generous than the ACA plan I have now. I have no reason to lie about that.

As to your second point, ACA is so popular with doctors that only one third of doctors in the U.S. accept ACA. In many markets, it is below 20 percent. This is according to a survey conducted by The Physicians Foundation. Furthermore, of the 20,000 physicians that responded, 46 percent gave ACA a grade of D or F.

I'm sure they were more generous, that's why so many plans that didn't meet minimum coverage requirements disappeared.

You may want to dive a little deeper on your acceptance statistics, overall public opinion in support of keeping the ACA, as well as provider opinions which the majority say increases access and reduces the number of patients with no ability to pay. You are correct, not every provider or health system accepts ACA marketplace coverages, just like not all providers accept Medicare or Medicaid. They are cost-driven plans and may provide lower reimbursement compared to a true commercial plan. Only about 46% of people with health insurance carry a commercial plan.

But who am I to argue. Attempts to repeal ACA have only failed at least 70 times. Speaks for itself.

[FrostedMoose]

I'm sure they were more generous, that's why so many plans that didn't meet minimum coverage requirements disappeared.

You may want to dive a little deeper on your acceptance statistics, overall public opinion in support of keeping the ACA, as well as provider opinions which the majority say increases access and reduces the number of patients with no ability to pay. You are correct, not every provider or health system accepts ACA marketplace coverages, just like not all providers accept Medicare or Medicaid. They are cost-driven plans and may provide lower reimbursement compared to a true commercial plan. Only about 46% of people with health insurance carry a commercial plan.

But who am I to argue. Attempts to repeal ACA have only failed at least 70 times. Speaks for itself.

Try your best to be objective rather than pushing a narrative.

Public opinion on ACA doesn't mean much, since it is intended primarily for self-employed folks, who are only about 12 percent of the U.S. workforce. If I work for ABC Company and have a group plan, ACA sounds like a really neat deal. Opinion polls about ACA should be limited to the few that actually have it.

"Not every provider or health system accepts ACA coverage". Actually, most do not.

ACA was a trojan horse, and it practically cannot be repealed. That doesn't mean it was a good bill, nor does it mean that it was all bad. But there were far more harmed by the bill than helped. The providers accepting ACA - only about 30 percent of them - are often doctors trying to get patients to keep their doors open: Those with limited admitting privileges at hospitals, no board certifications, foreign medical graduates, etc. Consider that, compared to ACA, 90 percent of providers accept Blue Cross (non ACA plans).

ACA sounds really good, until you have to use it.

[FrostedMoose]

Pre ACA we could buy private health coverage for myself and spouse for $6-700 per month with many companies to choose from.
When we were forced onto the ACA plan several years ago my rates were $1800 per month. That has gone down some due to raising the allowable income thresholds during Covid, but still not to private coverage cost levels. There are only 2-3 companies in our state that offer ACA coverage so you are stuck with one of them.

It's true anyone can get health insurance now with ACA but they accomplished this by eliminating most of the competition in the industry, and those that earn a decent income are basically paying the premiums for the low income earners who pay nearly nothing for the same coverage.
You are also now required by law to carry health insurance. I'm not suggesting it's a great idea to go without, but if you are in great health and have high enough worth to cover medical bills it shouldn't be forced on you.

Just another one of those areas the government should have kept it's nose out of.

ACA is only "affordable" for those that are receiving a subsidy, like retired doctors. And that subsidy is being paid for by rich people such as yourself. Folks act as if all of this stuff is free, like student loan "forgiveness". Real people somewhere are paying for all of this.

[disneysteve]

The ACA may have made things better for a few million, but it's certainly not in the tens of millions.

Before the ACA began, there were 50 million Americans who were uninsured. As of 2022, that number had dropped to a record low of 26 million. So right there it has benefited 24 million, and that number is from 2 years ago. ACA enrollment has been steadily climbing so it's probably more now.

And then there are the millions of people who fall into the other categories I mentioned. So yeah, I'll stand by the "tens of millions" comment.