OBAMA Care and Health Insurance Issues

[chauddog]

Just curious if anyone else has found themselves in this predicament. My spouse and I simplified, sold our house, got rid of most of our possessions, got rid of all debt, quite our corporate jobs, simplified and moved to rural Vermont in a much smaller house. Our goal was to work how/when we wanted, minimize our expenses, travel, volunteer, etc. I have been doing some consulting and some low paying community work. My spouse has been doing part-time work too. Just what we envisioned and except for health insurance, it has been working out great.

Health Insurance is becoming a HUGE problem for us. We have to purchase it through our state network. Originally, we had little income as we were still finding out what we wanted to do. Because we had little income, they wanted to put us on Medicaid. We said we did not want to be on Medicaid but we were told we had no choice and could not purchase commercial health insurance through the network because our income was so low. I started doing some consulting work and some paid community work (both for way less than I was making in my corporate job.) Now, although combined we are making less than 55K together (again perhaps less than 1/4 of our prior salaries), we are facing a dilemma. We are priced out of any health insurance subsidies (which I feel weird taking anyway) and our health insurance for the middle tier plan is going to now be about $900/month. We are paying it and since we keep our expenses very low, we have been able to swing it....but we just received notice that the rates may be increasing even more....and that could be a problem!

So...I'm torn...we are probably going to have to work more so we can afford the ever-increasing premiums or return to a full time job to get insurance. Or work less...and qualify for significant government subsidies and I don't really want to rely on the government for anything. Just wondering if anyone else has found themselves in this predicament. We have about 100K in the bank and money in our retirement accounts (401K and Roth IRAs) and no debt but if we have to pay over $12,000+ a year for health insurance, our savings may start to dwindle. I don't really want to take the bottom of the barrel plan and it does not cut our costs that much anyway.

Just wondering if any other "simplification" folks have found themselves in this dilemma. Not looking for an answer to our dilemma but just wondering if other folks have encountered this issue. I know some people have told me to just work less and take the subsidy but I don't want to have other working people subsidize my health care because of a life choice I made. The difference is pretty significant though, if I made even $15,000 less, our premium drops significantly due to the subsidies.

[catherine]

Yuck. As much as I'm a proponent of Obamacare, we definitely need an Obamacare 2.0.

First of all, I think you need to unwrap the perception that taking a subsidy from the government is like "stealing" taxpayer money. This is an unwieldy version of a national health plan, but it still is NOT the same as welfare or food stamps. It's a hybrid, patched together flawed system of agreements between the public and private sectors in order to enable coverage for the masses.

But to get to your issue--I'm a freelancer with varying income levels, although my income has steadily put me in a place where I'm paying through the nose for insurance every year (DH and I spend $1500/mo). I've had to look at it as a fact of life at least for now. I actually tried to get a bottom of the barrel plan, but couldn't! If I were in your shoes, I would say work if you want to work and/or find it fulfilling and work less if you don't really care that much. In other words, try to make your decision based on your need/desire to work, and not solely on the grim realities of the current healthcare system. FWIW, I think that Vermont's state plans are actually better than a lot of other states.

(I'm jealous about your move!! Congrats! Can you share which area of Vermont you're in i.e., southern, central, northern? Living up there is my dream)

[chauddog]

Thanks Catherine for the response. I am certainly willing to pay but it sounds like mine is not quite as expensive as yours! My consulting work is also up and down so I have to estimate my income. BTW...we live in North Central Vermont just on the edge of the Northeast Kingdom in a town of less than 1000 and we really love it here. Our whole life change has worked out much like we had hoped.

HealthConnect originally asked me to call every month to let them know if my expectations of income had changed but that just created an administrative mess and we ended up with multiple accounts and mass confusion. Not sure if Vermont is better than other states but I know I have generally waited over a half hour (sometimes over an hour) on the phone to speak to someone and it took me almost four months to get successfully enrolled. They then billed me back four months because they said I had to pay retroactively although I never received an insurance card until the fifth month. They originally told me to pay for any health care costs out of pocket and then apply for reimbursement once I was successfully enrolled. The people on the phone were very nice and very apologetic saying their systems did not work together so both I and the people working there had a frustrating experience. The state WEB site has also been up and down and they barely made a mandated deadline for getting it functioning again. It seems that Vermont was not the only state who has struggled though. But all in all...I think Obamacare is beneficial to the masses and Vermont is striving to do what they think is best under the Federal guidelines although I would much rather have a socialized plan that is centralized and controlled costs. I am not sure that health care should be open to free market competition.

[catherine]

But all in all...I think Obamacare is beneficial to the masses and Vermont is striving to do what they think is best under the Federal guidelines although I would much rather have a socialized plan that is centralized and controlled costs. I am not sure that health care should be open to free market competition.

I completely agree. Well, the journey of a thousand miles...

My kids live in Burlington, and my cousin lives in Walden. I've been dying to get to Dog Mountain in St. Johnsbury as I am a HUGE fan of Stephen Huneck's art, and have been praying for them to succeed since the death of both Stephen and Gwen.

[iris lilies]

We are newly FIRED/retired and our annual payments are $14,000 on COBRA which runs out this month. Then we will begin the Obamacare adventure and will pay about $6,000 anually on an income that is, I think, about $30,000. Forgive me, I have forgotten exactly what Obamacare looks at in figuring income.

OP, are you SURE you are out of the subsidy game at $55,000 for 2 people? Here, it was closer to $62,000. I cannot get the piece of sh@t ACA calculator to work at the moment, but your number seems a bit off. Of course it is as you describe not a system that deals with income fluctuation well at all. Our President said you should expect to pay 8% of your income on health care (or was that insurance?) so I do think there is good chance you can get you payments down from $900/month.

If was going to say "work less" but you dont want to rely on the government for anything (but you want a medical socialized plan?I dont think I'll touch that one. :~) ) so good luck.

[iris lilies]

163716381636


OP, I tried the ACA calculator for a random Vermont zip code. The costs for a couple under age 65 with income of $54,000 is $458 monthly for a silver plan.

What are you, or I, missing?

Do you use a fair amount of health services? If you do, thats where the cost comes in, not the insurance.

[iris lily]

P.s. Unlike Catherine, I think that ACA subsidies are rather like welfare payments. And I can hardly wait to get on the dole, Haha. About 20 days in countdown now, baby!

Medicaid, now thats a bigger ethical challange. I would have some problems in taking Medicaid. Fortunately my state doesnt offer it and I didnt have to work to avoid it. We canpick and choose our income to a large extent.

But I also understand this whole ACA system is a mishmash of programs where wealth and income dont necessarily mean a whole lot any more and taking gubmnt handouts is fair game. The program also trains us out of eschewing gubmnt handouts. Clever of them, Aint it? Building the dependant populatin is part of the tricks, intentional or not.

[freshstart]

I was on COBRA and Jan 1st was going to have to switch to my State's Healthcare Marketplace plans. They are relatively inexpensive if you don't use medical services very much but to get what I was getting with COBRA was going to cost me more than COBRA. So I was thrilled when I got my disability Medicare enrollee packet in the mail, I would choose an Advantage plan and save money. I was so wrong. I found a good plan, affordable except for meds. Because I am on two expensive meds, I end up in the donut hole very quickly and that is one expensive hole to climb out of. I cannot believe Congress hasn't totally fixed this issue. I had so many patients in the donut hole when I was working, many just chose not to take their meds. Once again, I will be spending 1/2 my disability benefits on healthcare.

[Teacher Terry]

I really think that Clinton will try to pass a national health care system once she is elected. The cost of insurance is crazy! The first year we were retired our pensions were 40/k total and 10 went to healthcare. Now that we work p.t. our income is up to 65-70 so it is more affordable. But at least my insurance a retiree benefit pays for things unlike the ACA with huge deductibles that many can't afford to use. My son had a MRI in Poland and is not on their healthcare. He paid cash and it cost 90.00. My DIL is on their insurance so gets all her tests, visits, etc done when she goes home. They try to get all their dental work there too.

[iris lilies]

P.s. Unlike Catherine, I think that ACA subsidies are rather like welfare payments. And I can hardly wait to get on the dole, Haha. About 20 days in countdown now, baby!

Medicaid, now thats a bigger ethical challange. I would have some problems in taking Medicaid. Fortunately my state doesnt offer it and I didnt have to work to avoid it. We canpick and choose our income to a large extent.

But I also understand this whole ACA system is a mishmash of programs where wealth and income dont necessarily mean a whole lot any more and taking gubmnt handouts is fair game. The program also trains us out of eschewing gubmnt handouts. Clever of them, Aint it? Building the dependant populatin is part of the tricks, intentional or not.

One of my friends is running into the donit hole with her very expensive medicatin. Their solution is to keep her husband's insurance for a while longer. He is 68 and still likes to work. He is one of those people who really cant think of much to do besides work, and he has kind of an easy job in sales after puttng in his time for decades. He still has to work weekends and evenings, though.

[ToomuchStuff]

I really think that Clinton will try to pass a national health care system once she is elected.
We already have a national health care system. It is in place, but discriminatory as you must have been a member of the armed forces. The VA has been in the light the last couple of years and I believe there would really be a backlist with the fewer doctors if they dropped the discriminatory part.

[chauddog]

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OP, I tried the ACA calculator for a random Vermont zip code. The costs for a couple under age 65 with income of $54,000 is $458 monthly for a silver plan.

What are you, or I, missing?

Do you use a fair amount of health services? If you do, thats where the cost comes in, not the insurance.


Thanks for the response. I apologize..our income is actually 65K..I typed that wrong I guess! We have heard that they expect the premiums to rise as well so our costs I expect will rise also. The calculator estimates $959..our cost at the moment is slightly below that since I think that is average for the plans. However, if we made even 10K less, it drops to about half that as you quoted. As far as the socialized medicine, you are right...that would be relying on government and I probably was a bit too hasty in saying that. I would not mind using government sponsored health care if everyone had access to it. I feel bad accepting a subsidy though when other people are working full time and not getting the benefit. I don't think health care should be free-market driven personally. I will probably continue to work and pay the premium but if it rises too much, I may swallow my pride, work less and accept the subsidy. I paid for years in a relatively high tax bracket so I guess I can look at it as receiving retroactive benefits from my taxes.

[chauddog]

I really think that Clinton will try to pass a national health care system once she is elected. The cost of insurance is crazy!

I agree. I can't swallow the idea that the free market system will produce low cost health care insurance. We have seen prices for pharmaceuticals go out of the stratosphere for new medications (or those without a generic counterpart yet.) Luckily, I don't take any medicines but I have dealt with it for my mom. She was prescribed some medicines she couldn't take because she couldn't afford them and her insurance would not cover them. We eventually found a workaround which I still don't understand but if she gets them administered in the doctor's office...they are covered but not if she takes them at home. Luckily the medicines in question are not daily medications. Otherwise, Medicare has been working very well for her.

[MaryHu]

I think the subsidies are crazy. We're not subsidizing the policyholders so much as the privateer health insurance companies. I don't like to be seen as on the dole but I figure that if the government doesn't have the balls to grow up and institute universal health care like all the other kids on the block have, then that's hardly my fault and I will take the stupid subsidy and be glad of it. In the first year it cut our medical insurance from about $8,000 (for the full year) to about $1,800. Of course now (after the election) who knows how they're going to screw us. My notice for health insurance next year says the policy costs almost $1500 per month (almost doubled in 4 short years!) that's $18,000 a year, more than half our yearly income! I'm just waiting to see what this "something really terrific" (with which they plan to replace the ACA) turns out to be, yeah right! I may have to take on another job strictly for the insurance.

Needless to say we have put many financial plans on hold;
Hire the local handyman to help put in new kitchen counter tops: NO
Put new insulation in the attic: I don't think so
Take a nice vacation to celebrate our 30th anniversary: not gonna happen
Rebuild the crumbling patio: not on your life

I can't be the only one whose whole financial life is thrown into a tizzy by this. There are 21 million Americans whose health insurance is threatened by this new administration. I'm sure that, like me, they are all tightening their belts and putting any spending plans on long term hold. Big downward pressure on the economy.
I understand they're also trying to kill Medicare so I can't even look forward to the light at the end of the tunnel. How many giant steps backward will we take in the coming years?

[ApatheticNoMore]

The reality is you can only expect so much from jobs either, work is dumping us on to a private exchange with individual plans. Now the employer will still subsidize some of the cost (call them my own private government :~) ) but don't expect to get a group plan just by getting a job, that's really not the case anymore. I suspect that these being individual plans that they do charge different prices based on all the things it is legal to do so for under the ACA (for age, for smoking etc. - not for preexisting conditions). So no group plans anymore.

I have more than 2 decades for medicare eligibility and even I wish for that light at the end of the tunnel (of course I also think all the time about social security minimum collection age which is 62 - can't take the job market anymore either. It is also too crazy). At 401ks and IRAs are available with penality at 59 1/2, it's ridiculous how often I think about this.

If I was in a position to take subsidies I'd take them as well, figuring absolutely nothing is being done at all to control cost by the government, not even anti-trust, so why not? I didn't make the system ..

[Zoe Girl]

If I was in a position to take subsidies I'd take them as well, figuring absolutely nothing is being done at all to control cost by the government, not even anti-trust, so why not? I didn't make the system ..

I agree that the insurance companies need to be monitored. Some of the information I have seen on the cost of medications is terrible. It really hit the fan with the epi=pens, parents often need 2-3 that expire every year (one for home, one for school and one for additional caregivers like sports or childcare). I can't see how it costs the companies THAT much more to make the same medication. There are so many people who don't take medications that they need and heave health insurance. It would benefit the government to not pay these subsidies that are really going to the companies. I am not a fan of bigger government but when it is necessary then we deserve some protection.

[bae]

It really hit the fan with the epi=pens, parents often need 2-3 that expire every year (one for home, one for school and one for additional caregivers like sports or childcare).

Bunny trail - if you are any real distance in time from definitive care, and have serious allergies enough to carry an epi-pen, carry two doses - there can be a biphasic allergic reaction *after* the initial treatment seems effective. (Plus the initial reaction may rarely require multiple doses.) Keep some H1 blockers around to help too (diphenhydramine for instance). And you might want to familiarize yourself with this possibility:


https://www.youtube.com/watch?v=sbpmYuixMAg

[Tybee]

What Bae said. Husband and I have serious allergies and they always prescribe 2 epipens and say first one will buy 20 minutes, second an additional 20.
My pulmonary guy said take Benadryl at first sign of anaphylaxis and I do that, too.

[bae]

What Bae said. Husband and I have serious allergies and they always prescribe 2 epipens and say first one will buy 20 minutes, second an additional 20.


The spring-back/biphasic reaction usually sets in a few hours later, just about after you've been discharged and gone home :-(

The 20 mins/20 mins you describe is the more simple initial-onset reaction, simply a really bad one.

Also, on epi-pens - really really make sure you are holding it correctly, and that you do NOT have a thumb over the end of it. If you have reversed the pen, you will inject your thumb, and probably end up losing the thumb because of the vasoconstriction. Really.

[jp1]

Not having allergies I wasn't aware of all these details about epipens. The movie Pulp Fiction made it look so simple...��

[creaker]

So far Trump has said he wants to keep the until 26 part - and the "no preexisting conditions" part. Given these are a couple of the costlier items in Obamacare, I would think those who remain on insurance are going to have to pay more to cover the rest.

I have a question - why don't entities like car loan and mortgage folks require (especially higher risk) people to carry health insurance as part of their loan agreement? I'm sure people declaring bankruptcy or having their paychecks attached due to medical bills don't have much money to pay off loans.

[iris lilies]

So far Trump has said he wants to keep the until 26 part - and the "no preexisting conditions" part. Given these are a couple of the costlier items in Obamacare, I would think those who remain on insurance are going to have to pay more to cover the rest.

I have a question - why don't entities like car loan and mortgage folks require (especially higher risk) people to carry health insurance as part of their loan agreement? I'm sure people declaring bankruptcy or having their paychecks attached due to medical bills don't have much money to pay off loans.

Right, retaining the mandate that pre-existing conditions must be covered while tossing out the mandate that everyne must buy an surance pretty much ensures prices will go sky high. But it may take a couple of years for that to shake out.

I am, and will always remain, deeply skeptical of a country's committment to constitutional nal,priciples if it requires everyne to buy a product. Sure I understand the practical reasonwhy, but the theoreticaly, no. It is just wrong. It is writing ng. And it creeps me out how that Supreme Court Decisi J came down to party lines (but doe tie breaker Justice Roberts.)

[JaneV2.0]

Right, retaining the mandate that pre-existing conditions must be covered while tossing out the mandate pretty much ensures prices will go sky high. But it may take a couple of years for that to shake out.

Prices will continue to climb as long as insurance companies are involved. It's the biggest racket in the world--paying a bunch of greedy middle men to sell us the right to deal with our doctors. Who ever thought that was a good idea?

[iris lilies]

Prices will continue to climb as long as insurance companies are involved. It's the biggest racket in the world--paying a bunch of greedy middle men to sell us the right to deal with our doctors. Who ever thought that was a good idea?

But doesnt the ACA cap profits by insurance companies?

I know that when I was working, my employer got back some money because our health insurance provider exceedd the allowed amount.

[JaneV2.0]

I think there are some guidelines and limits--I remember profit caps? and any extra monies going to programs or as rebates--but I'm sure they got around those somehow. And if they can't figure out how, they simply walk away.

[iris lilies]

I think there are some guidelines and limits--I remember profit caps? and any extra monies going to programs or as rebates--but I'm sure they got around those somehow. And if they can't figure out how, they simply walk away.
You mean, people just get around the laws they dont like? Laws dont really solve prpblems?


I am gobsmacked at ths news.:D

[JaneV2.0]

You mean, people just get around the laws they dont like? Laws dont really solve prpblems?
I am gobsmacked at ths news.:D

Yeah--the one percenters are impervious. Sucks, doesn't it.

[ToomuchStuff]

But doesnt the ACA cap profits by insurance companies?

I know that when I was working, my employer got back some money because our health insurance provider exceedd the allowed amount. Ever hear of Hollywood accounting? You can make millions and show a loss still.