The deductibles on the ACA seem to be really high. My brothers is $10,000. Is that per year?

[Logical]

That is the part that is scary. My wife's emergency gall bladder removal was over $20,000. So by brother, who has no savings, would still be bankrupt if that happens to him.

Am I missing something?

[NoOneMan]

1. But does he have an air conditioner!!!!

I need his street address, chest girth and hair color before I can believe you

[Logical]

6. LOL. n-t

[Rex]

2. 10k does sound really high.

What plan did he go with?

[Logical]

9. Silver. The payments are low per month, like $250. But the deductible is scary. n-t

[kestrel91316]

22. BS. My silver level plan on ACA/CoveredCA has a $500 deductible and a $2250 put-of-pocket limit.

That's for one person. With subsidies, my premium is well under $50/mo, so if I DO incur major medical expenses, I can still survive that OOP limit.

I think a $10k deductible must be for a family of AT LEAST 6, and they probably mean an OOP limit and not a deductible.

[moriah]

25. You might be on a reduced cost-sharing plan because you do have subsidies.

If you're under 250% of the poverty line and enrolling in a Silver plan, they're supposed to knock down cost sharing significantly.

[kestrel91316]

35. That might be it. Whatever the reason, I'm glad for it I LOVE ACA and it may end up saving my life.

[NYC_SKP]

3. Typically, yes, it's per year. All states are different. Low decucts=high payments.

...and high deductibles mean low monthly payments, as a rule.

We all have to balance what we can afford with what we think might happen to us.

Personally, I prefer higher rates with less fear of a catastrophic cost.

[Hoyt]

4. $10K sounds like cathrophic policy if from exchange.

[jaysunb]

5. 10k deductable = no insurance. n/t

[VanillaRhapsody]

18. Not getting no deductible no co-pay diagnostic tests = no healthcare

and is this a "High Deductible" or the total out of pocket cost? (the latter is the one I think).

Oh and is this for a single person or a family?

[wercal]

7. Prepare to be attacked...

But seriously, could you volunteer some info:

1. age
2. dependents?
3. State
4. Smoker?
5. Income.

[ReverendDeuce]

80. Indeed. I did this a few days ago and was brutally assaulted by our version of Dittoheads... nt

nt

[Pretzel_Warrior]

8. are there policies on exchanges with $10K deductibles?

Highest I saw was around $6,500. What state?

[Grateful for Hope]

10. I would like to know also.

[Logical]

11. Kansas, 2 people. 56 and 52. they both make about $20,000 a year each. $40,000 total. Silver plan.

[Pretzel_Warrior]

13. that sound wrong. why would a silver plan have $10K deductible on exchanges?

what is the BRONZE deductible? $20,000?

[NoOneMan]

14. Silver plans are for respectible middle class folks who shouldn't need to choose between food

or care....

That's for lower class bronze menschen

[Pretzel_Warrior]

15. but most silvers have higher monthly premium and lower deductible

so I deduce from that the Bronze that this person is looking at has even higher deductible.

I'm sort of politely calling bullshit and asking them to prove it.

[NoOneMan]

17. Why do we need different level of plans?

Of course, some levels will induce more self-rationing than others.


But if we want universal care and positive outcomes, why do we need all these bullshit different plans?

[Pretzel_Warrior]

19. you must not be familiar with insurance. or economic trade offs

[NoOneMan]

27. Why do we need different levels of plans?

And yes, very familiar.

[Pretzel_Warrior]

29. because people can choose whether they want to pay lower premium under the probability

that their good health will mean they don't use any services other than, say, wellness checks. Or, someone with higher likelihood of healthcare needs can pay higher premiums and have significantly lower deductible. This will ensure they don't have as much sticker shock if they do have a lot of health issues in the year that they would have to largely pay for until they hit a high deductible.

It provides choice based on a person's own assessment of their situation.

[NoOneMan]

34. So health insurance sounds like gambling.

How about the probablility of not getting sick so you dont get insurance?


And BTW, beyond risk, disposable income also impacts their bets

[Pretzel_Warrior]

37. most of life is about gambling. a poor person may choose to take on student debt

in the hopes of bettering their lot in life. it may turn out that way or they may just be saddled with years of debt.

same with someone starting a business or choosing to take the 405 instead of the 5 on their commute.

Life is full of choices and "gambles".

[NoOneMan]

41. Wow, we don't see the world the same

I think thats why Im a fan of a single plan with no deductible and copays. In fact, your view is preposterous in my opinion. It takes all kinds

[NoOneMan]

51. This whole thing is just crap

I think this tiered system creates some strange psychosis that tears the soul out of the concept of just taking care of the sick. Now its about craps tables, self-rationing, tiered care and deductibles that keep sick people at home. Frankly its disgusting to think about. Sorry I brought it up. I don't think the US people are ready for a real system yet

[arely staircase]

71. that is how all insurance works

Always has. Do you not know this. I wont be participating in the exchange because I am lucky to have insurance through my employer. I pay very low monthly rates but have a high deductible. I could pay more and have a low deductible. Nothing new here.

[Cal Carpenter]

74. "Nothing new here."

Exactly.

[NoOneMan]

75. Its how insane profit based insurance works

Some systems simply pay for all sick people to be treated, funded progressively from each according to their ability

[arely staircase]

79. only now everyone will be able to afford it

because it can't cost more than 10 percent of your income.

[moriah]

28. For people who don't use care, getting the lowest possible cost plan is better for them.

Hopefully they're being smart and combining that low-cost, high-deductible plan with a health savings account, so that the first year they have to touch their deductible they don't cry.

[NoOneMan]

31. So was not having insurance

But then we were told we have to increase the pool size. Why are we segmenting the pool and weakening it by sharding it up?


Those who don't use care? They don't get in car accidents or get the flu?

[moriah]

36. It does make sure everyone is paying a portion toward catastrophic costs.

It's not the flu that's going to bankrupt a person without insurance (unless they're like me and get double pneumonia in a week of having the flu), it's the car wreck that exceeds the maximum bodily injury claims for liability in your state. (Most insurance excludes costs from car accidents unless you allow them to subrogate and sue the driver's insurance on your behalf.)

[NoOneMan]

38. Why, you know, you could do that with a single plan

And then not create a system where bronzen menshen have to choose between food and surgery

[moriah]

43. For quite a few that would have absolutely no other way to finance a surgery....

... they're going to be on a plan with a cost-sharing reduction, because they will be low enough income to have purchased a Silver plan through the exchange with subsidies.

Now, I would HATE to be in a position where I had to take out a second mortgage on my home to pay for a knee replacement. But if I had a home to take a second mortgage out on, I'd hopefully have some other ways to fund it immediately -- like a good enough of a credit rating to get a CareCredit account and pay it off in a year interest free. (I had one, back in the day, for my cat's vet bills -- they really weren't a bad deal if you paid them off on time.)

[Pretzel_Warrior]

39. some % of people (usually young and healthy) who may opt for low premium/high deductible

will pay a premium every single month and use virtually no health care for multiple years. That was certainly true of me in my 20's and most of my 30's. Their premiums will go toward helping the high users of health care have more reasonable costs. See? That is what it means to widen the risk pool, etc. etc.

[Logical]

23. This link shows $12,000......

http://kff.org/interactive/subsidy-calculator/

Your out-of-pocket maximum for a Silver plan (not including the premium) can be no more than $12,700. Whether you reach this maximum level will depend on the amount of health care services you use. Currently, about one in four people use no health care services in any given year.

Not sure how accurate this is.

[ScreamingMeemie]

32. What was weird on mine (linked below) is the deductibles

for Gold were much higher than those for Silver.

The other thing that people need to be very, VERY careful about is selecting a plan that has providers participating. I could not find any of the BC/BS Advantage plans with providers in my city (Houston). Very strange. Humana (the plan I went with) had tons.

[DevonRex]

48. The Silver Plans are eligible for the reduction in Out-Of-Pocket expenses.

IF you qualify for them. You get the same level of care, if you qualify, as you would in Gold and Platinum plans but you pay less in the way of deductibles, copays, etc. But you have to buy the Silver Plan to get the savings.

If you qualify for out-of-pocket savings, you must choose a Silver plan to get the savings. If you qualify for these savings, you'll get the out-of-pocket savings benefits of a Gold or Platinum plan for a Silver plan price. You can choose any category of plan, but you'll get the out-of-pocket savings only if you enroll in a Silver plan.

You'll be able to choose your plan category when you fill out your Marketplace application.

https://www.healthcare.gov/will-i-qualify-to-save-on-out-of-pocket-costs/
That link tells you all about it. And note all the links in the page. And the search bar at the top. You can search for terms and just about any question. I've been doing it all week.

[ScreamingMeemie]

49. I've already done the application. That's how I got my plans.

We're basically going with the Humana Silver plan. It's a $1800/2900 max. With the 20% coinsurance for hospitalization, 25 copays for Dr. visits, etc. It's a good, solid plan.

[DevonRex]

56. Hooray! Well, maybe somebody else will see the info who needs it.

Thanks for sharing those plans below. It couldn't get better than that. Some will roll the dice on the bronze for a low premium but they can't say they didn't have the information upfront.

[ScreamingMeemie]

64. I'm glad to do it. I was really amazed at how all the information from the actual plan was

linked. You could spend hours researching. (and I was a naysayer)

[Ms. Toad]

50. For two people that is the maximum -

regardless of the plan. So I'm guessing that the OP's brother is subsidized slightly (bringing it down from $12,700 to $10,000 for max out of pocket), and that the deductible is considerably lower.

[Yo_Mama]

57. That's a two-person deductible.

ACA family out of pockets generally run around 12K. But the 70/30 silver split can be handled by any distribution of deductible and copayments, so they vary. The higher the deductible portion, the lower the premium.

In my home county in GA (Lowndes), for example, for a family with two kids, parents aged 50 and 52, non-smoking, there are various silver options, but the lowest premium is $1,445 a month and all the rest have monthly premiums above $1,500. But these are all real insurance - the highest premium has a $5,000 deductible, 10% coinsurance and an out-of-pocket maximum of $9,000, for a monthly premium of $1,568. The lowest has a $6,000 deductible, 10% coinsurance and an out-of-pocket maximum of $7,200 for $1,445 a month.

The lowest premium plan this family can buy on the exchange (and avoid the fine, I think) has a $986.00 monthly premium with a $12,700 deductible, no coinsurance. Once you pay $12,7000 in medical costs, the rest is paid for you. Coverages are of course the same. But $500 a month is $6,000 over the course of the year, so actually it makes financial sense to buy the "catastrophic" plan. If you do not have medical expenses you always come out ahead, and if you do you about break even. Plus, the money you save on premiums can be used to pay your medical costs.

The bronze plans have family deductibles of over 10K.

Higher income families without the subsidy will only be able to buy bronze or catastrophic policies.

If this same family had an income of 70K rather than 95K, they would be able to get the best silver plan ($1,568 base premium) for $608 a month. A lot of people with their own businesses and families are just going to stop making as much, to be honest with you. Between the taxes and the higher premium cost, it pays you to work less.

Cost-sharing kicks in at lower incomes and drops the deductibles and copayments.

[VanillaRhapsody]

26. It's definitely not true...that is the Total out of pocket without the subsidies

My friend with a $20,000 a year job (using her gross income) can get healthcare total silver plan for $57 a month when paid over 12 months. Her out of pocket estimate for 2014 total is $5700 and subsidies will pay her $5200. So in the end...she pays nearly NOTHING for healthcare for the year. AND this is a state that didn't expand Medicaid (South Carolina)! If Nikki Haley extended Medicaid she would be eligible for that practically free if not totally.

BTW, her $20,000 a year salary is considered 150% poverty.

So our friend got it wrong.

[Logical]

45. He is fine with the monthly rates. It is the yearly deductible that is scary. n-t

[Ms. Toad]

54. I think that it the out of pocket max, not the deductible. n/t

[DevonRex]

33. What zip code in Kansas?

[Logical]

44. 67501

[DURHAM D]

47. Reno County?

[pnwmom]

77. Are you sure you're not talking about total out of pocket costs

rather than your deductible?

[bluestate10]

12. I haven't seen one. nt

[ScreamingMeemie]

20. Yes. There are.

This is in Texas.

[Pretzel_Warrior]

21. that's pretty horrendous

[Logical]

24. Thanks for this! n-t

[MiniMe]

52. Wish we could see the headers on the post

We really have no idea what we are looking at

[ScreamingMeemie]

53. What is it you would like to see?

I can answer any question, and provide a snapshot. I've got my screen pulled up still.

[MiniMe]

55. What are the headers to all the columns

[ScreamingMeemie]

61. Each header is for each level (Bronze, Silver, etc.---screenshot enclosed)

It's the overview of all the plans I can enroll in. I can choose to view them all or select the ones I'd like to compare.

[MiniMe]

63. Thanks

I haven't gotten to the web site yet, and without the headers I had no idea what I was looking at.

[ScreamingMeemie]

65. If you have any other questions, ask me or PM me.

Hope you get in soon. It is frustrating, but once I cleared my cache (I have to do that each time I want to get in) it worked for me on Chrome. The sooner everyone can access, the better.

[Schema Thing]

66. what age?

[ScreamingMeemie]

67. 43 with a 15-year-old son.

[Ms. Toad]

58. Very odd.

I'd like to see what it is that makes the difference. I'd suspect the left plan is the catastrophic one, except for the premium rate. Is it by insurance company? In which case, the one on the left probably won't get much business.

[ScreamingMeemie]

62. Yes. I took another screenshot so you can see the top headers.

The left is the Bronze plans.




I've picked the Silver Plan that is listed at $176.19. I haven't pulled the trigger yet, but I'm 90 percent certain.

[Ms. Toad]

68. Just run the numbers.

Look at your bills for the last few years. In our family, if we had a choice between a low deductible at $176.19 and a high deductible at $369.52 it might well be worth the additional $2300 in premium costs to buy the high deductible.

[ScreamingMeemie]

69. I can't do a high deductible. I'm a preexister who got bounced off her coverage.

RA patient who hasn't had a treatment in over 4 years. Typical blood pressure runs 200/100-something. Tachycardia...basically lucky I held out long enough for this. Ran over it with a friend who is an insurance agent; decided this was for the best.

[Ms. Toad]

72. At least you've thought it through -

Since the averages you posted earlier has some high deductibles for the silver plans, it wasn't clear what the deductible was. I thought you might be going for cheapest high deductibel, which isn't necessarily the best option.

We're not on the exchanges, but we've got the same issue in our employment related plan. A difference in out of pocket maximum of $3000 can be purchased for about $2700. I think we'll hit the out of pocket max - either way, so we save $300 by buying it down. But they threw in the wrinkle that the prescriptions (about 1/3 of our costs) are not merged with the medical out of pocket. So it is a more complicated calculation.

[bluestate10]

16. What is the income of your brother?

Subsidies are based upon income. If your brother makes more than the amount needed to qualify for subsidies and don't have savings something is wrong with how he plans his finances.

I haven't see a deductible of $10,000. Something sounds wrong about your information based upon what I have seen. Can you produce screen captures to buttress your claims?

[VanillaRhapsody]

30. it is wrong...see my post above.

A single person with a $20,000 a year job is 150% of poverty. If your provided health insurance is more than 9.5% of your salary...you qualify for subsidies through the exchange.

[Logical]

42. Well, he did get subsidies for the monthly rate. But he still said he has a deductible. Are...

you saying maybe his subsidies may cover the deductible also? That would be good news.

[Ms. Toad]

59. I'm not sure about deductible, but there are subsidies for the cost sharing

at least to lower the out of pocket max.

[Logical]

40. I didn't sign him up so I don't have screen shots. So I cannot validate his experience. nt

[Logical]

46. See my post above. $20,000 each, 56 and 54. The monthly rate is fine. The deductible is scary. n-t

[Motown_Johnny]

60. What state does he live in.. what is his income (aprox.)?

How many are in the family?

No way to know if you are missing something when you give us no information.

[ileus]

70. This is what you get when profit

Remains the #1 focus...

Single payer now! Not some bullshit insurance exchange.

[quinnox]

73. Yep, crappy high deductible policies for all!

I'm sure everyone has an extra 5k to 10k laying around a spare room in their mansions, so no big deal.

[kestrel91316]

76. The silver plan I'm looking at has a deductible of $2250.

Only the bronze is higher, and it's not anywhere NEAR $10k for a one person policy.

I can only buy that $10k if it's for a family of at least 3.

What state is your brother in? How many people in the family?

Any of them smokers? Ages? Income?

Without all that it's impossible to have any idea if he's even telling you the truth.