I am especially curious what freelancers in the NYC area are doing.
Thanks!
I had 3 options:
1. Obama Care - I qualified for a $16 subsidy...
2. Individual plan from a health care provider in state
3. Health Share plan (think Credit union for health care)
Obama care cost 2x as much as an individual plan, and almost 3x as much as a health share plan, so even after the subsidy, this was not an option.
Health share plan was very affordable, however it only worked with the health care providers on the east side of the state(I live on the west), it had a low yearly deductible, much lower then the individual High deductible HMO, however it had a 20% copay for all health services, including routine physicals and checkups.
Individual Plan from an instate health care plan costs slightly more each month, but all routine check ups, generic brand pharmaceuticals proscribe from my doctor, and any specialist (Chiropractor, Knee Doctor, etc) visits are 100% covered IF I am referred by my primary care physician.
I went with an individual plan for about $140/m and $28/m for dental coverage.
A political side note: this same exact coverage would have only cost me $84/m before 2014 when Obama care went into play. (edit: Health Care cost, not Heath + Dental)
What is an Obamacare plan? I thought the ACA created a marketplace that listed plans from insurers, and set minimums for coverage (that would apply to options #2 and #3). I haven't had to deal with it so I don't know.
> this same exact coverage would have only cost me $84/m before 2014 when Obama care went into play
How else has the ACA affected your insurance? For example, I think it allows you to stay on your parents plan until now (i.e., through age 25), guarantees you won't be turned down, eliminates caps on coverage, etc.
EDIT: Remove something that I think was overly provacative, (even if not meant that way).
Ironically a plan through Priority health on the market place cost 2x as much as the same plan purchase through the same insurer individually. This is for a couple reasons:
On the market place, a qualifying plan must meet ALL ACA requirements. This includes a capped deductible, bundled Dental, vision coverage, prenatal coverage/birth control coverage. Also, ACA plans are held to a higher standard then individual plans purchased on the open market. I have fewer options to choose from, and those fewer options all come with lower deductibles and more coverage then I need/want. This means higher monthly premiums.
>Were you pricing insurance 2 years before you need it? Many years ago (before Obama was elected), when I was pricing individual insurance the price was several times more. Insurance companies seemed uninterested in individual consumers.
I had the wonderful experience of working at Priority Health from 2011-mid 2014. I got to see ALL sorts of chaos unfold as they tried to meet all the requirements and deadlines (They did just fine, but there certainly wasn't much cushion on time). This increase in coverage was literally over night, as in 12/31/2013 Individual Plan A (The actual name...) was $84/m, on 1/1/2015 Individual Plan A was $136/m (Priority Health did grandfather in the pre-ACA prices for anyone already on the plan for 1 year, however any new members paid the new price)
>How else has the ACA affected your insurance? For example, I think it allows you to stay on your parents plan until now (i.e., through age 25), guarantees you won't be turned down, eliminates caps on coverage, etc
Overall ACA has negatively affected my coverage and most people I know. However to be fair, I was in the Goldilocks zone for health care coverage. Young, white, healthy athletic male, no pre-existing conditions, never smoked, and located in a relatively low health care area when compared to LA, NY, Chicago, etc. Pre-ACA my health care costs would have been as low as low could be.
I do think that coverage until age 26 is a good additional, however I wish it was through the entire year they turn 26 in, and not just until the month they turned 26, (For me June and I had to find coverage within 30 days of my birthday).
I do like the fact that it give subsidies to the individuals who cannot afford even a $84-$150 monthly premium pre ACA, however I wish that they just expanded the medicare program to give these subsidies as these people only represent about 1/3 of 1% of Americans, and in many cases a large portion of this small percentage would have been covered under medicare anyways
I agree that per-existing conditions should not be denied for coverage, however I do not agree that those without conditions should be required to pay higher premiums to subsidize their premiums. (sounds harsh I know, but thats my opinion.)
I think it is stupid that my obama care plan purchased through the open market also includes Dental, Vision, Prenatal care, and Birth Control coverage. I think its a smart marketing move to bundle these together into one plan for certain females, however it is not possible to unbundle this. And yes that means all you males out there, and all you women after menopause have prenatal and birth control coverage...
I think its stupid that as a male i am REQUIRED to purchase prenatal care and birth control coverage for myself even though i will NEVER use this. why do i have to purchase this? All US Citizens are required to purchase a plan that meets the affordable care acts requirements, it does not mean i must purchase a plan on the open exchange, but yes that mean individual buyers must purchase coverage they will not use in an attempt to make health care for everyone good. If I dont purchase prenatal care, I will qualify for the penalty at tax season.
(I got stuck having to get a normal job because of a pre-existing condition.)
3. http://www.healthshareplan.org/ When I contacted them, they only paid out to UoM and Mercy Health networks, not spectrum health. Since I live in Spectrum health land, this wouldnt work well for me. however if you live in East MI, you may consider this.
I started freelancing in 2012 with BCBS of MI. Being young-ish and healthy with no kids, just a spouse, I was paying something around $200/mo for a PPO with an HSA (side note: get an HSA and save - it's your best option for not being screwed as a freelancer). 3 years later and the AHA has left me at $400 a month for a HMO (downgrade), higher deductable (downgrade), but thankfully I still am allowed to use an HSA (HSA compatibility is complete bullshit, BTW).
Everything is out of pocket except some bare minimum prevention stuff. Everything trip to the doctor involves me wondering if it's really worth the money and the hassle (thanks to the HMO I can no longer see my old family doctor).
Those of you bound to say that I should shop around using the marketplace - yup, I did. This was the best deal. Insurance is dependent on geography. I'd love to see an app that told me which address would give me the most reasonable insurance. Any takers?
My suggestion - budget something like $500/mo/person. Half for insurance and half for saving in the HSA. As a freelancer you'll likely make too much money to have any of your insurance covered by the government. It's outrageously expensive, but if you have serious health problems, a $12.7k deductible is way less than potentially ten times that in hospital bills.
As an aside - I do believe the AHA did some good. I had friends in states without a non-profit insurance provider like BCBS who simply could not leave their jobs due to pre-existing conditions. That no longer happens, thankfully. However - we can do better. It's insane that I have to weigh the monetary cost of going to the doctor in my decision to go. Of course we all go for an acute illness, but I believe there are millions with minor chronic illness that are simply not getting treated because they cost of even the most common diagnostic tests is astronomical.
If he has a healthy family who does not need coverage outside of basic physicals, then its likely he purchased this plan to only cover catastrophic events, I know I would rather purchase the $500/m with 23k deductible rather then the $1000/m 13k deductible if I only planned on using coverage in the event of a horrible catastrophe.
See https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...
I had a BCBS/MI family plan through the marketplace up until last month. (Silver Multi State) It cost $1,000/month and had a $6,000 (family) deductible, after which BCBS pays 80% of all costs until you hit that out of pocket max. It also allows you to bank $6,500 a year in an HSA pre-tax, which basically covers the deductible.
[edit] Forgot to mention that this plan included medical, dental, and vision.
After ACA, it got a lot better. Currently we have PPO through HMSA in HI. About $650/mo for me, my wife and one kid. Kind of high ded ($1500/$3000), but drugs are covered and also with basic vision and dental.
And you should also learn the generic drug names or IUPAC chemical names for the commonly prescribed antibiotics.
I'm not saying those two suggestions are in any way related, other than the possibility that doing both could save you a great deal of money, in certain situations. Otherwise, grocery stores and big-box stores with embedded pharmacies often sell generic antibiotics at prices below your drug co-pay, but you would still need a prescription, and therefore an office visit co-pay. It pays to shop around.
86% of people who sign up with Obamacare received a subsidy1 from the government for low income. Without that, I don't understand how anyone could afford the rates posted there.
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1 http://www.nytimes.com/2015/03/11/us/11-7-million-americans-...
http://www.target.com/pharmacy/generics-condition
http://www.walmart.com/cp/4-Prescriptions/1078664
(you have to click around more to get the list on Walmart)
I am married and have 2 kids. I got a gold plan through the marketplace for $1250 a month. I got no subsidies since I make more than is required. It's a pretty good plan but expensive.
My last job which was pre-obamacare they were deducting $450 a month every 2 weeks for just my wife and I. So nothing really changed for me.
On a sidenote my cousin is low income and she got a killer plan through obamacare for 75 a month. So now she can afford to go to the doctor and not "walk it off" :-)
> deducting $450 a month every 2 weeks
That is confusing/doesn't make sense.
My first suggestion: Keep the health insurance through your wife if you can and if she is still working. It is hard to beat the plans sponsored by employers as they get subsidized group rates to offer to employees.
But if you absolutely need to buy your own, you have 2 options:
Option 1: Use Obamacare [0] and see your options. You can try healthsherpa.com [1] which is a unofficial wrapper on top of obamacare and you can compare the various plans.
Option 2: You go and buy health insurance directly from an insurance company without the extra layer of obamacare in between. You can use sites like ehealthinsurance [2] to get some quotes.
Option 3: Use an insurance broker. Find someone locally in your area. Sometimes brokers can get you good deals.
All options have benefits and problems. I personally hated obamacare as it was too much bureaucratic crap to deal with and now you have 2 layers to work with. The only advantage of obamacare is that if you are considered poor by obamacare standards, you can get subsidy on your premiums if you enroll through obamacare. But if you don't care about these things or are not applicable to you, then just go buy insurance directly and not even bother about obamacare.
Monthly Costs depend on a few factors:
In-network vs Out-Network: Very important factor. You can only go to certain doctors/hospitals etc that are "in-network". Some plans only allow in-network. Some plans have both but have higher premiums. Also, out of network coverage is very limited usually.
Co-Payment: This is the amount (usually $10-$30) that you will pay for every visit to a doctor. Some plans have no co-payment while most have the range as I mentioned.
Deductible: This is the amount that you will pay first for any medical expenses before your insurance company pays anything. So if you go for a plan with "high deductible", then your premiums may be lower and so on.. I will say that for a family specially with kids, I personally prefer zero deductible as it can save you more over a year since kids visit doctors frequently. But if you think you won't visit the doctors as much in a year, then go for high deductible. Again, just a choice and no right answer here.
Co-Insurance: This is the portion that you will pay after your insurance company has paid the remaining portion. For example, if your co-insurance is 30%, then the insurance company will pay the 70% for the medical expenses and you take care of the rest. Again, to get here, you will have met your deductible first.
Out of Pocket limit: This is the total amount you may pay for an entire year. Anything over this, the insurance company pays regardless. For example, lets say your deductible was $500, co-insurance 30% and out of pocket limit is $5000 for the family and you end up with a bill of 14,000 on your very first visit during a calendar year. In that case, you will pay upto the total of $5000 (including deductible+co-insurance) and insurance company will pay the remaining balance of $9000. After that, you will not pay anything for that whole year (except copays). Plans with higher out of pocket limit may have lower premiums by logic.
PCP (Primary Care Physician) required: THis may not affect cost but important factor to know. Some plans require you to choose a PCP and only use that PCP as your well, PCP. You have to let the comnpany know if you change PCP.
Specialist Referral required: Some plans require you to get referral from your PCP before you can visit a Specialist. This is critical as you cannot go to a specialist on your own in that case.
Hope this helps. Happy to give you more inputs if you need.
[0] https://www.healthcare.gov
Medical underwriting is no longer a thing industry-wide and hasn't been since the beginning of 2014. No matter where you buy your plan, they will not ask about pre-existing conditions.
It's true that the only reason why you'd actually buy through an exchange is to get the subsidies, even if you don't it's worthwhile to check. They offer a pretty comprehensive survey of the companies that offer insurance in your state and roughly how much you'll pay, and you can go to those companies separately and check into their plans they don't offer on the exchange.
Another idea is to find a local insurance broker in your area. They're free to you (the insurance companies pay them) and they'll find you a good plan that fits your needs.
It has vastly improved the health care the poor receive.
I'm not a huge fan of Obamacare, but it is all he could get past the Rebublicans at the time. He tried to push for a sensable solution, but Republicans fought it. I am waiting for anyone to propose a better solution to Obamacare, but keep bill's core requirements.
As to what how for-profit insurance companies have explioted us, while blaming Obamacare; I hope there's a special place in hell for these heathens! In the original Obamacare bill there were measures that would limit rate increases, and out of pocket fees--the Republicans got rid of all of them. I recall them saying, 'Get ride of this language/requirement and we might pass it?"
What I am trying to say is get rid of Obamacare, but replace it with something better. I haven't heard any real alternative plans proposed by the Rebublicans? I though the the Rebublican Doctor(Bobby Jindal) would have a thoughtful, pragmatic plan--yea, he has a plan, but it just sounds like basically going back to the free market system we had before? That worked so well?
But with the Affordable Care Act, individual plans are no longer medically underwritten, so how are those groups helpful?
Based on his experiences I'd rather go directly to an insurer like Oscar.
Prior to ACA, we had my wife and kids on a COBRA plan out of Maryland from when we lived there (God bless Maryland for making COBRA last as long as you want, and making it last even when you leave the state) and me on a separate individual policy. Together they were about as expensive as our current plan, and they had higher deductibles/OOP max and poorer coverage.
Still grateful for the Maryland coverage, though, as I would have had to have a normal job once we moved to FL otherwise.
When you applied for insurance, did they acquire your medical history?
1. http://kff.org/health-reform/perspective/how-buying-insuranc...
2. http://blog.rmhp.org/2013/12/sticker-shock-obamacare-and-the...
PS I haven't noticed much effect due to ACA, except that some services that used to require a co-pay became free. It will be nice not having to worry about pre-existing conditions, too.
The Affordable Care Act has really taken the pain out of insurance when working for yourself. Things like Freelancers Union were almost a necessity before the ACA. Now individuals can buy insurance at competitive rates and without worrying about "pre existing conditions".
Some areas of the country seem to have been better served with the passage of ACA, but much of NC seems in the dark ages. I think we've got one other company that's now serving our county this year, and they're ... 20% more expensive, IIRC.
Granted the deductibles look high, but unless you have ongoing heath issues your generally better off using a higher deductible and putting the difference into a savings account.
PS: Don't forget the high ROI part of health insurance is simple negotiating power, the risk mitigation part is less useful.
Personally, I went with a plan from Oscar (http://hioscar.com). Oscar offers reimbursements for gym memberships, free unlimited access to Teladoc (http://www.teladoc.com/), and Amazon gift cards if you take enough steps per day (tracked by a free Misfit Flash).
Pre-2015, I had insurance with Freelancers Union (https://www.freelancersunion.org/). Their plans are not subsidized, but with some of them you get free, unlimited access to doctors at Freelancers Medical (https://www.freelancersmedical.org/). They have two offices, one in Downtown Brooklyn, and one in the Financial District.
ACA has basically made this a non-issue. Figure out how big of a deductible you can absorb, walk through your state's exchange and find something reasonable. Then (this is the most important part), raise your rate to compensate for your newly legitimate business expense.
I am firmly in the (b) camp, and see yearly medical expenses as the deductible plus premiums. And so, I pay $1500 a month in health insurance premiums, but have a $1500 deductible and $4000 out of pocket max. Yearly cost: $22,000.
So, depending on your health and tolerance for rick, go for a high deductible cheap premium plan OR a high premium low deductible plan.
As a freelancer, premiums CAN be tax deductible (see a CPA to make sure).
It's still about double what we were paying before the ACA, but it's a far cry from the $1500+ premiums some others here are paying.
It may be worth seeing if such a program exists in NYC, and if it would be worth the membership costs.
