ACA enrollment deadline Sunday Jan 31

[Jen and Ashwin]

As budget conscious people, I wanted to let everyone know that the deadline to enroll for health coverage on a state or national marketplace is this Sunday, January 31. The fine for going without health insurance in 2016 has jumped to $695 per adult or 2.5 percent of household income – whichever is higher.

https://www.washingtonpost.com/news...m-oblivious-as-aca-enrollment-deadline-nears/

This post is not intended to debate the politics of the ACA, just for information's sake.

 

[Marionnette]

As budget conscious people, I wanted to let everyone know that the deadline to enroll for health coverage on a state or national marketplace is this Sunday, January 31. The fine for going without health insurance in 2016 has jumped to $695 per adult or 2.5 percent of household income – whichever is higher.

https://www.washingtonpost.com/news...m-oblivious-as-aca-enrollment-deadline-nears/

This post is not intended to debate the politics of the ACA, just for information's sake.

Unfortunately, for some people it is still more affordable to pay the fine than it is to pay the insurance premiums.

 

[Jen and Ashwin]

Unfortunately, for some people it is still more affordable to pay the fine than it is to pay the insurance premiums.

Until they have medical needs.

 

[Marionnette]

Until they have medical needs.

True. But there are a lot of young people age 26+ who have no chronic illnesses and are willing to roll the dice. If I were younger and was weighing whether to pay the one-time fine or spend 3X-4X that amount for insurance that I don't think I'll ever use, guess what I would choose? I'm not saying that it's the wisest choice to go uninsured, I'm just saying that playing the odds is quite common among young twenty-somethings with no dependents.

 

[havaneselover]

True. But there are a lot of young people age 26+ who have no chronic illnesses and are willing to roll the dice. If I were younger and was weighing whether to pay the one-time fine or spend 3X-4X that amount for insurance that I don't think I'll ever use, guess what I would choose? I'm not saying that it's the wisest choice to go uninsured, I'm just saying that playing the odds is quite common among young twenty-somethings with no dependents.

Yep. And no assets to protect.

 

[Jen and Ashwin]

True. But there are a lot of young people age 26+ who have no chronic illnesses and are willing to roll the dice. If I were younger and was weighing whether to pay the one-time fine or spend 3X-4X that amount for insurance that I don't think I'll ever use, guess what I would choose? I'm not saying that it's the wisest choice to go uninsured, I'm just saying that playing the odds is quite common among young twenty-somethings with no dependents.

I would tell these people to buy a catastrophic or bronze plan with a high deductible, but not to go without coverage all together. It will be more than the cost of the fine, but not a ton more and you can continue to get preventative care and other benefits.

 

[Marionnette]

I would tell these people to buy a catastrophic or bronze plan with a high deductible, but not to go without coverage all together. It will be more than the cost of the fine, but not a ton more and you can continue to get preventative care and other benefits.

Again, I see the wisdom of your advice but that's not how a healthy young person is going to see it in a number of cases. The impact of the extra cost is relevant when they aren't concerned with preventive care or "other benefits". All that they see is the price of the fine vs. the price of paying for insurance.

 

[Jen and Ashwin]

Again, I see the wisdom of your advice but that's not how a healthy young person is going to see it in a number of cases. The impact of the extra cost is relevant when they aren't concerned with preventive care or "other benefits". All that they see is the price of the fine vs. the price of paying for insurance.

I think this is an oversimplification. Many young people understand the value of having health insurance and want to have coverage. There are definitely some who don't care, but making a broad generalization isn't helpful.

In a Kaiser Family Foundation pre-ACA study, 74% of California young adults (age 19-34), said that health insurance is something they need. Most people want coverage, it has more to do with the cost than with a blatant disregard for their health.

 

[Marionnette]

Just as a point of illustration. My daughter's boyfriend finished his master's degree a year ago. He is applying for PhD. programs in the area but will have to wait until the next semester to start. In the mean time, he is tutoring through an agency. He's an independent contractor, so he doesn't get any benefits. The young man turned 26 in November.

He's currently paying for a "catastrophic" policy. It has HUGE copays and deductibles. He got sick just after Christmas. Went to his primary care doctor (one of only a few in the area that accepts his insurance). An office visit costs him $50. His prescription plan copay is $25 for generics. He called the doctor earlier this week because the Rx she wrote was ineffective. She refused to call in a stronger antibiotic and insisted on seeing him. $50 more for an office visit and at who knows how much more for his new Rx. So far this month he has spent $100+ on health services ON TOP OF HIS INSURANCE PREMIUM plus the pharmacy costs.

If he had no insurance, he would have seen any physician he chose. He would have paid the customary rate for one office visit and then the retail price for his amoxicillin, plus the price of whatever the second antibiotic will be.

So what did his insurance get him in this case? Negotiated rates with the MD not of his choice (believe me, his insurance paid $0 to the MD for the visit) and a discount on a generic antibiotic at the pharmacy. Did he save any money by having insurance? NO!

His OOP maximum is so high that he will likely never reach it within a year unless he develops a chronic illness. He will continue to pay 40% of any medical bills once he has met his deductible (IF he meets his deductible).

So, you can see why the young and otherwise healthy would see paying for health insurance as a waste of money!

 

[Jen and Ashwin]

Just as a point of illustration. My daughter's boyfriend finished his master's degree a year ago. He is applying for PhD. programs in the area but will have to wait until the next semester to start. In the mean time, he is tutoring through an agency. He's an independent contractor, so he doesn't get any benefits. The young man turned 26 in November.

He's currently paying for a "catastrophic" policy. It has HUGE copays and deductibles. He got sick just after Christmas. Went to his primary care doctor (one of only a few in the area that accepts his insurance). An office visit costs him $50. His prescription plan copay is $25 for generics. He called the doctor earlier this week because the Rx she wrote was ineffective. She refused to call in a stronger antibiotic and insisted on seeing him. $50 more for an office visit and at who knows how much more for his new Rx. So far this month he has spent $100+ on health services ON TOP OF HIS INSURANCE PREMIUM plus the pharmacy costs.

If he had no insurance, he would have seen any physician he chose. He would have paid the customary rate for one office visit and then the retail price for his amoxicillin, plus the price of whatever the second antibiotic will be.

So what did his insurance get him in this case? Negotiated rates with the MD not of his choice (believe me, his insurance paid $0 to the MD for the visit) and a discount on a generic antibiotic at the pharmacy. Did he save any money by having insurance? NO!

His OOP maximum is so high that he will likely never reach it within a year unless he develops a chronic illness. He will continue to pay 40% of any medical bills once he has met his deductible (IF he meets his deductible).

So, you can see why the young and otherwise healthy would see paying for health insurance as a waste of money!

People do get sick and maybe the catastrophic plan doesn't make it cheaper or him to obtain general medical care, but as you say, young people are unlikely to have chronic conditions. They are more likely to be injured (car collision, work related injury, risk taking that leads to injury) than other segments of the population and this is why having some basic coverage is important.

I guess as someone who works in public health, I can't see health insurance as a waste of money. I have seen too much and know too much about the toll that medical debt takes on people, even young people. No one has to get health insurance, they can instead pay the fine and roll the dice. I was simply letting those who might not otherwise be aware that the enrollment deadline was on Sunday know in case that helped them better plan their health decisions.

 

[PerfessorZ]

Those co-pays don't sound so horrible. My company pays through the nose and my co-pays are half that.

 

[Jen and Ashwin]

Those co-pays don't sound so horrible. My company pays through the nose and my co-pays are half that.

I agree with this. I have very good health coverage through my university and my co-pays are $30 for a primary care appointment, $35 for a specialist and $15 for generic medication.

 

[supersnoop]

He's currently paying for a "catastrophic" policy. It has HUGE copays and deductibles. He got sick just after Christmas. Went to his primary care doctor (one of only a few in the area that accepts his insurance). An office visit costs him $50. His prescription plan copay is $25 for generics.

That's not a "catastrophic" policy. A catastrophic policy would have a high deductible and he'd pay the entire doctor bill and full price of the prescriptions.

 

[Jen and Ashwin]

That's not a "catastrophic" policy. A catastrophic policy would have a high deductible and he'd pay the entire doctor bill and full price of the prescriptions.

He likely has a bronze level plan.

Plans in the Marketplace are primarily separated into 4 health plan categories — Bronze, Silver, Gold, or Platinum — based on the percentage the plan pays of the average overall cost of providing essential health benefits to members. The plan category you choose affects the total amount you'll likely spend for essential health benefits during the year. The percentages the plans will spend, on average, are 60% (Bronze), 70% (Silver), 80% (Gold), and 90% (Platinum). This isn't the same as coinsurance, in which you pay a specific percentage of the cost of a specific service.

 

[Marionnette]

Those co-pays don't sound so horrible. My company pays through the nose and my co-pays are half that.

I agree with this. I have very good health coverage through my university and my co-pays are $30 for a primary care appointment, $35 for a specialist and $15 for generic medication.

You both have plans through your employer. Have you looked at the plans available through the exchanges? Especially the ones that are "catastrophic" coverage or bronze level? There's a reason that they are so cheap. It's because the consumer pays the price on the front end instead of the insurance company. High copays. High deductibles. High co-insurance payments. Restrictions as to where you can seek care (one plan actually groups doctors, hospitals and other providers into tiers with superior providers costing a greater copay or co-insurance).

In the case of a car accident (where the auto insurance would pay the medical costs of an injured party with no medical insurance), a work-related injury (where the employer's liability insurance would pay the costs), it doesn't matter if the injured party has health insurance. Their health insurance company would only go after the auto or liability insurance company for reimbursement if the individual had one.

The OOP maximum for an individual under the ACA can not exceed $6850 annually for an individual. That's IN ADDITION to their insurance premiums! And for those cheaper plans, pretty much everything is going to come out of your own pocket first!

 

[Jen and Ashwin]

You both have plans through your employer. Have you looked at the plans available through the exchanges? Especially the ones that are "catastrophic" coverage or bronze level? There's a reason that they are so cheap. It's because the consumer pays the price on the front end instead of the insurance company. High copays. High deductibles. High co-insurance payments. Restrictions as to where you can seek care (one plan actually groups doctors, hospitals and other providers into tiers with superior providers costing a greater copay or co-insurance).

In the case of a car accident (where the auto insurance would pay the medical costs of an injured party with no medical insurance), a work-related injury (where the employer's liability insurance would pay the costs), it doesn't matter if the injured party has health insurance. Their health insurance company would only go after the auto or liability insurance company for reimbursement if the individual had one.

The OOP maximum for an individual under the ACA can not exceed $6850 annually for an individual. That's IN ADDITION to their insurance premiums! And for those cheaper plans, pretty much everything is going to come out of your own pocket first!

I get it. You don't see the value of health insurance. I disagree with what you just wrote because I know that other forms of insurance (car, employer's liability) will not cover the full cost of care nor are you going to like the choice or quality of care any better.

 

[Marionnette]

I get it. You don't see the value of health insurance. I disagree with what you just wrote because I know that other forms of insurance (car, employer's liability) will not cover the full cost of care nor are you going to like the choice or quality of care any better.

I didn't say that I don't see the value of insurance. I pay a butt load every month to cover my family. But I deal with a lot of people who purchased the cheap insurance on the exchanges. Almost every one of them is shocked to learn that the money that they shelled out for those cheap plans, that you seem to think are so wonderful, actually pay zip until the patient has met that huge deductible. So many of them who opted for those cheap plans last year have placed their children on the state plan and have chosen to pay OOP for their own medical care. These are working people who make too little to be able to pay those premiums plus the rent and the PECO bill. A $1400 tax for two adults not carrying health insurance is a lot cheaper in their minds than spending $4800 per year for a plan than only begins to pay something after they have paid another $13,700 for the two of them.

 

[PerfessorZ]

You both have plans through your employer. Have you looked at the plans available through the exchanges? Especially the ones that are "catastrophic" coverage or bronze level? There's a reason that they are so cheap. It's because the consumer pays the price on the front end instead of the insurance company. High copays. High deductibles. High co-insurance payments. Restrictions as to where you can seek care (one plan actually groups doctors, hospitals and other providers into tiers with superior providers costing a greater copay or co-insurance).

I'm confused by what you're arguing. Those copays are pennies compared to what better coverage would cost you per month. That's absolutely ideal insurance for somebody young without serious medical issues - the rates are low because you won't be going to see a doctor or a specialist once a month. This is the same group of people I thought you were saying would rather not carry any insurance at all and pay the penalty. I'm saying that they're getting a lot for their money compared to what I'm getting for what my employer is paying, and I know how much that is. I have co-pays and deductibles, too, and for how much I use it and for how much it costs, your daughter's boyfriend is getting a much better deal.

 

[Jen and Ashwin]

I didn't say that I don't see the value of insurance. I pay a butt load every month to cover my family. But I deal with a lot of people who purchased the cheap insurance on the exchanges. Almost every one of them is shocked to learn that the money that they shelled out for those cheap plans, that you seem to think are so wonderful, actually pay zip until the patient has met that huge deductible. So many of them who opted for those cheap plans last year have placed their children on the state plan and have chosen to pay OOP for their own medical care. These are working people who make too little to be able to pay those premiums plus the rent and the PECO bill. A $1400 tax for two adults not carrying health insurance is a lot cheaper in their minds than spending $4800 per year for a plan than only begins to pay something after they have paid another $13,700 for the two of them.

I do not think that the plans on the exchange are "so wonderful." They vary from state to state and have much different pricing based on location, age, gender, etc. What I do think is that people should educate themselves and decide what is best for them personally. If that is to go without coverage and risk a major medical incident that costs well more than the yearly premium and deductible, then that is their call. I posted this thread just to make people aware of the deadline, in case they had forgot or put off getting insurance until now.

 

[leebee]

A 30 day supply of amoxicillin is $4 at Walmart. Just because he HAS prescription coverage doesn't mean he has to USE it. Also, I'd like to know where he is going that a visit to a doctor is only $50 (you said that's his copay and that his insurance pays nothing towards the doctor's visit, so it seems that he paid the doc $50 for the visit). Last time we took DD to an out-of-network physician, the office visit charge was $285. I know this because we were in Indiana and the doctor didn't take our insurance, so we had to pay OOP and then be reimbursed by the insurance company.