OT: Obamacare… Don’t say we didn’t warn you…

[no_such_reality]

I’m still worried about the expense curve between ages 55-65.

That silver/enhanced silver/gold plan is a little squirrely. If you’re really expecting a hospital visit, then Platinum may be more cost effective. The silver has a deductible and the gold doesn’t and the cost difference is the amount the deductible. Silver has a higher primary care visit but a lower brand drug expense after a $250/deductible. Then there are minor difference in the cost of certain coverage items.

[bearishgurl]

[quote=no_such_reality]I’m still worried about the expense curve between ages 55-65.

That silver/enhanced silver/gold plan is a little squirrely. If you’re really expecting a hospital visit, then Platinum may be more cost effective. The silver has a deductible and the gold doesn’t and the cost difference is the amount the deductible. Silver has a higher primary care visit but a lower brand drug expense after a $250/deductible. Then there are minor difference in the cost of certain coverage items.[/quote]

I looked at this also, nsr, I’m in that age group and the details are a bit sketchy at this point. The SD broker I talked to back at the end of June told me that I may very well qualify for the Platinum Plan for $212-$222 mo out-of-pocket based upon the cursory data I gave him. I’ve got to look at the “Enhanced Silver” (not sure if I can borderline-qualify), Silver, Gold and Platinum plan differences a little more closely.

I don’t really know if the two CA premium PPO carriers, Anthem Blue Cross and Blue Shield of CA will be administering the “Enhanced Silver” Plans, which are just a step up from MediCal/CMS (which will be administered my Molina Healthcare). In addition, I cannot use Sharp Health Plan or Anthem EPO because they do not have out-of-network coverage and I am in rural areas out of state for several days or weeks each year. We do not yet know which of the plans on Covered CA these two plans will administer. In any case, I will only choose a PPO and am less concerned about the deductible as ALL of them on CoveredCA are lower than my current deductible plus coinsurance.

I’ve recently had to fill two prescriptions where I was prescribed brand names but due to the brand names going to cost me 10-15 times as much as the “equivalent” generic, I had the pharmacist try to get permission from my drs to fill it generic. My drs did not want to write the generic prescription but verbally did so to the pharmacy at my request. I don’t really know if generics are inferior or not. I guess it depends on what it is. And of course, for many drugs, there is no substitute generic.

I was paying just $318 earlier this year out-of-pocket for my healthcare premium until I decided to formally “retire” to get my healthcare allowance started. After I did so, my premium went wa-a-a-ay up. So $212 to $222 after tax credits and HC allowance (versus ~$80 for an “enhanced silver plan”) won’t kill me and will likely be worth it in the long run.

It has been my experience that you pay for exactly what you get in this life.

[SK in CV]

[quote=spdrun]The real question is “why was the Obamacare law written in such a fucking boneheadedly stupid fashion?”

Instead of making subsidies end at 400% of FPL, they should have gradually tapered subsidies to zero depending on family income, number of dependents, etc[/quote]

It is gradually tapered.

[no_such_reality]

[quote=SK in CV][quote=spdrun]The real question is “why was the Obamacare law written in such a fucking boneheadedly stupid fashion?”

Instead of making subsidies end at 400% of FPL, they should have gradually tapered subsidies to zero depending on family income, number of dependents, etc[/quote]

It is gradually tapered.[/quote]

Not really, at 299% of FPL, you get a $986/month Tax credit, at 399%, you get $863/month credit, at 400% FPL, you get $0.

IOW, two 64 year olds making $62,039/year get a $863/month credit where as those same two at $62,040/yr, get $0/month credit.

The benefits taper much better in the 100% to 200% FPL range, but a quick cliff shows up at the higher ages for 400% and it’s a $5000-$7000/year difference.

The curve is basically designed so that 10% of your income is health care premiums and then hits a cliff at 400% FPL, where it can jump to 26% for a $1 income difference.

[SK in CV]

[quote=no_such_reality]
Not really, at 299% of FPL, you get a $986/month Tax credit, at 399%, you get $863/month credit, at 400% FPL, you get $0.

IOW, two 64 year olds making $62,039/year get a $863/month credit where as those same two at $62,040/yr, get $0/month credit.

The benefits taper much better in the 100% to 200% FPL range, but a quick cliff shows up at the higher ages for 400% and it’s a $5000-$7000/year difference.

The curve is basically designed so that 10% of your income is health care premiums and then hits a cliff at 400% FPL, where it can jump to 26% for a $1 income difference.[/quote]

There is that “drop off a cliff” thing at the 400% of FPL. They screwed up when they attempted to integrate it with the maximum % of income. It’s tapered below that level.

[bearishgurl]

[quote=no_such_reality][quote=SK in CV][quote=spdrun]The real question is “why was the Obamacare law written in such a fucking boneheadedly stupid fashion?”

Instead of making subsidies end at 400% of FPL, they should have gradually tapered subsidies to zero depending on family income, number of dependents, etc[/quote]

It is gradually tapered.[/quote]

Not really, at 299% of FPL, you get a $986/month Tax credit, at 399%, you get $863/month credit, at 400% FPL, you get $0.

IOW, two 64 year olds making $62,039/year get a $863/month credit where as those same two at $62,040/yr, get $0/month credit.

The benefits taper much better in the 100% to 200% FPL range, but a quick cliff shows up at the higher ages for 400% and it’s a $5000-$7000/year difference.[/quote]

Regardless whether an applicant can qualify for any subsidies at all, Covered CA premiums are HUGE improvement from what the individual plans are currently charging. I know a 62 yo female in SD who is in GREAT shape and currently paying over $1100 mo for indiv coverage. She will undoubtedly do MUCH BETTER on the exchange.

Other states premiums are lower than CoveredCA, but they do not necessarily correlate to a state’s perceived level of cost of living. Since the carriers themselves did the pricing, the exchange pricing is based upon the usage level of the various age groups in different states. For example, some states have a much higher percentage of lifetime smokers than does CA and also higher levels of obesity, diabetes and heart disease due to regional diets and cultural habits and traditions.

[FlyerInHi]

GE and IBM and big companies ending retiree health benefits has been a gradual shift for a long time. It would have happened with or without obamacare.

Retirees should be so lucky that there is a a fallback different than being left out in the cold.

I have a relative who is about to retire from IBM in New York after about 40 years. We talk about it all the time. There is a seniority level. The more recent employees get different benefits than decades long employees.

[FlyerInHi]

Someone said earlier that linking employment to insurance is bad. I agree.

That the link discourages mobility in the economy, especially for people who have families and medical conditions.

[bearishgurl]

[quote=FlyerInHi]GE and IBM and big companies ending retiree health benefits has been a gradual shift for a long time. It would have happened with or without obamacare.

Retirees should be so lucky that there is a a fallback different than being left out in the cold.

I have a relative who is about to retire from IBM in New York after about 40 years. We talk about it all the time. There is a seniority level. The more recent employees get different benefits than decades long employees.[/quote]

Medicare Part B, MediGap Coverage and Part D (Prescription Coverage) combined are a LOT cheaper per month than a comprehensive health plan for a 50-65 yo or even a HDHP (which, except for the “Bronze Plan” are now going away).

I have an Aetna Medicare Supplement Chart dtd 1/1/13 in front of me showing premiums as low as $90 mo (Plan “N”) to $129.60 mo (Plan “F”) for age 65 living in all SoCal zip codes. They charge $107.48 to $110.06 for Medicare Part B.

The 2013 Aetna Medicare Premier RX Chart (part D) shows premiums from $86.20 to $122.40 for SoCal ($118.40 mo in SD County). For example, generic drugs are $5 – $33 and preferred brand-name drugs are $45. Their annual drug-coverage cap is a generous $4750.

The total 2013 Part B/D premium PLUS the Plan “F” supplement (the best one) in SD County costs $355.48 mo ($107.48 + $129.60 + $118.40) for a 65 yo.

SoCal is a fairly high-cost region for medical costs. It can’t cost those companies in the OP THAT MUCH MORE, if any more than SoCal for Part B/D coverage plus Medigap coverage. I agree that the move to dump these retirees into the marketplace with an allowance was just to prevent them from absorbing any future rate shocks (just in case “Obamacare” blows up in smoke and more revenue from the Medicare programs are sought to make up the difference) :=0

Nearly all the big carriers offer a Medicare Advantage Plan (Part C, which includes Parts B, D and Medigap coverage) in the large metropolitan areas, which have slightly higher premiums but appear to have too many built-in constraints and gatekeepers in my opinion … they work kind of like “Tricare for Life.” However, the patient doesn’t have to fool around with medical bills because they never see any.

In any case, I’m going to “go away” to a rural-ish area where these types of plans aren’t available.

(This posted was slightly edited later when I discovered I read the Medicare Supplement chart wrong.)

[livinincali]

[quote=FlyerInHi]Someone said earlier that linking employment to insurance is bad. I agree.

That the link discourages mobility in the economy, especially for people who have families and medical conditions.[/quote]

So you’d probably agree that defined benefit pension pensions do the same thing correct?

[SK in CV]

[quote=livinincali][quote=FlyerInHi]Someone said earlier that linking employment to insurance is bad. I agree.

That the link discourages mobility in the economy, especially for people who have families and medical conditions.[/quote]

So you’d probably agree that defined benefit pension pensions do the same thing correct?[/quote]

I wouldn’t. The two have almost no similarity. You can separate from an employer and defined benefit pension plans remain intact (to the extent vested). Many allow for an immediate rollover to another plan. But they never disappear so long as the employer is following the law and funding the plan. Which means defined benefit plans are identical to defined contribution plans in that respect. Employer paid medical insurance disappears upon separation.

[Anonymous]

What’s the advantage of a system where employees have any financial ties to a former employer?

Many of the problems in the “retirement” systems would just go away if we got rid of the notion of “retirement savings.” It’s all really just “savings.”

There’s really no reason for employers to be in the health insurance business, even if they simply outsource it, as most do.

Likewise, there’s no good reason for employers to be in the retirement savings/investment business. This is particularly true for government as an employer.

One’s employer, health care provider, and long-term investments are separate concerns that should be handled be separate entities. The notion of mixing all these things together is a late 20th century phenomenon that needs to go away.

Note that I don’t see issues with government being in the insurance business – e.g. Social Security and public health care. Insurance systems work better with scale, and there is no bigger scale than the federal government. But there are way too many issues with government being in the investment business.

[FlyerInHi]

I just got an email from someone saying Obamacare sucks with a link to a huffington post article reporting that trader joes is cutting health insurance for part time employees

Obamacare sucks or trader joes sucks? I think more the latter.

The real policy issue is that health care costs us all a society.

The real money is being spent on emergency services and end of life care. If everyone has regular checkups and is healthy, costs will go down.

I’ve known many people in between jobs with benefits who did without health insurance for years. Their health deteriorated during those years. Total health care costs are a function of the general health of the population.

[no_such_reality]

[quote]”Depending on income you may earn outside of Trader Joe’s” — i.e., another job — “we believe that with the $500 from Trader Joe’s and the tax credits available under the ACA, many of you should be able to obtain health care coverage at very little if any net cost to you,” Bane wrote in the memo.[/quote]

Actually, much more cost effective for Trader Joes to let the government pick them up. I just punched it into CoveredCA.com and assumed $18K/yr in income (29 hours a week at $12) and came up with a 87% silver plan for $63 a month. Of which Trader Joes is kicking in $500.

Basically, out of pocket cranks in at $20/month for an 87% of costs health coverage.

[bearishgurl]

[quote=no_such_reality][quote]”Depending on income you may earn outside of Trader Joe’s” — i.e., another job — “we believe that with the $500 from Trader Joe’s and the tax credits available under the ACA, many of you should be able to obtain health care coverage at very little if any net cost to you,” Bane wrote in the memo.[/quote]

Actually, much more cost effective for Trader Joes to let the government pick them up. I just punched it into CoveredCA.com and assumed $18K/yr in income (29 hours a week at $12) and came up with a 87% silver plan for $63 a month. Of which Trader Joes is kicking in $500.

Basically, out of pocket cranks in at $20/month for an 87% of costs health coverage.[/quote]

What age of employee did you punch into the website?

And how are you figuring that the “out-of-pocket” for an “87% Silver Plan member” will only be $20 month?

[Author]

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