Obamacare Year 3 – TSHTF

Well, reality is hitting the fan.

Just a quick recap – I turn 60 in three weeks, live in North Carolina, continually insured since 1986, rarely see a doctor. This isn’t about me – just to provide a data point for you.

I currently have the most worthless Blue Cross Coverage, which is what I want. For $560 a month, it requires a Health Savings Account, and has a $5000+ deductible before it pays for anything – but it does lock providers into Blue Cross’s reimbursement schedules, even though I pay 100%. Think of it as medical extortion. I sure do.

Healthcare.gov put the prices up online over the weekend. In 2015, there were two providers – Coventry and Blue Cross. For 2016, there are three. Yay for competition. Coventry was acquired by Aetna in 2013, and now Aetna operates under their own name. The new entrant is Obama’s buddy UnitedHealthCare. During the summer, rumors were that UnitedHealthCare wanted to buy Aetna, but that hasn’t happened yet.

So, the comparable Bronze plan from Blue Cross – with an additional $1500 in deductible plus a much narrower Doctor list (basically those that accept Medicaid) rises from $560 a month to $815 a month.

What to do? Looking at the comparison, Blue Cross fell over the cliff. Staying with them with a 45% increase is not an option, no matter what plan I would consider.

North Carolina rejected Medicaid expansion, therefore the state is being punished. As an early retiree, my income is whatever I say it is – being 59 1/2, I face no early withdrawal penalty for pulling money from IRA and SEP accounts – but the income will be taxable as ordinary income, and ultimately influence Obamacare subsidy eligibility.

If I “make” less than $15k, there is no subsidy.
If I “make” $20,000, Obamacare will pay $770 a month.
If I “make” $45,000 a year, Obamacare still pays $550 a month.
If I “make” $50,000 a year, Obamacare pays nothing, because I’m “rich”.

Decisions, decisions.

Repeal and Replace is just around the corner!

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5 Responses to Obamacare Year 3 – TSHTF

  1. Fred Stiening says:

    I got the official offer today. Not only is it $815, the copayment after the $5000 annual deductible is met goes from 0% to 20%, and if the service is “out of network”, the copayment goes from 30% to 50%. One trap being set is just because you went to the ER in an in-network hospital does not mean the doctor treating you is “in network”. You can get hit with huge unexpected expenses, even though you “did the right thing” by having insurance .

  2. Fred Stiening says:

    For those who don’t know, or think I’m too stupid to know – the significance of the Medicaid expansion is that it does away with the asset test. You could be a millionaire and be on Medicaid so long as you keep your “income” low enough.

    However, North Carolina also doesn’t give Medicaid out to the “healthy” people. You have to be disabled, blind, “possibly” pregnant, over 65 or poor with dependent children. Your total “Near cash assets” must not exceed $2,000. The Affordable Care Act Medicaid Expansion does away with the asset test completely, relying only on income tests. Illinois expanded Medicaid, so if I wanted “free” Medicaid, I could just move back to Illinois, as long as I keep my “income” under $15k a year. The catch 22 is most rental places like senior apartments won’t rent to someone with “income” that low, even if I was inclined to become a parasite feeding off the government, which is about as far from what I believe as you could guess. It’s not about me. It’s about the chess game that the Democrats are playing.

  3. Fred Stiening says:

    I’ve BOLDED the sentence that this isn’t about me, for the anonymous person who suggested ways I could defraud Medicaid to get coverage.

  4. briand75 says:

    The most ridiculous thing I have seen. The mush-minded zombies from our school systems think this is the cat’s meow and “only fair” for folks that “can’t afford” health insurance. Well – if we are paying over $1000 a month for insurance, can we afford it? I can’t.

    • Fred Stiening says:

      What’s happened is what people knew would happen. Unless they “risk pool” was a broad swath of the population, the people who could justify being in the pool are only those that have very expensive preexisting conditions. The more the pool shrinks, the bigger the underwriting losses.

      I told my M.D. niece that everything is right on track. 2016 is the year “Obamacare” falls apart – probably with Blue Cross declaring bankruptcy or withdrawing from the individual market.

      That lays the foundation for “not letting a crisis go to waste”. If 10 million people are suddenly without health insurance, and hospitals and other providers are stuck with billions in unpaid bills, even the Republicans will scramble on board a solution. My guess is it will be to shift the people like me into Medicare before age 65.

      I don’t want the coverage and I’m certain the individual underwriting is going to fail. My guestimateis that 50% of the 2015 enrollees will opt out next year and go without insurance in 2016 – especially when they find out the “Penaltax” doesn’t apply to them anyway, because of the exceptions. Not many 20ish couples just starting their first jobs have $600 a month to pay for Obamacare bronze policies that cover nothing, for problems they don’t have.

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