Our Covered CA Monthly Premiums Are Going Up 106% In 2018

[stopbush]

Our current monthly premium is $1202. We get $1074 a month in subsidies, making our actual oop $128 per month. Next year, our premium goes up to $1338, but the subsidy stays the same, leaving us with a monthly oop premium of $264.

Notice this slight of hand: Covered CA says our premium is going up $136 a month, “a change of 11.4%.” Er, right, when set against the full premium of $1338 it’s only 11.4%. When compared to what I am paying out of pocket NOW compared to next year, it’s an increase of 106%.

And what do we get for that $16,056 in yearly premiums (before subsidies) for TWO adults aged 63? Well, a $9000 a year deductible per family of two, or $4500 a year for an individual. Office vists: $190 EACH. Urgent care: $190 per visit.

Prescriptions: most are $8-30 for a 3-month supply, but I can get the same rate at Costco without insurance.

Seriously considering dropping insurance next year, crossing our fingers and waiting until Medicare kicks in in 2019.

[MyNameIsKhan]

1. Seriously $190 per office visit as copay? or this is what insurance pays?

You can find a doctor for $75 bucks per visit in the part of CA I live. Also Kaiser gold plan has $20 as copay for office visit.

[stopbush]

5. We have Kaiser. I pay $60 for an office visit at the time of the visit

and am billed an ADDITIONAL $130 for the visit after the fact. I pay that, not insurance.

If I need to see a doctor I visit the doctor I saw when I had a job and was on UHC. They charge only $100 for a visit if you don’t have insurance.

I am on a Kaiser Bronze plan. I really don’t give a shit what an office visit costs on a gold plan as I can’ t afford a fucking gold plan.

[MyNameIsKhan]

7. I live in alameda county and you can find several doctors for $75 per visit

As you said if you are generally healthy basic medications are inexpensive.

[MyNameIsKhan]

9. Sorry to hear you are being charged this much !

I also have Kaiser and most of times PCP will prescribe and renew meds online and I am not billed.

Additionally your annual physical should be covered at no cost, I try to get everything done during this visit.

[Rollo]

18. I'm on Kaiser too, via employer/small business, Gold level

And I had Kaiser charge me for the annual visit because the doc said I asked him some questions about other problems I was having, so it was no longer a preventative visit.

I have filed a complaint with Kaiser about it for being charged for what should have been a free annual preventative care visit, and also for the routine preventative lab testing. Kaiser is taking its own sweet time reviewing the matter.

I actually qualify for Medicare now, but frankly the work plan I have has better benefits, mainly prescription drug costs, than Medicare. The employer subsidizes about 65% of the premiums (75% of Silver), and they are costing me about the same as Kaiser/Medicare Advantage plus Medicare B would cost. I'm thinking however of retiring in 2018 (full SS retirement then) and then we'll see... Not looking forward to the donut hole...

[virgogal]

2. I'm on Medicare and your figures stunned me.

Good health to you.

[SoCalNative]

4. I'm currently in a European country

(but moving back to the US next month) and all of it really astounds me now. Other than a 385 euro a year "deductible" I don't pay anything for doctor or dentist visits or prescriptions. No co-pays, nothing.

[virgogal]

10. Lucky you.

I've been on Medicare for many years and forgot how bad it could be.

My kids are all covered through their employers and the grandkids are all under 26 so they are covered.

[awesomerwb1]

12. You sure you want to move back to this mess?

Get ready to do some work so we can take the country back in 2018!

[SoCalNative]

15. Yep

don't like Holland and tired of paying rent when my house back home is paid for

[awesomerwb1]

21. Makes sense. nt

[MontanaMama]

3. We only had 3 plans

available to us in Montana. We chose the bronze plan at $1322 a month (family of 3). We're not eligible for a subsidy. This plan has a $6000 per person annual deductible so we pay $15,864 in premium plus the $6000 per person. It is highway robbery and the least expensive plan we could get. It is more than my mortgage.

[Doremus]

6. $980/mo with no subsidies

Give that a try sometime. DH and I have been paying it for 10 years. It's not easy but an absolute must due to his recurrent heart problems.

You have it pretty damned good from my perspective.

[BigmanPigman]

8. You might want to do some more research since the new 45 plan

today was announced.
https://www.cbsnews.com/news/trump-signs-health-care-executive-order-live-updates/
https://www.huffingtonpost.com/entry/trump-executive-order-obamacare_us_59de1dbde4b01df09b77ad19?ncid=inblnkushpmg00000009

Also consider that 45 is still not saying whether or not subsidies will continue. I have Covered CA with subsidies, have a serious illness and am 55. The subsidies are a very important factor as far as my situation is concerned.

[taught_me_patience]

11. $190 should be a one hour consult.

More routine visits should be significantly less.

[awesomerwb1]

13. Am I reading this right?

So if I need to go to a dr and I don't have insurance I can find one for $75 to $100 or so for a visit.
But if I had insurance, the doctor would bill my insurance company double that (or more) for the same visit?

[PoliticAverse]

14. And probably the insurance company then negotiates a final payment less than you'd pay cash. n/t

[JoeStuckInOH]

17. Correct. 3 times this year I opted to have a hospital bill ME directly and not send to insurance.

I know my costs had they submitted to insurance would have been 90%-150% higher out of pocket than negotiating a "self-pay" option.

Seriously, many hospitals have what's called "self-pay" options where YOU get billed at a lower rate than it would cost you if they billed insurance and then insurance denied the coverage (bouncing that crazy inflated bill back onto you).

[JoeStuckInOH]

16. My out of pocket premiums stay the same but my deductables are going up over 60%...

I wanted the same level of insurance I'm receiving currently, but to receive the same coverage next year I'll have to select the "High Premium / Low Deductible Plan" for 2018. Also, they changed our prescription coverage and insurance pays NOTHING for prescriptions until the deductible is met. Total bullshit. I feel bad for people in our office that have chronic medications and will have to start forking out 100% cost for necessary pills on January 1st until they've covered their (now 60% higher) deductible.

I can't stand how HR stand in front of us and tells us about all of our great new options next year. They all suck.

Our 2018 Health Plan Offerings.

"high contribution / Low Deductible Plan"
Premium: SAME
Deductible: +60% Higher

"Medium Contribution / medium Deductible"
Premium: 46% cheaper
Deductible: +140% Higher

"Low Contribution / High Deductible"
Premium: 66% cheaper
Deductible: +250% Higher

[Cicada]

19. Did your 2016 adjusted gross income increase compared to 2015?

The amount you pay after subsidy is based on your income. If your income goes up then it is not unreasonable that your share of the premium would go up.

Also I don’t understand what the deductible means. I have a deductible of something like 5000. I pay 50 a doctor visit, 60 for lab tests, maybe 200 a month for prescriptions. That’s all I pay beyond the premium. Yet the full cost of what I get from Kaiser is more than 120,000 per year, according to their statements. That is almost all for one drug I have injected every 4 weeks for arthritis. They say I use up only a tiny amount of my deductible each year. In my case almost everything I spend is not part of the deductible part I must pay for. I don’t understand how the deductible works.

[Rollo]

20. What we really need is Sanders' Universal Health Care (Single Payer) plan...

Someday....


.

[UCmeNdc]

22. Trump is the main cause of this.

Thanks Trump!

[UCmeNdc]

23. Trump has been making premiums higher all along.....

Trump has been undermining the law and its programs since he took office in January, and he has ramped up his efforts in recent weeks in the aftermath of his failure to get the Affordable Care Act repealed by Congress. Earlier Thursday, Trump signed an executive order directing federal agencies to change regulations to allow insurers to sell policies that exclude people with pre-existing conditions and have skimpier benefits than insurance governed by the Affordable Care Act.