California Health Insurance Exchanges (Obamacare) real numbers

[SHRED]

How does $140 per month premium for a couple sound? We are looking at a bit more as that $33K is a low-ball estimate on my part.

Here is my question (and answer) I posed to the organization setting up the California 2014 exchange pool:

http://www.cahba.com/advice/2012/12/subsidized_premium_example.html

This is thrilling news for us...all of us.

[kestrel91316]

1. That $140/mo will probably get you a policy that only pays 50% of medical costs.

So you'll still wind up bankrupt if you get sick or injured.

This is CA. Decent policies can't be had here for under about $700/mo for ONE PERSON.

[SHRED]

2. you didn't read the answer?

Answer: An annual taxable income of $33,000 for a 2-person family is equivalent to about 200% of the Federal Poverty Level (FPL) in 2014. Assume that your monthly unsubsidized premium is estimated at $700 for a Silver Level Coinsurance Plan ($1000 deductible, 70% coinsurance, and $5,500 maximum out of pocket). Applying the same subsidized percentage as the 4-person family, your subsidy will cover 80% of your premium, leaving you with a net monthly cost of $140. (I’m estimating but I’m not too far off.)

In addition to the premium subsidy, you will qualify for cost-sharing reductions. What that means to you is lower out-of-pocket maximums - $2750 rather than $5500 - giving your plan an actuarial value of 79% rather that 71%.


Also:

Standardized Coverage
Individuals and families can choose between four levels of Covered California qualified health plans — bronze, silver, gold, or platinum — plus catastrophic coverage available for people younger than 30.

Platinum: Highest premium cost. Covers 90 percent actuarial value.
Gold: Covers 80 percent actuarial value.
Silver: Covers 70 percent actuarial value.
Bronze: Lowest premium cost. Covers 60 percent actuarial value.
Catastrophic: High deductible and low premium cost, available in the individual market only for people younger than 30. Also pays for three primary care visits.

http://www.cahba.com/exchange/individuals.htm

[kestrel91316]

4. I guess I am having trouble reconciling the theoretical out-of-pocket maximums

with what I know about existing cheap policies and how little they actually pay out.

I think once ACA is fully implemented in 2014, actual premiums in the exchange are going to be so high that, even with subsidies, people are going to get stuck with HUGE costs that make it impossible for them to actually use their policies for medical care.

[pinto]

5. Check out the website for an estimate that fits your situation -

http://www.cahba.com/exchange/individuals.htm

There are other resources for info. I think a search for Affordable Care Act would be a good start. Haven't looked at it recently, but assume you can get more current info there. (aside) I always start with the official sources - us.gov or ca.gov - as a reliable start.

[pinto]

3. The estimates are based on Health Insurance Exchanges under Obamacare. Not today's

free-for-all situation. Two different set of parameters. One has some pricing regulation / subsidies, as seen in the example. The other is a whatever the market will bear insurance model.