Health insurance - healthcare.gov - insane monthly premiums and deductables

[OnTheGo]

Hey all. Has anybody considered how they will be covered for health insurance, which is mandatory for all people since Obamacare?

Unless you are covered by your employer from day one, and the cover is considered sufficient, you will have to buy your own plan. Furthermore, most employers now exclude family members from being covered since it has become too costly for them since Obamacare. The same applies to part-time workers ... anyone working for less than 30 hours per week will most likely not receive any employer healthcare benefits?

So I don't know about you, but unless you have that golden job opportunity waiting for you on your arrival from day one, it seems like a crazy monthly expense, especially when you have not yet settled and no income stream from day one.

https://www.healthcare.gov/find-premium-estimates/

So for myself and my wife, I just did a test run and just entered Florida (Miami-Dade) and our individual age.

The premiums ranged from around $500 to $800 per month for the two of us, but with an annual deductible/max out of pocket ranging from $8,000 to $12,000 !!!

Then I entered "some" income (of $25,000 reflecting a move to the US in the middle of a year and the uncertainty) and it showed the premiums with TAX CREDITS deducted...resulting in premimums ranging from 0 (null) to about $100 per month for the two of us.

Based on a household size of two and income of $25,000, you may qualify for a $516/month tax credit you can choose to apply to your premium for these plans. This tax credit has been applied to the premiums below.

So it seems that the alleviation comes from tax credits. I haven't played with it further, but just wondering what others have found out to understand this health care system...

PS: Just also found this subsidy calculator - http://kff.org/interactive/subsidy-calculator/

So I just entered the same info ...

results
The information below is about subsidized exchange coverage. Note that subsidies are only available for people purchasing coverage on their own in the exchange (not through an employer). Depending on your state's eligibility criteria, you or some members of your family may qualify for Medicaid.

Household income in 2014:161% of poverty levelMaximum % of income you have to pay for the premium, if eligible for a subsidy:4.51% Health Insurance premium in 2014 (for a silver plan, before tax credit):$7,344 per year You could receive a government tax credit subsidy of up to:$6,216 per year
(which covers 85% of the overall premium) Amount you pay for the premium:$1,129 per year
(which equals 4.51% of your household income and covers 15% of the overall premium)


Then I changed the income from $25,000 to $50,000:

results
The information below is about subsidized exchange coverage. Note that subsidies are only available for people purchasing coverage on their own in the exchange (not through an employer). Depending on your state's eligibility criteria, you or some members of your family may qualify for Medicaid.

Household income in 2014:322% of poverty levelMaximum % of income you have to pay for the premium, if eligible for a subsidy:9.5% Health Insurance premium in 2014 (for a silver plan, before tax credit):$7,344 per year You could receive a government tax credit subsidy of up to:$2,594 per year
(which covers 35% of the overall premium) Amount you pay for the premium:$4,750 per year
(which equals 9.5% of your household income and covers 65% of the overall premium)

 

[SusieQQQ]

I guess it depends what you're used to. Our current medical insurance for the family is almost $500 a month in our home country. So those numbers don't look completely crazy, but for someone coming from a country with free or heavily subsidised public healthcare yes it's a lot. My cousin in the US, who is self-employed, pays about $600 a month for his family (wife and 3 kids). I don't know details of deductibles on their plan though.

Presumably the chances of your employer providing coverage rise as income levels do, which I suppose is the reason behind the lower subsidy as income increases.

But yeah, the healthcare angle is a shambles in the US.

 

[Britsimon]

The premiums you are quoting may sound insane to you - but they are cheaper options than some (most) plans that were available previously. That is why 30+ million people had no health insurance.

When I received a job offer the company offered a few options for coverage. The plan I wanted (because it had good coverage and little/no exposure for out of pocket expenses would be partially covered by the employer. The cost of the plan was just over 24k a year (Two adults and a child) of which I was going to pay about 8k per year.

Health insurance in the USA is expensive - at least ACA (Obamacare) offers some option for those that cannot afford much - and as you point out, people on low incomes will generally get subsidies.

 

[OnTheGo]

Yep. We are used to two systems of public health insurance.
A - Australia: Medicare for all. Cost is: 1.5 to 3% of your annual income! If there is no income, then you don't pay but are still insured. While the public health care system may not be perfect, I have not experienced any other in another country that is so affordable and gives you at least cover for basic health needs and emergencies. People can opt to sign up for private health insurance on top of this, to boost their level of cover and service, and those on incomes above certain thresholds have the choice of paying the higher contribution (3%), or sign up for a private health insurance in order to only pay the lower contribution (1.5%)...and have better coverage anyway.

B - Germany: Health insurance is Government controlled and is about 15.5% of someone's income. If you are employed, the employer is legally obliged to pay half of that and deduct your half from your pay. If you earn above certain thresholds or are self employed, you can choose whether you want to get insurance from the Government controlled health insurance providers, or in fact take out private health insurance, which gives you better services. There is no such thing as deductibles with the Government controlled health insurance providers and most of the general medicine will be fully paid for, so you get your prescription and you get the medicine at any pharmacy for free. There is also no such thing as a co-payments for doctor's visits, either.

 

[SusieQQQ]

Re Germany is there a cap, or does it just keep rising as your income does?

Despite being on one of the best medical insurances in my country, my co-payments can be high, because private doctors always charge in excess of the rates they will refund. Public healthcare is a shambles here. A friend of my mom had a stroke and the ambulance took 5 hours to arrive.

 

[SusieQQQ]

But, again I've never really understood why Australians would feel the need to move unless they had say a great job lined up, precisely because of things like this.

 

[OnTheGo]

Re Germany is there a cap, or does it just keep rising as your income does?

Despite being on one of the best medical insurances in my country, my co-payments can be high, because private doctors always charge in excess of the rates they will refund. Public healthcare is a shambles here. A friend of my mom had a stroke and the ambulance took 5 hours to arrive.

Capped at an income level of around 4,000 Euros ($5,500) per month, i.e. no further increase after that and you can decide whether you want to stay in one of the Govt controlled insurance companies, or move onto fully private health insurance.

 

[OnTheGo]

But, again I've never really understood why Australians would feel the need to move unless they had say a great job lined up, precisely because of things like this.

To be honest, in hindsight ... having moved back to Europe after many years in AUS, and seeing what Europe has become (something we only realized after being back), I am so grateful for having that option to always be able to go back (as we took on citizenship and are now dual citizens).

Something drove us to come back here (EU), I think it was the feeling of being so far away from family (it's >20 hours on planes to get here). However, we feel that we no longer fit in - our values and 'world view' has changed too much in order to feel 'home'.
So yes, we would have moved back to AUS by now, but then we were selected in the DV lottery...where we entered twice while being back (without really knowing the consequences of actually moving to the US). Besides, things are not all pretty in Australia, either...it is a very expensive place to live these days.

Obviously, when you get selected in the DV lottery, you can't help but be excited!! You are visualizing a great lifestyle and all the new opportunities that will come with a move to a new country. It would be ideal for us in that it is the same language and similar culture to Australia, but only half the distance to family back in Europe.

Then you start doing some initial research, to see what life would be like for you over there (I don't mean the culture, which will be easy for us). There are things like cost of living, property prices, rents, grocery prices, demographics, crime rates, taxes, health insurance ... and the complexity of comparing these things between different states and cities inside the US.

So the bottom line is: We all come from different walks of life and have different expectations. I admit that there are days where we feel we should take up an opportunity of moving to the US, and then we have days where we are unsure and think it would be better for us in AUS.

 

[Vichel]

US Healthcare is expensive, yes. And also complex and confusing. Make sure you're aware of the whole in-network, out-network booby trap. You can be insured up to your ears with the best coverage but if you get care outside the network, you'll pay for it all yourself. And even if you do get in-network coverage, there'll often be extra bills you'll still have to pay for.

The health insurance companies of the US have spent the last several years offloading as much of the cost of healthcare back to the user with things like co-pays, co-insurance, balance-billing, etc. Obamacare doesn't change that much. Obamacare took a few baby steps and has some good things in it but it didn't go nearly far enough and doesn't resolve a lot of the cost-offloading. Yes, they can't deny people with pre-existing conditions anymore but these profit-driven insurance companies won't suffer their bottom lines for that.

 

[Vichel]

But, again I've never really understood why Australians would feel the need to move unless they had say a great job lined up, precisely because of things like this.

Taking into account the cost of living in Oz, at worst we'll break even by living in the US. We came here not having to flee anything, nor because we expect Nirvana here. We're adventurous and curious and want something different in life. New experiences. I've lived in 3 different countries now and I'm open to a 4th one day

 

[franko]

Taking into account the cost of living in Oz, at worst we'll break even by living in the US. We came here not having to flee anything, nor because we expect Nirvana here. We're adventurous and curious and want something different in life. New experiences. I've lived in 3 different countries now and I'm open to a 4th one day

Same here! We will probably break even too in the US. I would like to try and see for myself. Company paid long term assignments don't count.

I grew up in a country with "free" health care and I am pretty happy with the UK system (I think everyone has the right to get healthcare) and I think the fact that American system is based on private companies making money on people's lives is pretty sick (pun intended). Pre existing condition stuff was just heartless!!!

For me nut-jobs with guns and healthcare are the biggest worry if it comes to life in America. Hopefully, initially I will transfer within my company and they offer pretty good coverage. It is an old school corp with good benefits so I might be safe for a while

 

[OnTheGo]

US Healthcare is expensive, yes. And also complex and confusing. Make sure you're aware of the whole in-network, out-network booby trap. You can be insured up to your ears with the best coverage but if you get care outside the network, you'll pay for it all yourself. And even if you do get in-network coverage, there'll often be extra bills you'll still have to pay for.

The health insurance companies of the US have spent the last several years offloading as much of the cost of healthcare back to the user with things like co-pays, co-insurance, balance-billing, etc. Obamacare doesn't change that much. Obamacare took a few baby steps and has some good things in it but it didn't go nearly far enough and doesn't resolve a lot of the cost-offloading. Yes, they can't deny people with pre-existing conditions anymore but these profit-driven insurance companies won't suffer their bottom lines for that.

Thanks Vichel. May I ask what provider you are with and what your monthly premium and annual deductible turns out to be?
Or does an employer take care of that for you?

We're adventurous and curious and want something different in life. New experiences. I've lived in 3 different countries now and I'm open to a 4th one day

Yep, I could sign that - lol, even though I hope that we would find our place to settle for good.
PS: Living in the USA would be country number 4 for me, and number 5 for my wife

 

[OnTheGo]

BTW - I was thinking of signing up with an expat health insurance plan for the first year or so ... does anyone know if this would satisfy the requirement that everyone is required to have health insurance (or face penalties) while being a LPR there? The expat health insurance plans I encountered were cheaper and provided way better cover than anything available in the USA ..

​Here is another article on Obamacare:Source: http://www.thenewamerican.com/usnew...more-insurance-cancellations-than-enrollments

...if the new healthcare scheme proves to be a total disaster, as many feel it already is, that may just pave the way for a completely government-run "single-payer" system like many European countries employ. Some analysts feel that this may have been the plan all along, in fact.

Actually - this key sentence is what I have been thinking all along since the controversy surrounding Obamacare...


...it goes on like this:

Either way, such massive government intrusion into Americans' health decisions is unconstitutional and will cause economic hardship and lower-quality care for many people.

Not sure that I would agree with that last statement, because from what I experienced there is less economic hardship and stress and better affordable care under a completely government-run simple "single-payer" system just like in Australia (and in Canada I believe). In most of Europe, however it is totally over-regulated, inefficient and wastes too much money on administration alone.


1/24/2013: All health insurance providers downgraded by Moodys due to Obamacare.