# Health Insurance



## BrianGSDTexoma (Sep 30, 2020)

I am thinking of pulling the plug on work when I turn 60 next year.  So tired of the 60 mile commute into Dallas 5 days a week and working with Heavy metals.  Is anybody getting health insurance through healthcare.gov?  I guess its Obama care.  From what I can tell if income less than $48000 for single person you get around a $850 monthly credit and would end up costing me about $270 a month.


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## uncle eddie (Sep 30, 2020)

I used to live in Mansfield and commuted to downtown Dallas - don't miss the commute one bit!
My 30 y.o. son used Medi-Share for a while to get off Obama-care (he is self-employed) ... https://mychristiancare.org/medi-share/
Obama-care has ridiculous deductibles from what I recall.  It is more or less catastrophic insurance only.


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## chilerelleno (Sep 30, 2020)

And if Trump gets re-elected and he gets his wish of doing away with the unconstitutional Obamacare... Well then, it won't be there, will it.


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## chef jimmyj (Sep 30, 2020)

Obamacare will be history if Trump re-elected. My wife had it years ago,  it was horrible... JJ


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## JC in GB (Sep 30, 2020)

chilerelleno said:


> And if Trump gets re-elected and he gets his wish of doing away with the unconstitutional Obamacare... Well then, it won't be there, will it.



He won't need to get re-elected.  The new 6-3 SCOTUS will kill off the ACA effectively tossing over 20 million Americans off of health insurance and to the wolves.  The ACA has flaws but we all get sick and we all need health care.  Why should it be financial suicide to seek care?  I have worked and had private insurance most of my adult life.  I can easily see that the only thing standing between me and penury even with insurance is not being sick for too long.  There is a better way and we need to implement it.  And just like that, I broke my one rule for writing on this forum.


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## SmokinAl (Sep 30, 2020)

I never had health insurance until I turned 65, and got Medicare. If we got sick or needed an operation you just had to pay upfront, but you got about an 80% discount over what they charge the health insurance companies. Over those 65 years I saved thousands of dollars by not having health insurance, and I think it made me live a healthier life style, so as not to get sick. I never had any problems, but Judy had some female problems that required an operation, & she also had a knee replacement. Still I am way ahead. Now that I have Medicare, everything is just about free. Hope this doesn’t change with the election.
Al


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## PulledPorkSandwich (Sep 30, 2020)

My wife and I were forced onto Obamacare when I stopped working full time.  Initially, you could get a "PPO" policy here in the DFW metroplex under Obamacare.  Price and deductibles were very high unless you had little or no income.  I was lucky in that respect since I had saved a substantial amount of after tax money and had little or no taxable income while I was on Obamacare.  As a result, my premiums were high but affordable for me, but the deductibles were outrageous -- around $5K per year for the two of us.  Also, I had to give up my doctors -- they refused to take Obamacare insurance.

In short, because of the high deductibles, my Obamacare policy paid for almost none of our medical bills.

The last couple years I was on Obamacare we were forced onto an HMO policy as opposed to a PPO.  It was very hard to find a doctor to serve as primary care physician (PCP), and we needed a referral from the PCP to see specialists.

We've been on Medicare now for two years.  We find it much better than Obamacare.  I hope it lasts.

I'm not sure if Obamacare has gotten any better since we went to Medicare.  While we had it, it was absolutely terrible insurance.


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## sandyut (Sep 30, 2020)

BrianGSDTexoma
  I am about to be in the same boat a couple years earlier.  i found a local ins. broker and chatted with them for ideas.  the one here does not charge - they are paid commission.  But he was a wealth of info and helped us get both short and long term plans started.  COBRA for us is less than open market  ins.  and we can carry that for the first 18 months (its about $400/pp/per month).  after that my wife will be Medicare eligible but i wont.  I can get almost the same plan i have now at the same university system through them directly for a little more.  I am sure this varies alot by state, but if you like a healthcare system, see if they offer a plan.  google will get you a lot of sellers and such and it takes a little searching to find what you need IMO.  heathcare.gov does get you to the list of ins companies in your state/area tho.


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## sandyut (Sep 30, 2020)

took me a few tries to recall this link..  Enroll365 go that link from my employer.  it helped find some options.

let me know what you find.


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## BrianGSDTexoma (Sep 30, 2020)

Thanks for the idea's.  I trying out if I can really afford to do this.  You never know how much time you have left and I don't want to spend it all working!


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## thirdeye (Sep 30, 2020)

Brian Trommater said:


> I am thinking of pulling the plug on work when I turn 60 next year.  So tired of the 60 mile commute into Dallas 5 days a week and working with Heavy metals.  Is anybody getting health insurance through healthcare.gov?  I guess its Obama care.  From what I can tell if income less than $48000 for single person you get around a $850 monthly credit and would end up costing me about $270 a month.



I guess I'll be the odd man out.  I've been on ACA for 3 years and have 15 months before going on Medicare.  The open enrollment starts November 1, and insurance providers lock in a rate contract with the government around October 15, then start selling policies. Once that happens ACA  should live another year since funds are allocated. If Trump does come out with a better and cheaper plan it would be easy enough to transition over to that, but with 30 million people using ACA, this will take some time.

I have no issues with the plan or my insurance provider. We chose a plan which  was $1500 family deductible and when Mrs~t~ moved to Medicare it went to $750 for only me. The credit was between $3400 and $3600 per month (it's based on income), so our premium was $0.  We only have one ACA provider in the state (Blue Cross) which every healthcare provider accepts.  So, I kept my same doc's, and same pharmacy.  We did buy a rider for vision and dental.   Looking at the numbers and using the cost of a non-ACA policy from Blue Cross* without* the ACA premium, I have saved $120,000 so far and when I move to Medicare the savings will be around $150,000.

Now, for the rest of the story.  You need to plan for retirement, and part of that planning is insurance costs.  The ACA only cares about your income, which you estimate based on a number of factors. Your net worth is not a factor for eligibility.  So, for a starting place.... drag out your IRS 1040s and look at line 7 on the newer form, or line 37 on the older forms, 3 or 4 years of returns should be fine.  This is your AGI (or MAGI) which is your adjusted gross income, or modified adjusted gross income. Everything before the AGI line counts, everything after the AGI line doesn't count as income.  There is a slot limit you must fit into, around $11,000 for the minimum *family income*, and around $65,000 for the maximum *family income*.  If you are between those numbers you qualify.  I suspect if you are still working, your income is more than the maximum, so back out your income from your job, and see how that affects your AGI.   Your goal is to remain in the slot limit.  If you go under, and have a reason, you get a second chance next year.  If you go over, even by $1, you loose eligibility and have to repay all the credits.  Like $37,000 worth.  So it's really important to make a good estimate of what your income in retirement will be. If things change, you call the ACA and modify your estimated income. A big change may affect the credit, so they apply that beginning the next month.  If you look to be coming in under the minimum, you can take a one-time withdrawal from your IRA in December.  *Income is family income, *so even if your spouse is still working and insured through work, her income counts and appears as a part of your AGI.  If you or your spouse goes on Medicare, and decides to start taking Social Security.... that is also income, and may put you over the maximum limit.

Our plan was to accumulate a comfortable amount of cash before retiring, not take any distributions from IRA's (Roth IRAs are exempt), and not take Social Security because these things count as income and raise your AGI. I have some investment property that I knew I would hold (if I sold it, any profit is income) and my remaining income is all royalties, interest, dividends and capital gains on investments.  You should get a general idea of any int, div, cap gains from your old 1040 forms.  I track this information from monthly statements during the year, just so there are no surprises.

For starters.... Create an account at healthcare.gov then run some sample scenarios. The first few pages are general info, then you get to the sections on plans. There are Bronze, Silver, and Gold plans.... and sub-plans under each one. You basically pick a deductible and the details you want (like $5 prescriptions) and the site calculates your credit and premium cost. You can save each scenario and compare it with another.  As you enter different income amounts, it shows how the credit and premium is affected. There are insurance advisors out there, we did all the groundwork first, and had a plan selected, then went in for a 2-hour meeting which cost $150.  They confirmed all our information.  Normally the fees are in the $400 range if the advisors start from scratch.  You also want to visit with your financial advisor.  We rolled over 401Ks to self directed IRA s and I converted all bonds to CD ladders, and have unloaded most of my foreign investments until this pandemic settles down. I re balanced my equities to be a hair more conservative.


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## JC in GB (Sep 30, 2020)

Brian Trommater said:


> Thanks for the idea's.  I trying out if I can really afford to do this.  You never know how much time you have left and I don't want to spend it all working!



Amazing how much freedom that would give Americans to not have to worry about becoming homeless when you need medical care.  I want to run my own business.  I have for years.  The problem is that working for myself I would not have enough to pay for health care therefore I must work for a larger company so they can provide health care for me.  No matter how you slice it, I don't feel very free under this system.


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## thirdeye (Sep 30, 2020)

JC in GB said:


> Amazing how much freedom that would give Americans to not have to worry about becoming homeless when you need medical care.  I want to run my own business.  I have for years.  The problem is that working for myself I would not have enough to pay for health care therefore I must work for a larger company so they can provide health care for me.  No matter how you slice it, I don't feel very free under this system.


When I went into business in the '80's, we had to get a commercial liability policy, and asked the agent about health insurance. He asked where our wives worked.  One partner's wife worked for the telephone company and mine worked at the hospital, he pretty much said "stay on their policy".


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## JC in GB (Sep 30, 2020)

PulledPorkSandwich said:


> My wife and I were forced onto Obamacare when I stopped working full time.  Initially, you could get a "PPO" policy here in the DFW metroplex under Obamacare.  Price and deductibles were very high unless you had little or no income.  I was lucky in that respect since I had saved a substantial amount of after tax money and had little or no taxable income while I was on Obamacare.  As a result, my premiums were high but affordable for me, but the deductibles were outrageous -- around $5K per year for the two of us.  Also, I had to give up my doctors -- they refused to take Obamacare insurance.
> 
> In short, because of the high deductibles, my Obamacare policy paid for almost none of our medical bills.
> 
> ...



The only change to the ACA has been the dismantling of the individual mandate which will doom the program anyway.  The ACA was Newt Gingrich's competing market based plan with Hillary Clinton's plan in 1993.  The ACA intended to turn the nation into one big risk pool with the intent of lowering costs and improving access.  It was actually a decent plan from a market based perspective.  Unfortunately, the republicans hated the fact that Obama was going to steal and pass their plan so they sabotaged it any way they could.  Allowing states to opt out of provisions, suing over other provisions, not allowing any public option, not allowing the government to negotiate drug prices.  All of these poison pills made the ACA work for less and less people. 

Neither side thinks it is a success right now in part because there was no bi-partisan effort to pass a viable plan.  American citizens are now caught in the middle of this nightmare where we still have no guarantees of anything other than big bills.  The whole thing is a sham bleeding America while making a few select individuals obscenely wealthy.

Trump and the GOP have no plan and the democrats won't offer anything but tweaks to the ACA.

I don't get the argument about not wanting to pay for other people's insurance.  When you buy into a risk pool whether private or publicly funded, you are doing just that.

I just want all American citizens to be able to get medical care when they need it.  That doesn't sound like such a radical idea to me.


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## crazzycajun (Sep 30, 2020)

You may look into a insurance coop in your area in my area it’s atlas md. You basically pay a monthly fee similiar to a gym membership, and you go whenever you need to at no additional charge. Then depends on your situation you may choose catastrophic insurance just an idea.


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## sandyut (Sep 30, 2020)

Brian Trommater said:


> Thanks for the idea's. I trying out if I can really afford to do this. You never know how much time you have left and I don't want to spend it all working!


AMEN to that!  We just want to do what we want, when we want.  We both work at the company and things have changed and the love it long gone (for the company not each other).  we want have more time for our kids and surviving parents.




crazzycajun said:


> You may look into a insurance coop


I have heard of this idea as well  AARP does offer insurance of all kinds and I believe.


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## BrianGSDTexoma (Sep 30, 2020)

thirdeye said:


> I guess I'll be the odd man out.  I've been on ACA for 3 years and have 15 months before going on Medicare.  The open enrollment starts November 1, and insurance providers lock in a rate contract with the government around October 15, then start selling policies. Once that happens ACA  should live another year since funds are allocated. If Trump does come out with a better and cheaper plan it would be easy enough to transition over to that, but with 30 million people using ACA, this will take some time.


Thanks for taking the time for writing this.  I will have to go back and read again.  My plan was to combine savings with enough from IRA to cover the minimum than start collecting Social Sec at 65.  I have some research to do.


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## thirdeye (Sep 30, 2020)

You're welcome. I had so many friends ask questions over the last couple of years.... I had a lot of that information in a word document, so I was lucky to do a lot of cut and pasting. 

If you are concentrating on insuring you are over the minimum income, the slickest way is to set up a non-retirement money market account where ever you have your IRA. Then sometime in December electronically transfer a one-time withdrawal from your IRA into that money market account. It will usually move within 24 hours.   This will move a little faster is you have some cash in the IRA core account because they won't have to sell any positions. If you have them cut a check and mail it, the check must be dated in the current year, and that might take several days.  One year I had a loss in my business, so on December 29th I moved IRA money in order to offset that... the transfer was posted December 31st.


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## shoebe (Sep 30, 2020)

Remember full retirement age in social security is based the year you where born. In my case I was born in 1956 and will reach full retirement age at 66 1/2. Before then you get less, but after you get 8 percent per year.


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## BrianGSDTexoma (Sep 30, 2020)

shoebe said:


> Remember full retirement age in social security is based the year you where born. In my case I was born in 1956 and will reach full retirement age at 66 1/2. Before then you get less, but after you get 8 percent per year.


Yeah I have done the math before but would have to do again..  Seemed like if you started collecting at 62 it would take about 12 years to break even.  If you live past that it goes down.


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## thirdeye (Sep 30, 2020)

Investopedia lays out SS break even this way:

If we assume the full retirement age for a retiree is 65, and the retiree chooses to begin receiving Social Security income at age 62, their full retirement age benefit of $1,000 may be reduced by 20%, leaving the retiree with $800 each month.

If the retiree's co-worker with the same birth date and similar earnings history elects to receive their benefit at full retirement age three years later, the benefit may equal $1,000 each month. For the first three years, the first retiree received a total of $28,800 (or $9,600 per year), while the second received nothing. Once the second retiree starts receiving benefits, he or she receives $200 more each month, or $2,400 more each year than the first retiree.

The Social Security breakeven age is 77, or 15 years after the first retiree elected to receive benefits. After this point, the second retiree earns more over his or her lifetime than the first.

Although mortality is an unknown, retirees who think they may live past the breakeven age may want to defer taking Social Security benefits until full retirement age, while those who do not expect longevity may want to start benefits early.


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## sandyut (Sep 30, 2020)

shoebe said:


> 66 1/2. Before then you get less


I did the math on this.  you get less per year, but after some number of years (I forget ho many like 10-15 its a break even.  Its less for more months or more for less months...from the rough math I did on my pay outs of starting immediately vs waiting 5 or more extra years to start.


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## thirdeye (Sep 30, 2020)

Another school of thought.... you take the lower amount at 62 and invest it monthly into an index fund, for example something mirroring the S&P 500. Now you have dollar-cost averaging on your side, and let's say you get a 9.5% return.  If you let it ride you will beat the 8% return from Social Security.  And if an emergency arrises and you need the money, you have it to cash out.


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## tallbm (Sep 30, 2020)

I didn't read all the post but I have been self employed and depending on my contracts, I have picked up Obamacare plans (weren't other options) as needed when not on W2 contracts that offer me a plan.

The long and short is that Obamacare has been jacked with so much (one way or the other) that unless you qualify for credits it's just going to cost what it costs.  
These days there are individual plans from the insurance companies but not a lot of options.  I'm actually on an individual plan I liked better that wasn't on Obamacare.  Many insurance providers just provide Obamacare plans only but worth checking their websites and comparing vs Obamacare plans.

With Obamacare plans It took me the 4th try as the charm to learn that in TX the doctors ONLY want to accept Blue Cross Blue Shield plans.  If you pick BCBS then you have greater chances of keeping your doctor.
Do NOT listen to what any of the website says about your doctor accepting the plans and always call your doctor and ask them 10 times minimum to confirm that they accept the EXACT PLAN and PROVIDER you are looking at in Obamacare exchange.  Tell them 10X in a row its from the Obamacare exchange so u arent told they accept something they then don't when you show up.  AGAIN, beat this dead horse and have them confirm and send you proof of confirmation because I was burned 3 years in a row like this hahaha.

Avoid all other offerings besides BCBS or you will end up driving across the metroplex to find the 1 doctor that accepts whatever you pick that is not BCBS.

I have never qualified for Obamacare credits/discounts and the Obamacare plan pricing and options are comparable to individual provider offerings so its basically all the same when no credits/discounts are available. 
 I'm on an individual plan with BCBS that had a better configuration than the plans on Obamacare but honestly the cost wasn't very different.  The cost is just what it is going to be Obamacare or not.

If this new supreme court justice is confirmed it is almost guaranteed that Obamacare is going to get killed.
If/when Obamacare is killed, us self employed folks or folks in your position will just have to pick through whatever the insurance companies provide and hope the insurance companies offer something acceptable.  If they don't offer a sensible option then we pay an arm and a leg to be covered or we go with out.

I'm fortunate and will be ok no matter what.  I just hope the insurance companies are ethical enough to provide something acceptable for those who are not in my shoes.

These are our options and this is immediate future for those of us who are self employed or those who are in your shoes.


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## thirdeye (Sep 30, 2020)

You are correct.  Check, check and double check. The Healthcare.gov site does have a database so you can look-up each of your doctors.  Do this first before calling them so you have information in front of you. Also check surgical centers and rehab facilities too. 

Maybe the sitting President thinks that because he appoints a Supreme Court Justice (for life by the way), they will rule in any decision in his favor, however the purpose of the judicial branch of government is to interpret laws.  Normally, this is relatively clear-cut, but by selecting a Justice that may be more conservative for example  it might be assumed their rulings would be consistent in that direction, but it's not a shoe-in by any means.   30 million people are at stake in the ACA game, so it's political suicide for the President to take away their insurance. Imagine how many Senators, Congressmen and downstream politicians that would be out of a job. too. Even if the SCOTUS rules against the ACA there will have to be a replacement plan.


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## radioguy (Oct 1, 2020)

I just retired 2 years ago.  We opted to stay and buy private insurance from my employer.    The ACA choices while $4k cheaper,  offered poor or no coverage out of state.  Traveling is on our bucket list.  We will review when I  turn 65 in 2 years.  
We are enjoying life and spending our kids inheritance...cant take it with you

RG


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## bill1 (Oct 1, 2020)

JC in GB said:


> ...I just want all American citizens to be able to get medical care when they need it.  That doesn't sound like such a radical idea to me.


And it's hard to see how such a healthcare approach gets abused.  If I give the needy money, or even just food, I _suppose _that could be seen as a disincentive for them to work hard and provide it all for themselves. But having folks around me being healthy seems like a win-win for us all.


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## pineywoods (Oct 4, 2020)

Lets keep politics out of this or we will have to remove this thread.
If you go to a hospital any hospital with a life threatening condition they must treat you they can't turn you away. That goes for citizens or not it doesn't matter they can't turn you away.
As for Blue Cross Blue Shield we have had them or what they have become in our case Florida Blue for over 35 years straight and they get worse and worse about every year.
The premiums go up every year and the coverage gets worse.


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## bill1 (Oct 4, 2020)

pineywoods said:


> Lets keep politics out of this or we will have to remove this thread.
> If you go to a hospital any hospital with a life threatening condition...


I think it only gets political if you express a preference for govt-supplied health insurance vs. private insurance.  (One political party states they prefer less government involvement in our lives--we certainly shouldn't support or oppose that here.)  Opposition to private health insurance (well, insurance of any kind) was a position held by certain highly religious groups a century ago (shows you don't trust God!) but I can't believe either of the two major political parties wants to make that part of their platform today.  My state has mandated liability insurance before you can register and drive a car, and neither Party opposes that as an invasion of personal liberty.  Everyone recognizes that without it, the roads would be filled with smashed-up cars with metal appendages sticking out like Ben Hur hubcaps.  

And from a personal-freedom standpoint, I can certainly understand leaving those with life-threatening conditions outside the hospital to die...they can't hurt me if they're dead.  (And besides, some bleeding-heart Good Samaritans will come by and pay for their  health care just like in Jesus' parable of the same name.)  

No, the guy I worry about is the minimum-wage cook or chef who can't get healthcare (emergency room or otherwise) for a persistent cough.  He's the guy coughing in my lunch, makes _me _sick,  and thus I miss a week of work.  From a pro-business standpoint, I gotta' wonder if there's not an economic payback in mandating that guy get some basic coverage, even if the public has to chip in a bit for him to afford it.


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## thirdeye (Oct 4, 2020)

pineywoods said:


> Lets keep politics out of this or we will have to remove this thread.
> If you go to a hospital any hospital with a life threatening condition they must treat you they can't turn you away. That goes for citizens or not it doesn't matter they can't turn you away.
> *As for Blue Cross Blue Shield we have had them or what they have become in our case Florida Blue for over 35 years straight and they get worse and worse about every year.
> The premiums go up every year and the coverage gets worse.*



Have you shopped around with other insurers to compare costs against benefits?   Or had your agent give you a quote to bundle your auto, health, and homeowners?


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## kashif (Wednesday at 11:11 PM)

JC in GB said:


> Amazing how much freedom that would give Americans to not have to worry about becoming homeless when you need medical care. I want to run my own business. I have for years. The problem is that working for myself I would not have enough to pay for health care therefore I must work for a larger company so they can provide health care for me. No matter how you slice it, I don't feel very free under this system.


Agree with this, It's unfortunate that the current healthcare system in the US puts a burden on people to sacrifice their independence and autonomy in order to access healthcare coverage.


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## BrianGSDTexoma (Yesterday at 6:15 AM)

So far the Affordable Health Care been working out great.  I have a $25,000 income and get a plan with very low deductible and OOP.


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## GonnaSmoke (Yesterday at 6:20 AM)

BrianGSDTexoma said:


> So far the Affordable Health Care been working out great.  I have a $25,000 income and get a plan with very low deductible and OOP.


I was about to ask you Brian how things were working out. Have you had to use the plan, yet?


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## bill ace 350 (Yesterday at 7:16 AM)

i am sooooo thankful that I served honorably for 21+ years and have Tricare Prime.


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## BrianGSDTexoma (Yesterday at 7:57 AM)

GonnaSmoke said:


> I was about to ask you Brian how things were working out. Have you had to use the plan, yet?


Yes.  They seem to cover everything.  Have not had to pay for hardly anything last couple years.  I just lucky I have some savings to supplement my $25,000 income.  Have to keep this up few more years.


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## tallbm (Yesterday at 12:13 PM)

BrianGSDTexoma said:


> So far the Affordable Health Care been working out great.  I have a $25,000 income and get a plan with very low deductible and OOP.



Just a pro tip about using Healthcare . gov and the Affordable Healthcare Act benefits.

ALWAYS call up your Dr.'s office and triple or quadruple check that your doctor will accept whatever plan you are thinking about getting!!!!! 
Tell them its from the ACA and healthcare . gov and for them to reply in writing that they accept the exact plan you are looking to get if they say they accept it.

I work for myself as a 1 many company and took me 3 years to get this right and figure out the quirks.

The issue is that the doctor office clerks/receptionists don't realize that your plan is coming form ACA or they goof up and tell you they accept the plan when the only accept the corporate version of the healthcare provide/plan, not the ACA versions!!!

ALSO, the healthcare . gov site will tell you all kinds of doctors accept the plans but that information is almost always wrong and they fail to remove doctors listings OR the doctors just want more exposure even if they don't accept the plans.

In Texas, doctors only seem to want to deal with ACA plans that are Blue Cross Blue Shield of Texas.  If you get a different ACA provider and your doctor confirms they accept it then fantastic!
If not, then it is an act of God to find that one doctor near your area that actually accepts the plan.

To be fair to the doctors here in TX, dealing with Blue Cross Blue Shield is easy and worth their effort.  Most of the others are a nightmare for them to deal with so they simply don't work with them.

It took me 3 years/3 attempts to get this figured out then I was good to go.  Please use this info to your advantage and get a good cost effective plan your doctor or an acceptable doctor will support.

I went through the following ACA providers:

*Molina, *year 1  - it was super affordable BUT found out its was the "dollar store" of doctors offices that accepted it.  Bad areas, bad facilities, etc.  The doctors were actually ok but would not do it again and thank goodness I have like no medications or issues to really test the care
*Aetna*, year 2 - upgraded to a real healthcare provider and the girl on the phone of my doctors office said they accepted it even though I was sure to tell her it was through ACA.  I show up for an appt and they tell me they don't accept the ACA version.... pissed off!  I was told that the confusion was they accept all Aetna from employer insurance plans but not from ACA.... back to the Molina doctor because yep they accept Molina so they accept much better providers lol.  Was told they and other doctors accept BCBS through ACA because they are easy to work with so kept that in mind for year 3.
*Blue Cross Blue Shield of Texas*, year 3 and beyond - triple checked and yep accepted!  Issue here was that first visit had to be with a different doctor in my area for the plan.  Then from there I could switch to my doctor of choice in the plan.
The new doctor was better!  I stayed with the new doctor so that was a blessing in disguise.  Confirmed with the new doctor that for ACA in Texas the doctors really only want to deal with BCBS of TX.  Never had a problem since :)
So if you made it this far congrats!  I'm not knocking the ACA or affordable healthcare, it's a good thing for people to have options and access vs the old days of having no possibility in a number of cases.  As with all things you have to educate yourself to navigate the system so you make it work for you instead of you working for it.  We do this with our smokers all the time :)

On a final note.  I make good money but just need a healthcare provider being a 1 man business but it makes no sense to pay for crazy business healthcare plans.
If you can get subsidized plans or affordable plans through ACA go that route.
If you are not able to get a subsidized plan (my case) it seems the healthcare companies have caught up and offer individual healthcare plans that they often do not list on the ACA exchange.
The cost is often about the same or a little less and the benefits seemed a little better.

So in my case I check for both Blue Cross Blue Shield of Texas plans across ACA and from the actual BCBS website and I pick what works best.
The last couple of years the individual plans (not ACA plans) have been a hair more expensive but provided a few more meaningful benefits. I know the doctors here in TX take the individual BCBS plans so I have been going with those.  Early on with ACA the healthcare providers didn't do this in my area but they slowly came along with individual plans.

I hope this info helps some folks out there :)


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## BrianGSDTexoma (Yesterday at 3:04 PM)

tallbm said:


> So in my case I check for both Blue Cross Blue Shield of Texas plans across ACA and from the actual BCBS website and I pick what works best.


This how I found my plan.  Nothing decent using the GOV site but went direct to BCBSTX and found a great plan.


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## TripleLindy (Yesterday at 3:08 PM)

I’ve been using ACA plans for the past 5 years since I retired. I still have 5 years to go before Medicare, so I’m glad that the ACA is available, along with coverage for pre-existing conditions. I think I’ve met my deductible only once in 5 years, so the insurance is really for something catastrophic, like a car accident or cancer. I’ve had years where I had to pay the subsidy back, which sucks, but now that premiums are capped at 8.5% of income, it’s less of a concern.



 tallbm
 be careful about lumping all BCBCSTX plans together. There are lots of different BCBSTX plans on the healthcare.gov site and each one has its own provider network. Specialists, like orthopedic surgeons, are particularly hard to find on their HMO plans.


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## jcam222 (Yesterday at 3:48 PM)

BrianGSDTexoma said:


> So far the Affordable Health Care been working out great.  I have a $25,000 income and get a plan with very low deductible and OOP.


Brian if you don’t mind me asking is that your social security and any 401K draws combined? I’ve been looking through using the estimator combining what I estimate for both combined in the low $50’s and the decent Silver level seem to be around $375 per month. I’ll need 2 1/2 years worth to bridge from the end of my 18 months of insurance given for an early retirement package and 65 / Medicare. I’m considering taking out enough in a lump draw to supplement the SS for the 2 1/2 years so I can report SS income only for those.


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## jcam222 (Yesterday at 3:50 PM)

TripleLindy said:


> I’ve been using ACA plans for the past 5 years since I retired. I still have 5 years to go before Medicare, so I’m glad that the ACA is available, along with coverage for pre-existing conditions. I think I’ve met my deductible only once in 5 years, so the insurance is really for something catastrophic, like a car accident or cancer. I’ve had years where I had to pay the subsidy back, which sucks, but now that premiums are capped at 8.5% of income, it’s less of a concern.
> 
> 
> 
> ...


I assume you had to pay back because your income ended up grossly higher than your estimate?


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## tallbm (Yesterday at 4:08 PM)

TripleLindy said:


> I’ve been using ACA plans for the past 5 years since I retired. I still have 5 years to go before Medicare, so I’m glad that the ACA is available, along with coverage for pre-existing conditions. I think I’ve met my deductible only once in 5 years, so the insurance is really for something catastrophic, like a car accident or cancer. I’ve had years where I had to pay the subsidy back, which sucks, but now that premiums are capped at 8.5% of income, it’s less of a concern.
> 
> 
> 
> ...



Good point to bring up.  It reiterates the need for people to confirm with their doctors, specialists, etc. that the plan is accepted.

I absolutely look at ACA BCBS plans as well as the individual BCBS plans.  I want the best deal and coverage combo possible.

I'm fortunate that my healthcare needs are minimal. I have about 2-4 doctor visits a year and that's about it.  Specialist visits are even rarer and I make sure to see if they accept my insurance or are in my network before I make any plans.

Other's with a number of healthcare needs would have to do more checking than I do.  I just hope my health and everyone's health holds up to not have to fight with this on top of new health issues :)


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## BrianGSDTexoma (Yesterday at 4:13 PM)

jcam222 said:


> Brian if you don’t mind me asking is that your social security and any 401K draws combined? I’ve been looking through using the estimator combining what I estimate for both combined in the low $50’s and the decent Silver level seem to be around $375 per month. I’ll need 2 1/2 years worth to bridge from the end of my 18 months of insurance given for an early retirement package and 65 / Medicare. I’m considering taking out enough in a lump draw to supplement the SS for the 2 1/2 years so I can report SS income only for those.


I not old enough for SS yet.  That is in IRA withdraw.  It can be a little tricky as you have to include all income.  Any Interest, Capital Gains and Dividends. My biggest Dividends usually don't post until mid Dec which threw me off last year.   I went over by $3,000 and had to pay penalty but it was not to much. I withdrew 20,000 this year and the other 5,000 came from the rest. Insurance Brokers are free and can help you get the best plan for you and do all the filing.  The GOV site has a search for broker in your area.  My broker keeps trying to get me to do the no cost plans but have high deductibles.  He said he had 3 operations and still did not have to pay much.  I have a very low deductible and pay $160 a month.  Not sure who services your area but I got a lot better rate going direct to Ins site, for me BCBCTX.  The Gov site did not give me any good choices.  I had to play around with income to get a good plan.  That is where I came up with $25,000.


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## BrianGSDTexoma (Yesterday at 4:20 PM)

jcam222 said:


> I assume you had to pay back because your income ended up grossly higher than your estimate?


One more thing is you need to find a doctor that will accept the insurance.  This is very important.  I got lucky and a friends daughter worked  for a doctor and got me in.  Probably no private doctor going to take this.  Usually doctors associated with Hospital will take but they only do a certain percentage.  You really need to find a doctor and go for a visit to before hand to become a patient so you know you have a doctor.  A friend joined couple years ago and they tried to send him to Houston.  He had to find another ins.


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## TripleLindy (Yesterday at 5:00 PM)

jcam222 said:


> I assume you had to pay back because your income ended up grossly higher than your estimate?


Not grossly higher, but higher. The income limit for a couple used to be something like $65k, which is what I used for my estimate and I went over that by a few $k. Once over the limit, I had to pay back every penny of the subsidy - something like $15k. The rules have changed and the subsidy cliff has been eliminated, at least through 2025.


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## jcam222 (Yesterday at 5:41 PM)

BrianGSDTexoma said:


> I not old enough for SS yet.  That is in IRA withdraw.  It can be a little tricky as you have to include all income.  Any Interest, Capital Gains and Dividends. My biggest Dividends usually don't post until mid Dec which threw me off last year.   I went over by $3,000 and had to pay penalty but it was not to much. I withdrew 20,000 this year and the other 5,000 came from the rest. Insurance Brokers are free and can help you get the best plan for you and do all the filing.  The GOV site has a search for broker in your area.  My broker keeps trying to get me to do the no cost plans but have high deductibles.  He said he had 3 operations and still did not have to pay much.  I have a very low deductible and pay $160 a month.  Not sure who services your area but I got a lot better rate going direct to Ins site, for me BCBCTX.  The Gov site did not give me any good choices.  I had to play around with income to get a good plan.  That is where I came up with $25,000.


I definitely need to talk to one of the brokers.


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