It’s open enrollment season for many insurance plans, including Affordable Care Act customers. And yet the deadlock in Congress currently means that enhanced tax subsidies are in limbo, and that has put the process into unknown territory.
Will the enhanced subsidies be passed for this season? There’s no sign of a resolution to the impasse right now. And so the healthcare.gov site and the state exchange sites have gone live with prices reflecting the lack of enhanced subsidies — meaning sticker shock for a large number of enrollees.
Pain is also striking employer-sponsored healthcare. Insurance companies, seeing the mounting uncertainty in the market, have increased premiums and deductibles wherever they can, limited sometimes by regulatory agencies rolling back, say, a requested 26% premium increase to 13% — but the underlying rates are still often going up, separate from the enhanced subsidies for A.C.A. enrollees.
So what does it look like out there? Does it pay to wait until the logjam breaks in Washington? Here are some stories.
A.C.A. enrollees
“I’ve been on ACA since 2013…. so I’ve seen a lot of changes… this year has been horrific…” wrote a Milwaukee man who retired in 2013 when he returned to the United States after 20 years overseas. “The only provider from my network has pulled out of the market, now [UnitedHealthcare] has come in with really horrific HMO options… still trying to figure out what to do…. trying to learn new lexicon… co-insurance, co-pay… definitely frustrated.”
When he was first back in the States, he wrote, “We were just getting a Cobra plan at full cost. Then all the major suppliers pulled out. A ‘Community’ program came in, but pulled out of our county this year. UHC has offered HMO plans now, but they all pretty much suck…”
A Minnesota woman wrote: “Husband got a renewal letter for his ACA Obamacare health plan which basically said he’d ‘find out the new price on his January bill’!! WTF?
“He’ll be cancelling and moving to Medicare Jan 1st, but I’m now looking at [the state health exchange] MNSure for an ACA plan” for herself.
Later she wrote: “I spent today crunching numbers and reading the details on all the A.C.A. plans available in the Twin Cities. Because ‘$20 copay on generics’ doesn’t tell you about the $540 copay on specialty pharmacy meds. It’s always the details… It’s looking like just over $18,000 for MY individual healthcare alone next year.
“That’s premiums plus the OOP max (which I will hit because it’s the same as the deductible). Essentially, nothing is covered until I meet the $8500 deductible. Looked at some of the more expensive premium options, but with things like $540/mo (or worse, a percentage) specialty meds, they end up costing MORE over the year — over $20K, assuming nothing else goes wrong on my body.
“Husband’s total yearly expected healthcare and premiums should be less than $5000/yr on Medicare. Please can we have Medicare for All???”
A Georgia woman wrote: “Cobra is ending in March so we will be on the marketplace in GA. What I’ve read about costs is appalling.
“I have pre-existing conditions (don’t we all?) and the nature of mine means outside of ACA I have no hope of being insured.”
A New Jersey woman wrote: “I keep getting letters from Horizon Blue Cross Blue Shield of NJ saying that the cost of my coverage will increase, but no notice of the actual increase. And I’m following advice I heard on [public radio station] WNYC not to do anything until the last minute, in case Congress acts. Meanwhile, I’m front loading preventative care! Eye doc, gyn, dermatologist, mammogram…”
No, thanks
A 59-year-old healthcare professional in Washington State wrote: “I do this for a living and I had trouble figuring it out. How does anybody? Without subsidy Bronze premiums ranging from $682-1180/month. For the life of me, I can’t understand why such a big discrepancy. And one of the most expensive ones (United, naturally) has a deductible over $10,000! Most of the bronze deductibles are 6-7,000. But I saw one $5500 one and one $8500 one. Aren’t these supposed to be standardized?
“No silver plan options. WTF!?!
“Gold plans range from $868-1716. Which at this point is a mortgage payment not a health insurance premium. Again, I can’t figure out why such a huge range. Deductibles are either $1000 or $1900.
“And nothing with any out of network benefits. Last year I didn’t sign up because of the price but also the fact that my primary care practice had been taken off of all 40-something plans. If I can’t even get primary care visits covered, I’m simply paying for catastrophic and that’s a lot for a catastrophic only plan. And around here, if you can find a doctor that’s accepting new patients, it’s about a 9-month wait to get in. So you get in, and then… Your plan changes again next year and you start all over. It’s insane.”
Social media is full of people with tales of very high costs. Two examples: “My in laws Obamacare is going from $1800/month to $4125/month A full 50k a year” and “I know two people who pay $3300 a month thanks to Obamacare. It’s $40,000 a year. They are not rich by any means. This is 50% of their monthly budget where necessities are cut out due to the cost of healthcare. No special drugs needed or anything!”
Employer insurance
A senior manager at a Big 4 accounting firm wrote that her experience is “absolutely brutal” for her family of two children and two adults. “Our spend at full consumption was 12k last year and is now $17k. What was a 10k deductible with no additional OOP is now a 9k deductible with 20% coinsurance to a 15k OOP max. My wildcard right now is still being on a GLP-1 and not knowing what the PBM will pull.”
A mid-career educational researcher in his late 30’s in the Northeast wrote: “I have no idea yet. All my employer has told me so far is I will have the same health plan, but my premiums will likely increase. Hopefully they’ll tell me soon and the increase won’t be too much (so far it’s been pretty reasonable in terms of cost of premiums and minimal deductible/copay costs). Depending on the changes I could see myself going to my psychologist biweekly instead of weekly, although I would prefer weekly as I find it keeps me more on track with my goals around exposure for anxiety.”
He has also found that his insurance actually penalizes him on many prescription drugs. “I shop around for different pharmacies for prescriptions and often ask if the cost might be cheaper if they don’t charge my insurance (amazingly, about half the time I find it is),” he wrote.
An education professional in New York wrote: “This is a separate trend, but our self-insured higher ed institution and many others are trying to go the high deductible H.S.A. route instead of our historical Cadillac plan ‘to save money’ and in the process they’re alienating the entire campus. Rumor has it the faculty at the college across town voted down such an option there. One of these high deductible plans has an $8000 deductible, reportedly.
She added: “The super high deductible H.S.A. one & the not-as-high H.S.A. one are all that new hires can choose from starting in January, and they added some extra options for ‘catastrophes’ and whatnot that the H.S.A. plans can add. It’s bonkers and there are better ways to save a pittance that don’t include alienating everyone.
“We have a pool going on how long it will be before the high deductible H.S.A. plans are the only options.”
A 46-year-old nonprofit employee in Madison, Wis., wrote: “30% increase in premiums at my non-profit employer.”
Managers, individuals, unions
In southern Westchester County, just outside of New York City, one woman reported: “We got our rate change notice today from [the health plan] MVP. The increase is about 15%.”
Another woman in the same area said her rate with MVP went up by $2.
A third: “For one young adult, increase is 3.4%, so surprised.and relieved. For the other young adult, 7% increase.”
A Minnesota nonprofit executive, speaking of the workforce premiums, wrote: “16% increase in premiums (nonprofit employer managed plan through BCBS in MN).
“Last year was 6% by comparison.
“We’re able to absorb the cost, but had to readjust budget significantly to cover the increase.”
Some were luckier than others, though. A 46-year-old staff member at a community college wrote: “My employer based insurance is staying the same…. It’s the first time in about 20 years I’ve had a unionized job.”
A 47-year-old small business owner in St. Louis, Mo., wrote: “My cost is staying the same but I have insurance outside of the marketplace. I have a 3 yr contract with United health care. It covered more of my providers for lower cost than Obamacare. I don’t have employer provided healthcare offered as I own my own small landscaping business.”
Looking abroad
The cost of health insurance is still affecting the life decisions of many people.
A 50-year-old woman from Washington, D.C., is living in Medellín, Colombia. She wrote: “Didn’t move back to the US this year because insurance costs were too high. (And the world was imploding )
“We are living overseas on a travel insurance plan which provides excellent coverage for non-routine coverage. And insurance costs are so reasonable that I can cover those out of pocket. For instance a mammogram was less than $50 and my flu shot was $13.”
A 57-year-old American university professor who recently moved to Georgia after living for several years internationally wrote: “I am on an employer plan, but from my perspective health insurance in the US was already way overpriced, and the healthcare system offers an extremely poor standard of care. It is now getting even worse, but it was already horrendous.
“I moved back to the US 2 years ago from Taiwan, which has a single payer system. My wife and I together paid under $70 USD per month to be covered by the national health insurance. Co-pays for everything from physical therapy to seeing a doctor ranged from about $2-5. You don’t need an appointment to see a doctor, you just show up and always get seen within 30 min or so. And once you pay that co-pay, that is it. You are done. You don’t have to think about any possible further billing.
“Here, where I live, at least, you don’t even get seen that fast at an ‘urgent care’ that is anything but. And to see your GP you have to book a month in advance or so. Then we keep getting billed above our copay because our insurance doesn’t pay the providers as much as they want. And what they charge is outrageous.
“I think a significant part of the problem in the US is how overpaid health providers are. And if you try to dispute a bill, both insurance company and provider point their fingers at each other and try to wear you down until you just give up and pay.
“I have been disputing some charges for several months, demanding that someone explain what a service billed as an overly general line item even was, and despite multiple attempts, I can’t even get anybody to explain what it really was or why it was needed. They just say the insurance company accepted their portion of the charge, implying that means it is above board and need to pony up cash for something I don’t understand.
“Infuriating! I want to move back to Taiwan just to get away from this horrendous healthcare system.”
Medicare not exempt
Medicare enrollees, too, are facing rising costs. Many will see a substantial increase in their Plan D drug coverage, and they might also see shifts in the formulary — the list of preferred drugs on their plan. Plan D can be switched during the current open enrollment period for Medicare.
An 83-year-old Medicare enrollee in Long Beach, Calif., wrote: “I take a biologic, which is very expensive. It had been covered by Part D (which I pay for) and co-pays are capped by the Inflation Reduction Act.
“This year, my insurer of 17 years dropped me. I’m checking on other companies, but none will support my biologic, requiring a bio similar. My MD says it’s less good, but she’ll figure out the best path. I HATE that the profit motive runs our medical system.”
What you can do
Watch the news. The situation could change quickly. And the healthcare.gov site, which covers 30 states, and the states that run their own exchanges outside of healthcare.gov are likely to have different ways of coping with whatever happens in Washington.
Getting that preventive care done is always a good idea, so think about scheduling that before the end of the year — vision checkups, gynecological exams, mammograms, colonoscopies.
A lot of people are choosing to wait to sign up until the logjam breaks in Washington and things are clearer. But of course you can’t wait too long. People on healthcare.gov have until Dec. 15 to sign up for a plan starting on Jan. 1. If you miss that deadline, you can sign up by Jan. 15 for coverage that would begin Feb. 1. Some state marketplaces have different deadlines.
The New York Times has an overview of this topic by Reed Abelson and Margot Sanger-Katz; find it here (gift link).
Our “How to buy insurance” post may have some suggestions.
Think out of the box. This family had husband, wife and son all on different plans because of different health needs, and they saved a ton of money. A lot of people default to “all of us on a family plan” but that could be less good.
What happens if Congress extends the enhanced tax credits after you enroll? “It’s unclear what would happen if Congress decides to extend the enhanced tax credits after enrollment is closed,” The Times notes. “Any alterations could take some time to go into effect, meaning people would still pay the higher premiums for a while.”
