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(8,303 posts)
14. Well, it wouldn't be any better on an ACA plan
Mon Mar 10, 2014, 07:25 PM
Mar 2014

70/30 actuarial coverage is always going to have a high copay or high deductible.

The reason the employer plans are being changed so much is cost, the extended benefits required, plus the "Cadillac tax" provision.

For families with low incomes (200% of FPL or less), you get significant cost-sharing so an exchange plan might be better, but in any case you don't qualify for the subsidies unless the employer doesn't offer qualifying coverage.

So, for example, in my home county in GA, a couple aged 48 and 50 with an income of $42,000 can get a Silver plan for $302 (that's the second-lowest on which the subsidy is figured). But except for the three free visits, free mammogram, etc., your deductible is $5,000, and your out of pocket maximum is $12,700. So once you meet your deductible (everything that isn't free goes toward your deductible), then you get into the copays and coinsurance until you hit the OOP Max. So primary care is $40 + 10%, hospital is $500 + 10%, and so forth.

It's not particularly attractive for moderate income people, because if they get sick they are faced with a difficult situation. As you say, you have to save up to actually get treated.

I've noticed that some people in metro options have better choices, but in ruralish areas it seems to be very similar, and most of the complaints seem to be coming from the rural areas. But there's no way to cut costs by limiting the network as there is in metro areas, so I think that's why.

Now if that same couple had an income of $31,000, their premium would only be $162 a month, plus the deductible would be $1,500, the OOP Max would be $3,000, and it goes on from there. Their primary care copay would be $25 +10%, etc. So a couple like that would do better on the exchange, but the way the rules are written many can't get the subsidies.

so what is the deductible on your plan? Schema Thing Mar 2014 #1
It's pretty well implied she's got a $6k plan. jeff47 Mar 2014 #2
Thanks wryter2000 Mar 2014 #3
Actually, my deductible is $2500 and my premium is $222 per month. Walk away Mar 2014 #4
Lucky you Demsrule86 Mar 2014 #27
Except most people who get subsidies on their premiums also get credits on their deductibles. n/t pnwmom Mar 2014 #8
We have a new $4000 deductible this year and it's really hurting us LiberalEsto Mar 2014 #5
ACA is a subsidized 70/30 actuarial payout Yo_Mama Mar 2014 #7
Ours is through my husband's employer LiberalEsto Mar 2014 #12
Well, it wouldn't be any better on an ACA plan Yo_Mama Mar 2014 #14
That isn't the whole story. If you are eligible for subsidies.... Walk away Mar 2014 #13
Yes, that's true and I just gave an example in my reply Yo_Mama Mar 2014 #15
Group policies have been getting worse and worse every year without the excuse of the ACA. pnwmom Mar 2014 #9
Colonoscopy Demsrule86 Mar 2014 #29
Everybody doesn't have the same choice of policies Yo_Mama Mar 2014 #6
But that's how it works on the ACA, except for the young people pnwmom Mar 2014 #10
Your workplace health insurance costs $1,200 more woo me with science Mar 2014 #11
I wish we could get ACA Demsrule86 Mar 2014 #28
Funny that you forgot to mention Le Taz Hot Mar 2014 #16
I have a Silver plan.. Walk away Mar 2014 #17
I don't care how "covered" "most" prescription medications are. Le Taz Hot Mar 2014 #22
I don't think you are an idiot but... Walk away Mar 2014 #26
If you are low income aren't you eligible for subsidies? Walk away Mar 2014 #18
So, you're saying the ACA is not Le Taz Hot Mar 2014 #20
I guess I just don't get how no insurance is better than $300 a month... Walk away Mar 2014 #23
If you are eligible for subsidies, Ms. Toad Mar 2014 #19
The Bronze Plan Le Taz Hot Mar 2014 #21
It wasn't a lecture. The vast majority of people are not aware Ms. Toad Mar 2014 #25
K! Cha Mar 2014 #24
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