Obamacare question

Upfront I have to say I have no experience with the ACA. My healthcare is through work and so far covered under my contract.

If needed later I’ll give the backstory. Basically I want to know if what someone told me is true. I was told she can’t afford healthcare. This is someone who only works part time but I’m estimating makes about 30k a year. She says that healthcare would cost $800 a month. The insurance would only be for her and no one else. $800 seems to be way high from glancing at previous threads. Is there a healthcare expert here that would know? Or do I not have enough information?

I am familiar with ACA. While I don’t know her situation precisely, that could be a little high, but it depends. Don’t forget that there are several levels of coverage, usually called bronze, silver, gold, and platinum. In my own case – I’m in my 50s – a silver plan costs about $500 per month, but a gold plan costs about $700 per month.

Also, with her income she could be eligible for subsidies, but that’s another issue.

What state?

How old is she?

Depending on her age and what state she lives in, $800/mo. is not necessarily out of line.

Just as a point of reference, my church still carries insurance on our administrative assistant, who’s single and in her early 50’s. It’s not an exact comparison to Obamacare (for one thing the package includes disability coverage) but this year’s cost for her is $10,119 for roughly Silver-level coverage.

Is your church contractually required to cover types of insurance that a single person might not choose to add on to theirs due to cost, such as dental and/or eye-care?

New Jersey

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Here is where you plug in info to get your insurance costs, and here is a news article about the costs of Obamacare rates in New Jersey. Note that none of the examples are anywhere near 800 a month.

I buy insurance through ACA. The cheapest plans run around $300/month, and at $30k per year income she’d get a big subsidy. I don’t remember what the more involved plans cost, but I don’t think they even approached $800/month.

Why not go direct to the source?

You can play ‘what if’ without registering or giving email addresses. At $30,000 per year - the subsidy would be as much as $475 month.

A quick look at Sussex County gives plans from $114 - $958 per month after subsidy.

Not for the administrative assistant. The minister may have a more comprehensive package under the terms of his call.

I’m self-employed, 40 years old, and paying for some non-ACA insurance which is grandfathered in still. Currently paying around $130/mo. The cheapest Obamacare plan in my state is over $300, and that’s with $5k deductibles. Someone making $30k wouldn’t get nearly squat for subsidies here. (And tax returns are not enough… you’ve gotta submit your whole business plan practically.) When I started playing with numbers and plugged in ~$22k income I believe it said you get $75/mo off. Big whoop.

So I can definitely see how someone a bit older who wants a health “plan” rather than health “insurance” would approach $800.

If you do that, do not give them your real phone number. Every year around enrollment time I get tons of robocalls from them. There is no option to select for “leave me alone”. I changed my healthcare.gov registered phone number to a fake one – didn’t help. I have already called and talked to a real person twice. The calls still will not stop.

The article talks about silver plans. Gold plans could definitely be in the $800 range. We just don’t know enough about the OP’s friend’s situation.

Oops, I plugged in age 59 for those numbers.

Also, a better link - https://www.healthcare.gov/see-plans/

What, exactly, do those more expensive plans cover? They’re still far cheaper than what mine costs. I have my coverage fully paid from where I retired from. But if I had to pay for it out of my own pocket it would be $1700/month for both my wife & I.

These prices just boggle my mind. I live in the Netherlands and would have enormous trouble finding health Insurance that would cost me more than 150 euros per person. And that would include every single medical intervention that can be insured and some non-medical ones to boot (homeopathy, anyone?) plus dental. The deductible would in that case be 365 euros per year. I think the only thing wrong with the ACA is that it isn’t going far enough. Like setting prices for medications and procedures.

Depends on the plan, obviously. But as a general overview, looking at the plans offered by my workplace, a gold plan for a single person was 90% coverage in-network, 70% coverage out-of-network, deductible of $2500/year, $25 co-pay in-network, $75 out of network, with yearly max of $2500. (These numbers are from memory, so if one of them seems wildly off that’s probably why). The cost per month for one person was $650 (my employer covers up to $650/month, so if you want to add family/vision/dental, that’s up to you.

The silver plan is like $500/month, was 80% coverage in-network, 60% coverage out-of-network, deductible of $5000/year, $25 co-pay in-network, $75 out of network, with yearly max of $5000. Interestingly it also had an HSA component. That’s the plan I have.

The bronze plan is like $300/month, was 70% coverage in-network, 50% coverage out-of-network, deductible of $7500/year, $50 co-pay in-network, $100 out of network, with yearly max of $10000.

This is in Georgia, BTW.

Long story short you’re paying for more coverage, lower co-pays, and a lower deductible/out of pocket maximum, in exchange for higher monthly premiums, or the reverse if you want lower monthly premiums.

Thanks for the replies. I think I don’t know enough of her personal information to get a complete answer.

Will she be penalized for not having insurance?

The fee for not having health insurance in 2016
The fee is calculated 2 different ways – as a percentage of your household income, and per person. You’ll pay whichever is higher.

Percentage of income
2.5% of household income
Maximum: Total yearly premium for the national average price of a Bronze plan sold through the Marketplace

Per person
$695 per adult
$347.50 per child under 18
Maximum: $2,085

I’m 47, and $800/month is around what I pay for (Silver-level) coverage for my whole family through the ACA. Granted, we live in a low cost-of-living state and in an area saturated with large hospitals and medical providers.