I’m considering dropping my individual health insurance plan, because the premiums have gone up again, because with a multi-thousand dollar deductible I feel like I’m paying the company to pay for my own care anyway, and because having insurance seems to actively prevent me from getting access to healthcare, as I’m disqualified from sliding scale fees regardless of the fact that I’d have to pay out-of-pocket.
How badly do I screw myself if I drop coverage, then a few months later finally find myself in a position to pay for it again? I know there’s no longer a waiting period for pre-existing conditions, but can they deny me coverage outright? Or charge me ridiculously high premiums for them? Is there another pitfall of a lapse in coverage I’m unaware of?
Assume individual coverage, my future sources of income are far more likely to come from independent contracting or a start-up with no benefits than from an employer that offers a health benefits plan. I’m a single non-dependent adult.
The ban on pre-existing conditions for individual policies doesn’t begin until 2014. Coverage for pre-existing conditions varies from company to company. I think there is a 63 or so day window between coverage when your pre-existing conditions ‘reset’ at that point you’d have to be insured for 6-18 months (some period like that) before your company policy would cover pre-existing conditions again. My understanding is if you lapse your coverage for 4 months (any period longer than 2 months), then try to get back on your pre-existing conditions aren’t covered for X months, and X like I said could be 6-18.
Our system makes no sense. Medical inflation has been 3-5% a year the last 5 years, but health insurance premiums are going up 20-50%. The insurance industry is in a death spiral and just functioning as useless overpriced gatekeepers.
If you are a single adult w/o kids the subsides to buy private insurance all but disappear around 30k a year and are gone totally by about 45k a year in income once the subsidies kick in in 2014.
Ha. Of course, why wouldn’t I be penalized for attempting to be a responsible adult yet again?
Sigh. I’m not sure I can last another year. What happens when the ban goes into effect? Could they still just turn me down for coverage?
Hell, I heard that it may actually be cheaper to take the penalty for having no insurance than the insurance itself would cost, when the “individual mandate” takes effect. (When is that, anyway?)
Supposedly nobody will be turned down in 2014 onward. The mandate also takes effect during that period. My understanding is the penalty is pretty toothless, the only way they can take it from you is by reducing your tax rebate. The penalty will hit full force in 2016, when it will be $695 a year. That is going to be cheaper than health insurance if those are your options.
This is all what I think will happen, I’m not an expert on it.
Starting in 2014, you cannot be denied coverage or dropped for anything short of fraud. As you note, the mandate or penalty kicks in at the same time.
I am in the same boat as you, paying ever increasing premiums for an HD HSA but I have say that I don’t see the suggested option of dropping coverage and paying the penalty of $695 would be consistent with your intent to be a responsible adult… There will be assistance for those with low incomes.
In my experience, the government trying to tell me how much I can afford to pay for X is quite a different number from what I really can afford to pay for X. I’ll believe their financial assistance when I see it… it took 6 months of filing and refiling and dealing with incompetent people who sent us a “missed interview” notice while we were sitting in the waiting room just to get food stamps that only cover half our food bill.
What I mean by being a responsible adult: I’ve been looking for work for years, I literally never say no to a bona fide offer of work (and work some unbelievably crap jobs as a result), I saved like a fiend when I had a job (that I hated) which is the only reason I’m not living in a cardboard box right now, I went back to school and enrolled with a career outplacement company, which taught me “how to network to find a job” which still hasn’t worked more than a year later, I don’t have kids I can’t afford to feed so I’m ineligible for cash assistance, plus paying out of pocket for my own medical insurance, which means I have to wait til 2014 for these protections, as opposed to people who get insurance from their job (in other words, better, useable coverage for less out of pocket cost, and btw also a salary with which to pay for heathcare) who are apparently enjoying these protections now. And I’m supposed to believe this supposed safety net will amount to a hill of beans a year from now? I’m pretty much expecting there will be some reason they disqualify me, or some convoluted reason why the “assistance” isn’t enough to actually assist me with obtaining real world healthcare.
I’d love to keep my insurance. I can’t afford it. It actively prevents me from accessing healthcare because it disqualifies me from lower sliding scale fees even though I still have to pay for everything out of pocket. Tell me how I’m supposed to be “responsible” in these circumstances, since it offends you so?
The penalty IS less than what I currently pay for my insurance. Plus if I had no insurance (I sure as hell can’t afford the premiums on a better plan), I might actually be able to afford to see a doctor once in a while.
Do you seriously think I’d go without if the assistance was enough?
If you have a high-deductible plan you should be eligible for the lowest fees of all. Your carrier will have a contracted rate with in-network providers, which will be approximately the same charge as the fee schedule rate the carrier would pay if you’d met your deductible.
This is for providers that are operating as most do. There are a few providers that provide care for low/no income people on a sliding scale ability-to-pay basis. The care might be free to the poorest patients, up to normal cost for those able to pay it. (able as determined by the provider) These are typically subsidized by charity and/or grants. The fees are charged to those able to pay something in order to stretch the available funds to provide care to the most people possible. The OP is saying that having insurance (albeit very high deductible) disqualifies them from receiving this subsidized care.
Well, I wasn’t looking for advice as much as the actual impact of the confluence of my (possibly) needing to drop coverage and whatever is going on with healthcare reform right now, which presumably has a factual answer. The only parts of it I’ve been really able to understand from the media is the stuff that doesn’t apply to me (I’m over 26 and am not a dependent of my parents).
Correct. A few months ago I called up Howard Brown, which provides services on a sliding scale. I was told I’d have to pay full price (office visits in these parts go at about $150), because I had insurance. I told them that I had to pay for everything out of pocket because of my high deductible, but that didn’t matter – I had insurance, so I didn’t qualify for the lower fees. Since I can’t afford $150, I couldn’t see the doctors there. Whereas, had I been uninsured, I likely would have paid somewhere in the neighborhood of $15-20, not $150.
Anyway, if I’m understanding this correctly: IF I drop coverage sometime in the next couple months, I would have to do without until January 2014 before I could get covered again, because it is still legal to deny coverage or impose a waiting period for pre-existing conditions. Correct?
Is there any information on the financial assistance/subsidies available once the mandate goes into effect? Because right now I’m looking at paying a penalty that’s less than half my annual premiums, or paying that much in premiums for insurance that prevents me from getting care. In order for having insurance to make any kind of sense, financially, I would need enough in assistance to cover not only the other more-than-half of my premiums, but very likely a lot more than that (last I checked, premiums for useable insurance run at least three times my current premiums) in order to get insurance that I can actually use. Having insurance makes no sense when self-pay in most cases would be cheaper. (Thanks GOP, for completely pointless “reform.”)
Yes, I get twitchy over the idea of having no coverage in case of getting hit by a bus, but I can’t magic up the money, either.
No, I didn’t but someone else up thread suggested it.
Here is a link about assistance on a great site with lots of information on healthcare reform. Poke around that site and you’ll answer a lot of questions.
I think that your experience finding assistance will be different this time since the goal of the ACA is to help everyone get insurance which is 180 degrees from the current situation.
We’ll see how effective the implementation is. Ostensibly food assistance is meant to help, too, but in my experience they’re less than helpful. They’re impossible to get a hold of, for one. They’ve even stopped responding to my faxes. I stopped leaving voicemail because at least with a fax I have a written record of my attempt.
Could you afford to switch to the absolute cheapest HD HSA for the rest of the year? At least then you have catastrophic coverage. Looks like they can be had for $100/month or a bit more if you are under 40.
Oh, well, hell… tax credits? So in other words, I still have to come up with the entire premium on a monthly basis, and have to wait until the following year before I can get money back?
That’s… not helpful. That’s not structured with the reality of being poor and living hand-to-mouth, month-to-month in mind. I run out of money before I get to that extra money I have to pay every month for insurance. It’s not going to matter if I get it back in a year. My savings would run into negative numbers by then. I need the money every month, at that time. I can’t afford to essentially give the government a couple thousand dollar, interest-free loan. I don’t have a couple thousand dollars that I’m not going to be using.
Wow. This is messed up. Why not vouchers or discounted premiums? That at least might give me some chance of staying in the black from month-to-month.
This is way worse than I realized. It’s basically an enormous penalty on the poor.
I already did that a year ago. There are no cheaper (or worse in coverage) plans. They give me a list of what’s available to switch to every year when they notify me of my rate increase. This year there was nothing.
Switching companies is tricky at best. I have a medical history that no one wants, and it’s still legal for them to turn me down for coverage. I’ve been turned down for history that hadn’t been relevant in three years before. No way anyone wants a cancer survivor.
And the stuff it’s showing me on that website is more expensive, anyway.
Okay, so does that mean they are equivalent to a voucher, then?
I understood “available when an individual purchases coverage” to mean that said individual is eligible for the tax credit once they purchase the plan, not that the IRS pays out the tax credit at purchase. I have all sorts of tax credits available to me (like home office and student loan credits), but I don’t get money back on them til after I’ve sent in my tax return.
Thanks, but it still doesn’t seem to say whether I’m paying the entire amount of premiums up-front, and waiting for a refund on the tax credits the following year, or if they’ve got a system in place that I’m only paying for discounted premiums. Who am I paying if I’m buying insurance off the state exchange? The state or a private company?
And then there’s the last paragraph, which makes it sound like states can just opt-out of allowing people to get tax credits, in which case we’d be back at the penalty being cheaper than the insurance.
According to this calculator, the unsubsidized premiums I’d pay on the exchange are DOUBLE what I pay now. There’s no way in hell I could keep that up until I got a refund the next year. Is this a case of no one’s figured out how this will work because no one has set it up yet? Is there a plan here beyond “make exchanges”?