My insurance is through the Marketplace. I've had it since the beginning and doctors not accepting the plans has been a big problem for me. I have to travel 50 miles to see an endocrinologist and one town over for all my other doctors. Many doctors don't take Marketplace insurance at all, even if they do take other plans from the same insurer. I have found that they may only take certain levels from the Marketplace, like they don't accept silver but they do accept platinum.

With that being said, I think a lot of that has to do with Texas politics (one of the states that has fought tooth and nail against Obamacare).

DH and I are self-employed and our Marketplace insurance is HALF as
expensive as it was prior to Obamacare. We have a platinum plan with a
$500 family deductible, $10 co-pay and $3000 family out of pocket. Our previous insurance was $1200 per month with a $10,000 deductible!

Another problem, is that the plans change every year - well at least these first two years. They discontinued the plan and assigned us to a more expensive one. Then it's just a matter of shopping again and finding a plan that falls within our parameters. It's more of an annoyance than anything else.

Obamacare is a very flawed law (after it was hacked up) but, based on my experience, is way better than it used to be. Next step, universal.

When my husband sold his company we looked at Healthcare.gov. We had plenty of money but no wages and had not yet received interest income from the sale proceeds. Healthcare.gov wanted us to use Medicaid because we had little conventional income. Hmmm. I fudged our income number to put us above the Medicaid and subsidy level and then I was able to choose from the exchange plans in our area.

The website says you are allowed to estimate income and since I didn't decrease our income to get additional benefits I hope that I can't be accused of doing anything "wrong". So, for people that are being funneled into Medicaid and do not want to use it, you might try estimating your income to a higher level to be able to at least see the exchange choices in your area.

I think needing income info is just for the subsidy. The income estimate will eventually be verified through your income taxes. If you qualified/took a subsidy, and your income was not accurate, you will either get a refund or owe money at tax time.

Well, for my state, I was not able to even look at the market place offerings because of the lack of conventional income. I was directed to contact the state Medicaid office. I just added my experience for the people who did not want to use Medicaid. but wanted to see the marketplace offerings.

Oh, I agree completely. I'm just saying that an estimate is only needed because it gets worked out in the end. You can choose to over estimate if you want. It's just like filling out a W2 and claiming dependence - claim 0 and you have more taxes pulled from you income but you get a higher refund.

I misremembered; I have a Bronze level plan.

& the income estimate entered @ healthcare.gov is most assuredly for calculating any subsidies.

RE: finding Dr.s - my insurance is through Humana - an HMO - & I have a primary physician who refers me to any other Dr.s/ labs, etc. I need to see. If not referred, the ins. won't cover. Calling the insurer has been most helpful in dealing w/ situations involving getting a nearby primary care physician & dealing w/ prohibitively expensive or 'not covered' meds.

FWIW, I really like my primary care Dr. - she's @ a family health center about 10 minutes away which has its own pharmacy & also covers many procedures in-house, rather than having to send me elsewhere.

& man! I just did a preview & the deductibles have gone up enormously this year! I understand that there is no way for our state to negotiate lower costs for consumers because of our gov./legislature's choices...

writersblock - You were right. I had to create an account to see the list of physicians.

kswl2 - See! This is why I come here. Writersblock figured out I needed to create an account to see the information :) I definitely won't make my decisions based strictly on what is said here, but I find people here can always jump start the process whatever I'm doing.

My husband retired this year and he is a year older than me, so he went on Medicare. We considered buying Cobra but he would have had to go on it as well for me to get it through his prior employer. It would have been super expensive. So, from June of this year till I turn 65 in May, I am on Obamacare. I have the Bronze package, which is basically just a well care package. I get my checkup, mamo, and basic blood work but anything that would need to be followed up on after that I would have to pay for. Not what I am used to and I will be honest, I was not happy to settle for this plan. But, it is what it is and it is still really expensive for what I get. Because it was based on what my husband made before he retired, we got no discount whatsoever. So far I haven't had any real need to go to the doctor but I did have my mammogram done last month. I need to make my yearly physical appointment but I know she will want to have some tests done as she always does. I did get to keep my doctor as the large clinic we have here in town was on the list. BTW, my annual dermo appointment was not covered in the wellness package, so I didn't go this year.

Because it was based on what my husband made before he retired, we got no discount whatsoever.

You can apply for a subsidy when you file your taxes for this year, you know, if you think your overall income is low enough to qualify for one.

EDIT Just to clarify, I mean that you can get a subsidy for 2015 as part of your 2015 tax return.

Don't be surprised to get a few "you're insurer doesn't cover our services". Flu shots are not covered everywhere by all companies. Before Medicare, there was only one pharmacy that accepted payment from the insurer, CVS. We were denied by four others.

DD2 got letter today - insurance premium for her and her DS is increasing 28% January 1st. Freaking ridiculous.

I think the insurance companies are banking on the fact that people won't do anything and just allow the policy to renew automatically. That's why it's important to shop for a new plan every year. IMO, it's a pain but not a big deal.

This doesn't have anything to do with the law but rather an insurance company loophole that allows them to milk the system.

So far, it seems like it will cost at least $200/mth for the Bronze plan. My son only makes $5,000/year working for his dad. That just doesn't seem right and if we have a 28% increase the following year, that really won't be good.

The same Bronze plan for 2016 year will go up $113.00 PER MONTH! The only blessing is that I only need it for 5 months till I turn 65.

I joined Medicare 9/1 and still getting billed by insurance company. With recent letter of intent to collect for September and October, I received a notice that our 2016 premium will increase by $665 per month. That would take us to about $2500 month. Affordable Health Care? I never did save the $2,500 per year as promised.

If your son only makes 5K per year, then he can't afford health care insurance. As far as I can tell, he won't have to pay the penalty either, with that low of an income.http://taxpolicycenter.org/taxfacts/acacalculator.cfm

I've had to provide my own health care insurance outside of my employer for the past 8 years. For me, it has been about 5K per year but I am over 50. For your son, I'm imagining a basic plan might be around 3K per year, possibly much less depending on his health history. I'll bet you could get a basic plan for about 2K, but then again, I dont' know because I've only shopped around for my age group. I got my plan before the passage of the ACA, on a national insurance plan clearinghouse. My insurance is with the company UnitedHealthCare. You might go to their Web site and see if there are any plans they offer that you can afford for your son.

Since I have been paying for it out of pocket for 8 years, all I can say is welcome to the world of insurance coverage. It's costly, and mine hasn't changed dramatically one way or the other since ACA. At my age it is very costly, at his age less so, but still it's a big expense. When I was his age back in 1985, my health insurance cost me 85 dollars a month. Of course it was MINIMAL coverage. But I made 100 dollars a week back then, so it was still costly for me.

Revisiting this thread after the laugh frolic of reading the other one :-)

struck by this comment: "I have found that they may only take certain levels from the Marketplace, like they don't accept silver but they do accept platinum."

Mag, just FYI whoever is telling you that is lying. Physicians cannot only opt into certain levels of ACA plans---the contracts are for ALL plans. If anyone has told you that you should report it to your state insurance commissioner.

Well, it could be semantics. So in other words, a service may be covered by your insurance company if you have the platinum level of insurance, but not the silver level. But it isn't about "accepting" the insurance. It's about coverage, ie will your plan cover the cost. I have been privately insured since 2007, before ACA, with a plan I got on a national insurance clearninghouse Web site (before there was even gov't run ones) through UnitedHealthCare. I have been told various incorrect things by marginally competent staff at doctor's offices many times. These folks are not necessarily your friend or your advocate. There's a vast spectrum of competencies out there! Doctors may know gads about the human body, but knowing how to run an office and navigate insurance rules is a whole other skill set!

I would imagine Magdalena is a pretty savvy client / patient / customer and knows or would ask the difference between what a plan covers and what the doctor accepts.

The reimbursements are the same for all levels of ACA plans. The "level" refers to the monthly cost / deductible / OOP amounts. It wouldn't surprise me if a physician's employees did not know what they were talking about. A few weeks ago a 66 year old man with all his faculties (allegedly) told me his car insurance went up $21 per month "because of Obamacare." I asked him how he knew this and he said "the girl at the insurance company told me."

i fear we probably have exactly what we deserve.

I have twice been told by doctor's office staff that they don't accept my insurance. Well, what they said was, "I don't think we accept that insurance" which is a very poor way of putting things if you care at all about customer service. If you don't know, just say you'll have to check. This was after moving twice so I looked up the practice on the insurance carrier's Web site, which is how I found the new practice in the first place. So then I replied, "Well it said on my insurance carrier's Web site that you accepted their policies. You were listed there as one of there participating practices." So then they "checked" and lo and behold, they DID take my insurance. It floored me how they could be so blase about giving out accurate information. This last move/doctor change I had no problems at all, but then this practice came highly recommended.

I'm going over my insurance options for 2016 right now.

Absolute sticker shock. I'm flabbergasted. My eyes are blurring. Anything positive I felt about Obamacare is out the window. The ACA is set up to allow insurance companies to run out of control and this is bullsh!t.

To keep my premium the same ($680/mo), I'm going to have to go from a Platinum plan to a Bronze. My deductible will go from $700/yr to $13000/yr. Same for out of pocket. $10 Co-pay for doctors visits to paying full pop until the deductible is met.

Yes, my Bronze plan was $640 something in 2015 and will go up above $760 in 2016. No help for those who have worked hard and saved all their lives. For my 7 months that I have been on it, I got a mammogram and a physical but only lipid and blood sugar panel allowed in the coverage. My doctor asked me why I didn't have all the blood work and urinalysis done that she usually requests for a yearly checkup. I told her it wasn't covered. I did get my flu shot but not pneumonia, will have to wait till I am 65 for that.

My SIL was just saying that she can't find a plan under $1,000/mo, $5,000 deductible. Before the ACA, she was paying significantly less (unable to recall exact amount but I seem to remember around $400/mo). Catastrophic insurance would have been preferable to what is available to her now but that is no longer an option. I just don't understand how people will be able to afford their insurance now; $1,000/mo. is a huge chunk of change!

I did see one catastrophic plan available. Wasn't planning on looking at it but I might now. I will say, even though the plans are more expensive this year, it's still cheaper (for us) than pre ACA.

I read an article that said plans are increasing because the insurance companies didn't foresee how much people would actually being using their insurance. There's pent up demand and it's possible rates will decrease next year. Whatever.

Unfortunately, those experiencing this issue are not alone.

The NY Times did a big article on this issue this weekend on how many people buying on the exchange have described their insurance as "all but useless" due to high deductibles and high costs.

Unfortunately, the pool of those buying insurance has turned out to be smaller and sicker than people had hoped, and insurers had to either raise premiums or raise deductibles (or both). Unfortunately, this is likely going to lead to all but the sickest ending up dropping their coverage, which is likely to only make things worse. This may be the beginning of the death spiral...

I am very concerned about losing my $104/month coverage (for both DH and I) w/ my $10K family deductible (1 preventative exam per year included), since I was only guaranteed to keep it through 2016. I really hope that doesn't happen :( I will not go on the exchange either way, but I really like the coverage I have now and will be furious if I lose it.

I feel very badly for all the people who are facing these issues.

We are paying about $1600 per month for DH, me, and our son in college. That is ridiculously expensive. The ACA overall plan is set up to subsidize low income applicants. If you don't have a universal system that covers everybody, but want low income people to have insurance that is not not medicaid, this is the result. This is exactly what happens when people say "something has to be done" but who don't want to go to a single payer, universal system.

Someday we may have a single payer system. it can't come too soon for me.

"Someday we may have a single payer system. it can't come too soon for me."

Me too.

Medicare is a single-payer system and it works just fine. We just need it for everyone.

I've been getting the following email from Healthcare.gov, but yet I'm not seeing anything for $75/mth for my son.

8 out of 10 people who enrolled in a health plan at HealthCare.gov qualified for financial help to make their monthly payments more affordable. In fact, most people can find monthly premiums for $75 dollars or less per month.

Msrose, I'm afraid Texas has done everything possible to make it more difficult for individual affordable plans. Selection is limited, competition is low, premiums are high.

Which of these plans is the better deal? Why?

Many older people on medicare complain that they dont want "socialized medicine" in the US. They dont realize that THEY are the only ones who DO have it.

Medicare's admin costs run from 3-5% of budget annually. Private insurance companies are up into the high teens percentages for admin costs. Plus they have to make a profit to satisfy shareholders. Health care, like education, police and fire protection and the armed forces, should be paid for by taxation and available to every citizen regardless of their ability to pay. Our system is shameful and barbaric ----and unique among first world countries.

Magdalena, the plan on the right looks preferable to me--lower premium, lower deductible, lower max out of pocket, no co-pay after deductible, and it's HSA eligible. But at the same time, the info for the plan on the left seems funky--it has a higher deductible than the one on the right, so why wouldn't it be HSA eligible? And the max out of pocket is the same as the deductible, so where does the $15 co-pay come in? I'm very confused by the info presented.

kswl, your last two posts are PERFECTION! Single payer cannot come soon enough. The problem with the ACA is that it didn't go FAR enough.

Even though I'm on Medicare since 9/1, I still get the Marketplace email reminding me to go there and see how much I can save. LOL

Save? No. Increase of $655 month.

One thing to bear in mind, your health insurance premiums will go up as you age. Particularly if you are in a pool with older people too. It will not go down unless you get into a pool with younger people. That is not likely to happen as you age under the current private options. If your employer can somehow negotiate you into a younger cohort pool for your whole company, then rates may go down. But since the workforce is aging and most full time stable employees are older, I don't see pools getting big influxes of younger people. Old people are more expensive to insure, as are women. Workforce is older and full of women, thus high cost of insurance. Plain statistics. I work in academia, we are terribly expensive to insure because we are old women who put off having babies so we are probably the most expensive folks out there!

Oh, and like Cawaps, as for the policies above, I concur that it looks like only slightly splitting hairs to me on those two policies. Both have high deductibles, but that's the way it goes, if you want less expensive insurance, then high deductible and just hope you don't get a medium level of sick, because if you do, you will be out a lot of money! Ask me how I know!

No medium level of sick - check. LOL!

I think the $15 co-pay for doctors visits caught my eye for the plan on the left. However, the lower premium makes up the difference for the plan on the right I think. Plus it has a HSA.

This stinks, my current insurance is so much better than anything I could find, unless I want to pay over $1000/mo in premiums.

Go big sick or go home, literally!

Msrose, one thing you might want to check out for your son, is if there is a college he is thinking about going to, some of them will offer health insurance for their students at low rates. A college student health insurance pool is large and full of young people, if the school is large. I know I was self-insured and when I enrolled at Drexel I found out they have very competitive rates for students if they were enrolled at least part-time. Of course there is tuition, but if your son is thinking about going anyway, he might check out colleges that offer health insurance deals. They don't pay for it, they just allow you to sign up through them for the rates. One thing to think about is if your son is only making 5K per year, college, depending on his major, might be a good use of his time because it could (depending on his major) increase his earning power and ability to get or pay for health insurance.

If you are middle class like we are, I cannot believe you like ACA. Although, I guess it depends on which state you live in, apparently. In Oklahoma, it is AWFUL, unless you are lower income.

My DH and DS are on ACA-I am on my employer's insurance and adding my DH and son to my insurance is outrageous (I'm a teacher, I just went back to work this year after being a SAHM for 12 years) and we were notified yet AGAIN their insurance is canceling-which was not good anyway, but now, Blue Cross only offers plans with participating hospitals not even in our city any longer. So, if any emergency happens-not sure what happens-have to go 30 minutes away...my sister just told me this, as her DH and DD is on ACA right now, although, I have been getting emails stating BCBS is canceling, but I haven't had time to look yet, as it took FOREVER before!

My sister said that she contacted a private agent and only two companies offer policies for individuals in Oklahoma now-BCBS and United-something? The agent is suppose to get back to her. I dread this process again! I cannot believe anyone even wanted this. I, at least, thought, if it did pass back then, that it would be affordable and decent coverage-NOT in Oklahoma. Another confirmation on my feelings for Obama and his ilk.

Someone "somewhere" on here said they are getting it through a religious affiliation-so I will try that route, I guess. At least, will look into it.

Madgalena, definitely go with the one that includes the HSA. At least with the HSA you can roll the money over year to year.

Olliesmom, my preferred hospital is not in network either, which means higher out of network costs.

Probably United Health is the other one you mentioned. They have already announced they may be leaving ACA in 2017. We have the Bronze plan with them on ACA and its over $750 for me alone. My husband is on Medicare and has a supplement with Florida Blue (BCBA). My Bronze plan covers very little. Luckliy I only need it till May when I turn 65 - just hoping I stay well till then.

GSC, yes I agree. I'm waiting to see if my endo is accepting another plan (they aren't finalizing their contracts until the 30th) that's less expensive.

Good riddance to United Healthcare! They probably aren't making any money because they have to pay incompetent people to do the same task over and over again. They are my current provider and I've had nothing but trouble with them from the beginning. I have never made one late payment and yet they send me past due notices all the time. Twice they sent letters to my doctors saying they won't pay the claim because I haven't paid my bill! The problem is that they don't mark payments as being received properly and I've actually had to prove I've made the payments by sending bank statements. It's gotten to where I have to call every month to confirm the payment was received.

olliesmom, I mentioned I will be getting mine through a Christian health sharing ministry if my policy is cancelled next year.

There are three you can participate in that "count" so you don't get hit w/ the Obamacare penalty. Good Samaritan, Medishare, etc. I have not personally been covered through them, but I have talked to one other person who has purchased through them and been very happy.

From rococogurl: Fact remains, some 8 million people signed up for it. Perfectly or imperfectly it is meeting a need.

I'm sure there are numerous people who did not want to sign up, just like I did. When I was on it last year, there was ONE family practice doctor in my city who I could see. He then moved to New York one month later-so the rest of the year I didn't have one-just waited it out until this year, knowing I'd have a group plan by then.

beagles, thanks for the reminder-I will certainly look into to it.

Magdalena, I know what you mean. We get bills each month and actually we pay a month ahead so we are never close to being late. I go online and check to make sure it is posted. I think they say it takes 10 days to 2 weeks for a check payment to be posted. I know we tried to have a direct payment made monthly from our account and they would not allow us to do it. I'm not happy having to go with it, but we had no real alternative since I am a year younger than hubs. We were going to use Cobra from his employer but he would have had to be on it for me to get it and of course he didn't need it. Oh well, I am just biding time till May.

S I N G L E P A Y E R ! ! ! Insurance companies are for profit, doctors are for profit, hospitals are for profit, overhead and duplication are meant to provide cover and confuse the users.

What will a singlepayer system do to reduce rising medical costs?

kswl -- Well said.

@ollliesmom - Of course there are people who did not want to sign up. There are states that are not making it easier. But it still does fill a need. Very imperfectly and sometimes badly. No question. It's infuriating all around.

A friend of mine is a cancer survivor. She has been signed up with the only plan in my state that accepts the cancer hospital she goes to. Her plan has gone bankrupt. It's not clear what will happen. She has a little more than 2 weeks to figure it out. Fortunately, the hospital is large and influential and fighting for a longer extension.

I'm all for capitalism and profit making. But if we must do it at the cost of the lives and health of our citizens, so that the president of health insurance company can have a private plane, then we need to ask ourselves what's important in our country and our culture.

I have a United Healthcare policy and my premiums are paid directly and automatically from my checking account so not sure why Mboston says they tried to set that up and couldn't. I've had that for almost four years. Not saying it is the greatest insurance from a coverage standpoint, but I have never had any serious problems with them as far as service on records and bills. YMMV.

I think overhead and duplication are so more people can make money off of health care. It is one of the few sectors of our economy where people can find jobs.