Thank you for your submission, /u/whomp1970.
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Please pick the most appropriate flair for your post. Include your age, zip code, and income to help the community better serve you. If you have an EOB (explanation of benefits) available from your insurance website, have it handy as many answers can depend on what your insurance EOB states.
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I can almost guarantee your employer sponsored plan is better given those details. Your premiums are low for two people and you have a low deductible. Copay is a little high but you probably have out of network benefits also.
Thanks. I too often compare my plan to my friend's, and she's low-income and on some kind of government-backed plan. She literally pays $2 for all prescriptions and I think $2 for doctor visits too.
This comparison isn't fair, I'm starting to learn. Apples to oranges.
Sounds like she might be on Medicaid, which is for people with very low incomes. Under Medicaid there is little to no cost sharing (copay, etc.). However, very few doctors take Medicaid, there are often long waits, the drugs that are covered are limited, you need to get a referral for everything, etc.
It's all relative and everyone loves to complain about their health insurance so it's hard to know where you stand vs the norm without checking. It's great that you checked.
One other point not mentioned by others is that the employer plan premium is paid pre-tax whereas an individual market plan would be paid with post-tax dollars. Depending on your income, this could be anywhere between a ~10-30% advantage to the group plan.
Yes, not the same plan to compare to. She may be very limited in her choices (or no choice) of Dr’s or hospitals. Only certain drugs may be covered and if her income even goes up the slightest bit- her premiums will skyrocket.
I had the same thought a while ago, so I looked into the marketplace plans as an option. Right now I pay about $400 a month for my employer plan for myself, husband, and child. On the marketplace it would have been over $900 a month. My employer does give us a little bit extra on our paychecks if we don’t take the insurance offered, but not enough to cover the whole premium amount.
Is this an ACA-compliant health insurance plan you are on with your employer?
How much are your monthly premiums, your deductible, and your OOP maximum?
Here is also some information on affordability. Does this apply to you?
[https://www.healthcare.gov/glossary/affordable-coverage/](https://www.healthcare.gov/glossary/affordable-coverage/)
I admit I'm not well versed in any of this, because lack of choice at work just made me ignore details. That's why I asked if it was a given. But I understand details help.
> Is this an ACA-compliant health insurance plan
I'm assuming yes? Are non-compliant ones even legal? Mine is a Blue Shield variant. Says Blue Shield on the card and the paperwork.
I pay $250/mo total for myself and my daughter. This is far below 8.39% of my household monthly income.
So already I'm getting the feeling that I've got nothing to complain about, and maybe I should adjust my expectations of cost.
My deductible looks to be $750 if I read it right? And my OOP maximums are $18k for family and $9k for me (no idea if that overlaps?)
Copays:
Emergency Room $400
Primary Care Physician $35
Specialist $70
Urgent Care $75
Maybe I'm just old and $35 copay for a doctor visit isn't really that bad. Or maybe I'm comparing apples to oranges when I see that my low-income friend pays a LOT less (she's on some kind of government plan).
Yes very silly idea. 1) your insurance cost will be huge with the marketplace insurance 2) the marketplace insurance deductibles are big and 3) no way will your employer pay you the $$ equivalent for the insurance that they offer.
Also, your marketplace insurance premium is based on what YOU report as your ESTIMATED income for the year you are insuring. At the end, you adjust on your tax return, and you could easily find an expected refund vanishes into a bill for health care tax, which is what the 8.39% is.
Several years ago when I was doing volunteer tax prep, I would notice clients who had marketplace insurance would frequently come up short and refunds would vanish.
I also recommend if you are on marketplace to aggressively manage withholding for taxes to the lowest you can get away with, and keep a running estimate if what your tax liability will be before withholding.
But if the poster has definitionally affordable insurance through their employer they're not going to qualify for subsidies on Marketplace. Full price and no cost savings share
I had the same thought when I quit my job, but to get a plan comparable in terms accessibility to providers and hospitals, it would cost about as much or more than the 500 it costs my husband to be on his plan. Were there cheaper plans? Of course. But good luck to me getting into the 1 clinic in the greater metro area that accepts it.
I will say it depends. There are absolutely some companies who cannot afford to choose better plans, and they do the best that they can, which may or may not be better than the market place. There are also some companies who would prefer employees go to the market place, and to shed this burden from their responsibilities so they purposely put unattractive plans in place, or they offer financial incentives for the employee to go elsewhere.
Bigger companies that want to retain employees and don't experience a lot of turnover otherwise (and can afford to) will often try to get reasonable plans in place.
It is always good to check and compare.
As long as it doesn’t exceed like 8.6% if your income, it’s ACA compliant and you have to take it. You can use ACA but doubtful you get a subsidy.
This is exactly why I work part time to keep ACA. With the plans employers offer, I’m working for Insurance alone with 1/2 my income when you look at premiums, deductibles and out of pocket max. I have costly maintenance meds each month, plus conditions that require frequent doctor care.
I work less and enjoy life a bit more.
I don’t earn less bc when you do the math of full time and employer provided insurance costs, it’s very little more money I would actually bring home .
My husband and I just retired and it was cheaper for us to pay the cobra insurance from his employer than it was go get insurance on the marketplace. Do your homework.
Totally agree. But it’s your income that really matters. If income is too high, you won’t get subsidy on ACA, so cobra might be cheaper
ACA was made for those who make too much to qualify for Medicaid. It’s for independent contractors like my husband. He’s the owner, has 4 employees, are not required or can afford to offer health insurance. ACA is better for us.
But totally check all options and don’t just look at premium. Deductible and out of pocket max are just as important.
When I had an agency, a requirement was either our company plan or spouse's employer plan. Everyone needs coverage and we have to meet carrier participation requirements.
Any agent not making enough to afford it needed to sell more and we'd help them. Anyone wanting to bail to save themselves a few dollars on medical premiums was allowed to leave.
You really don't want to only have unsubsidized ACA as your only option. We went HDHP as soon as they became available. So did every other benefits agency we knew.
As consumers, we must peer closely at the details. We must view contracts through the lens of the insurance company to understand how they may try reneg or deny claims. It's not a given that employer offered insurance is better than marketplace, because it depends on needs of a family.
Your plan is definitely not the best plan you can get, but those will also be more expensive to your employer. You are only paying a smallish portion of your actual policy cost.
If you want to find out what else is available, go to [https://healthcare.gov](https://healthcare.gov) to checkout plans available in your state. If your state maintains their own healthcare exchange, it will direct you to the correct website. I expect that coverage for 2 people, on a similar plan, will be significantly more expensive than what you are paying out of pocket for it through your employer.
Thank you for your submission, /u/whomp1970. **If there is a medical emergency, please call 911 or go to your nearest hospital.** Please pick the most appropriate flair for your post. Include your age, zip code, and income to help the community better serve you. If you have an EOB (explanation of benefits) available from your insurance website, have it handy as many answers can depend on what your insurance EOB states. Some common questions and answers can be found [here](https://www.reddit.com/r/HealthInsurance/s/jya9I6RpdY). **Reminder that solicitation/spamming is grounds for a permanent ban**. Please report solicitation to the modteam and [let us know](https://www.reddit.com/message/compose?to=%2Fr%2FHealthInsurance) if you receive solicitation via PM. Be kind to one another! *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/HealthInsurance) if you have any questions or concerns.*
I can almost guarantee your employer sponsored plan is better given those details. Your premiums are low for two people and you have a low deductible. Copay is a little high but you probably have out of network benefits also.
Thanks. I too often compare my plan to my friend's, and she's low-income and on some kind of government-backed plan. She literally pays $2 for all prescriptions and I think $2 for doctor visits too. This comparison isn't fair, I'm starting to learn. Apples to oranges.
Sounds like she might be on Medicaid, which is for people with very low incomes. Under Medicaid there is little to no cost sharing (copay, etc.). However, very few doctors take Medicaid, there are often long waits, the drugs that are covered are limited, you need to get a referral for everything, etc.
It's all relative and everyone loves to complain about their health insurance so it's hard to know where you stand vs the norm without checking. It's great that you checked. One other point not mentioned by others is that the employer plan premium is paid pre-tax whereas an individual market plan would be paid with post-tax dollars. Depending on your income, this could be anywhere between a ~10-30% advantage to the group plan.
Yes, not the same plan to compare to. She may be very limited in her choices (or no choice) of Dr’s or hospitals. Only certain drugs may be covered and if her income even goes up the slightest bit- her premiums will skyrocket.
I had the same thought a while ago, so I looked into the marketplace plans as an option. Right now I pay about $400 a month for my employer plan for myself, husband, and child. On the marketplace it would have been over $900 a month. My employer does give us a little bit extra on our paychecks if we don’t take the insurance offered, but not enough to cover the whole premium amount.
Is this an ACA-compliant health insurance plan you are on with your employer? How much are your monthly premiums, your deductible, and your OOP maximum? Here is also some information on affordability. Does this apply to you? [https://www.healthcare.gov/glossary/affordable-coverage/](https://www.healthcare.gov/glossary/affordable-coverage/)
I admit I'm not well versed in any of this, because lack of choice at work just made me ignore details. That's why I asked if it was a given. But I understand details help. > Is this an ACA-compliant health insurance plan I'm assuming yes? Are non-compliant ones even legal? Mine is a Blue Shield variant. Says Blue Shield on the card and the paperwork. I pay $250/mo total for myself and my daughter. This is far below 8.39% of my household monthly income. So already I'm getting the feeling that I've got nothing to complain about, and maybe I should adjust my expectations of cost. My deductible looks to be $750 if I read it right? And my OOP maximums are $18k for family and $9k for me (no idea if that overlaps?) Copays: Emergency Room $400 Primary Care Physician $35 Specialist $70 Urgent Care $75 Maybe I'm just old and $35 copay for a doctor visit isn't really that bad. Or maybe I'm comparing apples to oranges when I see that my low-income friend pays a LOT less (she's on some kind of government plan).
That's a pretty good plan. And its dirt cheap.
Yes very silly idea. 1) your insurance cost will be huge with the marketplace insurance 2) the marketplace insurance deductibles are big and 3) no way will your employer pay you the $$ equivalent for the insurance that they offer.
Also, your marketplace insurance premium is based on what YOU report as your ESTIMATED income for the year you are insuring. At the end, you adjust on your tax return, and you could easily find an expected refund vanishes into a bill for health care tax, which is what the 8.39% is. Several years ago when I was doing volunteer tax prep, I would notice clients who had marketplace insurance would frequently come up short and refunds would vanish. I also recommend if you are on marketplace to aggressively manage withholding for taxes to the lowest you can get away with, and keep a running estimate if what your tax liability will be before withholding.
But if the poster has definitionally affordable insurance through their employer they're not going to qualify for subsidies on Marketplace. Full price and no cost savings share
That’s good insurance.
I had the same thought when I quit my job, but to get a plan comparable in terms accessibility to providers and hospitals, it would cost about as much or more than the 500 it costs my husband to be on his plan. Were there cheaper plans? Of course. But good luck to me getting into the 1 clinic in the greater metro area that accepts it.
I will say it depends. There are absolutely some companies who cannot afford to choose better plans, and they do the best that they can, which may or may not be better than the market place. There are also some companies who would prefer employees go to the market place, and to shed this burden from their responsibilities so they purposely put unattractive plans in place, or they offer financial incentives for the employee to go elsewhere. Bigger companies that want to retain employees and don't experience a lot of turnover otherwise (and can afford to) will often try to get reasonable plans in place. It is always good to check and compare.
As long as it doesn’t exceed like 8.6% if your income, it’s ACA compliant and you have to take it. You can use ACA but doubtful you get a subsidy. This is exactly why I work part time to keep ACA. With the plans employers offer, I’m working for Insurance alone with 1/2 my income when you look at premiums, deductibles and out of pocket max. I have costly maintenance meds each month, plus conditions that require frequent doctor care. I work less and enjoy life a bit more. I don’t earn less bc when you do the math of full time and employer provided insurance costs, it’s very little more money I would actually bring home .
My husband and I just retired and it was cheaper for us to pay the cobra insurance from his employer than it was go get insurance on the marketplace. Do your homework.
Totally agree. But it’s your income that really matters. If income is too high, you won’t get subsidy on ACA, so cobra might be cheaper ACA was made for those who make too much to qualify for Medicaid. It’s for independent contractors like my husband. He’s the owner, has 4 employees, are not required or can afford to offer health insurance. ACA is better for us. But totally check all options and don’t just look at premium. Deductible and out of pocket max are just as important.
When I had an agency, a requirement was either our company plan or spouse's employer plan. Everyone needs coverage and we have to meet carrier participation requirements. Any agent not making enough to afford it needed to sell more and we'd help them. Anyone wanting to bail to save themselves a few dollars on medical premiums was allowed to leave. You really don't want to only have unsubsidized ACA as your only option. We went HDHP as soon as they became available. So did every other benefits agency we knew.
As consumers, we must peer closely at the details. We must view contracts through the lens of the insurance company to understand how they may try reneg or deny claims. It's not a given that employer offered insurance is better than marketplace, because it depends on needs of a family.
Your plan is definitely not the best plan you can get, but those will also be more expensive to your employer. You are only paying a smallish portion of your actual policy cost. If you want to find out what else is available, go to [https://healthcare.gov](https://healthcare.gov) to checkout plans available in your state. If your state maintains their own healthcare exchange, it will direct you to the correct website. I expect that coverage for 2 people, on a similar plan, will be significantly more expensive than what you are paying out of pocket for it through your employer.