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I recently quit my six figure salary job at a startup here in Minnesota to start my own startup. Just before I quit I was looking at around $650/month premiums

I recently quit my six figure salary job at a startup here in Minnesota to start my own startup. Just before I quit I was looking at around $650/month premiums for my family of four as the absolute cheapest plan with the highest deductible. Right after I quit, the two largest health insurance providers in MN pulled out of our MNSure health insurance exchange, causing premiums to spike up across the board. Now I am faced with a $1200/month premium which is more than I'd pay for my former employer's health plan through COBRA. Having to cover such a high premium expense is significantly impacting my ability to start my company. So perhaps Sam is happy about all the ways in which the ACA has helped much younger entrepreneurs get off the ground with their companies, but a significant portion of the population is being impacted in a very negative way. Maybe he believes that only young people should be starting startups in the first place, but we know that's an absurd proposition. Even if I was under 26 I wouldn't have been able to rely on my parents for health insurance because they were unemployed. The only way I can make this all work is to claim a low enough income to qualify for medical assistance which is going to be hard to work out because of my monthly expenses. What I really wish I could do is pay for a very low premium "catastrophe" plan with an absurdly high deductible like $50k, because my family is very healthy and I have enough in retirement savings (IRA, HSA, 401K, etc) to cover it should something severe happen. In other words, I wish I could just buy health insurance that was like my car insurance. But I'm being forced to pay for a plan with far more bells and whistles than my family will ever use or frankly even wants to use.

fencepost 10y ago
Then if you're still on it, pay COBRA for the year. Based on what I can see without making up fake info to look at the Minnesota exchange[1], a Silver plan for a family of 4 went from $905 in 2016 to $1405 in 2017, but with $68k/year in income there'd be a $725 tax credit so the monthly premium would have gone from $622 to $680. I assume since your numbers were a bit lower that you were looking at the Bronze plans instead. Just take hope! If you can just make it through this year you won't have to worry about the question of purchasing insurance as an individual, because as a family with several preexisting conditions (fertile female, children/disease and injury vectors) without the ACA you'll be effectively uninsurable unless you can grow your startup fast enough to make a group plan feasible. [1] https://mn.gov/mnsure-stat/assets/2017-MNsure-healthcare-coverage-plan-rates.pdf https://mn.gov/mnsure-stat/assets/2017-MNsure-healthcare-cov...
- marknutter 10y ago
  I was seeing premiums way lower than $905/mo back when I was first shopping for plans. With my current income 2015 I do not qualify for any federal subsidies. I have no idea what my income is going to be for 2016 but I can keep a majority of my income in my business so that my personal income is well below the level I need it to be to qualify for medical assistance. It doesn't feel right to me to be going on medical assistance with my earning power, but I guess this is the reality we live in. I've been on hold with MNSure for 2 hours so far today and I can't start an application until I talk to customer support because of some problem in their system. The whole thing has been a giant comedy of errors so far. I'm definitely not a fan of the ACA.
  - fencepost 10y ago
    If this is your first year looking at Exchange plans it's worth doing a spreadsheet with some auto-calculating fields based on guesstimates of your number of primary care and specialist visits per year. One thing that I discovered when I did that my first year was that the big difference between some of the Gold plans and the Silver plans was pretty much only in the minimum amount I'd be paying per month as premiums - the maximum out of pocket was pretty much the same and there wasn't that much variation in my "expected" out of pocket - I was just paying it as higher copays IF we did go to the doctor or as a higher premium regardless of whether we went to the doctor. Something to watch out for is "coinsurance after deductible" aka "you get bupkis until you've used a lot of care." With school-age kids and probably a minimum of one checkup/physical per year per child plus vaccinations, etc. you might be better off looking for a plan with copays even if the premium is a bit higher. It's also worth looking at the emergency coverage, there can be some variation in there. Oh, and check the provider network - BCBSIL at least has different provider network levels, so if you see seemingly-similar plans from the same carrier with a significant price difference it may mean that most providers or hospitals are going to be out-of-network which means you pay more. Good luck
dmode 10y ago
I am wondering whether this is because you are in a weird transitory situation from a six figure income to a start up income. I just played around with Covered California. With 68K income and household of 4, I got plans as low as $282 per month. But if I increase my income to 120K, the cheapest plan was $750 per month. Can you use a projected income, instead of last year's income ? Also, I think when you file taxes in 2018, your should be able to get the tax credits back.

fencepost 10y ago

Then if you're still on it, pay COBRA for the year. Based on what I can see without making up fake info to look at the Minnesota exchange[1], a Silver plan for a family of 4 went from $905 in 2016 to $1405 in 2017, but with $68k/year in income there'd be a $725 tax credit so the monthly premium would have gone from $622 to $680. I assume since your numbers were a bit lower that you were looking at the Bronze plans instead. Just take hope! If you can just make it through this year you won't have to worry about the question of purchasing insurance as an individual, because as a family with several preexisting conditions (fertile female, children/disease and injury vectors) without the ACA you'll be effectively uninsurable unless you can grow your startup fast enough to make a group plan feasible. [1] https://mn.gov/mnsure-stat/assets/2017-MNsure-healthcare-coverage-plan-rates.pdf https://mn.gov/mnsure-stat/assets/2017-MNsure-healthcare-cov...

marknutter 10y ago
I was seeing premiums way lower than $905/mo back when I was first shopping for plans. With my current income 2015 I do not qualify for any federal subsidies. I have no idea what my income is going to be for 2016 but I can keep a majority of my income in my business so that my personal income is well below the level I need it to be to qualify for medical assistance. It doesn't feel right to me to be going on medical assistance with my earning power, but I guess this is the reality we live in. I've been on hold with MNSure for 2 hours so far today and I can't start an application until I talk to customer support because of some problem in their system. The whole thing has been a giant comedy of errors so far. I'm definitely not a fan of the ACA.
- fencepost 10y ago
  If this is your first year looking at Exchange plans it's worth doing a spreadsheet with some auto-calculating fields based on guesstimates of your number of primary care and specialist visits per year. One thing that I discovered when I did that my first year was that the big difference between some of the Gold plans and the Silver plans was pretty much only in the minimum amount I'd be paying per month as premiums - the maximum out of pocket was pretty much the same and there wasn't that much variation in my "expected" out of pocket - I was just paying it as higher copays IF we did go to the doctor or as a higher premium regardless of whether we went to the doctor. Something to watch out for is "coinsurance after deductible" aka "you get bupkis until you've used a lot of care." With school-age kids and probably a minimum of one checkup/physical per year per child plus vaccinations, etc. you might be better off looking for a plan with copays even if the premium is a bit higher. It's also worth looking at the emergency coverage, there can be some variation in there. Oh, and check the provider network - BCBSIL at least has different provider network levels, so if you see seemingly-similar plans from the same carrier with a significant price difference it may mean that most providers or hospitals are going to be out-of-network which means you pay more. Good luck

dmode 10y ago

I am wondering whether this is because you are in a weird transitory situation from a six figure income to a start up income. I just played around with Covered California. With 68K income and household of 4, I got plans as low as $282 per month. But if I increase my income to 120K, the cheapest plan was $750 per month. Can you use a projected income, instead of last year's income ? Also, I think when you file taxes in 2018, your should be able to get the tax credits back.