I’ve only returned to the US recently after 15yrs overseas… so no experience with ACA
Think I’ve sort of figured out how the subsidies work (yea, I’ve posted a question about this here before) but think that I’ve misunderstood the max OOP part… I initially interpreted this as the amount you pay before the insurance plan kicks in. This is wrong right?
Basically, ACA plans sort of work the way company sponsored plans worked before ACA? ie. I go see the doctor, let’s say the overall bill is $1,000 – I pay maybe $100 and insurance pays $900? Just throwing numbers out there and have no idea really what the typically break downs are – since I never really went to the doctor before anyways. The one exception was when our child was born… numbers sort of fuzzy now (17 yrs ago) but sort of remember a total bill of $25k and paying a very small portion of that (maybe <$1k)
So doing some reading about how these plans work – ie. looking at Bronze plans. In theory they have an actuarial value of 60% so I should expect to pay ~40% of whatever the total bill comes out to… up until I reach the max OOP? So for bronze, the max OOP (family of 4) is ~$15.5k which would correspond to total health cost of ~$39k? And then above this, insurance covers 100%? I realize that the 60% actuarial number is not perfect predictor of actual spend/co-pay… that this sort of depends on plan provider, hospital, doctor, etc
Or maybe put another way, is that the old school company provided health plans were similar to say a gold or platinum plan under ACA?
One additional oddball question… I actually went to visit the doctor recently and the receptionist/billing folks told me that I get discount on their “rack rates” when I’m paying on my own (it was non-urgent so I asked about costs upfront). Still need to sort out the details after actually receiving my bill… but is this normal? Maybe because they realize folks with no insurance are more willing to shop around and this is a way for them to price discriminate (ie. they don’t want to provide a lower rate to the insurance provider where the consumer is NOT price sensitive)?
EDIT: OK, sorry, noticed the HealthCare 101 sticky after posting this which answers most of my questions. So basically, in terms of overall cost, I need to look at the subsidy/premium + deductible + co-pay. Max OOP is basically just that, the maximum money I would have to pay myself if something catastrophic happened and based on the Bronze Plan actuarial value of 60% should be around $39k of total costs?
Also, with a subsidized ACA bronze plan, I can open an HSA right? The availability of an HSA is not a function of whether or not I’m being subsidized? Also read somewhere that there are investment limits? ie. If I contribute the max of $7,200 for 2021, can I invest all $7,200 in the stock market? Or the investment options are restricted in some manner?
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I’ve only returned to the US recently after 15yrs overseas… so no experience with ACA Think I’ve sort of figured out how the subsidies work (yea, I’ve posted a question about this here before) but think that I’ve misunderstood the max OOP part… I initially interpreted this as the amount you pay before the insurance plan kicks in. This is wrong right? Basically, ACA plans sort of work the way company sponsored plans worked before ACA? ie. I go see the doctor, let’s say the overall bill is $1,000 – I pay maybe $100 and insurance pays $900? Just throwing numbers out there and have no idea really what the typically break downs are – since I never really went to the doctor before anyways. The one exception was when our child was born… numbers sort of fuzzy now (17 yrs ago) but sort of remember a total bill of $25k and paying a very small portion of that (maybe <$1k) So doing some reading about how these plans work – ie. looking at Bronze plans. In theory they have an actuarial value of 60% so I should expect to pay ~40% of whatever the total bill comes out to… up until I reach the max OOP? So for bronze, the max OOP (family of 4) is ~$15.5k which would correspond to total health cost of ~$39k? And then above this, insurance covers 100%? I realize that the 60% actuarial number is not perfect predictor of actual spend/co-pay… that this sort of depends on plan provider, hospital, doctor, etc Or maybe put another way, is that the old school company provided health plans were similar to say a gold or platinum plan under ACA? One additional oddball question… I actually went to visit the doctor recently and the receptionist/billing folks told me that I get discount on their “rack rates” when I’m paying on my own (it was non-urgent so I asked about costs upfront). Still need to sort out the details after actually receiving my bill… but is this normal? Maybe because they realize folks with no insurance are more willing to shop around and this is a way for them to price discriminate (ie. they don’t want to provide a lower rate to the insurance provider where the consumer is NOT price sensitive)? EDIT: OK, sorry, noticed the HealthCare 101 sticky after posting this which answers most of my questions. So basically, in terms of overall cost, I need to look at the subsidy/premium + deductible + co-pay. Max OOP is basically just that, the maximum money I would have to pay myself if something catastrophic happened and based on the Bronze Plan actuarial value of 60% should be around $39k of total costs? Also, with a subsidized ACA bronze plan, I can open an HSA right? The availability of an HSA is not a function of whether or not I’m being subsidized? Also read somewhere that there are investment limits? ie. If I contribute the max of $7,200 for 2021, can I invest all $7,200 in the stock market? Or the investment options are restricted in some manner?
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