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Because I’m on Medicare, the Medigap part of my policy only increased about 10% - something like $25.

But I know that ACA peeps will soon be getting new premium bills if they haven’t already. This is a thread to find out what Surly-ites around the country are facing as we move through January.

For the same plan, year on year, up about 1600/month, or more than 100%. The original signing deadline was 12/15, so everyone should have seen it already.

I am guardedly able to apply a small amount of tax credit (that I may or may not be entitled to depending on how the income year turns out). I don't usually take it, but this year switched plans and applied a couple hundred a month to keep the increase to about 30%. May regret that next April, we'll see.

Edited by TwiceHorn

Just now, TwiceHorn said:

For the same plan, year on year, up about 1600/month, or more than 100%.

I am guardedly able to apply a small amount of tax credit (that I may or may not be entitled to depending on how the income year turns out). I don't usually take it, but this year switched plans and applied a couple hundred a month. May regret that next April, we'll see.

What the actual fuck?

My insurance, for just me, for a lower rated plan doubled. If I had stayed with my old plan it would've tripled. We'll manage but it sucks.

Just now, immamac said:

What the actual fuck?

Usually, the lowest plans available are right at or under $1000/month for two, approaching retirement age, reasonable health, light to medium utilization.

This year, they started at about $1600 for off-brand stuff.

Went with Oscar, which I had had before and went ok.

Premium's up $40 per pay period for same EPO.

  • Popular Post

22k a year for my family of 4. 14,800 deductible.

3 minutes ago, txduck87 said:

22k a year for my family of 4. 14,800 deductible.

That's the increase or the premium total?

My employer only raised the biweekly medical premium by a few dollars so I feel lucky to have that. I don't know how you self-employed or small business workers do it other than you have limited choices. I can understand when one partner in a relationship has to take the govt or corp job if only for the benefits.

5 minutes ago, txduck87 said:

22k a year for my family of 4. 14,800 deductible.

Is that Obamacare or employer-sponsored?

I'm self-employed and made the core decision years ago just to bear SE tax and insurance cost on Obamacare by myself.

I'm toying with seeking an of-counsel arrangement that would include access to a group plan, but as a 1099, probably going to have to bear full freight on that, and, in the past, small group plans haven't been a whole lot better than Obamacare. They do tend to offer more comprehensive coverage.

Like $30 for the year for my portion, $800 for my employer. CDHP, no dependents, put twice my paycheck premium into my HSA

Edited by Js1

14 minutes ago, TwiceHorn said:

Is that Obamacare or employer-sponsored?

I'm self-employed and made the core decision years ago just to bear SE tax and insurance cost on Obamacare by myself.

I'm toying with seeking an of-counsel arrangement that would include access to a group plan, but as a 1099, probably going to have to bear full freight on that, and, in the past, small group plans haven't been a whole lot better than Obamacare. They do tend to offer more comprehensive coverage.

1099 is technically against the rules to participate in health plan; not sure if it is enforced. If you and your spouse are fairly healthy look at a cost sharing plan. They do exclude some pre-existing issues, sometimes for a limited time period, but they put you in network with many providers and most hospital systems and pay for preventative care. You want a policy that has over a million lifetime in case of cancer or something like that, and if you drink and drive and get in a bad crash they might not cover because of lifestyle exemptions.

Caveat is they are not insurance and don’t strictly have to pay or keep the kind of cash reserves that insurance companies do, but Covid was a huge stress test and to my knowledge none failed.

7 hours ago, TwiceHorn said:

Never thought I'd say this, but bring on Medicare!

Let’s let AI handle this one: “Traditional Medicare's administrative overhead is notably low, typically around1% to 3% of total program spending, which is substantially less than that of private health insurance plans.”

Why not done? 

Premium comparisons without type, design, and employee/employer contributions are of limited value.

For my fam:

Commercial, high deductible (max OOP: 6k individual/12k fam), large group.

My share is ~$35 biweekly, employer share is ~$900. HSA contribution is maxed.

Edited by Anastasis

9 hours ago, TwiceHorn said:

Is that Obamacare or employer-sponsored?

I'm self-employed and made the core decision years ago just to bear SE tax and insurance cost on Obamacare by myself.

I'm toying with seeking an of-counsel arrangement that would include access to a group plan, but as a 1099, probably going to have to bear full freight on that, and, in the past, small group plans haven't been a whole lot better than Obamacare. They do tend to offer more comprehensive coverage.

I’ve spent several years following corporate, small business, individual, and Texas based ACA/Obamacare plans. Most people have no idea how bad the situation is for a significant segment of our population, including small business, contractors/self employed, and retirees under 65.

If you’ve had any sort of medical issue, including cancer, asthma, diabetes, the common cold, etc, you will not qualify for individual plans, which aren’t too bad on premiums. The problem is many people don’t qualify.

On most corporate plans, they are covering typical 70-80% of the costs, occasionally 50%. So most people employed by larger companies are fine.

Very small business and Obamacare are extremely expensive, but at least the small business plans are PPO’s. Everything on Obamacare in Texas is HMO’s and EPO’s, which provide terrible doctor networks.

I haven’t checked 2026 rates, but last time I checked an Obamacare plan was $2500 per month for two older people aged below Medicare, with deductibles >$12k. So before insurance covers hardly anything, you are in for $42k per year. How does that sound? Oh, and that’s shitty HMO’s or EPO’s.

1 minute ago, Dbeasy said:

I’ve spent several years following corporate, small business, individual, and Texas based ACA/Obamacare plans. Most people have no idea how bad the situation is for a significant segment of our population, including small business, contractors/self employed, and retirees under 65.

If you’ve had any sort of medical issue, including cancer, asthma, diabetes, the common cold, etc, you will not qualify for individual plans, which aren’t too bad on premiums. The problem is many people don’t qualify.

On most corporate plans, they are covering typical 70-80% of the costs, occasionally 50%. So most people employed by larger companies are fine.

Very small business and Obamacare are extremely expensive, but at least the small business plans are PPO’s. Everything on Obamacare in Texas is HMO’s and EPO’s, which provide terrible doctor networks.

I haven’t checked 2026 rates, but last time I checked an Obamacare plan was $2500 per month for two older people aged below Medicare, with deductibles >$12k. So before insurance covers hardly anything, you are in for $42k per year. How does that sound? Oh, and that’s shitty HMO’s or EPO’s.

ACA plans are really not viable for anyone, either the members, the providers, or the payers.

well it's a good thing we have concepts of a plan to fix it then

I have about 150 employees on our plan. My total cost exposure went up right at $1M this year. I run a captive health insurance plan so we are partially self funded and have partial back end coverage through a large insurance company for major medical and also a max potential liability amount. Prescriptions and cancer drugs are absolutely killing my insurance.

8 minutes ago, Brew said:

Prescriptions and cancer drugs are absolutely killing my insurance.

The rise of biologics and the related costs kill rx coverage. We're talking 10-20k per year drugs, expanding indications. Throw in the GLP1s at 5k per year, and basically every American under the indication, that is how with end up with 25k+ per year premiums.

30 minutes ago, Anastasis said:

The rise of biologics and the related costs kill rx coverage. We're talking 10-20k per year drugs, expanding indications. Throw in the GLP1s at 5k per year, and basically every American under the indication, that is how with end up with 25k+ per year premiums.

That, plus colossal rent-seeking by an industry that serves no real purpose.

1 minute ago, Rudiger said:

That, plus colossal rent-seeking by an industry that serves no real purpose.

Cute bumper sticker.

Pharma and hospital margins are the healthcare play. The rest is simply a volume game.

I’m pretty sure I’ve never seen the phrase “rent-seeking” on a bumper sticker.

7 minutes ago, Rudiger said:

I’m pretty sure I’ve never seen the phrase “rent-seeking” on a bumper sticker.

And you've certainly not seen one that includes "precision medicine" either.

Premiums are a simple math equation. The inputs are drugs costs and hospital/ed costs. The outputs are determined by risk share and benefit design. Witches (actuaries) run the numbers.

7 hours ago, Rudiger said:

I’m pretty sure I’ve never seen the phrase “rent-seeking” on a bumper sticker.

Let me introduce you to my mother-in-law.

~ $2k/mo for fam of 5 on aca, high deductible plan.

if you need dental, sometimes the cash price for cleanings,etc is cheaper than the annual dental premium. Haven’t done the math yet on vision,etc to see if it’s a benefit but I know you can usually get discounts on lens/contacts with it

11 hours ago, Anastasis said:

The rise of biologics and the related costs kill rx coverage. We're talking 10-20k per year drugs, expanding indications. Throw in the GLP1s at 5k per year, and basically every American under the indication, that is how with end up with 25k+ per year premiums.

$10k-$20k per year drugs are yesterday’s news. The onslaught of new expensive drugs is continuous at this point. I have several employees on maintenance drugs that are anywhere from $8k-$30k a month. That doesn’t even count the cancer drugs that are approaching $50k-$60k each treatment now. You can get a prescription for toenail fungus that costs $30k a month. My total prescription spend was $350k 5-6 years ago, it will be over $2M this year and we actively manage and control costs and cost sharing availability with the self insured plan. The actual nonprescription costs will be up some, but probably 50% at most unless we have an expensive major medical event like a NICU event.

22 hours ago, Nice Guy Eddie said:

My employer only raised the biweekly medical premium by a few dollars so I feel lucky to have that. I don't know how you self-employed or small business workers do it other than you have limited choices. I can understand when one partner in a relationship has to take the govt or corp job if only for the benefits.

We pay $600 "penalty" to add my wife to my company plan. That's $600 very well spent each year. She is not an educator, but works in the school system and has the same benefits, which I understand vary by school district- their offering was straight up bullshit and I don't know how regular teachers do it financially.

My premiums for work, which cover my wife and I went up about $17/ pay period, or $40/ month. Given the horror stories l've heard from friends and instances like this thread; I do feel great about that part of my compensation at work.

Edited by Iceman

8 minutes ago, Brew said:

$10k-$20k per year drugs are yesterday’s news. The onslaught of new expensive drugs is continuous at this point. I have several employees on maintenance drugs that are anywhere from $8k-$30k a month. That doesn’t even count the cancer drugs that are approaching $50k-$60k each treatment now. You can get a prescription for toenail fungus that costs $30k a month. My total prescription spend was $350k 5-6 years ago, it will be over $2M this year and we actively manage and control costs and cost sharing availability with the self insured plan. The actual nonprescription costs will be up some, but probably 50% at most unless we have an expensive major medical event like a NICU event.

Yeah, your situation is relatively unique in that you get a look under the hood and where all the money is being spent.

$2m/150 employees = 13k per year. And you haven't even paid for a doctors visit yet.

Edited by Anastasis

12 hours ago, Anastasis said:

And you've certainly not seen one that includes "precision medicine" either.

I've lived in both England and Germany, both of which have universal healthcare, and they both have precision medicine (both countries call it personalized medicine).

I would guess that we're both right--healthcare systems and pharmaceutical companies raise costs and private insurers raise rates in a continuous cycle. But we shouldn't discount the ability of government health systems to control drug and healthcare prices when they are the main payor in the market by a wide margin.

I'm riding dirty. No health insurance. Self employed so even before this year the premiums were crazy so have not carried health for at least 5 years. I'm at least 200k in the positive by self insuring. If you can afford it, i would totally self insure.

  • Author
2 hours ago, partytimesausage said:

I'm riding dirty. No health insurance. Self employed so even before this year the premiums were crazy so have not carried health for at least 5 years. I'm at least 200k in the positive by self insuring. If you can afford it, i would totally self insure.

Dude. I strongly recommend that you get a cancer policy. A cancer policy is not health insurance (or at least the cancer policy I had is not) - but the policy gives you a lump sum payment upon diagnosis, and also pays something towards diagnostic costs like CT scans.

Those policies are extremely cheap. For sure, they will not cover the high healthcare costs like insured cancer treatment, but they better than nothing.

BC/BS PPO policies for wife/I. $2,140/month in 2025 for both in our 60's, not quite Medicare age. $4,070/month for 2026.

10 minutes ago, Gladeite said:

BC/BS PPO policies for wife/I. $2,140/month in 2025 for both in our 60's, not quite Medicare age. $4,070/month for 2026.

JFC, that seems insane.

L

3 hours ago, partytimesausage said:

I'm riding dirty. No health insurance. Self employed so even before this year the premiums were crazy so have not carried health for at least 5 years. I'm at least 200k in the positive by self insuring. If you can afford it, i would totally self insure.

One catastrophic event will wipe that out and then some. You are the perfect person for a cost sharing plan. Probably wouldn’t cost you 100 bucks a month. They’ll get you in network pricing or routine thanks which will probably make the premium a wash

1 hour ago, Gatorubet said:

Dude. I strongly recommend that you get a cancer policy. A cancer policy is not health insurance (or at least the cancer policy I had is not) - but the policy gives you a lump sum payment upon diagnosis, and also pays something towards diagnostic costs like CT scans.

Those policies are extremely cheap. For sure, they will not cover the high healthcare costs like insured cancer treatment, but they better than nothing.

That was a saving grace when my mom got terminal cancer and paid for her hospice care.

  • Author
16 minutes ago, bolverk said:

That was a saving grace when my mom got terminal cancer and paid for her hospice care.

I think I paid $16 a month for three months and then was diagnosed. I wound up getting about 15 K out of it. Sweet! Best money I ever spent, and it was through work - so I did not get a chance to see what other plans with higher premiums offered.

2 minutes ago, Gatorubet said:

I think I paid $16 a month for three months and then was diagnosed. I wound up getting about 15 K out of it. Sweet! Best money I ever spent, and it was through work - so I did not get a chance to see what other plans with higher premiums offered.

It's been three years now, but I think her policy was some ridiculously low amount like that, too.

8 minutes ago, tx 3 putt said:

$845 / month

single male

That's about 20% of the average salary in Texas--essentially a new 10% tax on your earnings if you were self-employed, just lost your subsidies, and saw it double.

As of Dec 25, the average annual salary in Texas is $52,885. Just in case you need a simple salary calculator, that works out to be approximately 25.43 an hour. This is equivalent of 1,017.02 a week or 4,407.08 a month. Most salaries in Texas range between 36,856.00 (25th percentile) to 67,074.00 (75th percentile) annually.
https://www.ziprecruiter.com/Salaries/--in-Texas

5 minutes ago, bolverk said:

That's about 20% of the average salary in Texas--essentially a new 10% tax on your earnings if you were self-employed, just lost your subsidies, and saw it double.

As of Dec 25, the average annual salary in Texas is $52,885. Just in case you need a simple salary calculator, that works out to be approximately 25.43 an hour. This is equivalent of 1,017.02 a week or 4,407.08 a month. Most salaries in Texas range between 36,856.00 (25th percentile) to 67,074.00 (75th percentile) annually.
https://www.ziprecruiter.com/Salaries/--in-Texas

my meds are $1400 / month, so worth it

We have roughly 100 employees and about half are on our company plan. We managed only a 2.6% increase this year, but we had to switch insurers from UHC to Aetna to do that. Would have been 11% if we stuck with UHC. We offer 4 different plans (2 traditional PPOs and 2 high deductible plans). Premiums for a family cost between $2,776-$3,412 per month (before we pay the employer portion) for deductibles from $1,500 for individuals to $7,000 family deductibles on the cheaper high deductible plan. We have good insurance but it's absurdly expensive.

Healthcare costs are completely out of control in this country. There is no reason for healthcare to be tied to employment and there is no reason we can't figure out how to get everyone on Medicare (other than big, fat campaign contributions from the healthcare companies).

11 minutes ago, bolverk said:

That's about 20% of the average salary in Texas--essentially a new 10% tax on your earnings if you were self-employed, just lost your subsidies, and saw it double.

As of Dec 25, the average annual salary in Texas is $52,885. Just in case you need a simple salary calculator, that works out to be approximately 25.43 an hour. This is equivalent of 1,017.02 a week or 4,407.08 a month. Most salaries in Texas range between 36,856.00 (25th percentile) to 67,074.00 (75th percentile) annually.
https://www.ziprecruiter.com/Salaries/--in-Texas

i'll also add, i m the healthiest i've ever been. love my dr

52 minutes ago, Sawbonz said:

L

One catastrophic event will wipe that out and then some. You are the perfect person for a cost sharing plan. Probably wouldn’t cost you 100 bucks a month. They’ll get you in network pricing or routine thanks which will probably make the premium a wash

I agree. my catastrophic plan is to "retire" move to boston and enroll in mass health as a new resident. Terrible plan. haha.

good info above. i will look into the cancer plan and the cost sharing. i would pay for a plan with no benefits that just got me the contracted rates. Health care is such a pain in the ass for the cash patients. we are preyed on. example. Took me 4 allergists to find a reasonable cost for immuntherapy for my daughter. Nobody will disclose their costs without an exam appt. cost varied from 2500 to 15k annually for the same meds. wild.

8 hours ago, Anastasis said:

Yeah, your situation is relatively unique in that you get a look under the hood and where all the money is being spent.

$2m/150 employees = 13k per year. And you haven't even paid for a doctors visit yet.

We will probably end the year around $3.2M in cost with maybe 250 covered lives, so self insured with captive coverage is still much better than the alternative. We cover all employee costs, you just have to pay for family add ons.

The misinformation that is out there is significant. I have access to all the data on my people and see reimbursements, treatment costs, etc. Cancer is the number one hit to my insurance plan followed by new drug prescriptions. Heart attacks, joint replacements, major surgeries, even extended hospital stays don’t come close to the drug costs. Healthcare is also one of my largest practice areas. Doctors and your small practices aren’t the ones getting rich in this system. Most outside of a few specialties make less per patient than they ever have by a large margin. I see doctors regularly that have income off by 1/3 or more of where they were at the top. Insurance companies are squeezing reimbursements on FNP’s now because there has been such a runup in that practice area that practices are getting cut even further.

2 minutes ago, aggie08 said:

Jesus fuck, how is any of this sustainable?

It's not.

2 minutes ago, Brew said:

We will probably end the year around $3.2M in cost with maybe 250 covered lives, so self insured with captive coverage is still much better than the alternative. We cover all employee costs, you just have to pay for family add ons.

The misinformation that is out there is significant. I have access to all the data on my people and see reimbursements, treatment costs, etc. Cancer is the number one hit to my insurance plan followed by new drug prescriptions. Heart attacks, joint replacements, major surgeries, even extended hospital stays don’t come close to the drug costs. Healthcare is also one of my largest practice areas. Doctors and your small practices aren’t the ones getting rich in this system. Most outside of a few specialties make less per patient than they ever have by a large margin. I see doctors regularly that have income off by 1/3 or more of where they were at the top. Insurance companies are squeezing reimbursements on FNP’s now because there has been such a runup in that practice area that practices are getting cut even further.

Agree, physicians and other providers are not driving the increases in health care costs. It's hospital and pharmacy spend. From KFF:

annual-percent-change-in-consumer-price-index-for-all-urban-consumers-cpi-u-for-medical-care-by-category-june-2023-june-2024.png

3 hours ago, Gladeite said:

BC/BS PPO policies for wife/I. $2,140/month in 2025 for both in our 60's, not quite Medicare age. $4,070/month for 2026.

Jesus. What state are you in?

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