Health Insurance Nightmares

[jcam222]

Here is how I see it. Its not fully locked in till open enrollment ends. I have messed around on the CO marketplace after my consultant and I met and chose a plan (in previous years) to just check a few things and make sure I was solid on the decision. In CO I can change it as many times as I like till Dec 15.

If the government decided to extend the tax credits before open enrollment ends, I assume the market places will need to correct/reduce the monthly billable amount based on the additional credits. If they cant get it together till after Dec 15 then who knows. =MESSY AF.

My estimated costs for 2026 on my current plan just doubled to $334/month! The tax credit is pretty much identical ($15 less). Seems messed up that the plan cost went up so much. But given all that has happened in 2025 - I just cant go without ins.

Are those credits that are reflected actually approved?

 

[sandyut]

Are those credits that are reflected actually approved?

I think so...its hard to tell. But from what I researched in the last couple weeks I found this: "Standard tax credits" will remain in place for anyone with a MAGI of less than or equal to 4Xproverty level.
"Enhanced tax credits" are what is still set to expire at years end.
Our MAGI is pretty low since we are retired. I found some online calculators and the credit shown seems to likely be correct. Which I really hope is true. If I get no credits my monthly ins will run $830/month and thats gonna hurt.

 

[thirdeye]

Here is how I see it. Its not fully locked in till open enrollment ends.

That is good to hear. In my ACA years... WY only had one provider Blue Cross, so that limited the options.

If the government decided to extend the tax credits before open enrollment ends, I assume the market places will need to correct/reduce the monthly billable amount based on the additional credits

But the "adjusted" premiums are still in the hands of the provider. If Congress drags their feet too long, I would hope any adjustment to premiums is retroactive.

 

[sandyut]

But the "adjusted" premiums are still in the hands of the provider. If Congress drags their feet too long, I would hope any adjustment to premiums is retroactive.

We can only hope! Its rough out there.

 

[thirdeye]

Our MAGI is pretty low since we are retired. I found some online calculators and the credit shown seems to likely be correct. Which I really hope is true. If I get no credits my monthly ins will run $830/month and thats gonna hurt.

That's the sticker shock I was afraid of. Thinking out loud... the options are to draw down your emergency fund to keep MAGI in check, or withdraw (carefully) from IRAs which counts as cap gains.

 

[DougE]

On my new plan, co-pay for primary care is $0, Specialist copay went down. I will now get $350.00 for glasses, up from the $100.00 on my old plan. Free yearly wellness checkup and eye exams as always, $2500 toward dental.

Out of pocket max about the same for non-covered expenses.

 

[Fueling Around]

HI ALL!
Medicare :
...

Medicare is pretty straight forward and a pretty decent deal. The premium is deducted from your SS payment. For those wanting an Advantage plan or a Medi-Gap plan they each have advantages and disadvantages. Best to use a competent broker to help you select a plan.

The problem voiced here is for those on Medicaid which is ACA and is not affordable without the tax credits.

 

[BrianGSDTexoma]

BCBSTX sent me email. Doc not taking then next year so will be looking for something else but this what they sent me. Not looking good!

 

[Gonna Smoke]

Medicare is pretty straight forward and a pretty decent deal. The premium is deducted from your SS payment.

Yep, part A & B.

Best to use a competent broker to help you select a plan.

This is what we do. The person we use is actually a close friend who works for a broker and she only handles Medicare and supplement plans...

 

[jcam222]

BCBSTX sent me email. Doc not taking then next year so will be looking for something else but this what they sent me. Not looking good!

View attachment 726382

So aside from resolving credits they need to step in and stop the companies from gouging. 42% increases are insane. Longer term the real solution is to control pricing from providers and the insurance companies so that credits aren't necessary.

 

[sandyut]

BCBSTX sent me email. Doc not taking then next year so will be looking for something else but this what they sent me. Not looking good!

That is twice what I was quoted for unsubsidized. Insanity! Are all the plans that high and do you have more affordable options?

Medicare is pretty straight forward and a pretty decent deal.

My wife is on MC. Seems dreamy by comparison. She paid $275 for a hip replacement. I paid $9200 for a broken ankle.

 

[BrianGSDTexoma]

That is twice what I was quoted for unsubsidized. Insanity! Are all the plans that high and do you have more affordable options?

I have an phone appointment with broker on the 16th. Will see what they come with. I sure its going to be a high deductible plan. One of my meds is $1000 a month and will be giving that up.

 

[sandyut]

I have an phone appointment with broker on the 16th. Will see what they come with. I sure its going to be a high deductible plan. One of my meds is $1000 a month and will be giving that up.

I have a 6K deductible. Check out Cost Plus Drugs for your med. I have one that locally is over $200/month and its about $50 through them. They dont sell Repatha so I pay for that about $500 a month but it will also eat up the deductible. Next year I am gonna try their discount program and see if that helps ease the cost.

 

[jcam222]

I have a 6K deductible. Check out Cost Plus Drugs for your med. I have one that locally is over $200/month and its about $50 through them. They dont sell Repatha so I pay for that about $500 a month but it will also eat up the deductible. Next year I am gonna try their discount program and see if that helps ease the cost.

100%, I get one of my meds from them. Local cheapest price with insurance or med plans is $45 per month. I get 90 day supply from construction plus for $40

 

[thirdeye]

BCBSTX sent me email. Doc not taking then next year so will be looking for something else but this what they sent me. Not looking good!

View attachment 726382

Shocking, to say the least.

The examples I've seen so far in various articles or online were comparing a 2025 monthly premium with subsidy, against an unsubsidized estimate for 2026. Most of the 2026 amounts were double the 2025 amount.