ACA Otherwise Known As Obamacare
What can we expect for the 2027 ACA? The premiums are increasing again. About 14% increase according to The Kaiser Family Foundation and are based on several factors. Among them are increased costs for services, like drug costs and medical care and in general, the costs for goods and services. Salaries and other operational costs are considered and that’s why costs for the insured are increasing. As a consumer, the only thing you can do is take the highest deductible and maximum out of pocket which provides the lowest premium. Understand that when you do that you ill be paying the contracted rates for services, which is what the insurance company pays for those services. Think of it as retail versus wholesale. You pay the wholesale rate for services until you reach your maximum put of pocket, then the insurance pays all claims for the remainder of the year. Please understand, unless hospitalized, you will never reach your maximum out of pocket.
Insurance has changed since Obamacare went into effect and not all the changes are good ones. This blogger, an insurance broker, sees one good benefit but mostly dreadful things due to Obamacare. The good benefit is everyone can get insurance because there are no more pre-existing conditions. That has helped millions of people who are sick to varying degrees but still can get insurance and much needed treatment. The main problem is the cost. In addition to inflation the number of claims today has skyrocketed thus raising premiums. 2027 looks like it will be a 14% increase in premiums over last year.
Premiums Are Key
Unfortunately, as premiums rise, many more cannot afford them, so they drop the coverage regardless of their medical conditions. As premiums continue to rise more insured will drop their coverage. This trend will continue indefinitely.
Each new year brings more premiums and less coverage and as stated above many drop their coverage due to price.
There might be a solution, but it is drastic and has some downsides. I believe the government should create two insurance pools; one is for the extremely sick (and illnesses should be known by all policy holders). The other is for the healthy policyholders. By separating the groups, the government can subsidize those in the sick pool and monitor the costs to try and keep them under control. The healthy group’s individual premium should
come down, and they should be able to pay it without a financial drain on their income. By separating the groups, the healthy are now not paying higher premiums to cover the sick but managing their own illnesses. Obviously, some will go from the healthy group to the sick one and even vice versa. This will always happen. The idea is the extremely sick will continue to get subsidies from the government as they do now. The difference is that the government is picking up more of the costs for the sick while the healthy can enjoy much lower premiums. Not an ideal situation but giving relief to those who take care of themselves and not having to pay for those who do not take care of themselves. I have not found any statistics yet that tell us what the actual cost of these subsidies are to the government.
I offer this as an alternative to our current situation, which cannot continue much longer due to large premium increases annually.
The downside is that the government (you and I) will be paying for those who did not take care of themselves and that will continue indefinitely. Unfortunately, it is the only way to lower premiums for those who are healthy. The government can pass a law mandating you have insurance but that would be a large mistake where no one wins.
Is MedicareFor All The Answer?
I have heard talk of Medicare for all as an alternative but that will be the costliest of all the options. If everyone had Medicare, they would have a free (government paid) Part A or hospitalization. There is a Part A deductible of $1736 for each 60-day benefit period in the hospital. If you stay 60 days, go home for a couple of days and go back, the $1736 deductible happens again.
Part B would cost (2026) $202.90 per month with an annual deductible on Part B of $283.00. Medicare is the only insurance in the United States that does not have a stop loss of max out of pocket, so you are responsible for 20% of the bill with no stop loss.
There is also another provision called assignment of benefits. If the doctor or facility takes assignment, then they cannot bill you the approximately 15% that Medicare disallows. If they do not take assignment of benefits like the Mayo in Scottsdale, they can bill the 15% that Medicare disallows so you could be responsible for 35% of the entire bill. Think large hospital bill of $350,000 and see what that would cost you under Medicare without any other programs to assist in the payments.
Until Medicare has a maximum out of pocket, they are not an alternative for Americans. Seems like there is no suitable alternative but continuing the way we are is asking for trouble.
Both sides of Congress need to come together and solve this for all Americans. My suggestion is that all Americans have the same coverage Congress has and because Congress is always self-serving, they will monitor the situation and do what is best for themselves and the rest will follow their lead. We Americans are paying the insurance for Congress so why shouldn’t we have the same coverage? Seems fair and equitable to me.
In closing, I am sure that there might be other alternatives and would like to open the conversation for all to participate so we can produce the best alternative. We need to have this discussion nationwide and with our leaders.
I hope this information is useful,and if anyone has questions, please contact me via phone or email and I will respond quickly.
Also, you may want to take a look at 2026 Medicare Information.
Len Barend, Broker
Cell: 702-250-2200
Email: len@insurance4unevada.com
