The Cost of Health Insurance Under the Affordable Care Act - Specific Premiums By Age Cohorts

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The Amounts Of Required Health Insurance Premiums

A continuing question about the Affordable Health Care Act passed into law under the Obama Administration has been that of cost. A concrete answer had not been forthcoming until I found the website of Henry J. Kaiser Family Foundation. At that web site, a Health Reform Subsidy Calculator is located at http://healthreform.kff.org/Home/KHS/SubsidyCalculator.aspx?source=FS.

To use this calculator, enter either your expected 2014 income or the % of poverty level at which you expect to be (100%, 125%, etc.), your age, your marital status, and your regional cost factor Lower, Medium or Higher).

The calculator will provide:

  • Unsubsidized health insurance premium in 2014, adjusted for your age
  • Actual person/family required premium payment (the amount you must pay)
  • Government tax credit

The menu of healthcare under the act includes a catastrophic policy for young adults that do not usually purchase standard health and medical insurance; and for anyone exempted from the insurance mandate - they can purchases insurance that is less comprehensive, with a lower premium. This choice of catastrophic insurance is not added into the calculator program on the Kaiser site.


A "Medium" Regional Cost Factor Area

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Age and Premium Tables

The Kaiser website displays some user tables arranged by age and income level, sectioned into age cohorts of 20, 30, 40 and 60 years as milestone years for easy quick reference. The coverage cost calculator on the site takes into account all ages From 19 to 64, the presumption being that age 65 and over will be incurred under Medicare.

One immeeidate question is this -- How will the increasing age for Social Security Retirement that is attached as mandatory to Medicare Coverage impact people in their late 50s and early 60s today (the 2010s)? The Retirement Age is increasing, some people already are not permitted to retire with full benefits until ages 66 and 70 (in 2012).

If Medicare ceases to exist and/or SS retirement ages continue to increase per age cohort at the current rate, then all adults would be eligible for the non-employer-based new insurance available in 2014 until just below age 70.

Examples from the Kaiser tables follow.

Table I. The amount that the person or family pays (figures may change).

Percent of Poverty Level
Age 20
Age 30
Age 40
Age 50
Age 60
100%
Medicaid
Medicaid
Medicaid
Medicaid
Medicaid
150%
$690
$690
$690
$690
$690
200%
$1,450
$1,450
$1,450
$1,450
$1,450
500%
$3,391
$3,440
$4,500
$6,978
$10,172
Source: Kaiser Family Foundation calculations. Updated: 6/22/2010 For full tables, see: http://healthreform.kff.org/Home/KHS/SubsidyCalculator.aspx?source=FS.

This sample in Table I. hows reasonable rates until substantial income is reached and much higher premiums begun at 425% of poverty level. By 500% of annual poverty level, the monthly premium for age 40 is $375 per month (8% of total income) and for age 60 is $847.67 monthly, which most people of that age cannot possibly afford, even if income truly is $55,850 (2012 poverty; I don't have the 2014 number), making the $10, 172 annual premium over 18% of income.

However, the Kaiser explanations state that premiums will range from 3.0% of the annual income of 133% of poverty level to 9.5% of annual income at the 400% of poverty level. After 400%, the percentage seems to skyrocket for ages 40 - 60. or some individuals, this may be incentive to stop working at age 40 or to reduce work hours to half-time or fewer hours, or to hang on until 50 or so and retire. With the historic becoming an ongoing trend toward laying off older workers in their early to mid-50s, this may take care of itself. Alternatively, people may decide to work harder and smarter to become rich.

Subsidies to help pay the premiums listed above come in the form of a Government Tax Credit. However, if this does not happen until 2015 filings for the 2014 IRS Tax Return, then some people will not be able to afford even the lowest premium of $690/year and I understand that only a once-per-year full payment can be accepted. If monthly payments should be allowed by the tie 2014 arrives, then this lowest amount would be $57.50 per month. Some individuals and families will have difficulty paying even that low rate, but many older Americans required to pay the high-end rate won't be able to pay that either.

Aloe Vera. Some are turning to herbal and other alternative medicine sources. Will it be enough?
Aloe Vera. Some are turning to herbal and other alternative medicine sources. Will it be enough? | Source

Turned Away From the ER

Radio talk shows have several times broadcast Sean Hannity and other commentators as they give the comment that those who cannot afford doctors can be treated in any ER at any time and cannot by law be turned away. This seems incorrect by what I have wtinessed --

Heart Failure

During Autumn 2011, college student Mia Welch of Mesa Community College in Arizona went to the emergency room with fatigue and chest pain, but was turned away by the ER because it was not a life and death situation. She was in heart failure. That is certainly a life and death scenario! That story has a happy ending, though, because when pain increased and she could no longer sleep lying down, she went to another ER that accepted her.

Broken Sternum and Severe Bruising

In my large city in Central Ohio in 2013, an uninsured woman over 60 years old suffered a severe fall over a faulty entrance-way rubber mat in a large restaurant. She required the help of two men to get up.

Having had two problematic knee replacements, this lady could not arise by herself. With help from two men, she was able to get up, terrified, and she thought she had broken ribs and a broken sternum and found bruised chest, knees and legs. She had also hit her head.

The manager saw to it that she had a customer's standard insurance claim form and written permission from himself to present to staff when she went to the ER. In the ER, the doctor laughed at her, gave her a prescription for Vicodin, and walked out of the examining room.

The lady had no family physician and was turned down by a number of doctors in her area, because she had no insurance and because they no longer treated senior citizens over age 55.

I think that people are turned away from medical care every day in our country. I agree that drug addicts would be turned down for medications if found doctor-shopping, but I think neither case mentioned above included an addict.

Hopefully, the Affordable Care Act makes scenarios like those above and many more in my experience obsolete. The fact that it eliminates the possibility of turning away people with pre-existing conditions is good and much needed. Many wellness/prevention activities and services are encouraged and covered completely under the ACA. Howver, premium amounts from ages 40 - 60, as well as those for above 425% of the federal poverty level seem too expensive.

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Comments 10 comments

Larry Wall 4 years ago

This Hub is very good and I am interested because I am 61 and unemployed. However, you left a few questions unanswered. By July 2013 both my wife and I will be drawing Social Security. Does that income have to be counted?

Secondly, what level of insurance are we buying. Are routine Doctor visits cover, is there a co-pay for Dr. visits, lab work, etc. Does the plan provide prescription coverage and if so, what are the co-pays.

You are probably not in the insurance business, but your Hub is the best info I have seen thus far. Right now my wife and I are stuck with a limited medical indemnity plan because we both have pre-exisiting conditions and the coverage is marginal at best--decent on drug coverage, no bad on Dr visits, miserable for major hospital stays because it is not major medical. If you plan on doing another hub on this, it would be great if you have access to the answer for these questions.

Also the chart gave the choice of single or family. Is a husband and wife considered family, even if they have no dependent children.


Patty Inglish, MS profile image

Patty Inglish, MS 4 years ago from North America Author

This Hub, by purpose, highlights the turning down of patients currently, which reportedly will not happen under AHCA. You pose good questions. I would actually like to see a Declarations Page for each of 1 person family, 2 person family, 3 person family, 4 person family and 4+.

However, I have found an analysis of the coverage, which is available in 4 levels of coverage, written by Alex Lickerman, M.D. and I have added that link to the Hub. It is a good analysis, but I sense that some questions will be unanswered until 2014.

Thanks for your thought-provoking post.


Christoph Reilly profile image

Christoph Reilly 4 years ago from St. Louis

I know one hospital here (Barnes-Jewish) whose policy is that they do not refuse treatment, however, you will still rack up a bill which--if you can't pay it--will be sold for pennies on the dollar to a collection agency, and then the collection agency can come after you with everything at their disposal; badgering, dunning and ultimately, they can take your car or your house unless you go into bankruptcy.


Larry Wall 4 years ago

Than you for doing this. I am in that group of people, who lost their jobs, am over 60 and can only my limited medical indemnity insurance, which is almost like trying to stop a flood with an abandoned car that has no windows. I know that is a crazy analogy, but it is early for me. I do appreciate your efforts and like I said you have provided some good information. There is the PCIP program out there right now, but you have to go six months without credible coverage. Unfortunately, the insurance industry's definition of credible coverage is different than the federal's government definition, so despite meeting that requirement, I cannot purchase the federal insurance because my non-credible coverage pays by the event, i.e. a doctor's visit, and not by time. How does a doctor bill by time? I had my two Senators and Congressman check on this and they came up empty.


Sandyspider profile image

Sandyspider 4 years ago from Wisconsin, USA

This is very important information. Insurance or lack of it and hospitals is a hot and scary topic.


Patty Inglish, MS profile image

Patty Inglish, MS 4 years ago from North America Author

I am very concerned that the new plans will be too expensive for most people in 2014.


Angela Blair profile image

Angela Blair 4 years ago from Central Texas

Excellent Hub and most needed information -- thanks for addressing this. There's no way I can afford what I'd be required to pay for insurance -- and a recent experience tells me not to count on Medicare too much -- that's going to be a different ball of wax also. There doesn't appear to be any way out for those over 65 at all -- and I see that as a planned event by this government. Definitely voted up! Best/Si


Patty Inglish, MS profile image

Patty Inglish, MS 4 years ago from North America Author

I was shocked when I read the tables of premiums, Angela. There must be some better system than this or the one we have now.


fetty profile image

fetty 3 years ago from South Jersey

Thank you for an informative and needed hub. As usual you stand alone. Today, with my own insurance , I thought I was going to a new doctor's office for an ultra-sound. Earlier, my doctor had to cancel his part of the exam probably due to July 4th; but I would go in get the test and return on a later date for his consultation. Even though he changed my appt. the clerk tried to get a $5o co-pay from me and then in two weeks I would be paying another $50 co-pay. I did not keep this appt. but put everything back on one day and saved $50 . I find that we must always be vigilant when using any kind of medical care. But this one was galling. Yes, I agree the rates are too high. I have been told by my carrier one year ago, that I would have to use the new insurance because they were not caring health insurance for the self-employed in 2014. Wish me luck. Yes, I am over 60 with pre-existing health care issues. Ya think that had something to do with this decision?


Patty Inglish, MS profile image

Patty Inglish, MS 3 years ago from North America Author

@fetty - I am angered by the doctor's staff attempting to derive two $50 co-pays from you and by the employer suggesting you buy the expensive insurance. Pre-exiting conditons and age are big factors, I am certain.

I learned that in the first year that we do not purchase the new insurance if we are uncovered at work, college, or elsewhere, then the penalty attached to our federal income tax is only ("only" - Ha!) $94 for the first year. At the sixth year, the tax/penalty reaches a cap of over $600. I think that means we pay, but still receive no healthcare.

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