Your ACA premiums for 2021

Anger, frustration, and $7,550 deductibles

Last week, I asked you to send me details about what you’re paying on the exchange this year, either through Healthcare.gov or your state exchange. And boy, did you come through; I had too many responses to run in one newsletter. I’ll run the rest later this week. Thanks so much to everyone who shared their stories with me.

A few themes cropped up across responses: Frustration at having to navigate the process of picking between plans or calculating subsidies; anger at paying for something you can’t actually afford to use; gratitude to have insurance at all. A lot of people reported difficulty estimating their income and exhaustion at the whole process, though others found it simple enough. A lot of people mentioned being insured but unable to get routine care because of the cost, or buying insurance just to avoid major, catastrophic costs—like you would for a plane journey or a rental car, but for your own human body, the thing that tethers your soul to this earth.

Most people I heard from were middle-class. They were people who had jobs that didn’t provide insurance, or were laid off from jobs that did—remember, if you like your plan, you can keep it. A couple respondents were low-income enough to be eligible for plans that cost almost nothing after subsidies, but still had to choose between paying almost nothing for a plan that covered almost nothing, and paying more (of their low incomes) for a plan that still didn’t cover a lot. The premise of this subsidy process is that it’s possible to calculate, with crude estimates of annual income, how much you can “afford” to pay for insurance (up to 400% of the poverty line. After that, you’re on your own, since you’re Scrooge McDuck over there, making $51,040). If their idea of affordability is wrong—if Healthcare.gov is incorrect that $120 a month is affordable for someone making $26,000 a year—well, the whole damn thing might just be bullshit.

We talk a lot about this notion of “choice” in health insurance, since it’s often offered as a reason to oppose single-payer. Keeping private insurance allows people to choose the option that best suits them, we are told, instead of a “one-size fits all” plan. The fine print here is that there’s no guarantee any of the options will actually suit you. No one can promise you with a straight face that the plans will actually be affordable, or let you see the doctor you want to see, or cover the drugs you need. Most of the people who emailed me were choosing between one or two plans, but they didn’t have much “choice.” It was pay now, pay later, or go without care. (Plenty of them will do all three.)

All premiums listed are after tax subsidies, if applicable. Submissions have been condensed for length and lightly edited for grammar and punctuation.

The Highest Premium

Costs: $732/month, $6,250 deductible 
State: New York
Job: Nanny

I am relatively healthy with post traumatic stress disorder (from significant childhood abuse) and scoliosis as my only pre-existing conditions. I haven’t had mental health counseling or physical therapy since I was at UCLA undergrad, which was 14 years ago, because private health insurance is so expensive. Next year I’ll have to pay $732/month in premiums to be able to see a counselor and a physical therapist for long overdue treatment. I don’t get any subsidies for my premiums because even though I’m legally classified as an employee who receives paystubs through GTM Payroll, household employers aren’t required to provide nannies with health insurance. Current rules actually disincentive them from providing it because if they give a subsidy to one household employee, like a nanny, they are required by New York State law to offer it to another, like a housekeeper. 

I do make a great income, but given that rents within walking distance to my employer (crucial for COVID times given that the child in my care spends time with her elderly grandmother) are at least $2,000/month for a modest studio, a $732/month health insurance plan that doesn’t provide great coverage is a big financial burden. It’s also frustrating that because I don’t work somewhere like Google I can’t have access to any fertility related treatment. I’m nearly 37. If I could afford it, I’d absolutely freeze my eggs. I know it’s a very first world problem, but it’s hard to love and work with kids and know that I probably won’t have the option of having a biological child because I’m burdened by education loans and health care costs.

The Disaffected Lawyer

Costs: $318.01/month, $7,550 deductible
State: South Carolina

I'm buying marketplace insurance because my current job ends in January. I'm in a temporary position with the NC Department of Justice. The contract was 11 months long because, you guessed it, if I worked for a year then they'd have to provide me full benefits. This job had no paid sick/vacation leave and no retirement benefits, but it did include a high-deductible health plan that only cost me $99 a month. 

At this moment, I have $239,000 of law school debt, which I'm planning to handle with PSLF. I've completed about 49 of the 120 monthly qualifying payments so far, working for the federal judiciary, a health law non-profit, and state government.   

[...]

I was on a zoom call with some law school friends last week, which was great. This would have been our five-year reunion year. The friends that went into big law have bought homes and paid off their loans. I had a federal clerkship and then went into public interest, and here I am, unemployed and signing up to pay $300 a month for something I'll probably never use. I feel like a chump. I'm in the middle of running this decade-long financial obstacle course while these enormous pendulums of debt — student debt, medical debt, probably a mortgage at some point — are whizzing by. The structure of American society is fighting so, so hard for me to not do public interest work, and constantly reminding me that it would have been so, so much easier if I worked for BP denying oil spill claims instead. At this point I usually remind myself that I'm lucky to be where I am right now. 

The Other Disaffected Lawyer

Costs: $510.69/month, $750 deductible
State: Texas

I'm a lawyer in Fort Worth, TX, but I work document review, which means I'm employed on a project to project basis. My usual employer offers insurance, but it goes poof whenever the project ends (which can be very sudden). So I stay on the exchanges because who the fuck wants to have to deal with COBRA. The Texas Bar has its own exchange but it's nothing special or discounted or anything like that. I've worked more regularly the last couple of years which has put my income right on the line for subsidies (I think mine this year is $9/mo, not even sure if I accepted it.) 

I hate my plan. It's one of the better ones offered, and I trust BCBS to fuck me in a more dignified way than whatever the hell Oscar or Friday are. 40% coinsurance means that it's basically unaffordable to use beyond primary care visits/prescriptions, though. I made the mistake last year of trying to get treatment for the bulging discs in my neck, which didn't work and saddled me with $1600 of extra debt even with the insurance. I went to the ER a few years back for a panic attack I thought was a heart attack and ended up with a $2400 bill for them to give me an EKG and tell me I wasn't dying. The process is opaque and awful, there's no way I can find to change/update my plan directly through BCBS without signing up like a new customer so I will probably stick on the exchange even though my subsidies are basically nil. The IRS tax form (1095?) is also very hard to figure out what the fuck I'm supposed to do with it, and I've passed a law school tax class ffs. That's a general theme with everything, too, that I'm a lawyer and like to consider myself marginally intelligent and I still never get through this process feeling like I have any fucking clue what I'm doing.

The Non-Gambler

Costs: $438.14/month for two people, $13,400 deductible
State: Pennsylvania

I do have a job, and it does offer health insurance. But it's a new one and there's a 90 day waiting period for the health insurance to kick in. Therefore my new insurance doesn't kick in until January 10. I haven't had coverage since the end of October. Fortunately, because I used to work for a COBRA administrator, I am savvy enough to know that I have until January 1 to elect continuation coverage, and that that coverage can be retroactive. So while I am uninsured now, if I get hit by a bus, I can retroactively continue my coverage from November 1 and cover myself. 

But I won't be able to do that anymore after the 60 day election period, which means I'll have a window from 1/1 to 1/10 that I will be uncovered and unable to retroactively elect COBRA if something happens. I am not one to gamble, especially having had an unexpected hospitalization almost exactly a year ago when I broke my ankle in a car accident and needed ambulance transport, an ER visit, and a subsequent surgery with all the bells and whistles (follow-ups, PT, pricey drugs, etc.) So that means I will have to shell out $438.14 just so I can have ten days of "just in case" coverage that would still require me to pay up to $17,100 if the unthinkable should happen. Potential total cost to me if my husband or I am hospitalized in that 10-day window: $17,538.14. 

That makes one wonder... what's the point of insurance then? $17,538.14 is a TON of money. But when I totaled up my last hospitalization it was a lot more than that so... there is enough upside in my mind to go through with it. I picked the absolute cheapest plan because the odds of something happening in that 10-day window are so slim (especially considering the auto insurance paid for the bulk of my last go-round with the healthcare system). I elected myself plus spouse coverage. 

I will never feel good about buying health insurance. I'm glad the marketplace exists... it beats not having it at all. But I do think it's awfully silly that I'm paying $430 just for peace of mind, essentially.

The Asthmatic

Costs: $166/month, $8,500 deductible
State: Oregon
Job: Video producer

I pay $166 a month after the subsidy kicks in for garbage insurance. It doesn't cover urgent care, and only covers the most basic visits at my doctor. I am about to pay approximately $250 out of pocket for blood tests as part of a physical. Most importantly, I have severe asthma, and I still have to pay for my inhaler out of pocket. Fortunately, it's only $65, and given my use, it's cheaper to stay on this plan.

[...]

I hate everything about this. I regularly say if I wasn't already a socialist, this process would make me one. I can't afford to see a doctor, dentist, or therapist (I've struggled with depression in the past, but have been forced to deal with it on my own this year) and the money I spend each month is a significant chunk of my budget. All I'm paying for is the hope that I won't be completely bankrupted if I end up in the ICU.

The Professor

Costs: $119.80/month, $1,000 deductible
State: Pennsylvania

This is my second year working as an adjunct professor at 2 or 3 universities. Buying insurance is an absolute nightmare because I might teach anywhere from one class a semester at one university up to 5-6 classes spread across three universities. This means it is very, very difficult to estimate my income.

I tried to get the same plan as last year, but my estimated income increased by $2K and now that plan (0 deductible, 40 min. copay)  is unavailable. So I chose the attached plan instead. It doesn't look too bad, lower premium and copay, but now I have a 10% coinsurance after $1K deductible. My other option was a 0 deductible plan with 80 (min.) copay. The rest were too expensive even with the subsidy—and my estimated income at the moment is $26K/year.

I am adjuncting for reasons other than the pandemic, but I lost my best paying adjunct position due to Covid. This entire process is stupid and a nightmare, but I need to have coverage. What a dumb system.

The Diligent Comparison Shopper

Costs: $307.17/month, $2,000 deductible
State: Colorado
Job: Grad student

I gross about $40k yearly from this (net around $2800/mo) - it varies depending on what kind of contracts I can take on - which puts me at the edge of the subsidy cliff. [...] I would describe myself as a 'best-case' beneficiary of the ACA - no real health issues, low-middle income.

The tools on the website that let you compare plans, at best, are broken. At worst, they directly mislead you as to which plans provide better/worse coverage; the cost of most common things (GP visits, prescriptions, etc) was hidden in these comparisons. Links to actual information on the plans from the providers themselves were usually broken, or linked to the wrong documents. I wound up consulting with friends in the area that had also shopped for insurance and browsing forums online instead of using the exchange site because of these issues.

After doing a ton of comparisons, I realized I would only save $50/mo in selecting a silver plan over a gold plan. The bronze plans covered so little by comparison, I did not even consider them.

Things have worked out at the end - I actually like having services under one roof, and I've had some health issues I have put off treating on my out-of-state insurance that have justified the Gold plan's cost - but as someone who is extremely privileged overall, I struggle to see how someone with less spare time and expertise would be able to navigate this system, let alone afford a premium. I would estimate that I've spent 12-24 hours actively working on getting insurance from this system, not counting time spent waiting for coverage / going back and forth via mail about whether I was eligible / looking elsewhere for descriptions of how the plans work, etc. I don't think this is feasible for the middle-income families the ACA is supposed to help.

Once again, thanks to everyone who sent in their stories. I’ll send out more later this week.