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Comment by perl4ever | Hacker News Reader

In my experience, when I was unemployed, an ACA plan doesn't cost $4K or even $800. I'm not sure even COBRA was that expensive.

Perhaps your anecdote is from before the ACA, but is it really productive to still be complaining about the way things were? Maybe spend more time making sure we vote for people who will keep it going.

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COBRA is essentially the employer's plan without employer's subsidy. The employer's plan seems cheaper because of that subsidy.

> The employer's plan seems cheaper because of that subsidy.

And it is cheaper, because that part of it is tax-free.

That's a good point, forgot about that.

Has the ACA caused prices to go down? I'm getting mixed messages about who has actually benefited, with "only insurers and people who were covered by the Medicare expansion actually benefited" being the impression that I get.

Whether prices have gone down may be of importance to society, but on a personal level, being able to pay is more germane. Before the ACA, when I was unemployed and not in school, I just wasn't insured. At this point though, that's kind of a long time ago.

Also, I think you may be confusing Medicare and Medicaid. I've never been covered under either.

Yes, I am mixing them up.

It did (especially for older people), but in the states that were willing to expand medicaid (the red states refused so there's an income gap where you make too much to qualify for subsidy, but too little to afford the regular prices)

It dramatically decreased prices for people with pre existing conditions. Which slightly raised prices for everyone else. Considering that expensive medical conditions are the point of medical insurance this is likely a good thing on average. Aka, cheap insurance that’s not actually covering you is kind of pointless.

All Marketplace plans must cover treatment for pre-existing medical conditions. No insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started. Once you're enrolled, the plan can't deny you coverage or raise your rates based only on your health.

I don’t think there is anywhere a single-person ACA plan costs anywhere near $4K. Even a “platinum” family plan in most places is $2K or less (not that that is cheap, but it isn’t $4K either) But these are also the “retail” unsubsidized prices. If you just lost your job and are without income, its extremely likely that you would qualify for a subsidy, making even a $1600 family plan likely much, much cheaper (and much cheaper than keeping your employer’s plan via COBRA as well).

Of course, as evidenced by people on this discussion thread, a lot of people are not aware of how ACA plans and subsidies work. Anyone who would even consider sticking with a COBRA plan after losing a job probably doesn’t realize they would come out much better with an ACA plan. When filling out the form you have to estimate what you’re whole year income will be... assume that you’ll be unemployed for the rest of the year when entering your yearly income. Even if you do end up getting a job in a month or two, you’ll just have to pay back some of that subsidy at tax time (the following April), but in the mean time you had cheap health insurance when you really needed it (while unemployed).

It varies based on pre-existing conditions.

COBRA is just regular health insurance.

I have had an ACA plan during two separate periods of time over the last decade and it was on the order of $400/month, with no consideration of pre-existing conditions. I've also had the opportunity for COBRA, which was too expensive, but still under $800.

Where do you get your "information"?

I think you need to consider your age and zip code as well. I have a family member who is an insurance broker and she had to factor in age and zip code to give me quotes on insurance.

Maybe the original anecdote was about a family plan. I interpreted it as not, but then reconsidered.

Currently, in an urban area of NY state where I am, a basic family plan is ~$1600 and an individual plan is ~$550.

You may say "what about the deductible", but it looks to me like the deductible is effectively only a payment plan. Even if you have a chronic condition, and you know you will go through the deductible for sure, you don't gain anything by paying for a lower deductible. The deductible is nowhere near the difference between $1600 and $4000 anyway.

Yes, with ACA the government basically made it so health insurance premiums are a tax, and young people subsidize old people by capping old people’s premiums as a multiple of young people.

Of course, pricing will vary by zip code because healthcare providers cost different amounts in different places, so a rural area might be more expensive where there are fewer doctors who have more negotiating power versus in urban areas where there are more doctors competing.

Pre existing conditions don’t affect premiums or eligibility for coverage since Jan 1, 2014:

https://www.hhs.gov/healthcare/about-the-aca/pre-existing-co...

Depends on the state and plan. For me COBRA was $2000/mo. When employed I paid like $20/mo and my employer paid $1980/mo. When I left I paid the entire amount.

For an individual or family?

Actually in your case it depends on the employer.

The plan you had was $2,000 (wow, that's really a lot though) and your employer was willing to pay $1,980 (again, that's a lot compared to employers I worked for) in addition to your salary.

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