Yeesh, what a freakin' mess.
Our paid-for time on COBRA ends this month, so we need insurance in place for January. Can I add my voice to the chorus exclaiming that insurance is insane in this country, that we pay more for less compared to the rest of the civilized world, that an absurd percentage of our medical dollars go to finessing the question of whether we need/deserve treatment, that in short the whole system sucks and the most cost-effective insurance pool is the largest and therefore can we just have everyone in a single pool, people, please?
Oh, I can? Oh, good. I'm sure it will make all the damn difference.
Aside from the cost -- although, again, ohmygods the cost -- there's just the question of what-the-hell-to-do. It's exceedingly difficult to make a financial decision for the entire year ahead when you have no real regular income and no idea what your actual income might be.
So here are the parameters defining our position. I think.
1. Any plan will cost us well over $20k between premium, deductibles, medications, and copays.
I have several chronic medical issues which require regular testing and physician/therapist visits, while Spouse takes a medication that runs $400+/month (in defiance of conventional market wisdom, the price continues to climb since the drug became available as a generic several years ago). We have typically hit our $4k deductible before mid-year. We are, in short, unlikely to have a light-use medical year. So the cheaper-premium-plans, since they're offset by higher deductibles/copays, are unlikely to save us any money.
2. While I have no idea what we'll actually earn, I do feel we're unlikely to qualify for an ACA subsidy.
Our Adjusted Gross Income would have to be less than half of what it was in 2016 and 2017 for us to qualify. And those 2016-2017 figures were substantially lower than gross income because we maxed out our 401k contributions; if we work as freelancers/contractors, we're unlikely to have that opportunity, so the same gross income would actually result in a higher AGI.
3. Premium paid out-of-pocket is still deductible. Well, some of it is, sometimes, for some people, anyway.
I have to check the new laws for the percentage, but premiums count as deductible medical costs for federal taxes so long as you're paying for them with post-tax income (rather than having the money deducted by an employer, which is then deducted from your taxable income -- pre-tax being income-deductions before taxes).* But that only applies to costs over the set percentage of income, which is either 7.5% or 10%, and it's only valuable if the itemized amount is higher than the standard deduction.
The standard deduction for 2018 will be $24,000, so it would only make sense to itemize if our medical costs were higher than $24,000 + 10% (or 7.5%) of our income. Again, without an actual income, how can we know? Still -- if AGI were $100,000 for the pair of us (to pick a convenient round number), that would make the threshold either $10,000 or $7,500 plus the $24,000 -- $34,000 or $31,500; if AGI were $50,000, the threshold would be either $29,000 or $27,750. My best guess is that medical premium + expenses will be low to mid $30,000s (though they could be higher!).
4. If you decline or drop COBRA, you can change your mind within 60 days and get it back, with coverage retroactive to when you dropped it.
I think. Still looking for an official/government source that says this.
5. Our COBRA coverage is a little better than, and a little more expensive than, the (non-subsidized) gold plans available here.
So it's properly priced? My head is swimming.
6. There's no way to tell if our doctors are covered by any of the plans I've looked at.
Which is a biggish deal, since we see some specialists.
So yeah: pinball pachinko twister -- I've been banging from one consideration into the next, and (figuratively) working myself into impressively yogi-esque knots trying to script scenarios where we do (a) and (g) happens and (x) applies, versus when we do (b) and (g) happens and (z) applies, and oh gods I'm just exhausted.
I think decision fatigue set in, and we decided point 6 is the most important and sent the check off for the COBRA payment. Done. Decisioned. Definitely.
Although we can still quit, and since paid-for COBRA coverage ending is a qualifying event we actually have another 60 days to decide about an ACA plan, and oh god stop me just stop me I don't even care anymore if single payer is more efficient it's just less damn exhausting.
And that's the story of our health insurance. So far.
*I edited this sentence to fix a mistake and clarify pre- and post-tax income within it, since I keep muddling them up.
Our paid-for time on COBRA ends this month, so we need insurance in place for January. Can I add my voice to the chorus exclaiming that insurance is insane in this country, that we pay more for less compared to the rest of the civilized world, that an absurd percentage of our medical dollars go to finessing the question of whether we need/deserve treatment, that in short the whole system sucks and the most cost-effective insurance pool is the largest and therefore can we just have everyone in a single pool, people, please?
Oh, I can? Oh, good. I'm sure it will make all the damn difference.
Aside from the cost -- although, again, ohmygods the cost -- there's just the question of what-the-hell-to-do. It's exceedingly difficult to make a financial decision for the entire year ahead when you have no real regular income and no idea what your actual income might be.
So here are the parameters defining our position. I think.
1. Any plan will cost us well over $20k between premium, deductibles, medications, and copays.
I have several chronic medical issues which require regular testing and physician/therapist visits, while Spouse takes a medication that runs $400+/month (in defiance of conventional market wisdom, the price continues to climb since the drug became available as a generic several years ago). We have typically hit our $4k deductible before mid-year. We are, in short, unlikely to have a light-use medical year. So the cheaper-premium-plans, since they're offset by higher deductibles/copays, are unlikely to save us any money.
2. While I have no idea what we'll actually earn, I do feel we're unlikely to qualify for an ACA subsidy.
Our Adjusted Gross Income would have to be less than half of what it was in 2016 and 2017 for us to qualify. And those 2016-2017 figures were substantially lower than gross income because we maxed out our 401k contributions; if we work as freelancers/contractors, we're unlikely to have that opportunity, so the same gross income would actually result in a higher AGI.
3. Premium paid out-of-pocket is still deductible. Well, some of it is, sometimes, for some people, anyway.
I have to check the new laws for the percentage, but premiums count as deductible medical costs for federal taxes so long as you're paying for them with post-tax income (rather than having the money deducted by an employer, which is then deducted from your taxable income -- pre-tax being income-deductions before taxes).* But that only applies to costs over the set percentage of income, which is either 7.5% or 10%, and it's only valuable if the itemized amount is higher than the standard deduction.
The standard deduction for 2018 will be $24,000, so it would only make sense to itemize if our medical costs were higher than $24,000 + 10% (or 7.5%) of our income. Again, without an actual income, how can we know? Still -- if AGI were $100,000 for the pair of us (to pick a convenient round number), that would make the threshold either $10,000 or $7,500 plus the $24,000 -- $34,000 or $31,500; if AGI were $50,000, the threshold would be either $29,000 or $27,750. My best guess is that medical premium + expenses will be low to mid $30,000s (though they could be higher!).
4. If you decline or drop COBRA, you can change your mind within 60 days and get it back, with coverage retroactive to when you dropped it.
I think. Still looking for an official/government source that says this.
5. Our COBRA coverage is a little better than, and a little more expensive than, the (non-subsidized) gold plans available here.
So it's properly priced? My head is swimming.
6. There's no way to tell if our doctors are covered by any of the plans I've looked at.
Which is a biggish deal, since we see some specialists.
So yeah: pinball pachinko twister -- I've been banging from one consideration into the next, and (figuratively) working myself into impressively yogi-esque knots trying to script scenarios where we do (a) and (g) happens and (x) applies, versus when we do (b) and (g) happens and (z) applies, and oh gods I'm just exhausted.
I think decision fatigue set in, and we decided point 6 is the most important and sent the check off for the COBRA payment. Done. Decisioned. Definitely.
Although we can still quit, and since paid-for COBRA coverage ending is a qualifying event we actually have another 60 days to decide about an ACA plan, and oh god stop me just stop me I don't even care anymore if single payer is more efficient it's just less damn exhausting.
And that's the story of our health insurance. So far.
*I edited this sentence to fix a mistake and clarify pre- and post-tax income within it, since I keep muddling them up.
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