California Obamacare Health Insurance Sample Quote

healthOpen enrollment for individually-bought health insurance through state exchanges was supposed to start October 1, 2013, although several states experienced some delays and/or technical glitches. If your state exchange isn’t up and running yet, you can still estimate your premiums and tax credits here.

However, I was able to get a sample quote from the California health exchange website CoveredCA.com using my family’s demographic information.

Income: Above 400% of federal poverty line (roughly $60,000 for a 3-person household), so no tax credits or premium assistance.

Number of people: 3, specifically

  • One 35-year-old male
  • One 35-year-old female
  • One under-18 dependent child

Here are the monthly premiums I was quoted for each plan tier. The lowest quotes for our family situation were all from Blue Shield of California. $628 a month for Bronze, $722 a month for Silver, $910 a month for Gold, and $1,042 a month for Platinum.


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Here’s how the $628 Bronze plan breaks down by individual:

Here’s how the $722 Silver plan breaks down by individual:

This table illustrates the differences in deductibles, copays, and out-of-pocket caps between the Bronze, Silver, Gold, and Platinum plans. Note that the cheapest Bronze plan allows you to contribute to a Health Savings Account. Click to enlarge.


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While we still have employer-provided health insurance at this time, quotes like this will help us plan for a time where we are either self-employed or in early retirement pre-Medicare (age 65). If I were to assume that we may have another child, I can roughly estimate that our premiums would cost about $1,000 a month ($12,000 a year). That’s quite a large percentage of our current household budget.

Comments

  1. Your cost calculation does not include the very real out-of-pocket expenses that rapidly accumulate in these plans.

  2. That would be pretty hard to estimate for everyone. That’s why we buy insurance. Preventative care like wellness visits are included. Prescriptions have a reasonable copay. The maximum out-of-pocket is $6,350 a year / $12,700 for a family (less for platinum). These plans don’t seem that much worse than what I have from my employer now.

    Bronze plan is definitely best for those that are healthy and want minimal coverage because they don’t plan on spending much out-of-pocket.

  3. Very cool. Try putting in low incomes like minimum wage. This thing is clearly helping out the people it was intended to help through subsidies. Finally, uninsured people shouldn’t be showing up and getting a “free” hospital ride paid for by just you and me. They’re finally supposed to contribute, which lessens the burden on us. I’m a healthcare provider. See it happen way too many times. It’s finally accounted for and paid through a system.

  4. @Jonathan

    They don’t seem much worse than what you have from your employer now but nor are they any better. To me that is the problem. They remain exorbitantly expensive.

    For you, I think you’ll find that health insurance costs are the biggest hurdle to achieving your goal of an early retirement or even going independent. It’s a massive recurring cost that you cannot minimize in any meaningful way without sacrificing your health prospects. I know I’m in that boat.

  5. Jonathan,

    I am self employed and have insurance with BCBSTX for almost 6-7 years now which started out for $300 and now $500 exact for 4 people in a family with just $25/copay and 80/20 coinsurance. I got a letter from them yesterday asking to check out whether I will be eligible for any credits. I went to http://www.bcbstx.com/keepmeblue website and checked it out. I can see similar plans but nothing comparable to what we way. I know I am not going to get credit but want to see and compare. Similar plans is coming out to $500+ even without credit and thought to myself, I think I have much better plan and going to stick with it unless I see something better from other providers.

    My only concern, I hope the price stays same or doesn’t go up drastically. We have to wait and watch…

  6. @Delta they are still getting a free ride we are just making it easier on them with instant subsidies. I think this law means well but very clearly hurts the young/middle aged self employed middle class to help the lower class. Wealthy and those with employer plans aren’t impacted much.

  7. Also I haven’t read this anywhere – how will the penalties for lack of insurance be assessed on illegal immigrants and those that don’t file tax returns?

  8. I hate that’s not a plan that covers nothing unless its a catastrophic, bankrupting illness like cancer or some major surgery. I currently spend about $100-500 a year on healthcare with no insurance. I can’t afford to take a 10% paycut, and still have to pay out every time I go to the doctor or buy medicine. Young, healthy, self-employed people have no good option but to pay the penalty, which is what I’m doing.

  9. @Chris Folks under 30 can indeed buy just a catastrophic plan from the marketplace. https://www.healthcare.gov/can-i-buy-a-catastrophic-plan/

  10. I think the deductible is what will cause problems. We arent really providing much coverage for low income. What happens when someone who makes $15k a year gets free “insurance” goes and has a $10k surgery and is told they owe $7k (after deductible and copay)? Seems like it would be better to just give vouchers or something similar for free doctor visits,etc . As is the biggest benefit to all of this is to the insurance customers who are gaining several million more customers.

  11. Chris, there is a catastrophic option available for people under 30. There is an income test to qualify, but it was basically designed and priced to convince “young, health, self-employed people” to enroll rather than pay the penalty. So do you still hate?

  12. @Chris
    Yeah, it will probably sucks for families that are currently living paycheck-to-paycheck to be asked to pay this much in premium. Insurance payment seems like a waste of money … until shit hits the fan.

  13. @Chris: or hope that the 1-year delay on penalties that keeps passing through the house (and getting shot down in seconds when it reaches the senate) becomes permanent.

    On a side note, quotes from healthcare.gov for my family are much higher than if I had entered the individual insurance market last year, and cover much much less with higher out-of-pocket maximums.

    I’m with you, Chris. And I think everyone’s in favor of protecting the most destitute among us (@Delta), but forcing people like me to pay this much more is not the way! It would have been cheaper to subsidize BCBS individual coverage for everyone in my state than the bronze coverage listed above.

    @Jonathan: Could you please add your employer-covered plans to the charts above, along with what the employer would pay extra if you opt out of their plan?

  14. dood –

    Can you post more information about that option. I could be interested.

    Jonathan –

    How do those rates compare to what you were currently paying / what you would pay outside of Obamacare?

  15. And I believe that it was just to get people with no insurance to purchase some kind of insurance as Delta mentions. My problems is that those uninsured who were getting a free ride by showing up at the hospital without insurance and forcing others to pay their bills will now be covered, show up whenever they wish and the rest of us (taxpayers) still pick up the tab because with their subsidies many will pay virtually nothing or close to it.

    It is also not necessarily the poorest who will get the biggest benefit, but those who are perceived as such. Meaning the ones who have little or no “reported” income.

    The worst part is the bloated bureaucratic government is getting involved and we all know just how incompetent they are with running anything and everything. God help us all.

  16. People promoting Obamacare including Mr. President himself says, “If you have health insurance now and you like it, keep it.” I wish…

    I have health insurance now and I like it and it costs less than the Bronze plan from my state. But my current plan will discontinue because it doesn’t meet the requirement of Obamacare. My insurance company offer me a new plan which costs me twice as much!

    Now, my options are, I have to pay double for the premium to stay with the same insurance company, or
    buy the Bronze plan from the state exchange which will cost me more than I’m paying now. Something is wrong…

  17. What happened to “if you like you’re plan, you keep it”? I just got my notice from BCBS that my policy would terminate Jan 1, 2014 and I would be moved to a new qualified plan. Oh yeah, premium went from $67/month to $195/month.

  18. My employer is currently paying about $400 for a single adult for a plan that is slightly worse than the Silver 70. So the marketplace rates of $249 are cheaper than what my employer is paying for me.

  19. As a point of comparison : For 3 people the full cost of health insurance plans offered at my place of employment ranges from around $600 to $1300 per month (total cost including employer and employee shares). The $600 /mo plan is a high deductible HSA plan and the $1300 plan pays almost everything with a $20 copay. So thats the span on costs my employer is paying. Not far out of line with the quotes seen here for the exchange.

  20. Nic asked : ” how will the penalties for lack of insurance be assessed on illegal immigrants and those that don’t file tax returns?”

    How do you propose to enforce law on people who break laws? The normal way.

    If someone doesn’t file a tax return then they’re presumably committing tax evasion already illegal.
    If an illegal immigrant is an illegal immigrant then they are already illegal.

    You have to catch the criminals in order to penalize them.

    If we catch people committing tax evasion I”m sure the IRS will take care of it in the normal way. If they catch illegal immigrants then I’m sure they’ll deport em as usual.

  21. Nic asked :
    ” What happens when someone who makes $15k a year gets free “insurance” goes and has a $10k surgery and is told they owe $7k (after deductible and copay)? Seems like it would be better to just give vouchers or something similar for free doctor visits,etc . As is the biggest benefit to all of this is to the insurance customers who are gaining several million more customers.”

    At $15k a year you’d qualify for expanded medicaid. Unless your state opted out. If your state opted out then thats up to your state.

    If your state has no expanded medicaid then you get a subsidy and could get a silver plan for $300 a year. Since you’re low income you also get discounted rate and your total out of pocket can be no more than $2250 per year.

    So no you would not be told you owe $7k or $10k.

  22. Jack said :
    “My problems is that those uninsured who were getting a free ride by showing up at the hospital without insurance and forcing others to pay their bills will now be covered, show up whenever they wish and the rest of us (taxpayers) still pick up the tab because with their subsidies many will pay virtually nothing or close to it. ”

    People do not go to the emergency room for fun. Even if its free.

    There are rare exceptions for someone who has some sort of mental illness but generally people do not over use health care simply for kicks and giggles.

    If you fear that people will over use health care because its free to them then I think generally that fear is not warranted or based on any normal reality. If someone wants to milk the system they don’t do it by sitting in a ER waiting room and pretending to have an injury or illness for no good reason or financial gain.

    People who go to the emergency room now do so because the emergency room in hospitals are forced to accept anyone regardless of insurance coverage. So if you’re uninsured you can go to the ER and get treatment. Thats basically abusing the system but they feel they have no choice if they’re ill or injured and uninsured and broke. If they get insurance then they can go to an urgent care clinic, a doctors office or wherever else which would offer appropriate level of care needed and not waste the expensive time and resources of an ER.

  23. I worked in the healthcare industry for the last 5 years and worked for the largest provider in the USA. They made over 100 billion last year and did it by denying service, shortchanging customers and cheating the government. The fact is, the for-profit healthcare insurance system is a MAJOR problem in the USA. It is robbing from all of us and providing lower quality service than most major industrialized nations. I see no value in private healthcare and I made a gob of money working for that industry. It’s very, very greedy.

  24. I just think it is fantastic that health insurance no longer has to be tied to your employer to get a decent rate. The old system was a hindrance to entrepreneurship…

    I also think that many companies are using this change as an excuse to drop health insurance for their employees and blame it on the new system. I have a feeling those health care expenses they can “no longer afford” will be showing up as profits on the bottom line.

    It will need a lot of tweaking, but this is a huge step in the right direction.

  25. Chris in Boston says:

    Exactly how is this affordable?

    Even the bronze plan is ridiculous when you consider the cost of the deductibles that must be met.

    I used the mahealthconnector.org site today, after many struggles and errors with accessing the site I was finally able to find out for myself the costs for my family coverage…

    The bronze plan I priced out does not provide anything close to the level of coverage I currently have.
    Monthly premiums of $908 and the max out of pocket deductibles for it are $12,700 annually!

    If I had a bad health year and had to max out my deductibles we would have to pay $23,596.

    A gold plan… with coverage that comes close, but still not the same as what I have today will cost me $15,600 a year in premiums and still has a fairly large deductible of $10,000.

    $26,212 a year in medical costs if I max out my deductibles.

    This is INSANE. Even if I stay healthy, and don’t visit the doctor… my costs will be 5 times higher than I pay today.

    What happens when my employer decides to opt for paying the penalty, rather than offer me insurance?

    I lose the level of coverage I have, and I am forced to buy an expensive shitty plan approved by the government.

    How is the affordable?
    How is this progress?

    As a comparison… last year was a bad health year for me. My medical bills totalled over $97,000. I had great coverage through my employer and my actual out of pocket expenses came to only $5,876. Far more reasonable, and with a plan that offers far better coverage than the shitastic bronze plan.

  26. @Chris – your employer is probably picking up a great deal of your insurance costs. This is not the norm in 2013. The fact you spent only 5k on insurance and medical assistance for a family in 2013 in extremely unusual. Extremely. My last employer, UHG, charged employees with families $1200 a month for their Home Depot Health Plan. What’s that? Essentially you’re better off going to Home Depot and getting materials than going directly to your doctor. The UHG supplied”health plan” dind’t begin to cover anything until employees hit the max out of pocket (about 8k for a family).

  27. Jim says, “People do not go to the emergency room for fun. Even if its free.”

    Actually this is not true. I know first hand that many “homeless” people often decide they want to sleep on a warm bed for a few hours, check into the ER claiming chest pain and the next morning and a few expensive tests later leave with thousands in unpaid medical bills compliments of the rest of us.

    Again, this bloated, experimental catastrophe does nothing to get to the heart of the problem, which is working to lower the cost through tackling the causes for the outrageous expense of care now.

    Jim also says, “If we catch people committing tax evasion I”m sure the IRS will take care of it in the normal way. If they catch illegal immigrants then I’m sure they’ll deport em as usual.”

    Actually, the normal way for the government to deal with illegal immigrants is not to “catch…and deport them as usual.” It is to ignore the problem and stick their collective head in the sand.

  28. Thanks Jonathan. I was really confused by the complexities of obamacare, so it helped to see a real example. A few questions:

    1. What do the 60/70/80/90 numbers mean? I assumed it meant the % that the plan would cover, so you would have 40%/30%/20%/10% copay. But it doesn’t seem to correspond.

    2. When you estimated $1000 monthly premium for your family, which plan were you using?

    3. How much would a similar plan cost today for your family with private health insurance?

  29. and just wait til the rates go up next.

  30. AdirondackJack says:

    Jonathan, are you sure you wouldn’t qualify for premium assistance. I tried putting in your rough numbers and it showed that you would qualify for premium assistance.

    I’m with Chris in Boston on this. In his situation, regarding the gold plan (because he provided details for this plan) he is paying out $25, 600 (premiums + deductible) a year before his insurance has to pick up a cent of his health care costs. That’s outrageous. It seems as though they made health insurance more affordable by simply raising the deductible. The more important figure here is health care costs, not health insurance costs.

    I’m a lower income earner in New York, so I qualify for premium assistance, so it’s not bad for me. But, I feel for those in the middle class that won’t qualify for premium assistance.

    Nic said “I think this law means well but very clearly hurts the young/middle aged self employed middle class to help the lower class.” Definitely agree with you here.

    Nic also said “I think the deductible is what will cause problems. We arent really providing much coverage for low income. What happens when someone who makes $15k a year gets free “insurance” goes and has a $10k surgery and is told they owe $7k (after deductible and copay)? Seems like it would be better to just give vouchers or something similar for free doctor visits,etc . As is the biggest benefit to all of this is to the insurance customers who are gaining several million more customers.”

    I was playing around on New York’s site before October 1 and you didn’t have to register to get quotes. You play around with a bunch of different scenarios. In New York, not only was there premium assistance for low income earners, but the plans themselves were different. The deductibles, copays, coinsurance, pharmacy, etc. were all much lower for what was still called the bronze, silver, gold, etc.

  31. Until we follow other industrialized nations to universal system we’ll all continue to pay far too much (2nd most per person in the world) so businesses can make money for doing nothing (most of the hangers-on involved in skimming off the top of medical costs). Do a little research on programs in Japan, Europe, etc. The US pays more per capita than all but one nation and the us healthcare system ranks near the bottom.

    There are people who want the current system… UHG, Aetna, etc…

  32. One sure way of not letting UHG, Aetna, etc. take my premium and turn it in to profit would be to not patronize them by buying their product. But, now I am forced to buy their product or I will be fined.

  33. FYI, not paying the Obamacare penalty was explicitly not criminalized. The IRS cannot garnish your wages or property in order to make you pay it. The only thing they have said they might do is reduce any future tax refund you may be owed by the amount of the penalty.

    That’s easy enough to avoid though, just reduce your withholding so you owe taxes at the end of the year.

  34. I have my family insurance that i got thru ehealthinsurance.com

    $250 for whole family of 4 with 10K deductible, which I wanted.

    Do we get to keep this?

  35. Bucky asked:
    “1. What do the 60/70/80/90 numbers mean? I assumed it meant the % that the plan would cover, so you would have 40%/30%/20%/10% copay. But it doesn’t seem to correspond.”"

    Those numbers are actuarial figures. What they mean is that overall 60,70,80 or 90% of the total costs for everyone in the plans combined are paid by the insurance and the rest if paid by people via out of pocket costs including deductibles, coinsurance and copays. So no it doesn’t directly translate into a 40,30,20,10 coinsurance/ copay for each person. Really the 60,70,80.90 numbers don’t directly translate into anything other than knowing what % of the money overall is really paid by insurance. THey could just as well them them fair, good, better and best.

    Say for example that health care costs run $15k average per family. A $5000 deductible would cover 33% of the costs. If you add some copay and coinsurance on top of that then the plan may only pay 60% and be a bronze level plan. But with the same average health care costs you could have a plan that has a $1500 deductible and $0 copapy, 0 coinsurance and be 90% which is a platinum plan. Or maybe its $500 deductible and a $50 copay. They can mix the numbers however they want between deductible, copay and coinsurance (within some limits) to hit the right % of out of pocket.

  36. Jack said :

    Actually, the normal way for the government to deal with illegal immigrants is not to “catch…and deport them as usual.” It is to ignore the problem and stick their collective head in the sand.

    I don’t disagree but thats a different problem that we need to address isn’t it? Obamacare didn’t cause illegal immigrants and isn’t responsible for fixing it. Nor did it create tax evasion or homelessness.

    Yes some homeless people may abuse ERs. That again is a different problem that Obamacare isn’t causing nor really responsible for fixing.

  37. Is it me, or did the premiums for insurance on the marketplace seem a bit high? Perhaps the insurance co’s are raising prices because of all this mandatory purchase balony? Last year I got quotes for a single adult at ~$100 per month, now it seems to have doubled for the same level of coverage.

    I also wasn’t impressed with the subsidy amount for the very low income people, I’m below poverty level and I’d still have to pay about $50 a month in premiums. Thank the lord I live in a state w/ Medicaid expansion.

  38. brkf Says:
    “Until we follow other industrialized nations to universal system we’ll all continue to pay far too much (2nd most per person in the world) so businesses can make money for doing nothing (most of the hangers-on involved in skimming off the top of medical costs). Do a little research on programs in Japan, Europe, etc.”

    My father, a UK citizen is covered by the NHS. He had a heart artery condition that the UK doctor told him would kill him almost instantly if it ruptured. He was put on an 8 month waiting list for surgery. He decided to travel to Thailand for the surgery – for which he spent the equivalent of $6,000 USD and a week at the beach in Hua Hin Thailand.

    Had he taken advantage of the oh so great industrialized nations universal system, he’s sure he would not have been here today. Governments trying to run anything are not efficient or profitable.

  39. The fact the surgery could be done for 6k US proves there is something very wrong with the costs in the USA. If he called 5 hospitals in a 20 mile radius he’d get 5 different answers.

    The private option still exists for people with money. The fact is right now in the USA, people pay quite a bit for very poor service. So while you can find outlier examples of people paying and getting a lot or outliers in universal systems getting screwed, the in the long run most people make out far, far, far better in a universal care system than the totally corrupt US system. In the US every decision is governed by $ and trying to find a way to save money or divert the cost to the “insured.”

    For profit health insurance is an contradiction. It means they have no interest in health, but rather finding ways to reduce their costs to show shareholders a profit. UHG didn’t make 110 billion by generously supplying heart surgeries… they made it by denying coverage and pushing costs to others.

  40. @brkf, thank you for your comment. I’m in near agreement although I think you villainize the whole current system where I believe the US hospitals, physicians, and nurses do a very good job. I take issue with “very poor service”. Demonstrated how? I realize there are a lot of different ways to spin the numbers but in terms of quality of care, the US is the worldwide leader. Our hospitals, diagnostic tests, and medical training is above the rate of other nations. What differs is the heterogeneity of our nation and our poor access to care. It is widely acknowledged that access to preventative care is both cheaper and more effective than state of the art care once problems arise. This is how other nations are able to have more impressive outcomes over the US despite lower overall cost.
    We should strive for that and cut out the middlemen insurance companies.

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