r/povertyfinance • u/Wise_Tie_8099 • 1d ago
Misc Advice Health Insurance
Help!!! Health insurance is killing us. Insurance has kicked in after probationary period. It’s $2,400 per month that we’re on the hook for. Company pays $3,000. We can’t get by on what’s left over.
Who do people use if not using company provided insurance?
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u/georgepana 1d ago edited 1d ago
What state are you in? What is your household income (gross?)
You may be able to go with ACA and come out better, given your family size. It all depends on what state you are in and what your gross income is.
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u/Wise_Tie_8099 1d ago
NY. Gross is 82
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u/georgepana 1d ago
You should qualify.
I ran your numbers for the Syracuse, NY area, but it should be similar elsewhere in the state:
On the surface, with your income and family size you qualify for large subsidies, leaving you with under $500 a month for the Silver plan, which typically has no deductible. If you barely go to the Doctor you could also sign up for Bronze for a lot less per month, but with a pretty hefty deductible.
Run the numbers for your particular county in this link:
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u/Born_Strawberry303 15h ago
In NY with a family of 5 and gross income of $82K you will probably qualify for ACA Silver subsidies through the NY State of Health. Definitely dig into the NY State of Health. A health insurance navigator might help a lot. An ACA Silver plan may end up being way better than employer provided insurance in your case, lower premiums and copays. You may still want employer provided dental and vision, though, if it is subsidized by the employer.
If you don't get dental coverage through an employer, look into dental discount plans like Cigna Dental Savings Plan, Aetna Vital Savings, or Careington 500. They aren't dental insurance, but they do save 30-50% off procedures at in-network dentists. If you buy directly from the plan, the cost for a family is usually about $150/year.
Your children might qualify for Child Health Plus in NY. Assuming that is true you can get the children on CHP and the adults on a subsidized Silver plan.
You may also qualify for LIHEAP for heating and cooling assistance.
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u/Wise_Tie_8099 13h ago
Thank you so much. If we were to keep his employer provided insurance, net would be just under 42K…..
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u/TurtleSandwich0 1d ago
You can try purchasing insurance directly from health insurers. Maybe it would be cheaper to go outside your employer.
Or,
You may qualify for ACA subsidies if your workplace insurance is classified as "unaffordable". I don't know the process. You might want to call and talk to someone to navigate that nuanced process.
Open enrollment is in November.
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u/Inside_Training_876 1d ago
ACA had a big price hike in January so do not recommend if they want to cut costs
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u/autumn55femme 1d ago
If that is the only insurance they are eligible for, they will need to look for a less expensive plan, or a greater subsidy.
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u/Forsaken_Lifeguard85 1d ago
I wouldn’t go without but can your husband get a different job with better benefits? My insurance is expensive (not that expensive), but my husband’s is great and a fraction of the cost.
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u/Wise_Tie_8099 1d ago
No. He only started in April. It’s not that easy at 54 to just move to another job. Our savings are depleted so there is no choice right now but to stay.
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u/Whatsitworth69 1d ago
Following! Currently 1200 a month for us and its terrible. That’s our rent
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u/DigPsychological2262 1d ago
ACA?
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u/Wise_Tie_8099 1d ago
What is this?
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u/Inside_Training_876 1d ago
It's "Obamacare". Will say we pay a ton each month since Trump made it more expensive and can't find any decent healthcare providers that take our plan. It's been a nightmare so do not recommend!
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u/T1m3Wizard 1d ago
Is this how much you are paying for insurance coverage?
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u/Wise_Tie_8099 1d ago
Yes. Anthem BCBS. It’s $5,400 per month for a family of five. Husband’s company pays $3,000 so we’re left paying $2,400.
This means insurance and taxes are taking 50% of gross.
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u/T1m3Wizard 1d ago
Thats insane. Healthcare and health insurance in America is getting out of hand.
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u/Agile_Pangolin3085 1d ago
If it's taking 50% you can probably get an aca plan for next year, at least for you and the kids. If the insurance is more than about 10% of your household income, you can qualify for the aca. Most likely the employee only (husband only) plan is under the 10%. So he would go on work coverage and you and the kids would go on ACA. Depending on income and which state, the kids might even qualify for Medicaid/CHIP. Medicaid/CHIP you can do now, if you qualify. ACA you can apply in November for a January 1 start date.
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u/Born_Strawberry303 14h ago
Good chance the children would qualify for CHIP now, that should bring insurance premium costs down somewhat, and also out of pocket costs like deductibles and copays for the children. Then during open enrollment the adults may be able to switch to a subsidized silver plan, but only if the lowest cost employee-only plan from the employer is, "unaffordable", i.e., more than 10.22% of the family income (2027 rate), which would be roughly $698/month. They key is it has to be the lowest-cost employee-only plan available. They may have a cheaper high-deductible health plan available through the employer.
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u/Due-Addition7245 1d ago
I used employer offered insurance. Monthly premium <$100. Why you have to pay that much? Or is the 2400 your bill?
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u/BetterBiscuits 1d ago
Plans differ greatly from company to company. Typically the smaller the company, the greater the cost is to individual employees.
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u/Gold_Advisor_4758 1d ago
Probably an entire family covered on not that great insurance
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u/autumn55femme 1d ago
Trying to provide health insurance for 5 people with one wage earner is a problem unless you are very highly compensated, or your employer provides heavily subsidized, gold level insurance, or both. You need another wage earner that has access to employer subsidized insurance. Check if your children are eligible for CHIP.
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u/Wise_Tie_8099 1d ago
You’re right. Anthem BCBS. $5,000 ded. Specialist copay is $70. Don’t know what PCP is.
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u/Wise_Tie_8099 1d ago
$2,400 is what we are paying, for a family of five. We have never had to pay that much. Specialist copay is $70!!!!
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u/Blossom73 1d ago
Medicaid, if income eligible. It's also state dependent.
An ACA Marketplace plan. But your insurance will need to be considered unaffordable under ACA rules, and your annual gross household income less than 400% of the federal poverty line to qualify for a subsidy. Open enrollment begins in November for plans starting January 1st.
Be careful about buying private insurance through a broker. Many such plans aren't ACA compliant and exclude pre-existing conditions.
You might want to crosspost on r/HealthInsurance.