Should I Really Be Paying This Much?

I’m a 25-year-old male in good health and don’t use tobacco. My dad decided to remove me from his insurance to save money. I’m not too upset since it’s a terrible BCBS plan with very high copays ($40 for a PCP visit, $100 for urgent care, and $500 for the ER).

Since my coverage ends at the end of the month, I checked out the healthcare.gov marketplace. I filled it out—25, male, no tobacco, $14k income per year in Texas. I was shocked to see the cheapest plan cost $275 a month!

I always see ads about coverage through healthcare.gov for “as low as $25 a month.” Why am I not seeing that? I’m well below the poverty line.

What other options do I have? I want to keep copays low since I need a few PCP, urgent care, and specialist visits each year. But $275 a month is too much. (I chose the “moderate” usage estimate.)

With my low income and being in college, I thought I’d get subsidized options around $50. My college offers a plan, but it’s terrible, and in Texas, adults aren’t eligible for Medicaid no matter their income.

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  1. Your father’s plan was actually pretty good—those copays aren’t bad compared to deductibles. You’re likely in for a $5,000–$10,000 shock each year, if not more.

  2. Unfortunately, since you’re in a state that didn’t expand Medicaid, you’re left without good options. If you earned more, your premium might actually be lower. Vote for change in your state, but that’s a long-term solution.

  3. For now, your school’s insurance might be the best option for you.

  4. If someone offers you a non-ACA compliant plan, be careful. Those plans are usually poor and not worth the money. Also, health share “plans” aren’t real insurance and have no guaranteed benefits—watch out for those.

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This is probably the best answer, to be honest! I can relate to point #1: I have a high deductible plan and a condition that requires me to see my PCP every month. I end up paying around $100 for each visit since it goes toward my deductible. I would love to have OP’s $40 copays, even if it means paying higher premiums!

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Yeah this state isn’t very friendly to low income peoples, it sucks. Thank you for all the advice! I learned a lot.

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Emphasis on the vote :wink:

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That price is the best you’ll find for comprehensive health insurance in Texas.

Your income level is actually at the Medicaid threshold. If you earn less than 138% of the federal poverty line, you can’t get subsidies through healthcare.gov. In 40 out of 50 states, people in your situation would qualify for free Medicaid coverage.

Texas is one of the 10 states that refuse to expand their Medicaid programs. This leaves you in the Medicaid gap. You don’t qualify for Medicaid based solely on financial need unless you meet certain criteria, like being pregnant, caring for a child, blind, or disabled.

Your only options for cheaper coverage are to:

  1. Increase your income above 138% of the federal poverty line. You could do this with a second job or by working more hours.
  2. Get employer-sponsored coverage. This is usually available to full-time employees at medium to large businesses. Small businesses aren’t required to offer insurance.
  3. Move to a state that has expanded Medicaid and apply for their program. You can check which states offer this using this map: KFF Medicaid Expansion Map.
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Texas Broker here— and I agree with these assessments.

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Thank you I’ll recalculate my income. A lot of my income is cash, gig jobs, part time jobs, etc since I’m in college. I estimated on the low end so I could be sure to get subsidies. I’ll aim a little higher I guess

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I know you say your school’s coverage is awful, but these are often the most viable option for folks in your situation. Something to consider as you evaluate your options for increasing income to secure ACA subsidies.

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I checked it out, and the cost was about $2,000 to $3,000 for half a year of coverage. The coverage itself was very poor.

Thanks for all the information! I really appreciate it. Insurance is such a complicated mess, and schools don’t prepare us for it at all.

I might look into whether Curative offers any subsidies. Their coverage is similar to the Medicaid plan I used to have, and I miss that a lot.

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You won’t be able to get Curative unless you are employed by a company that offers that to their employees. Curative is specifically a group insurance product.

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Ask your dad about the cost difference between the self + 1 plan and the self-only plan. Since he wants you to pay for it, would he allow you to cover the difference? Generally, the cheaper marketplace plans aren’t very good.

Also, look into insurance options through your college.

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The kid is turning 26…… :thinking:

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Yeah but I still have awhile until then :slight_smile:

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That BCBS insurance has high co-pays: $40 for a PCP visit, $100 for urgent care, and $500 for the ER.

However, those co-pays are actually quite good if you can find a plan with only co-pays and no deductibles. By today’s standards, they aren’t high at all.

But paying $275 a month feels like robbery.

Actually, that’s not “robbery” at all.

I know these aren’t the questions you asked, but it seems you don’t have a good understanding of how much healthcare costs.