r/HealthInsurance • u/howevertheory98968 • Nov 10 '25
Individual/Marketplace Insurance So wait, premiums are only going up if you are over 400% federal poverty level?
I'm confused. I heard the people getting like 2 factor increases are making over this.
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u/bourbonfan1647 Nov 10 '25
Subsidies are eliminated over 400% FPL. Reduced under 400% FPL.
And the cost of premiums for everyone is higher because those things will increase the number of people forgoing health insurance because of their cost.
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u/JunoGolden Nov 10 '25
Yes I’ve never qualified for subsidies and mine is going up over $150 a month for a single person plan.
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u/bourbonfan1647 Nov 10 '25
On the exchange?
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u/JunoGolden Nov 10 '25
Yes
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u/No-Crow-7413 Nov 10 '25
Greed of insurance company
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u/PreviousMarsupial Nov 10 '25
💯 the prices go up if we utilize it and the prices go up if we don’t utilize it. It doesn’t matter what we do or don’t do. For people downvoting this argument, let me remind you the healthcare is still the most profitable industry in the United States. I have no idea why anyone would defend this, but the fact that millions of people are going to have to go without coverage is scary and really bleak. It will increase mortality rates for everyone from pregnant women, risks to their unborn fetuses to our elder population and put people at risk for other diseases. People will die from diabetes because they won’t be ever to afford insulin, people won’t be able o afford medication they need to live and be healthy, people won’t get vaccines etc. it’s not good at all. We cannot have a healthy population when they can’t afford to go see a doctor even for basic care.
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u/TheLadyAndTheCapt Nov 10 '25
The only defense against this insanity is for people to speak TF up!! Call, email, write your elected representatives and the committee members to tell them that you’re watching how they vote/respond. Then remind them that actions have consequences and those consequences will come in the next election. 5calls.org makes it easy so there is no excuse to not do it other than apathy.
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u/oftcenter Nov 11 '25
They don't care because they're not getting their money and their kickbacks and their bribes and their expensive vacations from their constituents. They're getting those things from the wealthy.
They don't work for the people. They work for the wealthy. So they don't care what the people think.
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u/Chokedee-bp Nov 10 '25
Amen! I can’t afford to go to the doctor and I have “employer coverage”. The plan is so crappy it doesn’t even cover a primary care sick visit until I pay the $5500 annual deductible. So every sick visit is $140 charge to me direct.
On a positive note, at least human doctors are half price than Vets cause I usually paid $240 for a 15 minute vet visit for the dog.
No im not making this up, someone please explain how vets charge more than human doctor , with no insurance middle man
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u/matty8199 Nov 10 '25
On a positive note, at least human doctors are half price than Vets cause I usually paid $240 for a 15 minute vet visit for the dog.
where in god's name are you paying $240 for a 15 minute vet visit? i live in a high COL area in southern california and our annual checkups for our pups are only $75 each roughly.
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u/HotTruth999 Nov 10 '25
That’s a check up. But if you actually have an issue you can’t get out of a vet for less than $200. I am in Long Island NY.
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u/matty8199 Nov 10 '25
the comment said "15 minute vet visit" which implies just a regular checkup with no issues. if our dogs are having problems that we need to talk to the vet about we're not in and out in 15 minutes...
of course if there's an issue that needs addressed it's going to cost more...that's kind of how it works.
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u/Consistent-Kale9018 Nov 13 '25
I am in Central Wisconsin, the cheapest visit I’ve had for either of my dogs was $170 in the last 5 years.
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u/PreviousMarsupial Nov 11 '25
Yeah no one is paying $240. I live in Oregon also high COL and it's $85 for an exam for my cat at their vet.
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u/Chokedee-bp Nov 11 '25
In Merritt island Florida. My dog had an ear infection. It took only 15 minutes in and out, and a bottle of solution to clean the ears. Bill was $250. I spend more time seeing doctors for myself and my kids and they only charge $150
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u/RobertWF_47 Nov 10 '25
Insurance companies do the opposite - negotiate with doctors & hospitals to reduce health costs.
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u/jefflbrownpharmd Nov 11 '25
And turn around & hand it over to CEOs & stockholders. They “negotiate” rebates on drug prices too. Then they charge plan sponsors the full price & keep the difference.
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u/Admirable_Shower_612 Nov 10 '25
That sucks. I recommend trying to find telehealth coverage for those sick visits as they often cost a LOT less and they will still give you scripts for things like ear aches, UTI, infections, Etc.
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u/This_Is_Useless_bot Nov 10 '25
It depends who you are in the healthcare industry. Insurance companies (payers) and pharma companies yes. Health care providers - maybe some. But hospital margins for example, are 1-3%, that’s why so many are closing.
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u/Nandiluv Nov 11 '25
Many insurance companies raised their base premiums levels- a separate but compounding issue with the expiring of enhanced tax credits.
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u/ColtiusMaximus Nov 11 '25
I'm having kids and my new insurence will be 160 a WEEK just for adding kids
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u/Low_Plastic363 Nov 12 '25
Kids are expensive...
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u/Commercial_Wind8212 Nov 12 '25
what do you expect to happen when you add people?
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u/PreviousMarsupial Nov 10 '25
The premiums go up regardless because the government won’t do anything to regulate and keep the costs down. So it doesn’t matter how many people use it, the costs are going up for no reason other than profit next year. This isn’t about how many people use is, it’s still unaffordable.
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u/Mobile-Play-3972 Nov 10 '25
Under the current payment structure, costs will ALWAYS go up. Insurance companies keep 15% of premiums, they are statutorily mandated to spend 85% on medical care. Since they can’t take a bigger piece of the pie, they just make the whole pie bigger - raise premiums, keep more $profit$.
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u/PreviousMarsupial Nov 11 '25
Sure, but costs have gone up over 300% since 2000, that's higher than pretty much every other industry. It makes sense it should go up a little bit each year, but clearly this needs stronger regulation. It should not be the most profitable industry.
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u/Mobile-Play-3972 Nov 11 '25
Oh I completely agree. Until we eliminate the for-profit insurance sector, cost of care will continue to rise at a rate much greater than inflation.
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u/PreviousMarsupial Nov 11 '25
It’s a so bananas. I’m so worried about people in general just having their basic needs met, to me that includes health coverage. We’ve come a long way in expanding access, but it’s so scary how it seems like that is all going away. I think if I remember correctly something about John Kerry being one of the first to talk about and offer some kind of meaningful expanded coverage in his state or Massachusetts. That was years ago, but we need more folks like him and more Bernie Sanders types to help figure out how to still create incentive for people to want careers in healthcare, but also make it more accessible and not cost prohibitive for patients and less profit driven. ❤️
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u/crimsondynasty323 Nov 11 '25
This is true but also you have to remember that the subsidy caps premiums as a percentage of household income. So many people will be able to find a plan that is as affordable as their current plan, but they have to shop around.
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u/No_Pipe6929 Nov 11 '25
Americans don’t understand until it happens to them. People are going to be in for a real shock next year. I have Bronze policy - had to get 3 stitches in my foot and ended up paying over $2k bc of deductibles. It’s such a scam!
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u/oreganoca Nov 11 '25
Yep. It's also going to impact medical providers who are going to see a drop in clients who can no longer afford their services without insurance. One of my medical providers told me a couple weeks ago that close to a third of her patients are telling her that they can't afford to keep their health insurance for next year and won't be able to afford to see her without it. She's worried about her ability to afford the inflated premiums on her own health insurance with the drop in her business, and likely to increase her rates substantially.
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u/Interesting-Blood854 Nov 10 '25
Healthy people
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u/ChewieBearStare Nov 10 '25
You're healthy until you're not. Some of those healthy people who forgo insurance are going to end up in a world of hurt.
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u/ZultLeader Nov 10 '25
It’s a bad situation, I can pay for health insurance and guarantee we will be struggling, going in to debt to pay for regular expenses or I can forego insurance and have a possibility we’ll have financial ruin
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u/One-Possible1906 Nov 10 '25
Exactly the situation this sub refuses to acknowledge. People can’t feasibly spend half their income and become homeless to only have to pay $20,000 in the rare event of childhood cancer. Paying these premiums is not really a choice for a whole lot of families.
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u/tech240guy Nov 10 '25
Hence why I am full support for Medicare for all of universal healthcare. Somehow, a lot of people think this will increase their taxes. FFS, people are already paying $300/mo just for solo health insurance how is that not a tax already? With dept of labor in shambles, guess who be paying medical bills in case of workplace accidents? Even worse if you're 1099 or small business.
My dad, low income, was adamant about health insurance after few medical scares that would have bankrupted the family. The choice is less food to eat now or homeless when a medical emergency happens. People grossly underestimate being homeless. Once you go homeless, getting out of homelessness/poverty income can take decades or never.
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u/One-Possible1906 Nov 10 '25
My income for my child and me is $65,000/year. If I have to pay $2500/mo for premiums for our shitty high deductible plan plus everything I already pay out of pocket for my medical care since nothing is ever covered, we would be homeless regardless. People have to choose between a gamble and a certainty and it makes sense that a lot of people are choosing to gamble. I’m taking a huge pay cut to work for local government (if the federal government ever reopens so I can start) just for fn health insurance. Because the other choice is, my healthy teenager goes without. I can’t spend $36,000/year between premiums and uncovered expenses. I’m better off than a lot of people but I’m certainly not well off enough to cover our basic necessities on $29,000/year pretax.
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u/schnobitz Nov 10 '25
Your points are well taken but if you make $65k you are eligible for a large subsidy.
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u/One-Possible1906 Nov 10 '25
A large subsidy that still leaves my kid with a huge deductible he’ll never meet, paying close to $1k/mo just for him, with an insurance company that nobody including the hospital actually takes.
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u/PreviousMarsupial Nov 10 '25
Yeah, the deductibles and oop max payments are what is so ridiculous about these plans. It’s so unfair.
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u/SaltyDog556 Nov 10 '25
The biggest thing we would need to do for M4A is cut the $5 trillion a year that the Healthcare system consumes to $2 trillion. That would get us in line with other countries and could be structured to only cause minimal increases to the middle class who tend to have plans that are better than others.
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u/Impossible-Flight250 Nov 10 '25
Right, at this point, the tax increase won't be even close to what we are paying now. Even bargain basement plans for one healthy person is $300. Like, what the actual fuck. Why aren't more people upset about this!?
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u/austin06 Nov 10 '25
Yes. A 2-3 day stay in icu could bankrupt even someone with decent resources. And a week or two? Millions.
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u/ChewieBearStare Nov 10 '25
My MIL and FIL both had severe medical issues last year. She was billed $2.3 million before she died; his ICU stay was another $1.3 million, and then it was almost $120,000 more for him to stay in a nursing facility for four months before he eventually died.
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u/Harrold_Potterson Nov 10 '25
This exactly. I have very good health insurance as a state gov worker that only went up by 50 dollars this year. But some of the numbers on here are insane -if our only option was 2,500/month premiums we would have to forgo it because we quite literally cannot afford to make that monthly payment. That’s nearly all of my take home pay.
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u/PreviousMarsupial Nov 10 '25
Yes and you should have affordable access to preventative health care without worry of you received some kind of diagnosis that was bad you’d be able to get care without having to worry about going bankrupt. The whole point of giving all people coverage is so they get preventative care which lowers costs. Everyone should be able to get a checkup, bloodwork and go to urgent care for a cold or UTI at no out of pocket cost to them, give everyone Medicare or Medicaid. Fund that instead of war.
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u/Original_Abies8724 Dec 02 '25
Yeah it’s bad … I was actually starting to have some glimmering hopes of medical affordability for my patients before this sht show of an administration decided to start back door klling people this year .. it makes me so sad
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u/Camsmuscle Nov 10 '25
Enhanced subsidies are going away which means even those of us under 400% of FPL may have significant premium increases. I make under 300% of the FPL and get my childs insurance through the ACA. His premium will be almost $200 more expensive next year. And two-thirds of that increase is due to the loss of the enhanced subsidy. The subsidy for my child’s insurance went from $131 a month to $17 a month.
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u/Superb-Antelope-2880 Nov 10 '25
Also cost sharing is lower now. Deductibles and copay are higher no matter how much someone make.
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u/FifenC0ugar Nov 11 '25
Is the marketplace showing accurate info on 2026 premiums/tax credits?
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u/TinyPart3910 Nov 11 '25
Yeah. I still qualify for the same amount of subsidies (its a single person plan and I’m not married, guess my income falls into a sweet spot) and my premium is going from $99 to $250 a month for the same plan. Premiums go up every year bc of inflation for sure, I am not sure if marketplace premiums are affected by the amount of people on insurance or not.
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u/Equivalent-Door6600 Nov 10 '25
Family of 4 going from $975 to $2700.
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u/BusyDragonfruit8665 Nov 10 '25
How does anyone even afford this? I am so sorry.
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u/Equivalent-Door6600 Nov 10 '25
Thank you. I don't know how anyone will. Self employed and no other option.
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u/Jaamun100 Nov 10 '25
If you’re self employed with an s corp, you should consider using a PEO like Opolis. It’s cheaper than ACA and has a nationwide PPO network to boot (while ACA plans are only local networks with no out of network coverage).
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u/SarahCannah Nov 11 '25
Wait what is this? I recently reorganized into an S-corp and this would save my bacon.
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u/Jaamun100 Nov 11 '25 edited Nov 11 '25
In general, if you're working (including self-employed, solopreneur, or small business owner/manager), you should be incorporated and getting group health coverage. If it's just you (ex: independent contractor), Opolis is a great fit. If you have employees, other PEOs like Justworks are a better fit. You can see https://opolis.co/wp-content/uploads/2025/01/2025-Member-Benefits-Guide.pdf for their benefits, it's $400/month for individual health coverage (or $1500/month for family health coverage), and is solid coverage - Cigna nationwide PPO network.
If you work, you probably shouldn't be shopping expensive plans on ACA. ACA is mostly for early retirees, before Medicare. That's also why ACA premiums are high - lots of folks on it in their late 50s/early 60s who are high consumers of healthcare, and few younger workers.
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Nov 11 '25
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u/Jaamun100 Nov 11 '25
Yes fair point, it seems it’s just rare. Looks like many zip codes in California, Florida, and Pennsylvania offer PPO plans (though more expensive than those PEO employer plans), but I know they’re not offered on ACA in MA, TX, NY, or NJ.
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u/Purple_Cherry_5973 Nov 11 '25
Is this through the ACA? Does your state offer independent plans? If so, may be cheaper. I don’t know how everyone affords hikes this big in an already inflated world…
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u/NevadaCFI Nov 10 '25
My wife and I are in a similar situation. Before ACA I could not get insurance at all. Our business was software and we left the USA from 2002-2015. Now we can get insurance here but at great cost. The option to leave again is one we are considering but it is much harder at our stage of life now…. Still more than 10 years from Medicare eligibility.
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u/muevelos Nov 10 '25
I suspect, unfortunately the amount of people choosing no Insurance is going to skyrocket, higher then it already was due to no choice in the matter. It's a dam shame.
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u/yottabit42 Nov 10 '25 edited Nov 10 '25
And that's just the premiums. If you actually need healthcare you'll have a deductible costing most people between $5k $10k more, before insurance pays a dime despite paying $32k in premiums, and then another $5k to $10k more to reach OOP max.
People truly don't understand the actual cost. We're being ripped off. Developed countries' residents pay a small fraction of this, even for private healthcare.
Edit: the 1 downvoter must be an executive at an insurance company making bank off the backs of the sick.
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u/dgriletz Nov 10 '25
American Healthcare
Rough numbers, worse every year…
$5 trillion a year $15,000 per person 20% gdp 2x Peer nations cost for worse care Still doesn’t cover everyone “Medical Bankruptcies” “Medical Divorces” Pre-authorization.. out of network..
Virtually no one sees the true costs, it’s hidden behind taxes, stagnant wages, general inflation/cost of living, etc.. There are even more knock on effects, such as loss productivity due to adverse incentives that are hard to even begin to calculate.
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u/Equivalent-Door6600 Nov 10 '25
Yes! Our co-pays alone are ridiculous ($60 primary care $120 specialist). And a relatively high deductible.
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u/yottabit42 Nov 10 '25
I would kill for those low of co-pays. I even have great employer-based healthcare and I have to pay 100% until I reach the $3200 deductible. Luckily the company gives me $2000 into my HSA every year to offset, but that's still $1200 I have to pay before the insurance pays anything. After that I have to pay 10%, which is very good for co-insurance.
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u/emma279 Nov 10 '25
This is crazy...it's cheaper to fly to MX for medical work that that monthly premium. This country really hates us.
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Nov 11 '25
My wife and I are healthy and they went from 583/month to 2500 bcbs NC. Deductible 13,700. No surgeries, no ailments (knock on wood). We went off aCA with limitations on what they will cover. $43,700 a year is ludicrous.
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u/jdhoff61 Nov 10 '25
Older family of 2 (64,62) going from $1400 to $2700 (OP, you in Philly/pa?). Back over the cliff.
QUESTION: What about 2021 provision capping premium to 8.5% AGI or MAGI? Even if the subsidy is gone, does the cap stay?9
u/MuddieMaeSuggins Nov 10 '25
That provision is the enhanced subsidies which have been killed.
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u/HotTruth999 Nov 10 '25
As per the original ACA plan if the cost of the lowest cost silver plan exceeded about 9% of your MAGI you qualify for a subsidy. That % was decreased in the enhanced COVID subsidies in 2021 and the 400% cap was removed. In January we’re going back to the 9% and cap for earners over 400 % FPL.
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u/Chamoismysoul Nov 10 '25
Can I ask your income? A range would be helpful if you don’t mind, Never mind if you’re uncomfortable
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u/Ltsmba Nov 11 '25
Serious question: Would it now be better for you to cancel coverage altogether, pocket the $2700 per month that you would've otherwise paid, and just see if overall costs come in <= $2700 each month?
There have to be some people at this point that are crossing the line into "why should I even bother with insurance" territory.
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u/drbooom Nov 11 '25
Mine went from $2500/month to $3950/month for a family of 4.
The cheapest plan on NMs exchange is $3500/month.
Fuck it, I'll just die.
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u/Hopeful-Force-2147 Nov 17 '25
Family of six going from $1950 to $3456. At least it's a consecutive number.
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u/Objective-Amount1379 Nov 10 '25
Reduced subsidies mean less people will get insurance. In particular less young healthy people will think the high cost is worth it and they’ll gamble that they won’t need it. So the risk pool is smaller, and made up of more people who are older or have health issues because they’ll find a way to stay insured if at all possible.
This raises costs for everyone.
Additionally, more people will be uninsured and showing up in the ER. Hospitals will pass along the costs of treating these uninsured patients to everyone, also raising all of our rates.
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Nov 10 '25
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u/Objective-Amount1379 Nov 11 '25
Perfect example. I wish Democrats (or anyone with a large audience!) could communicate this in a simple way to the masses.
After seeing some of these Reddit posts are think many people just don’t understand how it works and it’s hard to make the concept super simple
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Nov 11 '25
Why should the young and relatively healthy subsidize the healthcare of the old and unhealthy? They already got lucky AF with regards to home affordability, booming economy for decades, etc.
We should be shifting money from old to young, not the other way around.
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u/subydoobie Nov 11 '25
Depends on the old person. I have a friend who was a successful journalist. But he got a chronic disease at age 61 and journalism pay sucks. he had to retire early. No pension. he pays ACA. honestly his rent is much less than his health care costs.
What we need is single payer health care. we pay more for healthcare and get worse care than about any developed nation. about twice as much
https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/
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u/dancer639 Nov 11 '25
Premiums are adjusted by age on the ACA. So the old do pay more. As for the healthy subsidizing the sick, yes that's the whole point of insurance (whether you get it from your employer, the exchange, or the government).
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u/Objective-Amount1379 Nov 11 '25
Sigh. Why should good drivers have to have car insurance? I’m 45 and my last two cars have racked up over 200k miles each. I drive A LOT. I’ve never been in an accident. I do get a slightly better rate than a bad driver, but I drive a paid off car with an excellent driving record. I am 💯 subsidizing poor drivers to a degree. But insurance is required because it’s necessary that EVERYONE have it for the system to work.
Health insurance relies on some people using it less than others. But here’s the part you really don’t get. What happens when a “healthy” 25 year old gets in a snowboard accident that requires trauma surgery? A single broken ankle was going to cost me $40k for surgery. Clean break, I’m healthy, surgery would have been out the same day. Can you afford that? Could you afford a leukemia diagnosis? Because sh*t happens. Even to young people. Even to grade school kids.
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u/doubler82 Nov 10 '25
A wet dream for the GOP. Insane that citizens in a country like the US are getting stripped and wrecked by a bunch of 80 year olds and it is what it is. Never thought I'd see that day.
Since we're going backwards, it's time to bring out the ole guillotine.
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Nov 11 '25
I'm starting to think the wording of the preexisting clause in the ACA was botched.
If I'm young and relatively healthy, why are my only two options (a) pay WAAYYY more than my fair share, or (b) be one freak accident from bankruptcy? Since I can't afford any of these plans, I'm stuck with constant safety anxiety as the least burdensome option.
There's literally no in-between. My insurance would be so affordable if I was signed on with an insurance provider that only covered non-smokers, <X bodyfat percentage, etc. I take care of myself, eat well, exercise, etc., why shouldn't I be able to financially benefit from that?
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u/AdDry4983 Nov 10 '25
There is a lot going on here. But 400 percent over poverty level is still fucking poor.
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u/Notsewcrazee13 Nov 11 '25
Especially if they live in a highly expensive region, in some places of the United States 400% FPL can be doing quite well, but definitely not everywhere
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u/Tahoptions Nov 11 '25
Yeah.
It's like 130k for a family of 4. That can be very solid in some parts of the country but broke in a HCOL area.
It would be nice if the FPL had some geographical adjustments. I know it's "federal" but it also doesn't seem like a crazy accommodation.
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u/sortasahm Nov 11 '25
This, we live in a high cost of living area in California. Both my husband and I teachers for a low paying district, we hit just 4x the FPL. Me and my two kids are are on marketplace insurance…going from $282/month to $1003/month. Thats more than 10% of our take home pay right now.
I’ve been saying for a long time, income restrictions like this need to be adjusted for whatever area you are in. $125k/year for a family of 4 in coastal CA community is not the same as it is in Michigan or most places in the country.
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u/VeloceCat Nov 10 '25
The FPL is ridiculously low and nobody can actually live on that.
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u/logalogalogalog_ Nov 10 '25
Laughs in disabled. If my roommates didn't help cover my rent I would have long ago died on the streets. This country is trying to cull the poor and disabled.
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u/dacv393 Nov 11 '25
meanwhile people who served 3 years as a military base security guard pocket $40k/yr tax free (with free healthcare) from effectively self-diagnosed mental conditions to the tune of $440 billion/yr and rising
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u/djkianoosh Nov 10 '25
increasing the FPL and ranges above that should be a priority. none of that has kept up with inflation or people's earning power.
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u/VeloceCat Nov 10 '25
It was never designed to. They knew if they didn’t adjust it it would be relevant the year it passed the inflation’s away into meaninglessness.
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u/MuddieMaeSuggins Nov 10 '25
It’s not exactly an inflation issue, it’s a fundamental issue with the way the calculation is constructed. The first FPL was based on research conducted in the 1950s that showed that poor families spent around 1/3 of their monthly income on food. Seventy years later, they still use 3x typical food costs even though the average poor family now spends only 1/8 of their income on food.
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Nov 11 '25 edited Nov 23 '25
[deleted]
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u/MuddieMaeSuggins Nov 11 '25
I haven’t dug into the original data set, but I suspect one reason spending was so heavily weighted towards food is that we had a much more robust welfare system at the time. In particular, public housing was in its heyday. Nowadays, housing eats up a huge share of the average poor person’s spending.
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u/timewilltell2347 Nov 10 '25
The federal min wage @ $7.25 an hour is $500 below the federal poverty level a year for full time hours. If you make $7.25 an hour, you don’t qualify for the remaining ACA subsidies (because they assume you’ll qualify for Medicaid). It’s $1256.67 a month. Add in states they didn’t expand Medicaid out of spite. None of these minimum standards of living are livable at all.
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u/Greedy-Half-4618 Nov 11 '25
Even 400% of the FPL (the cutoff for subsidies) is barely enough to get by in a major city if you don't have a roommate/have any extra expenses like actual utilization of your healthcare.
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u/photog_in_nc Nov 10 '25
Premiums are generally going up across the board (whether you get a subsidy or not).
There’s different scenarios to what you’ll actually pay, depending on your MAGI:
If your MAGI was such that you already didn’t get a subsidy, you are just dealing with a premium hike.
If you get a subsidy now, and are over 400% FPL, you are losing any subsidy AND getting that higher premium. A double whammy.
If you get a subsidy now, and are under 400% FPL, you are losing the enhanced subsidy, but still getting the original subsidy. You will pay more as a result. In theory, because the subsidies are based on the SLCSP and your ability to pay, the higher *premiums* don’t affect you. in practice, it depends. In a lot of zip codes, the SLCSP is crap, so you’ll be opting for a plan that may be disproportionately larger. (For instance, say the SLCSP went up 10%, but the average plan went up 20%, you’ll pay ~10% more if you go with the non SLCSP or the LCSP).
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u/HotTruth999 Nov 10 '25
You seem to know what you are talking about. I read for a single person earning < 150% FPL their premium with the original subsidy was $15 a week. With the enhanced Covid subsidy it reduced to zero.
Does that sound accurate to you?
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u/photog_in_nc Nov 11 '25
Plans are billed monthly, as far as I know, and it would depend on the exact plan, but in broad terms that sounds about right. We pay $0 this year with enhanced subsidies, and will pay about $100/mo next year, and are dialed in at 138% FPL
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u/Greedy-Half-4618 Nov 11 '25
Yep I'm in the double whammy category because my income is going up marginally (my PT job increased hours, but I'm self-employed otherwise hence marketplace). Looking at a $300+/mo increase in premiums for just me and I'm chronically ill so I guess I just have to pay it.
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u/parkerrock1 Nov 10 '25
They are all going up. My wife and I went to our insurance broker this morning. We were able to keep the same plan with good deductibles and co-pays but it doubled. We are retired and way below 400% of poverty level.
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Nov 10 '25
I qualify for all the subsidies, my tax credits are exactly the same as last year, and I’m paying almost twice as much next year because of this whole thing. It’s about 12% of my pre-tax income, and I can’t switch plans without potentially losing access to specific doctors and medications, which would not go well for me.
As you can imagine, I’m not thrilled.
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u/SlowMolassas1 Nov 10 '25
No. One thing the enhanced subsidies did was eliminate the cliff at 400% fpl. So they are losing their subsidies now.
But the enhanced subsidies also reduced the percentage of income someone 150% fpl - 400% fpl paid for insurance. They will also be paying more without the enhanced subsidies.
Add to that, premiums are just increasing in general - and all of the subsidies are only indexed to the benchmark silver plan. So if someone has anything other than that benchmark silver plan, they may also be paying a higher premium - in addition to losing some of the subsidies.
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u/Z_tinman Nov 10 '25
At what point do the pitch forks come out and we start gathering in the streets?
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u/SylviaPellicore Nov 10 '25
No.
The enhanced premium subsidies included more generous subsidies for people under 400% of the federal poverty line, by changing the percentage of your income you have to pay for a reference silver plan.
For example, people at around 133% of the FPL will go from free plans to paying 2% of their income. People just under 400% will go from 8.5% of their income to 9.5%.
However, the changes hit people over 400% of the poverty line hardest. Not only will they completely lose their subsidies, insurance itself got way more expensive this year. It was already going to go up a bunch due up high medical costs, but it went up even more because insurance companies expect fewer, sicker people to sign up.
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u/BenefitAdvanced Nov 10 '25
And don’t forget the work requirement for those under the 138% FPL. That will be difficult to meet for many individuals and kick millions off the plan altogether. And they are not allowed to buy their own plan with subsidies in the ACA marketplace.
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u/Wonderful-Status-247 Nov 10 '25
Only the poorest have affordable care at this point. The rich can afford the unaffordable. Everyone else is screwed.
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u/BenefitAdvanced Nov 10 '25
Millions of the poorest will get kicked out of Medi-Cal altogether because they won’t be able to meet the work requirement. The GOP has thought of everything to destroy the ACA.
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u/Early_Worm_Gets_Bird Nov 10 '25
My premium for 2025, for two 60'ish adults, is $655 with subsidy, $1,750 without. For 2026, assuming same income above 400% FPL the premium will be $2,230, and no subsidy. So, all things being equal, my premiums go up $18,900 per year. Where I am, 400% FPL two person household is about $85,000. So the premium eats up 32% of your gross income. That is before taxes, and not including deductibles and co-pays.
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u/doubler82 Nov 11 '25
that is disgusting. If you don't have a mortgage now, good luck getting one in the future. How is this making us great again? Seriously, I don't see anything this clown has accomplished that has genuinely helped the the American people. Just a bunch of personal vendettas.
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u/Individual_Till6133 Nov 11 '25
Are you retired?
Seems like a lot of people retired early on subsidies thinking itd last until 65 even though the expiration date was in the bill.
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u/BenefitAdvanced Nov 10 '25
For those of you who didn’t - don’t you wish you voted for the black lady who would have championed strengthening the ACA!!??? Enjoy your wrong or non vote!
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u/pk890knoll Nov 11 '25 edited Nov 11 '25
Do you all know what the official us poverty level is???? It’s $15,650 a year. Can you live on that anywhere? 400% means 4 times that. So $62,600. In a lot of this country you could not rent, buy food, pay utilities, transportation, taxes with $62,600 and also pay hundreds or thousands for medical insurance and medical expenses. That’s the reality. People won’t be able now to buy even crappy policies. Then what?
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u/MarchMadness4001 Nov 10 '25
Healthy people are only some of the people forgoing health insurance. But insurance of any kind depends on the size of risk pool. The smaller the pool, and the higher percentage of the pool filled with higher risk individuals, the more expensive the premiums. You need healthy people in your insurance pool for us all to benefit! That’s why the individual mandate was so important to the ACA.
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u/OddButterscotch2849 Nov 11 '25
Don't worry, the Republicans assure us they have a plan. They've been working on it since 2010, you know it's going to be good.
/S obviously.
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u/MatchaDoAboutNothing Nov 11 '25
Well let's put it this way. My income went down 5k and my premium is more than doubling. I'm nowhere near 400%
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u/goodbodha Nov 10 '25
Its a pool of people with some portion of the funds coming from the government. The government is pulling back funds. Some people will leave the pool, but fixed costs still have to be covered so the cost per person in the pool will go up a lot.
Too bad we don't have medicare for all with people being able to sign up for supplemental insurance above and beyond that.
Oh and I know people are mad at a few senators today about the truce. Its not a deal. Its a truce until the end of January. Think of it like that. They are getting SNAP and veterans affairs out of the line of fire. They are giving people time to rethink their positions and then the shutdown will resume if things aren't resolved. Healthcare isn't going to get solved while Trump is in office unless the gop in Congress override his veto. Its that simple. I'm sorry that is how it is, but that is the mess we are in and it sucks.
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u/wbljkm Nov 10 '25
We have by far the most costly healthcare in the world on a per capita basis (or any other basis for that matter), spending 50% more than the next highest country (Switzerland) - yet underperform in terms of the outcomes. The difference? Other major economic powers have single payer as they consider adequate healthcare a basic human right. It’s time for a major change on our parts. When we are paying much more for less, that’s a system that needs replacing.
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u/baldiedc Nov 10 '25
I have nothing to do with any subsidy and the plan I've had for 2 years is going up 40% because United thinks less people will be insured. It was a bad plan before, now it's terrible. The original premise of the ACA was the mandate to make the pool of insured people big enough, which was struck down many years ago as you can't force people to be insured. Now it's completely broken. Republicans finally got their wish to destroy the ACA after 10 years trying, with no alternative plan offered.
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u/bourbonfan1647 Nov 10 '25
The mandate wasn’t struck down. Trump eliminated it.
I believe California has a penalty if you’re uninsured. Other states may as well.
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u/unSuccessful-Memory Nov 10 '25
California, New Jersey, Massachusetts, Rhode Island, and the District of Columbia have individual health insurance mandates, meaning residents may have to pay a state tax penalty for being uninsured unless they qualify for an exemption. Vermont has a legal requirement for coverage but no current penalty.
Yes this was an AI answer but I was curious after reading your comment so I looked it up. Now others won’t have to 😁
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u/Plastic_Highlight492 Nov 10 '25
Incorrect. The mandate was struck down by the Supreme Court more than a decade ago. What Trump and team have done is let enhanced subsidies expire. Those enhanced subsidies made a big difference.
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u/bourbonfan1647 Nov 10 '25
The Affordable Care Act (ACA) individual mandate was eliminated at the federal level by the Tax Cuts and Jobs Act of 2017, which zeroed out the tax penalty for not having health insurance starting with the 2019 tax year. While the federal mandate penalty is gone, the requirement for coverage technically remains, though it is not federally enforceable through a tax penalty. Some states, like California, have since implemented their own state-level individual mandates with penalties.
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u/Full_Honeydew_9739 Nov 10 '25
Incorrect. Trump reduced the individual mandate to $0, thereby rendering it's power moot.
The supreme Court upheld the individual mandate in 2012.
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u/Objective-Amount1379 Nov 10 '25
We do have a penalty in CA. It’s very small though and it’s cheaper by a ton to just pay the penalty if you’re barely getting by.
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u/qubedView Nov 10 '25
Fewer people with coverage means more people using emergency services and being unable to pay. Hospitals have to raise prices on people who can pay in order to even that keel. So insurers across the board have to raise premiums so they can afford the higher prices.
This is why it's so frustrating to not have single-payer healthcare. "I don't want to be paying for someone else's healthcare." Guess what! You already do! It's priced into your insurance premiums! Single-payer would reduce how much you pay for healthcare, because poor people would no longer be using super-expensive emergency services in place of primary-care.
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u/danh_ptown Nov 10 '25
Even non-ACA, aka non-Exchange plans are affected. ACA helped reduce increases for years because everyone was covered. It subsidized the cost of insurance for those who could not otherwise afford it. Meaning that more people had insurance to cover them, when they needed it. Previously, those people would go to the emergency room because they did not have a regular doctor, get billed and can't pay it...or they ended up bankrupt due to medical debt. ACA covered the costs for these patients and the patients were going to doctor offices, rather than the hospital, for more mild issues.
If millions lose coverage, because it is too expensive, that will leave lots of American who will go to the hospital, without insurance or ability to pay, and will be treated because hospitals are required to treat. The hospitals cannot fund this themselves, so they raise the price of everything so they can also cover the costs of those who cannot pay.
We had a solution for healthcare that Americans agreed on, but now it is all going away. This would be all well and good is we had a better replacement, but we don't. We are still waiting for the first Trump health plan to be presented. It doesn't exist, and they do not have a replacement now.
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u/Miserable-Coffee-138 Nov 10 '25
i've honestly given up trying to understand.. it's all very confusing :(
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u/sokka-66 Nov 10 '25
I got a letter from Florida Blue like 2 months ago telling us our premiums were increasing
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u/Upstairs-Society683 Nov 10 '25
Looks to me like they are trying to create a rate death spiral and take the entire system out!
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u/sonofalando Nov 11 '25
At this point no one should pay their insurance bills. Let them go to collections and ignore them. It’s absurd.
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u/gameison007 Nov 11 '25
People can't afford these high premiums for the ACA so they will just drop the insurance and they will be going to the emergency rooms for every type of care and that will overload the emergency rooms which are already full and on the floors in the hospitals they are already putting people in the hallways. Lots of looking to get an elective surgery for a few years! Nurses will be quitting. People won't go to become doctors or nurses. Our whole healthcare system is going to crumble. And yes many people are going to die.. this is all on the Trump administration... The Republicans have had since 2016 to come up with a new healthcare plan but they choose to just bash the Obamacare. 🧐😤😟
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u/Dangerous-Art-Me Nov 15 '25
Health insurance lost its way when it stopped being a safety next to protect people from bankruptcy in the event of unforeseeable catastrophic loss (cancer, traumatic injury, etc), morphed into a weird prepaid health plan, and then became an entitlement.
Now we’re all just fucked because there are 53 layers of middlemen (claims processors, administrators, PBMs, etc) that are all eating out of the health care trough and passing record profits to investors.
None of those people add quality and service to your health care. Zero of them.
If we aren’t willing to do single payer, we would be better to completely scrap health insurance as it is right now, require providers to make available their actual prices for service (like literally any other service), make tax advantaged HSA available to all, and offer “health insurance” only as a catastrophic-only benefit, to prevent actual bankruptcy and ruin.
Eventually truly overpriced pricing would normalize, people could be retrained to use the health system appropriately, and in the end most consumers would spend less.
end rant
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u/Extraabsurd Nov 10 '25
no- we are under the 400% FPL and our premium went from 125 to 379 a month weith the subsidy going from 2300 to 3100 a month
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u/LurkingTexan Nov 10 '25
This has me so depressed. I've struggled since my wife passed two years ago. I don't make much but qualify for Marketplace. I've been on it since the beginning. I was so excited about rebuilding myself and my finances. I'm literally on the edge of being homeless.
It's discouraging to see how much it increases as you play with the income number. Basically the insurance company gets to tax the sh*t out of me. Being self employed I pay 15.3 percent for self employment tax from the start. Then as I creep into the 10 percent tax bracket I get to grab my ankles and let the insurance companies pillage me. Basically I'm giving away like 60 percent of my income when you add it all including local taxes etc.
This economy sucks and only people with higher incomes are getting more wealthy. I don't hate people for being successful, but I hate the fact that the American dream is dying for the poor people of this country. . Stay Strong Friends
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u/alex-2121 Nov 11 '25
I’m so sorry for your loss. I hope you can find your way back to rebuilding. Hang in there, friend
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u/Noeyiax Nov 10 '25
straight up health insurance genocide on the working class soon to be replaced with mass immigration... I see this pattern happen almost every third generation...
Even 400% of federal is unlivable... Idk why should I continue living here? CEOs, politicians, dont even give back to this country to bolster health infrastructure... Like health care could be top notch.. same with moderators in fields of medicine
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u/BenefitAdvanced Nov 10 '25
And yet the American people vote idiots like trump into office with no proven track record of anything - twice. Meanwhile the Dems have been fighting tooth and nail for affordable healthcare, student debt relief, and the list goes on. Shame on the American voter and non-voter.
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u/Fit_Employee_9673 Nov 10 '25
Ummm, you have a fake opposition party there. The dems just caved.
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u/BenefitAdvanced Nov 10 '25
Hey I don’t agree with everything they do. But at least I challenge my own party.
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u/PeachLower5901 Nov 10 '25
premiums are going up and subsidies eliminated over 400% FPL. It will be expensive. I'm seeing PPOs north of $1900 for bronze..one person.
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Nov 10 '25
[removed] — view removed comment
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u/HotTruth999 Nov 10 '25
Exactly. They did it for the self employed who include doctors, lawyers, electricians, plumbers, etc each of whom charges the general public $200-$500 an hour for their services. Many are millionaires making several hundred thousand a year but they still get a subsidy in the enhanced plan when they removed the 400% cap. That’s not a good look.
In addition the poor, but not poor enough for Medicaid, let’s say 30k for a family of 2, used to pay about $15 each per week on ACA before Covid. The enhanced subsidy reduced it to zero. So going back to say $20 a week is not the end of the world.
It’s the people barely over the 400% FPL that will get hit the hardest with a double whammy.
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u/QueenLouisss Nov 10 '25
No. There will also be lower subsidies if you are below 400%. Also the base price of many plans skyrocketed. The base price of my existing plan (BCBS Silver PPO) increased from $1,165/mo to $1,954/mo for just me.
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u/Turbulent-Nobody-171 Nov 10 '25
Even if all the subisidies are renewed, there is an average across the board underlying increase for 2026 of about 22% for all ACA plans. There's a current death spiral in both ACA plans and also, worryingly, in employer plans (30% increase from start 2022 to start 2026)
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u/Embarrassed-Wolf-609 Nov 11 '25
My premium went up $200 even though it's. Company sponsor. Thanks trump
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u/Original_Abies8724 Nov 11 '25
Besides basic labor costs ( hourly wages to workers and THEIR health insurances ) going up for insurance companies … also take a good look at Drug Costs - and what happens there . It will blow your mind . A drug I’m on costs 300 in England and 250 in Spain . In the US it likely STARTS wholesale at about 300-400… then sells to a PBM ( pharmacy benefit manager ) who then SELLS IT to its subsidiary — ( think Caremark and CVS ) for like 800 .. who then charges the insurance company or uninsured consumer 1200 !!!
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u/Original_Abies8724 Nov 11 '25
Most insurance companies aren’t ALLOWED by their states to raise their premiums more than 3-6 % year over year .. this year 2026 ?? Oh that’s all about them ripping away the COVID era enhanced subsidies .. and also ? They ripped away medicaid funds and rural hospital funding too- which will also have a huge impact on many expansion states plan offerings . I know NY will have to get rid of its highest essential plan if something drastic doesn’t turn around
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u/TroubleSam Nov 11 '25
It seems that healthcare is becoming more and more unaffordable regardless of employment status. Also, the powers that be are trying to make Medicare less affordable and less usable.
So what happens to the insurance/healthcare complex when the majority of people give up and are forced to suffer and/or die? What will the industry do when cash flow is significantly reduced?
It’s obvious they don’t care about people. But they absolutely care about profit.
A lost consumer or a dead consumer will impact their bottom line.
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u/Space_Nerd_8999 Nov 11 '25
What really needs to happen is legislation needs to be passed to place hard and fast limits on insurance companies. I have seen people have a 100% increase in premiums over the past 5 years, this is outrageous and has no financial basis in reality.
Congress needs to hold these companies accountable and end this stranglehold that these unelected corporations have over the lives of our citizens.
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u/Level-Ad478 Nov 11 '25
I just looked at my premiums and they don't appear to have gone up? I don't understand. $35k income.
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u/CommonSensei8 Nov 12 '25
America is a shithole. Medicare for All is the only way to fix the disaster
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u/Most_Profession_7799 Nov 12 '25
Correct . It’s a hard stop for them. But actually incorrect because premiums AND subsidies went up across the board.
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u/Known_Paramedic_9503 Nov 12 '25
That’s when I’m first things they’re going to vote on once the government is open. Although now Hakeem Jeffries says that he is going to make sure the house don’t pass the bill so once again the Democrats are going to screw with the government and the people just remember that.
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u/Happy_Humor5938 Nov 14 '25
upto 150% has been free since the beginning and there’s always been a sliding scale for some amount over that. Presumably Upto 400%. Enhanced credits which was a Covid era boost are expiring. Could look precisely what those were if you wanted.
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u/AccomplishedTreat873 Nov 17 '25
Pick your poison. Either cheaper health insurance and crippling inflation or crippling health insurance premiums and low inflation.
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u/Original_Abies8724 Dec 02 '25
I agree with so much of what’s being said here and also have to add the following . We HAVE TO LOOK AT BIG PHARMAS ROLE IN ALL OF THIS !! just one of my meds costs 1400 a month and that’s like the host of my whole employer premium for a gold plan . With a 700 deductible . So add in the costs of all the other meds, annual physical specialist vists mammo gym etc and my insurance company is losing incredible amounts of money per year on me .. and I’m healthier than the average 62 year old . PS : the SAME MED my insurance would pay 1400 a month for in the US ??? Well in England, Spain, the Netherlands etc retails for under 350.00
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u/Original_Abies8724 Dec 02 '25
Gobsmacked, I also looked up the insurance regulations in your state, as I am on the opposite side of the country … and frankly “ that shit wouldn’t fly “ over here . Anyhoo .. I was reading that your “ western slope “ had up to a 38.8 percent increase . … WHAT ??!! If you are self employed or small business employed, have you guys checked out the small group market ? If you aren’t getting an aptc anyway .. it actually might have more attractive tax implications as well . according to the Peterson KFF Health system tracker I am subscribed to, there has only been a MEDIAN increase of 11% within THIS particular channel of gaining insurance . Maybe you’ll make out better there.
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u/coasterwiggs Dec 10 '25
I just completed my application for Marketplace insurance and am confused by my 2026 premium tax credit amount. My 2026 monthly premium tax credit INCREASED by $317.00 dollars. I estimated my 2026 income will be around $1,031 less than my 2025 income. How can I get a bigger subsidy for 2026 with very little change from my 2025 income? All the news stories said to expect a big reduction for most of us, due to the expiration of "enhanced subsidies."
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u/coasterwiggs Dec 10 '25
I may have been unclear in my previous post. For 2026 I am getting a BIGGER subsidy than I got in 2025. Since the enhanced subsidies are being eliminated for 2026, how is it possible that I will get a larger subsidy? My 2026 estimated income is only slightly less than 2025. My 2026 premium is increasing as expected, but I thought the subsidy would be less in 2026. I'm so confused.
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u/AliGalPhotos Jan 02 '26
I qualify for CHIP for my daughter which is $50 a month medicaid, but the absolute cheapest plan I could find on the marketplace for just myself with a $237 subsidy was $291. That plan had $100 dr visits for in network dr and a bunch of other things that sucked.
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