Health Insurance for those under 65

[Michael 61]

Moving in a few weeks to my new home in TV from another state. I am under 65, so too young to qualify for Medicare. My earnings last year exceeded the cap for Obamacare. I will need to get insurance through the Florida exchange. Is this something I should try to navigate on my own through Florida’s healthcare website, or are their brokers I could go to help me choose a plan. I don’t even have a doctor yet in Florida, and need to make sure that the eventual plan I get will be honored by my primary care provider as well as a few specialists (dermatologist and cardiologist) I will see a few times a year.

[retiredguy123]

I would contact SHINE and see if they can help you. They offer free, unbiased advice.

SHINE - Home (https://www.floridashine.org/)

[tophcfa]

I am under 65, so too young to qualify for Medicare. My earnings last year exceeded the cap for Obamacare.

Ouch, get ready for some serious financial pain (I share your pain). Unfortunately, somebody has to pay for all the people getting free and highly subsidized insurance. I’m not in any hurry to get older, with the exception that I am highly anticipating becoming eligible for Medicare.

[Michael 61]

Ouch, get ready for some serious financial pain (I share your pain). Unfortunately, somebody has to pay for all the people getting free and highly subsidized insurance. I’m not in any hurry to get older, with the exception that I am highly anticipating becoming eligible for Medicare.

You’re right - in a bizarre sort of way I’m looking forward to turning 65 to become Medicare eligible (still 4 years off). I retired at 59, and my former employer reimburses me each month for a good chunk of my medical premium, so that helps, but I have to find my own coverage on the open market.

[ThisTimeIsDifferent]

Also moving to the Village of Richmond and under Medicare age. Hi neighbor.

Unable to help with the question of where to source plans but can share our experience over the last 3-months.

We were rejected by the Villages Healthcare System because the few primary care doctors that accept non-Medicare patients have a full patient load. We pleaded our case to a “Villages Healthcare Coordinator” but only qualified for one primary care doctor who eventually rejected us anyway because he does not treat patents under age 60.

Exploring in a 5 mile radius outside VHS, we found a few primary care practices that accept new non-medicare patients and we are on a 6-month first appointment waitlist. Until then, we will drive to Lady Lake or use the Urgent Care in Wildwood. For specialty docs, same issues so we will drive outside the 5 mile radius to Lady Lake or Clermont (2 and 3 month waitlists)

We were advised by helpful local sources that United Health is widely accepted but, as luck would have it, one of our preferred docs rejected same. Blue Cross/Shield PPO plans are more costly (for us) but appear to provide greater access to local primary care and specialty doctors accepting non-medicare patients.

Best of luck in your search. I hope you find excellent healthcare.

Also a Michael, age 61!

[Garywt]

Luckily the company I retired from supplies insurance at $145 a month. I retired at 56, turning 59 soon so I have a few years before I need to worry about it. Good luck finding something.

[OrangeBlossomBaby]

Also moving to the Village of Richmond and under Medicare age. Hi neighbor.

Unable to help with the question of where to source plans but can share our experience over the last 3-months.

We were rejected by the Villages Healthcare System because the few primary care doctors that accept non-Medicare patients have a full patient load. We pleaded our case to a “Villages Healthcare Coordinator” but only qualified for one primary care doctor who eventually rejected us anyway because he does not treat patents under age 60.

1. There's no such thing as "Villages Healthcare System." There is The Villages Health, which is a large group with several locations in The Villages and includes GPs, Internal Medicine doctors, specialists, PAs, their own lab and x-ray machines, and access to other specialists at The Villages Regional Hospital.

2. I just did a quick search on their website and see that Dr. Hugo Boise is welcoming new patients with individual insurance plans.

You can probably also call them directly, since sometimes those websites aren't 100% accurate or up to date.

[jhambley]

My wife and I are in the same boat (60 and 63 years old). We logged into healthcare.gov and we eligible for 11 pages of various plans. Thankfully, we were referred to Robert Buckmann with Mid-Florida Agencies. He asked questions about our particular needs and quickly narrowed it down to two plans. You can Google both Robert Buckmann and Mid-Florida Agencies to read what others have to say about them. His number is: (352) 630-9996. He’s only taking referrals now during open enrollment so feel free to use our names (Jerry & Carol Hambley) as an introduction. Good luck!

[OrangeBlossomBaby]

My wife and I are in the same boat (60 and 63 years old). We logged into healthcare.gov and we eligible for 11 pages of various plans. Thankfully, we were referred to Robert Buckmann with Mid-Florida Agencies. He asked questions about our particular needs and quickly narrowed it down to two plans. You can Google both Robert Buckmann and Mid-Florida Agencies to read what others have to say about them. His number is: (352) 630-9996. He’s only taking referrals now during open enrollment so feel free to use our names (Jerry & Carol Hambley) as an introduction. Good luck!

If he's not available you can ask for Leonel Barron - he just helped me figure out which of the Florida Blue options were best for us. Turns out we've been paying WAY too much for a Silver plan that doesn't cover as much as a cheapo Bronze plan covers. That's on the exchange with our tax credit, based on our income.

[Michael 61]

My wife and I are in the same boat (60 and 63 years old). We logged into healthcare.gov and we eligible for 11 pages of various plans. Thankfully, we were referred to Robert Buckmann with Mid-Florida Agencies. He asked questions about our particular needs and quickly narrowed it down to two plans. You can Google both Robert Buckmann and Mid-Florida Agencies to read what others have to say about them. His number is: (352) 630-9996. He’s only taking referrals now during open enrollment so feel free to use our names (Jerry & Carol Hambley) as an introduction. Good luck!

Thank you for these referrals - I’ll be transitioning between Colorado and Florida for the next several months, so hanging onto my Colorado coverage until March or so - but want to get the ball rolling now (finding both coverage as as well as a doctor) - Since moving is a life-altering event, I’ll be able to switch out my insurance to Florida when the time comes.

[rustyp]

Moving in a few weeks to my new home in TV from another state. I am under 65, so too young to qualify for Medicare. My earnings last year exceeded the cap for Obamacare. I will need to get insurance through the Florida exchange. Is this something I should try to navigate on my own through Florida’s healthcare website, or are their brokers I could go to help me choose a plan. I don’t even have a doctor yet in Florida, and need to make sure that the eventual plan I get will be honored by my primary care provider as well as a few specialists (dermatologist and cardiologist) I will see a few times a year.

Obamacare eligibility is based upon next year's projected income. Thus looking for insurance for 2023 you project your income for 2023. The risk is if you go over your projection you will owe a penalty. The benefit is based upon "earned income". You should read the definition of earned income in the Obamacare rules. There are ways to limit your next year's income. For example if you are planning on drawing from a retirement account next year consider drawing it out this year. Compare Obamacare benefit to what extra tax will be this year Vs next year which you are going to pay on it anyways but perhaps in a different tax bracket.

[tophcfa]

Obamacare eligibility is based upon next year's projected income. Thus looking for insurance for 2023 you project your income for 2023.

Unfortunately, what is considered earned income is not limited to wages and drawing from a taxable retirement account. It also includes interest (including interest from tax exempt municipal bonds), dividends, and realized capital gains (which can be offset by only $3 K in realized capital losses for a couple filing jointly). So as usual, responsible people who saved their money for retirement are penalized by the Obamacare definition of earned income. Many under 65 retirees now have a new dilemma, they should be happy that they can finally earn some interest on their savings, but then learn that the increased interest will be more than offset by the loss of Obamacare tax credits
because the increased interest puts them over the eligibility cap.

[champion6]

Regarding looking for a primary care physician, I don't claim to be better than google. But over time, I have created a list of primary care groups in this area. Maybe this will help a little.

[SusanStCatherine]

If under 65, you pretty much need to buy a plan listed on Healthcare.gov, which lists the ACA plans, meaning no preexisting conditions and the like. You can buy them off the exchange, but might as well buy them on the exchange in case you qualify for a subsidy. Income limit for subsidy was pretty high lately due to Covid. A broker can help you and will not affect your cost. Expect to pay a high premium (due to age) with an extremely high deductible.

[tuccillo]

You also have the option of a non-obamacare compliant plan for catastrophic coverage at a lower cost.


If under 65, you pretty much need to buy a plan listed on Healthcare.gov, which lists the ACA plans, meaning no preexisting conditions and the like. You can buy them off the exchange, but might as well buy them on the exchange in case you qualify for a subsidy. Income limit for subsidy was pretty high lately due to Covid. A broker can help you and will not affect your cost. Expect to pay a high premium (due to age) with an extremely high deductible.

[Rainger99]

Should getting healthcare be this complicated?? Whether it is pre-Medicare or Medicare??

[tophcfa]

Should getting healthcare be this complicated?? Whether it is pre-Medicare or Medicare??

Absolutely not, but you know what happens when the Government gets involved with anything.

[Babubhat]

Florida blue via healthcare.gov. Decided to take social security early and pay the premium for 2 years. Deferring lots of taxable income was no longer an option. Accepted by villages health without issues

[Nucky]

If he's not available you can ask for Leonel Barron - he just helped me figure out which of the Florida Blue options were best for us. Turns out we've been paying WAY too much for a Silver plan that doesn't cover as much as a cheapo Bronze plan covers. That's on the exchange with our tax credit, based on our income.

Oh boy, do you speak the truth! I'm having a hard time going for a Bronze plan for my wife but the facts are, the plan is much better than the Silver Plan that they seem to push on us every year. The Silver plan is about double what it was last year. That's a no go for us. It's been smooth sailing for us since this coverage was available. This is the first year I'm struggling to decide. They text and email and now call daily. I guess it's better than letting me forget. I'm not rushing into this decision.

Thanks for sharing OBB. I'm not the only one in the Bronze Boat vs Silver Boat.

I got my butt handed to me back in the day when the Political Forum was up and running. I was always honest about what was going on and others felt the need to criticize instead of helping. It was a long time ago and the ones who buried me are mostly not around anymore for whatever reason. The ones who helped us became good friends. Life is good. We'll figure this out. :mademyday:

Don't miss the Political Forum. The smartest thing they ever did was let it go by the wayside. It was BRUTAL! :faint:

[Rainger99]

I am on Medicare but wife is not eligible. Can someone give me a ballpark estimate of how much insurance would cost for her? She is in good health. Thanks.

[OrangeBlossomBaby]

Oh boy, do you speak the truth! I'm having a hard time going for a Bronze plan for my wife but the facts are, the plan is much better than the Silver Plan that they seem to push on us every year. The Silver plan is about double what it was last year. That's a no go for us. It's been smooth sailing for us since this coverage was available. This is the first year I'm struggling to decide. They text and email and now call daily. I guess it's better than letting me forget. I'm not rushing into this decision.

Thanks for sharing OBB. I'm not the only one in the Bronze Boat vs Silver Boat.

I got my butt handed to me back in the day when the Political Forum was up and running. I was always honest about what was going on and others felt the need to criticize instead of helping. It was a long time ago and the ones who buried me are mostly not around anymore for whatever reason. The ones who helped us became good friends. Life is good. We'll figure this out. :mademyday:

Don't miss the Political Forum. The smartest thing they ever did was let it go by the wayside. It was BRUTAL! :faint:

When we lived up north we qualified for free health care via the medicare expansion, after beloved spouse's department closed down, he was out of work and no one would hire him as a new employee for even close enough to what we needed to make ends meet. I was working two part time jobs. His social security wouldn't come for another two years.

Same situation, one year closer to his social security check but not there yet, and we were here in The Villages, having to pay for health insurance for the first time ever in our adult lives (since we both had our own employer-provided health insurance before we met, and between the two of us we always had employer-provided benefits for both of us while we were married). Florida doesn't participate in medicare expansion, so we had to pay for the privilege. So much for a lower cost of living here compared to the north.

Fast forward to this past year, and his SS checks started, and our premiums have been $436/month. We earn less than $40,000 after taxes between social security, pension, and one of us working part time. I can no longer work due to arthritis and bursitis. But neither of my illnesses are considered "disabilities" so I'm also not eligible for social security disability.

I'm due for a hip replacement which will set me back $15,000 AFTER I satisfy the deductible and out of pocket max. PLUS $436/month premium.

So I'll go with the bronze plan, get the 0 deductible, $9100 out of pocket max, 900 pay for ambulance, 1000 for emergency room, and tiddly winks of copays that go toward the out of pocket max for usual and customary visits to doctors. And then I'll get my hip replacement. My total cost will be around $10,000 out of pocket in total, instead of $15,000. Plus my premiums will only be around $150/month. Which gets off-set by the Florida Blue rewards program where you plug in how many days you ate vegetables or got enough sleep or exercised or whatever, and get points toward dollars off the premiums. And then - MY social security will start next year, so my premiums wil go up again. I did some math, estimating tht my premiums wil go up to around $500/month once get my first check. The MdStategroup are pretty terrific though. Very happy to receiieve help from them and recommend them to anyone else seeking information agojt florida BLure. i realze my typing might not be o good right now, sleep meds are kickng in. so goognidht!

[ewstanley]

I've been paying my own medical insurance since moving here in 2011. It is expensive and with the expansions healthcare professionals will be very in short supply.
I will be happy to be getting Medicare soon.
I have Florida Blue Cross Bronze.
Good Luck.

[Cobullymom]

I'm under medicare age and found Dr's easily in the area, with not the greatest insurance company. Premiere Medical has numerous offices in TV. Believe me TV HC isn't that special, and there is lots of offices with primary care MDs just outside TVs I found a wonderful one in Belleview, being on the Northside, on the South end there is several in Sumterville, Leesburg, and Wildwood. I'm a 29 yr retired nurse and I'm very picky and I've managed to find Drs and have major surgery without much trouble. Just don't focus on TV healthcare.

[bowlingal]

Florida Blue ( blue cross/blue shield) is available. There is a stand alone Florida Blue store on CR101 on the left side in a strip mall down the block from CVS located on 466

[golfing eagles]

I am on Medicare but wife is not eligible. Can someone give me a ballpark estimate of how much insurance would cost for her? She is in good health. Thanks.

Hard to say. If you go to the Florida Blue website, you can get a pretty accurate estimate. Personally, I retired at 56, I'm now 63, and my 2023 premium will be $17,600 for the year with a $7,000 deductible and no pre-existing conditions. (Bronze plan). I was self-employed, so no employer benefits, don't qualify for "Obamacare", and even if I did, I wouldn't accept it.

[LoisH]

I am 58 and was fortunate to be able to keep my health insurance (Humana First Local) at the group rate. Finding providers took a long time though. I go to Leesburg, Clermont,
Ocala Family Medical, and still have a couple doctors down in Clearwater.

[Dantes]

Ocala family health

[PoolBrews]

I would contact SHINE and see if they can help you. They offer free, unbiased advice.

SHINE - Home (https://www.floridashine.org/)

Looking at their site, it appears that SHINE only offers medicare assistance.

[LLJorgs]

There are Florida Blue brokers offices located next to many (perhaps) all The Villages Heath locations. Just walk in and they were very helpful finding, reviewing/comparing plans that met our needs. Wonderful experience!

[Nucky]

Hard to say. If you go to the Florida Blue website, you can get a pretty accurate estimate. Personally, I retired at 56, I'm now 63, and my 2023 premium will be $17,600 for the year with a $7,000 deductible and no pre-existing conditions. (Bronze plan). I was self-employed, so no employer benefits, don't qualify for "Obamacare", and even if I did, I wouldn't accept it.

My situation is chicken s&$t compared to the numbers that you laid down.

Paying for medical coverage thru an employer or the exchange is just sickening. The coverage is for my wife and you know what will happen if I go the cheap way. We’ll get bombed with Doctor Bills.

I think I’ve made mistakes over the last two or three years by not giving more than just a glance at the Bronze plans. I know better and could have investigated much deeper. That’s water under the bridge. This new decision is the one that really counts.

When I compare two different Bronze plans a the same Silver plan we’ve had for about 8 years I can’t believe what I’m looking at. Bronze it is……. I think! Lol

[bragones]

I retired at 57. I paid aprox. $16,000/year for health insurance for me and my wife on my first year of retirement. Then I learned about health sharing plans. They are basically catastrophic plans with a few perks and the cost was $500/month (6,000/yr). With the $10k annual savings, I happily paid for any occasional doctors visits. Also, Quest offers services where you can get deeply discounted blood work which you can order yourself on line. Grassroots also offers this lab service. The health sharing plan I used was Medishare until I found Zion health share (http://www.zionhealthshare.org/), which was better. My income was over the limit for any meaningful healthcare.gov tax credit. The health share plans worked out well for us but we had no pre existing conditions and we are in good health. I am happily over 65 now and on medicare. The time goes by quickly!

[SusanStCatherine]

Hard to say. If you go to the Florida Blue website, you can get a pretty accurate estimate. Personally, I retired at 56, I'm now 63, and my 2023 premium will be $17,600 for the year with a $7,000 deductible and no pre-existing conditions. (Bronze plan). I was self-employed, so no employer benefits, don't qualify for "Obamacare", and even if I did, I wouldn't accept it.

Isn't over $1,400/mo premium rather high? Especially having to satisfy a $7,000 deductible?

[retiredguy123]

Isn't over $1,400/mo premium rather high? Especially having to satisfy a $7,000 deductible?
It doesn't sound high to me.

[golfing eagles]

Isn't over $1,400/mo premium rather high? Especially having to satisfy a $7,000 deductible?

Sure is. I had the same coverage (actually a $6,000 deductible) in NY for $325/ month. When I moved here in 2015 it jumped to $1,050/ mo and has been going up ever since

[tophcfa]

Isn't over $1,400/mo premium rather high? Especially having to satisfy a $7,000 deductible?

Not if you have to by insurance through Obamacare and don’t qualify for federal tax credit subsidies. Before Obamacare I was paying about $350 a month for excellent private insurance with a low deductible and max out of pocket. After Obamacare the monthly premiums skyrocketed along with the deductible and max out of pocket. Somebody has to pay for all the people getting free or highly subsidized insurance.

[rustyp]

Not if you have to by insurance through Obamacare and don’t qualify for federal tax credit subsidies. Before Obamacare I was paying about $350 a month for excellent private insurance with a low deductible and max out of pocket. After Obamacare the monthly premiums skyrocketed along with the deductible and max out of pocket. Somebody has to pay for all the people getting free or highly subsidized insurance.

Obamacare went into existence in 2010. In 2010 the median price of a house was $158700. Today's house median price is $379100.

[golfing eagles]

Obamacare went into existence in 2010. In 2010 the median price of a house was $158700. Today's house median price is $379100.

It was passed in 2010, and then slowly implemented. It wasn't fully in effect until 2016

[tophcfa]

Obamacare went into existence in 2010. In 2010 the median price of a house was $158700. Today's house median price is $379100.

It was passed in 2010, and then slowly implemented. It wasn't fully in effect until 2016

And the increases in prices were immediate and very substantial.

[OrangeBlossomBaby]

Isn't over $1,400/mo premium rather high? Especially having to satisfy a $7,000 deductible?

The insurance plan I'm on now (FloridaBlue BlueSelect Silver 1443) retails at just under $2000 per month. Of course no one actually pays that much, but that's the MSRP for it. I'm charged $436/month for that plan.

It's $12,000 deductible (for the two of us) and $17,400 out of pocket (for the two of us). Our copays are 50% for anything that's covered but not preventative maintenance (which has no copay and no additional cost at all). Prescriptions are $30 each for a month's supply, so I don't bother and get mine at Walmart or Publix without going through insurance at all. Of course that also means that what I /do/ pay for my prescriptions doesn't count toward my deductible.

Last year wasn't nearly as bad, the deductible was lower, the out of pocket was lower, the premium was lower, and the copays were lower. But because hubby's social security checks kicked in, we had to deal with a thing called "cost sharing" and that blew us into a different level, which meant that ALL our costs increased. Not just the premiums (which went from a high of $84 to $436 within a window of two months - approximately a 500% increase even though our income level only went up around 40%), but all our medical expenses covered by insurance.

[OrangeBlossomBaby]

Sure is. I had the same coverage (actually a $6,000 deductible) in NY for $325/ month. When I moved here in 2015 it jumped to $1,050/ mo and has been going up ever since

Welcome to the lower cost of living - where instead of just losing a few bucks out of your paycheck every week, you lose a crapton of money every month to pay for all the things that income tax would've covered. As long as you never get sick or injured, you can absolutely save a fortune in Florida. But god forbid you have an unexplained sneeze - hope you have a lot of money invested, in someone else's name, so the hospital can't take it from you.

[OrangeBlossomBaby]

Not if you have to by insurance through Obamacare and don’t qualify for federal tax credit subsidies. Before Obamacare I was paying about $350 a month for excellent private insurance with a low deductible and max out of pocket. After Obamacare the monthly premiums skyrocketed along with the deductible and max out of pocket. Somebody has to pay for all the people getting free or highly subsidized insurance.

That's not how it works. No one has to buy through the marketplace. Anyone can walk into a Florida Blue office, or call Cigna or United Health, and sign up for whatever insurance package they offer to the public. Individual plans are, and have always been incredibly expensive no matter where you are.

But now, if you DO go through the marketplace, you are guaranteed certain minimum of care: all vaccines are covered. All yearly checkups and yearly bloodwork is covered. Routine mammograms, pap smears, prostate exams, all covered. You can go bare-bones, and the law requires these plans, no matter how expensive or cheap, to cover these things 100% with no co-pay.

Private insurance is not obligated to cover those things, free or otherwise. If you don't qualify for ACA subsidies, then don't buy from the marketplace. The marketplace exists for the purpose of providing health care to people who qualify for subsidies and guarantee a minimum of health care to everyone who signs up for it.

[OrangeBlossomBaby]

It was passed in 2010, and then slowly implemented. It wasn't fully in effect until 2016

It was never fully in effect. A huge and significant chunk of it was completely gutted and eliminated before it ever got to the President's desk. That's why it is the mess that it is now.

It would've been an amazing legislation. Now, it is helpful to those who qualify - but it's not nearly as good as it could have or should have been, and does cost people who don't qualify, more than it would have.

[keepsake]

Medicare in some ways is a curse. Many of the drugs from Big Pharma, that you see on ads on TV for as low as $30, or $10, or $0 INTENTIONAL BLOCK MEDICARE PATIENTS.
The public doesn't learn this from anyone or the MSM. The MSM is too busy pocketing all the $$$ from Big Pharma ads. The truth is suppressed again.

[Rainger99]

Hard to say. If you go to the Florida Blue website, you can get a pretty accurate estimate. Personally, I retired at 56, I'm now 63, and my 2023 premium will be $17,600 for the year with a $7,000 deductible and no pre-existing conditions. (Bronze plan). I was self-employed, so no employer benefits, don't qualify for "Obamacare", and even if I did, I wouldn't accept it.

Wow! With those prices, it looks like she isn’t going to retire any time soon! Social security wouldn’t even cover her medical costs.

[tophcfa]

That's not how it works. No one has to buy through the marketplace.

You are both correct and totally wrong at the same time. You don’t have to buy your insurance through the marketplace if you don’t qualify for free or subsidized
Health insurance. That being said, the premiums for everyone not getting insurance through an employer are all dictated by the “affordable care act marketplace”, regardless of where you purchase the insurance. So where you actually purchase the insurance is simply a matter of semantics. The pricing for those who pay the full price for insurance got jammed down everyone’s throat to help pay for free and subsidized insurance.

[tophcfa]

The insurance plan I'm on now (FloridaBlue BlueSelect Silver 1443) retails at just under $2000 per month. Of course no one actually pays that much, but that's the MSRP.

So wrong, many people pay the full MSRP. The reason the MSRP is so ridiculously high is because the people paying it are subsidizing those who are paying only a fraction of the cost.

[dewilson58]

You are both correct and totally wrong at the same time. You don’t have to buy your insurance through the marketplace if you don’t qualify for free or subsidized
Health insurance. That being said, the premiums for everyone not getting insurance through an employer are all dictated by the “affordable care act marketplace”, regardless of where you purchase the insurance. So where you actually purchase the insurance is simply a matter of semantics. The pricing for those who pay the full price for insurance got jammed down everyone’s throat to help pay for free and subsidized insurance.

:bigbow:

[tuccillo]

That is not true. FB offers numerous plans. Some are obamacare compliant and some are not. The obamacare compliant plans are the same price whether you buy them through the marketplace or not. Buying them via the marketplace may allow for a subside, which can be applied each month or you can opt for no subside each month and receive the total subside when you do your taxes the next year. Plenty of people pay the full price because they don't qualify for a subside. You can probably guess how I know this.

The insurance plan I'm on now (FloridaBlue BlueSelect Silver 1443) retails at just under $2000 per month. Of course no one actually pays that much, but that's the MSRP for it. I'm charged $436/month for that plan.

[Hifred]

Hi - My husband and I are both under 65. The Villages health care latched on to us - We have United Health Care PPO. It must have been the type of insurance you have. No doctor in Florida has turned us down. Our monthly charge for our insurance is $1350 a month. But it is a lousy policy - we pay $100 deductible when seeing a specialist and then 20% of the remaining balance. We pay a lot in addition to our policy cost. Our experience with TV Healthcare and seeing a primary care doctor has been exceptionally poor. Whenever we need to make an appointment with the doctor we have to see a nurse practitioner. We have been misdiagnosed on several occasions, sent for unnecessary tests per doctors at Shands when we ended up there because of poor care at The Villages Health Care. Moving here from Chicago the health care protocols followed here seem 3rd world. My husband had his blood work done at The Villages Health Care and the nurse put the tubes of blood in her pocket without any label. Typical protocol is to read the name and birthdate on the label and confirm identifying information with the patient before taking blood. The results of the blood work was inconsistent with our past results so we ended up getting our blood work redone at Shands and the results didn't reflect what we got from TV. The doctor at Shands jokingly said are you sure they didn't mix up the tubes and we thought - hmmm no we are not sure that didn't happen. In short - don't feel bad you didn't get a doctor to treat you at The Villages Health Care. Although the people are very nice there you will find better health care outside The Villages. I would look at a University Health Care System like UF Health Shands, University of South Florida, or Orlando. UF Health has physicians in Ocala, Summerfield, Gainesville. University of South Florida has doctors with offices as close as Wesley Chapel. What I do is I keep a doctor close by if I get a cold or flu and for specialty care I drive to see specialists connected to University Hospitals that use research based treatments. However, I went to The Villages for what I was told was a cold and was really sick. I was told to expect to have a cough for a month. I ended up at Shands because I was in horrible pain and couldn't keep my head up. Turns out I needed antibiotics which the physician's assistant at TV would not give me. I had an ear ache and went to TV. I was prescribed an antibiotic drop with steroids in it. The pain intensified and I ended up at an ENT in Orlando who told me you should never put a steroid in your ear if there is an infection because the steroid takes down swelling and with pus in the ear from the infection there is no room for the swelling to go down so it can damage the drum of the ear. I was told to stop the drops immediately and was treated with an oral antibiotic. I have a long list of things I could write about mistakes at The Villages. The physician's assistants there have less education than vets yet they diagnose and more times than not with my husband and I they have made mistakes. I have had good health care outside of The Villages. I suffered a finger fracture where the ligament separated and got really good treatment by a hand specialist at Shands. Yes the drive was long to get there and back but my finger works perfectly now.. I had a series of removeable casts that were remade at different angle degrees every two weeks and was given daily exercises that were changed every two weeks to do in warm water so that the finger would heal properly. At some point when I get older and can't drive outside TV for good health care I will probably end up moving out and going to an area with better health care.

[Rainger99]

Some of these posts are very disturbing. Who is in charge of TV Health? Has he ever addressed these issues? It would be great to have a meeting with the top medical people so that these issues can be addressed.

[PoolBrews]

Obamacare eligibility is based upon next year's projected income. Thus looking for insurance for 2023 you project your income for 2023. The risk is if you go over your projection you will owe a penalty. The benefit is based upon "earned income". You should read the definition of earned income in the Obamacare rules. There are ways to limit your next year's income. For example if you are planning on drawing from a retirement account next year consider drawing it out this year. Compare Obamacare benefit to what extra tax will be this year Vs next year which you are going to pay on it anyways but perhaps in a different tax bracket.

It's not a penalty, you just have to return the difference. i.e. if you claim a certain income and it says you get $1,700/month in credits, and then at the end of the year your income was higher so the credit should have been $1,600/month, you have to pay the $1,200 ($100 x 12) back when filling out taxes.

[OrangeBlossomBaby]

Some of these posts are very disturbing. Who is in charge of TV Health? Has he ever addressed these issues? It would be great to have a meeting with the top medical people so that these issues can be addressed.

There's no singular person in charge of The Villages Health. There's really only one issue: most of the current roster of primary care physicians there are not accepting new patients. That means their schedule is already full with existing patients and they simply can't accommodate more.

Many patients refuse to see a Physicians' Assistant for simple things like a gynecological exam and pap smear, or a sprained finger check or mandatory 5-minute visit to get a renewed prescription of certain medications, which puts more of a burden on the physicians, and devalues the PA's work (which at the Villages Health is actually pretty good). So the physicians are in short supply with an increased demand. The facilities exist. They just can't get enough doctors to work in them to meet that increased demand.

[tuccillo]

Villages Health has a CEO, he is in charge.

There's no singular person in charge of The Villages Health. There's really only one issue: most of the current roster of primary care physicians there are not accepting new patients. That means their schedule is already full with existing patients and they simply can't accommodate more.

Many patients refuse to see a Physicians' Assistant for simple things like a gynecological exam and pap smear, or a sprained finger check or mandatory 5-minute visit to get a renewed prescription of certain medications, which puts more of a burden on the physicians, and devalues the PA's work (which at the Villages Health is actually pretty good). So the physicians are in short supply with an increased demand. The facilities exist. They just can't get enough doctors to work in them to meet that increased demand.

[golfing eagles]

There's no singular person in charge of The Villages Health. There's really only one issue: most of the current roster of primary care physicians there are not accepting new patients. That means their schedule is already full with existing patients and they simply can't accommodate more.

Many patients refuse to see a Physicians' Assistant for simple things like a gynecological exam and pap smear, or a sprained finger check or mandatory 5-minute visit to get a renewed prescription of certain medications, which puts more of a burden on the physicians, and devalues the PA's work (which at the Villages Health is actually pretty good). So the physicians are in short supply with an increased demand. The facilities exist. They just can't get enough doctors to work in them to meet that increased demand.

Exactly!!!

[Nucky]

Many of the last posts are slipping off into the care people receive. That ain't da subject here. Coverage for young's is.

Everybody here has stories about the shortcoming of medical care around these parts. I wonder if anybody has success stories? Once I got past the ER in The Villages Hospital I got what I think was great care. All except for the severe infection I got from rusty instruments in the Operating Room. Just kidding. I don't know where I got it in the hospital but I went in there uninfected. The only reason I didn't lawyer up is it may have dragged my primary doctor into the situation somehow and I wouldn't do that to him or her for all the money the people have on the other side of Route 44.

Back to more people who I really respect who have Bronze instead of Silver, Gold, or Platinum. Let's go for more info, please. I gotta make a decision by December 15th.

[Nucky]

Exactly!!!

Gotcha Doc!!! Here is the Head of The Hospital. I sent a registered letter to him and I have saved his name. Gimme a minute. Here it is Director of Customer Relations Vinnie Boombatz! :$:

[tophcfa]

Many of the last posts are slipping off into the care people receive. That ain't da subject here. Coverage for young's is.

Everybody here has stories about the shortcoming of medical care around these parts. I wonder if anybody has success stories? Once I got past the ER in The Villages Hospital I got what I think was great care. All except for the severe infection I got from rusty instruments in the Operating Room. Just kidding. I don't know where I got it in the hospital but I went in there uninfected. The only reason I didn't lawyer up is it may have dragged my primary doctor into the situation somehow and I wouldn't do that to him or her for all the money the people have on the other side of Route 44.

Back to more people who I really respect who have Bronze instead of Silver, Gold, or Platinum. Let's go for more info, please. I gotta make a decision by December 15th.

Hey Nucky, our insurance is in Mass, not Florida. That being said, I believe all the metallic tires of health insurance are the same regardless of state. Being the rather quantitative/analytical person that I am, I put together a very detailed spreadsheet with all the details of each metallic tier and ran through several hypothetical insurance need scenarios. My analysis showed, hands down, that the Bronze tier was the best option (cheapest) under the widest range of scenarios.

At the end of the year, if one has a series of unfortunate health events, the insured always ends up paying almost exactly the same amount regardless of the tier. With the Platinum, you pay up front in the form of premiums but pay way less over time as you utilize health care. With the Bronze, you pay way less up front in the form of premiums but must pay a lot more over time as you utilize health care. If one is very sick and anticipates needing lots of health care, it’s best to go with the highest premium Platinum tier, as most bills are covered so the insured won’t have the hassle of having to pay for everything a-La-cart. On the other end of the spectrum, the Bronze tier has the lowest premiums, but the insured has to deal with the hassle of paying for just about everything a-la-cart until they reach the annual max out of pocket.

The biggest difference between the Platinum and the Bronze is that if the insured is fortunate enough to have a very healthy year, and needs only basic health care, they will save lots of money in the lower premium Bronze tier.

The gold and silver tiers fall somewhere in between the two, with the gold being closer to the platinum tier, and the silver being closer to the bronze tier.

In summary, the Bronze tier always has the potential to be the cheapest tier if the insured has a healthy year, but also has the potential to be the most work for the insured if they wind up requiring extensive health care. The Platinum tier is typically the most expensive tier unless the insured has a very unhealthy year (then the cost of all plans winds up almost exactly the same), but the insured has the benefit of less ongoing work as the coverage is more extensive.

The biggest advantages of the Bronze tier is that you pay the lowest premiums and if your health care needs are minimal it’s absolutely the cheapest plan. That huge advantage is offset by the fact that if your health care needs become extensive, the pay as you go becomes lots more work for the same cost. That disadvantage is what makes the pricing of the bronze tiers premiums so cheap, as the hassle of paying as you go discourages the insured from seeking health care unless it’s absolutely necessary.

Kind of long winded, but hope that helps.

[Nucky]

Hey Nucky, our insurance is in Mass, not Florida. That being said, I believe all the metallic tires of health insurance are the same regardless of state. Being the rather quantitative/analytical person that I am, I put together a very detailed spreadsheet with all the details of each metallic tier and ran through several hypothetical insurance need scenarios. My analysis showed, hands down, that the Bronze tier was the best option (cheapest) under the widest range of scenarios.

At the end of the year, if one has a series of unfortunate health events, the insured always ends up paying almost exactly the same amount regardless of the tier. With the Platinum, you pay up front in the form of premiums but pay way less over time as you utilize health care. With the Bronze, you pay way less up front in the form of premiums but must pay a lot more over time as you utilize health care. If one is very sick and anticipates needing lots of health care, it’s best to go with the highest premium Platinum tier, as most bills are covered so the insured won’t have the hassle of having to pay for everything a-La-cart. On the other end of the spectrum, the Bronze tier has the lowest premiums, but the insured has to deal with the hassle of paying for just about everything a-la-cart until they reach the annual max out of pocket.

The biggest difference between the Platinum and the Bronze is that if the insured is fortunate enough to have a very healthy year, and needs only basic health care, they will save lots of money in the lower premium Bronze tier.

The gold and silver tiers fall somewhere in between the two, with the gold being closer to the platinum tier, and the silver being closer to the bronze tier.

In summary, the Bronze tier always has the potential to be the cheapest tier if the insured has a healthy year, but also has the potential to be the most work for the insured if they wind up requiring extensive health care. The Platinum tier is typically the most expensive tier unless the insured has a very unhealthy year (then the cost of all plans winds up almost exactly the same), but the insured has the benefit of less ongoing work as the coverage is more extensive.

The biggest advantages of the Bronze tier is that you pay the lowest premiums and if your health care needs are minimal it’s absolutely the cheapest plan. That huge advantage is offset by the fact that if your health care needs become extensive, the pay as you go becomes lots more work for the same cost. That disadvantage is what makes the pricing of the bronze tiers premiums so cheap, as the hassle of paying as you go discourages the insured from seeking health care unless it’s absolutely necessary.

Kind of long winded, but hope that helps.

I absolutely concur. Big premiums and the the coverage sucks anyway. What’s up with that? I’ve been doing the same thing. Bronze is the new Gold for Mrs. Nucky. God Bless that woman. Not going to finish the application until I get some sleep. Haven’t been to sleep yet.

Thanks for the helping hand hand to all!!!!

[Plinker]

It's not a penalty, you just have to return the difference. i.e. if you claim a certain income and it says you get $1,700/month in credits, and then at the end of the year your income was higher so the credit should have been $1,600/month, you have to pay the $1,200 ($100 x 12) back when filling out taxes.

How about zero deductible, zero or very minimal monthly payments and a $5400 out of pocket maximum for pre-Medicare retirees with multi-million dollar net worths.
Easily accomplished:

Access Denied (https://www.cnbc.com/2016/01/27/theyre-millionaires-and-they-get-obamacare-subsidies.html)

[OrangeBlossomBaby]

The biggest advantages of the Bronze tier is that you pay the lowest premiums and if your health care needs are minimal it’s absolutely the cheapest plan. That huge advantage is offset by the fact that if your health care needs become extensive, the pay as you go becomes lots more work for the same cost. That disadvantage is what makes the pricing of the bronze tiers premiums so cheap, as the hassle of paying as you go discourages the insured from seeking health care unless it’s absolutely necessary.

Kind of long winded, but hope that helps.

The tiers have changed a LOT since the ACA was first passed. Also medical needs of subscribers change from one year to the next, especially as we get older. As of January 1, my new plan will be BlueSelect Bronze 2139.

I'm expecting to need hip replacement surgery next year. The customary cost, for operation, facility fee, doctors and anasthetics, pain meds, follow up visits, scans and xrays and whatever the heck else they do, will be somewhere around $25,000.

Under my CURRENT plan - BlueSelect Silver 1443A, I pay $436/month just to be on the plan. It has a 7000 per person deductible and a 8500 per person out of pocket expense. Having the procedure at the hospital instead of a surgical center is only covered to something like 40%, leaving me with having to pay 60% of the balance. Certain other parts of the surgery aren't covered at all, though I'll get some kind of schedule of fees discount. It's pretty complex, lots of things that are and aren't covered, covered only partly, with a bunch of exclusions.

The tl;dr is I'll likely be on the hook for around $15,000 total for the surgery, assuming I have no other medical issues all year, and including my premium.

For the NEW plan, it's a $9100 out of pocket max, 0 deductible. That basically means I pay for all my expenses as I go, and once it hits $9100 total payout, everything else is covered at 100 or with a reasonable additional copay (like $50 for a doctor's visit for a sprained ankle or whatever else).

This new plan will cost me $146/month, for myself and beloved spouse.

The tl;dr of the new plan is I'll be on the hook for around $10,000 total for the surgery, assuming I have no other medical issues all year, and including my premium.

[OrangeBlossomBaby]

How about zero deductible, zero or very minimal monthly payments and a $5400 out of pocket maximum for pre-Medicare retirees with multi-million dollar net worths.
Easily accomplished:

Access Denied (https://www.cnbc.com/2016/01/27/theyre-millionaires-and-they-get-obamacare-subsidies.html)

Of course, because the multi-million-dollar income earners need to welch off the system, costing the middle-class more since they /can't/ change their income, since they're still working and rely on that paycheck for living.

Excellent example of why the insurance companies are valuing their plans at $2000/month or more.

[tophcfa]

The tiers have changed a LOT since the ACA was first passed. Also medical needs of subscribers change from one year to the next, especially as we get older. As of January 1, my new plan will be BlueSelect Bronze 2139.

I'm expecting to need hip replacement surgery next year. The customary cost, for operation, facility fee, doctors and anasthetics, pain meds, follow up visits, scans and xrays and whatever the heck else they do, will be somewhere around $25,000.

Under my CURRENT plan - BlueSelect Silver 1443A, I pay $436/month just to be on the plan. It has a 7000 per person deductible and a 8500 per person out of pocket expense. Having the procedure at the hospital instead of a surgical center is only covered to something like 40%, leaving me with having to pay 60% of the balance. Certain other parts of the surgery aren't covered at all, though I'll get some kind of schedule of fees discount. It's pretty complex, lots of things that are and aren't covered, covered only partly, with a bunch of exclusions.

The tl;dr is I'll likely be on the hook for around $15,000 total for the surgery, assuming I have no other medical issues all year, and including my premium.

For the NEW plan, it's a $9100 out of pocket max, 0 deductible. That basically means I pay for all my expenses as I go, and once it hits $9100 total payout, everything else is covered at 100 or with a reasonable additional copay (like $50 for a doctor's visit for a sprained ankle or whatever else).

This new plan will cost me $146/month, for myself and beloved spouse.

The tl;dr of the new plan is I'll be on the hook for around $10,000 total for the surgery, assuming I have no other medical issues all year, and including my premium.

I hear ya, I have essentially the same insurance except I pay a crap load more in monthly premiums without the tax credit subsidies. I got really sick in 2021 from an infectious disease from a tick bite and had to spend 8 days in critical care in a Gainesville Hospital before they finally figured out was was wrong with me and how to treat it (basically the same treatment used for Malaria). They ran just about every imaginable test on me trying to diagnose what was making me so sick. The billable expenses from that episode ran close to a quarter million dollars, but I only had to pay the max out of pocket, which was close to 10 grand. Now I need a second knee replacement (too many years of pounding ice moguls in Vermont), but I’m going to suck it up a little longer until I turn 65 because it will be way cheaper once I am on Medicare.

Best of luck with the hip.

[OrangeBlossomBaby]

I hear ya, I have essentially the same insurance except I pay a crap load more in monthly premiums without the tax credit subsidies. I got really sick in 2021 from an infectious disease from a tick bite and had to spend 8 days in critical care in a Gainesville Hospital before they finally figured out was was wrong with me and how to treat it (basically the same treatment used for Malaria). They ran just about every imaginable test on me trying to diagnose what was making me so sick. The billable expenses from that episode ran close to a quarter million dollars, but I only had to pay the max out of pocket, which was close to 10 grand. Now I need a second knee replacement, but I’m going to suck it up a little longer until I turn 65 because it will be way cheaper once I am on Medicare.

Best of luck with the hip.

Thanks! Same to you with the knee. I almost got the hip done this year, but it turned out the excruciating pain I experienced was probably just a mild bone infection caused by the cortisone shot they gave me to relieve the hip pain (go figure). THAT pain resolved itself, the cortisone shot worked perfectly otherwise. And now, it's just starting to wear off.

It's my third and final cortisone shot, I'm not allowed to get more than 3 lifetime. Once the pain progresses back to where it was before I got the last shot, it's time to replace the thing.
So - probably next year. If not, then I will have saved a fortune in premiums without needing expensive care, so it'll be a win-win.

[La lamy]

Hard to say. If you go to the Florida Blue website, you can get a pretty accurate estimate. Personally, I retired at 56, I'm now 63, and my 2023 premium will be $17,600 for the year with a $7,000 deductible and no pre-existing conditions. (Bronze plan). I was self-employed, so no employer benefits, don't qualify for "Obamacare", and even if I did, I wouldn't accept it.

Wow, as a Canadian those insurance costs are astronomical!!

[kkingston57]

Moving in a few weeks to my new home in TV from another state. I am under 65, so too young to qualify for Medicare. My earnings last year exceeded the cap for Obamacare. I will need to get insurance through the Florida exchange. Is this something I should try to navigate on my own through Florida’s healthcare website, or are their brokers I could go to help me choose a plan. I don’t even have a doctor yet in Florida, and need to make sure that the eventual plan I get will be honored by my primary care provider as well as a few specialists (dermatologist and cardiologist) I will see a few times a year.

I had same issue in 2021. ONLY carrier in Sumter County was Florida Blue and was able to get a PPO plan. Happy with the plan and cost around 10k.

[kkingston57]

Should getting healthcare be this complicated?? Whether it is pre-Medicare or Medicare??

Not a problem for me, but I had only one choice last year in Sumter County. No insuance company wants to insure 64 year olds.

[kkingston57]

It's not a penalty, you just have to return the difference. i.e. if you claim a certain income and it says you get $1,700/month in credits, and then at the end of the year your income was higher so the credit should have been $1,600/month, you have to pay the $1,200 ($100 x 12) back when filling out taxes.

Agree 100%. Last year I had capital gains which pushed my premum up $800 a month since I did not anticipate high capital gains in 2021 and instead of getting an IRS check, I sent them a check.

[tuccillo]

There is a difference between income and net worth. "multi-million-dollar income earners" aren't "welching" off the system but they are paying a crap-load of taxes. Retired and under 65 with high net worth and low reported income can get a subside. Complain to the people who wrote the obamacare law such that the means testing is on reported income and not net worth. Just like with every other aspect of the tax law, people will adopt tax reduction strategies.

Of course, because the multi-million-dollar income earners need to welch off the system, costing the middle-class more since they /can't/ change their income, since they're still working and rely on that paycheck for living.

Excellent example of why the insurance companies are valuing their plans at $2000/month or more.

[golfing eagles]

There is a difference between income and net worth. "multi-million-dollar income earners" aren't "welching" off the system but they are paying a crap-load of taxes. Retired and under 65 with high net worth and low reported income can get a subside. Complain to the people who wrote the obamacare law such that the means testing is on reported income and not net worth. Just like with every other aspect of the tax law, people will adopt tax reduction strategies.

Exactly. Which is why I refused to get a subsidy even though I have essentially zero income. While the law has a few good points, it is also deeply flawed and was more political than medical in nature. Back in 2009 I was on one of the committees that was developing part of "Obamacare". I quickly resigned when I found out there were 70 people on this committee and only 2 physicians, most were politicians and bureaucrats, and it was obvious the outcome was already pre-determined.

[tophcfa]

Retired and under 65 with high net worth and low reported income can get a subside. Complain to the people who wrote the obamacare law such that the means testing is on reported income and not net worth. Just like with every other aspect of the tax law, people will adopt tax reduction strategies.

The scenario outlined above is highly unlikely. If one is truly a high net worth individual than the income on their investments will almost certainly put them well above the income cap to receive Obamacare income tax credit subsidies. For a high net worth individual to keep their income low enough to qualify for subsidies, they would basically have to stuff their savings under a mattress. Who in their right mind would forego many thousands of dollars of investment income to save a few thousand dollars in health care premiums? I suppose there are some examples of idiots that stashed their savings in crypto to avoid reporting income, but how did that work out for them?

[tuccillo]

I agree that the number of people who can do this is limited. If most of your money is in IRAs then it is entirely possible you can do this. You could be living off of non-qualified money that doesn't generate a tax event or much of a tax event. Did you read the link posted previously? It was about financial advisors and clients who are doing this. I know savvy people who have done this.

The scenario outlined above is highly unlikely. If one is truly a high net worth individual than the income on their investments will almost certainly put them well above the income cap to receive Obamacare income tax credit subsidies. For a high net worth individual to keep their income low enough to qualify for subsidies, they would basically have to stuff their savings under a mattress. Who in their right mind would forego many thousands of dollars of investment income to save a few thousand dollars in health care premiums? I suppose there are some examples of idiots that stashed their savings in crypto to avoid reporting income, but how did that work out for them?

[mtdjed]

Absolutely not, but you know what happens when the Government gets involved with anything.

Or doesn't get involved. I used one of our urgent care facilities on a Sunday recently for sudden dizzyness and balance problems. I walked in waited 15 minutes and was taken into a room and was asked by the nurse what my problem was. Took my pulse and BP, checked my response to several simple head and eye movements. Nurse went and discussed with doctor and returned with script for Meclizine (which you can buy off the shelf). Total time less than 1/2 hour, never saw doctor. Advice was vertigo and go to see my doctor if it did not get better in a day or so.

Urgent care bill to Medicare was $2800, and Dr was $1300, Total was $4100+. Medicare authorized a total of $300 (Less than 8% of charge).

What happens to a person with no insurance? How is this type of billing tolerated? I know Medicare has payment codes for provider services, but such a difference leads to total mistrust of all involved.

Perhaps someone on this forum can help explain.

[OrangeBlossomBaby]

Or doesn't get involved. I used one of our urgent care facilities on a Sunday recently for sudden dizzyness and balance problems. I walked in waited 15 minutes and was taken into a room and was asked by the nurse what my problem was. Took my pulse and BP, checked my response to several simple head and eye movements. Nurse went and discussed with doctor and returned with script for Meclizine (which you can buy off the shelf). Total time less than 1/2 hour, never saw doctor. Advice was vertigo and go to see my doctor if it did not get better in a day or so.

Urgent care bill to Medicare was $2800, and Dr was $1300, Total was $4100+. Medicare authorized a total of $300 (Less than 8% of charge).

What happens to a person with no insurance? How is this type of billing tolerated? I know Medicare has payment codes for provider services, but such a difference leads to total mistrust of all involved.

Perhaps someone on this forum can help explain.

Yup.

Dehydration caused fainting in the town square. Needed IV fluids, nothing else. Mandatory ambulance ride: $670. Two sets of chest x-rays because patient was stressed out (I mean who would NOT be stressed out after being transported to the ER?), 1.5 hours laying on a gurney watching TV with no visitors allowed, full CBCs, to get 2 bags of fluids that only took 1/2 hour to administer. Patient didn't know they could just refuse more service and walk out, the spouse was not permitted in to explain that to him.

Finally after 1.5 hours the spouse was able to flag down a medical employee to explain the situation, and was allowed in. Patient was angry, had wanted to go home an hour before, didn't want ANY of the tests he was told he HAD to take...

Nurse made nasty comments...

and the bill for THAT lovely service was $2000.

Oh that $600+ ambulance ride was one BLOCK away from the ER.

Insurance covered only part of the cost because UFHealth's free-standing emergency center was considered "out of network" and therefore not covered, so the payment to ambulance and UFHealth ended up being around $1800 total.

[melpetezrinski]

It's not a penalty, you just have to return the difference. i.e. if you claim a certain income and it says you get $1,700/month in credits, and then at the end of the year your income was higher so the credit should have been $1,600/month, you have to pay the $1,200 ($100 x 12) back when filling out taxes.

If you fall within the income limits, you not only qualify for a subsidy amount that will lower your monthly premium but you also get lower copays and a lower out of pocket max. Now, if you significantly underestimate your income (maybe you sold stock or a rental property for a $50k capital gain), you will have to pay part of the subsidy back that reduced your premium. This is a fairly straightforward process. However, what about the copays? Maybe you initially had zero copays with the estimated low income and now with the actual higher income, you should have been paying $20 copays all year. These would have been paid directly to the doctors' office or hospital, etc. How are these recaptured or clawed back?

[steve3860]

Moving in a few weeks to my new home in TV from another state. I am under 65, so too young to qualify for Medicare. My earnings last year exceeded the cap for Obamacare. I will need to get insurance through the Florida exchange. Is this something I should try to navigate on my own through Florida’s healthcare website, or are their brokers I could go to help me choose a plan. I don’t even have a doctor yet in Florida, and need to make sure that the eventual plan I get will be honored by my primary care provider as well as a few specialists (dermatologist and cardiologist) I will see a few times a year.

It should be based on what you will make this year. Last year after having covid I was unable to work. After losing my job I signed up for Obama Insurance. I estimated my income for this year at $18k. I ended up making $20k no problem. The year before I made $120k for the year.

[tophcfa]

It should be based on what you will make this year. Last year after having covid I was unable to work. After losing my job I signed up for Obama Insurance. I estimated my income for this year at $18k. I ended up making $20k no problem. The year before I made $120k for the year.

At the end of the year it always is based on the actual income for the year (income as defined by Obamacare). Everything is trued up when you file your federal tax return and any discrepancies between projected and actual income will result in an adjustment to tax credits, unless you go over the cap, then all credits received will have to be returned.