The copay for the GLP-1 drugs will be $50 under the Bridge program.

Kevin Knauss: Health, History, Travel, Insurance




If an individual is working, paying taxes, and has an income low enough to qualify for the health insurance subsidies, they should be allowed to participate in the ACA program. These folks are our neighbors and are no different from the rest of us. They are trying to be responsible residents by enrolling in health insurance so some unfortunate accident does not make them a burden to the state.


If your employer has less than 20 employees, Medicare is primary payor. This means the group plan may wait until Medicare pays their portion of the health care. If you don’t have Medicare then you may have a big health care bill to pay. If you have coverage through a small employer group, seriously consider enrolling in Medicare.



But does the High Deductible Plan G protect you from catastrophic Medicare health care costs? In the example below, the Medicare beneficiary has a medical event where they must be hospitalized for five days. They must then reside in a skilled nursing facility for 30 days to recuperate. The costs are 2026 and 2036 where a 5 percent inflation adjustment has been applied to the Medicare costs.


A few of the carriers will offer discounts on dentistry, optometry, pharmacy purchases, and hearing exams and hearing aids. These discount offerings are NOT insurance. Some of the carriers also offer dental, vision, and Part D prescription drug plans. It’s possible that those carriers would rather you enroll in their insurance plans instead of using a discount program. The discount plans may be valuable for some people who can leverage the programs to save money.




The slope of the curve increases at the $125k income group. This is also the point where, for many families, the 2.5% of income penalty calculation is greater than the flat penalty amount. The highest average penalty happens at the $900k and $4 million income groups. The $900k income group had an average penalty of $7,921 and the $4 million group average penalty was $8,118. There was no data published for the $5 million income group.

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