Anyone sign up with Obamacare yet?

[Greg Bernhardt]

I'm sitting here a little depressed. I need to sign up my wife and I and the cheapest plan is $450/m with a $9000 deductible. We are both super healthy, rarely visit the doctor and were happy with our old catastrophe plans which were about $100/m each.

 

[Evo]

All I know is that Obama made it possible for my older daughter, Spawn of Evo, who has Chrons disease and was canceled by her previous insurance and uninsurable to get cheap insurance. His law made it illegal for insurance companies to turn her down. It's not the new plan, but I thank him every day.

Greg have you shopped around for insurance directly from companies?

 

[Greg Bernhardt]

Greg have you shopped around for insurance directly from companies?

As far as I can tell, the only non obamacare plans you can get are temporary insurance.

 

[Evo]

As far as I can tell, the only non obamacare plans you can get are temporary insurance.

Well, that stinks.

 

[Monique]

I'm sitting here a little depressed. I need to sign up my wife and I and the cheapest plan is $450/m with a $9000 deductible. We are both super healthy, rarely visit the doctor and were happy with our old catastrophe plans which were about $100/m each.

That's $450/m for you both? That's a lot.

One thing you can be happy about: you are super healthy and rarely have to visit the doctor. People like Spawn of Evo don't choose to be chronically ill and it makes sense to spread the costs over society, but that's my socialist view. I pay less than €100/m, or $120/m for mandatory insurance, to give an indication.

Hopefully you can find a better deal, otherwise time will probably bring the cost down.

 

[jtbell]

As far as I can tell, the only non obamacare plans you can get are temporary insurance.

My understanding is that you can bypass the exchange (healthcare.gov or a state exchange if you have one) and deal with an insurance company directly. The main difference is you can't get a subsidy if you do that, but if you make too much to be eligible for a subsidy anyway, that's not a problem.

There are requirements that all insurance plans have to meet, whether they're on the exchange or not, e.g. not being able to deny coverage because of a pre-existing condition. I think I remember reading that those requirements eliminated the catastrophic plans with super low premiums.

 

[Greg Bernhardt]

There are requirements that all insurance plans have to meet, whether they're on the exchange or not, e.g. not being able to deny coverage because of a pre-existing condition. I think I remember reading that those requirements eliminated the catastrophic plans with super low premiums.

That's likely what's hurting me. I bet this is why they are having trouble getting young people to sign up. A healthy person under 30 is going to have a real problem paying $250/m when they never see the doctor.

 

[Evo]

Does your wife's employer not offer insurance Greg?

 

[Greg Bernhardt]

Does your wife's employer not offer insurance Greg?

No because she is technically not full time :(

 

[Evo]

No because she is technically not full time :(

I would like to see employers give part time employees the option to benefit from an employer's group policy, even if they pay a larger premium, it's still got to be better than buying an individual policy.

 

[Danger]

I haven't signed up. Being Canadian, I already have something even better. :p

If I were a Yank, though, I definitely would.

 

[Medicol]

I don't know why many American complain so much about their medicare policy. Most of them already have monthly incomes as high as $5000 on average. Extracting from it only $400-$500/m is not a big deal.

 

[Greg Bernhardt]

Extracting from it only $400-$500/m is not a big deal.

You would enjoy paying $500 and not getting anything for it? I haven't been to the doctor in years. It might not be if that were the only monthly expense And the $5000 a month average is before taxes.

 

[Monique]

You would enjoy paying $500 and not getting anything for it? I haven't been to the doctor in years. It might not be if that were the only monthly expense And the $5000 a month average is before taxes.

You are getting something for it: insurance.

The idea that you need to spend as much as you pay in a year is a strange one. Then you don't need to insure yourself, if you think you can pay medical bills without problem. A single round of chemotherapy can cost $20,000: you need to pay insurance for seven years to just cover that cost. You might be healthy today, but how about tomorrow? The insurance company needs to cover that risk.

The bill of $225/person/month is a lot in my opinion, but it's well known that medical care in the USA is very expensive (maybe that's where change is needed).

Can you opt for a certain amount of own risk? That will reduce your monthly bill and saves money when you don't need any care.

 

[Greg Bernhardt]

Then you don't need to insure yourself, if you think you can pay medical bills without problem.

The point of obamacare was to mandate coverage. Either you sign up or pay a penalty. This is a big problem. Many young people are choosing to pay the cheaper penalty.

The thing that gets me is the deductible. The plan I am looking at has $9000 annual. So pretty much unless I get cancer, I'm paying $500/m and out of pocket for everything. To get value I better get in a train wreck.

 

[Medicol]

You would enjoy paying $500 and not getting anything for it?,,,.

Oh you may become interested in this
http://dealbook.nytimes.com/2014/06...o-consider-investments-in-united-states/?_r=0
That you buy a health package from them is also meant to save your money at a very low interest rate. They also pay your checkup fee at a low percentage. Go with your own country's policy. Life span is in the US also higher than that in many others.

 

[SteamKing]

Hopefully you can find a better deal, otherwise time will probably bring the cost down.

That's what everyone thinks. But Obamacare's little surprise, which was carefully concealed until after the recent elections, is that the premiums for most plans are going up. Merry Christmas and Happy Birthday.

Also, plans are priced in part on your age. Someone 25 years old is not going to pay the same premium as someone 50 years old. As you get older, even if you are healthy, you can expect to see an increase in your premiums. Obamacare may have repealed the laws allowing denial of coverage for preexisting conditions, but it didn't do anything about this.

 

[Monique]

The thing that gets me is the deductible. The plan I am looking at has $9000 annual. So pretty much unless I get cancer, I'm paying $500/m and out of pocket for everything.

Gee, you pay $9000 out of pocket before any coverage? Yes, that's ridiculous. Apparently the system needs to go through a serious reform, I'm glad I'm not part of it. You can come to the Netherlands, we have good insurance plans ;)

To get value I better get in a train wreck.

Don't speak of getting value, you don't want to get value for your money when it comes to insurance.

 

[Monique]

That's what everyone thinks. But Obamacare's little surprise, which was carefully concealed until after the recent elections, is that the premiums for most plans are going up. Merry Christmas and Happy Birthday.

That's how it goes, I'm working with a lawyer now (again) to find a way that I don't have to go into unemployment, while I pay myself with a government subsidy. It's easy to become vicim of rules that are supposed to be there to help you.

 

[SteamKing]

You are getting something for it: insurance.

While the ACA mandates that coverage be purchased, there is no similar mandate that physicians or hospitals are required to accept that coverage to pay for your treatment. If the coverage is turned down or not accepted, you still get a bill.

http://americanactionforum.org/insi...ers-are-opting-out-of-obamacare-exchang-plans

Reimbursements to physicians and hospitals, even should they accept the coverage, are very low currently and subject to going lower.

 

[Monique]

Why would physicians or hospitals reject coverage? They don't make enough profit from the plan?

 

[SteamKing]

Why would physicians or hospitals reject coverage? They don't make enough profit from the plan?

If the reimbursements from the plans don't cover the cost of coverage, who makes up the difference? Hint: it's not the government.

Private physicians and hospitals must make enough revenue to pay the utility bills, pay the staff, buy supplies and medical equipment, etc. If it costs, for example, $100 to treat a given patient, but you can expect a reimbursement of only $60 for that treatment, how long before that missing $40, multiplied by the number of patients who are treated, adds up to real money?

For every $1.00 paid by private insurance, Medicare pays about $0.80, and most ACA plans pay about $0.60. In fact, the trend is to tie ACA plan reimbursement rates with prevailing Medicaid reimbursement rates, which are rock bottom as it is.

For those of you not from the US, Medicare is the federally-administered healthcare program for those who are 65 and older.

http://en.wikipedia.org/wiki/Medicare_(United_States)

Medicaid is a health care program set up and administered by the individual state governments to care for the indigent or others with low incomes or limited resources:

http://en.wikipedia.org/wiki/Medicaid

The reimbursement rates for physicians and hospitals are set by the Centers for Medicare and Medicaid Services, the department inside the Department of Health and Human Services of the federal government which administers Medicare. Various fee schedules for treatment have been set up over the years, but because Medicare is administered by the federal government, these fee schedules and the reimbursements provided are subject to revision by Congress when it comes to drafting the federal budget. In general, over the last decade or so, the trend is to provide smaller reimbursements to doctors and hospitals for their services.

As of 2008, Medicare alone consumed 13% of the federal budget. Over the period 2010-2019, this share is expected to increase to just under 15%.

 

[Monique]

If the reimbursements from the plans don't cover the cost of coverage, who makes up the difference? Hint: it's not the government.

Does that mean that Greg actually should be paying more to the insurance plan? Why does it work in other countries, but not the USA?

 

[Evo]

Greg, have you actually checked with companies like Humana, United Healthcare, Kaiser Permanente, Aetna, Coventry, Blue Cross Blue Shield, etc... I had individual insurance policies with no deductible, included prescription meds and was only $400 a month for the two of us. Of course it was top of the line coverage, you might not need a plan with that much coverage. That was two years ago, so, I would assume the premiums are a bit higher now, but you probably don't need as much coverage as I carried.

 

[SteamKing]

Does that mean that Greg actually should be paying more to the insurance plan? Why does it work in other countries, but not the USA?

Long story short, Greg is already paying more for his insurance plan, to cover the cost of treating those who cannot be denied coverage.

In other countries, like the UK with its NHS, the cost of hospitals and physicians is a budget item, i.e., the government pays for health care. Now the money for these programs can come from only one source: the taxpayer. You have an elaborate national taxation system to collect revenue, in the form of income taxes, fees (like the National Insurance), and a particularly burdensome Value Added Tax system on goods and services, i.e., a tax on consumption.

http://en.wikipedia.org/wiki/Value_Added_Tax_(United_Kingdom)

Because of the nature of the VAT (it is levied in increments at each stage of production), often the true amount of tax is obscured in the price being paid by the consumer.

In the US, there is no national tax system which resembles the VAT, although one has been proposed on occasion. Certain programs, like Medicare and Social Security, are nominally funded thru payroll taxes, but in recent years, the amount collected thru taxes has been exceeded by the amount of benefits paid out. The surpluses which were accumulated in previous years have been borrowed by the federal government, in part to make up for financing its annual budget deficits.

By mandating coverage for all comers, ACA plan rates are necessarily going to reflect that the costs of covering those who cannot pay for insurance or whose insurance coverage does not cover the cost of their treatment will be shifted and proportioned over all the policyholders in that plan.

 

[Monique]

Thanks for the explanation, I looked up how that's distributed in the Netherlands (for comparison): 8% of healthcare is financed through the government, 38% through basic insurance fees, 9% through extended insurance fees and 39% through employer contributions. Still hard to compare with your example, but I'm surprised the government percentage is quite low.

Long story short, Greg is already paying more for his insurance plan, to cover the cost of treating those who cannot be denied coverage.

I'm curious: is this perceived as a good or a bad thing? Sure, the charges are excessive, but making sure everyone has access to healthcare must be a good thing?

 

[SteamKing]

Thanks for the explanation, I looked up how that's distributed in the Netherlands (for comparison): 8% of healthcare is financed through the government, 38% through basic insurance fees, 9% through extended insurance fees and 39% through employer contributions. Still hard to compare with your example, but I'm surprised the government percentage is quite low.I'm curious: is this perceived as a good or a bad thing? Sure, the charges are excessive, but making sure everyone has access to healthcare must be a good thing?

I don't think anyone is advocating that someone should be denied coverage.

The healthcare financing system in the US before the ACA had many recognized problems, but it is not clear that the provisions of the ACA have addressed or solved these problems, and in fact, almost certainly these provisions have created new problems.

The law itself has been phased in in stages. The current controversy involves those who previously did not have access to health insurance thru their employer, either because they were self-employed and purchased their own policies on the open market, or because they chose not to purchase a plan because they are young and healthy, for example, and thought the money could be spent on other things, or worked only part-time, and were not eligible for the same coverage which was offered to full-time employees. This portion of the population is relatively small.

The next portion of the ACA to be implemented will affect the health insurance plans which are offered by employers to their full-time employees. Employers will have to offer plans with similar coverage that are being offered to individuals, or pay a fine for each of their employees who are not covered. In response, many smaller employers have switched formerly full-time workers to part-time work. Other employers have announced that coverage thru the company would no longer be offered, and the employees would have to shop for plans on one of the health insurance exchanges.

The ACA, for better or worse, is a great dislocation in the one thing which a lot of people were counting on should they get sick and need treatment. Contrary to promises issued by the Administration, health plans and doctors which people liked and depended on were not preserved under the law.

 

[SteamKing]

Thanks for the explanation, I looked up how that's distributed in the Netherlands (for comparison): 8% of healthcare is financed through the government, 38% through basic insurance fees, 9% through extended insurance fees and 39% through employer contributions. Still hard to compare with your example, but I'm surprised the government percentage is quite low.

That 8% is probably just the line item in the national budget which covers health costs. The rest is going to come from the population in some form of tax, although it may be designated a 'contribution' or a 'fee' rather than a 'tax'.

In the US, the amount in payroll taxes paid by the employee to fund Social Security and Medicare is supposed to be matched dollar for dollar by the employer. If you are self-employed, you get to personally match your own payroll tax contribution when making your tax withholding payments to the government. At least the IRS (the federal tax agency) has the decency to call this a 'self-employment tax' on the forms.

 

[RonL]

The point of obamacare was to mandate coverage. Either you sign up or pay a penalty. This is a big problem. Many young people are choosing to pay the cheaper penalty.

The thing that gets me is the deductible. The plan I am looking at has $9000 annual. So pretty much unless I get cancer, I'm paying $500/m and out of pocket for everything. To get value I better get in a train wreck.

Hi Greg,
I don't have a clue that there might be something here that might be of help, but I'll throw it out:), my wife volunteers to help people with the insurance signup and in tax season ones that qualify can have their taxes done for free.
In Texas,( your state might be different ) look at these links and see if you see anything that helps.

http://www.foundcom.org/get-financially-stable/insure-central-texas/

http://www.foundcom.org/documents/Insure_Central_Texas/Resolving_an_Inconsistency_-_English.pdf

One that she helped today had lost his job, he needed coverage to extend through the years end ( I don't know about next year) married with two children, a zero deductible policy has a government assist grant that covered a little over $400.00 and he paid around $380.00.
In today's economy, as one that has paid insurance to cover a family of six for many years, this sounded pretty good to me.
In all the years of raising my family there were never enough medical bills to exceed the minimum allowable on tax returns (I count my blessings every day):)

Look for insurance marketplace in your state, if that is not what you have already been looking at.

Other countries have higher taxes, but offer everyone complete health coverage, the US of A could step up to first place if everyone would just open their minds (IMO):)

 

[Nugatory]

Why would physicians or hospitals reject coverage? They don't make enough profit from the plan?

The large insurance companies negotiate standard fees with physicians and hospitals ahead of time. A doctor who has made such an arrangement with your insurance company is "in network"; when you visit that doctor they treat you and then bill the insurance company for the agreed-upon fee, less any possible copay.

If the doctor is out of network, they have two choices. Either:
1) They bill the insurance company for their usual fee, the insurer pays whatever amount is called for by your contract with insurer, and the doctor bills you for the difference. They are more likely to do this for regular patients and people with good credit ratings. They are also more likely to do this if the practice is large enough to have people on staff who shepherd claims through the insurance company process.
2) They bill you (often requiring payment during your visit). You file a claim with your insurer, and they pay you whatever amount is called for by your contract with them.
When someone says that their coverage was "rejected" by the doctor/hospital, they mean that the provider is going with option #2 above.

None of this is new with Obamacare.

 

[Danger]

Jeez, but you guys have it hard! My entire life is paid for by the government (ie: taxpayers :s). I'm on AISH—Assured Income for the Severely Handicapped. It pays me a monthly income to cover the cost of housing, food, utilities, and whatever else I choose to spend it on in the form of an automatic bank deposit. I'm allowed to maintain ownership of my house which I still live in, and vehicle, even though I no longer drive. (Aside from my beer, internet, cat-related expenses, Phillips Lifeline service, delivered meals, and basic cable TV, I don't indulge.) All of my medical bills including ambulance rides (about $250 each), hospital stays, prescription meds and the like are covered. (My oxygen equipment is paid for by Alberta Health Services, a different entity, even though it's legally a prescription drug.) I've had a lot of ambulance trips to the ER for overnight stays (including last Wednesday), at some unknown cost. My two separate 3-week hospitalizations in ICU ran about $2,500 per day. If that were my responsibility, I would have stayed dead the first time.
On the whole, though, I'd rather be able to work for a living.

 

[mheslep]

Private physicians and hospitals must make enough revenue to pay the utility bills, pay the staff, buy supplies and medical equipment, etc. If it costs, for example, $100 to treat a

What hospitals charge, in particular, have little connection unfortunately to what care must actually cost. The primary reason for this is a lack of transparency in pricing. One generally can not shop around costs for some routine medical procedure. Also, hospitals have a monopoly arrangement with many local governments, with regulations in place preventing new hospitals from going into business in an area; i.e. the regulation basis is something like, "is likely to create disruption"

 

[mheslep]

I'm sitting here a little depressed. I need to sign up my wife and I and the cheapest plan is $450/m with a $9000 deductible. We are both super healthy, rarely visit the doctor and were happy with our old catastrophe plans which were about $100/m each.

Apparently the law now requires that catastrophic-only plans are only available for those under 30. Plugin under 30 and the lowest price I see on e-health is Aetna - $255/mo, $6600 deductible per individual, $13,200 deductible family. But, even the ACA version of "catastrophic" plans include "Well Baby Care" and other things you don't need - also mandated by the law and forcing the cancellation of plans people already had in pocket which did not include what the ACA says it should include.

Above 30 yrs old, and I get about the same price you see for over 30 (my zip code).

The US has traditionally made goods and services available to the middle class by making these things highly affordable, from transportation to housing and even to medical care before the WWII laws. Hopefully another round of reforms can place the focus where it should be.

 

[Evo]

The large insurance companies negotiate standard fees with physicians and hospitals ahead of time. A doctor who has made such an arrangement with your insurance company is "in network"; when you visit that doctor they treat you and then bill the insurance company for the agreed-upon fee, less any possible copay.

If the doctor is out of network, they have two choices. Either:
1) They bill the insurance company for their usual fee, the insurer pays whatever amount is called for by your contract with insurer, and the doctor bills you for the difference. They are more likely to do this for regular patients and people with good credit ratings. They are also more likely to do this if the practice is large enough to have people on staff who shepherd claims through the insurance company process.
2) They bill you (often requiring payment during your visit). You file a claim with your insurer, and they pay you whatever amount is called for by your contract with them.
When someone says that their coverage was "rejected" by the doctor/hospital, they mean that the provider is going with option #2 above.

None of this is new with Obamacare.

Some policies offer no coverage for 'out of network" providers, unless it is an emergency outside of your coverage area, and then maybe not. But these plans are usually the cheapest, plans that let you see any doctor anywhere usually cost more.

 

[SteamKing]

Also, hospitals have a monopoly arrangement with many local governments, with regulations in place preventing new hospitals from going into business in an area; i.e. the regulation basis is something like, "is likely to create disruption"

It's a pretty small town or city in the US which has access to only one hospital, clinic, doctor's office, vet practice, witch doctor, holistic healer, kids playing doctor, etc. Usually, such circumstances occur because the particular town is too remote or too sparsely populated to require the services of more than one hospital or clinic, however small it might be.

I would like some examples of this practice, please.

AFAIK, hospitals are not regulated the same as public utilities, cable companies, police and fire departments, or other municipal services. Hospitals are usually regulated and accredited by state departments of health, rather than local governments, and there are a raft of federal regulations which apply as well. Such local monopoly regulations on hospitals are unlikely to withstand legal scrutiny, IMO.

The shortage of physicians willing to practice in remote or under served rural areas is so acute that programs have been set up which provide that if new physicians commit to practice in these areas for a certain period of time, all or part of that physician's student loan debt would be forgiven/repaid.

This is a list of state/federal Loan Repayment/Forgiveness and Scholarship programs:

https://services.aamc.org/fed_loan_...1&CFTOKEN=29841B58-E60F-A638-686BBE40975118D8