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My Experience with ObamaCare

bogey21

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Before I start, understand that I'm not passing judgement here, just passing on the facts. I bought the cheapest Bronze ObamaCare Policy for my underemployed Son and his wife for two reasons, (1) so they can avoid next year's $1,390 penalty for not having insurance and (2) to have coverage in the event something really bad happens to either of them.

These are rounded numbers from memory. The total cost of the policy is $6,000 with the Government paying $3,600 of it (the subsidy) and me paying $2,400 on behalf of my Son and his Wife. With the exception of a couple of little things (primarily preventive care) the policy pays nothing until the deductibles (roughly $6.500 each) are met.

IMO this is a great deal for the Insurance Company as they get premium income of $6,000 and essentially don't pay anything out until each insured has covered the first $6,500 of his/her medical expenses. It is also a reasonable deal for us as our cost for catastrophic coverage is only about $1,000 (our $2,400 share of the premium paid minus the $1,390 my Son and his wife won't have to pay for not having insurance). The big loser appears to be the Government;i.e the taxpayer who is paying $3,600 for what?

Yeah, I know there are a few things benefiting my Son and his wife like a small amount of preventive care; maybe a flu shot and some birth control pills and getting the benefit of the Insurance Company's negotiated rates rather than the rack rate if/when they ever go to the doctor.

What am I missing here?

George
 

taterhed

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Well, before this thread gets locked...

What happened before ACA when someone with NO insurance (preexisting conditions, finance, chose not to..) went to the hospital? Who paid?

I think I know who is paying. The question is: which pocket is it coming out of? My right or my left?

Glad your kids have a safety net.
 

ronparise

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without the subsidy your son would either not have insurance or would be paying $6000 (instead of $2400)

If we accept the premise that we are a government of the people , by the people and for the people (I know, an outdated idea) then what you are asking is; What do I get out of it?

The answer is the same thing you are, for the $2400 you are paying. Im happy to pay my taxes, as Im am sure you are, knowing that your son (and a whole lot of other fellow citizens) will get affordable health care. Thats much better in my estimation than letting folks die from something that can be treated.

What doesnt make me happy is that the insurance companies profit from handling the money. It could be done so much cheaper if we took the insurance companies profits out of the equation. I would much rather pay my taxes (and your son pay no insurance company premiums) and have the government pay the doctors and hospitals directly.
 

dwojo

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The Affordable Care Act is horrible. My insurance cost went up 38% this year to cover some of the Costs for others (Cadillac tax) so I went to a lesser coverage to avoid the increase. I understand many people need coverage, but penalizing others is ridiculous. I spent 30 years working hard and having 2 jobs much of time so that I could afford better coverage. There has to be a better way for everyone.
 

Ken555

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To my knowledge, all ACA plans include some preventative care at no charge with limits on others. These benefits are greater than were previously provided.

The ACA is a great step forward but we're not yet done. It can be much better. We have had numerous threads on this very topic over the last couple of years, and I suspect we won't learn much new with path is one.

My insurance is increasing 22% next year. Do you hear me saying the ACA is horrible? Nope.


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Luanne

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Before the Affordable Care Act my younger dd was denied insurance due to an existing condition. With ACA she has a policy through BC/BS (which will be going away next year as they are pulling out of the state program). Premiums are about $200/month and just about everything is covered almost completely. Luckily for her next year she will be attending school in Canada and will get Canadian health insurance. But for her, the ACA was a godsend.
 

isisdave

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Our 23-y-o- DS had several medical events growing up, and ONE of which would have made him uninsurable before ACA. My wife and I, both self-employed, actually had to form a 2-person company so that under California law, we could get "group" coverage, which cannot exclude anyone for pre-existing conditions.

Before ACA, he would only have been able to be covered while working at a job that supplied group health insurance. This would have made him unable to study, to travel abroad, or to be self-employed. Maybe not so bad in a thriving economy, but not a great position to be in when good jobs are hard to find.

Before ACA, my company insurance would have covered him until age 24, so I probably would have felt obliged to continue working two years longer than I did, just to keep him insured.

Due to the aforementioned medical events, insurance has paid FAR more than we'll ever have to pay in premiums, so we have a pretty positive attitude about it all. Some folks say this is "paying someone else's costs," but we have sure heard their tune change once it happens to them or a loved one of theirs. Risk pooling is, of course, exactly what insurance is about.
 

SMHarman

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Before I start, understand that I'm not passing judgement here, just passing on the facts. I bought the cheapest Bronze ObamaCare Policy for my underemployed Son and his wife for two reasons, (1) so they can avoid next year's $1,390 penalty for not having insurance and (2) to have coverage in the event something really bad happens to either of them.

These are rounded numbers from memory. The total cost of the policy is $6,000 with the Government paying $3,600 of it (the subsidy) and me paying $2,400 on behalf of my Son and his Wife. With the exception of a couple of little things (primarily preventive care) the policy pays nothing until the deductibles (roughly $6.500 each) are met.

IMO this is a great deal for the Insurance Company as they get premium income of $6,000 and essentially don't pay anything out until each insured has covered the first $6,500 of his/her medical expenses. It is also a reasonable deal for us as our cost for catastrophic coverage is only about $1,000 (our $2,400 share of the premium paid minus the $1,390 my Son and his wife won't have to pay for not having insurance). The big loser appears to be the Government;i.e the taxpayer who is paying $3,600 for what?

Yeah, I know there are a few things benefiting my Son and his wife like a small amount of preventive care; maybe a flu shot and some birth control pills and getting the benefit of the Insurance Company's negotiated rates rather than the rack rate if/when they ever go to the doctor.

What am I missing here?

George
Seems a pretty good deal to me. I work for a bank that employs over 20000 across the US.
Our plan for next year will cost me 350 a pay check x 24 = 8400 for a family of 5.
Like your sons the family has a 6500 deductible (medical and prescription). My eer kicks 1800 into a HSA but I have a potential gap of the 4700 before the policy pays a penny.
And with a child with chronic allergies thus is an expensive change for 2016.

I'm happy the ACA is in place. Coming from the UK and the NHS it is a step in the right direction.
 
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normab

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The ACA makes insurance available, but I personally don't find it affordable.

I would like to see an overhaul of the entire system. Makes no sense how they bill and what actually gets paid. Why not just have fair and reasonable rates that are paid by all? (Like back in the old days..)

I have a friend who lives in MD near DC and she said the docs are all going "concierge" because financially it makes more sense for them and their patients. So they have had problems finding docs in their network.

Just my 2 cents worth...
 

easyrider

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We have always had individual family type policies before the ACA. These were the worst coverage and most costly overage. The deductible was $6500 x 2 before the insurance company needed to pay 80% of covered costs. There was no limit on my 20%.

With the ACA the policy cost is less and coverage is more. We now have separate policies for my wife and I. I think our deductible is about $2000 and 20% up to $12,500. It could be a bit more or less as Im just going off of memory.

The preventative care included our colonoscopies. The colonoscopy was covered unless they find a polyp, which turns this into a procedure instead of preventative care. We argued that wasn't right and because of many complaints by others on this issue , we did not have to pay for the polyp removal.

So for us, the ACA has been good for us.

Bill

Bill
 

Ken555

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Why not just have fair and reasonable rates that are paid by all? (Like back in the old days..)


Because that wasn't the old days. There never were "fair and reasonable rates" for all. If there were, change wouldn't have been desired for the last 30+ years!


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bjones9942

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I believe that a healthy citizenry and an educated citizenry will only make our country stronger. There are a few socialistic programs I believe we should adopt, and medicare for everyone and free education are two of them.

And before you jump all over me, I have no illusions that this is 'free'. There's a cost to everything. I just believe some things are worth the cost.
 

Elan

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The ACA makes insurance available, but I personally don't find it affordable.

I would like to see an overhaul of the entire system. Makes no sense how they bill and what actually gets paid. Why not just have fair and reasonable rates that are paid by all? (Like back in the old days..)

I have a friend who lives in MD near DC and she said the docs are all going "concierge" because financially it makes more sense for them and their patients. So they have had problems finding docs in their network.

Just my 2 cents worth...
That would require some sort of government regulation of healthcare costs. If we're going to do that, we might as well just go to a single-payer system. Effectively, it would be nearly the same thing.

Sent from my Nexus 5 using Tapatalk
 

WinniWoman

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We have always had individual family type policies before the ACA. These were the worst coverage and most costly overage. The deductible was $6500 x 2 before the insurance company needed to pay 80% of covered costs. There was no limit on my 20%.

With the ACA the policy cost is less and coverage is more. We now have separate policies for my wife and I. I think our deductible is about $2000 and 20% up to $12,500. It could be a bit more or less as Im just going off of memory.

The preventative care included our colonoscopies. The colonoscopy was covered unless they find a polyp, which turns this into a procedure instead of preventative care. We argued that wasn't right and because of many complaints by others on this issue , we did not have to pay for the polyp removal.

So for us, the ACA has been good for us.

Bill

Bill


Usually, when you have a screening colonoscopy and they find polyps, the removal and the lab work are not necessarily covered, depending on insurance, of course. The other thing is after you have that colonoscopy, you are supposed to come back for another in 5 years.

At that time- the colonoscopy becomes a Diagnostic one instead of a Screening and is usually not covered as a preventative procedure because preventative screenings are only covered every 10 years by most insurance companies and because a polyp was found upon the initial screening.

In my case- I had one benign polyp found during my screening in 2007 and I was supposed to come back for another colonoscopy in 5 years. I put it off a few years and just had it this past week. The week before the procedure the doctor's office called me and said I would be responsible for $1100 because of my high deductible plan and since it is under 10 years and also since it is a f/u to a polyp finding.

I did have polyps again so we shall see how the surgery and lab work is handled, not to mention the pre-procedure office consultation.
 
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bogey21

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I have a $0 premium Medicare Advantage Plan for myself. Yes, there are things I have to pay but what is covered by the Plan is 100 times better than my Son's Bronze ACA Plan.

Medicare sends dollars to the Provider of my Medicare Advantage Plan. The Government sends roughly $3,000 dollars (the subsidy) to the Provider of my Son's ACA Plan which includes his Wife. Thus both Insurance Companies are getting support from the Government .

It would be interesting to be able to compare the the dollars my Provider gets from Medicare to the dollars my Son's Provider gets from the taxpayers. Maybe then I would be able to understand why my coverage is so much better.

George
 

Timeshare Von

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For some, the ACA plans are seemingly the best we can do.

Our situation was that for 2014 and 2015 hubby and I had bought individual plans, not through the exchange. We had decent plans with $2000 deductible and $6600pp max out of pocket with 80/20 copays and reasonable doc and rx copays.

In September we were advised by our carrier that we were being non-renewed effective 1/1/16 because they no longer will cover Milwaukee County (where we live) and several surrounding counties.

We shopped and shopped, and to find a decent plan, our only option was through the exchange. Had we gone with a private plan outside of the exchange, the best we could get was a bronze plan with high deductibles and copays.

The alternative going with the exchange is that we got a gold level plan with $0 deductible, max out of pocket of $6850pp, 70/30 pays and reasonable doc & Rx copays.

For the new plans (changing companies) our rates went up 13%, keeping in mind the 2016 plans are not quite as good as what we have this year.

As a cancer survivor, it is critical that I am insured and that the out of pocket expenses for medical care are affordable. (My medical expenses this year were over $100,000 and I was only out of pocket the $6,600.)

There are new requirements, however, on the new ACA compliance plans for 2016. One is that I/we must use "free standing labs" in order to receive the maximum benefit under the 70/30 copay otherwise coverage drops to 50/50. This is the case with my routine labs as well as my cancer follow-up labs.

I'm not looking forward to having to chase around the city to find a free standing lab rather than using the lab located right at the cancer center where my oncology team is . . . but to keep my out of pocket expenses down, I don't have any choice.

There are other quirks now with this exchange medical plan . . . such as no three month mail order pharmacy so that will cost me/us more money.

I don't know all of the ins & outs of it, but clearly my healthcare coverage won't be as good as it was this year . . . and it's costing me a lot more money.
 

Timeshare Von

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Deleted original comment with quote of another poster's comment.
 
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presley

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To me it's the same as it has always been. The healthy pay for the sick. Our rates have gone up every year forever and the benefits slowly decline. I think Obamacare helps those who couldn't insurance before and it helps those who have serious health problems. Everyone else has to pitch in and pay for them now.

In my state, 18% of the people who originally signed up for the new plans have dropped them. There is supposed to be some big expensive investigation to find out why. I think it is simple. People who didn't have insurance before bought it, paid thousands of dollars, didn't go to the doctor and decided it was a waste of money. That' my take anyway. It's cheaper for the people who don't go to the doctor to pay out of pocket in the rare times that they do and pay the penalty for not having insurance.
 

Timeshare Von

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That would require some sort of government regulation of healthcare costs. If we're going to do that, we might as well just go to a single-payer system. Effectively, it would be nearly the same thing.

Sent from my Nexus 5 using Tapatalk

Personally, if insurance coverage was portable across state boundaries, I think rates would be more competitive.

Insurance here in Wisconsin is absurd because of the near monopoly held by a few big companies, all of which are tied into medical provider conglomerates. Aurora is the worst here!

When we moved back to Wisconsin from Iowa, even with employer sponsored plans, we saw our medical costs skyrocket (jumped 30%) and our benefits not nearly as good in terms of deductibles, copays and max out of pocket expenses.
 

Timeshare Von

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During my time working for an association of economists, I had the pleasure of attending a keynote speech by Harvard Professor Michael C. Porter. That was back in 2006. He said at the time, before all of the hub bub over ACA, that we needed to fundamentally change the value proposition equation in healthcare.

In most value based purchasing decisions, consumers attempt to obtain the best price/value. But the healthcare segment of consumerism, competition is not in play to help drive costs down like other consumer markets.

Rather, it is a massive shell game with the same costs being pushed around between the three entities involved . . . the medical provider, the insurance company and the consumer. Ultimately, the consumer will be left holding the bag on escalating costs. ACA did nothing to fix that; rather I would argue, it just continued the shove in our direction at an accelerated pace.

For more information on the work of Porter and his colleagues you can Google him and find his academic writings based on economic theory.
 

WinniWoman

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I would be careful about discussing this publicly on social media.

We were in similar situations (hubby and me) and when we asked about coding as screening vs. diagnostic, our doctor's office said that would be insurance fraud and they would have no part of it . . . particularly since we were seeing the same facility/doctor and our medical records could be viewed/audited by the insurance company.

In our case our first screening scopes were done in 2008 under an employer sponsor insurance plan and the most recent one was under our privately obtained individual plans in 2014. We both had polyps in 2008 so no longer screening option for us.

I hear ya. Adjustment in post made.Thanks. It's so ridiculous though. In reality, it really is a fine line between a screening and a diagnostic as the benign polyp was removed in the prior colonoscopy. But, like I said, insurance only covers preventative screenings every 10 years. I told my doctor that as long as my lab results come back negative this time, I am not coming back in 5 years. I will wait out the 10 years. (heck- I waited 8 years this time. Colon cancer is also very slow growing.). Although - I will have different insurance again in 5 years- then it will be Medicare!

It's crazy! These insurance companies have people jumping through hoops on everything.
 
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WinniWoman

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To me it's the same as it has always been. The healthy pay for the sick. Our rates have gone up every year forever and the benefits slowly decline. I think Obamacare helps those who couldn't insurance before and it helps those who have serious health problems. Everyone else has to pitch in and pay for them now.

In my state, 18% of the people who originally signed up for the new plans have dropped them. There is supposed to be some big expensive investigation to find out why. I think it is simple. People who didn't have insurance before bought it, paid thousands of dollars, didn't go to the doctor and decided it was a waste of money. That' my take anyway. It's cheaper for the people who don't go to the doctor to pay out of pocket in the rare times that they do and pay the penalty for not having insurance.


And- the funny thing is the insurance companies and employers are always promoting wellness- a good thing- to incentivize people with discounts on the premiums, like being tobacco free, and exercising, and getting routine exams and screenings. Yet- the premiums are still outrageously high and keep going up and up every year. So- sure we are grateful to be well and want to continue to be so- but then somehow we feel a bit resentful as we really are not seeing the financial benefit in the premiums that we should be. We are just told the premiums would be even higher then they already are. And every year it's the same old story.
 
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rapmarks

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my former brother in law was warned about prostate cancer issues five years ago. He chose not to pay for insurance until he got on Medicare. the cancer has spread to his bones and spine. Even with the ACA, he didn't try to buy insurance.
 

WinniWoman

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my former brother in law was warned about prostate cancer issues five years ago. He chose not to pay for insurance until he got on Medicare. the cancer has spread to his bones and spine. Even with the ACA, he didn't try to buy insurance.

Oh, no. That is terrible. I work in healthcare and I am seeing quite a number of people put off getting care because of cost even with insurance because of high out of pocket costs.
 

rapmarks

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I had an experience at the doctor on Friday that had me fuming.

In late October during an examination, we decided to dry the plugs for dry eye; I came back a couple of days later and had them inserted.
I was referred to an eyelid specialist, and after a two hour wait to see her, she said they were out and called my doctor to make the appointment to replace them.

Back to eye doctor, 9:30 appointment, in the chair at 10:45 at which time they told me I had to come back again because insurance required that I have the determination I need the plugs and the insertion on different days. I said you had the determination already, these are replacements. they said they would look into it.
After a few minutes I called my insurance company. They called the doctor's office and then got on the line with me. They said you can have them inserted, and if they fall out, you can get them inserted again today or any day. They told the doctor's office this. about 11:30, the office staff comes in, claims they insurance company wouldn't guarantee service and made me sign paperwork that I would pay if insurance refused coverage. I finally got them in. and there is no way to tell if they are still there!

At one time I had allergy testing and the office claimed that I had to return the next day for the doctor to tell me the results or I wouldn't get covered. this was way before ACA, but this whole system is a mess.
 
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