General Discussion
In reply to the discussion: Yes, the deductibles for a lot of people really stink in ACA [View all]mwooldri
(10,317 posts)Let's say you have a health insurance plan that covers in-network providers very well, but when it comes to out of network providers.. no so good...
You take your child to the ER, and your child needs surgery right there and then... the hospital is in network but the doctor isn't - and there is no choice to choose an in network doctor. Both bill separately. The doctor bills a large amount of money... the insurance company pays what is "reasonable and customary", and the plan has a high part that you are responsible for. Example: the doctor bills $20,000. Insurance says $10,000 is reasonable and customary, and sends you a check for $7,000 because the plan pays 70% for out of network providers. You owe the doctor $13,000.
If instead the doctor was in network, the doctor may still bill for $20,000, the insurance determines that the doctor is owed $5,000, and your in network part is 10%, insurance pays 90%. Your bill is $500.
A lot of people could work out that $500... $13,000 not so much. If there are any other financial pressures... bankruptcy can look very tempting.
This happened to me, and I have good insurance coverage through my employer that is better than plans on offer in the marketplace, cheaper, and covers more procedures...
Medical bankruptcy or IVAs (similar to a US chapter 13 bankruptcy) due to the medical bills are rare in the UK. Bankruptcies and IVAs because of reduced income caused by a medical situation.... same as other people who lose income due to other external forces. In the land of the free.... bankruptcy because of medical bills alone aren't rare.
Is the ACA perfect? Far from it. It's better than what it was before.... but this is good news for low to moderate income families... especially those who couldn't get insurance.
"ObamaCare" is a horrible brand... States need to take it over, rebrand it in their own state, implement Medicare expansion, and even possibly expand Medicaid further with a "buy-in option" that can be made available on the marketplace. This will increase competition with the private insurance companies... or lead to single payer in that state. Instead of Medicare for all it could be Medicaid for all.