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Tue Feb 25, 2014, 12:39 AM

 

ACA insurance. what you need to know about forced shit insurance

the max deductible for most plans is 6350 per year. That does NOT mean the bill is satisfied.

The insurance companies can continue to charge you 6350 EVERY YEAR until the hospital/nursing home bill is satisfied to their approval.

The Bronze plans cover 60/40, meaning insurance covers 60% and you cover 40%, after the deductible has been paid, which in the bronze plans is up to 6350 dollars per year.

The bill isnt magically written off after the 6350 has been paid. The Hospital/Nursing home will continue to bill you EVERY YEAR until the full balance, often including interest, is paid in full(up to the legally mandated 6350 per year)


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Arrow 133 replies Author Time Post
Reply ACA insurance. what you need to know about forced shit insurance (Original post)
frwrfpos Feb 2014 OP
NYC_SKP Feb 2014 #1
DURHAM D Feb 2014 #2
Cha Feb 2014 #43
frwrfpos Feb 2014 #4
NYC_SKP Feb 2014 #6
Ms. Toad Feb 2014 #25
lostincalifornia Feb 2014 #54
joeglow3 Feb 2014 #34
frwrfpos Feb 2014 #17
NYC_SKP Feb 2014 #22
frwrfpos Feb 2014 #29
NYC_SKP Feb 2014 #33
lostincalifornia Feb 2014 #57
OKNancy Feb 2014 #80
sabrina 1 Feb 2014 #27
NYC_SKP Feb 2014 #37
sabrina 1 Feb 2014 #44
VanillaRhapsody Feb 2014 #69
sabrina 1 Feb 2014 #72
VanillaRhapsody Feb 2014 #92
sabrina 1 Feb 2014 #100
progressoid Feb 2014 #104
VanillaRhapsody Feb 2014 #114
pnwmom Feb 2014 #111
VanillaRhapsody Feb 2014 #115
WorseBeforeBetter Feb 2014 #113
VanillaRhapsody Feb 2014 #116
WorseBeforeBetter Feb 2014 #118
VanillaRhapsody Feb 2014 #119
WorseBeforeBetter Feb 2014 #127
VanillaRhapsody Feb 2014 #119
WorseBeforeBetter Feb 2014 #128
VanillaRhapsody Feb 2014 #119
WorseBeforeBetter Feb 2014 #124
VanillaRhapsody Feb 2014 #126
SammyWinstonJack Feb 2014 #123
WorseBeforeBetter Feb 2014 #125
VanillaRhapsody Feb 2014 #129
pnwmom Feb 2014 #110
VanillaRhapsody Feb 2014 #117
sabrina 1 Feb 2014 #130
pnwmom Feb 2014 #132
Ms. Toad Feb 2014 #45
NYC_SKP Feb 2014 #46
Ms. Toad Feb 2014 #59
Demo_Chris Feb 2014 #91
NYC_SKP Feb 2014 #93
lostincalifornia Feb 2014 #58
JaneyVee Feb 2014 #99
sabrina 1 Feb 2014 #101
pnwmom Feb 2014 #108
sabrina 1 Feb 2014 #131
pnwmom Feb 2014 #133
Post removed Feb 2014 #3
missingthebigdog Feb 2014 #5
frwrfpos Feb 2014 #7
missingthebigdog Feb 2014 #9
lostincalifornia Feb 2014 #60
bravenak Feb 2014 #8
frwrfpos Feb 2014 #10
Lex Feb 2014 #11
frwrfpos Feb 2014 #13
Lex Feb 2014 #14
frwrfpos Feb 2014 #15
Lex Feb 2014 #16
frwrfpos Feb 2014 #20
Lex Feb 2014 #23
lostincalifornia Feb 2014 #65
jeff47 Feb 2014 #28
frwrfpos Feb 2014 #32
jeff47 Feb 2014 #36
sabrina 1 Feb 2014 #70
TexasTowelie Feb 2014 #76
Fumesucker Feb 2014 #78
sabrina 1 Feb 2014 #94
TexasTowelie Feb 2014 #96
sabrina 1 Feb 2014 #97
TexasTowelie Feb 2014 #103
sabrina 1 Feb 2014 #109
jeff47 Feb 2014 #84
phleshdef Feb 2014 #49
bravenak Feb 2014 #12
Sunlei Feb 2014 #53
lostincalifornia Feb 2014 #61
Bluenorthwest Feb 2014 #87
pnwmom Feb 2014 #106
Ms. Toad Feb 2014 #18
frwrfpos Feb 2014 #24
jeff47 Feb 2014 #30
joeglow3 Feb 2014 #31
Ms. Toad Feb 2014 #40
TexasTowelie Feb 2014 #74
Ms. Toad Feb 2014 #77
Ms. Toad Feb 2014 #79
alcibiades_mystery Feb 2014 #41
phleshdef Feb 2014 #51
lostincalifornia Feb 2014 #62
pnwmom Feb 2014 #112
TexasTowelie Feb 2014 #26
Ms. Toad Feb 2014 #42
TexasTowelie Feb 2014 #47
Ms. Toad Feb 2014 #52
TexasTowelie Feb 2014 #75
Pretzel_Warrior Feb 2014 #19
Recursion Feb 2014 #21
Ms. Toad Feb 2014 #48
Recursion Feb 2014 #50
Ms. Toad Feb 2014 #56
MysticHuman Feb 2014 #73
Ms. Toad Feb 2014 #85
MysticHuman Feb 2014 #102
Ms. Toad Feb 2014 #122
lostincalifornia Feb 2014 #67
Ms. Toad Feb 2014 #68
lostincalifornia Feb 2014 #71
Ms. Toad Feb 2014 #86
jeff47 Feb 2014 #35
davekriss Feb 2014 #38
bluestateguy Feb 2014 #39
krawhitham Feb 2014 #55
lostincalifornia Feb 2014 #63
TheKentuckian Feb 2014 #81
lostincalifornia Feb 2014 #82
Pretzel_Warrior Feb 2014 #66
Bluenorthwest Feb 2014 #89
Pretzel_Warrior Feb 2014 #64
uppityperson Feb 2014 #83
Dorian Gray Feb 2014 #88
FSogol Feb 2014 #90
postatomic Feb 2014 #95
NCTraveler Feb 2014 #98
pnwmom Feb 2014 #105
Hoyt Feb 2014 #107

Response to frwrfpos (Original post)

Tue Feb 25, 2014, 12:44 AM

1. Since we're cursing, are you really somehow bitching about the Affordable Healthcare Act????

 

Because I will shut you down unless you can come up with some fucking links and stats.

My COBRA was over $1,300, now my ACA plan is $544.

Did nursing homes used to be free or something?

What is your beef, again?

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Response to NYC_SKP (Reply #1)

Tue Feb 25, 2014, 12:48 AM

2. I think the problem is beer, not beef.

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Response to DURHAM D (Reply #2)

Tue Feb 25, 2014, 01:51 AM

43. Good

analysis.

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Response to NYC_SKP (Reply #1)

Tue Feb 25, 2014, 12:49 AM

4. the links and stats are in the ACA language

 

There is nothing stopping insurance companies from charging consumers the max deductible every year until the bill is paid in full

COBRA has exactly nothing to do with the ACA and how it has been implemented.

No, nursing homes were never free, in fact many are for profit.

Which continue to fuck over anybody who buys shit health insurance.

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Response to frwrfpos (Reply #4)

Tue Feb 25, 2014, 12:53 AM

6. You would do well to be specific in your Original Post (OP) rather than expect us to do the research

 

Because I DID the research as it applied to me, I don't need to back up your observations.

I'm sorry that you're disappointed.

EOM

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Response to frwrfpos (Reply #4)

Tue Feb 25, 2014, 01:23 AM

25. Nonsense.

You fundamentally misunderstand insurance.

Bills do not carry over from one year to the next. Once you have hit the out of pocket maximum, you pay nothing more on any covered expense incurred in that year.

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Response to Ms. Toad (Reply #25)

Tue Feb 25, 2014, 02:21 AM

54. Exactly, that is the way it always has been with insurance

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Response to frwrfpos (Reply #4)

Tue Feb 25, 2014, 01:34 AM

34. Expenses are recorded in the year incurred

 

You pay your out of pocket max and the insurance company pays the rest. The hospital or other facility will not charge you the next year, as their bill would have been satisfied.

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Response to NYC_SKP (Reply #1)

Tue Feb 25, 2014, 01:12 AM

17. COBRA is for unemployed people

 

and 544 is almost half of my monthly wages, so yea, I have a beef with that example. No One who makes anywhere between 7 and 11 bucks an hour can pay for insurance that costs 500 plus dollars a month.

Nursing homes and hospitals should all be non profit. Unless you think that making money off of sick and dying people is a good thing.


Sick stuff

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Response to frwrfpos (Reply #17)

Tue Feb 25, 2014, 01:19 AM

22. Have you even looked into an ACA plan? If you take home $1088/month your plan will be almost free.

 

Which is so much better than using expensive ERs for healthcare, or stiffing doctors, or getting sicker, or whatever one does.

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Response to NYC_SKP (Reply #22)

Tue Feb 25, 2014, 01:29 AM

29. I did look itno in very extensively. I take home around 1200 a month

 

the cheapest plan was 90 a month with a 6350 deductible. That is not affordable at all. And I use CHC's. ER's bankrupt people by going after them in collections. So do many Dr practices.

You seem to completely miss the point that this law forces people on the financial edges into financially shit situations by forcing them to choose between paying for insurance they cant afford to use or being fined/taxed.

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Response to frwrfpos (Reply #29)

Tue Feb 25, 2014, 01:34 AM

33. So, about 1.5 days of work to pay that expense? Super! What did you pay before?

 

Don't get me wrong, you might not have paid anything before, but you also didn't have any preventative care or anything to prevent creditors from taking what few pennies you have.

Give it time, your salary or wages will increase and when they do you'll thank Obama for this over what there was before.

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Response to frwrfpos (Reply #29)

Tue Feb 25, 2014, 02:26 AM

57. If you take home 1200 a month you qualify for the subsidy, heck, you might qualify for the Medicaid

expansion.

The limits are the following:

Up to the low 40Ks a year if you are single, you qualify for a subsidy

Up to 63K a year if their are two people, you qualify for a subsidy, so I don't know where you are getting your facts.

In addition, if the premium of the bronze plan exceeds 8% of your income you can be exempted from the ACA mandate. That means no fine, no taxes.

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Response to frwrfpos (Reply #29)

Tue Feb 25, 2014, 09:18 AM

80. about the same as my daughter

hers is a 0 deductible, silver plan. low co-pays. With the subsidy it's $28.00 per month. It's Blue Cross/Blue Shield.
( She is only 29, so that could be one reason for her low rates )

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Response to frwrfpos (Reply #17)

Tue Feb 25, 2014, 01:27 AM

27. I'm sorry, truly I am. We have tried to point out how this legislation effects the poorest

people, but there is simply NO empathy for the poor here on DU anymore. It is all about politics. I will not be covered either, but so what, I never was, I just won't get sick I suppose. I have been lucky so far in managing to be healthy. And I won't pay any fines either, they will have to sue me. I have other more important bills to pay. But I don't bother talking about my situation here on this forum where all you will get for being poor, is attacks, sadly.

Otoh, as Wendell Potter told us BEFORE this Health Insurance bill passed, when he expressed his concerns for the uninsured who were going to cow stalls to get free treatment from organizations that normally operate in Third World countries, to his Insurance Corporation employees, expecting some empathy from them, they told them what they saw in his photos of Americans lining up for third world charity, was 'a whole new market'. He realized then the Ins Corps were going to try to get Medicaid to pay THEM first after which they would take out about 30%, reduced later to approx. 20% or so we are told, in PROFIT. Money that in the past went directly to HC for the poor.

I apologize to you for the treatment you are getting. It is the reason why I don not discuss my personal problems here ever. Unless it makes the Dem Party look good, your situation, sadly, is of no interest here anymore. Most progressives who fought for the poor here have moved on. All I can do is wish you well. We who cannot afford HC have no advocates.

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Response to sabrina 1 (Reply #27)

Tue Feb 25, 2014, 01:38 AM

37. +1 Unkind remarks aren't helpful.

 

I don't think anyone who hasn't the funds will actually be fined, and their chances of care are probably going to be better than before, I mean how can they NOT be?

Mitch McConnell will probably lose his seat, and maybe others, so I think this is a good thing.

But I've yet to meet a person who will truly be WORSE off under ACA than they were before, so the complaint is largely that it's not as much as we deserve, which is true, but to suggest that it's worse is, I think you would agree, is just a misstatement.

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Response to NYC_SKP (Reply #37)

Tue Feb 25, 2014, 01:53 AM

44. People who had no coverage because they could not afford it, and no, we were not, as

Right Wingers often claimed, trying to get a free ride and letting others pay for our HC, something that made me shudder when I heard the president I supported repeat btw, we simply could not afford it. Now we have a bill to pay which formerly we did not have OR pay a fine. I supported this president over Hillary partly because he addressed this problem directly when he opposed mandated insurance. He said, and I applauded him at the time for saying so, in opposition to Mandated Ins, 'if we could solve homelessness by forcing the homeless to buy homes, we would do it'. And then, he betrayed those of us who thought he understood.

Now people like me are worse off, because we have no choice but to pay a bill we did not have to pay before. I have been healthy so never have 'used' others to 'pay my HC bills' as the Right often said. 44, 000 Americans die each year BECAUSE they cannot pay for HC and unlike me, have sadly been sick.

Frankly I don't care anymore one way or the other about this bill. I opposed it but Dems passed it, Repubs letting them do it alone and take the blame for WHAT THEY ACTUALLY wanted. All I care about are the bills we need to pay which are getting higher and higher each day. I will not pay for a shoddy product I probably won't be able to use due to the high co-pays for those who can only afford the cheapest in order to avoid the fine.

But all this was discussed long ago. Now we all have to make choices on which bills are most important and whether a fine for not buying a product from a private corporation is cheaper than buying that shoddy product. I made my decision but I can understand how others, who may need HC, are suffering with that decision. Clearly there are, as we predicted, many people who will be worse off now. But who cares? We have been told how wonderful it is, yes, for those who HAD coverage, who could afford it.

I don't need anything from anyone. I'm just trying to offer some understanding to the OP because I know s/he is suffering and not too many care. It's all about 'winning', for someone, somewhere I suppose.

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Response to sabrina 1 (Reply #44)

Tue Feb 25, 2014, 03:15 AM

69. do you live in a state that didn't expand Medicaid?

 

cuz that is what I am guessing....If so your fight isn't with the ACA.....your fight is your governor....take it up with him or her. Bashing the ACA which HAS helped millions is not changing your situation...

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Response to VanillaRhapsody (Reply #69)

Tue Feb 25, 2014, 03:38 AM

72. My fight is to pay the most important bills which are increasing each and every day.

I will do as I have always done, try to survive the increases in home heating Oil, Electirciy and Propane, property taxes which were just told will be increasing by over 8% or 'suffer cuts to services'. I don't have TIME to negotiate complicate bills that at the moment I thankfully don't need. My priorities are to survive all the other increases and I will NOT be buy a shoddy product from a HC Insurance Corp that I don't need right now nor will I pay any fine.

I am in NY where we are currently trying to stop them from fracking, taking over private property IF they should need it. Frankly I don't much care about HC right now. I once had dreams that if we elected Dems, Obama eg, who OPPOSED mandated ins, we would not have to worry about being forced to pay yet another bill we don't need at the moment. And yes, some people are struggling day to day to simply survive, and this latest 'bill' is at the bottom or our needs right now. Let them fine us for not being able to deal with this latest burden, we will have to go to court I suppose. But we cannot afford one more unnecessary bill for a product we will not be able to use, simply to provide profits for Private Corps.

I don't have time to negotiate these complex issues, I am more than occupied just trying to negotiate what is NECESSARY right now. Nothing that deals with people's health should be this complicated. Unless you've been in a situation where each day you have to worry about the lights being turned off, or the oil running out in zero degree temps, I guess you wouldn't understand.

And neither do our billionaire Reps. We need Reps who do understand, but money from Corps ensures such candidates will never make it. So here we are after all the hope for a better country, just totally disillusioned and being slammed by our OWN party for not being rich enough to cheer for this legislation.

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Response to sabrina 1 (Reply #72)

Tue Feb 25, 2014, 01:23 PM

92. YOUR fight is with YOUR governor....

 

take it up at the State House....

The ACA is a fine first step and it has already helped millions....

But I guess since Sabrina didn't get hers.....we should tell all those other millions it has helped to just piss off.

(But we must ALL blame President Obama because Sabrina didn't get "hers".....because it fits her standard narrative).

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Response to VanillaRhapsody (Reply #92)

Tue Feb 25, 2014, 03:35 PM

100. Thanks for your understanding of the poor who actually don't need

heartlessness, they experience enough already. I personally am fine, and not at all worried about myself, I am worried about those I know who are not even aware of this law, too busy trying to survive. It's okay that you feel they are just selfish, they are not concerned about your opinion of them.

However this: But I guess since Sabrina didn't get hers.....we should tell all those other millions it has helped to just piss off. .... is exactly what I was talking about to the OP, not to expect anything resembling empathy here, which at one time, before so many progressives moved on, represented the best of this country's progressive democrats.

I appreciate you providing me with a perfect example of what I was talking about .... this is not the place to go to when you can't afford HC anymore.

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Response to sabrina 1 (Reply #100)

Tue Feb 25, 2014, 03:48 PM

104. ...



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Response to sabrina 1 (Reply #100)

Tue Feb 25, 2014, 04:42 PM

114. What you NEED to do is focus on what CAN help you....not just complaining about OBAMA!

 

Does that help your situation? No it doesnt...

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Response to VanillaRhapsody (Reply #92)

Tue Feb 25, 2014, 04:07 PM

111. NY has accepted expanded Medicaid, so anyone with income that low should be benefiting greatly. n/t

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Response to pnwmom (Reply #111)

Tue Feb 25, 2014, 04:43 PM

115. Exactly...some on DU just like pissing and moaning about Obama though...

 

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Response to VanillaRhapsody (Reply #92)

Tue Feb 25, 2014, 04:27 PM

113. Aaaand the pony rears its ugly head.

Bra-vo.

This crew has been taking it to the North Carolina state house for going on a year:



And from what I hear, it will take ten more years to undo the damage caused by the Republican takeover. A takeover that occurred because wingnuts hate the ACA. Thanks, Obamacare!

Meanwhile, thousands suffer and your compassionate reply -- "Sorry you didn't get yours, suckers"?

New studies: Medicaid opt-out costly for NC

It's obvious many on this board have a hard-on for Sabrina, but your reply was just rude.

Stay classy, classiest of classy Obama fans.

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Response to WorseBeforeBetter (Reply #113)

Tue Feb 25, 2014, 04:44 PM

116. thats not my reply....that is HERS!

 

She is saying PISS on all those poor people that HAVE been helped.....because she wants to Rag on Obama....

I am not fooled for a minute...

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Response to VanillaRhapsody (Reply #116)

Tue Feb 25, 2014, 04:56 PM

118. Here's how your messages come across...



"She is saying PISS on all those poor people that HAVE been helped"

No, Vanilla, no she's not.

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Response to WorseBeforeBetter (Reply #118)

Tue Feb 25, 2014, 05:09 PM

119. Yes in fact she IS.....She is Anti-Obama AND anti-ACA....

 

she refuses to accept the help that is there for her.....she just wants to Rag on Pres. Obama...


I am not fooled for a minute...

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Response to VanillaRhapsody (Reply #119)

Tue Feb 25, 2014, 05:38 PM

127. 1x...

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Response to WorseBeforeBetter (Reply #118)

Tue Feb 25, 2014, 05:09 PM

119. Yes in fact she IS.....She is Anti-Obama AND anti-ACA....

 

she refuses to accept the help that is there for her.....she just wants to Rag on Pres. Obama...


I am not fooled for a minute...

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Response to VanillaRhapsody (Reply #119)

Tue Feb 25, 2014, 05:39 PM

128. 2x...

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Response to WorseBeforeBetter (Reply #118)

Tue Feb 25, 2014, 05:09 PM

119. Yes in fact she IS.....She is Anti-Obama AND anti-ACA....

 

she refuses to accept the help that is there for her.....she just wants to Rag on Pres. Obama...


I am not fooled for a minute...(by you either)

and Kathleen Sebelius agrees with me.....her issue is her gov if they haven't expanded Medicaid..

http://www.democraticunderground.com/1251354987

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Response to VanillaRhapsody (Reply #119)

Tue Feb 25, 2014, 05:32 PM

124. I can typing 3x!

I live in NC. Trust me, I know ALL ABOUT governors who haven't expanded Medicaid.

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Response to WorseBeforeBetter (Reply #124)

Tue Feb 25, 2014, 05:38 PM

126. then what is your major malfunction....that is what I SAID!

 

her problem ISN'T ACA.....her problem is her governor....as is YOURS!

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Response to WorseBeforeBetter (Reply #118)

Tue Feb 25, 2014, 05:25 PM

123. ROFL!

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Response to SammyWinstonJack (Reply #123)

Tue Feb 25, 2014, 05:37 PM

125. Careful... you'll be accused of "not fooling anyone."



Better yet, join the club!

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Response to WorseBeforeBetter (Reply #125)

Tue Feb 25, 2014, 05:55 PM

129. Yes that would be the Hate Obama and everything he does Club...

 

they just hate his guts!

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Response to sabrina 1 (Reply #44)

Tue Feb 25, 2014, 04:06 PM

110. Congratulations on having always been healthy. You are deluding yourself if you think

that makes you invincible.

If you are low-income, as the poster you are addressing, then you can buy good insurance with a large subsidy both for the premium and for the deductible. You should get the facts rather than reinforcing the poster's ignorance.

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Response to pnwmom (Reply #110)

Tue Feb 25, 2014, 04:46 PM

117. She will forgo it if it means she can complain about Pres. Obama causing her problems...

 

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Response to pnwmom (Reply #110)

Tue Feb 25, 2014, 06:30 PM

130. I'm afraid you just don't understand. Let me put it this way, the working poor

don't have ANY extra income, NONE, ZERO. Many can't even afford school lunches, or three full meals a day. Now you are advising them to 'buy a good insurance policy'. Do you actually know anyone with a family whose income already doesn't cover the ever rising bills while the salaries do not keep up with them?

Giving that advice, 'just go buy a good insurance policy and then do the research to see what can you get to REDUCE it' is like telling someone with no vision to go look at the beautiful sunset, somehow oblivious to the fact that they won't be able to see it.

I know it's hard for a lot of people to even imagine the plight of the working poor. And that is why we have to put people in office WHO DO. This bill was thought up by business people whose lives are far, far removed from those of the working poor which is why it is so easy for THEM to toss out these 'products' to the public and just assume, ironically as Repubs always have, that anyone who can't afford any of it, is just too lazy and dependent.

I can't help you to understand, so I'll leave it at that, and restate, this is not the place for the working poor to come to for help. There are places, thankfully, and still people who are capable of understanding and they are better off, and it appears there are not many here seeking advice anymore, going elsewhere, where people are not looking to defend politicians, but really are interested in helping people.

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Response to sabrina 1 (Reply #130)

Tue Feb 25, 2014, 08:36 PM

132. I helped a young woman who is a member of the "working poor" sign up for Medicaid.

You are wrong. It covers everything -- she won't have any expenses to pay for.



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Response to NYC_SKP (Reply #37)

Tue Feb 25, 2014, 01:56 AM

45. There are people who are worse off

Young, healthy people are a prime example. Their rates will - by and large - be higher than before the ACA.

And people, like my daughter, are better off - but heavily penalized for having a chronic illness. Her costs - every year - will be $6350 (or whatever the max is for each year) + premiums. Granted - she is far better off than she was before (her only options were the limited open enrollment plans at around $20,000/year). But, compared to people who have an occasional expensive year, these plans do not serve her well.

I am grateful it passed, and fought like hell to get Obama elected again to make sure it would not be repealed. And it is not enough.

But what I find intolerable is spreading lies about how the ACA works. It doesn't matter whether you support it or oppose it, the debate should be based in fact.

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Response to Ms. Toad (Reply #45)

Tue Feb 25, 2014, 02:02 AM

46. Young and healthy people who "never need care" are, indeed, not better off.

 

But that's not the way insurance works, or has ever worked.

It's like saying safe drivers who are really careful are screwed by having to carry auto insurance.

Life simply isn't that predictable.

And, true, some younger workers may have higher premiums under ACA than actual premium prices before, I don't know and never asked a person in their 20s about that.

It's not single payer, not yet, but it's immensely better for the vast number of Americans than what was before, and a step in the right direction.

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Response to NYC_SKP (Reply #46)

Tue Feb 25, 2014, 02:31 AM

59. Agreed. n/t

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Response to NYC_SKP (Reply #46)

Tue Feb 25, 2014, 01:07 PM

91. young means poor, but screw them right? Older affluent folks need their money. nt

 

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Response to Demo_Chris (Reply #91)

Tue Feb 25, 2014, 01:49 PM

93. How do you figure? I mean that's the model for social security.

 

Except that ACA is means tested, so the affluent don't really benefit so much and probably don't even use it.

Think that one through again, I think you miss how the thing works.

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Response to NYC_SKP (Reply #37)

Tue Feb 25, 2014, 02:30 AM

58. The ACA specifically says you will not be fined if the premium of the bronze plan exceeds 8% of your

income. In that case you are not subject to the mandate.

However, based on what the OP said he makes, he is entitled to a subsidy, and maybe Medicaid.

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Response to sabrina 1 (Reply #27)

Tue Feb 25, 2014, 03:28 PM

99. There is no actual penalty to not getting insurance unless you get a tax refund,

 

Then it will be 1% if you make over $9500/yr. there is also no criminal charges for avoiding the penalty.

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Response to JaneyVee (Reply #99)

Tue Feb 25, 2014, 03:40 PM

101. Well, that doesn't help someone who earns $15, 000 or more. Their tax return, if they

even have one, is like gold to someone who is earning so little. To try to take ANY of that away is simply cruel. As for there being no criminal charges, sorry, I find it difficult to find words to express my feelings that this was ever even a THOUGHT, let alone proposed, initially and can only thank all those who expressed so much outrage over such a draconian proposal it became too toxic to try to enforce anymore. The words 'criminal' and 'Healthcare needs' should NEVER been spoken in the same sentence in this democracy.

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Response to sabrina 1 (Reply #27)

Tue Feb 25, 2014, 04:02 PM

108. This person isn't giving the facts. It is not mean to correct mistakes that could hurt this person.

With an income that low, s/he will be eligible not only for a subsidy paying the monthly premium, but another subsidy/credit on the $6350 deductible s/he's worried about.

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Response to pnwmom (Reply #108)

Tue Feb 25, 2014, 07:26 PM

131. I'm envisioning a place where when someone is sick, they go to the doctor/hospital

and get the treatment they need. I remember in Michael Moore's 'Sicko' he took the trouble, mainly to slap down the Right Wing noise machine's lies about other countries where they actually had such a system, he went to the hospital in Canada, in Cuba even, and on his way out, asked for the bill. Or paperwork or something to show that everyone has to wade through all the hurdles and forms etc that we in the US sadly have taken for granted. He even argued with the receptionist in one hospital who told him 'there is no bill'. Yes, he was exaggerating in order to make his point.

Having been in countries where this was the case, forgive me if I have problems with HC being 'sold in a marketplace' where naturally the most wealthy will be able to buy the best 'product'. I never supported this, it's a done deal now, which doesn't mean I have to turn around and start supporting it now. Actually Obama himself didn't support it as a candidate. He has never explained to those of us who agreed with him then, what changed his mind. Nothing I have seen has changed mine.

All we can do now is to continue to fight for what we should have as a civilized nation, Health Care as a right, not a product and try to make the best of what we got, for now.

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Response to sabrina 1 (Reply #131)

Tue Feb 25, 2014, 08:39 PM

133. The ACA is making it possible for Vermont to expand clinics

as well as to switch to Single Payer in a couple years.

Any state could do this with help from the ACA, but Vermont will be the first.

I agree that single payer would be the best. But the ACA is a large step forward in the right direction, and you don't help your case against it by lying about what it will offer to poor people through the expanded Medicaid program.

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Response to frwrfpos (Original post)


Response to frwrfpos (Original post)

Tue Feb 25, 2014, 12:51 AM

5. This simply isn't true.

Please provide links or stop posting about this.
There are some legitimate problems with ACA, but you seem to be misinformed about what they are.

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Response to missingthebigdog (Reply #5)

Tue Feb 25, 2014, 12:54 AM

7. yes, it is true.

 

The Bronze Plan has an actuarial value of 60%. This legally leave the consumer on the hook for 40% of the bill. The max out of pocket every year is 6350, until the balance is paid off, every single year

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Response to frwrfpos (Reply #7)

Tue Feb 25, 2014, 12:57 AM

9. I don't have time to educate you on this.

I suspect you don't really have any interest in being educated.

Go and try to find some links to support your position. In so doing, I think you might discover the truth.

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Response to missingthebigdog (Reply #9)

Tue Feb 25, 2014, 02:45 AM

60. You are correct. In addition, the yearly physical is NOT subject to the deductible, and based on

his income of 1200 a month, the subsidy should cover the premium.

However, assuming 1200/month income, that would be 14400/year. I put those figures into the CoveredCa calculator and it said the following:

Good news! Because your household income is below the Medi-Cal limit, you may qualify for Medi-Cal. To get more information about Medi-Cal, you can call or visit your county social services office.

Now this is California, and perhaps his state is different, but if it is because they haven't expanded Medicaid under the ACA, that isn't the fault of the ACA, but of the state the person lives in

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Response to frwrfpos (Original post)

Tue Feb 25, 2014, 12:54 AM

8. Calm the heck down!!

 


We all want single payer!


If you don't want the insurance you can pay the fine. You might even get a waiver from paying the fines if you don't make much.

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Response to bravenak (Reply #8)

Tue Feb 25, 2014, 12:57 AM

10. Im not buying the shit insurance and Im not paying to be poor

 

I make 10 an hour or so and even after the subsidy is 90 a month, which is unaffordable in addition to the 6350 deductible every year

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Response to frwrfpos (Reply #10)

Tue Feb 25, 2014, 12:59 AM

11. OK, good, so don't.

Doesn't sound like you make enough to be fined anyway.

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Response to Lex (Reply #11)

Tue Feb 25, 2014, 01:01 AM

13. yes I do make enough to be fined

 

anything over poverty level people are going to get fined for, unless they qualify for medicaid, which almost half the states refused to implement. That leaves millions of working poor to buy insurance they cant afford to use or pay a fine.

Its fucking cruel and a joke

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Response to frwrfpos (Reply #13)

Tue Feb 25, 2014, 01:04 AM

14. If one makes enough to qualify for Medicaid, then the penalty is waived.

Even if that state didn't implement the Medicaid expansion.

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Response to Lex (Reply #14)

Tue Feb 25, 2014, 01:07 AM

15. 10 dollars an hour does not qualify me for medicaid

 

its makes me just above the poverty line but subject to being fined for not buying this insurance which would bankrupt me anyway

The penalty is NOT waived for anybody making a dollar more than those above the poverty line.

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Response to frwrfpos (Reply #15)

Tue Feb 25, 2014, 01:09 AM

16. So how much is your monthly premium?

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Response to Lex (Reply #16)

Tue Feb 25, 2014, 01:15 AM

20. it would have been 90 a month

 

and I make a bit over 10 an hour. That is absolutely unaffordable for me. Would you have me cut a weeks worth of groceries? How about asking my landlord to live for free for a few days a month? Or maybe walking 9 miles to work 7 days out of the month?

What fucking country do I live in that thinks this is ok?

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Response to frwrfpos (Reply #20)

Tue Feb 25, 2014, 01:20 AM

23. There are lots of exemptions at this link

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Response to frwrfpos (Reply #20)

Tue Feb 25, 2014, 03:02 AM

65. Then tell what state are you from. I would like to plug in the figures myself to verify

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Response to frwrfpos (Reply #13)

Tue Feb 25, 2014, 01:28 AM

28. Nope.

unless they qualify for medicaid, which almost half the states refused to implement

Nope, the penalty is waived if you would have qualified for expanded medicaid. You were provided a link on the other thread you were ranting in.

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Response to jeff47 (Reply #28)

Tue Feb 25, 2014, 01:33 AM

32. wrong

 

I dont qualify for expanded medicaid because it wasnt expanded in my state! duh! so now im going to be fined/taxed for it.

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Response to frwrfpos (Reply #32)

Tue Feb 25, 2014, 01:37 AM

36. Reading. You should try it.

Go look at the post again, and notice where it doesn't require medicaid to actually be expanded.

Even better, I'll quote and underline it.

Nope, the penalty is waived if you would have qualified for expanded medicaid.


If you would have qualified under expanded medicaid, then you owe no penalty. Even if your state did not expand medicaid.

You were even provided with links in the other thread describing this. It's almost as if you're not paying attention, and are just looking to yell about stuff. Too bad you're wrong about your tirade.

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Response to jeff47 (Reply #36)

Tue Feb 25, 2014, 03:18 AM

70. It's really nice, and I mean that, that you are in a position where your every thought

isn't about how are we going to pay the electric bill which has gone up this month, or convince the oil company to deliver a few gallons of oil, also increased beyond what we can afford, so our children or elderly parents don't freeze, or try to buy enough food which has also gone up so at least the children have enough to eat, that you have time to sit at your computer and figure out these incredibly complicated issues regarding whether or not someone whose main concerns is just surviving until tomorrow, can afford to pay one more bill they did not have to worry about BEFORE this legislation passed.

Why is this so complicated that it requires someone to spend time they DON'T have, workiing two and sometimes three jobs to just survive in this society?

It's nice of you to throw more complicated mish mash at someone who has clearly told you they cannot afford one more bill. I know, because neither can I. People have to make choices, whether to spend time trying to negotiate this complicated 'garbage', which is what it is to those trying desperately to stay warm, to eat, to pay the electric bill, many don't have a computer, to decide if they can afford ANOTHER bill to pay for a shoddy product from a Private Corp they cannot afford, or just pay the fine?? A FINE for being too poor to buy a shoddy product which they cannot use due to the high copays when you can ONLY afford the cheapest product?

Hey, thanks for your empathy for all those who have more to do and think about than spend hours trying to figure out if they can afford to be sick, or not.

Appalling, the attitude here towards the working poor. I don't recognize this as a progressive democratic forum anymore.

My heart goes out to the OP but I have nothing to offer her/him. We lost, they won and many of us will be more burdened as the HC Corps are bailed out with Medicaid money, and we are fined for not being able to buy their shitty product.

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Response to sabrina 1 (Reply #70)

Tue Feb 25, 2014, 04:46 AM

76. If you don't recognize this as a progressive democratic forum anymore,

then why are you still here on DU?

Personally, I don't hang around anywhere that I don't feel welcome or relate to the people that assemble there. It seems almost masochistic to subject yourself to the anguish if you truly feel that way about DU.

Please note that I'm not unsympathetic to your circumstances since I'm also struggling financially and receiving my health care through a community clinic.

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Response to TexasTowelie (Reply #76)

Tue Feb 25, 2014, 07:17 AM

78. I feel much the same way and I'm still here

Mostly out of habit these days and because I like some of the personalities, like Sabrina1 for instance.

And I also find this place utterly hilarious nowadays, watching the spinning gyrations to defend all things Obama particularly on things like the mandate for private insurance which Obama specifically ran against is funny as all get out.

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Response to TexasTowelie (Reply #76)

Tue Feb 25, 2014, 01:51 PM

94. I feel very welcome here but thanks for your concern. Sorry, we haven't met before

welcome to DU. I always feel wecome where people support Democratic policies such as HealthCARE for all who need it, as a RIGHT, not a commodity, how about you?

I certainly was never welcome on right wing sites where mandated insurance throughout the Bush years when Romney was pushing it in Mass, was their choice in order to 'force those lazy lieberals who live off of other people, would be FORCED to pay their fair share'. Remember that? So I supported Obama for president, who opposed Mandated Ins agreeing with him that you can't force people to pay for something they cannot afford. Did you agree with that very Progressive Democratic viewpoint or with those on the Right who slammed him for speaking out against their policies?

You are unsympathetic to those Obama was speaking of when he was campaigning against mandated insurance. But that's okay, those of us who remain progressive regarding policies will continue to push for Progressive Health Care policies as we always have. I don't support Corporate takeover of public funds, never have and never will, not even when some dems get roped in to suchv policies, for a while.

Thanks for demonstrating why most of us Liberals fought and continue to fight hard for the poor though. There isn't much sympathy for them in a corporate controlled society where all they are viewed as are potential profit for Corporations. Thanks to Wendell Potter, Whistle Blower, for confirming the attitude of the Health Insurance Corps who are nothing more than middlemen who do nothing other than profit, for people's health care, and who need to be removed from that position so ALL HC money is used for that purpose.

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Response to sabrina 1 (Reply #94)

Tue Feb 25, 2014, 03:03 PM

96. First, let me introduce myself to you.

I've been here at DU for 2.5 years and the majority of my posts are in the Texas and LGBT groups.

And now let me address three of your misconceptions:
a) I did not make or imply any statement about health care being a commodity instead of a right.
b) I did not make any unsympathetic statements to those Obama was speaking of when campaigning against. The final paragraph of post #76 indicates exactly the opposite.

I regret if you were unwelcome on RW sites discussing the Romney mandated insurance plan, but I had nothing to do with that since I didn't have Internet access prior to 2011 except at work and was prohibited from browsing while employed. It does reinforce the point that I tried to make about hanging around places (or Websites) where you do not feel welcome though.

I admit that I was offended by your accusations since I don't recall making any statements along those lines ever--anytime, anywhere. So please make certain that the accusations that you are hurling around at other people are correct before doing so since you are most certainly uninformed about me or what I believe.


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Response to TexasTowelie (Reply #96)

Tue Feb 25, 2014, 03:17 PM

97. I believe you suggested that I should leave DU suggesting that I did not 'feel welcome' here.

I did not 'hang around 'right wing' sites, knowing full well that a Liberal Democrat who supported at least a Public Option, among other Liberal viewpoints would not be welcome there for very long, in fact I would have been banned after one post, which is fine with me, a testament to my Liberal Creds.

I am still at a loss, though NOT offended, I don't offend easily, as to why YOU suggested that someone whose Liberal views are well known here on this Liberal Democratic site, was not welcome here.

If supporting Healthcare for all now makes someone unsuitable for DU, no one told ME we had abandoned Progressive Democratic support for Progressive Democratic policies.

I'm sorry you were offended, my intention was to correct your assumption that a Progressive Democrat supporting Progressive policies such as myself, should not feel welcome here on DU where I have been a member for over nine years.

I don't recall pushing Right Wing policies in my comments in this thread, on the contrary, I have stated clearly and always have, my opposition to Right Wing policies, one of which is mandated insurance.

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Response to sabrina 1 (Reply #97)

Tue Feb 25, 2014, 03:43 PM

103. And I apologize for making the suggestion that you leave DU, but it seems that you were discontent

with a large segment of DU because we are trying to make the best of the new law that we can. However, the original OP made several statements that were erroneous and most of the responses in the thread were made to correct those misstatements about the current law instead of returning to the debate about universal care, the public option, mandated insurance or any other health care mechanism.

You are certainly within your rights to advocate for healthcare for all and I support you in that cause since I also am a Progressive Democrat.

Please note I also didn't make any statement about you favoring RW policies on DU or anywhere else since I have no reason or evidence to support such an accusation. It's your right to comment on those sites if you wish, but I avoid those sites since it probably isn't good for my blood pressure or mental health.

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Response to TexasTowelie (Reply #103)

Tue Feb 25, 2014, 04:05 PM

109. No problem. I understand trying to make the best of what we got.

But I opposed this bill before it passed and can't pretend to support it now, that would be dishonest. However it passed, a once in a lifetime opportunity was missed to get a better bill especially since they were able to pass it without one Republican vote. That has angered many Democrats who worked so hard for their party and while we have no choice but to accept it for now, I believe people have a right from now on to be very skeptical of campaign promises, and they are.

As for dealing with right wingers politically, I encountered many of them on mixed sites during the Bush years, before finally discovering that there were Dem sites, I agree regarding it not being good for one's health to even try to talk to them.

Anyhow, no problem, it was a misunderstanding, that is all

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Response to sabrina 1 (Reply #70)

Tue Feb 25, 2014, 11:48 AM

84. That's why they set up the navigator program

Why is this so complicated that it requires someone to spend time they DON'T have, workiing two and sometimes three jobs to just survive in this society?

That's why they set up the navigator program. They can help walk you through the complexity, without you having to take the time to understand the law.

It's nice of you to throw more complicated mish mash at someone who has clearly told you they cannot afford one more bill.

Except they aren't doing that. They've already been provided with links showing they would owe no penalty, and that they're wrong about how the out-of-pocket cap works. Then they created this thread, and ranted about the penalty and the out-of-pocket cap.

Almost like they low-post-count person might not be what they seem.

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Response to frwrfpos (Reply #32)

Tue Feb 25, 2014, 02:06 AM

49. No, anyone that would've qualified for Medicaid, but can't because of their state, is exempt.

 

If you wouldn't qualified for Medicaid under the expansion (that didn't happen in your state), then that means your income is WELL below the income level where the mandate kicks in.

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Response to frwrfpos (Reply #10)

Tue Feb 25, 2014, 01:00 AM

12. Don't pay the fine.

 

They can't lock you up for it. Are you in a state that refused the Medicaid expansion like mine??
That sucks. I hate it too.

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Response to frwrfpos (Reply #10)

Tue Feb 25, 2014, 02:20 AM

53. Even with 18k a year income the bronze plans are fully paid by the gov.

There are some plans that cost a bit more and those have much lower deductible. Are you sure you didn't make a mistake?

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Response to frwrfpos (Reply #10)

Tue Feb 25, 2014, 02:47 AM

61. I put your numbers into the calculator and in California you qualify for Medicaid, so I do not know

what you are referring to.

What state do you live in

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Response to frwrfpos (Reply #10)

Tue Feb 25, 2014, 12:13 PM

87. What's your State? Here in Oregon, you would qualify for the Oregon Health Plan

 

which is free of charge to the beneficiary and includes prescriptions and dental coverage, no co-pay, no premiums, if you are single and your income is $15,800 or less per year. You said 1200 a month. You'd have pretty good coverage for nothing.

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Response to frwrfpos (Reply #10)

Tue Feb 25, 2014, 03:57 PM

106. You are wrong. I DARE YOU to speak to an ACA navigator and get the actual numbers in your case.

You are making a large mistake which would be cleared up if you spoke to a trained ACA person.

If you only make $10 an hour, you will be eligible for a subsidy on BOTH the monthly premium AND the yearly out of pocket costs.That's the way it works. Somehow you've been misinformed.

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Response to frwrfpos (Original post)

Tue Feb 25, 2014, 01:14 AM

18. This is absolutely false.

For all covered charges incurred in 2014, the maximum you can ever be charged is $6350. Period. They cannot carry the charges over to another year and charge you an additional $6350 toward your 2014 expenses.

Once you hit your out of pocket maximum for the year, the insurance company is responsible for satisfying the rest of all charges for that year. You fundamentally misunderstand insurance (generally) and the ACA, specifically.

In addition for you (as I pointed out in another thread), your out of pocket maximum will be closer to $2350 a year. The ACA not only subsidizes premiums, it also subsidizes cost sharing. Most people eligible for subsidized premiums will also be eligible for reduced cost sharing. Here is a way to check what your out of pocket maximum will be.

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Response to Ms. Toad (Reply #18)

Tue Feb 25, 2014, 01:21 AM

24. That is incorrect

 

you dint understand the law as it is written. There is nothing from stopping companies from charging you up to the maximum limit until the actuarial value is reached


There would be no point in having Bronze Sliver Gold and Platinum plans if that were the case.


You are giving people who read this a false understanding of insurance law that they arent responsible for anything other than the deductible, which is the farthest thing from the truth

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Response to frwrfpos (Reply #24)

Tue Feb 25, 2014, 01:31 AM

30. No, she's right.

I do have to congratulate you on getting the most wrong in single topic though.

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Response to frwrfpos (Reply #24)

Tue Feb 25, 2014, 01:32 AM

31. I think you need to spend some time reading how the plans work

 

It is clear you don't understand it.

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Response to frwrfpos (Reply #24)

Tue Feb 25, 2014, 01:43 AM

40. I happen to be an attorney, well versed in this particular law -

Last edited Tue Feb 25, 2014, 06:58 AM - Edit history (1)

As well as a very experienced insurance consumer. You do not understand how insurance - or this law works.

In most insurance, there is a different deductible than out of pocket maximum. That is why there are different plans. In many marketplace plans there isn't a difference.

(***See the correction, and excellent examples, in post 74 - I was crunching numbers too late at night and made a silly mistake in these numbers***)

But let's start with an example of the norm:

If, for example, both plans have a $3000 deductible, and a $6350 out of pocket maximum, here is the difference:

$10,000 expenses in a year -

Under the bronze plan, you pay the first $3000. You pay 40% of everything else until your out of pocket costs hit $6350. 40% of $10,000 is $4000, but that would be more than $6350. So you would only pay $3000 + $3350 (a total of $6350), and the insurance company would pick up the remaining 650 of "your" 40% share (and NO, you do not have to pay the $650 back the next year. Every year in insurance you start with a clean slate).

Under the silver plan, you pay the first $3000. You pay 20% of everything else until your out of pocket costs hit $6350. 20% of $10,000 is $2000. So you would pay $3000 + $2000 = $5000.

In that example, if the bronze plan cost more than $112.50 less a month ((6350-5000)/12), it would be the better deal. If not, the silver plan would be.

In many marketplace plans (and the last plan I had) the deductible and the out of pocket maximum are identical - which means that the insurance company pays nothing until you hit the deductible, and since once you hit the deductible you have also hit the out of pocket maximum and it immediately starts paying 100% (making the plan distinction between silver and bronze meaningless). In that case, pick the one with the cheaper premium.

What a smart consumer does is look at their medical bills for the past few years, and calculate which plan is likely to cost them less - premiums + out of pocket expenses. (like the $10,000 example above).

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Response to Ms. Toad (Reply #40)

Tue Feb 25, 2014, 04:02 AM

74. I believe that a couple of corrections might be in order.

$10,000 expenses in a year -

Under the bronze plan, you pay the first $3,000. You pay 40% of everything else until your out of pocket costs hit $6,350. Since you already paid $3,000, there are $7,000 in bills remaining to be paid. 40% of $7,000 is $2,800 so the yearly max of $6,350 isn't hit yet. The total expenses would need $11,375 in total expenses to hit the yearly max (that's the $8,375 after the $3K deductible multiplied by 0.4 to get the $3,350 amount to hit the yearly max). Under the bronze plan for a $10,000 bill, $5,800 would be paid by the insured and $4,200 would be paid by the insurance company.

Under the silver plan, you pay the first $3,000. Since you already paid $3,000, there are $7,000 in bills remaining to be paid. 20% of $7,000 is $1,400 so the yearly max of $6,350 isn't hit yet. The total expenses would need $19,750 in total expenses to hit the yearly max (that's the $16,750 after the $3K deductible multiplied by 0.2 to get the $3,350 amount to hit the yearly max). Under the silver plan for a $10,000 bill, $4,400 would be paid by the insured and $5,600 would be paid by the insurance company.

Now what happens when the expenses are $15,000 a year?

Under the bronze plan in the prior example, we established that it takes $11,375 in expenses to hit the yearly max. In this instance the individual pays $6,350 and the insurer pays the balance of $8,650.

However, for the silver plan there is $12,000 in expenses to cover after the deductible and the insured is responsible for 20% of that amount. The insured will pay $5,400 ($3,000 + (0.2)X$12,000) and the insurance company will pay the remaining $9,600 (80% of $12,000). That's a difference of $950 or about $80/month.

Therefore, the questions that arise are what are the expected medical losses during a particular year (if someone has a chronic condition then using expenses from prior years are helpful) and what provisions one is willing to allow for the unexpected expenses (which is why people need insurance to begin with).

With all other things being equal and one is willing to take the risk of shouldering the burden of unexpected losses, then if the expected expenses are $3K or less then it makes sense to take the bronze plan. However, if the expected expenses are between $3K and $11,375 , then it makes sense to upgrade to a higher plan as long as the monthly premium difference is less than $140/month difference. If the expected medical expenses continue to increase, then the financial benefits of having the upgraded coverage plan decrease since the mid-range expenses between $11,375 and $19,750 are covered at 100% under the bronze plan versus 80% under the silver plan.

For example, what occurs if someone projects annual expenses of $20,000?

Under both the bronze and silver plans the threshold amounts have been met and the individual would pay the annual max of $6,350. So why would that individual choose the silver plan over the bronze plan when they can have lower premiums and the payouts on losses are capped at the $6,350? If all of the considerations and services offered by both plans are identical, then there isn't any incentive to choose the higher premium plans.

What all of this means is that some people will choose the wrong plan for their particular situation. Meanwhile, there are others that will recognize how perverse the system is and choose a bronze plan so that they receive any declared "visible" subsidy from the federal government and a separate "hidden" subsidy by playing the system.

With that in mind, why should people risk paying the additional premium for a silver policy when they really need to insure against a large catastrophic loss? Unless there are other benefits (e.g., larger provider networks), I don't understand why anyone would choose anything other than the bronze plans. It makes more sense to save the difference in premiums between the two different plans to self-insure (particularly if a medical savings account that accepts pre-tax contributions is available), or if one views the situation over the long term and realize that they only need to save one or two years to build that savings account.

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Response to TexasTowelie (Reply #74)

Tue Feb 25, 2014, 06:56 AM

77. I was crunching numbers too late at night

(conceptually, at least - I haven't re-crunched your numbers.

Good catch - I'll read it more carefully later.

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Response to TexasTowelie (Reply #74)

Tue Feb 25, 2014, 08:05 AM

79. the reason to choose the bronze plan

For some, is that subsidies are only available for the silver plan - so if you are in the subsidy range there can be a considerable advantage to the silver plan.

And, although it isn't applicable here, the delay in implementing the merged cap - with uncapped prescription costs made the costs I could predict nearly identical - and unexpected prescription costs which would continue to grow ,Ade the silver plan equivalent a better deal.

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Response to frwrfpos (Reply #24)

Tue Feb 25, 2014, 01:43 AM

41. It's very simple: you have no idea what you're talking about

 

You have been corrected numerous times, and it always ends in you saying nothing, or harumphing, or offering embarrassing misreadings of clear statements by your interlocutors. You don't know what you're talking about. you're ignorant on this subject. It's very plain for everybody to see.

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Response to frwrfpos (Reply #24)

Tue Feb 25, 2014, 02:09 AM

51. You couldn't be more wrong. Its insurance, not a friggin credit line.

 

The different level plans just means that you have less out of pocket expenses and pay a higher premium as the plans increase in quality.

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Response to frwrfpos (Reply #24)

Tue Feb 25, 2014, 02:49 AM

62. What state are you in? In California you qualify for Medicaid. Provide the link to your state's

ACA web page. I want to put the figures in and see for myself

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Response to frwrfpos (Reply #24)

Tue Feb 25, 2014, 04:10 PM

112. She is correct and you're wrong. Call the ACA, speak to a navigator there,

since reading whatever you read left you misinformed. Please get the facts and you'll be much better off.

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Response to Ms. Toad (Reply #18)

Tue Feb 25, 2014, 01:23 AM

26. The key word is "incurred".

I wonder if the OP missed that piece of information.

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Response to TexasTowelie (Reply #26)

Tue Feb 25, 2014, 01:49 AM

42. The OP seems to be missing experience with insurance,

in general.

I understand it - it is complex, and those opposing the plan from both sides of the political spectrum have done their best to create scary monsters out of it.

And (as the poster latched on to) the concept of a merged deductible and out of pocket maximum which many of these plans have is odd - and I understand why the OP is searching for why they even bother with coinsurance (60% or 80%) when it doesn't seem to be applied to anything (which it isn't when the deductible and out of pocket maximum merge).

But it is annoying, nonetheless, to see false information spread around because it scares off people who might really benefit from the insurance.

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Response to Ms. Toad (Reply #42)

Tue Feb 25, 2014, 02:04 AM

47. I also knew the OP was wrong immediately,

but I worked for the state department of insurance for 13 years and for a property and casualty insurer for a decade.

I'm dubious when I read almost of the statements about ACA since most people know jack-squat about insurance.

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Response to TexasTowelie (Reply #47)

Tue Feb 25, 2014, 02:19 AM

52. That's why it has been so easy to lie about it

and get away with it.

The number of people (even those who have insurance) who really understand how it works is pretty small. I am amazed at how much even the well educated attorneys I used to work with let the insurance companies get away with - mostly because they had no clue what the policy covered.

Unfortunately, our family has way too much interaction with the medical community to be ignorant about insurance.

I have had to explain to customer service workers at some of the more complicated plans how their plans worked - and (even though I had never actually seen their user interface), how to find documents which were electronically misfiled. That was one bad year - I spent about 100 hours fighting over a bill of under $100 when both the insurance company and the provider screwed up and the insurance company sucked back a payment I had made along with their mis-payment, which the provider wanted to bill me again for.

And I have had domestic partner forms rewritten, because they were legally inaccurate - and the software for a major insurance company in Ohio was rewritten once I pointed out (and was a PITA about the fact) that it did not properly handle families headed by same gender couples. Once there were children involved, the deductible for the family increased by at least $3000 - and as much as $6000 - over a family headed by a mixed gender couple because they were issuing separate policies which deprived us of the family out of pocket cap (even though they said they intended to provide equal coverage). Their first response was that I should be grateful my family was covered at all - and there was nothing they could do about it. Wrong answer.

Not that I have any familiarity with insurance.

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Response to Ms. Toad (Reply #52)

Tue Feb 25, 2014, 04:13 AM

75. Yes, I agree.

Please check post #74 to see if I'm on target for a single individual. I know that some additional considerations come into play with different circumstance as you see within your own family. I have a degree in math and background in insurance so I can do the calculations, but most people are so adverse to either math or insurance that it might as well be an alien language.

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Response to frwrfpos (Original post)

Tue Feb 25, 2014, 01:14 AM

19. Tick tock tick tock

 

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Response to frwrfpos (Original post)

Tue Feb 25, 2014, 01:17 AM

21. You're confused about several things, both what 60/40 means and what OOP/deductibles are

The Bronze plans cover 60/40, meaning insurance covers 60% and you cover 40%, after the deductible has been paid, which in the bronze plans is up to 6350 dollars per year.

Wrong.

The 60/40 means the policy is supposed to actuarially cover 60% of user's costs in general; your actual coverage may be more or may be less. The most common medical visits (wellness & preventative) are covered 100%. But how the insurance company gets there and how they deal with the deductible is up to them (some plans coinsure at some rate up to the deductible; cheaper ones may not). You also seem to be confusing the deductible with the out-of-pocket maximum. The out-of-pocket maximum satisfies all obligations for treatments during that year; the deductible does not. The $6350 is the highest out of pocket maximum for a single person. You can't have a deductible that high (or, I suppose you could, but it wouldn't be a "deductible" in any real sense).

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Response to Recursion (Reply #21)

Tue Feb 25, 2014, 02:05 AM

48. Unfortunately, many of the marketplace plans are odd

And do have deductibles = out of pocket maximum.

(My last plan had that same arrangement - it is strange, but very common in the marketplace plans.)

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Response to Ms. Toad (Reply #48)

Tue Feb 25, 2014, 02:07 AM

50. Weird, though I guess that's like the old "catastrophic plan" idea

I hope the people get "insurance" prices from the hospital...

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Response to Recursion (Reply #50)

Tue Feb 25, 2014, 02:25 AM

56. Basically,

And yes - they do. That's one of the benefits of having insurance that folks like the OP are ignoring - it is a substantial discount.

Our billed costs the first 9 months of last year under a $6000 deductible/$6000 out of pocket maximum were around $66,000. The providers were actually paid about $42,000. It didn't make a difference for us (since our costs are always so high), but for families with more typical costs, the lab costs run about 10-15% of the billed rate, doctor's cost run about 80-95% of the billed rate, and the rest is somewhere in between. If you have insurance, you get (on average, where I live) about a 35% discount over the uninsured rate.

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Response to Ms. Toad (Reply #56)

Tue Feb 25, 2014, 04:01 AM

73. Ms Toad... I must say....

You are a special lady! Your patience is something to behold. Your understanding of the issue is solid and you tried your best to explain your knowledge and understanding of the situation. I just want to say Thank you for taking the time to share your wisdom. It may not have sunk in to the original poster but I am sure you helped many others who were following this thread. I know it helped me some. So I say cheers! Keep up the great work.

MH

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Response to MysticHuman (Reply #73)

Tue Feb 25, 2014, 12:05 PM

85. I hope it helps others -

I have a daughter with a chronic progressive liver disease, so a large part of my spare time since she was diagnosed with a different chronic disease nearly 2 decades ago at age 4 has revolved around understanding insurance so that we didn't go broke trying to keep her alive - and so that she can manage to pay her massive medical bills once she is able to move out on her own (she isn't yet).

We've been through pretty much every imaginable insurance configuration & had to battle with each one to make sure we got every penny we were entitled to get. So far - I have only lost the few battles I have chosen not to fight because the cost was small & I was too overwhelmed with things that mattered more (like keeping the job which provided the access to insurance).

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Response to Ms. Toad (Reply #85)

Tue Feb 25, 2014, 03:42 PM

102. That certainly would explain things...

You have my deepest respect for rising to the challenge you have before you. With my understanding of the lives we live, we have knowledge of many of the challenges we may experience once we are here. None of us are immune to living through difficult challenges yet many do not meet that challenge with focus and determination needed to overcome it. I see that you are. Your daughter is fortunate to have such a person walking with her on her journey.

In the end we grow and learn and somehow become a more evolved Soul through the process.

With that being said, it is a sad country we live in that works against those that need the proper healthcare to survive.

In my personal opinion we should treat the healthcare industry much like we treat the military. They have a budget and we (government) approves that budget or not. For the most part we fund whatever the military wants. The healthcare industry could be the same... each facility submits a budget for the upcoming year... and that budget if reasonable would be approved. Any U.S. Citizen would then be able to just go to any facility without all the mess of paperwork or payment. I know it seems overly simple...but if the military can have a budget that uses 58 or 59% of our budget ... it's not that we couldn't fund the healthcare industry this way it's whether we want to make bombs or help people.

MH



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Response to MysticHuman (Reply #102)

Tue Feb 25, 2014, 05:11 PM

122. I am hoping that once people get used to have better access to health care

via insurance, people (even those who hate the current plan from the right) will start to demand more - and we'll move toward something closer to what you have described.

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Response to Ms. Toad (Reply #48)

Tue Feb 25, 2014, 03:09 AM

67. However, there is a minimum requirement

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Response to lostincalifornia (Reply #67)

Tue Feb 25, 2014, 03:15 AM

68. I'm not following you.

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Response to Ms. Toad (Reply #68)

Tue Feb 25, 2014, 03:21 AM

71. Didn't word it right. A minimum basic standard of coverage. For example all the policies under

the ACA will cover one yearly physical, no pre-existing condition penalty, a cap, etc.

What I am saying is there are minimum basic requirements to offer insurance under the ACA

Just stating the obvious, not being profound at all




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Response to lostincalifornia (Reply #71)

Tue Feb 25, 2014, 12:06 PM

86. Got it! Thanks for the clarification. n/t

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Response to frwrfpos (Original post)

Tue Feb 25, 2014, 01:34 AM

35. So your claim is the Hospital/Nursing home will break federal law?

The bill isnt magically written off after the 6350 has been paid. The Hospital/Nursing home will continue to bill you EVERY YEAR until the full balance, often including interest, is paid in full(up to the legally mandated 6350 per year)

No, billing for care that was not provided in that year would break federal law.

The bill isn't magically written off. It's paid by the insurance company. That's kind of the point.

As having recently met my out-of-pocket yearly maximum in two different, non-sequential years, I can assure you the hospital does not send another bill the next year.

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Response to frwrfpos (Original post)

Tue Feb 25, 2014, 01:41 AM

38. Too Bad for You

My ACA plan is MUCH different than yours. Reside in a heavy Red state, do ya'?

100% of charges incurred in 1 calendar year are subject to deductible and copay. My deductible and copay, though large, is much less than yours (I chose a good silver plan).

If I fall incredibly ill in 2014 and run up, say, $500,000 in bills for services rendered in 2014, I pay $1500 deductible plus another $1500 coinsurance period. I pay $3,000, my insurance pays $497,000 or whatever they can negotiate with the provider.

Now, if in 2015 the hospital goes oops, we forgot to bill and additional $100,000 for services rendered in 2014, I pay zero while my insurance pays $100,000. If any of those services were provided in 2015, payment for those services are subject to the 2015 deductible and coinsurance.

Too bad you have such a sh*tty plan. However, if you read its language more closely I think you'll be pleasantly surprised. You are simply wrong.

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Response to frwrfpos (Original post)

Tue Feb 25, 2014, 01:42 AM

39. Then get a silver or a gold plan

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Response to frwrfpos (Original post)

Tue Feb 25, 2014, 02:23 AM

55. I do not know if you're a troll or just dumb, but you are 100% wrong

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Response to krawhitham (Reply #55)

Tue Feb 25, 2014, 02:57 AM

63. It could be just pure flame bait, because the numbers do not make sense, and it a most states

those numbers qualify for Medicaid, which makes this entire post even more suspect.

All the OP needs to do is supply a link to the ACA website for his state, or tell us the state he is from, and we can put the figures in to verify. However, several people have requested that, but it seems to have been ignored, or it is intentional flame bait as I suspect


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Response to lostincalifornia (Reply #63)

Tue Feb 25, 2014, 09:51 AM

81. Meh...I don't think the OP understands insurance and I think folks keep conflating

their take home pay with their gross or adjusted gross which also results in misinformation.

Nobody is right, everyone is wrong.

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Response to TheKentuckian (Reply #81)

Tue Feb 25, 2014, 10:35 AM

82. Actually it is Modified adjusted Gross. A subtle, but sometimes, significant point. I do not think

it pertains in this case.

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Response to krawhitham (Reply #55)

Tue Feb 25, 2014, 03:02 AM

66. It's a dead ender who is in denial

 

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Response to krawhitham (Reply #55)

Tue Feb 25, 2014, 12:34 PM

89. The poster attacked LGBT people for boycotting the Olympics, called it 'red baiting'

 

even though of course, the Russians are no longer 'reds' at all. Far, far from it. So my opinion is that this poster is not very high.

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Response to frwrfpos (Original post)

Tue Feb 25, 2014, 03:01 AM

64. Your negative publicity flops. Millions including young, healthy

 

People are signing up for it. Obamacare is going forward and is now a fact of your life. You lost. Get over it and stop spreading transparent lies.

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Response to frwrfpos (Original post)

Tue Feb 25, 2014, 10:58 AM

83. Not right. Insurance can be difficult to understand. Let me try.

Let's say you go to the hospital, they say you have a bill of $500,000. They send it to the insurance company.

If the insurance company says "usual and customary bill is $100,000 not $500,000", the hospital will have to write off $400,000. This is typical.

The insurance company will pay their part, $60,000 leaving you $40,000. However, that is more than your max out of pocket a year, so you are liable for only $6500. That is what you can be billed for. Period.

The question here seems to be what happens to the other rest of the $40,000. The facility must write it off. They can not bill you next year for more on that bill beyond that initial $6500.

You ARE liable for the max out of pocket, including interest, until it is paid in full. And they can continue to fill you every year for that original $6500 until you have given them the amount of your annual max out of pocket for the year and ONLY for the year you got the bill initially.

This is why people get more things done later in the year than in the beginning because they are more likely to have met their annual deductible and max out of pocket expenses.

But yes. The extra amount beyond the deductible/max out of pocket (you say legally mandated $6350/yr) IS written off. They can ONLY bill you for the original amount to meet your ded/max out of pocket. And they will continue to bill you until that bill and only that bill is paid off.

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Response to frwrfpos (Original post)

Tue Feb 25, 2014, 12:18 PM

88. I don't know if you are making this up

or if you truly believe it, but it's not true.

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Response to frwrfpos (Original post)

Tue Feb 25, 2014, 12:49 PM

90. Lalo describes this perfectly:

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Response to frwrfpos (Original post)

Tue Feb 25, 2014, 02:20 PM

95. I can certainly understand your concern

It is far from anything I thought it would be.

We are too young for medicare and too old to really benefit from ACA. I'm thinking of retiring early so I can qualify for the expanded medicaid program of ACA.

Our problem is we actually earn a living wage and we're in the "wrong" zip code. ACA won't cover my non-generic meds that I need to survive and any ER visit (which on our old insurance was a co-pay) is now paid for with the mega-deductible out of our own pocket.

Best program we've found so far is $1,800 a month for the two of us.

I know that the young and/or poor are benefiting from ACA but you won't find us in the cheerleading section on this program. It sucks.


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Response to frwrfpos (Original post)

Tue Feb 25, 2014, 03:22 PM

98. Our current health insurance situation sucks.

 

Without fundamentally changing that aspect of it, many will be fucked when it comes to health care with or without insurance.

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Response to frwrfpos (Original post)

Tue Feb 25, 2014, 03:53 PM

105. Ms. Toad had a great post about this yesterday that included info you left out.

Most people qualify for subsidies to pay for their monthly premium. Most of those people are also eligible for subsidies to help them pay the out of pocket cost -- so the $6350 is a maximum, but people with lower incomes will pay less.

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Response to frwrfpos (Original post)

Tue Feb 25, 2014, 04:01 PM

107. Simply not true for the same incident of care. Now if you get readmitted to a hospital every year,

you might have to cover the deductible. If you are that sick, I think I'd see about purchasing a policy with a lot lower deductible -- saw some on the Exchanges with $500 deductibles. In fact, if you are that sick, you'll probably end up on Medicaid pretty quickly.

The ACA has deficiencies, but this ain't one of them.

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