I found out my options under the ACA.

[Are_grits_groceries]

I waited to try to log in and I did this weekend.
I first found out I would have a credit of $340. Yay!

I was offered over 10 options. The coverage varied, but there were a couple I could afford. There was just one teeny catch. THEY ALL HAD $6000 DEDUCTIBLES. There were Bronze, Silver, Gold and Platinum plans or as I refer to them: Tin, Aluminum, Brass and Lead.

I am not calling anybody to complain. All has been said about the ACA's faults. I know that a lot of people will have better coverage or coverage period. I could bitch to my RINOs-Representatives-In Name Only.

Those shites and others in their coven are responsible for a lot of the trouble in setting up this program. They have obstructed it at every turn. In addition, the coverage that is available would be better if they had helped or at least done nothing negative. However, some ire has to be aimed at those who put the website together- R.Goldberg Inc.

I am in the same leaky boat I have been bailing out for a long time. In the meantime, those jackasses better not touch Medicare, Social Security, or any other program that benefits people. It is past time to close tax loopholes, cut corporate subsidies and raise taxes on the 1-damn-%. Don't give up one red cent.

I am now waiting for Medicare. I hope Godot isn't driving that bus.

[Lars39]

1. That's catastrophic insurance.

Who in the hell thought that $6,000 deductibles was acceptable?!

[Are_grits_groceries]

2. I know.

I could have purchased basically the same thing before.

[eqfan592]

66. Unlikely.

Deductibles pre ACA worked differently. How much does your insurance cover prior to you hitting the deductible?

[enlightenment]

81. There are several

plans on my state exchange that advertise as "bronze" (and at least one "silver&quot that pay nothing until the deductible is met. The deductibles range from $4000 to $6350 for an individual.

That's catastrophic coverage, no matter how you want to slice it.

(I'm in Nevada, if you want to look it up yourself - here's a zipcode: 89101)

[eqfan592]

88. Fair enough. However, insurance companies also negotiate discounts with healthcare providers.

Discounts you take advantage of, even if you haven't used up your deductible. I agree, tho, that a flat deductible of $6350 is catastrophic coverage. But that being said, such coverage is far superior than what was available to the vast majority of people without health coverage prior to the ACA.

Still, makes me wish we had just gone to a damn single payer system. I pay $4-600 a month to insure my family, we have a $3000 deductible with a $7500 catastrophic limit, AND we still pay into Medicare on top of it. I would gladly ship the entirety of my contributions over to Medicare if it meant a universal healthcare system.

[Yo_Mama]

3. This is what a lot of people in ruralish counties are facing

If you don't get the cost-sharing subsidy, moderate income folks are going to be shit out of luck when it comes to getting medical care.

And this is why all the left talk about "crappy policies" is failing, because all too many are finding that their only ACA options are the crappy insurance we all so hated and that people believed ACA was meant to ban.

The worst part of it all is that in many areas, these people could get cheaper, better policies before.

And whatever you see as an individual is pretty much what small companies are faced with, so this affects tens of millions more that are not being officially acknowledged.

We have to close with this issue and address it, otherwise it will turn many purple counties red.

This country desperately needed health care reform, and no attempt to reform is ever totally successful when attempted, but we cannot stop here.

[LuvNewcastle]

4. This will hurt the Democrats if something isn't done, and soon.

The Republicans aren't going to help fix it because they're getting traction from it. A $6,000 deductible is awful! People might as well opt for the catastrophic policies if that's the best alternative.

[n2doc]

12. Which is why the House Republicans will never allow it

They see this as their 'get out of Jail' card from the shutdown debacle. And they are being proven right.

[bluestate10]

96. People have to show their asses up at the Polls and vote. That is the only way that it will

get fixed, with Democrats in firm control in the House and Senate and holding the Presidency. I think Democrats have seen the problem with the ACA and will fix them if they regain control of all of Congress.

[Are_grits_groceries]

7. I got a $340 credit.

I still had to pay $150 for the cheapest policy with it.

[BlueStreak]

29. I don't really understand the complaint

Yes, I get that $6000 deductible is high. However, for $150/mo you are getting protection from a financial wipe-out. You are getting insurance that cannot be cancelled. You are getting preventive health care for free. What is the complaint, exactly?

And no, you could not buy any of that before for $150/month. You couldn't buy a policy at any price that couldn't be cancelled. And You sure couldn't buy a policy for $150/mo that included preventive care for free.

Look, the ACA is about cutting our national drain of HC costs by allowing Americans to be healthier and moving health care from the ER to the PCP's office whenever possible. You have an obligation to do your part, and it seems to me this is a darned good deal.

[Humanist_Activist]

33. How does it protect from a financial wipe-out? If I got hit with a 6 thousand in expenses

in a single year, that's a financial wipe out, I don't make enough to pay that off in any reasonable amount of time, especially combined with other debts.

[BlueStreak]

39. If a person is not receiving any subsidy, that means their income is

$50K or so. While a $6300 hit is not pleasant, it should be possible to pay that off, and the insurance guarantees that there won't be anything more than that to pay per year.

We are left to speculate that the OP and you are at income levels under 400% but greater than 133%. That provides a huge subsidy -- which can partially offset some of those out-of-pocket costs. I am very suspicious of the claim that there isn't a single policy under $6300 out-of-pocket. If a person is under the 250% level, the SILVER plans are supposed to have a sliding deductible that would be more like $1000 than $6000.

See http://www.kaiserhealthnews.org/features/insuring-your-health/2013/070913-michelle-andrews-on-cost-sharing-subsidies.aspx

OK, if the person is at 251% of poverty level, I get it. That's going to be difficult to swing. But at 400% of poverty level. this should be manageable by giving health care priority over other purchases.

[Are_grits_groceries]

42. I am at that level that is hard to swing.

Satisfied?

[Humanist_Activist]

48. I make less than half of 50K, and won't receive a subsidy, so I don't know what you are smoking.

I don't know the OP's financial situation, my employer does provide insurance that is crappy, and I make about 200% of FPL, and it squeaks, barely, under the 9.5% threshold for me getting on the exchanges, so I don't qualify for them, without going on the exchanges, I get no subsidies.

[BlueStreak]

67. The ACA was primarily intended to address the 45 million who have no coverage

I am sorry that you don't like the coverage you have. I am sorry that all our health care isn't free. I am sorry there really isn't a beer tree. I wish somebody would buy me a new car.

But I don't see where it is helpful to blame the ACA for a situation it was never intended to address and nobody ever claimed it would address.

It is OK to say "The ACA wasn't designed to help those of us with employer insurance." It is not OK to say or imply "The ACA sucks." when you are talking about something it wasn't intended to do in the first place.

If you are with a small business. I hope the business owner has made the effort to look into the ACA provisions that do help small businesses afford better coverage.

[Humanist_Activist]

73. Its not a matter of liking it, its a matter of being able to afford to use it.

Jesus fucking Christ could you be any more condescending and insulting?

[TroglodyteScholar]

97. It may have been worded in a way you don't like, but the point is valid.

You're complaining that it doesn't fix problems it never aimed to fix.

People with employer-provided health insurance were never NEVER the intended beneficiary of this law.

[SoCalDem]

112. No matter what your premiums are/were, you still have to pay a copay

Perhaps the best you can do is to find the one with the smallest copays & monthly premium, and know that IF you got a major illness, the most you would be hit with would be that deductible (and whatever percentage your plan makes you responsible for)..

Insurance always sucks, because you are paying for something you hope to NEVER use.. No one wants their house to burn down, but they all pay for fire insurance..

I am SO happy to be only months away from medicare, even though the "cushy" advantage plans others be fore us got to have, will be gone, and we will pay more for less..


Mostly, I regret not being French or Swedish, Finnish

There are many freebies along with the ACA, so I hope your health holds up and you find some peace knowing you cannot be canceled..

[Humanist_Activist]

116. There's a difference between paying an affordable copay and having to shell out 10-25% of your...

yearly income(on top of premiums), in order to get any coverage at all.

[B2G]

49. Your presumptions about others' finances

is becoming tiresome.

Your little lectures are no better than the right's assertions that people who have cellphones or televisions shouldn't need food stamps.

Get off your high horse. The thin air up there is scrambling your brain.

[politicaljunkie41910]

74. I agree with you that $6000, at least, is not going to bankrupt you and that you can pay that over

time after you have been treated. The OP would be better off than if he had nothing, particularly as you discussed the visits to your primary care. It appears that some people just don't want to pay anything. Maybe Romney was right. The system may not be perfect, but it's a start. Imagine how much further along we would be as a nation if we had two political parties working to make the ACA work for all Americans.

[Lars39]

84. So people with chronic conditions should have to pay $6,000 deductible every year.

Fuck that.

[eqfan592]

89. Like it or not, it IS far better than what we had before.

But what we NEED is single payer. The ACA is a band-aid on a sucking chest wound that is the US healthcare system.

[Humanist_Activist]

91. No, that's maximum out of pocket, which they will pay, on top of premiums, and on top of RX copays..

which don't contribute to the maximum out of pocket for the year.

So, we are looking at, for individual coverage of someone with a chronic condition at least paying 6 grand a year, and most likely paying, total, about double that.

[Fumesucker]

86. Everything is relative

Six thousand may not bankrupt you but there are plenty of Americans for whom it would be impossible to pay off that much, they simply have more expenses than they do paycheck.

[Skittles]

111. yeah, don't save for retirement, for example

insurance companies need that money

[solarhydrocan]

40. "You are getting insurance that cannot be cancelled"- but it will be cancelled if you don't pay

the premium. Then, you're up for a fine of $695 (per person) in 2016.

add interest too.

[Ms. Toad]

117. Part of your statement is not true.

You could, and still can, buy a $6000 deductible policy for $150 a month.

Here's one with a $2500 deductible, an out of pocket maximum of $5000 for $124.29 a month for a 50+ non-smoker: http://www.ehealthinsurance.com/ehealthinsurance/benefits/st/GR/OH-GR-122012.pdf

There are major drawbacks - it is a short term plan (up to 12 months), it does not cover pre-existing conditions (but you cannot be rejected for pre-existing conditions), and there is no prescription coverage (details based on the price I selected - you can get prescription coverage or a lower deductible for a higher premium). And it likely won't qualify to avoid a tax penalty. But it was, and is available for under $150/month. It is the kind of plan I used (only much better) when I was not insurable, but couldn't risk a catastrophe. For 2-3 years I used short term insurance (a series of plans; the max on each is between 6 months and 18 months) to make sure that if anything other than my pre-existing condition acted up we would not wipe out our savings covering it (because to get coverage for the pre-existing condition would have cost between $1500 and $2000/month).

[Yo_Mama]

30. You got the premium subsidy

There is also a cost-sharing subsidy which is only significant for those with incomes 200% or below the poverty line.

If you do fit into that category, the deductibles and copayments are cut dramatically, so some of these crappy ACA policies become quite good.

But if you are in a ruralish county without much competition where everyone is using the same healthcare providers, the deductibles are mostly very high for moderate income people and then they are shit out of luck if they actually need healthcare.

This is why so many people are so upset. They are realizing that effectively, they won't be insured in terms of access. And with a lot more people with high deductible insurance, hospitals can no longer afford not to collective the copays/premiums.

It's one thing to go BK because of high copays or deductibles. It's yet another thing - and much worse - to not even get treated because of them. And that is what too many are discovering about ACA policies - the 70/30 actuarial split is putting them in a bind.

Of course, the people who don't get the premium subsidies are confronted with having to pay for very expensive insurance PLUS high deductible/copays, and they are in a lot of cases effectively going to have to allocate 30-40% of their income to medical/insurance costs each year if they have health issues.

[Bluenorthwest]

5. Of course the one option you did not find is the Public Option

"Any bill I sign must contain a strong public option to help control costs." This is what Obama said. But we did not get one.

[Poll_Blind]

8. +1

PB

[Yo_Mama]

31. True, and it is shaping up to be a tragic error. n/t

[woo me with science]

98. +10000

[Hoyt]

6. The deductible is a lot, but a lot of the plans have copays on office visits, drugs, etc., such that

the deductible doesn't come into play until you have a serious illness and need surgery, hospitalization, etc.

Years ago, you had to meet the deductible -- even for doctor visits and drugs -- before the Plan paid anything.

Nowadays with a lot of the plans, the deductible doesn't even come into to play as long as you are seeing doctors in their office, taking prescription drugs, getting annual wellness exams, getting a mammogram, getting a screening colonoscopy, etc.

The sad truth is, modern healthcare is expensive. Providers are going to get their pound of flesh, and some patients are going to be unreasonable about things as well wanting access to any doctor, any medication (even when an older generic works fine, at a much lower cost). Until providers quit wanting everything they can get out of the system, and patients are willing to accept clinic type medicine, no one is going to be happy except those who never had any insurance.

[Are_grits_groceries]

10. I checked.

They say 0 copay after deductible or x% after deductible.
This includes primary doctor visits and the other items you mentioned.

[jeff47]

13. Yes, but that is still separate from wellness visits before deductible.

It's 0 co-pay after deductible, but it's still going to be $20 for a wellness visit before you hit the deductible. (Or whatever the copay is for wellness visits).

The deductible becomes relevant if you have a significant incident, or if you have certain chronic problems. If you have a relatively uneventful medical life, then the only thing you'll be paying is co-pays.

[B2G]

14. Is strep throat a 'significant' incident?

Because that wouldn't qualify as a well visit. You'd pay for office visit, labs, etc. That adds up.

[jeff47]

16. Whether or not it qualifies depends on the plan, and what else you've been doing.

There isn't going to be a blanket answer, because there is not a single plan.

If you are the type to never go to the doctor unless you are sick, and your plan is rather stingy about what is "wellness", then your strep diagnosis will just so happen to coincide with your annual wellness visit.

What maneuvers are available and what maneuvers are necessary will depend on the details of the plan in question. Just like it has for decades for those of us with employer-provided insurance.

There's three good things about the ACA:
-Medicaid expansion
-It's actually possible to buy insurance on the individual market even if you are not wealthy
-It moves the battle for single-payer to the states. Successes in "blue" states will greatly help the national battle.

[Are_grits_groceries]

17. I'm 61 and have several problems.

I need more than wellness visits unfortunately.
So what I have posted applies. I know people are trying to help and focusing on good points. However, I have read these policies and called people, and I am still screwed.

As I said, It is going to be a great program for many people. At least there is a bright side. For me personally? Not so much.

[jeff47]

18. "Wellness" is a terrible name for those visits.

Because an enormous number of things count as "wellness". Even stuff that doesn't appear to at first glance.

Those of us with employer-provided insurance have been navigating this system for quite a while now - our plans have very similar concepts as the "Exchange" plans. I've gone to doctors for check-ups, as well as "take a look at this lump"-style appointments. The only time deductibles became relevant were the years my two kids were born.

What is covered depends on the specifics of the plan, your doctor, and most importantly the billing specialist at your doctor.

[Hoyt]

71. You have to look closely at the different Plans. Some plans have a copay for "Diagnostic" visits.

But the deductible does not apply.

One plan in my area has no deductible for most drugs, like one with diabetes might need. The copay is $5 or $10.

In-network doctor visits are not subject to the deductible, but have a $25 to $35 co-pay. There are a number of preventive tests with no copay or deductible. They also pay for $300 in lab tests before the deductible requirements kick in. That would get you a couple of good lab panels a year.

Point is, if a plan like that is available in your area, for the $150 a month premium after subsidy, you'd get coverage for a lot of needed care.

Again it varies, by Plan -- just don't give up until you've looked closely at what is available.

[TheKentuckian]

85. I find it interesting that the same folks who blow off a 6k deductible

Think a damn office visit copay and some every few years colon check or a mamagram justifies hundreds of dollars in increased premiums and even increased deductibles.

This is small potatoes cost wise and poor justification of cost.

[jeff47]

109. I find it interesting that folks think we have never seen these plans before.

Those of us with employer-based insurance have been navigating these plans for years - the exchange plans are based on what we have to deal with for a long time now.

A very large number of procedures at a surprisingly short interval do not require meeting the deductible in order to be covered

[pnwmom]

22. You are completely misreading something.

The preventative care is done for free -- without having to meet the deductible.

https://www.healthcare.gov/what-are-my-preventive-care-benefits/

Most health plans must cover a set of preventive services like shots and screening tests at no cost to you. This includes Marketplace private insurance plans.

Preventive care benefits

Preventive care helps you stay healthy. A doctor isn’t someone to see only when you’re sick. Doctors also provide services that help keep you healthy.

Free preventive services

All Marketplace plans and many other plans must cover the following list of preventive services without charging you a copayment or coinsurance. This is true even if you haven’t met your yearly deductible. This applies only when these services are delivered by a network provider.

(SNIP)

(Note that the list of free benefits continues on another page.)

[Are_grits_groceries]

24. I know that.

I am talking about doctor visit's I know I will have for chronic bronchitis, depression and other things.

[pnwmom]

27. If you knew that, why did you say this:

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=4051344

And what is your annual out of pocket, if the deductible is $6K?

[Yo_Mama]

37. But that doesn't include ANY treatments for actual ailments

Consider the person who goes to their annual FREE checkup, and discovers that they are a diabetic.

Their costs in the first year, including medication, education, and the minimum evaluative tests are usually going to run from 3K to 6K. If any of the evaluative tests turn up significant complications, it can be much more.

And many of these people are apparently going to have no help covering these expenses until they get to 2.5-6K in expenses, which is money that many of them literally don't have.

The woman who earns 26K a year who has the free mammogram and has a highly suspicious lump may have to write a $2,500 to $6,000 check to begin treatment of that lump. AND SO FORTH.

This is not good insurance.

[pnwmom]

41. The woman who earns $26K a year will qualify for a tax credit

that will help pay not only for her premiums, but for her out-of-pocket.

She is unlikely to have to write a check in that range to begin treatment of the lump.

[Yo_Mama]

46. She gets a 3% cost-sharing subsidy only

Which is what is mandated under ACA.
From 100-150% of FPL actuarial value is 94%, which hugely cuts the deductibles and premiums.
From 150-200% of FPL actuarial value is 87%, which is a big help.
From 200-250% of FPL, actuarial value is 27%, which is only 3% more than the standard Silver split of 70/30%.

So you are very wrong - depending on the county she lives in, this poor lady might find herself asked to cough up more than $5,000 to start treatment.

[mike_c]

68. "tax credits" are not the answer when people need care today, rather than after April 15....

I have excellent health care from my employer because I belong to a strong union. Everyone in the U.S. should have comparable health insurance. But for much of my life I was either uninsured, because I could not afford it, or under insured because my employer bought the cheapest, crappiest group plan they could obtain. Regardless, for most of that time a $5K+ initial out of pocket expense was a death sentence, as I didn't have a tenth that sum available for short notice discretionary use.

The ACA is a stopgap at best, and a poor stopgap based upon republican ideals at that. Single payer, universal health care for all Americans is the only answer.

[pnwmom]

70. These tax credits are different. They will be available beginning in January

to pay for the subsidies -- without waiting to file anything in April. The government will pay its portion directly to the insurance company at the same time individuals are paying their (reduced) premiums.

[Ms. Toad]

118. Any ACA compliant plan has to cover the preventative visits

before the deductible is met.

[Humanist_Activist]

23. Then why do plans explicitly contradict what you say?

my employer's plan explicitly says that they pay nothing until the deductible of 2,000 dollars is met. So I guess you are right, we do pay a copay, of 100%, until then.

[Hoyt]

50. Plans are different. Sounds like your employer took the cheap route and put everything

up to $2000 on your back.

I have not come close to meeting the deductible on my Plan, but so far I have had a few office visits with a $25 copay, a number of prescriptions with a $15 copay, and a colonoscopy with no copay. I have seen similar Plans on the Exchanges.

How many Plans have you actually looked at, and in what parts of the country?

[ChazII]

55. Unreasonable???

I don't understand. I am curious and not trying to sound hostile.

and some patients are going to be unreasonable about things as well wanting access to any doctor, any medication

How is wanting access to any doctor unreasonable? Not all generics work fine either. There are exceptions and a patient should be allowed to have any doctor of their choice. I know that I am unwilling to accept clinic type medicine until the plan has been fully explained. In other words, I want to read about it before being told the clinic plan is the only option.

I do have some experience with clinics as my son was a patient at both CHLA and CHOC. I am thankful for the insurance I had that I was able to travel out of Arizona to get the specialized care my son needed for his tumor. But heaven help anyone who tells me what doctors I can't see or that I cannot leave Arizona to get the medical help I want for my son.

[Hoyt]

62. People are unreasonable on things like wanting the latest "new" drug at 10 times the price of

a generic drug that is just as good, but you have to remember to take it twice a day.

Or, people gripe about cheaper plans the require you to go to a network doctor (you mean I can't see MY doctor), or certain hospitals, or get prior approvals, immediate access to an MRI when it's a chronic condition that can wait, etc.

My former right wing friends were unreasonable because they didn't want to sit in a waiting room with "poor" people, see a Physician Assistant, etc.

You can get all those things if you just gotta have them, but it's going to cost you.

And, like I said -- Providers are greedy with what they want too.

[ChazII]

72. I agree 100%

in regards to having the newest or latest drug. MRI's are not always necessary and should not be done on demand.

However, we will need to agree to disagree about the network doctors. Children with serious illnesses do need certain hospitals as not all hospitals are equal in specialities. Personally, I have no problem with taking my son to our primary care office and seeing the PA when it comes to the sniffles. Hell, I don't even take him when it is just the common cold. That is a BIG waste, in my opinion, when people go to the doctor for the common cold. Friends on the left and right visit the doctor when there really is no need.

On the other hand, I have numerous friends via the internet who have children with very serious illnesses. Different types of cancers and in my family's case neurofibromatosis. We are willing and many of us have paid because we 'just gotta have' them when it comes to the health of our child. St. Jude's, Cleveland Clinic, the Shriner's Hospital, CHOP, CHOC and CHLA are just a few hospitals that many of us travel out of state to get the best health care we can for our child. These families are not rich and many are just scrapping by and several do receive aid from their state.

So yes, I will gripe because networks do not always provide the best health care.

Thank you for your answer and I do appreciate the fact that we are able to disagree in an agreeable manner.

[Hoyt]

75. I hear you and get it. In that case, you pay increased premiums for out-of-network coverage.

Me, as long as they are a competent physician, I'll take my chances with whomever is on duty. I learned a long time ago, there are very few Marcus Welbys anymore.

Kids with serious illnesses are very different and I would want a plan that covered the best for them.

[Le Taz Hot]

9. Brace yourself for the

"ACA-is-the-most-wonderfullest-thing-ever-and-you're-just-too-stupid-to-understand-it" brigade.

I'm facing EXACTLY the same situation -- the premiums I can afford don't cover anything (example: I have to pay a $60.00 co-pay to see my doctor. My doctor only charges $60.00) or premiums I can't afford which actually will cover something.

I'm 58 years old, I've been without insurance for 4 years now. I've got medical conditions that need attending YESTERDAY. I was told just a few days ago that I should just shut up, be grateful that I can get insurance and if I don't want it, just spend $98.00 to opt out.

I'm just SO much better off.

[Are_grits_groceries]

11. Well if they do post,

they can shut the hell up!
I said I recognize that a lot of people will benefit from the ACA. I also said I wasn't going to bitch to the media or my 'reps' because the bitching has been done.
Just don't expect me to jump up and down with joy about my situation. Nothing has changed. I am on a limited budget and can't find a job. I can't afford this coverage AND pay what I will have to anyway. So, the beat goes on.

[Yo_Mama]

47. I am truly sorry for your situation and I think it needs to change

I absolutely support health care reform, but no meaningful reform leaves individuals in the lurch like this.

And may I point out that any theories about reductions in costs because of earlier/better treatment are totally blasted away by people in your situation? Because you can't afford it, you won't get early care. All too many people are in this situation.

It wasn't intended, but it is here and we do have to deal with it.

[Myrina]

19. I think it had already arrived.

cough cough upthread a bit cough ...

[Are_grits_groceries]

20. I know.

I am ignoring it for now. Testing my last nerve.

[pnwmom]

28. Have you checked to see what your subsidies would be? nt

[Le Taz Hot]

44. Yes.

Really?

[Puzzledtraveller]

53. The defense force must have got the call.

[Le Taz Hot]

56. Yes, and the OP is obviously distressed

about her situation, as are many of us. Their reaction from these people is disgusting.

We're not lying and we're not stupid. We've gone over the numbers, played with the numbers, moved things around in different scenarios and the outcome is always the same. The insurance that you can afford doesn't cover anything and has huge deductibles. The good stuff, the stuff you really need, is unaffordable. And yes, that's WITH subsidies.

[Fumesucker]

15. "There's an old saying in Tennessee—I know it's in Texas, probably in Tennessee—

that says, 'Fool me once, shame on...shame on you. Fool me — you can't get fooled again.'"

[JNinWB]

21. Deductibles and annual out-of-pocket are different thngs.

For many, satisfying a deductible for $2000 will seem as bad as the AOOP of $6300.

Here is a link I found that does a pretty good job of explaining how both the deductible and the out-of-pocket work:

DEDUCTIBLE

Your health insurance deductible is the amount that you will have to pay annually for your healthcare (such as surgical procedures, blood tests, or hospitalizations, but not routine office visits) before the health insurance pays anything.

For example, if you have a $2,500 deductible and undergo three $1,000 procedures in a year, you will have to pay the full bill for the first two procedures and $500 of the third…your insurance will cover half of the third procedure.

Increasing your deductible is the easiest way to lower your premiums and, if you’re mostly healthy, might be a good idea. Just understand, however, that if you have a $10,000 deductible and get sick, you could end up with $10,000 of medical bills in a year. Typically, your deductible does not apply for preventative health checkups and many routine health services…you’ll just pay a co-pay instead.

Read more at http://www.moneyunder30.com/health-insurance-deductible-co-pay-out-of-pocket-maximum#xfU0M5J1oaDubcW0.99

Deductible vs. out-of-pocket maximum

The difference between your deductible and an out-of-pocket maximum is subtle but important. Out-of-pocket maximum is typically higher than your deductible to account for things like co-pays and co-insurance.

For example, if you hit your deductible of $2,500 but continue to go for office visits with a $25 co-pay, you’ll still have to pay that co-pay until you’ve spent your out-of-pocket maximum, at which time your insurance would take over and cover everything.

[Humanist_Activist]

25. Uhm, soulnds like OP has some chronic health conditions, which more or less guarantees that...

he will hit at least the max deductible if not max out of pocket every year.

[BlueStreak]

35. If that is true, then it will clearly cost a whole lot more to NOT have insurance

The OP didn't provide details about income or costs of chronic conditions. We are left to surmise that the income is below 400% of poverty because evidently a subsidy brings the net cost to $150/month. But we also surmise that the chronic condition must cost more than $6000/year because the OP is complaining that he or she will have to spend that much.

But without insurance, obvious he or she would have to pay THE FULL COST of the chronic condition. If that condition costs more than $7800 a year, then the OPer is ahead of the game by buying the insurance, not to mention that this policy will cover ALL MEDICAL CONDITIONS for that same price.

Yes, that's a lot of money, but so is getting sick without insurance.

I an not sure why bronchitis should cost $6000 a year to manage unless it turns into a more severe condition requiring hospitalization. In that case, the cost could easily be $50,000, which would all be covered once the max out-of-pocket is reached.

[enlightenment]

92. Are you seriously moving from

"The OP doesn't know what they're talking about" to "I can't see any reason why bronchitis is such a problem for them - why aren't they in the hospital if it's that bad?"

Christ on a pogo stick. I'm surprised you haven't choked on your own sense of superiority by now.

[Hoyt]

58. Good link in your post. Hope people are reading it before panicking.

CO-PAY [for services in which the deductible does not apply]

Your co-pay is the fixed amount you pay for using routine services like visiting your primary care physician or an emergency room or purchasing a prescription drug.

In most cases, the payment is the same regardless of the extent of the visit or the cost of the drug. For example, a plan may require co-pays of $20 for office visits, $100 for emergency room visits, and $15 for generic prescriptions or $30 for name-brand drugs.

[On top of that, there are mandated preventive services in which there is not even a co-pay or co-insurance.]

Read more at http://www.moneyunder30.com/health-insurance-deductible-co-pay-out-of-pocket-maximum#TmgxJmrFkCIqijAx.99

[pnwmom]

26. Are you talking about a deductible of $6K? Or an annual out-of-pocket?

They are two completely different things.

The annual out of pocket means that no matter how many costs you accrue -- no matter how many co-insurance payments or whatever you owe in hospital costs, your total amount owed in a year can't add up to more than that figure.

[Are_grits_groceries]

32. Stop it!

Deductible 6300
Out-of-Pocket 6300

Primary care doctor visit No Charge After Deductible In-Network; 50% Coinsurance after deductible Out-of-Network
Specialist visit No Charge After Deductible In-Network; 50% Coinsurance after deductible Out-of-Network
X-rays and diagnostic imaging No Charge After Deductible In-Network; 50% Coinsurance after deductible Out-of-Network
Laboratory and outpatient professional service No Charge After Deductible In-Network; 50% Coinsurance after deductible Out-of-Network

Stop telling me what I do or do not understand!
I do understand. I have purchased insurance policies before.

You can't make chicken soup out of this chicken shit!

JUST STOP IT!
EVERYBODY!

[pnwmom]

34. So every policy you looked at had the same deductible and out of pocket?

Out of ten?

So the question is what you would owe after a subsidy, which can help to cover both premiums and out-of-pocket costs.

[Are_grits_groceries]

38. Did you not read my post?

STOP IT!

I have looked at everything about every policy from deductibles, subsidies, out-of-pocket, copay, coinsurance and partridges in a pear tree.

To get even a $600 deductible my premiums are $500 AND THAT'S WITH MY SUBSIDY!

I said I was happy that a lot of people would get needed coverage. I mean that. I explained what I found for myself.

But noooooo.....That was not enough though. Here comes THE HEALTH CARE INQUISITION ABOUT EVERY JOT AND TITTLE OF WHAT I FOUND!

YOU are the ones wearing on my last nerve insisting I am an illterate moron. Take your advice twice a day. WITH FOOD and leave me alone.

[BlueStreak]

43. Why did you post this thread if you didn't want any responses?

That ain't the way a discussion forum works. If you post a thread, then others have a right to comment. Your numbers do not sound right to many of us. Rather than providing additional information that would explain why your numbers are coming out the way you claim, you are just yelling "stop it?.

If you aren't prepared to have some feedback you really shouldn't start a thread making claims like this.

[Are_grits_groceries]

45. I am trying to maintain some privacy without revealing everything

about my financial and health conditions.

I posted what I found when I entered my information. Apparently, I am a liar and a dolt. That is the general consensus of those commenting. In addition, people aren't commenting, they are telling me what to do or what I don't understand.

None of it sounds right to me. It is what it is. I am going to follow up to be sure, but not with the mob here who refuses to believe ANYTHING remotely like what I said could be true.

Feedback is different from hit back.

[BlueStreak]

51. I understand your privacy concerns

But you made a rather broad condemnation of the ACA and I think it is fair for people to inquire about that, I don't see anybody attacking. I see some posts that say, basically, "this doesn't sound right".

So let me sum it up. We know there are some situations where the ACA really gives people a problem. The worst one is those that should be in the Medicaid expansion, but have the misfortune of living in a state ruled by a Luddite Republican that doesn't have the brains to accept a gift-horse that is truly a no-brainer economic development program which also happens to bring health care to missions of our most vulnerable.

Your post highlights another "sub-optimal" point in the ACA program. If a person is just over 250% of poverty, they may not have any low deductible options on the exchange. This creates a theoretical exposure for a small number of Americans who will have to accept a higher deductible and then end up having big unplanned medical expenses. That will be a relatively small number of people. There is a further group, again just over 250% of the poverty level who have a chronic condition that will cost just a little bit more than the deductible each year. They will end up paying that high deductible every year and if that is their only health problem, the insurance will not have helped them very much other than wellness coverage.

But let us be clear. If a person had to pay $7000 a year for a chronic condition, the insurance doesn't hurt. It is still better to be insured than not and one's costs aren't really going up.

If the hope was that the ACA would come in and pick up the entire tab, well, I don't know that anybody ever presented the ACA as doing that.

[Are_grits_groceries]

57. I did not make a broad condemnation of the ACA!

I said I knew it covered a lot of people who needed it and that I was glad about that. I am not saying that for grins.

I made a statement about what I found. Now I find myself under attack from people basically calling me a liar to your broad condemnation statement.

I am not happy with my particular situation. I happen to fall in a crack. I will live with that.

Let me sum it up.
I don't like my coverage.
A lot of people will get well-deserved and needed coverage.
It is a great plus overall. For me, not so much but que sera sera.

[Le Taz Hot]

52. "Feedback is different from hit back."

Some people are here only for the latter. There are lots of us out here that are in the same type of dilemma. We know what you're going through because we're going through the same thing. Focus on those of us who UNDERSTAND and not on those who are here only to "hit back."

LTH

[defacto7]

60. I'm sorry your position is a difficult one.

I'm sure at this stage there are a lot of cracks to be fixed no thanks to the GOP undercutting the original plans. I do think that in time the system will maneuver to make up for problems. It's a huge undertaking and government vs. business is a hard combination. It's probably little consolation to look forward to better balance in the future when the problem you face is right now, but the whole new system is in flux and probably will be for a couple of years at least. My hope and confidence is that it will improve in time.

[stevenleser]

78. No, you stop it. Any information posted is subject to being challenged. This is no exception.

If I tell you XYZ candidate is the best one, plenty of people are going to challenge me on that.

I have no idea why some people have the problems they do to understand this. Its not a special exception when someone posts outlier information on the supposed quote they got from healthcare.gov

If you have a doubt on how information can be challenged here, try posting something pro or anti Hillary or Elizabeth Warren.

If your expectations are that you can post something on DU and not be challenged, you need to adjust your expectations.

[stevenleser]

77. That is the bronze plan, correct? Show us the silver, gold and platinum plan. nt

[bettyellen]

102. I'm curious about the same thing. Learning lots here about how complicated it is with co pays

out of pocket, etc.... And the OP seems to say all the levels coverage are the same. I don't believe that is possible, especially if you already have chronic conditions. But yeah, deductibles have gone through the roof. I'm not surprised people who haven;t had insurance in years are shocked. Those of us who have been paying in for years, are less shocked by this. I have steadily been paying more for less for years.

[Ms. Toad]

119. Look for preventative care as a specific line item

Primary care doctor visits are different from preventative care visits (although they may be performed by the same doctor). I'm fighting with my doctor at the moment because he coded some of the labwork as preventative care, and it doesn't fall within the list of preventative care tests - so they were rejected as not preventative, and not medically justified as routine care. He did the same thing last year at my preventative care visit.

(Not challenging your understanding of Deductible & out of pocket - I just know that any ACA compliant plan has to include preventative care at no cost before the deductible.)

[Humanist_Activist]

36. I just tried...again, and it still returns me to a null page(blank) for my eligibility results...

but I signed up for my employers crappy insurance, which disqualifies me from subsidies or help of any sort, so I'm going to be paying over 150 dollars a month for one annual visit to a clinic, and hope nothing is wrong with me.

[MineralMan]

54. How does that compare with your current health insurance?

Premium and deductible?

[Are_grits_groceries]

59. I don't have any.

If I get insurance, i will now owe a premium without coverage for most of my problems.

[MineralMan]

61. Oh, OK.

Tough situation, I agree.

[Are_grits_groceries]

63. Thank you. nt

[meaculpa2011]

64. I don't know the OP's details...

but my premiums went from under $13,000 to over $19,000 with higher deductibles and co-pays.

Apparently my old plan with lower out-of-pocket costs and lower premiums was deemed: "Shitty Coverage."

I'll qualify for Medicare in two years. I hope it still exists.

Please save us from those who have pledged to save us.

I'm considering alternatives, including an out-of-state or even out of country move.

[Hoyt]

69. You must live in a high cost area, if an Exchange Plan has a premium over $1500/month.

That's a lot for a non-smoker.

Where I live, the highest Platinum Plan is less than $800 (I looked at a 64 year old).

That has a $1000 deductible, but only $500 for some drugs. Most drugs don't have any deductible, and the co-pay is $5 or $10. In-network doctor visits do not have a deductible, but have a $25 ro $35 co-pay.

BTW -- I too can't wait for Medicare, although there are some serious coverage gaps with it too.

[BlueStreak]

79. and *THAT* is really where lack of a public option screws us

Lot of markets are highly competitive and the "free market" concept is working -- at least should be considered acceptable. But there are loads of places where competition is not working at all -- either by an absence of competitors or by price collusion among multiple competitors. So you can have a case where a policy in California might cost $500 while a policy with the exact same parameters -- maybe even from the same damn company -- might cost $1500 in Indiana or some other place where competition is not working.

A few people have tried to argue that this is to be expected because of regional differences.

Buuuuuuul-shit. There aren't any regional differences that would account for that. It shouldn't cost three times as much to be treated for a slipped disk in Indianapolis as it does in Sacramento.

THIS is exactly where the public option would have helped. It would have provided a baseline cost in every single market. And it is such a shame. There was a very simple political compromise available if Obama hadn't ruled this out before even opening the first discussion. We could have proposed that the public option:

1) Would only be offered in cases where there was not effective competition (e.g. where the policies in the exchange averaged more than 25% more than the national average for the same coverage.)

2) Would be Medicare's actual cost for that age pool, marked up by 10% to allow insurance companies a reasonable opportunity for shareholder return

3) Would pay the excess 10% premium straight into the Medicare trust fund, making all of Medicare solvent for the next 75 years.

It was tragic that Obama ruled this out. I wonder if he has yet figured out why that was so important?

[Hoyt]

90. I think Medical Loss Ratio controls a lot of that. I think the difference is more due to providers.

In some areas of the country, providers order a lot more costly services than other areas -- in some areas, you'll find rates for heart caths, knee repalcements, etc., are four times the rate in other areas. In a lot of areas of the country, there is no management of care delivery.

If you think a doctor -- or health care facility -- that has a full lab, xray, MRI, surgical suite, etc., is going to order only the services you really need, then there is not much reason to talk further.

Thus, I think it is the competition within the health care delivery system that's the problem, not so much the insurance companies. The insurance companies are capped on what they can earn now. Look at rates in Alabama where there is essentially one insurance company, they are pretty low.

Medicare is a pretty expensive system from the standpoint of cost, even though they have ratcheted down payments to providers (and obviously, the elderly need more care than most of us).

In fact, a significant portion of Medicare beneficiaries have turned to Medicare Advantage Plans because the plans squeeze out excesses (like they actually negotiate drug costs) that unmanaged traditional Medicare does not (of course, the methods used to do that can be questionable at times). Thus, 28% of Medicare beneficiaries choose Advantage Plans because they think they get more for their money than traditional Medicare with a drug plan and a Medigap policy.

I believe a public option should be offered, but I don't believe it will be much cheaper -- if any -- than what is available on Exchanges. It would keep people honest, and force the government to design a managed care system that they have been experimenting with for decades.

There's more, but too tired to type.

[BlueStreak]

100. Providers are not more expensive by 300%.

Anthem operates in a lot of markets. They undoubtedly will find ways to shift overheads to avoid the 80% limit. They'll run 10% overhead in competitive markets and 30% overhead in the uncompetitive markets.

[Hoyt]

105. Agreed, providers are not more expensive by 300%, and you can't show me a plan for $1500 or anywhere

near that on the exchanges. And, I don't think it will be as easy to commit insurance fraud as you suggest, the actual health care costs - which controls how much they can spend on overhead under MLR - is pretty easy to link to each insured.

[BlueStreak]

107. I told you exactly where to look.

The policies in my area for 2 people age 59 and 60 are all in the range of $1300-$1600. The same policies in Detroit are way less than half that. Same for most of California.

Don't call me a liar. Go look for yourself.

[Hoyt]

110. First off, you or I got off track. This sub-thread got started with post 64, where

the poster claimed their single rate went to $19,000 a year, or roughly $1500 month. I'll still stick with $800 per person is about standard for what I have seen. Again, l wish the premiums I paid when in individual market had been so reasonable.

[meaculpa2011]

120. Sorry for the misunderstanding.

I never claimed it was a single rate, but I didn't make it clear that this is the rate for a family of four.

Mea culpa.

[Hoyt]

121. This whole topic is easily confusing, there are so many aspects, a lot unknown. Take care.

[Hoyt]

93. Just looked up a rural area in Indiana. A Gold Plan for a 64 year old is less than $800/month.

Haven't looked at all areas, but I would be surprised if there is anything at $1500 a month.

I'm beginning to think -- but will certainly admit I don't know for sure -- that the poster above is quoting the premium his insurer quoted him as a conversion for a cancelled policy. . . . . . and it is not an Exchange Plan. I've looked at a lot of states, and just don't see any plans for $1500/month (unless one is a smoker maybe).

[BlueStreak]

101. I said it was for 2 people.

Check Marion County -- that's Indianapolis -- for two people aged 59 and 60, non-smokers. You will find that the prices range from $1300 to $1600 before subsidies.

[Hoyt]

103. That's pretty much the going rate before subsidies. I was paying $600 in my 40s with an obscene

deductible years ago. There was very limited mental health coverage, which was changed under ACA; no preventive care to speak of; they could cancel you and you might not get new coverage because of preexisting conditions.

We are much better off under ACA.

[BlueStreak]

106. My rate today is $635 for 2 people

That's an $11,000 family deductible, so that's $5000 more than the ACA deductible. The existing policy does cover my routine office visits basically 100%. It should have covered my colonoscopy, but they jacked me around on that. Their game is that if the doc takes any action (removed a polyp, biopsies a questionable area, or treats a hemorrhoid while he's in there, they declare it was not a preventive test and therefore the patient pays the co-pay portion. One of those things is almost certain to happen on every colonoscopy, so that is a real scam.

My non-ACA policy is with Anthem with a good network that includes all of the docs I have seen in the past 5 years. Anthem is the only recognizable company in my exchange, but for those policies they have a new network that includes only the lowest rated hospital system in the county and includes NONE of the doctors I have ever seen. And for that, I would pay more than twice what I am paying now?

There is a no-name company that offers policies for the same price as Anthem, and they have my docs in their network.

So I dispute the generalization that the ACA policies are better. In my case, there are clearly some trade-offs, and for now I've decided to keep my non-ACA policy.

[Hoyt]

108. That $5000 deductible difference is pretty much the difference in premiums.

Maybe you should ask you docs why they aren't in the network, they are probably holding out for more money.

In any event, under the policy you are keeping, you benefit from better mental health coverage, better preventive care benefits, no more lifetime caps, no preexisting exclusions, and the like.

Good luck to you.

[BlueStreak]

113. I did. They didn't give a direct answer, but the answer seems clear enough

Anthem went out for bid with a set of low, low reimbursement terms and the only system that agreed was the lowest rated hospital system in the county. The better places can't provide the service at those reimbursement rates. I think this is not well understood. Correct me if I am wrong, but it is only the Medicaid expansion that is subject to government-mandated reimbursement rates. Private insurers are free to negotiate their rates with the providers who join the network. It was clear from my discussion with my PCP's office manager that the Anthem ACA plans weren't paying them enough to participate.

You know, Ann Coulter made a really hateful and ignorant comment saying no Doc with a degree from an American university would accept Obamacare insurance. That is absolutely wrong as a general statement, of course. But in the case of this new Anthem network, that actually isn't so far from the truth. My mother died 2 months ago in the hands of that lowest-rated hospital system, and it was an unbelievable battle to get these people to do their jobs, After 9 weeks of being kicked around, I finally got her into the progressive care unit that did actually diagnose her problem, but that was 36 hours before she died. It wasn't a complex problem either, but it was just too late to deal with it. The 8 weeks of ineptness killed her.

Anyway, my point is that in the course of that ordeal, I came into contact with about 20 docs. I did research their backgrounds. Probably 25% of them got their degrees outside the US -- mostly from Pakistan. That doesn't necessarily mean they are incompetent or less capable than others. It is just an observation and people can form their own conclusions. My opinion is that there was at least a kernel of truth to what Coulter said, which might just have been a lucky guess on her part.

Regarding the difference in deductibles, I am fortunate enough to be able to pay the $5000 difference in deductible if that were to become necessary. I think it is very unlikely, considering I've never had any need for hospitalization in the past 50 years and I take care of myself. So a certain $9000 increase in premiums for a very slim possibility of saving $5000 on the deductible does not seem like a good deal to me. This is why people are so angry about the "you can keep your policy" business.

[Hoyt]

114. I am not sure I agree with you on doctor competence. Personally, I prefer doctors who take Medicaid

Why, because it's the right thing to do. Unfortunately, you are right that a bunch of American docs don't feel the same way.

Docs do negotiate for rates, and like every business person I have met, they'll blame Obamacare for all kinds of things if they can squeeze another nickle out of your pocket using insurance companies as the excuse. At some point, you will see local hospitals and health systems offering plans on the Exchanges.

If the docs and hospitals are getting paid so little that many won't participate, folks who take these ACA policies might get a big refund when the MLR is applied.

Personally, I think it is the greed that is throughout our health delivery system (and some patients can be a bit greedy too) that create the problem.

[spanone]

65. k&R...

[stevenleser]

76. You are almost certainly confusing Out of Pocket Limit with Deductibles. This link shows

What average silver and bronze plans have for deductibles and out of pocket limits. http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8303.pdf

Gold and Platinum would have even lower deductibles but if you notice, the out of pocket limits are all at $6350

[BlueStreak]

80. Averages don't work. There is little consistency across markets.

A 300% spread for the exact same coverage is not unusual.

I have seen places in California, and Wayne County Michigan, for example that have 17 or more different companies competing on the exchange. In my market, Anthem has 90% of the policies, and there is a local outfit that offers a couple of policies. That's it. Two companies. And they obviously are in collusion on pricing because their prices come out almost identical when the benefits are comparable. The smaller company is attractive because they have a very good provider network, whereas the Anthem BCBS network is really piss-poor.

[Hoyt]

94. If the provider network is much better, and the cost is the same, who will most people go with.

Then if most people go with the smaller plan, Anthem will have to do something or lose people acquiring insurance on Exchanges, and likely employers who say they want a better deal than they can get on Exchanges.

[BlueStreak]

95. The rates are so high that few will do this unless they get subsidies

This is definitely a market that needs the relief from the "you can keep your insurance" deal.

Re: the provider networks, I don't know. The off-brand is called MDwise. Nobody has heard of them. They are a local company that has apparently been servicing Medicaid. Indiana is one of those states that tries to privatize everything, which is a sure sign of graft. I think if somebody follow the money, they will find that this MDwise outfit is putting a lot of money into Republican pockets around here.

But are they any sleazier than Anthem? I don't see how you can top an outfit that pays its CEO $31,700,000.

I think few people will make the effort to find the difference in provider networks. My current non-ACA policy is with Anthem and it has a decent network. I began with the assumption that the ACA network would be the same. But I had to wander around the Anthem website and eventually talk to two different Anthem employees to find out what they are doing. Their strategy with the ACA is to go as cheap-ass as possible. They struck a deal with the lowest rated hospital system in the county, and that's all that is in the network. That's only about 10% of the providers, and none that I'd ever want to see. I had to do the same kind of research to find out who is in the MDwise network. That took 4 or 5 hours. I just can't see most people doing this.

But I think it is a moot point. Who is going to pay $1500/month for two people and still have a $4000-$6000 deductible? Only people who get a big subsidy. I think a lot of these folks are going to be in for an unpleasant surprise when they find out just how lame that Anthem network is.

They can get away with this crap because there literally are no other providers is n the market. This is the big failure of the ACA. The website is not the problem. The website is fine. It is the policies that are the problem. Franking I think it was really stupid of Obama to expect that insurance companies would not find ways to screw their customers. That's what they do.

[Fumesucker]

83. A person shouldn't need a degree in finance to figure out how to pick their insurance coverage

Many Americans are semi-literate at best, making sense of all this stuff is beyond a lot of them.

The average person *loathes* making these insurance choices because it demands they master an opaque and confusing nomenclature while simultaneously looking in their crystal ball to foresee what medical misadventure to which they might fall prey.

The degree of literacy displayed on DU is fairly exceptional and we still have plenty of members here who do not understand what is going on with the ACA and insurance choice.

[grantcart]

115. yep.

[peace13]

82. The truth of the matter is ...

... that all private insurance has gone the way of the huge deductible. We have had to take the huge deductible just to keep our premiums at the hugely inflated rate that once provided a 2500.00 stop loss. This is Congress keeping the insurance companies in the middle. Unless you are willing to pay huge premiums you will have at least a 5000.00 deductible. We insure three people at our business. Before we got the 'ACA is forcing us to drop you' letter our premiums had gone through the roof. Now they say, pay us 300.00 more a month and you can keep your illegal policy for 12 more months. This has nothing to do with Obama and everything to do with the insurance companies. He needs to refuse to accept the responsibility for this one!

They have been robbing us for years! With the threat that if you don't insure you could lose everything if you get sick. Go figure!

[Fumesucker]

87. It was the Democrats who gave us to the tender mercies of the insurance companies

~Zero~ Republicans voted for the ACA so the Dems have the sole responsibility for what's in it.

[Demo_Chris]

104. ouch! nt

[woo me with science]

99. K&R The corporate vultures have been handed the whole system.

And they are laughing all the way to the bank.