What's the point of insurance when the deductable is $10,000?

[davidn3600]

So you are paying hundreds of dollars a month for an insurance plan. And even with this plan, if something happens and you end up in the hospital, you would STILL be looking at possible financial ruin.

Does everyone have $10,000 just lying around?

There are good things with the ACA. But it missed the mark here. Just making sure everyone has insurance doesn't change the fact the healthcare is still too expensive for many people to afford. People will still not go to the doctor and still not have needed diagnostic tests done because the insurance is still not going to cover it because of the massive deductables.

[Ed Suspicious]

1. It's to make sure hospitals get paid I guess. To many $10,000 might as well be

$100,000 might as well be $1,000,000 I guess the hospitals and the insurance companies win.

[brush]

86. How many people have a 10k deductible with the ACA?

Most people, with the ACA subsidy don't get anywhere near a 10k deductible.

The ACA was really designed to get affordable care to those that had no coverage or expensive junk policies that hardly covered anything. That is actually happening if research the sites that calculate ACA rates and subsidies.

It needs tweaking, no doubt, to fix the 10k deductible wrinkle for those with higher incomes who aren't eligible for the ACA subsidy.

I hope it gets done — meaning I hope the repug obstructionists/corporate media/mislead and/or poorly informed don't succeed with their smoke screen in making everyone believe that the ACA is so bad that we should get rid of it instead of tweaking it. And I don't just mean fixing the website.

[Myrina]

112. Anyone with family coverage.

The subsidy supposedly helps you PAY the deductible but in my case, I'd get $58. That leaves me on the hook for $9,942.
Useless.

[brush]

116. That's what needs fixing. Agreed.

You must be self-employed, running a business?

[riversedge]

152. whow!

[SharonAnn]

103. And remember, that's $10,000 PER YEAR! If your treatments continures past Dec. 31, it starts

all over again on Jan. 1. So a chronic condition or treatments that cover more than one calendar year can result in deductibles to be paid of $10,000, $20,000, $30,000 etc. you get the idea!

Let's say you have a major accident in December and are int he hospital for a series of surgeries. That could cost you $10,000 deductible in December and then January starts all over with another $10,000 deductible.

[NYC_SKP]

2. Fewer than 1% of us ever reach that deductible, I'm guessing. nt

[Fumesucker]

34. In my own family over half of us have had incidents that would easily reach that

Last edited Wed Nov 20, 2013, 05:10 AM - Edit history (1)

Emergency gall bladder surgery, several broken bones, breast cancer, hernia operation, ectopic pregnancy, all of those would have gone over that amount these days.

ETA: I forgot that my daughter had an operation to fuse two neck vertebra, they went in through the front of her neck to do that.

[HockeyMom]

95. My ectopic pregnancy cost $3,000 in 1982

that was being in the hospital for 4 days. I thought that was a huge amount of money since my daughter's birth in 1979 was $500 for a 2 day stay. See what the problem is? Heath costs have SOARED. Subject for another thread, but have wages kept up the pace?

[Yo_Mama]

100. No they have not! And you are right, the high medical costs are what we must address.

70/30 insurance might be okay with lower medical costs, but with current costs it is not adequate for the average person.

You have to have a damned good job to be able to afford medical care with 70/30 insurance.

[The Midway Rebel]

3. 10K covers about 3 hours in an ER.

That's my experience. And I did not have 10K laying around but I was able to pay it off in about three years. Sucks. We need single payer.

[cilla4progress]

4. I agree

Round peg square hole. I don't think it's gonna work. Insurance companies aren't helping. In fact, I think they are deliberately sabotaging.

What options does Obama have now to bring on a public option? Any chance they have a plan for this? "3-D chess" anyone?

[global1]

5. Help Obama By Getting The Dems To Keep The Senate And Take The House In 2014.....

that's the only way he's going to be able to get anything done in his last years as President.

[Fumesucker]

45. The ACA got ~zero~ Republican votes

Therefore it's a program enacted entirely by Democrats and signed by a Democratic POTUS.

The conclusion seems inescapable to me, the ACA is what the Democrats intended for us, electing more Democrats would only give us more of the same.

[eqfan592]

58. I've seen you repeat this over and over again.

Were you not paying attention during the development of the ACA? Shortly after the senate bill passed, the Dems lost their filibuster proof majority in the senate, basically forcing the dems in the house to vote on the bill as is and make zero changes to it, least the entire program be scrapped outright. Conservative dems basically shot the idea of a single payer system down outright early on, and they were able to do so because they knew that the dems needed their votes to pass any sort of bill.

Thus, more dems, especially non-conservative dems, means more flexibility, and a chance to see some serious improvements.

In politics, a party doesn't have to vote for something to have a major impact on it.

[Fumesucker]

59. Conservative Democrats are Democrats, no?

I've been paying attention all along, in fact on Nov 19 of 2008, immediately after Obama's election and before he ever took office I predicted right here in GD that the individual mandate was going to be what we eventually ended up with. This despite the fact that Obama mocked the mandate during the campaign.

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=4494168&mesg_id=4494251

[KG]

74. word

[brush]

84. Conservatives Dems are dems in name only (Dinos)

They are actually republican lites who have screwed the President and the other dems many times with their repug-siding votes.

[VanillaRhapsody]

106. Bet they would gladly take a few Conservative Dems in North Carolina right about now...

just sayin.

[brush]

115. Maybe. But if they're just repugs in dem clothes . . .

where does that get you?

[VanillaRhapsody]

117. ANYTHING is better than them....see Virgina Foxx

would take a ConservaDem over Virginia Foxx any day....thank you very much!

[Jackpine Radical]

119. So why did the party leaders support DINOs like Blanche Lincoln

over Bill Halter in the 2010 primary?

Remember this guy? Notice which way he's facing to give his "salute."

[brush]

122. Exactly. Your photo nails why

He's the reason for the blue dogs. We should have listened to Howard Dean instead of Immanuel.

[mike_c]

163. I was paying attention-- dems prevented single payer from even being at the table....

Thank goodness I have a good union job with excellent health insurance through collective bargaining.

[Divine Discontent]

46. +A GAZILLION X A BILLION!!!!!!!!!!!!!!!

I rarely say that kinda jokey title comment, but your subject matter is EXACTLY what must be our focus to clear out the garbage of the teahadists and transform our country's policies. If we can just outmaneuver the GOP-Tea Party and win a few more seats than they do, we can say goodbye to this shutdown/just say No mentality of theirs that's crippled our nation!!!



http://www.zazzle.com/shutdown_the_gop_by_voting_in_2014_government-128195183613839642?rf=238107662556833486



http://www.zazzle.com/the_party_of_no_has_to_go_gop_republicans_obstruct_bumper_sticker-128224072221438203?rf=238107662556833486

[Llewlladdwr]

6. Why would the insurance companies sabotage a law that forces people to buy their product?

That would be foolish at the very least.

[Demeter]

17. short term profit planning

Most corporations in America never look more than a year ahead...mostly just one quarter-year. Then you get your bonus, and move, retire, or work out next year's scam...

[daleanime]

25. Unfortunity...

true, long term planning has disappeared from Corporate America.

[Llewlladdwr]

28. That makes even less sense.

The ACA is about to dump millions of new customers into the insurance companies' laps *right now*. Why would the insurance companies sabotage that?

[Demeter]

82. the insurance companies aren't sabotaging themselves...they're sabotaging the customers

it's harvesting the livestock

[cilla4progress]

124. I agree

The insurance companies win either way - more customers, or control the pool (with less customers). They get to protect their profit.

This system (profit) just isn't going to work with getting health care for all. I think that's why the Medicaid part of ACA is doing best - it's moving folks into single payer.

Those of us out here on the individual market are taking it in the shorts.

[Freelancer]

137. "Fear will keep them in line" -Tarkin, Star Wars

Insurance companies aren't about the elimination of concern, but shaping concern and directing it. They have a product that needs a level of fear in order to be sold. As long as we have a little fear that we've got the wrong thing, or some mistake we've made will leave us vulnerable, we'll keep opening those fliers that come in the mail on a daily basis. They need that.

[solarhydrocan]

43. bonus indeed- 5 yrs of bonus

5 yr chart for UNH- United Health- the biggest (ending October 24th)
current: http://finance.yahoo.com/q/bc?s=UNH



Link for 5 yr. charts on AET AFL AIZ CI CNC CFIN HNT HUM SIE TMK UNM WLP

http://finance.yahoo.com/quotes/AET+AFL+AIZ+CI+CNC+CFIN+HNT+HUM+TMK+UNM+WLP/view/dv

Impressive, no?

Any sector could do as well. Pass a law requiring its goods/services.

[Nuclear Unicorn]

72. "Most corporations in America never look more than a year ahead"

That is ridiculous, as if "most" means "all" and it is especially ridiculous considering long term projections are the one thing insurance companies rely upon exclusively as a business model.

[alc]

93. many quarterly "tricks" but they also have long-term plans

They do all sorts of things to make this quarter (and year) numbers look good. Accelerate or delay sales and purchases. Give discounts to buyers and bonuses to vendors. Etc.

But the big companies are very much focused on long term.

When will they need to retool a factory or build a new one? How much cash will they want saved up and in what part of the world? They may put it off a year or more or accelerate it based on the economy or upcoming tax changes or tax breaks they can get when the economy is bad.

Employees are expensive to hire and are a financial loss the first year until they are trained and up to speed. The business wants 3-5 years out of anyone they hire to break even. They budget a competitive salary and raises for that amount of time to give them the best chance to keep anyone they hire.

When they have layoffs (RIFs, or whatever you want to call them) it's a multi-year financial and operational loss in order to reduce costs 5+ years down the road.

They are looking at potential mergers/purchases 5-10 years down the road. With globalization and growth in emerging markets there will be many mergers in "regional" corporations (North America, Europe, Asia) that will have more evenly distributed worldwide sales rather than mostly regional sales over the next decade. The market won't support all of them so they will merge. Companies are positioning themselves to be the buyer rather than buyee a decade from now (but will gladly be on either side of the merger next month if it pays out enough)

When they do merge it's a short term loss. The integration of systems, policies, etc. and the exit of certain employees costs significantly the first year or two and possibly much longer.

[Yo_Mama]

118. ACA mandated 70/30 actuarial split!!!

The insurance companies aren't sabotaging it. A 70/30 actuarial split means that the consumer is expected to pay 30% of all health costs (although it's figured on expected health care costs for the group). That means either high copays or high deductibles or both, but it really doesn't matter if you don't have the money.

With the advent of high cost-sharing plans, which preceded ACA but ACA makes pretty much standard by 2019 (even corporate insurance will work like this), the hospitals have changed their habits. They now want you to pay the copays and deductible upfront. You can still get emergency care, but for anything that's diagnostic or non-emergency, you have to come up with some cash or sign your life away to get treated.

The reason why corporate health insurance is changing is that ACA mandates that the premiums can be no more than 9.5% of the employees' wage, so the premiums have to be cut down. If the employee is charged more than 9.5% of wages, the company has to pay a fine. But essential coverage can include a 60/40 actuarial split, so a lot of employees are getting this type of insurance now from their employers.

[lostincalifornia]

42. actually it is in the insurance companies interest to see this works.

[Recursion]

13. We have single payer for the elderly, with a $2000 deductible

The Netherlands, with a system closer to ACA than to Canada's, has a mandatory 200 Euro deductible (if you don't spend that much on health care, you pay it in a tax -- it's basically an HSA where they don't force you to put the money in a separate account).

I'd say split the difference: limit deductibles to something like $5K, cap HSA contributions at $5K, and let people choose between rolling their excess over or receiving it back as a tax refund.

[JDPriestly]

32. We need to review how much we pay for pharmaceuticals and medical equipment.

How long do the patents last?

Do the pharmaceutical companies pay the government back for the value of the government-funded research that helps them develop their products?

No one and I mean no one should make a profit on the misery of others.

Professionals should be paid, but people who own stocks in companies that are involved in healthcare should get limited returns. The ACA is supposed to limit the profits to about 20%, but I wonder is it will succeed in meeting that goal. I doubt it. The insurance companies hire clever accountants. I hope that my suspicions about the insurance companies' greed are unfounded.

[Hoyt]

62. To be fair, it limits profit to a lot less than 20% because administration, risk, marketing,

CEO salaries, claims payment costs, etc., come out of that 20%.

[Warpy]

54. Depends on where you are and what hospital you go to

I spent 4 days in the ER and one day on a stepdown unit in septic shock. My bill was $14,000. They knew I was uninsured and an RN with the brains to seek follow up care, so they let me loose a lot sooner than civilians might be.

I specified the county hospital to the ambulance guys. I'm glad I did. The bill would easily have doubled elsewhere.

[global1]

7. Dumb Question Here: Is That The Deductible Amount For Most ACA Policies?......

I haven't heard anyone comment on the deductibles in the ACA Insurance Plans. I'm assuming that the cheaper the plan - the higher the deductible. Is that the case?

[bhikkhu]

24. It is, but it varies a lot

I've been browsing plans in my semi-rural area of Oregon, and most have 10K or so max out of pocket. Those also tend to have co-pays that kick in before the whole deductible is reached, and various other benefits. There's also a plan that has a $1000 max out of pocket and low deductible, but insurance doesn't kick in until the deductible is reached...the premiums are close to the same either way...

We don't have many general practitioners around here, so I'm probably going to try to find a ppo, one way or another, that local doctors use. Just started looking at that though.

btw - for me and my two kids, at 30k or so a year income, with subsidy we'll pay about $85 a month. I can live with that even if the coverage isn't great. Physicals and vaccinations and so forth will be free, which will be a big help.

[Act_of_Reparation]

140. Here's a rough review of a Bronze Plan offered in Michigan:

A family plan at a monthly premium of $523.00, you get:

A deductible of $11,900! and an out-of-pocket max of $12,700

Coinsurance: 40% for most services, $800 max.

Copays: $30 for pcp, $50 for specialist, $250 for emergency rooms

Pharmacy (and here's the killer):

Tier 1A (Pref. Generic): $4.00

Tier 1B (Generic): $20.00

Tier 2 (Pref. Brand): 25% coinsurance with a $40 min, $100 max

Tier 3 (non-pref Brand): 50% coinsurance, $80 min, $100 max

Tier 4 (Pref Specialty): 20% coinsurance, no minimum $200 max.

Tier 5 (non-pref Speciality): 25% coinsurance, no minimum $300 max.


In short, this plan is shit. After years of billing insurance for a Long Term Care Pharmacy, I can tell you, with some authority, most Medicare plans look luxurious compared to this awful crap. A $20.00 copay for generic drugs is patently ridiculous; for most, you will be paying the entire negotiated cost out of pocket.

For people who do not qualify for assistance, this plan is useless. Absolutely useless. The insurer, on the other hand, makes over $500 a month for doing absolutely nothing.

[Act_of_Reparation]

141. And for an extra $100 dollars a month...

You could get a Silver Plan, which brings the deductible down to $3,300.

$879 gets you a Gold plan with a $500 deductible.

[Hoyt]

162. Unless you need a heart/liver/kidney transplant, cancer, etc., then the coverage is good to have.

And as you said above, pay some extra and get almost first dollar coverage.

So, if you know you are going to spend a lot on health care, you go for the Gold Plan if there is any way you can pay the premium. If not, you probably qualify now, or will soon, for Medicaid.

[Hoyt]

64. It varies a whole lot. Some plans have a $1000 deductible, office visits without a deductible,

drugs without a deductible, preventive care without a deductible, etc.

[IronLionZion]

83. You can browse plans and prices yourself without signing up on healthcare.gov.

The options vary by location. And you can also look at ehealthinsurance.com. The prices won't factor in subsidies, but its a way for you to see what prices and options are available to you.

The very high deductible plans are usually paired with a health savings account, or its a catastrophic plan that one would get only in case of major stuff. I would advise a young healthy person on a low income to get that instead of taking the risk of no coverage.

Every ACA plan covers checkups and the list of minimum preventive stuff.

[ScreamingMeemie]

127. It is not the deductible for most of the plans on my exchange.

The Silver plan I picked has a deductible of 1800 with a $2900 max.

[Cleita]

8. Not only that, it kicks in every year.

It's a bad deal in every way unless you have a disease that is chronic and expensive and most likely the insurer will find a way to deny you or dump the first time you miss a cross or a dot on your ts and is.

[Ms. Toad]

53. That is the way insurance always works.

It is actually a fairly good deal as long as you are relatively healthy. Most people don't have medical expenses anywhere near the level of the high deductible policies. It is the people with chronic illnesses who will have to pay the full out of pocket maximum each and every year who will really be hurting. Yes - they won't have to pay over $60,000 a year (our family's annual bills), but paying $6-9000 each and every year is no picnic.

And - insurance companies cannot dump you for missing a cross or dot on your ts and is. You will need to pay attention to the rules of the policy you buy to make sure you get the most benefit. I suspect since deductibles and out of pocket maximums being an annual occurrence seems to be a surprise to you, you may have trouble following the rules (like needing referrals, for example), in which case coverage will be denied for those claims where you didn't follow the rules.

[Cleita]

94. Before I got Medicare, I found a $3,000 deductible and a premium of

$325 a month a very bad deal on the combined income of my husband and myself so I dropped it. I noticed what a great deal it was for the insurance company. Then I found out that most doctors didn't take it because the fee reimbursement was so low, so my out of pocket was even more than the $3,000 deductible.

So it resulted in my not going to the doctor. By the time I got Medicare I was a mess with an accumulation of untreated chronic medical problems and needed surgeries. I finally got access to the health care I needed with Medicare. That's what people need, health care not insurance.

As far as I'm concerned, a pox on Max Baucus and the other DLC Democrats who blocked the public option or a buy into Medicare as part of the exchange.

[cilla4progress]

125. I agree about Baucus

Makes me sick. If only Teddy had lived a little longer...

Do YOU see any way a public option could be worked in, at this point, e.g., under executive order? Or would that take another Congressional act - e.g., no way gonna happen.

[Cleita]

134. Maybe a revolt led by both health care providers and patients.

You will have to scare your reps and senators into doing it, I fear. And while your at it demand a living wage. That should make a twofer and a good revolution. My taste for this legislative nonsense and not getting anywhere is becoming very sour.

[cilla4progress]

136. I hear you

I'm in Washington state. I think we have it better than most. Certainly our congressional delegation (Patty Murray, Maria Cantwell, + Dem Governer).

[libdem4life]

9. For some of us $1,000 is a lot. What's the situation on what used to be the free clinics?

Not hospitals, but the places one could get some primary health care. Usually staffed by Interns, Nurse Practitioners or Physician's Assistants. I wonder if the ACA reorganizes that funding. It wasn't much, but in a pinch, it was there. Illegal immigrants would go there because no one asked questions. Other poor, for non-emergency health care, too.

One thing I noticed, and this was my own insurance at Kaiser, that many health situations did not require an MD. I personally preferred going to one of the NPs or PAs, but the co-pay was the same.

[Recursion]

11. ACA greatly expanded clinic funding. It's why Sanders supported it

The FQHC program had its funding tripled, and hundreds of new ones are opening.

http://findahealthcenter.hrsa.gov

[libdem4life]

12. Wow. Complete with map. Long list. Thanks for the info.

[Recursion]

14. You're welcome. I have no idea why this isn't better advertised

I know in my hometown in Mississippi the Cooperative Extension office hands that out, and social services in DC and Boston do too, but it doesn't seem to have made it into general public awareness yet

[libdem4life]

15. Hopefully the local/county Health and Human Services offices...where they hand out Food Stamps would

have this local list/site handy. Also, maybe they could help some with ACA who can't manage or don't have the computer skills.

[bhikkhu]

26. Yes, I live in a sparsely populated area of Oregon

but there are three open health clinics within 25 miles. I haven't heard whether they are expanding, but the extra funding is bound to help.

[uponit7771]

151. ****THIS SHOULD BE AN OP*****

[Recursion]

193. Cali and a few others have done several OPs on it

I have no idea why the message isn't getting out better

[renie408]

203. Hey, thanks!

[Recursion]

10. Two reasons

1. It keeps you from going bankrupt

2. It makes you care how much a treatment costs

Now, $10K can still cause a bankruptcy, but it's a lot more manageable from a lot of perspectives than $250K, and more to the point it means the provider knows at most its going to eat a $10K loss on you, which means they don't have to charge everyone else enough to cover that risk.

The cost-sensitivity was added because a lot of our problems are based on the fact that there have up til now been two classes of patients: people who didn't care how much something costs, because they have insurance, and people who can't afford how much something costs, because they don't have insurance. Preventive and wellness care are now free, but they want people to start asking questions about costs and benefits when deciding on treatment. (And, no, it's not for when you're in the ER after having been hit by a bus; it's for when you have impetigo and need to decide between topical and oral treatment.) This, incidentally, is the same reason Medicare Part A has a $2k deductible, and the complaints about that are main reason there's a Medicare Part B (and expect outfits like AFLAC, etc., to start selling "ACA Part B" insurance to help cover deductibles).

A big complaint from the right (and remember, this is mostly a conservative idea) was that we don't really have health "insurance" in this country, we have prepaid medical care. So, the deductibles are now matched to the contribution limits to HSAs. High deductible plans were not meant to be used without an HSA, but at least the systemic damage that raises the prices on everyone else is somewhat limited.

Are those good reasons? To me this is an example of how a bad idea can still be better than no idea. Still, having lived a lot of my life hand to mouth, I think it's really out of touch with that lifestyle -- when you're missing payments on something every pay period, and nervously checking your bank balance at 11:59 pm every other Thursday waiting for it to be positive again, there's not really financial space to be making any medical payments at all, which will mean people will skip treatments like they do now, so a lot of the problem isn't solved.

[JDPriestly]

35. A $10,000 deductible is way too high.

Most American families could not afford it even if it happens only once in a lifetime.

[Recursion]

38. It's less than one fifth of the median household income (nt)

[Fumesucker]

56. One Third of Americans One Paycheck Away From Homelessness

http://www.nakedcapitalism.com/2011/10/one-third-of-americans-one-paycheck-away-from-homelessness.html

This stunning factoid was reported in DS News last week and appears not to have gotten the attention it deserves. A mid-September survey ascertained that a full one third of Americans were living paycheck to paycheck, and if they lost their job, they would not be able to make their next rent or mortgage payment. And the article stresses this was not a function of being in or near the poverty line:

Despite being more affluent, the poll found that even those with higher annual household incomes indicate they are not guaranteed to make their next housing payment if they lost their source of income.

Ten percent of survey respondents earning $100K or more a year say they would immediately miss a payment….

Sixty-one percent of those surveyed said if they were handed a pink slip, they would not be able to continue to make their mortgage or rent payment longer than five months.

The implications are grim. The odds of an economic recovery any time soon are close to non-existent. Many large companies (like Bank of America) have announced layoffs. Flagging top lines and a likely to be weak Christmas season, if Chinese shipping volumes are any guide, means more cuts are likely go be announced next year. And that’s before you factor in the impact of a strengthening dollar, state and local government belt tightening and a possible financial crisis.

With so many citizens on a knife’s edge financially, a slackening of demand will have a more severe impact than usual. I strongly suspect that most macroeconomic models don’t allow for the shock of job losses leading so quickly to the loss of the primary residence or extremely rapid curtailment of spending (as regular readers once know, once a homeowner misses a mortgage payment or two, pyramiding late fees pretty much assure they are on a path to foreclosure). In other words, if we have another economic leg down, it will feed on itself in a more pernicious manner than most experts foresee.

[Posteritatis]

188. When those households are living paycheck-to-paycheck that's meaningless. (nt)

[JDPriestly]

199. Let's say your median household income is $26,000 per year.

1/5 of that is $5200. if you had to pay that each year for say 5 years because you had a wife or husband with a chronic or serious disease, in 5 years you would spend nearly a year's salary.

And each year you paid the $5200, you would have just over $20,000 in income. It's hard to live on that. That is less than $2,000 per month when at least one member of the family has a serious medical problem.

If you pay $750 for rent, about 9% for your sales, payroll, etc. taxes (everybody pays those; when people say the poor pay no taxes, they forget that everyone, even renters, have to cover property taxes, taxes on telephone usage, sales taxes etc.) and utilities, you start getting down to the bare bones of life. Mashed potatoes and a half a hot dog once a day is where you end up.

If you have never been poor, you cannot imagine what it is like to have to choose whether you will feed your children a glass of milk OR some frozen vegetables. Yet, were it not for food stamps, many Americans would have to make that choice. Been there and know what it is like. If you have never been there, well, I can understand that it is hard to imagine how those with very, very tight budgets manage and how frustrated they may feel. .

[cilla4progress]

128. Also - have you ever tried asking how much something costs

in the medical system? They have no answer!

[pnwmom]

16. The maximum is $6300, but most people will pay significantly less,

depending on the policy they choose, after subsidies are counted in. Or are you talking about a catastrophic policy that's only available for people under 30?

But you're correct. Choosing a policy with such a large deductible is not such a great idea unless you have the money to pay for it (or unless you have a parent who could help you if the worst happened.)

[StrayKat]

19. It's $6,350 for an individual, $12,700 for a family.

A car accident, a heart attack, a stroke, or a slip on the ice could easily put you at that $10,000 mark.

It doesn't make sense for low-income or even medium low-income people to choose high premium/low deductible plans either since it can mean diverting those funds from other more pressing basics like food, clothing, housing, transportation, hygienic products, etc.

[pnwmom]

20. It still makes sense. It's possible for a medium income family

to get out from under a $12,700 bill -- just as it's possible for them to buy a car for that amount (over time).

It's not possible to pay the hundreds of thousands in bills that could be the result of a car accident or a stroke.

The other factor that people forget is that the original bill is always higher for uninsured patients -- I know, that's so unfair. But that's what happens. All the insurance companies have negotiated for discounts with the providers, so it's only people with no insurance who are expected to pay the full, non-discounted rate.

So by having a catastrophic plan you both lower your initial bill and limit the maximum you'd have to pay -- to an amount that, while painful, is achievable over time.

[StrayKat]

22. A catastrophic plan is not a high premium/low deductible plan.

Choosing a policy with such a large deductible is not such a great idea unless you have the money to pay for it (or unless you have a parent who could help you if the worst happened.)

You've changed your argument. Your earlier post stated an opinion that large deductible plans (e.g. catastrophic) were not good idea for those who couldn't afford to actually pay the deductible should something happen.

[pnwmom]

30. Part of the problem is I'm not sure whether you were talking about

a regular policy with a large deductible or a catastrophic plan. They're not the same thing. The ACA allows people under 30 to opt for true catastrophic plans.

I don't think there is a one-size-fits all solution to this. At least a catastrophic plan limits the possible damage to a definable amount (as do out-of-pocket limits). We are currently paying for health insurance for a family friend, and it is a comfort to know that no matter what happens, her/our out-of-pocket cannot exceed a certain amount.

Some people, especially those who have some money set aside, or friends/relatives to help them, might do okay with a catastrophic plan. Other people are better off stretching themselves with a higher monthly premium, but a manageable deductible.

And then they have to look at what's really important. It's hard for me to agree with people who think it's okay to have a $200 monthly cable/phone bill and to spend $150 a month in cigarettes, but insist it's not possible to purchase a decent ACA policy.

[StrayKat]

69. Both.

Catastrophic and Bronze plans are not exactly the same, but they are close and both are low premium/high deductible plans.

[pnwmom]

77. If you get a silver, the subsidy is supposed to help keep the

premium down, right? So wouldn't most people be better off with a silver?

[Nuclear Unicorn]

80. Not everybody qualifies for the subsidy and, if I understand correctly

the subsidy is a tax credit, which means you pay first and the subsidy comes through at tax time.

[pnwmom]

81. That's not how this particular tax credit works.

With this one, a person who signs up by Dec. 15th could actually get a tax credit subsidizing his premium in January (the payment paid directly from the government to the insurer.) You don't have to wait till April.

[StrayKat]

89. It depends.

The premium subsidy is just a flat rate. If you qualify for $100/month subsidy, you can take it off the $163/month Bronze plan or the $251/month Silver plan. So, your choice is now between a $63/month plan and a $151/month plan. Lower rates, but same choice of paying upfront with higher premiums or at time of service with higher deductibles.

[JDPriestly]

37. If you have a family member with a chronic disease, a $10,000 deductible per year

is ridiculous. I know someone whose cancer medication is $10,000 per month. Her deductibles would add up very quickly, and she could not pay her debt of $10,000 over a period of years because she has needed the medication every month of every year.

Think of families with children who have serious diseases that require very expensive medications.

That is unrealistic.

We need single payer with very low deductibles and co-pays for all. Anything less isn't really much help for the families that need the ACA the most.

[pnwmom]

41. If you have a family member with a chronic disease,

you might be better off opting to pay higher monthly premiums and have lower annual out of pocket costs.

One thing that will change in 2015 is that there will only be one out-of pocket maximum covering everything, including medication.

But in the example you give, knowing your out-of- pocket, including medication, is limited to $10,000 a year is a lot better than accruing debts of $120K a year just to pay for your medication.

[Humanist_Activist]

57. When you are poor, then the choice is affordable premiums, unaffordable care...

or unaffordable premiums and affordable care. When people say you have a choice, its a lie.

I remember, a few months ago, someone telling me, it may have been you, to try to get a platinum plan for my fiancee because of her chronic conditions, honestly, that advice was just frustrating considering that a gold or platinum plan would have cost us around 1/3rd of our income in premiums alone. Thankfully, starting in February, she gets to go on Medicare, and we can have some relief and options compared to craptastic Missouri Medicaid.

As far as individual coverage for me, well, I'm signing up to my employer's plan, for the free doctor's visits only, all my money goes into her medical care right now, so I can't afford my own(look above about craptastic Medicaid). Even then, we are unsure of premiums and copays for Part B, and she has a lot of doctor's visits in the course of a year, more or less monthly, sometimes bimonthly, so even Medicare might be too expensive to use, but we are seeking help and options through it.

I'm just glad she's been on disability long enough to qualify for Medicare, without having to be 65 years old.

But I also want to bring up another point about chronic conditions, if we used my employer's maximum out of pocket as a guide, from this past year, assuming my fiancee was on my plan as a dependent, a family plan, it would have been a 16,000 dollar max out of pocket(excluding prescription copays) that would be maxed out, every year, for the foreseeable future. Considering that that is about half of our income, every year, how would be ever be able to pay that off? More importantly, how would be able to visit the same doctors, month after month, while owing them unpaid bills that we can't pay?

Its easy to say we can make arrangements, but if we can only afford to pay a small fraction of the amount owed, and still have to use the services, hence accumulating more debt, what are we supposed to do?

[pnwmom]

67. The poor in states with Democratic governors will have access to

expanded Medicaid; and people with incomes up to 400% of poverty will get subsidies to help pay premiums and out of pocket costs.

I am very sorry that people in other states are being denied this -- and that Medicaid itself is "craptastic" in your experience. My father, with an effort (a lot of time spent on the phone), was always able to get good care for his partner's two foster sons through Medicaid (including necessary surgery), but I realize that there are probably significant regional differences in how well the program works.

I have never told anyone to get a platinum policy (I didn't even see any on our state exchange), so that wasn't me.

Your current employers plan has a maximum that is too high under ACA. Have you checked to see if it will be changing? Also, as of 2015, medication costs will be covered under the same out of pocket limits.

I hope things get better for you in February, and I'm sorry that we don't have national single payer because it would be more efficient and people like you wouldn't be suffering. I also hope that Vermont's experiment in single payer can lead to to something better for everyone down the road.

[Humanist_Activist]

200. Its craptastic in many different ways, mostly related to spenddown, think of that as a monthly

deductible or premium, that's about 300 dollars, we use other ways, due to her income, to get assistance to meet it, but until then, you can't pick up prescriptions without paying full price. It was just met, today, notice the date, over half the month gone, and she is damn near out of medications, and has so far had 3 doctor visits and an ER+hospital stay this month. The coverage is supposed to be backdated, but they fucked that up, so its not backdating far enough, which means we just wracked up some more medical debt on top of other things.

To give an example, about 6 months ago, due to a case worker screw up, the spend down wasn't met until after her ob-gyn appointment, an appointment she couldn't miss because of her depo shot. So we had to shell out about 120 dollars just for that(they demand payment up front), and that's not the first or last doctor's visit we have had to pay for with cash, cash we frankly don't have, thanks to that one, we didn't have heat or hot water for 3 months, thankfully it was in the summer, but cold showers suck.

Thankfully, with the spend down having been met today, with 6 of her medications needing to be filled, we were able to get that done for about 9 bucks. Copays are around 1 dollar for generic and 2 dollar for brand name. Still, when the start of next month happens, we will have to go through the bullshit all over again, and just hope spend down is met near the beginning of the month, she does something that's very bad, for some of her medications, she doesn't take them as prescribed, but tries to ration them out so she doesn't run out before spend down is met.

[JDPriestly]

170. That's why we need Medicare for all or single payer.

We still have a deductible on our Medicare plan but ours is not $10,000 even though for most Medicare recipients who rely on Social Security for their income the deductible is monstrous.

My very elderly mother pays a lot of money for her Medicare Advantage which she obtained due to the fact that her plan is her teacher's pension plan's provider.

I am shocked at how much she pays. She still has a high deductible.

We need to get medical costs down to a reasonable level.

In other countries that have had single payer plans for decades, costs are across the board cheaper. I lived in several European countries on their single payer plans. It was great. I loved it and my children thrived on it although one of them had a chronic condition that required medication almost from birth.

So we just have to keep working for single payer.

One of the advantages of single payer is that children have coverage from birth to death. If we get good medical care before and after birth and through our childhood and young adulthood, we can take care of conditions that cause later problems earlier. In general that would make our health better.

For example, conditions that caused great misery not all that many years ago can be operated on in utero. The quality of children's lives can be improved drastically thanks to that.

I have to say that the delivery of health care especially for people like your fiance with chronic conditions is going to change in the coming years. A doctor in San Diego has devised a computer ap so that he can track certain physical indicators of his patients without their coming to his office. If you have high blood pressure or high cholesterol and your doctor can monitor your readings without actually touching you or seeing you in his office, that will save a lot of money for the health care system. That is coming and what we are seeing now of that is just a beginning. So health care will get cheaper in the coming years. It will also get better.

Did you call the number to get some personal assistance when you signed up for the ACA?

I agree that the deductibles may be too high. I note that a lot of the articles about the ACA do not mention them. But getting no health care is far more dangerous than paying a high deductible. The high deductibles can be dealt with in future legislation. Not going to a doctor can mean death or making your condition worse.

[cilla4progress]

130. Is there any way to get there from here

do you think? Can Obama pivot to single payer without Congress' help at this point? What about the states?

[Ms. Toad]

51. So - if you don't have insurance now and you have any of those things,

what do you do?

(And, as for low and medium low income people, aside from the idiotic states which rejected Medicaid expansion, they will have no cost, or significantly subsidized cost - including subsidies that lower the cost sharing (co-pays and co-insurance) and out of pocket caps, something which many people who are determined to sink the plan before it starts seem to be forgetting.)

[StrayKat]

68. I don't know, what do you do?

The choices don't make sense either way.

If money needs to be diverted from absolute or practical necessities to pay for an unknown contingency (as is the case for many people), it doesn't make sense to pay a higher premium while forgoing basic needs or imminent practical concerns. For some people, the immediate mundane financial hardships loom larger than the vague possibility of an uncertain future health outcome.

On the other hand, what you're postulating is a situation where the contingency is already realized, and so in the extreme people have to decide whether no food or no medicine will hurt them more. In less extreme cases it could mean forgoing higher education and limiting their long term resources and prospects or cutting into transportation costs and jeopardizing their livelihood.

As far as the subsidies go, they're calculated based on the Silver plan which has a 'moderate' deductible and co-insurance, but to people who actually qualify for subsidies on premiums these might as well be high deductible plans that pose a significant barrier to treatment.

[StrayKat]

91. Good luck and good health to you and your family.

I'm sorry you're going through a rough spot with your family's health. Dealing with setbacks and the associated rising costs can be a real drain emotionally and financially. I hope the coming year is better for you all, too.

[Soundman]

92. Thank you!

Yeah, almost two years ago exactly I woke up in the middle of the night with some serious chest pains, tried antacids and when that didn't stem the pain we decided to call an ambulance. 6 hours later I was Sporting a brand new stent in my LA. I was back working on Friday and felt really really crappy the next day. I thought that I had tore a spot in my arm where they first ran through. Turns out I had diverticulitus and it ruptured, of course I didn't find that out until the following year when the rupture developed into a fistula. After having that repaired last December we thought that we were finally over the hump. That was until my wife was diagnosed with stage 3 cervical cancer and I had to have two hernias repaired that resulted from open surgery I had. We spent he majority of this year going through her treatment and the resulting complications.

On the bright side. As I type this she has been declared cancer free and I am feeling great. Just had a nuclear strees test and it came back good. We are relatively young at 50 and hope we are now tuned up and ready for our last 25 (or so) years. Things have started to turn for us financially and we hope to get these bills knocked out over the next three years.

This should probably be post of its own but in case you didn't know it, if you receive treatment from a college hospital they have recourse to garnish tax returns etc. as they take state money. Anyway probably tmi for here but I appreciated your response and wanted share the story.

[cilla4progress]

132. Very moved by your story

Glad things are on the mend

Blessing to you and your family!

[StrayKat]

138. Thanks for posting back. Your story is uplifting.

It's great to read that you and your wife are doing so much better physically and financially. Cancer free is awesome, and feeling great after multiple operations is wonderful, too.

[Soundman]

185. Thank you both very much!

[cilla4progress]

129. Plus with a 70/30 split

that's not much coverage! At least there are annual maximums, making these policies more like catastrophic coverage.

I just think this thing was rolled out badly. Maybe Pres O should have been in more constant contact with the public. Like daily 15 min. PR sessions, for the 1st month or so?

[Bonobo]

18. What's worse is that it would likely only cover ONE incident.

They phrase it as $10,000/year/incident.

[pnwmom]

21. That is not true under the ACA. n/t

[Egalitarian Thug]

23. To ensure that your campaign contributers can continue to steal with impunity

while simultaneously convincing your less-than-brilliant constituents that you're doing something other than simply laundering the proceeds from the extortion.

[solarhydrocan]

48. +1. Outstanding. Simultaneously funny and sad.

[Egalitarian Thug]

52. Mostly very, very sad, but thank you so much for the compliment.

The Orwellian ACA is, horribly, better than nothing, but unfortunately most won't learn just how bad it is until it is needed.

[SheilaT]

27. If you are in an insurance plan with a high deductible

the benefit you get is the much lower charges that an insurance plan gets you, rather than the full freight amounts you get if you have no insurance at all.

I work in a hospital. I used to do out patient registration, and I recall asking someone with a huge deductible why they even had insurance. And she told me. They were charged less than if they had no insurance.

So how many of the plans offered under the ACA have that huge a deductible? Maybe if you buy up into a higher plan you'll have a smaller deductible.

I sincerely hope that all this will lead us in not too many years to a much better system.

[pnwmom]

31. Yes! Too few people realize that the actual charges are lower

if you have an insurance plan than if you're an uninsured patient.

[SheilaT]

40. Yes. I did not fully understand that until I had the job

registering outpatients at a hospital, and it was explained to me by one of my patients. Duh.

For the most part, so far as I could tell, these sorts of people tended to be fairly wealthy but who decided to do their health insurance this way. I'm sure it made sense.

I am hoping that now with the ACA in effect, people will figure out what makes sense for them.

[pnwmom]

44. I guess you could say they were "self-insured."

They managed their costs by getting a cheap plan that would reduce their bills. But that cheap plan would cover them in the case of a truly catastrophic expense, like a hospitalization.

[Hoyt]

156. I had a plan like that once for that very reason.

If he doc charged me $400, I knew the plan allowable would be $150. That is not unusual, nor is it unusual for a hospital to charge $100,000 for an inpatient stay, and have most of it written off because the insurance company allowed only $8,000.

[jtuck004]

29. Because it is profitable to the ins companies whose lobbyists played a significant part

in writing this bill. Also the reason they insisted on mandatory coverage for everyone. (It was profitable before mandatory coverage, but if they had to limit it to 15%, then they wanted a bigger pool. They aren't stupid. These people have been in the business of making profit for a long, long time, and they know how to insure servitude.

That is also the reason there is no upper cap on how big premiums can grow, just a slight impediment on how much it can grow every year without extra paperwork. Bigger pool of cash, that 15% gets larger.

[Hoyt]

65. Well the Exchanges are a major impediment, unless everyone is stupid enough to select the

plan with the highest premium. I'm not.

[Spitfire of ATJ]

33. "Does everyone have $10,000 just lying around?"

I guess if it's from an accident you are supposed to sue for damages. Then the insurance company pays the insurance company and,...uh,....wait a sec...

[Divine Discontent]

36. well, for most poor folks, the basics like primary doc visits are included for $5-20 per visit,

and then you could get Rx prescribed for $5 generics, but yes, even though if poor or working class poor, and your monthly premium is all or mostly covered, if you go to hospital you would possibly pay 20-30% Coinsurance on the billed amount, according to many of the plans, unless I'm mistaken, and that's fine if I am, and you have to pay the $6300 (single person) deductible first before they pay that 80%, but the bigger point being, poor unemployed and poor working class don't have thousands floating around to pay deductibles, so they would have to pay monthly amounts like $25-50 a month back to a hospital, surgeon, for labs, etc, that they're responsible for, however, the max you have to pay is called the OOP (out of pocket) and it has a max. So, regardless, the easiest way to say this is,

go to HRSA govt facilities if you can and show them you make zilch and have no health care (esp. if medicaid isn't expanded to include non-sick unemployed people), and if you do make a wage, they will make you pay based on a sliding scale, very low amounts. You don't have to pay a penalty if you are poverty level and don't "buy" insurance as req'd by the law. If you do work, yes, the premiums will get covered mostly if you don't make a lot, but you'll still have some costs if you get a major illness or surgery.

Heck, I was at the ER for a bronchial infection in the summer, they perfomed ZERO tests, and gave me some breathing med through a plastic device, and the ER doc wrote the prescriptions for the antibiotic, and the bill came a few months back for $1800 for the hospital, and $400 for the ER doc! LOL... riiiiiiiiiiiiiiiiiiiiiight!!!! Again, ZERO tests were run, no blood, no urine... just listened to my chest. Unbelievable....

[jazzimov]

39. Preventive care is free. The deductable

is for max out of pocket costs. Would you rather pay $100, 000?

[davidn3600]

47. If they have a moderate problem though, I guess they are out of luck

Say someone finds bleeding in their stool. The doctor orders a colonoscopy, only now because symptoms are present, it doesn't qualify as "preventative." Now the test is considered "diagnostic." Which means the patient now will have to pay out the entire cost of the procedure which could be in the thousands of dollars....plus any treatment that might be required.

[eomer]

61. The deductible and max out of pocket are two different things.

For certain services you pay until you reach the deductible, then you pay just a copayment or coinsurance until you reach the max out of pocket, then you pay nothing for the rest of that year.

[Yo_Mama]

110. No, generally the deductible is paid up front except for the free services

Those free services do not include any treatments for ailments, although most people (unless they have to take the catastrophic) may be able to use their free visits for illnesses. But the deductibles in many plans are all up front.

So if you get sick, you pay all the deductible in treatment costs, then once you have exceeded the deductible the copay kicks in until you have reached the max out of pocket costs, after which everything is paid.

So in my county in GA, the second lowest Silver plan for a 52/55 aged couple with 47K of income would have a $7,000 deductible and a $12,700 OOP limit.
http://www.valuepenguin.com/health-insurance/GA/anthem-bcbshp-silver-directaccess-cbds

With the subsidy the premium for that plan is only $372 a month, which is good, but if something happened and this couple needed diagnostic tests, they would first have to pay $7,000 of costs before the insurance would kick in.

There are gold plans available with a $1,500 deductible and a $6,000 out of pocket, but the lowest premium after subsidy is $700 a month or $8,400 a year, and most of these couples would not be able to afford that, because it is almost 18% of their before tax income and over 21% of their after tax income. Most moderate income couples can't afford that with rent/mortgage, car payments, car insurance and other costs.

There is no cost-sharing past 250% of FPL, and there is no significant cost-sharing past 200% of FPL.

[JimDandy]

182. It will cost that couple $17,164 or 36.5% of their income

before they no longer have to pay any more for medical expenses--that is their REAL Obamacare Out Of Pocket cost ($12,700 OOP + $4,464 in premiums after subsidy).

Obamacare will now exceeded what would usually be that couples largest expense: a rent/mortgage expense of 25%-30% of their income.

ETA: this provides no real relief and will not be sustainable year after year for that couple without going bankrupt, which is why we need single payer

[Yo_Mama]

191. I have been expressing these concerns for some time

Insurance is not insurance if you can't afford it when you get sick and need it, and insurance is not insurance if you can't afford to get medical care while you are insured.

ACA helped with the affordability part (because when income changes you can get subsidies), but many Americans are experiencing crushing disappointments when they find out what type of insurance they are qualified for.

I do support single payer or a public option, paid for by payroll taxes plus some investment tax. That way everyone pays, and when their income changes the contribution automatically changes.

We can have small copays & deductibles with special funding for low incomes, but not this shit.

[Humanist_Activist]

201. You forgot prescription copays which don't contribute to out of pocket max until 2015...

which, depending on how many medications a person has to take, can easily add 100+dollars to their monthly medical expenses.

[JimDandy]

205. Good point! n/t

[Warpy]

49. You don't go broke surviving cancer

and that's about all it does. You'll be in debt to the tune of 10 grand (20 if you're tacky enough to get sick in the fall and your policy runs January-January), but someone who survives cancer is expected to be able to work long enough to pay that off.

Just forget about saving for retirement. The cheap bastards.

These deductibles are going to kill the ACA but it's going to take some time. By then the insurance companies will be agitating to lower the Medicare age because they don't want any of us old crocks over 50, soon to become 45. Once the powerful start to demand it, it will be done. Once the Medicare age starts getting lowered, it is likely to continue.

[cilla4progress]

133. I suppose that's the best fix...

lower Medicare age.

Can Obama do it without Congress?

[Warpy]

145. No, Congress has to do it

and they likely will when the insurance companies scream about their declining profits.

[Ms. Toad]

50. You should check again.

The maximum out of pocket for an ACA eligible plan for a single person is $6350, so the deductible cannot be more than that.

(Of course the numbers can be higher if you are talking about more than one person.)

And, most people do not spend anywhere near $10,000 in a year. People typically spend a few hundred a year (beyond the preventative care which is covered before the deductible).

(This structure will hit people with chronic illnesses very hard, though - our costs for next year are guaranteed to be at least $8900, and $6000 the year after that, and after that, and after that...)

[Hoyt]

111. Yes. There are ACA plans on Exchanges that have lower deductibles and Out-of-pocket max.

I think the $6350 is like the the maximum deductible an ACA Plan can have. But, in the states I have looked at, there are usually plans with lower deductibles and Out-of-pocket caps. Of course, you pay more in premiums, but for some folks it's worth it.

[Ms. Toad]

150. My point wasn't that there are lower deductibles -

but that for a single individual $10,000 cannot be a deductible on an ACA compliant plan.

[Fumesucker]

55. The point is having lower middle class peons deny themselves all but crucial medical care

[riqster]

60. The ACA didn't invent such deductibles. In fact, high deductibles have been common

...for quite some time. My last employer health plan had a 12000.00 deductible, for example.

In fact, the ACA put a cap on the maximum size of deductibles.

[antigop]

139. re: "maximum size of deductibles", read this...

http://www.democraticunderground.com/?com=view_post&forum=1116&pid=43852

[riqster]

144. Also common before the ACA.

My last plan had separate 12 k deductibles
for in and out of network. This long before the ACA.


The ACA did not claim to fix every problem within the murky world of Health care finance. People need to remember that, and to differentiate between what ObamaCare did and did not create, and what it did and did not promise to fix.

[antigop]

146. the point of the OP is "affordability". It's called the AFFORDABLE CARE ACT.

The point is, that for many, IT WON'T BE AFFORDABLE when you look at co-pays/deductibles/out-of-network costs.

[riqster]

147. Then the author should have chosen something the ACA created that made health care less affordable.

Instead of pointing out (in a borderline-misleading manner) items that the ACA did not create or exacerbate, and acting as though ObamaCare was somehow responsible.

[antigop]

148. NO, the OP pointed out that the AFFORDABLE CARE ACT is NOT AFFORDABLE. nt

[riqster]

149. No, the author focused on deductibles.

Here's the OP in its entirety:

So you are paying hundreds of dollars a month for an insurance plan. And even with this plan, if something happens and you end up in the hospital, you would STILL be looking at possible financial ruin.

Does everyone have $10,000 just lying around?

There are good things with the ACA. But it missed the mark here. Just making sure everyone has insurance doesn't change the fact the healthcare is still too expensive for many people to afford. People will still not go to the doctor and still not have needed diagnostic tests done because the insurance is still not going to cover it because of the massive deductables.

That was a narrowly focused OP that dealt with deductible size. And large deductible sizes did not, repeat did NOT originate with the ACA. As stated before, ObamaCare actually capped deductible sizes, so the OP blew it on just about every level.

[antigop]

155. and the deductibles don't make healthcare AFFORDABLE. READ WHAT IT SAYS!

Just making sure everyone has insurance doesn't change the fact the healthcare is still too expensive for many people to afford. People will still not go to the doctor and still not have needed diagnostic tests done because the insurance is still not going to cover it because of the massive deductables.

Healthcare under The AFFORDABLE CARE ACT won't be AFFORDABLE because of the deductibles.

Good grief.

[riqster]

161. And the ACA IS. NOT. THE. SOURCE. OF. THE. DEDUCTIBLES.

Before the ACA, some plans had higher or lower deductibles.

Since the ACA, some plans have higher or lower deductibles.

No difference (except the part I mentioned) due to the ACA.

Blaming large deductible sizes on the ACA is ignorant at best, and a partisan hit piece at worst.

[Fumesucker]

166. The ACA sets the rules for medical insurance policies now

I'm not sure what part of that you fail to understand.

[antigop]

168. amazing, isn't it? nt

[riqster]

186. Yep, and it added a rule that capped deductibles.

It did not add a rule that required high deductibles.

So yes, there are rules. But maybe they don't do what you think they do, or what you wish they did.

And a very good day to you as well.

[Fumesucker]

195. Then it is the fault of the ACA that high deductibles exist

The clear purpose of those deductibles is to make sure that lower middle class peons don't access health care unless it's something really crucial.

Wouldn't want to burden the health care system with all those recreational colonoscopies.

[antigop]

167. the ACA specifies what the max deductibles are. GOOD GRIEF! nt

[riqster]

172. You are blaming the ACA for something it never claimed to fix.

If you were going to complain about something the ACA promised and failed to deliver, that's fair game.

But this OP and these "defenses" thereof are just willfully uninformed bashing.

Yes, the ACA left lots undone. And more needs to be done. We need to have full national health care.

But when we are handed a partial solution that is advertised as a partial solution, blaming that partial solution for not being complete is ridiculous on the face of it.

[antigop]

174. It's called THE AFFORDABLE CARE ACT. The OP is claiming it doesn't make healthcare affordable

because of deductibles. And my point was that the deductibles as high as they are, may only be for in network coverage. Your out-of-pocket may be even higher because of out-of-network charges.

Telling the truth is not "bashing."

What part of that don't you understand?

[riqster]

177. Oh, I understand you, right enough.

I just disagree with you, because your argument fails due to a false premise. And not one that is uniquely your own: a fair number of other people are similarly ill-informed.

That premise is as follows: "since the ACA is called the Affordable Care Act, it must make all health care affordable to everyone at all times in all places". The problem with your premise is that the people who gave us the ACA made no such claim. And so that premise is nothing more than the projection of your own (very commendable) desires onto the ACA.

But the ACA is what it is, what it was made to be; not what we wish it to be. It is a device to start making health care more affordable, not the culmination of that process.

The only way to make health care as affordable as it needs to be is to elect shitloads of liberals and progressives to both houses of Congress, so we can remove the profit motive from health care entirely.

That is not what the ACA does, and not what it claims to do.

[antigop]

179. nope. We are not "ill-informed". Keep digging! nt

[antigop]

180. and you never replied to post #166. Have a GREAT afternoon. See ya! nt

[riqster]

187. Just did. Takes us old farts a while, sometimes.

And I'd also mention that you have never tried to rebut my points: just restated your own. Put another way, your mentioning my lack of a reply in terns of quantity kinda makes me question the lack of quality being returned.

[Yo_Mama]

192. The insurance is generally affordable but the health care may not be

That is a crucial distinction.

[antigop]

194. It's called THE AFFORDABLE CARE ACT. nt

[sendero]

63. If you get a bill...

.. for $200,000, a $10,000 deductible sounds pretty good. And people get such bills every day.

[Le Taz Hot]

73. And to many people,

$10,000 might as well be $10 million -- they've no way of paying it. I'm glad that sounds good to you, but to many others, it sounds terrifying. People will hesitate to get treated and people will die because of it -- much like it works now without paying insurance premiums.

One can always tell on this board who is/has been poor and who has never been poor. They "out" themselves with their "let them eat cake" commentary.

[KG]

75. word.

[antigop]

105. ***THIS*** nt

[Myrina]

114. +2

Thank you.

[Fumesucker]

121. "One can always tell on this board who is/has been poor and who has never been poor."

Quoted For Truth.

[leftstreet]

126. +1

[uponit7771]

158. Some have to learn the hard way, it's ok as long as we all learn

[sendero]

190. You know..

... I didn't "out" anything, I am not ashamed of my financial position. I grew up very poor and I decided at age 10 I was not going to live paycheck to paycheck and always worrying about paying for necessities as I did growing up.

My wife has a serious medical condition and is a transplant patient. $10K sounds like a dream bill.

I have sympathy for people of limited means (that is why I am a Democrat) and I would have preferred single payer. But since people of all incomes continue to vote for assholes and believe in the evils of "socialism", I don't see that happening, and it's not my fault.

[Le Taz Hot]

196. Your original assertion was that "only" having to pay out $10,000

was a good thing. Even after I replied that $10,000 would be an insurmountable amount to obtain for too many families, you continue to claim that $10,000 is a "dream bill." It's become a circular argument.

There was no accusation of "fault" in my reply to you, only a seeming inability to understand the conundrum in which many people find themselves.

The "people of all incomes continue to vote for assholes . . ." probably doesn't apply to many DUers.

Just understand that there are thousands and thousands of different situations people find themselves in with the ACA. People aren't stupid and people aren't lazy -- they're just trying to figure out a way to make it work.

[sendero]

197. I understand everything.

.... including the simple fact that people who have the means can and should pay the $10K. People who are destitute should pay nothing. And those in the middle should pay something.

I've probably given 50 times more thought to the whole scenario than you and I don't appreciate being preached at.

[Le Taz Hot]

198. I'm done here.

Have a nice evening.

[newfie11]

66. There should be the same deductables as Medicare

This is bullshit. You pay for insurance but if you need it ya pay some more. Deductables are a ripoff.
I have Medicare and Champ VA. 100% is covered. They each pay the others deductable!
This is what this country need socialized medicine for all!!!!!!!
Sorry I think ACA was written for and with the help of insurance companies.

[solarhydrocan]

70. Meet Karen Ignagni

"I think ACA was written for and with the help of insurance companies."

Karen Ignagni- key player in the ACA

Karen Ignagni is the president and chief executive officer of America's Health Insurance Plans (AHIP). She is often mentioned as one of the most effective lobbyists and the most powerful people in healthcare. She is involved in health care reform in the United States, working to benefit health insurance companies
http://en.wikipedia.org/wiki/Karen_Ignagni

(Karen Ignagni estimates the size of just one of her balls)

AHIP has spent more than $31.4 million on lobbying from 2005 to 2009, according to the non-partisan Center for Responsive Politics. This includes $3.9 million alone in 2009, which paid for the work of 50 lobbyists at eight different lobbying firms.[10]
http://en.wikipedia.org/wiki/America's_Health_Insurance_Plans

http://www.opensecrets.org/lobby/clientsum.php?id=D000021819&year=2009

AHIP, Ignagni and "Sicko"

On the July 10, 2009 edition of Bill Moyers Journal, Wendell Potter, former Vice President of corporate communications at the health insurance corporation CIGNA, claimed that the industry was "afraid" of the Michael Moore documentary Sicko.[11]

As a result, AHIP formed a strategy to "discredit this film".[12] As part of the reporting on this allegation, Bill Moyers Journal provides May 2007 and June 2007 drafts of a memo entitled "Ensuring Accurate Perceptions of the Health Insurance Industry".[13][14]

This memo outlines the strategy the health insurance industry would use to battle Moore’s documentary. The later draft lists the following as the "5 Strategies We Reached Consensus On":

1. "Debate the System, not the Anecdotes. Set the record straight then get off Moore’s turf and on to ours."

2. "Reframe the Debate: Mount Campaign against a Government-run Health Care system."

3. "Define the Health Insurance as Part of the Solution."

4. "Caution Democrats Against Aligning with Moore’s Extremist Agenda."

5. "Game Plan for Various Potential Scenarios."

The AHIP memos do not list any factual errors in Sicko. The memos instead focus primarily on media messaging in terms of influencing politicians and public opinion. http://www.pbs.org/moyers/journal/07102009/transcript2.html

[newfie11]

76. +infinity

I defended ACA to my friends and in the end they were right.

[riversedge]

153. Wendall Potter has done good work but few will know of it.

[Hoyt]

164. I appreciate what Potter is doing now, but he did get filthy rich signing peoples' death warrant

when he worked for insurance companies showing them how to deny coverage, usually for pre-existing conditions. The ACA, essentially put him out of business.

[polichick]

78. Absolutely - on all counts.

[Hoyt]

169. If you check ACA offerings, you can probably find a plan with deductibles lower than Medicare.

Most won't be happy with the premiums, though.

I would like 100% coverage too, but somebody is going to have to pay for it, one way or the other -- direct premiums or taxes. I suspect most people aren't ready to contribute what it would cost to do that, even if it is scaled to income and resources. Folks are going to say, "let the guy who makes more than me pay it." Unfortunately, that won't work.

And, yes, I agree we need to slash the military budget and increase taxes on the wealthy, but there are other uses for much of that money too -- education, food stamps, expanded unemployment benefits, welfare benefits, SS, etc.

[MadrasT]

71. To strip money from the peasants

to line the pockes of the insurance industry, and continue to enrich our massively inflated healthcare system and phrarmaceutical industries.

It is a joke to call this "affordable care".

[beachbum bob]

79. are we still confused

to deductible, copay and max out of pocket terms mean?

I have seen references to these terms that have been 99% incorrect when discussing ACA (or any medical insurance coverage)

[Auggie]

85. The point is insurance companies are ripping you off

[geek tragedy]

87. people have the choice of paying higher premiums to get lower deductibles.

Sorry, the ACA was never going to perform magic and make everyone get the maximum benefits while paying minimum premiums.

And $10,000 won't pay for cancer or heart surgery treatment. Or a whole lot of other serious diseases.

[TBF]

90. Be sure to really look at the policies - we have lots of deductibles but find they don't always kick

in like we think they will.

I think it depends on what they consider preventative vs. optional to start with. If I go for a yearly wellness exam in January I won't pay the whole thing (I may pay a $25 copay but that's it). They seem to consider that preventative and cover it. But if I went in at January and asked about doing an MRI for my deviated septum (which I will definitely fix at some point but they don't consider it something that "has" to be done) - I'd likely have to pay full price for procedures like that until the deductible is met).

I know it is confusing but that is what I've found with United Healthcare. It probably varies a lot depending upon who the insurance carrier is and how they classify everything.

[ecstatic]

96. It's not what some of you are thinking

It's not like car insurance where you have to pay the deductible in full before you can get any care. Each non-routine treatment/procedure/surgery will come with a copayment which will be the percentage your policy states. You would only have to worry about that 10k if you have a series of HUGE catastrophic medical emergencies back to back in the same year. I wish I could explain it better, but I can't. I'm just explaining what I experienced when I was on the individual market. I had high deductibles, but at no point was I asked to pay the entire 10k upfront and I never reached that limit despite surgery, MRIs, and a bunch of non-routine medical treatment.

[Lars39]

97. Have a severe accident Dec 31st, out $10,000 for that year and out $10,000 again the next day.

Get diagnosed with cancer and have to have a week or so of tests. You *will* be asked to come up with the full deductible and substantial co-pays before those tests are given. Been there, done that, and got the bankruptcy tee shirt to prove it.

[Orrex]

99. Also

If your doctor sends you for an MRI, don't be surprised if your insurance company decides after the fact that they're not going to pay for it, even if they approved it in advance.


Great stuff, insurance! Quite a racket!

[Lars39]

102. Oh, yes....and then you're out the $4000 for the MRI

[Orrex]

109. On the bright side, you'd only have $6000 left on your deductible

Until next year, of course...

[uponit7771]

159. That is so horrible!! I've had this done before

[Hoyt]

154. Some health plans have a carryover of deductibles for expenses incurred late in the year.

[Lars39]

171. Never heard of that and have never had such a policy myself.

[Hoyt]

175. I have and pretty sure I hsvr seen it on some exchane policies.

I'm on a tablet now, but searc under deductible carryover, and you will find discussion.

[Lars39]

178. Not seeing it, sorry.

[Yo_Mama]

113. No, most of these deductibles are up front

That's how it used to work. Not any more. ACA Silver plans have a 70/30 split, meaning that individuals are expected to pay about 30% of their medical expenses.

In some places you can get plans with lower deductibles and higher copays, but the health care providers, including non-emergency hospital care, will want the copays up front in cash.

Health insurance has changed - even corporate health insurance has changed.

[Humanist_Activist]

202. Many plans won't pay anything until the deductible is met first, and this includes...

non-emergency(but not preventative) doctor visits. I know my employer's plan is like that, states it outright, and then they pay a percentage(80%), and you pay a copay(20%) AFTER the deductible is met until you hit the out of pocket max, then your copay drops to 0.

[librechik]

98. raw, ruthless scam. And no help from the government.

[JimboBillyBubbaBob]

101. That is a damn...

...good question.

[JNinWB]

104. Here is an article that clarifies some HI terminology

Health Insurance: Understanding Your Deductible, Co-pay, & Out-of-Pocket Maximum


http://www.moneyunder30.com/health-insurance-deductible-co-pay-out-of-pocket-maximum#Ap5TVCqJODVIV3ht.99

[antigop]

107. You also have to look at whether that deductible applies to out-of-network

http://www.democraticunderground.com/?com=view_post&forum=1116&pid=43852

[PasadenaTrudy]

108. I enrolled

in a Silver plan with a $2k deductible. Had to choose that one to keep my monthly premiums low enough. Gold and Platinum have zero deductibles, but I'd be paying over $100 more a month...

[lumberjack_jeff]

120. How much is your house worth?

even a $10,000 maximum out of pocket will protect you from losing everything.

[Fumesucker]

123. House?

That don't scare me no more, lost it years ago.

because otherwise I'll

[duffyduff]

131. Because this isn't about covering people. It's about scamming them for profit.

n/t

[cilla4progress]

135. Great thread

Appreciate there has been minimal piling on.

One obvious fact: there is still a lot of confusion about ACA and health insurance in general. If the reasonably knowledgeable folks on this thread don't understand it, what about the rest of the country?

Sadly, I think this version of health care "reform" is, dare I say, a failure. I hope I'm wrong. I know it's working for some. But it needs so much work, I wonder if it is even salvageable.

I'm sick..at heart..

[FreeJoe]

142. Catastrophic insurance for those that can afford the deductible

It makes no sense when you are looking at health insurance as a means of provisioning health care. It does make sense if you look at it purely as a means of insuring people against catastrophic health care costs. Insurance gets much cheaper as your deductible gets higher. We have steadily ramped up the deductibles on our auto and home insurance as our ability to pay deductibles has increased.

[One_Life_To_Give]

143. Deductible or Max. out of Pocket?

Deductible means you spend 10,000 on medical before insurance pays their first dollar. Max out of pocket, which many didn't have before, means after your portion of the total bill exceeds 10,000 insurance covers your payment portion as well.

[TampaAnimusVortex]

157. This is why contributions to a HSA should roll over year after year...

You should be able to save up a few thousand dollars over a few years in an HSA in case an emergency hits, so that you could cover the deductible. For those who cant afford to do this themselves, it could be handled with tax credits deposited directly into the HSA for them.

[cbdo2007]

160. Wow, the lack of understanding of health insurance in this thread is astounding.

[mmonk]

165. To take your money while you pay the bills.

[taught_me_patience]

173. Higher premiums = lower deductables

You get to decide what your own piece of mind is worth...

Go check out how much cancer treatment costs... my sister survived cancer and her bills easily totalled over $1M. Her total out-of-pocket was about $15k... if she didn't have that much money, I would have gladly paid it to keep her here.

[HERVEPA]

176. $10,000 will not cause most people to go bankrupt. That is the point of insurance

I do understand it is still a lot of money.

[meaculpa2011]

181. If you run the numbers...

it seems that the high-cost, comprehensive health plans involve nothing more than pre-paying most of your deductibles.

[StrayKat]

184. Based on what?

Isn't the average medical debt for those in bankruptcy less than $20,000, just two years worth of those deductibles?

Out-of-pocket medical costs averaged $17,943 for all
medically bankrupt families: $26,971 for uninsured pa-
tients, $17,749 for those with private insurance at the outset,
$14,633 for those with Medicaid, $12,021 for those with
Medicare, and $6545 for those with Veterans Affairs/mili-
tary coverage. For patients who initially had private cover-
age but lost it, the family’s out-of-pocket expenses averaged
$22,568. --American Journal of Medicine

[ecstatic]

189. and usually hospitals offer interest free payment plans

I've been paying 142/month on a balance I have. It is frustrating... Maybe one day care will be free, but it's unrealistic to think such a drastic change could be made by one president in one step.

[magical thyme]

204. I can put $10K on my credit card.

And although now I'm pretty broke, I used to have that kind of money lying around.

For a significant number of people -- more than 1% -- a $10K deductible does make sense.