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[Walk away]

This message was self-deleted by its author (Walk away) on Sun Jan 17, 2016, 07:46 AM. When the original post in a discussion thread is self-deleted, the entire discussion thread is automatically locked so new replies cannot be posted.

[Schema Thing]

1. so what is the deductible on your plan?

[jeff47]

2. It's pretty well implied she's got a $6k plan.

Which would also comply with the results she's seeing - there's a host of preventive and diagnostic care that is covered with a copay instead of a deductible.

Now, if she broke an arm, she'd probably have to pay $6k (or the remainder of the deductible).

[wryter2000]

3. Thanks

That's been confusing my coworker, and I didn't know how to explain it to her.

[Walk away]

4. Actually, my deductible is $2500 and my premium is $222 per month.

My old premium was $750 a month without a deductible. However, I had all kinds of limits on my old coverage. I only had $500 per year of testing coverage. That was $500 to cover all blood tests, xrays, sonograms and MRIs. Now, they are all covered 100% if they are performed in hospital or in one of the many facilities that have a contract with BCBS. I also had a total of $500 coverage on prescriptions and then I was shit out of luck. Now I pay between 10% and 20% for meds and my out of pocket gets applied to my deductible.

As far as the broken arm theory goes, my out of pocket for a hospital stay is $500. The people at BCBS told me that I would probably never meet my deductible and I am senior with health issues in one of the most expensive counties in the country for health care.

So far this is just terrific.

[Demsrule86]

27. Lucky you

I have a 3500 deductible and my private insurer (employer based) pays nothing until I meet the entire deductible...most years we don't meet it so I pay big money for the plan and all my medical expenses as well...I have one of those medical spending accounts which helps.

[pnwmom]

8. Except most people who get subsidies on their premiums also get credits on their deductibles. n/t

[LiberalEsto]

5. We have a new $4000 deductible this year and it's really hurting us

The coverage is from my husband's company. Last year there were reasonable co-pays.
Now we have to pay full price for every doctor visit and prescription. I have to postpone a colonoscopy because we don't have the money for it up front. We have to save up for it.

I think these high deductible policies were created purposely by the employers and the insurance companies to punish people for the ACA's existence.

[Yo_Mama]

7. ACA is a subsidized 70/30 actuarial payout

That's written into the law. If you can afford it, you can buy higher levels of coverage.

But the "Silver" plans are supposed to leave the insured person paying 30% of their total costs, so it's by law, not a revenge thing.

The "Bronze" plans are 60/40. And that's the level of coverage the PPACA mandates for employment insurance, so by that standard you are getting better than the minimum required. But I understand, it still sucks for you.

[LiberalEsto]

12. Ours is through my husband's employer

It's not an ACA plan.

My problem is that it seems like employers who do provide coverage are now offering these high-deductible plans that totally screw people.

And I think this is being done to push people off company policies so they'll go to ACA plans.

[Yo_Mama]

14. Well, it wouldn't be any better on an ACA plan

70/30 actuarial coverage is always going to have a high copay or high deductible.

The reason the employer plans are being changed so much is cost, the extended benefits required, plus the "Cadillac tax" provision.

For families with low incomes (200% of FPL or less), you get significant cost-sharing so an exchange plan might be better, but in any case you don't qualify for the subsidies unless the employer doesn't offer qualifying coverage.

So, for example, in my home county in GA, a couple aged 48 and 50 with an income of $42,000 can get a Silver plan for $302 (that's the second-lowest on which the subsidy is figured). But except for the three free visits, free mammogram, etc., your deductible is $5,000, and your out of pocket maximum is $12,700. So once you meet your deductible (everything that isn't free goes toward your deductible), then you get into the copays and coinsurance until you hit the OOP Max. So primary care is $40 + 10%, hospital is $500 + 10%, and so forth.

It's not particularly attractive for moderate income people, because if they get sick they are faced with a difficult situation. As you say, you have to save up to actually get treated.

I've noticed that some people in metro options have better choices, but in ruralish areas it seems to be very similar, and most of the complaints seem to be coming from the rural areas. But there's no way to cut costs by limiting the network as there is in metro areas, so I think that's why.

Now if that same couple had an income of $31,000, their premium would only be $162 a month, plus the deductible would be $1,500, the OOP Max would be $3,000, and it goes on from there. Their primary care copay would be $25 +10%, etc. So a couple like that would do better on the exchange, but the way the rules are written many can't get the subsidies.

[Walk away]

13. That isn't the whole story. If you are eligible for subsidies....

Your co-pay, out of pocket %, deductible and yearly out of pocket is reduced. My "Silver"plan costs 20% of total costs and my co-pays are also reduced to $10 doctors visits.
Someone earning less than I do and paying for a "Silver" plan could be paying 10% or less.

[Yo_Mama]

15. Yes, that's true and I just gave an example in my reply

It does help a lot.

[pnwmom]

9. Group policies have been getting worse and worse every year without the excuse of the ACA.

But if there's enough of an uproar about that, eventually we'll all move to single payer.

[Demsrule86]

29. Colonoscopy

Colonoscopy and mammograms are well care and are covered under hubs job and I think in your case to under the ACA.

[Yo_Mama]

6. Everybody doesn't have the same choice of policies

That does seem quite good to me, and I'm happy for you, but many don't have that kind of coverage, nor access to it.

[pnwmom]

10. But that's how it works on the ACA, except for the young people

who are allowed to get catastrophic policies.

[woo me with science]

11. Your workplace health insurance costs $1,200 more

http://www.democraticunderground.com/10024623144
Posted by Javaman

http://economy.money.cnn.com/2014/03/06/workplace-health-insurance/?iid=HP_LN

Employees are shelling out 28% more for workplace health benefits than just three years ago.

Most probably realize their monthly premiums are going up because they see more taken out of their paychecks. Workers are seeing their premiums rise year after year, going up by 19% on average since 2011, according to a report issued Thursday by Towers Watson/National Business Group on Health.

This is happening though the overall growth in health care spending has slowed in recent years.

Companies, meanwhile, are paying 14% more for their share of the premiums than they did in 2011, as they seek to shift more of the expense to their employees. Premiums cost an average of $9,560 per worker in 2014, up from $8,364 three years ago.

more at link...

[Demsrule86]

28. I wish we could get ACA

Our workplace insurance is very expensive but we would receive no subsidy because we have it...of course if it goes much higher ...might as well.

[Le Taz Hot]

16. Funny that you forgot to mention

which plan you bought. There are four of them. The Bronze and Silver plans have the $6,000.00 deductible per PERSON per YEAR. That's the one I have which means I can't actually use the insurance. To top it off, I USED to be able to get free Advair because we're low income and was able to sign up for the Bridges to Access plan which provides low-cost or free medications to people who qualify. Now that we're "insured" and I get to pay 100% of the cost, that is, if I could afford it, which I can't. That means that I'll be doing without meds. Again.

I'm happy that you're happy you got forced insurance as opposed to health care but pardon the rest of us who aren't real thrilled at having to purchase insurance that we won't actually be able to use.

Btw, I have the Bronze plan and I DO have a $6,000.00 deductible. Don't take my word for it, check it out here:

www.coveredca.com

[Walk away]

17. I have a Silver plan..

have you checked with your insurance company. As I said, Dr visits, testing, all preventative care and most prescription medicine is covered before you pay a penny in deductibles.

I don't understand why you can't use those things.

[Le Taz Hot]

22. I don't care how "covered" "most" prescription medications are.

FREE was affordable. Whatever the hell they're going to charge me now will be untenable for us. YOU try gasping for breath, not knowing if you're going to be able to take in enough air to continue to survive. Now, go ahead and minimize my concerns and address me like I'm an idiot again.

[Walk away]

26. I don't think you are an idiot but...

If you are actually low income then, possibly, you haven't researched your options completely. Maybe you should check with an insurance counselor.

[Walk away]

18. If you are low income aren't you eligible for subsidies?

The top silver plan in CA costs even less than here in NJ. I checked it out on your link.

By the way. I don't have forced health insurance. I have always had health insurance but now I have better coverage.

[Le Taz Hot]

20. So, you're saying the ACA is not

mandatory? Seriously?

Yes, I get subsidies. My premiums are $300.00 a month which is a tremendous hardship on us.

[Walk away]

23. I guess I just don't get how no insurance is better than $300 a month...

premiums for really good insurance. I always expected to have to pay into health care either directly, through taxes or through an insurance company. The care I have been getting since January would retail for many times $300 per month.

I was under the impression that low income people would pay a dramatically reduced yearly fine. I must be wrong. How much will you have to pay if you don't insure yourself?
I am not being forced to insure myself. I am sorry if you are.

[Ms. Toad]

19. If you are eligible for subsidies,

You would probably have been better off with the silver plan. In addition to the premium subsidy, the coinsurance, copays and out of pocket caps are also subsidized. Meaning that the silver plan would have had a nominal $6000 deductible - but the amount you were required to pay would likely have been lower because of the additional cost sharing on the silver plan.

[Le Taz Hot]

21. The Bronze Plan

was almost $200.00 more a month. The $300.00 a month for the Bronze Plan is almost more than we can afford now. There's NO WAY we could up that. I know $200.00 a month is pocket change for many people but for those of us living on the edge it's a difference between living in a house and not. But thanks for the lecture!

[Ms. Toad]

25. It wasn't a lecture. The vast majority of people are not aware

that not only is the Silver premium subsidized, but so are all of the rest of the costs under the silver plan for many people who are eligible for subsidies.

[Cha]

24. K!