Let's imagine life prior to the ACA

[theboss]

A long, long time ago - say 2009 for argument's sake - if you had a chronic disease you had two choices:

1. Stay employed forever and pray that your health insurance never changes, or
2. Quit and risk dying

It's so along ago, but 2009 was a very different place. There was a show called "Heroes" on the airwaves. And we barely talked about Somali pirates - let alone made movies about them.

In 2009, if you had a chronic disease and either quit or lost your job, you had 63 days to get a new job or to buy expensive COBRA coverage. If you went longer than 63 days, you could get hired again, but you were probably never going to get any kind of coverage from your treatment until you qualified for Medicare.

You had no options on the individual insurance marketplace. They could deny you coverage immediately regardless of how long you waited to purchase the coverage.

If you did buy COBRA, you had either 18 or 36 months (more likely 18 months) to find a new job or get married and pick up your spouse's coverage or you were screwed forever.

Today, you cannot be denied coverage for your chronic disease. You can buy a - yes, expensive - individual policy that will cover your chronic disease.

Now, here's the catch, and it is - admittedly - a big one. What is covered varies by plan. Some kind of treatment for nearly all category of diseases must be covered. But it is up to the plans to determine what that treatment is. We all need to become wise consumers. (Which considering how I test drove 16 different brands of cars over Memorial Day Weekend in 2012 before buying a Mazda is something I think everyone should be at all times).

However, even in the dark days of 2009 there were processes in place to get your prior treatment covered by your new insurance carrier. This happened a lot, because most employers have to choose their plan once a year and there are nearly always changes, particularly if they switch carriers.

My understanding is that the ACA provides for an accelerated review process in these circumstances, but I could be mistaken. (I'm still learning the real nuts and bolts of how this works. Give me a year and I will be able to do lectures, I'm sure).

So...good day. And remember what the kids said in 2009:

"I'm so three thousand and late; you're so two thousand and late."

[lostincalifornia]

1. COBRA is a minimum 18 months, not 6 months. There are also alternatives after COBRA expires

depending on the state. For example, California has Cal-COBRA which could be used after COBRA expires.

In my specific case COBRA is 300 dollars a month cheaper than the ACA. The cost is more dependent on the COBRA plan offered by the company one works for, and also whether one qualifies for the subsidy or not. However, if someone is slightly over the income level for the subsidy, the costs could be significant for the premiums under the ACA, especially if they are older. That is why there is an exception in the ACA mandate that an exception is granted if the premiums for the ACA bronze plan exceeds 8% your income. They realize in those situations it could be a hardship for some. Of course then they would not have insurance.

The ACA is actually insurance reform, not real healthcare reform.

Because of the practices of insurance companies, it does benefit many people, uninsured, those with pre-existing conditions, etc.

[theboss]

2. You're right

I was doing this from memory and got 180 days in my head instead of 18 months.

I'll change that.

[lostincalifornia]

23. In most cases though COBRA is significantly more expensive than the ACA without the subsidy

[theboss]

3. Also, COBRA is almost always going to be cheaper - at least until enrollment goes up for ACA plans

Simply because group plans are cheaper than individual plans.

[ProSense]

4. COBRA is "cheaper"?

In some states COBRA used to be as much as $1,200 per month before ACA. The stimulus reduced COBRA for a period.

http://www.dol.gov/ebsa/cobra.html

For those receiving subsidies via the exchange, COBRA isn't cheaper. I also doubt it's cheaper for those earning above that limit.

[theboss]

5. That's actually cheaper than a lot of ACA plans I've looked at

Especially considering what the copays and deductibles on some plans are.

Granted, I've just been "playing" on the healthcare.gov website to some degree. But if you aren't getting subsdies, some of these plans are kind of incredible - particularly if you consider yourself "healthy."

The math in healthcare is pretty simple - the healthy pay for the sick and that reduces the cost for everyone. If you need several thousand dollars a month in healthcare to live, the ACA is a deal. If you are the 28-year-old who hasn't had the flu in five years, it's a staggering cost.

This is ultimately why single payer is needed - to create the biggest pool possible.

[ProSense]

7. You've seen a lot of individual "ACA plans" that are $1,200 per month?

Where?

[theboss]

8. Is the $1200 a month for a family or individual?

Maybe I'm misunderstanding.

[theboss]

11. And by the way, it was the response in #1 that was suggesting that COBRA plans are more reasonable

What he said sounded correct in my experience.

COBRA is not a good long term solution for anyone, but was a good stop-gap under the old system.

[lostincalifornia]

25. Yes, it MAY be. On covered cal they say that, so that is my case, especially if you are on the

borderline, slightly over the subsidy, and older.

[lostincalifornia]

24. It depends. In my case the ACA is 300 dollars more than COBRA. If you are subsidized from the ACA,

yes, the ACA most likely will be cheaper. If you are younger, yes, the ACA most likely will be cheaper unsubsidized. However, if you are older, the ACA may be more expensive than COBRA, depending on your plan.

I know in my situation it is. 300 dollars a month more

[lostincalifornia]

27. For the Silver Plan in California, if I make 63K a year for 2 people, premiums would be from 800 to

1000 dollars a month for the Silver Plans. I choose the Silver Plan, because that is the equivalent of my COBRA coverage.

COBRA in my case would be 550 a month. 600 dollars if I include dental and vision.

[uponit7771]

30. BULLLLLLLLL FUCKIN SHIT!!!

[ScreamingMeemie]

6. COBRA was $2400/month for me and my children. nt

[theboss]

9. Out of curiosity, how many children?

You don't have to answer if you don't want to.

[ScreamingMeemie]

10. 2

It was actually $2456 for 80/20 coverage through BC/BS of MI with a $2K deductible.

[theboss]

12. For similar coverage in MI

It looks like you'd be paying somewhere around $700 a month. (Again, I'm completely guessing on income and such).

[ScreamingMeemie]

13. Nope.

I'm paying $176/month in TX for better coverage.

Please don't get all up in my face. I'm covered. I was just correcting some mistakes Prosense made. That COBRA coverage figure is lowballing it.

[lostincalifornia]

28. For most COBRA plans probably. In my case COBRA happens to be cheaper.

[theboss]

14. Not in your face

I find this interesting and am trying to get my arms around it.

You are paying $176 for all three? Are the children on CHIP?

Again, I'm being really personal and don't want to ask anything you don't want to answer.

[ScreamingMeemie]

15. You didn't respond to me, but I'm going to assume you are responding to me.

My daughter is now 24 and on her own plan through work. It is $176/month for me and my son $1800/deductible, vision for both, dental for my son.

[theboss]

16. Your son is not on CHIP?

He's on a plan with you? Because I can't figure out how you are doing this without something around a $12K deductible.

[ScreamingMeemie]

17. I make too much for CHIP.

[theboss]

18. Is your deductible under $10K?

[ScreamingMeemie]

19. I JUST told you what my deductible is...

[theboss]

20. Sorry...missed that

Well...that's really good.

I like stories where ACA is working, because it needs to work.

I was at a training last week (in Texas) where we were going through healthcare.gov and plugging in scenarios and people were gasping at some of the premiums and deductibles. So, good stories are helpful.

I don't work on the front end of reimbursement so I'm only now starting to deal with the impact of ACA. I won't really be seeing work on it for probably 6 months to a year. So, I'm slowly eductating myself.

Thanks!

[theboss]

21. Thanks again

But I feel like this thread has gone completely off-track from the original intent which was explaining what the ACA actually does in the big picture- not the nuts and bolts of individual coverage.

[ScreamingMeemie]

22. I don't feel it has, but remember I was only

Here to correct a common understatement about COBRA coverage.

[Gothmog]

26. My daughter turned 26 last summer and I tried to get her insurance

My middle child is in law school and turned 26 last summer. I tried to get her a policy and she was rejected due to "pre-existing conditions" including her past used of ADHD medications. My daughter now has her own policy under the ACA

[theboss]

29. I still think the original post is worthwhile

Have a good weekend.

[Cha]

31. Thank Goodness for Obamacare! It has helped so many people with

life threatening diseases!

Thank you for the important reminder, theboss.

[Doctor_J]

32. I'd rather imagine life with real HC and no bloodsucking middle men