Instead of saying "Screw the ACA", why don't people ask for help to find their best plans?

[moriah]

I see people posting that they can't find anything affordable, yet their state has great plans available.

1) Biggest thing: Make sure you say you're going to file a tax return. Without that, you're not eligible for a subsidy!
2) If you're a smoker, yes, you're going to have higher premiums. Sorry about that. Tobacco's hard to beat, but it'll beat you in the end.
3) Post your state, and if you want to, your zip code. Others who have navigated the ACA site can help you find the plan you need.

Or, before giving up, go to one of the places in your state where there are people to help you put in your information, or call the Helpline to help find your best rate.

For those who are eligible for subsidies, those without employer-sponsored coverage below the 400% of the poverty line threshold, or those whose employer coverage is more than 9.5% of individual income make sure you look at Silver plans. Those are the ones with cost-sharing adjustments so that deductibles and copays are reasonable.

Thank you for at least giving the ACA a chance to help you.

[Wella]

1. When a law serves the needs of the insurance industry as opposed to the needs of the people

it is thoroughly legit to blow off steam.

The only real solution to this is single payer, and I think everyone on this board knows it at some level.

[sharp_stick]

3. If you can think of a way to progress

single payer into our situation that would probably be pretty welcome.

[Art_from_Ark]

76. A public option would be a stepping stone, I think

I doubt that the US will ever get single-payer in my lifetime, but providing a public option may be a way to get the proverbial foot in the door. At any rate, the current system just seems to further entrench the private insurance companies.

[Cha]

94. MIllions of People are covered for Free thanks to Obamacare and there's No Denying Insurance for

Pre-Existing Conditions..

A Great start.. and only rw asshole Govs in red states seem to think that's a horrible idea.

[moriah]

5. The ACA is a stop-gap measure, but it's helping people, too.

Until we have the support for single-payer to get it passed and make it a reality, getting rid of the ACA is just as stupid as suggesting that we should have gotten rid of DADT without securing the rights for people to openly serve in the process -- making things go back to the dark ages where anyone who was disliked could be brought up on charges of being gay and discharged.

[tridim]

11. Do you consider limiting profits of the Insurance industry, "the needs of the Insurance industry"?

Do you consider any of the ACA's strict regulations on the Insurance industry, "the needs of the insurance industry"?

Because if you don't, WTF is wrong with you?

[NCTraveler]

100. You say "limiting the profits of the Insurance industry."

What were the profits of BCBS the year before the ACA?

[groundloop]

53. The ACA, if nothing else, is a step forward

Sure, single payer would have been great. But Joe Lie-berman and a few other traitors prevented that from happening and the Affordable Care Act was born. Yes, most of us are still stuck dealing with insurance companies and policies which are tied to our employment, but at least we have free yearly checkups, free vaccinations, the ability to insure our kids until they're 25, and no discrimination against pre-existing conditions. And in addition to all that insurance companies are now more heavily regulated in terms of the percent profit they can make (but granted, they have an expanded customer base now).

In any case, the ACA is a step forward and I'll accept it while I patiently wait for the next time we control Congress and the White House.

[csziggy]

75. Single payer would be awesome - but we need some kind of insurance TODAY

Actually my husband and I will need it as of January 1 since he is retiring Dec. 31 and will no longer have coverage.

I'll keep pushing for single payer, even after we go on Medicare in three years, but we can't wait for some coverage while we work towards it.

Since we both agree that single payer is the ideal, what specific suggestions do you have for getting it passed?

[Prophet 451]

2. Too much effort

It's always easier to say "screw that".

And if you're a smoker, switch to ecigs! Satisfies the nicotine craving without tar and the other 3000+ chemicals.

[Curmudgeoness]

42. Do you know if you are considered a smoker

with the ACA if you use ecigs?

[Prophet 451]

43. Really? That's weird

Because e-cigs don't dispense smoke, they dispense steam. Which will usually, but not necessarily, contain nicotine but is still vastly less harmful than regular cigarettes.

(full disclosure: I quit smoking six months ago with an e-cig which I love and still use).

[Sgent]

47. You would have to look at the

specific policy / wording.

Most life insurance policies will consider you a smoker if you have ingested nicotine in any form in the last year.

[Prophet 451]

50. Thankfully, I'm British

so covered by the NHS.

[appalachiablue]

59. Friends are trying to too. Any particular info. that helped?

[Prophet 451]

66. Not really

I never intended to quit. But I used to smoke roll-ups and on the rare occasions when I leave the house (I'm severely mentally ill and don't go out much), I used to have the problem that I kept having to re-light them. My SO convinced me to give e-cigs a try because I wouldn't have to constantly re-light them.

I posted here, requesting some info. Then I tried one of those disgusting disposable ones that Big Tobacco has put out and, while it was disgusting, it showed me that the concept could work for me if I got some decent liquids. I ordered myself a Tornado V3 with a few liquids, was lucky enough to hit on a tobacco flavour I really liked straight off ("7 Wolves" from VapeEscape.com). Overnight, I went from 50 to 5 and over the next couple of weeks, I dropped the last five. April 23rd, I decided to see if I could manage purely on the e-cig and haven't smoked since. My own doctor is now recommending e-cigs as a harm reduction strategy for those who have trouble quitting. My SO is overjoyed and my cats much prefer to the new smells. Like most people on e-cigs, I'm also gradually tapering down the amount of nicotine in my liquids until eventually, I'll just be huffing flavoured steam for the taste.

What info helps them depends on what kind of people they are. You could mention the chance to get out from under Big Tobacco (I'm extremely anti-corporate). You could point out that e-cigs are vastly cheaper or that they satisfy the nicotine gremlins without any of the other nasty stuff that's in tobacco. If they have pets, you could point out that the pets have to breathe in the smoke. Even if someone doesn't care about their own well-being (as I didn';t), they might care about their dog or cats.

[appalachiablue]

71. Appreciate info. & suggestions much, will pass along.

We're familiar w/ MI also. Take care & all the best. Glad your SO & Kitties are doing well, good for you!

[jtuck004]

73. Yes. Doctors, the New England Journal of Medicine, says they are an acceptable route

if, like many, the smoker has tried to quit using any number of the useless methods for them that are out there. The difference between the outcomes:

450,000 deaths a year attributable to smoking. 2 in the past 4 years from e-cigs,
1) Kid was given it to play with and drank it
2) Guy injected the solution
(Don't do those.)

is so dramatic that they suggest the use of a vaping pipe/e-cig. With some competent help. The e-cigs have been around since 1960, and the research that has been done says they are far safer, for everyone, and potentially save a few hundred thousand lives every year. The science deniers don't like that, so know that not everyone who says these are bad cares about anyone but themselves.

About 45% of the population here smoked in the 50's, that dropped, with all the work in awareness, etc, to about 15% years ago, and it plateaued there. States and private business get funding to continue to flail at it, but the reality is that about 15% of the population is more than just lightly addicted. They are addicts.

And as addicts, treatment which works is the only humane route, and this is one which removes everything except the nicotine, and there is no evidence that the small amounts involved. or the 3 or 4 other chemical used - in a known mix, and not all are. Possibly, maybe likely worse to eat at McDonald's all the time.

Anyway, I smoked for 40+ years, 1 1/2 packs a day or more, never without them. Learned in Navy boot camp. Go Navy.

Tried to quit like many others, tried off the shelf e-cigs, still smoked. So I tried one of those that you refill with e-cig juice, still smoked.

Walked into a little e-juice store one day, and the woman said it was likely because the nicotine wasn't high enough. Pulled a bottle of their "house special" out, 36 mg/ml - you have to hunt that down - and about 3 days later I noticed I had laid my cigs on a table and forgot them.

I had not been without my cigarettes for over 40 years, and I forgot them. < That really was amazing. Smokers are physically changed, and those cigs occupy that space - it is a constant reminder when they are not there, whether you want one or not, and I know that from experience. Yet that didn't happen this time.

That was about a year ago. Periodically I still find myself reaching, (psychology tells us the behavior will increase before it extinguishes, so that is expected), fingers in my pocket when I realize they aren't there, and I get my pipe.

Be sure they allocate a bit for trying a couple - even if they spend $3 or $4 hundred to figure out what works, that's just a month of cigs, and then the cost drops to less than $15 a month.

New - Temps dropped, and I pulled some clothes out. Found a pack with one cig in it. Looked at it, set it on a shelf. Considered lighting it - told you this was strong stuff - but that feeling went away. I shredded it and put it in some garlic/rosemary spray - used it for insecticide. The stuff works! If that had been before last year I would have lit that thing.

I don't sell them, (probably should) but they can buy a Kanger Pro Tech Mini II or III, coils, and a battery on ebay for $35, though they should get 2 or 3 of each for when they are broken or lost - you want them at hand. Juice is hard to buy - it's a taste thing - but many stores have samples. Have them buy small bottles (you can mix them together yourself as well) so they can try a variety to find what they like. $15 or so for small bottles, that varies of course.

Cannot buy e-juice with nicotine on ebay -guess they would rather see hundreds of thousands of people die - but you can get it from stores out on the Internet. That's not always safe or trouble free, and you have to use a credit card and paypal seems to have something against it as well.

(Think how much less states would spend on treatment if they would just buy these - $15 for a top, $20 for a battery, $15 for juice - and give them away. Instead they piss away lives and dollars. Sad. )


hth

[appalachiablue]

78. Great info. Glad you had success, will give to friends. They'll make it for sure.

(Doing lots family genie now, incl. Tucks from VA c. 1900. Noticed your moniker, but maybe not a family thing or name. That's ok). Congratulations and thanks again, very helpful info.

[Prophet 451]

93. The NHS is looking into them

Here (UK), your doctor can prescribe you loads of different smoking cessation aids for the small charge of getting the prescription filled (about $15 and the young, old and poor are exempt). Gum, patches, the whole shebang. Well, after so many NHS doctors said "my patients quit using e-cigs", the NHS is now working out how to add them to it's smoking cessation aids. It still has to go through an efficiency trial with NICE and then a logistics test but assuming those go well, they'll be available on prescription in about a year.

The reason is exactly what you suggested: Treating smokers costs the NHS about £7 billion a year whereas, buying in bulk, they can get a battery and tank for maybe £12 and liquid for about £5. It's vastly cheaper to get people onto e-cigs than it is to treat smoking related illnesses.

[jtuck004]

95. We have a HUGE industry making money from over the counter crap that doesn't work for millions

of people. They keep trying, but no one is there to tell them that the problem isn't theirs, it's how society treats an illness, addiction. Instead you have corporations making money like Walmar$, and the government making policy that rewards companies for doing so, and in the process screwing the very people they are supposed to serve. Letting them die.

Read where a community was going to make smokers addicts criminals by banning smoking. Nice. Easy to beat up on victims. Cowards and bullies do it all the time.

They should be careful, however. Addicts have been known to respond with lethal force when tortured. If one knocks one of these clowns off of their high horse of self righteousness, they better hope I'm not on the jury. I'll just laugh at the stupid, like I do at any fascists.

[herding cats]

55. Insurance requests a blood test for nicotine I believe.

I imagine it's still the same now as it was before. The insurance requests a blood nicotine test from your doctor and that's how they verify if you're a smoker or not. So, any form of nicotine replacement therapy would show up.

[Prophet 451]

67. That seems insane to me

Granted, nicotine is not harmless but it's vastly less harmful than tobacco smoke.

[herding cats]

99. I always thought it was foolish.

The people I knew who smoked or used nicotine products would mostly just abstain for two weeks to pass their test. The rational behind the testing was it was the only way to prove if a person was a smoker or not, even though smoking cessation products are widely accepted to not cause nearly the same health hazards as actual tobacco products.

I don't know for sure if this is still done, and one poster said their insurance did not test them at all. So, this policy may be specific to certain insurers, it could be dropped completely.

[subterranean]

81. They didn't request a blood test for me.

I signed up for a plan this year and did not have to provide a blood nicotine test or any other test. On the application they just asked whether I smoke, and I answered no. I believe they can still cancel your insurance if they find out you lied on the application.

[herding cats]

98. I imagine, if this is even still done, it's up to the individual insurance company to choose.

I know that at least my employer's insurance did request the testing. I didn't get benefits, but I know several other employees there would try and abstain from all nicotine for 2 weeks before their appointment to avoid the extra charge.

[HockeyMom]

101. Medicare doesn't

Only questions asked were for your SS number and whether you had other insurance. No tests, period.

[herding cats]

102. I wonder if any Medicare supplement policies do?

Do you know if any of those charge more if you're a smoker?

Honestly, since for the majority of smokers by the time they're on Medicare the worst of the damage has already been done to their bodies, it really seems silly for them to charge more if they do use tobacco products. I do think they may cover smoking cessation therapy, though. I'm not sure about that, but I think I read it once, I remember thinking that was a good policy to have.

[HockeyMom]

104. Medicare Advantage are private Insurance Companies

I am sure they can and do ask questions, require screenings, and charge more for smokers whatever their age. Federal Original Medicare doesn't. I am sure there are many anti-smokers who think 70 or 80 year old Grannies should be charged more as smokers. That is almost like penalizing people just because they are old and WILL get sick from something eventually.

[Rex]

4. I'm cloudy on why they didn't make it a mandatory federal law?

I guess people would have cried states rights over a federal law. I think health and education should be free in this country.

[LawDeeDah]

8. Wasn't it supposed to be federal but the Supremes went with each state making the decision?

[Spazito]

13. Yep, it would have gone to the Supreme Court and lost if it had...

and any federal law on this would have been struck down. The US constitution gives primacy to States and severely limits the federal government's power.

Countries which do have 'single payer, by and large, also have a Parliamentary governance system which gives primacy to the federal government over States rights. The same goes for countries that have made education free although it's not really free as it is paid for by taxes the public must pay.

Edited to remove an errant "are" for clarity.

[Rstrstx]

17. you are correct

In the bill it actually states that "Each state shall establish an Exchange" then goes on later to spell out what will happen to the states that don't do this, knowing full well the courts have established that Congress can't force such a program on the state.

[Matrosov]

6. Because health care is a right, not a privilege

Anything short of a single-payer system is unacceptable. We should have expanded Medicare to provide coverage for everybody and kicked out the insurance companies. Anything short of that and we're basically saying that your worth as a person is defined by your income.

[moriah]

7. So you're saying I should have been denied help now, until we could have gotten single-payer?

Cuz, ya know, we couldn't have. But we did get the ACA. Which has kept me out of the hospital for a full year now.

Edit: It's great for those who HAVE insurance to hold out for their pony or nothing, but I had none and was in the hospital four times in 18 months. I needed the help as soon as it was available.

[LawDeeDah]

9. I think you will find that every country that does have single payer

sure did not get it in 2 years. It's a long and hard struggle to get there, there is no instant gratification with this baby.

[jwirr]

14. If I am correct Canada got theirs one state at a time. It took them a while. Unfortunately we do not

have any states trying start the ball rolling.

[Sgent]

48. Vermont is

and without the ACA, and its changes to ERISA and the Medicare law, it would have been impossible.

[jwirr]

52. One step allows another step. Thank you.

[Doctor_J]

63. Canada never made for profit insurers part of the federal government

which is now the situation here.

[jwirr]

69. Did not say they did we were talking about programs taking time to get in place.

[Rex]

16. 'we're basically saying that your worth as a person is defined by your income.'

Sadly, that is how America works in general. That is pure capitalism. Don't forget, we've already been defined as nothing more than human capital by the 1%ers.

Personally I believe we should pay taxes so that education and health care are free to every citizen.

[truedelphi]

56. Exactly. n/t

[Autumn]

10. May I ask how you know what is affordable to other people? Unless they post their

bank statement, all their bills and expenses, their tax information and everything a person would need to find out if they can afford it or not you don't know anything and anyone would be fool to post any of that information here.

No one needs to post their information here. The exchanges have people that will help them to navigate the ACA site and if you or any other DUer is a trained navigator it's really not up to you to help them here on this web site.

I repeat, there are navigators on the exchanges who do a wonderful job of helping, they do not need you or any other DUer to help them.

[moriah]

12. Hence why I suggested going through a navigator, either in person or through the Helpline.

But when you state your approximate income by saying $6000 is 25% of your income, that gives people the ability to do searches on their own. And find out that there are far cheaper plans available than they one they said was their only option.

[Autumn]

15. The navagators are awesome here. And the site allow you to compare every insurance plan

to others.

[jeff47]

21. The thing is "best" is not necessarily easy to find.

My work-based insurance offers 2 plans - a PPO and a "high deductible/HSA" plan.

It looks like the PPO would be better, since it doesn't have a giant multi-thousand deductible to meet before coverage starts on anything not routine. Especially since I'm going through some "not routine" problems right now.

Until you add up the premium difference. Which is almost double that giant multi-thousand deductible. I happen to have enough credit to smooth out hitting that giant deductible early in the year. If I didn't, I'd have to go with the PPO to essentially finance the deductible.

"Best" ends up depending on your finances and your guess about what medical care you'll need over the next year. So it isn't trivial to pick a good plan, and a navigator can be extremely helpful in spotting differences you don't realize are critical.

[Autumn]

24. The way the one here was set up everything could be compared.

There were drop down on the meds, doctors everything. It was easy, only thing is it didn't save my password and log in for me and "they" lost the paper I wrote it on. now I'm waiting for them to contact me so I can get on and find another insurance plan since my silver insurance plan went up $84.00

[Daemonaquila]

37. Anyone who thinks that will help a lot of folks is living in a dream world.

It's easy for people to find plans. My clients have no problem with this. Yet they realize once they've found them that they're a HORRIBLE deal on the exchange even with subsidies. Poorer folks can't get plans with a deductible that would be any help to them. Paying more money than they can afford for the "privilege" of having a plan that will still leave them essentially paying for everything out of pocket is no deal.

[moriah]

40. That's why they need to look for PPO plans. I didn't have to touch my deductible at all last year.

I had copays on my medications and doctor's visits.

[pnwmom]

44. It will help millions. I personally know two who got good deals last year. One is now eligible

for Medicaid, which she never qualified for before because she's single. The other got a new gold policy that costs half of what his old COBRA policy costs.

The policies all include the Essential Benefits that apply without any deductibles, including physicals, important screening exams like colonoscopies and mammograms, and vaccinations. I don't know who you are to be giving clients advice on this, but you're misleading them if you're not explaining that.

[lumberjack_jeff]

45. The ACA says that for the wealthiest customers 9.4% of income is affordable.

Provide refundable and advanceable premium credits to eligible individuals and families with incomes between 100-400% FPL to purchase insurance through the Exchanges. The premium credits will be tied to the second lowest cost silver plan in the area and will be set on a sliding scale such that the premium contributions are limited to the following percentages of income for specified income levels:
Up to 133% FPL: 2% of income
133-150% FPL: 3 – 4% of income
150-200% FPL: 4 – 6.3% of income
200-250% FPL: 6.3 – 8.05% of income
250-300% FPL: 8.05 – 9.5% of income
300-400% FPL: 9.5% of income

http://kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/

I find the above parameters affordable, especially considering that prior to the law, many people couldn't obtain insurance at any price.

[truedelphi]

57. The insurance premiums themselves might be affordable, but how does an

Individual who is making less thn $ 25,000 come up with $ 5,000 deductible?

And many Big Insurers make sure their policies require that the policy holder come up with 20% of the payments for a catastrophic event like cancer. If a cancer illness and its treatments extend to the point the family has a $ 600,000 bill, where does that middle class family get that 20% ? (That is, $ 120,000.)

[Hoyt]

62. That's where the annual cap on out-of-pocket cost come in.

I think the maximum cap is roughly $6250, and some plans have a much lower cap.. That's one thing that even traditional Medicare does not have unless one buys a supplement or Advantage Plan.

[Sgent]

65. All policies

Cap maximum out of pocket at 6250 or less. That includes deductibles co-pays coinsurance etc

[TheKentuckian]

84. I find it interesting that "wealthy" is like 29k now but people that made 250k were in the poorhouse

when it was time to do away with Bush tax cuts and they whined and cried until it was raised to 400k. I've seen 20 year olds making 10 bucks an hour called deadbeats while 20 year olds making 10 bucks an hour with parents that can and will cover them painted as desperately needing the help.

I've seen desperate, sick, and poor people bullied. The destitute and infirmed called selfish. I've seen people share letters from their insurance companies called liars for stating the facts as provided.

Yup, when the insurance cartel wants their's about anybody is "wealthy".

"Pay up. You can afford it because we said you can, see look at the chart we made and ignore your lying wallet" I bet you have CELL PHONE, maybe A FLAT SCREEN TV!, if you had 500 four or five years ago, surely we can count on you for a few hundred a month, ya fucking deadbeat, dumbass consumer of health care".

BULL MOTHERFUCKING SHIT!

Now we are wealthy! Jeeves, have the pilot bring the whirlybird around, I need to go to dinner and you can't get a decent meal in this time zone at this hour.

[lumberjack_jeff]

90. Did Costco have a coupon for hyperbole this week?

"wealthiest" for the purposes of this conversation is those for whom no subsidy is available (400%+ of fpl). For a single person this year, that's $46680.

People who are desperate and sick (who have any experience with the previous system) tend to appreciate the ACA, because prior to the ACA, care was unavailable at any price.

I am not trivializing the cost. $6600 would be a lot of money to come up with in event of major medical crisis. But it's doable for most people when the alternative is dying. In fact, most people wouldn't even lose their house.

I had an acquaintance who died a few years ago because she couldn't raise hundreds of thousands via spaghetti feeds to pay for cancer treatment. She'd still be alive today if the ACA were in place.

[TheKentuckian]

91. Opps...I missed that 2nd bracket went from a little over 8% to 9.5 so wealthy starts at about 35k

The person making 29k is just upper crust, I reckon and can only "afford" a little over 8%.

I'm sorry for the loss of your friend.

[lumberjack_jeff]

92. I'm sure we've all lost friends.

It's absolutely true that 18% of GDP is an intolerable and unacceptable cost for healthcare. Nevertheless, it is what it is, and until we do something radically different, it will cost each of us a share of that 18% - whether we can afford it or not.

Is 8% of our income an affordable share of an industry that eats 18% of every GDP dollar the country produces? YMMV.

I simply think we're forgetting how much the previous system sucked.

[Curmudgeoness]

74. How do you find a navigator?

I had a job last year, so I didn't have to deal with this, but I have been banging my head against the wall on the ACA website and realize that I really need help. But how do I find it? I have to say that the options are so confusing that I am ready to give up, and I just can't do that.

[csziggy]

79. Call them at 1-800-318-2596

Cut through the voice menu and as soon as possible ask for a representative. It only took a few minutes for a human to pick up today.

The site was overloaded this afternoon and I could not get some parts to work - the links to lists of providers and lists of covered drugs. (I did manage to get to the providers lists for the two companies I'm considering by seeing what URL showed up when I hovered the mouse over the link.) The earlier in the day you can go online would be better. I waited until today to even start since I figured the first weekend enrollment was open would be bad.

I did everything but the final enrollment today and will probably finalize tomorrow or early Wednesday.

[Curmudgeoness]

83. Thanks. I will try that.

I was on the website comparing plans for over five hours, because every plan I saw as affordable between the out of pockets and the per use copays had a stumbling block.....like one or the other of my doctors were not on those plans, or the hospital close to me was not on the plan, or the "co-pay after deductible of 20%" scared the crap out of me. Every single plan had a problem with either the hospital or my doctors. Damn it.

I did just see something here on this thread that means that I will have to go back to step one though---that the 20% after deductible would still not go over the total out of pocket listed (although I wasn't sure what it meant when all the plans said "estimated out of pocket" instead of "total out of pocket"----what the hell does that even mean???)

[csziggy]

87. One thing about ACA - at least we get to compare plans on the same terms

Decades ago (before I became uninsurable) my husband and I tried to compare plans and found it impossible. Insurance companies would not provide the information in the same format and everything had to be interpreted to try to get information in the same format to make comparison meaningful. It took a lot of time and once we got the information sorted out, we couldn't afford any of the plans. Once we could afford them, the wouldn't cover me at any price because of my history of accidents and illnesses.

Then my husband got a job off the farm in order to get health insurance for the two of us. Even then, with the limited choices his employer offered, it was hard to compare the different tiered plans to make the best choices for us. And it seemed every few years his employer switched insurers, our choices of plans changed, the doctors that were in network changed, and life continued to be complicated.

While making the choices on ACA is not easy, it is no more complicated than buying insurance has been for the self employed - and the options are no more complicated than that or for those who have no choice of coverage from their bosses and are forced to make changes in who they go to for care.

In 2011 I tried to make selections from the options for our coverage from my husband's employer to best suit our needs. I knew I was planning to get knee replacements and tried to minimize our out of pocket and maximize what the insurance would cover. NONE of the employer's plans had ever covered the orthopedic clinic I have always used so I knew I would have a high amount out of pocket for using an out of network provider.

Dealing with the insurance company during 2012 with the two knee replacements and carpal tunnel surgery was a complete nightmare. The insurance company sent "statements" of how much they had been billed, how much they paid, how much went to the deductible, etc. They never made sense and I could never get the figures to reconcile with the bills I got from the medical providers. I finally just gave up, waited for the second or third bill from each provider and paid what it seemed the insurance was never going to pay. I ended up with a little over $10,000 out of pocket - not too bad for what I had done, especially since that included two stays at a rehab hospital and lots of physical therapy. But it was a lot of money and I'm still in the hole.

So don't expect the information about how much you will have to pay out of pocket or after deductible to make sense. The insurance companies have their scam down to an art.

Just compare the information that is available and make your best guess at what the best plan is for you. Good luck!

[Curmudgeoness]

89. I feel for you. That is a lot of hassle you have had for years.

This is the first that I have had to deal with this. My employer had never had options, so it was basically "take what we offer", and I did. But the total premiums to the company were less than many of the high deductible plans I see on the website and the plan benefits were better, and I don't see why. I guess it is a suck-it-up situation that I am in.

I am going to call and see if someone can help me figure things out and answer a few questions that I can't find answers for.

[Autumn]

86. I just called the number as soon as I got a bit confused. They called me back

and walked me all the way through it. They stayed with me on the phone, explained everything I didn't understand about all the details like deductibles and stuff like that. He made the whole process easy. And called back after I had selected my insurance to see if I needed anything else.

[m-lekktor]

22. wow. where have I heard *that* talking point before? nt

[Curmudgeoness]

77. You are simplifying the problem.

No one is saying that we are not willing to do the "hard work", but I am tired of being more and more responsible for becoming an expert on so many things that have to do with my financial condition.

It used to be that there was company health insurance and there were HR people who were trained and knowledgeable in health insurance. Now each and every one of us is being told that we must jump through all those hoops ourselves---untrained and ignorant or all the things to look for. It used to be that there were company pensions, and now we are asked to become experts in how to invest for our own retirement---again untrained and ignorant. It is just not easy to be an expert on everything that used to require a lot of training for people to hold those jobs.

[SidDithers]

19. Because spittle-flecked outrage gets more hits and a higher rec count...

see "Piece of shit used car salesman" for the perfect example.

Sid

[Atman]

20. Are we forgetting how many states did not opt in to Medicaid expansion?

I hear lots of my friends from Southern, red states bitch about how horrible "Obamacare" is. Besides thinking there is such a policy as "Obamacare," they are utterly clueless as to the fact that their Red governors refused to actually enact the full plan. Therefore, it MUST be Obama's fault. It's not as if their own governors are going to tell them that it was they who screwed them over.

[Hekate]

32. State governors opting out is not Obama's fault, however, & too many here at DU are ....

....misdirecting their wrath. Somehow, their state screwing them over = Obama selling people to the industry. Somehow, asking which state the distressed person lives in = lighting incense in front of a photo of Obama striking a godlike pose.

We have a long way to go.

[Brigid]

33. Believe me, we know who screwed us over.

At least I do. But the fact remains, ACA leaves us out, and we have the right to say so.

[Atman]

35. You don't have the right to say so if you are wrong.

Actually, I take it back...you have the right to utter any nonsense you want. Which Red state do you live in? Which Republican governor refused to opt in to the full terms of he ACA?

[Brigid]

36. That would be IN. And Pence the Dense.

And to think he may run for president!

[Atman]

38. So then, how is the OBAMA's FAULT that Pence refused to opt in?

This is what I don't get. How can you blame Obama because your governor refused to opt into the full provisions of the ACA?

[Brigid]

41. It's not Obama's fault.

Except that I don't get the impression he cares that much. I don't think he realizes that hearing him tout ACA just rubs salt into the wounds. And I also don't recall him going to the mat and fighting for single payer or the public option.

[Atman]

61. Rub the salt into Mike Pence.

Again, this has NOTHING to do with Obama. Mike Pence decided that you shouldn't get expanded Medicaid provision. Nothing to do with Obama. Yes, Single Payer is the way to go, but we don't have it. So why is it Obama's fault that Mike Pence didn't adopt the ACA provisions?

[Brigid]

64. It isn't.

But neither did he fight for single payer or the public option.

[Cha]

96. Sorry about your gov Pence who cares nothing for people who can't afford health insurance, Brigid.

I actually think the President cares a lot or he wouldn't have gotten this done in the first place.

And, now Bernie is explaining why the repubs are so nervous about it..

Bernie Sanders: Republicans Are Getting Very Nervous About Obamacare’s Success

Sen. Bernie Sanders explained on MSNBC that Republicans are very nervous about the success of Obamacare, because the ACA proves their ideology that the government can’t help people wrong.

http://www.politicususa.com/2014/11/17/bernie-sanders-republicans-nervous-obamacare.html

[truedelphi]

28. Agreed. I spend some twenty years inside the medical system

Of health care in the USA. What I saw from 1996 on has been disheartening. Hospitals with few qualified people, nurses having been replaced by nursing aides. (Many of whom refuse to speak English, even though state laws demand that they do.)

The few nurses are often traveling nurses, meaning they are in one facility for a day or two and then on to another,. They spend a lot of their time simply learning where important things are. Then they are moved away to another yet again unfamiliar hospital. But this practice saves the hospitals from having to pay for taxes on the employees, or health benefits or vacations or any of that.

So I would say in California the system of health care is falling apart.

When the big 'reform" efforts came along, many sinister and deadly practices should have been outlawed.

Look at how last summer, there was a nursing home owned by people who had already been in trouble with the laws of the state of California regarding deficiencies in operating a nursing home.

Those owners simply left the facility, and once the trained medical people found out that they weren't going to be paid, they left the facility too.

Who didn't leave? The patients, who of course were too disabled, or too elderly or too sick to leave. And some of the janitorial staff, who actually rolled up their sleeves and kept people alive. For close to a week, this facility was run by janitors! Luckily finally the state came in and got patients transferred, but the operators should never ever have been allowed to open a second facility when they had been found guilty of improper operations at the first facility.

[Atman]

34. Which Red State do you live in?

Which Republican governor do you live under, who refused to opt in to Medicaid expansion? Do tell. Then explain why it's Obama's fault.

[truedelphi]

39. California is a Blue state.

Yet the situation a person is in when they are forced to deal with "California Covered," the state exchange, is depressing.

Especially once you realize that the companies being offered to us on that exchange are fraudulent parasites, with a business model that actually prefers if we die.

[pnwmom]

46. Then go to a California non-profit insurer. Blue Shield, for example. n/t

[truedelphi]

54. If you' re on the Calif. exchange, due to low income,you can't.

In my county, (Lake County) I get exactly three companies to choose from.

In my reply 25, I detail the exact reasons why I view all three companies I can choose from as being parasites. And pls read to the end, wherein I describe the deplorable situation in Marin County.

And in our case, since we have already lost everything to Big Insurers, and Big For Profit medicine, why do I need insurance? California will provide some of our medical payments this year, even if we don't pay out. (That is not told to people at all. But if you are poor enough and without any assets, you can get services via hospital charity, unless you are willing to pay for an insurance policy, in which case, your big deductible will screw you, and also, you won't be eligible for any hospital charity programs.)

[truedelphi]

25. In many places there are NO good plans.

California Covered, which is the exchange created by whoever it is that does such activities here in the state, allows for unscrupulous profit-eaters to suck the money and life out of people.


Here in Lake County, I had three choices last year at this time.

One was Kaiser, which had already misdiagnosed my spouse, causing a job loss (for him) and then we spent a lot of money keeping him alive, as diabetes is very serious when it goes undetected for three months. Even after those first three months, when Kaiser finally admitted their $ 4,000 workup had not included a simple $ 15 blood glucose test, they put him on the latest thing for diabetes, which is not insulin but Glucophage, and due to a liver infection, the Glucophage did nothing for his high blood sugar situation, but almost killed the poor guy. (Who was sort of hanging on tentatively as it was.)

By the first week of the New Year's, 2006, he was finally on insulin, but had gone blind due to the debauchery of Kaiser "We care and you thrive" subset of mis-directed energies. We were also being told he might not pull through, as he had needed the insulin back in September and here it was January, before he got it. There was a huge possibility that his body would not accept insulin, and he coul have become insulin-resistant and died. Luckily that was not the case and he did recover. Surgeries in the summer of 2006 removed the cataracts that had formed as a result of the high sugar - and we were broke but starting out on the road to recovery. (Our retirement monies were gone by October 2006.)



Final injury to us: We ended up bankrupt. Then his medical record (which of course is computerized) was erased by Kaiser so we couldn't do a lawsuit against them.

That was one choice; it is understandable why we didn't feel safe going with Kaiser.

One of the other choices on the state exchange was Anthem, which never ever makes it easy to collect for treatments (You have to pay out of pocket and then they re-imburse you, except they never re-imburse you!) The Anthem on the state exchange is not at all the Anthem that people get as a premium package if it is part of an employer's insurance network.

Since I had never heard of the third company on the California Covered exchange, I decided that for FY 2014, we would simply pay the minuscule penalty, and hope we can make it til Feb 2015 when M goes on MediCare.

Other counties might have more insurers to choose from, but there are problems as well.

A friend of M's wrote to tell us this: in Marin County, one of the Big Insurers on the Exchange has a website up with photographs of popular local doctors, and there is this big hullabaloo made to the effect that these doctors are part of this insurance network. Why, you can read quotes from your favorite doctor, and isn't his or her portrait lovely!

But in turns out the doctors with the pictures and quotes aren’t really on the network of this Big Insurer. Ha Ha, stoopid consumer! You will now have to drive out of the county to get any service, because NONE of that Insurer’s doctors actually work in Marin County!! (Although you' re free to click on that website and gaze at the doctors' pretty photos any time you want!) Ha Ha Ha Ha!! Stoopid Americans! And if it is an emergency, and traffic is in its usual San Francisco gridlock, then double or triple the Ha Ha Ha’s!!

In any other nation in the world, this situation of inferring by photos and quotes that doctors are part of the network would be considered fraud committed by the Big Insurer. But in the USA, this is considered "The Free Market."

[progressoid]

31. I've heard horrible things about Kaiser.

Here, we get two choices. A shit sandwich or a shit taco.

[pnwmom]

49. I know people who think Kaiser is great -- personal anecdotes mean very little.

Consider Blue Shield then, or another non-profit.

[progressoid]

58. non-profit.

[Hoyt]

68. I have Kaiser and it's OK. No frills though. The dislike for HMOs

is one reason we have a long way to go before we have an affordable healthcare system. Until providers and consumers change what they expect, we are in trouble.

[Hekate]

26. Because how else are you going to get over 600 responses & the chance to flame those who ask basic Q

Because how else are you going to get over 600 responses & the chance to flame those who ask basic questions in an effort to sort out the problem?

Members of this board have, in all past years, gone to great lengths to pull together useful information for other DUers in need of succor and advice.

However in this instance, a lot of people got called a lot of nasty names, and it was so over the top that I (and others) began to question whether there was an agenda of some sort behind it, rather than your run of the mill anxiety attack over having to do something different while under stress.

I hope that everyone who goes to the exchanges gets what they want and need this year. We have a long way to go, but this ACA was the best that could be gotten under the circumstances.

[MannyGoldstein]

27. Thank you for this.

It can definitely help some people - folks shouldn't bite off their nose to spite their face.

[gmb92]

30. Too many make conclusions based on selective and incomplete information

The media has done a very good job of stoking fear, blaming any and all problems with the health care industry on ACA. Average premiums go up 5% and it's ACA's fault, even though the increase is half of what was observed annually the previous 12 years.

Meanwhile, progressives have done a good job of framing it solely as a "giveway to private insurers", failing to notice that it's mostly progressively-financed and includes hundreds of billions in fees and cuts to private insurer payments, which is why the insurance industry has been lukewarm on the act.

http://takingnote.tcf.org/2010/12/how-the-aca-saves-money-raises-revenues-numbers-you-can-count-on.html

http://fivethirtyeight.com/features/why-progressives-are-batshit-crazy-to/

Then there's the fact that much of the expansion goes to Medicaid (not private insurers) although that's been thwarted in most red states due to the right-wing Supreme Court ruling in 2012.

[Doctor_J]

51. because that's just prolonging the inevitable

Last edited Mon Nov 17, 2014, 06:33 PM - Edit history (1)

A system whereby you must, every year, research a new plan, find a new doctor, read through the fine print, 're-calculate your income and which plan you can afford, get new websites to visit and phone numbers to call, and then do battle just to get enrolled, then, regardless of what plan you have, spend hours on the phone trying to find out why you got six bills for one procedure, is not workable. It's fine for luxury items like cars and cable television and cellphone plans, awful for an essential like healthcare. Why try to make a silk purse from a sows ear?

[KingCharlemagne]

60. I think you've really distilled the essence of the absurdity. We are a rich enough

country that, when one gets sick, one should be able to visit a doctor and receive treatment as one of the 'rights' of citizenship. Instead, healthcare is commodified, typical of capitalism, and citizens are NOT receiving equal protection.

[bigwillq]

82. Good post.

[uppityperson]

70. k&r for asking for help when you need it.

[tabasco]

72. I stopped asking why

and came to the conclusion there are just a lot of stupid people in the world.

[carolinayellowdog]

80. OP Content: A but OP Title: F-- Why are SOME people so accusing towards a generalised other?

I'm very interested at this point by the fact that I could have chosen a higher deductible Silver plan from Anthem instead of a low deductible Gold plan, and saved myself more than a thousand dollars in 2014 since I never met even the low deductible. So will definitely pay attention to all the suggestions from various points about how to do better in 2015.

The content of your post is just great and helpful, but the snarky accusing tone towards people having a nightmarish time navigating all the hazards of the ACA almost drove me off this site last fall. It was three months of sheer torture, hours and hours and hours on hold first with healthcare.gov and then with the insurance company. Had to get a land line after years of having cell only, rather than drive an hour to a friend's house to wait forever on hold, or pay outrageous phone bills if I called from home. Rather than be accused of being a Republican troll here for complaining about it, I just left DU. Don't add to that punitive atmosphere of accusing people of being "whiners" by a "what is wrong with you people" title for an OP the content of which is not accusing but helpful.

[TBF]

85. Why would folks want to "shop" for new plans each year

that they can't afford anyway. Why would they want to have their records sent from office to office? This is an incredible pain in the ass for those of us who are chronically ill and need to see specialists (who won't even see us unless they have the past records in hand). This isn't like buying ketchup in the Kroger.

[JEB]

88. I'm 63, self employed and my income varies from year to year.

Made just a bit too much to qualify for any subsidy so I'm out close to $800 a month for a policy for me and my wife that we really can't afford to use. Spend endless hours last year trying to work with Cover Oregon. Too busy this year. Not to comfortable reading policies and imagining future health scenarios. I hope it is helping some folks, but for me its been a waste of time and effort.

[Cha]

97. Aloha moriah.. good question.. thank you. Sen Sanders on ACA/Obamacare today..

"Republicans Are Getting Very Nervous About Obamacare’s Success"

Sen. Bernie Sanders explained on MSNBC that Republicans are very nervous about the success of Obamacare, because the ACA proves their ideology that the government can’t help people wrong.

MOre
http://www.politicususa.com/2014/11/17/bernie-sanders-republicans-nervous-obamacare.html

Senator Sanders believes Obamacare/ACA is actually helping people.. oooops.

[Jamastiene]

103. I found a plan that is rather high, but the lowest that I could get.

I can pinch some pennies and get it, but I have a different problem entirely.

I've been locked out and had my account disabled. Last year, when I tried to get in, it turned out they could not verify my identification because my mother gave me 4 names to go along with my surname and no two government agencies have ever used the same iteration of my name. So, I'm listed under one thing as these names and under another thing as those names and the only thing they seem to have in common is my first and last name.

Well, last year, I sent the photocopy of my driver's license like they requested and was told to wait. Well, I waited then got locked out of my account. They told me to keep waiting to see if they decided to approve my proof of identification. They never did.

This year, I jumped in early, hoping they had gotten it straightened out, but I'm locked out of the account. It said to call the same number and go through the same crap again.

I wish someone could help me straighten it out without having to kill my phone battery waiting on hold like last year. I would love nothing more than to find some actual help, besides the number they give you on the web site. If you call that number, expect to kill your phone battery waiting. That's what has happened to me every time I have called.

I'm frustrated. I want to use ACA and be one of the ones that it will benefit, but the aggravation and lack of communication and lack of any progress at all, once I did what was asked of me by them, is so frustrating. I would love for someone to help me get through that red tape part of this, because even though the lowest plan that my doctor's office will accept is kind of high, it would be worth pinching the pennies to me. I would love for the ACA to be able to work for me, but so far, I'm coming up locked out/account disabled over and over again. Nothing seems to be working and the phone dies when I call and try to find out what's the hold up/why I am locked out.

I would have qualified for Medicaid, if I am not mistaken (not over 133% of the poverty level), but my lousy state didn't expand Medicaid. So, I really do want to use it, just to prove the state of NC is needlessly turning down federal money JUST to punish those of us who are single and poor, but do not have children. That is what it is too. The only difference is that the expansion would allow single people with no kids in my state who are in poverty to get benefits from Medicaid.

I would be willing to pay the money for the insurance if only I could get this straightened out. I wish I knew someone I could call directly who would be able to help on that, because the standard number they give you to call is hold until the phone battery dies and that isn't helping.