OK, one last time, how will the Health Care Reform Bill help me pay my medical bills?

[Cleobulus]

I'm mandated to buy into my Employer's Insurance plan, I make 10 dollars an hour, and with this bill I will have subsidized premiums to afford the insurance. OK, fine, that the end of the premium discussion, it has no relation to what I'm about to this discussion.

My employer's insurance has a 2,000 dollar deductible.

It has a 20% copay for doctor's visits, hospitalization, tests, etc.

It has a maximum of 5,000 dollars out of pocket expenses for a year.

This is the plan I will be covered under.

Now, I have a preexisting condition which, when all is said and done will max out my out of pocket expenses if I get treatment(surgery, hospitalization, physical therapy). That's 5,000 dollars that I will have to pay for, and will be damn near a quarter of what I made that year, before taxes. Is there ANYTHING in this bill that will reduce this cost?

[Raineyb]

1. As far as I can tell. No. n/t

[Cleobulus]

3. That's what I thought, all the supporters of the HCR do is deflect to premiums...

as if that was even the issue.

[Maru Kitteh]

41. So you don't have any insurance now at all?

[Cleobulus]

46. No I don't. n/t

[Mass]

2. How do you do now? Do you have an insurance? If not, do you ever go to the doctor?

[Cleobulus]

4. I do without, and I guess I will continue to do without when HCR passes...

The difference is I'll have to pay a premium to do without.

[Mass]

8. So, if you get sick, what do you do. Hope and pray?

[Cleobulus]

10. Right now, in a word yes.

Outside of my preexisting condition, I've been to the doctor for a staph infection, and yes insurance would have helped me pay for that, thank goodness that the pharmacy he recommended was giving away antibiotics that week. However, again, having this insurance doesn't help with the pain I live with everyday.

[polpilot]

40. Hope & Pray (More) - The NEW Insurance Program.

[havocmom]

68. And after the mandate, he will still just be able to hope and pray, but will be out $$ too

Why so many proponents of this charade can't grasp that is just fucking sad.

[Mass]

81. delete. Not worth arguing with people on that

[havocmom]

86. Sorry you deleted that. I would be interested to know there is an alternative for OP

[laughingliberal]

75. That's what we do now. And that's what we'll be doing after this bill passes

Oh, and probably pay a fine, too.

[LWolf]

84. That's the reality that proponents of this bill won't acknowledge:

insurance does not equate care.

[FiveGoodMen]

5. K&R

[Hello_Kitty]

6. I don't see any benefit to you besides the premium help. eom

[Mass]

9. Limitation of out of pocket costs. If he gets into any serious accident and get hospitalized

how much do you think it costs him right now.

[Cleobulus]

11. And how useful is that(you seem to be ignoring my preexisting condition)...

when I can't afford the limit?

[laughingliberal]

76. Well, and even if you could afford the limit, they might impose a 'conditional' annual cap

on your coverage. For instance, your diabetes or heart disease might have a cap on how much they will pay to cover it for a year. And it might not be as much as it costs. So, you could wind up having to foot the bill for your treatments for part of the year until the calendar changes again.

[Cleobulus]

12. I just realized, you basically just agreed with the post you responded too...

because if I signed up for the insurance my employer offers now, then I get the SAME limitation of out of pocket expenses, just be more difficult to afford the premiums. The out of pocket expenses are still way too high for me to afford.

[Hello_Kitty]

13. Based on the info the OP has provided, it costs her as much as $5K

The bill doesn't change that.

[Cleobulus]

14. Uhm, I'm a guy.

:)

[Hello_Kitty]

15. Sorry, I saw 'Cleo' and assumed! eom

[Mass]

16. delete. Not worth arguing with people who dont care. In fact, with a preexisting condition,

he would get coverage for his condition. So, certainly the $2000 deductible is a little bit stiff for his salary, but he should read the text of the bill.

[Cleobulus]

19. But that's only a difference between being uninsured and insured...

There are two reasons I have not paid into my employer offered insurance, the first is that the premiums are too expensive(the HCR will help with that), the second is that its so expensive to use its simply not worth it. Even if and when my preexisting condition is "covered" I still can't use it to treat that condition.

ON EDIT: You call 2,000 dollars "stiff" on my salary, but that's only the initial cost I'd have to pay, then I have to pay 20% of any thing else until I hit 3,000 dollars, why are you neglecting that?

[Mass]

20. delete

[Cleobulus]

23. What do you mean why, I can't afford to pay 5,000 dollars...

period, not unless I sacrifice something like food or shelter. I guess I could move into a homeless shelter until my bills would be paid up, but the question is, why should I have to do that?

[Mass]

27. Sorry, I missed the fact that you are not on the individual market.

[InkAddict]

49. When it's all said and done, that depends on who caused the accident

and what his newest BBF, the ambulance chaser, will accept for payment plans.

[havocmom]

69. And doesn't that come the next year, when he files his taxes?

Assuming who ever does his payroll does the with holdings accurately (never foolproof)

The monthly payments still have to be made before subsidies kick in? So now, healthcare is hope, prayer and hunger at the end of the month for working poor

[ChiciB1]

7. I'm Sorry I Read Your Thread... I Feel Even WORSE NOW!! I Don't Have

an answer for you because I'm STILL trying to figure out EXACTLY WHAT this "thingey" is going to do or NOT do!!

And that's sad too!! Or is it even written completely yet??

[The Straight Story]

17. $5000 is only 500 hours you have to work

If there were no taxes/health care coming out. So maybe 700 hours.

;)

[kenny blankenship]

39. And you can supplement your income with prostitution - free of any tax!

Oh yes, with this bill you should soon be on Easy St. - twirling a gaily colored kerchief in front of traffic, even.

[jljamison]

18. what may happen

of course this may be a bit optimistic

given the influx of new participants in the health care plans, and the exchange that is set up - there may be a new plan made available to your employer with a lower out-of-pocket amount that the company can switch to. Does it help you any time soon? probably not.

[griffi94]

21. you're not computing it the right way

here let me help you.

obama = good
this is obamas plan so it also = good
i realize the president said any bill he signed would have to have a strong public option, but you have to understand he was running for office, and it's not fair to expect him to champion something he promised before he was elected. besides i'm sure the president would be happy to put a public option is this bill, except the insurance lobby won't let him, so it's not his fault, so stop saying that.

you will have access to medical care....if you have money....which you don't....but if you did you could get healthcare.

you will be able to buy insurance, in fact you'll be manadated by law to do so.
the insurance will make the healthcare you can't afford more affordable, but still well out of your price range.

if you had money you could get medical care.
have you tried being a ceo of a fortune 500 company, i hear that pays well.

if you're running your numbers thru that calculator thingy and it's not looking very good for you, then put in some different numbers, that's how congress does it.
it won't change the reality of the thing but you will feel better knowing that you're helping give the democrats a victory, and that rush limbaugh is so mad he's threatening to leave the country. and really, isn't that why we work to elect democrats, so we can take joy in the gops impotent rage.

with apologies to bob boudelang.

[Chemisse]

30. I don't necessarily believe that Obama = good - not anymore

But if it gets Rush Limbaugh to leave the country, I will be more than satisfied.

[griffi94]

34. ha like limbaugh or any rw batshit crazy

would ever leave this country. you couldn't run those assholes out with a bucket of shit and a mop.

[Chemisse]

44. I know - but it's the dreams that keep hope alive

I am still daydreaming of the peace and joy for those of us 'left behind' following the Rapture!

[berni_mccoy]

22. How do you pay for your treatment for your pre-existing condition today then?

[Cleobulus]

24. Its not a continuous treatment...

I take over the counter ibuprofen(whatever is cheapest pain reliever) to try to control the pain, was on prescription NSAIDS until it got too expensive. But, all I need is Surgery and I can fix it so I'm not in pain anymore.

[berni_mccoy]

35. Treatment isn't going to be forced on you. And you need to read the hardship excemption

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x7941563

[Cleobulus]

38. And the hardship exemption only applies to PREMIUMS, not everything else...

Also the low cost catastrophic plans are useless for my situation. I want the treatment, I WANT TO BE OUT OF PAIN, but I can't AFFORD IT.

[berni_mccoy]

42. The subsidies apply to all out-of-pocket, not just premiums.

[Cleobulus]

Where does it say that? n/t

[griffi94]

25. i don't think he does

he's not getting treatment because he can't afford it, and couldn't afford it even with healh insurance.

[Cleobulus]

26. OTC drugs, and that's it. n/t

[griffi94]

28. otc drugs isn't really healthcare

so under the new hcr bill. you'll be forced to buy insurance that won't really do you any good.
i'm in the same boat.

[Cleobulus]

32. Ha! True, though its all I have access to...

Actually, the only thing this bill may help me with is getting Piroxicam again, then again, that stuff only worked a little bit.

[slipslidingaway]

33. Maybe you do not understand that people who have insurance through

employers are doing without and this bill will not help them.

:shrug:

[LWolf]

85. I can't speak for the OP,

but I also do not get care because, after paying my premium, I can't afford the copays and deductibles.

That's a reality. Insurance doesn't equal care, and forcing people to pay premiums for insurance they they may not be able to afford to use is no kind of reform.

[kirby]

29. Your employer...

Maybe your employer will be able to get another plan that does not have a 20% co-pay via an insurance exchange (opening in 2014). Your employer is probably very limited in what plans they can offer.

[Cleobulus]

31. True, but a couple of things, first it doesn't help now...

that 2014, I could have a different job then, and the other thing is that I could end up under a worse plan between now and then, whether through a different employer, or under this employer.

[subterranean]

36. Sorry, the bill provides no help in paying out-of-pocket costs.

If you need to get treatment, try to get it at the beginning of the year. That way you'll max out your deductible early and then be covered for anything else that happens the rest of the year.

[Cleobulus]

37. great if you just have 5 grand lying around in January, I sure as hell don't. n/t

[grantcart]

43. How are you going to get any coverage without the bill when you change jobs

for a job that pays $ 20 an hour but has no health plan.

It seems that the current situation has you in a permanent status of slavery because you can make no employment changes out of fear of losing your current plan.

It is possible that your spouse will be able to enter the exchange and you can drop this plan.

In anycase the plan you have now will not be in its current form next year whether the bill is passed or not.

If the bill is passed the issue of your preexisting condition becomes moot.

There is a lot that the bill has to reduce cost but unlikely to have an immediate effect and unlikely to have an impact on surgery.

[Cleobulus]

45. Not married, also I'm not covered by my employer's plan, too expensive, too useless...

even if my preexisting condition were covered by the plan, at the way its currently stated, I cannot afford to pay for it, so not having insurance makes no difference to me at this time.

[grantcart]

59. If you don't have an employer's plan then you will be able to quit your plan

and enter the health exchanges.

You probably will benefit from changing to the new high risk pool.

[Cleobulus]

60. high risk equals high deductible, how will I be able to afford that? n/t

Also, remember my employer OFFERS a plan, I'm just not on it currently, but the mandate states I will have to sign up to it.

[Emit]

47. You might be eligible for a reduction in your OOP expenses based on your annual income

according to the various things I have read.

[Cleobulus]

48. I'm searching now for subsidies or reduction in expenses...

Almost everything I've seen refers to premiums, or access to low premium high deduct catastrophic plans. Not useful to me, obviously.

[Emit]

95. Here, try this info and link

Using the side-by-side comparison link below, checking the boxes for both the Senate and House Bills, then checking the "Creation of insurance pooling mechanisms" box, I found that the Senate bill proposes to reduce the OOP limits and it appears that, according to this calculator here, http://healthreform.kff.org/SubsidyCalculator.aspx , you would fall somewhere at about 192% of Poverty, depending on how many hours of work per year you average, whether you have dependents and your age, which I guessed at 30, etc.

Senate Bill
Patient Protection and Affordable Care Act
(H.R. 3590)

Reduce the out-of-pocket limits for those with incomes up to 400% FPL to the following levels:
100-200% FPL: one-third of the HSA limits ($1,983/individual and $3,967/family);
200-300% FPL: one-half of the HSA limits ($2,975/individual and $5,950/family);
300-400% FPL: two-thirds of the HSA limits ($3,987/individual and $7,973/family).

Comparison Link: http://www.kff.org/healthreform/sidebyside.cfm


Here is the 2009 POVERTY LEVEL GUIDELINES, although the calculator above will also show you:
http://www.dhhs.state.nh.us/NR/rdonlyres/e7xgivwj7zrojopvtjh4rfgmf7ablliwx7gbzalbbrb2mnkkyfqxrpjnzjm6a2v5e3ioyqrmc6fdz5vceaf2jwn2kqe/Fed+Poverty+Guidelines+2009+Annual-Monthly.pdf

[Emit]

98. $1,983/individual for OOP expenses. That's a significant savings if accurate.

According to my link directly above. Did you check it out yet?

[Individualist]

50. The bill is useful for insurance and pharmaceutical companies, not patients.

We patients are to be cast off like so much rubbish.

[laughingliberal]

79. Don't forget the hospitals. It is immensely beneficial to them.

In fact, they may have come out better in this deal than anyone.

[county worker]

51. How will you pay it without the bill? Will pay for all of the surgery yourself?

[Cleobulus]

52. Does it make a difference to me? No, I can't afford it now, I can't afford it...

under this bill, so what difference does it make?

[quiller4]

53. Under the bill preventive screening will be exempt from deductible

[Cleobulus]

57. And what does that have to do with this discussion? n/t

[quinnox]

54. sounds like the working poor are going to be screwed

if all this is true, the Democrats are going to have a bloodbath in coming elections. And if this scenario comes true, the health care reform will probably be overturned or thrown out by the republicans anyway when they take power back, so it won't go into effect in the first place.

[Cleobulus]

58. yep. n/t

[stray cat]

55. Which of us pays for your health bills currently?

[Cleobulus]

56. No one, I borrowed money from my parents initially and now I do without...

health care, I was finally able to pay my parents back for the initial doctor's visits.

[havocmom]

70. IF you have actually read what OP has been saying, and you ask that...

boy, that is cold.

[Luciferous]

74. What a terrible thing to say.

[Neecy]

77. What an ass.

You sound like a goddamn Republican. He's already indicated that none of "us" pay his health bills currently.

Disgusting.

[Cleobulus]

80. It is quite illuminating how callous these "oh so caring" reformers are, isn't it? n/t

[Cleobulus]

61. Does no one have even so much as an estimate on what could be used...

to reduce the cost I listed above?

[mdmc]

62. I do - and I know how the plan helps you

The HCR bill gives millions to Community Health Centers. They might be able to help you with some of the basic stuff that you need. They might be able to refill meds if you got scripts from a specialist. They may even let you run a tab and get treatment on credit.

I know it ain't much, but it is something..

peace brother..

[Cleobulus]

63. Are Community Health Centers going to be performing surgeries and MRIs too?

Because that will help a lot.

[mdmc]

66. nah, ya have to go bankrupt still for those things..

Or ya have to go without..
Ditto with the PT..

But as far as help in the bill, community health centers is where its at..
frankly, the dems could have just funded the community health centers and called it a day.. no drama and just as good..

[Cleobulus]

67. Damn, and here you are getting my hopes up.

:P

[mdmc]

87. Hang in there brother

peace and low stress and good health..

[Emit]

96. Yes, Your OOP expenses may be reduced to $1,983/individual if that portion of the Senate Bill

is included and passes. See post #95 above.

[GinaMaria]

64. Is there a free health clinic near you

Does you primary physician volunteer there? If not, the doctors that volunteer are deeply committed to public and community health care. They may have sample medications from drug reps that they can give you. Talk to them about your financial limitations. Maybe they could waive the 20% and still bill the insurance company to get partial payment. That is more than they usually receive so you would be helping them. It's not ideal, but it might get you some of the care that you need.

Wish I could help more.

[Cleobulus]

65. Pills aren't exactly what I need, and they don't work as well as advertised.

What I need is surgery.

[Yo_Mama]

72. I have bad news

Employees really don't get much help with premiums - only on the exchanges. But maybe in 2014, if the premiums are too much for you to afford, you'll be allowed to buy insurance on the exchange. That would get you the full subsidy.

In the Senate plan, if the employer plan pays less than 60% or the premiums cost more than 9.8% of your gross, you can get a tax credit on your return to help you with the insurance premium. There is a section (1412) that allows for advance payments of the tax credit. Also the out-of-pocket maximum for an individual between 200-300% of the federal poverty level is 1/3rd of the $5,950.

The best news it that your employer (in most versions) will get fined if the cost to you for their plan exceeds a certain percent of your income, but hahhah, you don't get the fine. That would be too helpful.

PS: My favorite part of the Senate bill is that it fines kids (yes, humans under the age of 18) if they don't have health coverage. 1/2 the adult amount. Because, damn it all, there is nothing like making kids into good citizens, is there? But seriously dude, when you are a working woman with two kids, and the government shows up to make the kids pay for the fact that you cannot afford health insurance for them, you're just going to be raising your eyes to heaven and thanking GOD that you voted Democrat. If Rush Limbaugh weren't too lazy to read this thing, he'd be peeing his pants with pure joy:
Sec. 5000A. Requirement to maintain minimum essential coverage. Requires individuals to maintain minimum essential coverage beginning in 2014. Failure to maintain coverage will result in a penalty of $95 in 2014, $350 in 2015, $750 in 2016 and indexed thereafter. For those under the age of 18, the applicable penalty will be one-half of the amounts listed above. Exceptions to the individual responsibility requirement to maintain minimum essential coverage are made for religious objectors, individuals not lawfully present, and incarcerated individuals. Exemptions from the penalty will be made for those who cannot afford coverage, taxpayers with income under 100 percent of poverty, members of Indian tribes, those who have received a hardship waiver and those who were not covered for a period of less than three months during the year. So basically we are going to fine teenagers $116 in 2015 and $250 in 2016 if they haven't purchased insurance coverage? But only if they work, huh. This is one of the weirdest provisions I have ever read in any bill ever. Hell, yeah, confiscate that 14 year-old's lawn-mowing money for being irresponsible or for the crime of having working-class parents.

Another really eye-popping moment was when I read that the states would be required to assess charges on plans with lower-risk enrollment. This applies to individual and small-group plans, so many people would see their premiums increase. So it's not like these irresponsible teenagers who haven't bought health insurance could sign up for the "Teen Plan"; no, such a plan would be fined for being a low-risk pool.

[GinaMaria]

83. So sorry.

This is heartbreaking

[laughingliberal]

78. I don't know about private insurance companies but Medicare will go after providers who waive the

patients' copays. Their position is that if the provider can afford to write off the copay they are overcharging. Not sure how private insurers view this.

[GinaMaria]

82. Thank you for that info

Medicare is badass and the payments are low for docs that they probably could not waive copays and stay in business. The free clinics I know in the city ask for a donation... anything you can afford. The insurance portion of it would be more than they normally receive for patient care.

[beardown]

71. Quit interupting the celebration here.

Egads. The democratic party and Obama are going to get a bill through that has 'health' somewhere in the title or in the articles. Isn't that enough for you? We'll fix it later when we elect 20 more democratic senators and 100 more democratic representatives.

My suggestion. Get whatever care you can as soon as you can under this bill because I'm afraid that it's going to get amended and 'fixed' quickly and heavily by the same driving forces (health insurance industry) that corrupted a bill that started out as a health reform bill with a public option or single payer and turned it into one with conscripted customers for the guys that have helped cause the whole health care affordability mess. Think of it as TARP II, the health insurance industry bailout.

[Luciferous]

73. Nope, there isn't anything that will reduce the cost.

[saracat]

88. K+R

[treestar]

89. So this whole thing is only about you?

If I looked at it that way, I wouldn't think much of this bill either.

[Cleobulus]

93. The question remains, if it doesn't help me, how many people doesn't it help?

Its not like my situation, even removing the preexisting condition, is far from unique.

[JohnWxy]

90. you say you will be "mandated to buy" your employers insur. plan. Meaning you have no insurance now.

You said you have a pre-existing condition.

1. Without HCR YOU WILL NOT BE ABLE TO GET ANY INSURANCE.

2. You're care would only be obtained by going into the emergency room at your local hospital.

Now, you will not be getting care for your pre-existing condition in an emergency room UNTIL YOU ARE IN A CRITICAL STATE(requiring immediate intervention). So what care you will be able to obtain will only come in the LATEST STAGES OF YOUR CONDITION.

Do I need I point out your prognosis if you put off care tiil the later stages of your condition?

NOw, this doesn't fit into the calculator that ProSense provided a link to elsewhere but it is, none-the-less, woth some consideration. Wouldn't you say?

I hate to be blunt, but which position would you rather be in: poorer but alive, or better off (financially) but sooner dead(possibly after much suffering).

Think about it.

[Cleobulus]

94. My condition is painful, not fatal...

well, not fatal for my entire body, worst case scenario, one of my arms is paralyzed, not exactly something anyone in an ER can do anything about.

[Abq_Sarah]

97. Think about this

If someone is already exhausting their income just surviving now, how can we expect them to default on other obligations by forcing them to pay for insurance? Are you going to make them choose between paying their health insurance or their car insurance? Oh, sure, I know it's been suggested that there will be hardship exemptions but do we want a government agency micromanaging our personal finances and deciding for us what we can afford? And if you can scrape up the money for the premiums, how do you save so you have the money to pay for the 40% the basic insurance doesn't cover?

[warm regards]

91. This is not about helping you or anyone else.

This is about getting something done.

[Moondog]

92. BOHICA -

A fine old acronym from my days in the military.

It means

Bend Over, Here It Comes Again.