ObamaCare Info

[kajs22]

I'm using my "middle" for my family.
The problem with defining the middle class is that you cant just do it by household income and number of family members.
I live in a high COL area, our household salary doesn't stretch the way it would if I lived in some small town in Nebraska.
We make too little to be considered upper middle class here, but we make too much to take advantage of the tax benefits/breaks or other government programs others can.
It is what its, I accept that, doesn't mean I have to be happy about it. It is disappointing knowing that our insurance premiums will go up, coverage will go down, and because on paper we make X amount of money we are SOL with finding something more affordable under Obamacare. Wasn't that program supposed to make insurance affordable for all?
I am glad for the people who will benefit from it, but lets be honest, someone has to be shut out in order for that to happen and unfortunately its "my" middle class.

I agree - we live in an area considered very expensive by national standards. Property taxes are $17,000.00 on my home. The problem is I worked very hard and went to school for many years and incurred a lot of school debt in the process to make my current income. I had no special opportunity to go to school and no one paid for my education, but, I made it happen.... Obama care is more money coming out of my families income.

 

[karice2]

It has been answered many times... This isn't a replacement for private insurance, and all of those people you mention have private insurance. They aren't "exempt", they just aren't in need of exchanges or subsidies to obtain insurance coverage for their families.

And the unions are seeing themselves losing a competitive edge - "cadillac" health insurance is a big reason workers are happy to organize and pay union dues, and with those plans now subject to taxation and access to insurance no longer being a selling point for unionization the unions are likely to see their political and social influence decline further as a consequence of this law.

I am not union or pro-union but I currently have "cadillac" insurance. I worked very hard to get in a position where I would have quality health insurance. It is a slap in the face to be told that we are going to punish you financially for working hard by making it so expensive for your company to continue to offer decent insurance. We are going to tax your company instead of the billions of dollars that health insurance companies make every year with their triple inflation premium raises.

I am not a millionaire or even close to one. I make a salary that is pretty good but our company also have people that make far less than I do. They had the same type of "cadillac" insurance for less than what the exchanges cost. Now they are going to have to go to a plan that requires a few years of bubble wrap before they can begin to meet their deductibles.

This an extra tax on the middle and upper middle class and saying that it isn't is disingenious. What it should be called it wealth redistribution.

 

[mikek]

So far we have been told we can keep the insurance plan we already have. I hope this is correct. Our premiums are not going up, but last year our coverage went down a bit (higher co-pays and higher deductibles.)

Dawn

Interesting comments; thank you; I still hope the info helps some.
...

1. "Keep your current plan" - That quote was part of information regarding "will the government force me to switch to ObamaCare". The answer is "No"; the government will not "force" anyone to drop their current health care plan. I know as a fact the context of the quote because I heard it many times on TV by many different persons. Now - Can the government force employers to keep offering their current plan? No (at least not at this time). So that statement, "keep your current plan" was not a lie by those discussing what ObamaCare requires.


here's a blurb the letter i got from BC/BS here in NJ last week:

...becasue of these requirements, your current insurance plan cannot be renewed....

so dont plan on keeping your existing insurance.

I could waste everyones time and post the whole letter but basically they wont renew their current plans after 10/1.

Bottom line I'm sure that technically the insurance company could add all the new stuff (eg dental for minors) to their existing plans- but clearly they also can decide that's not worth it and stop offering the current plans.

 

[mikek]

...

However, all this focus on the exchange is overlooking the provision that may very well help families like yours... The fact that insurers will have to pay 80% of what they take in as premiums out on claims. ....

unless you own a small business and don't have any employees, then you don't qualify for that provision and your insurance company may continue to rip you off. I got that letter last month- actually was a threat that if i didn't fill out more forms on their website they would cancel me.

I spent 15 minutes reading about this great new provision would send me rebates if they happen to overcharge me. I just needed to answer some questions. 1)are you a small business owner? 2) do you cover anyone besides yourself? NEVERMIND- doesn't apply to you. They left out how they loved me since they could continue to rip me off with government blessing. lol

open season on small businesses...

I actually don't think it's open season- just that like so many other things the government does there are unintended consequences. Probably they want to keep small business owners from only buying themselves coverage and not covering employees. But they forgot that some people might just be too small to have employees. They should have added question #3) do you have ANY employees besides yourself. But they forgot so I'm hosed

 

[mikek]

I know they have made changes, and I've spent a while on that website searching, but when the ACA first passed I actually read through the whole thing (alarmist small business owner parents) and I remember that they had limits on what the deductibles and out of pocket maximums could be for the plans.
Does anybody know if the current numbers for that information is listed anywhere? I keep reading people panic about how it will get worse while complaining about deductibles that are currently over what I thought the new limits would be. That sort of information might help people weigh their thoughts better.

SOrry don't have a primary source but recently i've seen the max out of pocket is 12,700 in a couple papers/websites.

Also people need to understand that max out of pocket does NOT include the insurance premium. It means copays, deductibles, etc.

 

[johde]

As far as the copays, I think that's reasonable. With an OOP max in place, that's the only logical way to handle it. Cover sick visits and testing 100% and you encourage overuse. Subject preventative care, which is inherently limited by its scheduled nature, to the same copays and you discourage people from getting those check-ups. A copay combined with a cap that protects against running up catastrophic levels of medical debt offers the best balance between those two excesses.

But I think universal, high deductible insurance coupled with preventative care coverage is really the ideal solution - let people who want more extensive coverage (vision, dental, etc) pay for supplemental plans, let the people who want to see a doctor for every sneeze pay for that themselves, but at the same time protect American citizens (and by extension, medical professionals) from medical bankruptcies and catastrophic levels of debt incurred for treatment. The problem with that is that it would be impossible to pass - any successful reform in this day and age needs to pass muster with the insurance lobby, and that rules out any plan that weakens the demand for their services.

You slightly missed the point. I've done a large amount of looking into several states, since full details about Ohio aren't available yet. Comparing silver plans in New York's plans to California's plans may explain it better.

New York

Preventative- 100% No deductible.
Most out patient services - Co-Payment After deductible
Most In Patient Services - Co-Payment or Co-Percentage After
Prescriptions - Co-Payment No Deductible.

California is the same except Most out patient services are no deductible.

So, in New York, a relatively healthy individual needs to pay the full price of a Dr. Visit until they reach their deductible. Someone is California, just pays a co-payment. The only time a Californian needs to worry about deductibles on a silver or higher plan is if they are hospitalized or possibly a few obscure treatments.

Thanks for link Johde. I had seen the rates for each county and plans but no details. This gives more information and as you say only the platnium plan is exempt from a deductible. Interesting that all the other plans you have to meet the deductible before the copay for a primary or specialist visit kicks in. The Gold plan offers a $600 deductible which is OK but most healthcare plans do not make you meet the deductible for primary visits. Also I did not see info on going to an out of network doctor. Is that where the out of pocket is involved?
I'll look forward to see details from different insurance companies. I do not want an HMO. Just curious also do you know what the silver plan with cost sharing reduction variation at different percentages is all about? I didn't find anything specifice when I googled it. one of the links was to the NY State health exchange site but I didn't find it there.

Low income (below 250% of the poverty line) not only get premium subsidies but the government picks up part of their deductible and copayments. The cost sharing reduction plans are those plans. A standard silver plan has an actuarial value of 70%. Between 250%-200% of the poverty level it bumps up to 73%, 200%-150% it 87%, and 150% to 100% it's 94%. This website is convenient for most of them.

 

[Colleen27]

unless you own a small business and don't have any employees, then you don't qualify for that provision and your insurance company may continue to rip you off. I got that letter last month- actually was a threat that if i didn't fill out more forms on their website they would cancel me.

I spent 15 minutes reading about this great new provision would send me rebates if they happen to overcharge me. I just needed to answer some questions. 1)are you a small business owner? 2) do you cover anyone besides yourself? NEVERMIND- doesn't apply to you. They left out how they loved me since they could continue to rip me off with government blessing. lol

open season on small businesses...

I actually don't think it's open season- just that like so many other things the government does there are unintended consequences. Probably they want to keep small business owners from only buying themselves coverage and not covering employees. But they forgot that some people might just be too small to have employees. They should have added question #3) do you have ANY employees besides yourself. But they forgot so I'm hosed

I thought I heard, and I could be wrong on this, that sole proprietors are a different category? IIRC, you should be answering "no" to the small business owner question because by the definitions used in the act "small business owner" is not the same as "self employed".

That issue would impact my family too because DH & I are both self-employed, but aren't small business owners in the sense of having any employees. He's a handyman/contractor that at most uses temp/day labor on occasion and I'm a freelance writer/proofreader. And actually, the ACA is a big part of why he's heading back into business for himself. Last year he closed the business to take a job that offered insurance because we just couldn't afford it on our own any more, but then he was laid off early this year. In the exchange, we'd be paying lower premiums for better coverage and it puts his business back in the realm of possibility. Since he hasn't found anything permanent, full time, or with benefits so far but is keeping busy with his own work we'd love to see that happen.

 

[mikek]

Lol where would that be? Sure as heck ain't the usa. I have lived in another country with waaaay better healthcare.

You are going to have to give me your definition of "best".
out of the 34 developed nations, us health care ranks 27th...

AND WE SPEND THE MOST PER CITIZEN for this privilage. So seriously, how are we the "Best".

Health care is only good if you can get it.
Like every thing else here, if you can afford the best, that's what you get. If you can't pay for it, you are on the same level as most 3 world countries.

This country stopped being the "Leader" in health, education, science, technology decades ago.

I totally agree though, politicians need to stop getting privileges unavailable to every one else. but these are the guys who can vote themselves a raise so it doesn't surprise me.

It's way more complex then us being 27 th. When some king or head of state gets ill, why do they come here and not Canada or England or Norway? Why? You hit the nail on the head that the people who can afford it get super care but many get left out. The issue here is we're aiming at everyone getting super care. THAT will in fact bankrupt the country. We pay much more per person on average becasue the people get the great care are probably spending twice or four times what England does. So if everyone gets care four times that that of England theres a problem in paying for it.

The whole issue of affordability is really complex and the pols avoid if like the plague. If they want everyone to have coverage then they have to do something to cut costs. There's PLENTY of waste to go around but eventually there has to be a grownup talk about LIMITING care. (medicare is just as wasteful and without limits so single payer in the US manner wont help) I don't know that there is a right or wrong answer but we need to talk about it opening and honestly without fear mongering on both sides.

I work with an Irish woman and one of our other co-workers was talking about how his 80+ year old dad got this heart surgery and how it was amazing like his dad was a new man. The Irish woman, very matter of factly, explained that her father too had the same condition, but as he was over 70 they just dont do those operations for them under their system. She explained how it's basically a waste of resources. She wasn't upset at all- Americans would have a cow.

Read up on the UK system of womens preventative care- sure mammograms are free but they get them much later in life and less frequently then U.S. standards. The math is it just doesnt save enough lifes for them to do it otherwise.

Read about how they pay for cancer and similar medications. They put a value on your life, and it's a lot less than many would think. Of the top of my head you get ~40k a year with a "bonus" that the last year they can toss on is worth like 20k more. Oh and it has to be on the 'approved list' - if it doesn't work good enough then nope- none at all. So if there's a drug that on average would cost 70k/year to keep you alive- sorry you're out of luck- costs too much. Now you can decide to pay on your own for that drug but if you do then the penalty is they throw you out of the system entirely and you now have to pay everything on your own. Guess who can afford to do that- again the rich get better care.

Actually I'm not sure their math for limiting Rx's is bad. But look around. Who do you think pays for it? The pharma companies are no dopes and they know the exact amount per year of life and they do the math- guess how they price the drugs in such countries? Just below the threshold. IF they mess the math up and the commision decides they priced it too high for the statistics then the pharma company goes back with a lower number that fits. The problem (FOR US) is if it costs 2 billion per cancer drug in research and they can only make half that in the rest of the world, where do you think they charge more to make it up...right here in the good ol' USA. We subsidize the worlds medicines. That needs to stop to control costs- we need to tell Europe and Canada and all that they need to pay their fair share.

The whole cost isssue is very complex- and the affordable care act basically ignored it and is throwing money at the existing broken system. Putting many more people into an already broke mess. Maybe it will fix it, maybe it will make it worse. who knows....

 

[lauradis]

So far we have been told we can keep the insurance plan we already have. I hope this is correct. Our premiums are not going up, but last year our coverage went down a bit (higher co-pays and higher deductibles.)

Dawn

Lets hope the employer chooses to keep covering the spouse, because they don't have too and they can still get the tax credits. which can save a company tons. And cost you a ton.

But wait for it you have to have insurance as a spouse or pay the tax penalty

woo hoo go government I would like to thank them for adding lots of woman health issues and screwing the spouse out of family insurance.

oh and by the way... most "spouses" are woman covered under husband policies.

 

[mikek]

What I think is ridiculous is that the government thinks ANYBODY can actually AFFORD insurance that costs 9.5% of their annual income.

Yeah if you make 20k a year you can afford to pay $2k a year for insurance but if you make $100k a year (which I guess is rich according to the government) that would cost $10k a year. That is almost a thousand dollars a month JUST FOR THE EMPLOYEE. Even ppl who make $100k a year cannot afford to pay $1k a month in insurance premiums.

...

I own my own business and on paper we're "rich". To put in perspective we live in a townhouse and my 2 boys share a bedroom- so there's no McMansion. We ARE VERY LUCKY and we can afford to vacation in Disney so I'm not crying poverty.

Anyway. We pay well over 10+% of my income for family coverage. Actually it's $1271 a month for family coverage. And that gets us a plan with a $5,000 deductible. Yes that's a 5 with three zeros. After the deductible the Rx's are 40% copay. $50 copay for dr's. Etc. So it's no cadillac plan. We've had some surgeries and serious health issues so we routinely pay over 20k a year in medical expenses for premiums, deductibles, and copays.

I can't wait till the exchange opens tuesday to see my options. But I'm not feeling great. Because there is NOTHING that i hear in the law that makes anything affordable. They just tossed in more things that insurance is required to pay for so the insurance companies keep raising the rates. When they write the law they alsmost completely ignored costs and are, like so many other things, just going to throw tax payer dollars at it.

I'm posting on a board for people that can afford to go to disney (and all have a computer, half the posts say "from my ipad- lol". So everyone reading this is likely very fortunate.

I make enough to be able to afford to pay plenty more than 10% of my pay for insurance and another large percentage for out of pocket costs. My family is very fortunate.

Still there is nothing here to make it cost less- just government subsidized.

 

[mikek]

I thought I heard, and I could be wrong on this, that sole proprietors are a different category? IIRC, you should be answering "no" to the small business owner question because by the definitions used in the act "small business owner" is not the same as "self employed".

That issue would impact my family too because DH & I are both self-employed, but aren't small business owners in the sense of having any employees. He's a handyman/contractor that at most uses temp/day labor on occasion and I'm a freelance writer/proofreader. And actually, the ACA is a big part of why he's heading back into business for himself. Last year he closed the business to take a job that offered insurance because we just couldn't afford it on our own any more, but then he was laid off early this year. In the exchange, we'd be paying lower premiums for better coverage and it puts his business back in the realm of possibility. Since he hasn't found anything permanent, full time, or with benefits so far but is keeping busy with his own work we'd love to see that happen.

it's all a big mess than as you know first hand. Yes in NJ we're a small business. I actually have a partner and the company is set up as an LLC so we are defined as a small business since there are two of us.

I hope the exchange is reasonable- we'll dump the small business plan and just hit the exchange.

Even if it's a few bucks more- I waste hours and hours each year with the paperwork for having "small business" insurance. and get stressed out about 3-4 times a year with threats to drop my coverage becasue i dont have a full time beneftis manager so i fill out some stupid form incorrectly.

 

[mikek]

You slightly missed the point. I've done a large amount of looking into several states, since full details about Ohio aren't available yet. Comparing silver plans in New York's plans to California's plans may explain it better.

New York

Preventative- 100% No deductible.
Most out patient services - Co-Payment After deductible
Most In Patient Services - Co-Payment or Co-Percentage After
Prescriptions - Co-Payment No Deductible.

California is the same except Most out patient services are no deductible.

So, in New York, a relatively healthy individual needs to pay the full price of a Dr. Visit until they reach their deductible. Someone is California, just pays a co-payment. The only time a Californian needs to worry about deductibles on a silver or higher plan is if they are hospitalized or possibly a few obscure treatments.




Low income (below 250% of the poverty line) not only get premium subsidies but the government picks up part of their deductible and copayments. The cost sharing reduction plans are those plans. A standard silver plan has an actuarial value of 70%. Between 250%-200% of the poverty level it bumps up to 73%, 200%-150% it 87%, and 150% to 100% it's 94%. This website is convenient for most of them.

sorry- the thread is long and i went back and couldnt find your first post.

But if you are buying your own coverage dont get hung up on copays or deductibles alone. you have to do the math when comparing to figure out what the premium+ the out of pocket will be. that's all that really matters.

I willingly went to the 5k deductible plan becasue it was only 3k more than the old plan we had but the premium was (at the time) about 6k lower.

So I dont care who pays the first dollar as long as my total cost at the end of the year is lower.

Also the out of pocket cap at 12,700 is very intriguing to me. Curently I'm paying 14+ for premiums. 5k for deducible- which we nail every year. Then some addtional copays that ranged from maybe 2-5k in a typical year.

If i can get something on the exchange with a premium under 8k - even if it has a 10k deductible I'm better off as the 12,700 stop loss would limit me to never paying over 20,700. I routinely pay that every year for my family of 5.

My fingers are crossed that there is some really high deductible with low monthly premium like that on my states exchange. And the larger "out of pocket" part as opposed to premium will help hit 10% of my income to make that deductible (remember to pay for this they raised the medical deduction from 7.5 to 10%)

 

[arminnie]

I'm so glad that I am old.

My medicare policy had no deductibles and no copays for a premium of about $100 a month.

I was in ICU for several days with a major illness with about 8 doctors treating me and didn't pay a penny.

 

[johde]

sorry- the thread is long and i went back and couldnt find your first post.

But if you are buying your own coverage dont get hung up on copays or deductibles alone. you have to do the math when comparing to figure out what the premium+ the out of pocket will be. that's all that really matters.

I willingly went to the 5k deductible plan becasue it was only 3k more than the old plan we had but the premium was (at the time) about 6k lower.

So I dont care who pays the first dollar as long as my total cost at the end of the year is lower.

Also the out of pocket cap at 12,700 is very intriguing to me. Curently I'm paying 14+ for premiums. 5k for deducible- which we nail every year. Then some addtional copays that ranged from maybe 2-5k in a typical year.

If i can get something on the exchange with a premium under 8k - even if it has a 10k deductible I'm better off as the 12,700 stop loss would limit me to never paying over 20,700. I routinely pay that every year for my family of 5.

My fingers are crossed that there is some really high deductible with low monthly premium like that on my states exchange. And the larger "out of pocket" part as opposed to premium will help hit 10% of my income to make that deductible (remember to pay for this they raised the medical deduction from 7.5 to 10%)

For me personally, I have a HDHP with a $2500 deductible and no copay after deductible. That best meets my budget and my needs. Most year, I pay nearly all of my health care out of pocket. In the past couple of year, I've got vaccinations and a wellness visit for no copay. Depending on the state you live in, that type of plan isn't available. Over time, I've increased deductible to keep the premium affordable.

In 2007 I had a traditional 80/20 plan with copayments for Dr visits. I paid $130 a month. By 2009 that plan was paying $165 a month and it was set to go up again. I went to an HSA plan with $1,500 deductible and no copay after deductible and my premium dropped to $140 a month. I used the money I saved to fund my HSA. By 2011 the premium on that plan had increased to $213 a month so I switched to a plan with a $2,500 deductible for $177 a month.

Fortunately, Ohio has allowed insurance companies to offer a variety of in each metal level, instead of doing the one size fits all plan of some states.

 

[ZoeBell]

After reading this thread I've learned a few things. 1. I'm more confused then ever over ObamaCare 2. I don't know what it means for my family, if anything. 3. Maybe my husband's insurance wasn't so bad after all compared to what others have been paying. 4. I didn't realize it was a bad thing to see doctor's regularly, like the Dermatologist. Apparently the key is to pay the premiums but not dip into your deductible. Who knew??

 

[leahjade]

"Keep your current plan" - That quote was part of information regarding "will the government force me to switch to ObamaCare". The answer is "No"; the government will not "force" anyone to drop their current health care plan.

But your company can opt out and pay the penalty (cheaper for many) so you will be FORCED TO GET OBAMA CARE!

 

[MickeyMickey]

But your company can opt out and pay the penalty (cheaper for many) so you will be FORCED TO GET OBAMA CARE!

But your company could always drop your health insurance, this is nothing new with Obama Care, only difference is now they will have to pay a penalty.

 

[mikek]

Tuesday is a banner day...

Not only do i need to keep checking here to see if Dec 1 checkings are getting MB's (maybe rollling dates 2 months out...) But i have to check the exchange for rates in my state to try and save some cash.

Not sure which i'm more ramped up by.

LOL

 

[Robbi]

Tuesday is a banner day...

Not only do i need to keep checking here to see if Dec 1 checkings are getting MB's (maybe rollling dates 2 months out...) But i have to check the exchange for rates in my state to try and save some cash.

Not sure which i'm more ramped up by.

LOL

Glad you're happy. Wish we all could feel the same.

 

[mikek]

But your company could always drop your health insurance, this is nothing new with Obama Care, only difference is now they will have to pay a penalty.

I was reading a thing about all the guestimates the economists are making. Basically they all say that since there is no data at all to measure people's reactions they have no choice but to make all these statistical models with hundreds/thousands of small simulations to see what happens. A tiny change in assumptions makes vastly different things happen- that's why we hear so many different things. (prices go up, prices go down, prices go way up, prices go way down)

Anyway they basically said it's all for naught becasue the biggest assumptions the economists make is that people will act rational. With such an emotional subject (health), so much pent up anger over being 'screwed' over the years, so much lack of knowledge, so much misinformation, and so much polarized politics who knows if ANYONE will be rational- lol. As I posted above I'm likely to ditch my small business plan and buy personal insurance from the exchange if the fine print is decent even if i have to pay a little more. I'm just totally fed up with the stress/aggravation/abuse of having a small business policy over the years- paying more is not rational but i just want out of the existing small business system since i've had such horrible experience with it.

There was another article in the New York Times yesterday/today about various unknowns and one thing was the federal government hasn't even finished making up their own rules- how long do they need? The best part is one of the rules is about those coupons all of us with crappy plans get from pharma to make things affordable. Seems they can't decide if they will allow the pharma companies to give them to people on the exchange plans or not- they might consider them a kickback. Are they crazy? They wont let pharma give people coupons to make things more affordable???? It's a kickback? So many unintended consequences and no common sense....