Obamacare success stories please

[mistysue]

Clearly the numbers and results are going to vary by state. We also know NOTHING about how it is working until after it takes effect. A health center shutting down is done out of panic, not because they know the effect in advance. If they didn't have some idea that it may work out they would have closed in one phase, not two.

I checked pricing and we do not qualify for subsidies. Still, I can get a platinum plan for nearly $600/month less than our current plan costs. Even if we paid our OOP max with the new plan, we would be saving a couple thousand dollars per year.
As it is we have a plan through DH's employer but usually end up on COBRA for 4 months every year... so it will probably save us about $3,000 per year just for the 4 months.

I think people are forgetting one major detail too, while you are essentially guaranteed a deductible you don't have to pay for well visits. Insurance is changing so they pay for your maintenance, then the deductibles, prescriptions, copays and fees are all ONLY if you get sick or have a condition. When people are seeing doctors for regular check ups it's unrealistic to think that overall costs in the system aren't going to go down after a couple of years. Things are going to be found sooner and will cost less. This means the insurance companies will pay out less, and the law triggers a system where they have to lower rates and pay the money back. That is not a trick, it has already happened that companies had to reimburse people because their profit margin was too high. My parents' company has actually and a decrease in their monthly rate the last two years.

 

[scard192]

My sister has been out of work for almost 5 years and her husband off and on for the last few years. What work they can find is a temp, temp to perm or part time with no bennies. She signed them up this week; they had been paying OOP for their medications. As she put it "if we get sick, we can actually go to the doctor, instead of hoping it will eventually go away or get better".

 

[tvguy]

Another issue in California......you can't find out which doctors accept which insurance. That's a big oversight that will have to be fixed.

http://www.latimes.com/business/la-fi-exchange-doctors-20131004,0,6689326.story?track=rss

 

[kydisneyfans]

Clearly the numbers and results are going to vary by state. We also know NOTHING about how it is working until after it takes effect. A health center shutting down is done out of panic, not because they know the effect in advance. If they didn't have some idea that it may work out they would have closed in one phase, not two.

I checked pricing and we do not qualify for subsidies. Still, I can get a platinum plan for nearly $600/month less than our current plan costs. Even if we paid our OOP max with the new plan, we would be saving a couple thousand dollars per year.
As it is we have a plan through DH's employer but usually end up on COBRA for 4 months every year... so it will probably save us about $3,000 per year just for the 4 months.

I think people are forgetting one major detail too, while you are essentially guaranteed a deductible you don't have to pay for well visits. Insurance is changing so they pay for your maintenance, then the deductibles, prescriptions, copays and fees are all ONLY if you get sick or have a condition. When people are seeing doctors for regular check ups it's unrealistic to think that overall costs in the system aren't going to go down after a couple of years. Things are going to be found sooner and will cost less. This means the insurance companies will pay out less, and the law triggers a system where they have to lower rates and pay the money back. That is not a trick, it has already happened that companies had to reimburse people because their profit margin was too high. My parents' company has actually and a decrease in their monthly rate the last two years.

There was nothing stated the entire facility was closing, it's a case of they are going to have to do more with less. Phasing out has to happen as not all insurance claims will be submitted and received by 12-31, but the volume will drop. Some staff will remain to follow up, audit, and post money received in the first half of 2014 earned in 2013.

We learned about an hour ago our neighbor, a single lady with 2 high school kids and a teacher herself, learned her insurance is increasing by $4200 next year, along with all educators in KY. That is essentially a 10% pay cut. We've been neighbors for 10 years but this is forcing her to sell her home and move as the pay cut will make her mortgage unaffordable.

It's great to hear some success stories, nobody should ever be denied insurance over a previous condition. There has to be a better way though.

 

[OrangeCountyCommuter]

The truth is insurance companies have found a scapegoat. Lots of these premium increases have nothing to do with health care reform, but..,, insurance companies will take the excuse all the way to the bank

 

[johde]

This means the insurance companies will pay out less, and the law triggers a system where they have to lower rates and pay the money back. That is not a trick, it has already happened that companies had to reimburse people because their profit margin was too high. My parents' company has actually and a decrease in their monthly rate the last two years.

Of course, under ACA most insurance companies, the system is stacked towards that happening, even if there is no cost containment. Insurance companies are required to pay out a certain % of premiums in benefits. If they pay out less than that they give a refund. If they pay out more than that, they can't ask people to pay more that year for coverage, they just eat the loss and raise premium for next year when the whole system starts over again. If I'm an insurance company, I'd want to charge people enough to guarantee I wouldn't pay out too much.

My last year with my prior insurance company, my monthly premium went up went up by 28%. Then in the middle of the year I get a refund check because they didn't pay out enough in benefits last year. The check barely covered 1 month worth of the increase in premiums.

As I see it, the big "success" stories are going to come primarily from,

1) people with preexisting conditions who were previously denied insurance or required to pay exorbitant premiums,

2) people who earn between 100% and 200% of the poverty level who previously purchased their own insurance and some of the previously uninsured. The Silver 87 and Silver 93 plans in most states I've look at are plans most people would kill to have. You're paying highly subsidized silver plan rates or platinum plan coverage. You can look at California as an example at https://www.coveredca.com/shopandcompare/#benefits .

3) Women planning on giving birth. It's not uncommon for maternity benefits to be a separate rider previously. It's included in all policies not.


The big losers

1)people just over 400% of poverty level. Depending on age 400% could get a sizable subsidy, 401% gets nothing. A similar thing happens explained above at 201%, the premium doesn't change but you go from great coverage at 200% to fair coverage at 201%.

2) Healthy men, especially young healthy men. They are required to pay for a whole host of preventative services that they can't take advantage of. There's an entire page of "free" (really included in premiums) women's health services. The comparable Men's health services, except for maybe 2 or 3, fall under deductible or co-payment. For example, Women can get their tubes tied for "free", Men pay to have a vasectomy.

 

[ZehnJahren]

The truth is insurance companies have found a scapegoat. Lots of these premium increases have nothing to do with health care reform, but..,, insurance companies will take the excuse all the way to the bank

+1

I hope there's some way of this working, but no matter how rich insurance companies are, they are NOT in it for anyone but themselves. Premiums don't HAVE to go up --- but they will, and now there's an excuse.

I was one of those people who was not insured through most of my 20s. I have insurance through my job now, and our benefits were just released this week for 2014 election. My premiums are only ("only") going up by about 10%, and my deductible is just a bit higher, but I think maybe the size of my company is able to spread the costs a little further instead of lumping everything on just a few employees? Regardless, I'm still comfortable for 2014 and won't see any MAJOR cost changes.

 

[barkley]

Clearly the numbers and results are going to vary by state. We also know NOTHING about how it is working until after it takes effect. A health center shutting down is done out of panic, not because they know the effect in advance. If they didn't have some idea that it may work out they would have closed in one phase, not two.

I checked pricing and we do not qualify for subsidies. Still, I can get a platinum plan for nearly $600/month less than our current plan costs. Even if we paid our OOP max with the new plan, we would be saving a couple thousand dollars per year.
As it is we have a plan through DH's employer but usually end up on COBRA for 4 months every year... so it will probably save us about $3,000 per year just for the 4 months.

I think people are forgetting one major detail too, while you are essentially guaranteed a deductible you don't have to pay for well visits. Insurance is changing so they pay for your maintenance, then the deductibles, prescriptions, copays and fees are all ONLY if you get sick or have a condition. When people are seeing doctors for regular check ups it's unrealistic to think that overall costs in the system aren't going to go down after a couple of years. Things are going to be found sooner and will cost less. This means the insurance companies will pay out less, and the law triggers a system where they have to lower rates and pay the money back. That is not a trick, it has already happened that companies had to reimburse people because their profit margin was too high. My parents' company has actually and a decrease in their monthly rate the last two years.

keep in mind that grandfathered insurance plans are exempt from many of the provisions such as free preventative appointments and accountability for excessive premium increases so people need to investigate if their existing plan or one that they are looking at buying into falls under grandfathered status (and it's based on when the plan was created vs when an individual joined up).

 

[crisi]

I have a facebook feed with several people - mostly writers or people who do freelance sort of work - who are going to be insured for the first time ever in their careers. They simply couldn't afford it before. They are thrilled.

 

[crisi]

2) Healthy men, especially young healthy men. They are required to pay for a whole host of preventative services that they can't take advantage of. There's an entire page of "free" (really included in premiums) women's health services. The comparable Men's health services, except for maybe 2 or 3, fall under deductible or co-payment. For example, Women can get their tubes tied for "free", Men pay to have a vasectomy.

I wonder if the men lobbied to have vasectomies excluded. They aren't, in my experience, a popular option and are often done under duress (their wife saying "I had the kids, if I went through labor, you can do this!) Excluding them gives all those men a convenient excuse to say "but honey, if we tie your tubes, its free!"

 

[Colleen27]

Of course all of that is assuming most of the 40% will have insurance now. Its very possible they will still choose to not purchase insurance, pay the penalty and still get their "charity care".

I don't think many will choose to do so. I think that idea is largely spin - most of the uninsured I know are young (mid-20s to mid-30s) and healthy, but it is still a source of stress. Everyone knows that accidents happen, and these days it seems like everyone knows someone who battled cancer or another serious/chronic issue at a young enough age that there's not much sense of "it can't happen to me". And in my state, auto insurance rates are significantly higher for those who don't have health insurance, which adds another cost of remaining uninsured on top of the ACA penalty.

The truth is insurance companies have found a scapegoat. Lots of these premium increases have nothing to do with health care reform, but..,, insurance companies will take the excuse all the way to the bank

Exactly. And the fact is most of us would do the same. If we were told we couldn't spend more than 20% of our income next year on non-essentials, wouldn't we all manage to do a lot of "fun" spending now before that limitation took effect? The insurance companies are doing that with their profits - they'll be limited in the future so they're going to make the most of today.

I have a facebook feed with several people - mostly writers or people who do freelance sort of work - who are going to be insured for the first time ever in their careers. They simply couldn't afford it before. They are thrilled.

I'm seeing a lot of happy stories from my writer's group as well.

I wonder if the men lobbied to have vasectomies excluded. They aren't, in my experience, a popular option and are often done under duress (their wife saying "I had the kids, if I went through labor, you can do this!) Excluding them gives all those men a convenient excuse to say "but honey, if we tie your tubes, its free!"

 

[arminnie]

My sister is low income, self employed and has had serious medical conditions.

She always has kept insurance though because she needed it.

She will save a lot of money with the new plan.

Many people will pay more. Many will pay less.

It is supposed to sort of even out overall.

 

[cheap traveler]

I'm in NY, so of course I have had VERY limited access to our information thus far. (The website had 30million+ hits in the first 2 days, when we only have 2.7million uninsured people)

From what I have been able to see, if my employer were to switch to 85% of the plans available to purchase, we will save money. As a small business (4 employees), we were already covered under the low-cost insurance (Healthy NY). These plans, available to everyone, are cheaper with similar OOP costs (only the deductable is higher it seems.)

I want to check out the individual plans available for comparison, but they seem to be working on the site very slowly, I still can't get access. If I qualify for some sort of subsidy, my costs will be much lower than they were this year.

I am a healthy adult woman, my 2 kids won't need coverage (insured through their father's employer), and I have no pre-existing conditions. Last year I had no insurance, and contracted Lyme Disease. I am still paying off that hospital bill! Unfortunately, preventitive care could not have prevented that illness, but having insurance would have meant a few small copays, instead of a bill that resembles college tuition at a private college!

 

[disney1990]

The truth is insurance companies have found a scapegoat. Lots of these premium increases have nothing to do with health care reform, but..,, insurance companies will take the excuse all the way to the bank

Yes, but, if they raise them more than a percentage of the actual costs, they will have to send out refund checks. I know people that received them last year when their insurance was raised "too much".

 

[daughtersrus]

Yes, because its been a whopping 60 hours since implementation -- we should be able to determine the success or failure of this legislation by now.

Actually, it's been a few years since it started to be phased in.

As a result of this, my children are able to stay on our family insurance plan until they are 26 years old. Prior to this, they were only allowed to be on the plan as long as they were full-time college students.

 

[crisi]

Actually, it's been a few years since it started to be phased in.

As a result of this, my children are able to stay on our family insurance plan until they are 26 years old. Prior to this, they were only allowed to be on the plan as long as they were full-time college students.

I believe my mammogram has been covered under this already for several years as well as well as coverage for preventative care - at least, my insurance company stopped passing on those charges a while ago - either from the goodness of their heart, or because they had to.

This is the "big bang" part of it - the opening of exchanges and the part where the government says you can't turn down people for pre-existing conditions.

 

[daughtersrus]

I believe my mammogram has been covered under this already for several years as well as well as coverage for preventative care - at least, my insurance company stopped passing on those charges a while ago - either from the goodness of their heart, or because they had to.

This is the "big bang" part of it - the opening of exchanges and the part where the government says you can't turn down people for pre-existing conditions.

I guess it just frustrates me that so many people (not here but a lot on Facebook...) keep saying that "Obamacare" just started a few days ago.
It's funny how some of my friends that have been vocal the last few days come up with a different reason for why some of their preventive care that wasn't cover before has been covered the last few years. I guess they think that the Union/Insurance Company (our DH's get insurance as part of the their union contract) suddenly had a change of heart and decided to cover these things. If they had read the papers we have gotten explaining the changes, they would see that the Union specifically said that the changes are a result of the Patient Protection and Affordable Care Act. It doesn't help that the media uses the term Obamacare instead of the accurate name.

I forgot to say in my earlier post that some of the other changes that have helped us is that we no longer have a $1,000,000 life-time max on our policy. A million dollars may sound like a lot but our youngest DD is now 19yo. She was born with a very rare genetic disease. Although she only had one major hospital stay, we were close to reaching that amount.

Well visits were only covered under our plan until a child was 2 years old. Now they are covered regardless of age. There was a yearly limit of $5,000 total for all speech, occupational and physical therapies. At the rate of almost $400/hour, we hit that very quickly. Now there is a limit of 70 visits per year instead.

We previously had a $5,000 lifetime limit for chiropractic/spinal case and $25,000 for substance abuse. Luckily, we never needed to use either but it's good to know that if we need it, there's no longer a lifetime limit.

These changes were effective January 1, 2011 so it's been almost 3 years, not just a few days like many people are saying.

 

[crisi]

I guess it just frustrates me that so many people (not here but a lot on Facebook...) keep saying that "Obamacare" just started a few days ago.
It's funny how some of my friends that have been vocal the last few days come up with a different reason for why some of their preventive care that wasn't cover before has been covered the last few years. I guess they think that the Union/Insurance Company (our DH's get insurance as part of the their union contract) suddenly had a change of heart and decided to cover these things. If they had read the papers we have gotten explaining the changes, they would see that the Union specifically said that the changes are a result of the Patient Protection and Affordable Care Act. It doesn't help that the media uses the term Obamacare instead of the accurate name.

To me, mammogram coverage is a huge deal. My sister survived breast cancer at 36. My cousin at 42. Her mother at 65. There is enough family history there that this is a really big deal in my mind. I've always gotten them - had my first before I was 40 because of my sister. But its nice to have them included in coverage. And for people who don't have a family history covered in red flags, who might not do it because they are expensive - like my friend Cindy who died of breast cancer five years ago at 55 without ever having had a mammogram before her diagnosis- no insurance coverage and a low income, this could be a life saver.

 

[mhsjax]

I don't think many will choose to do so. I think that idea is largely spin - most of the uninsured I know are young (mid-20s to mid-30s) and healthy, but it is still a source of stress. Everyone knows that accidents happen, and these days it seems like everyone knows someone who battled cancer or another serious/chronic issue at a young enough age that there's not much sense of "it can't happen to me". And in my state, auto insurance rates are significantly higher for those who don't have health insurance, which adds another cost of remaining uninsured on top of the ACA penalty.



Exactly. And the fact is most of us would do the same. If we were told we couldn't spend more than 20% of our income next year on non-essentials, wouldn't we all manage to do a lot of "fun" spending now before that limitation took effect? The insurance companies are doing that with their profits - they'll be limited in the future so they're going to make the most of today.



I'm seeing a lot of happy stories from my writer's group as well.

I know that there are some that refuse to do it, according to a Dr on the radio. He advised his patients to do this but they said they would rather not, they had no intention of doing it. Also don't know all the details but a relative of mine signed up and the closest Dr to accept it is 27 miles away. The is pathetic.

I do know something has to be done about Insurance coverage and I will just leave it at that.

 

[johde]

I guess it just frustrates me that so many people (not here but a lot on Facebook...) keep saying that "Obamacare" just started a few days ago.
It's funny how some of my friends that have been vocal the last few days come up with a different reason for why some of their preventive care that wasn't cover before has been covered the last few years. I guess they think that the Union/Insurance Company (our DH's get insurance as part of the their union contract) suddenly had a change of heart and decided to cover these things. If they had read the papers we have gotten explaining the changes, they would see that the Union specifically said that the changes are a result of the Patient Protection and Affordable Care Act. It doesn't help that the media uses the term Obamacare instead of the accurate name.

That's the thing, the Affordable Care Act, front loaded most of the popular provisions and saved the things that adversely affect large numbers of people until after the presidential elections.