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Dreamer Tatum
(10,996 posts)Have him join DU and someone will straighten him out.
Cali_Democrat
(30,439 posts)Dreamer Tatum
(10,996 posts)Hang that question in your ass. Some people are going to suffer and couldn't
give two shits if they look like a bad democrat for not liking it.
Logical
(22,457 posts)grahamhgreen
(15,741 posts)NYC_SKP
(68,644 posts)I guess there are winners and losers, but I suspect the people who think they're losing haven't really gotten the true costs down.
Or, they are comparing last year with ACA for next year without knowing that next year their existing plan could double or disappear.
Apples and Oranges comparisons being made and then the complaints in 9 of 10 cases.
Response to Dreamer Tatum (Reply #1)
lostincalifornia This message was self-deleted by its author.
daleanime
(17,796 posts)give us a ballpark figure.
20,000-30,000?
40,000-60,000?
70,000-90,000?
Without that kind of knowledge we're just walking in the dark.
bornskeptic
(1,330 posts)North Carolina Knigh
(39 posts)$94,000 is a lot of money no doubt but if I live in New York or California it is much less for a family of four when you compare it to flyover country.
alarimer
(17,146 posts)That's a used car.
And I'd be hard-pressed to think of how a healthy person could rack up that much in health care costs, unless there's an accident or something.
Insurance is a scam. No matter how you want to pretty it up, or fix it around the edges, without single-payer eventually we are all going to be screwed.
Boom Sound 416
(4,185 posts)
dflprincess
(29,342 posts)can run over $14K (I know this from recent personal experience). And that was the negotiated amount that insurance paid, what was billed was more than $24k.
But I managed to get through nearly 60 years before I ran up a bill that high.
Hekate
(100,133 posts)"Unless there's an accident or something" -- boy, howdy. 
I once knew a girl who came from an active family in which a year did not go by without someone breaking a bone. I thought that was excessive -- but then one of my brothers had his own affinity for sharp, often rusty, objects that required stitches and tetanus boosters. Then there was the year my teenage boy had a bicycle accident and needed almost 2 weeks in the hospital plus dental restoration plus extensive plastic surgery. THAT could have bought a house in some parts of the country, so thank you Blue Cross circa 1994.
I have a friend who was without medical insurance for 17 years until she hit age 65. She was never so grateful in her life to be able to pay what she had to pay for Medicare.
We're not getting single payer this year or even this decade, so how about if we figure out some other best way of making sure most people can have access to affordable health insurance and wellness checkups and stuff like that? Maybe we could call it -- I dunno -- the Affordable Care Act? It won't be perfect, but we can keep working at it to make it better.
1000words
(7,051 posts)
dawg
(10,777 posts)Otherwise, he would qualify for at least some subsidy.
MattBaggins
(7,948 posts)
Barack_America
(28,876 posts)...not the cost of family coverage, so long as he gets his insurance from his employer. This is the "family glitch".
What the OP does not mention is that his friend can deduct any amount >10% of his income from his taxes.
cilla4progress
(26,525 posts)It was going to cost my husband $1300 / mo. to cover my daughter and me.
We are so fortunate that we had the option of joining the union (Teamsters...not sure how this happened). In any case, the Teamsters will be covering our butts for an affordable cost.
Pisses me off it's not available to all. I have always appreciated unions conceptually. Was in the restaurant workers years ago - excellent benefits for very low dues. I am a sworn loyalist now, for all their faults. They are needed to give working folks some influence relative to corporations, lobbyists, big money interests.
Mass
(27,315 posts)Or is it that he had a lousy insurance and now has to have one that makes sense. In which case, he was wasting his money before that.
Response to Mass (Reply #2)
lostincalifornia This message was self-deleted by its author.
pnwmom
(110,261 posts)You said he's basically paying for catastrophic, and none of the plans on the Exchange, except for people under 30, are only catastrophic. They all cover the Essential Benefits.
His wife will be able to get free mammograms and pap smears, for example. They will all be able to get free preventative care. Unless he's been neglecting the medical care of his family, all these expenses add up -- and now will be paid for in any of the Exchange policies (and not subject to the deductible).
ScreamingMeemie
(68,918 posts)Rather unfortunate choice of words.
Most of us have not been "neglecting the medical care of our family or ourselves..." Most of us are "unable to afford the upfront fees..." There is a difference.
pnwmom
(110,261 posts)So I wouldn't give him a pass on the costs of preventative care. If you have children, that's something that should be a priority -- and he's got the money.
ScreamingMeemie
(68,918 posts)I was lucky enough to find coverage that I'll be able to scrimp for, finally, after 4 years. I have a son. He's been on catastrophic temporary coverage because ACA didn't "allow" for insurance companies to cover children on their own policies in order to get out of covering kids with preexisting conditions. <<<That right there makes it a less than perfect solution.
I'm sorry. While I've admitted that I am pleased with my ACA result, I realize that others are going to suffer. Whether I agree with this person's story or not is outside of the point that you have been horribly rude and condescending to people who are having legitimate troubles with ACA. I've been sitting on my hands until I saw that "neglect" comment, which is really, really nasty.
pnwmom
(110,261 posts)who doesn't give his kids basic preventative care? Is there any income level at which you think it would apply?
ScreamingMeemie
(68,918 posts)making that assessment.
It's shameful.
DebJ
(7,699 posts)stunned that someone who makes $90k would not prioritize health care for their children.
I just can't fathom that as being an 'unnecessary expense'.
ScreamingMeemie
(68,918 posts)but I would never be quite so cruel.
As it happens, up until the ACA, I was not able to prioritize health care for my son... His catastrophic plan (healthy kids couldn't get coverage under their own policies to get out of having to cover preexisting conditions--a little-known ACA negative that many choose to brush under the rug) covered nothing but a major event.
I am not poor, but mortgages, car payments, and school fees (before someone jumps, public schools now have tremendous fees) can eat up my income rather quickly. This does not make me a neglectful mother.
If you scroll down, you will see where I suggest to the poster that his friend is lying to him... as I have had basically the same situation. It's not going to be easy to afford the cost of health insurance. But the catastrophic policy I had, just for him, was far more expensive.
pnwmom
(110,261 posts)something like this twice:
"
healthy kids couldn't get coverage under their own policies to get out of having to cover preexisting conditions--a little-known ACA negative that many choose to brush under the rug)"
The ACA doesn't allow insurers to bar people with preexisting conditions anymore, and it requires employers to cover children thru ages 26 on their parents' policies. So what is the "negative"?
ScreamingMeemie
(68,918 posts)couldn't deny coverage to children based upon a preexisting condition?
It contained a loophole. Insurance companies could stop covering children on their own policies altogether: healthy or sick.
So my healthy son, and many others like him, were forced on to temporary (11 months and 29 days and then you had to pay to "re-up" again) "insurance" policies that were high deductible ($15k) policies with no preventative care. I couldn't cover him under a policy because the high risk pools will only cover the "high risk patient" with no dependents (and that was unreachable for me financially anyway) That's what ACA "did" for us before the entire law kicked in. And it was a negative. No way to spin it. Now? It has been amazingly beneficial to my family. I have hope that I will survive past the age of 45. Now? We need to work to cover all. Instead of snorting at them and deriding them.
This is a start. But a lot of good, hardworking people are still going to suffer here.
Neoma
(10,039 posts)ScreamingMeemie
(68,918 posts)I was explaining something to someone. 
pnwmom
(110,261 posts)Have a nice day.
ScreamingMeemie
(68,918 posts)Sorry, but I hope you'll think before you post cruelty next time.
pnwmom
(110,261 posts)Right.
All because I said someone who makes more than 90K would be neglecting his kids if he didn't get them preventative care.
I can see where there could be instances -- bad years -- where that didn't happen. But if you have kids, one of your duties to them, if you can afford it, is to put their health above most other things.
valerief
(53,235 posts)ScreamingMeemie
(68,918 posts)That makes absolutely zero sense. 
valerief
(53,235 posts)
ScreamingMeemie
(68,918 posts)Okay then, have a nice day.
Kind of scary there.
Chan790
(20,176 posts)Yes! Yes! You should use common sense, sane thinking and reason to make assessments of the common good and to judge the appropriateness of other people's actions. This used to be a core-tenet of liberal thinking. It needs to be again.
There is no reason for anybody making $94000 a year to neglect the well-being and preventive care of their children nor to argue that it's an unnecessary expense. None. Unless your financial priorities are severely out-of-wack (We could get tetanus booster shots for the kids but that would mean I wouldn't be able to afford that cruise to Greece...), there is no basis for this. People making these kinds of assessments in their own shoes need to have someone else making the decisions in their shoes because they are clearly not mature or capable enough to make them themselves.
Yo_Mama
(8,303 posts)Or even $500 a month.
Of course this dude was paying a lot of pocket, and he still will be.
I think you are being rude, mean and misrepresenting the situation. $700 more a month is $8,400 more a year, and I defy you to make that up on basic preventive care. To assume that this guy's wife and kids weren't getting basic preventive care is ridiculous.
We all knew there would be winners and losers, and this guy's just a loser under ACA. On the other hand, if something happens and his income goes way down, he will get a lot of help with the premiums. There is more security under ACA but higher costs for all but the lowest income earners or the older/iller crew.
enlightenment
(8,830 posts)Go to the Nevada exchange.
Add some basic information - Jane Doe, an age over 30, a zip code (here's one for Las Vegas - 89101 - premiums are cheaper in the urban areas than the rural areas, though premium isn't what we're discussing here).
Look at individual coverage plans. The cheapest BRONZE plan - not labeled catastrophic - offers a combined medical/prescription deductible of $6250 (which is the max out-of-pocket, of course) with no coverage until the entire deductible is paid.
That, pnwmom, is a catastrophic health insurance policy that is being marketed as a bottom tier policy to people over 30.
And so what if they get free preventative care? Do you know how many people have been "neglecting" their medical care for YEARS because they couldn't afford treatment?
Preventative care is a nice little bell and whistle for people who have had regular medical care and can optimistically anticipate that their mammogram/pap smear/blood pressure/diabetes/cholesterol check isn't going to reveal a problem.
For people who have been "neglecting" their medical care (because they couldn't afford those regular check-ups), a revealed problem is a real possibility - and their Bronze tier plan with the outrageous deductible and $40 or $50 or $90 dollar co-pays (that don't go toward that outrageous deductible) aren't going to be in much better shape for now KNOWING that they have a problem and still can't afford to have it treated.
pnwmom
(110,261 posts)should not have been beyond his means.
enlightenment
(8,830 posts)Are you willing to concede my initial point about catastrophic/crap coverage insurance plans - or are we ignoring that? Just asking.
pnwmom
(110,261 posts)and I think it would be better for most people to go for silver -- which, by the way, is what the subsidies are based on. The government isn't trying to push people into bronze; it's just offering that as an option for people who prefer something more like catastrophic.
enlightenment
(8,830 posts)describe it, pnwmom - it is a catastrophic plan, by definition.
These things are being marketed to people with low-incomes. Of COURSE it would be better if people would "go" for better plans and for people who are subsidized, I would assume it makes no sense not to do that if the subsidized rate between Bronze and Silver plan are the same. I can't honestly address that, because I don't know if they will be the same. My state exchange is so screwed up that it is impossible to get to a point where you can see premium costs after the subsidy is applied - all I can do is browse to see the full cost (which are, I just discovered, appallingly high compared to the federal exchange full premium costs).
If the premiums are not the same - if the difference is even as small as $20 dollars - then it is realistic to believe that people who are already stretched will choose the cheaper of the two.
The subsidy is great - really. All the reforms they have managed to put in place are great. But those things are not going to FIX the situation that so many people are in right now - and for many, it is going to make a difficult situation worse. We do ourselves a disservice to ignore the problems to the extent that I am seeing on DU, because they are real problems, with real people attached to them.
It astonishes me to see posts (and I'm not pointing at you) that will admit in one sentence that "of course it could be better" and chastise someone for posting their issues with it in the next sentence. If we admit that the system is imperfect, shouldn't we be able to talk about the problems without being called trolls or liars or worse?
pnwmom
(110,261 posts)It's too bad that even on DU there have been so many unfair complaints about the ACA (from people who were either ignorant or deliberately misstating things) that people who think the ACA is a big step in the right direction are getting frustrated and losing patience with people making valid complaints about the law.
And it's too bad we don't have a normal Congress -- like any Congress ten or 15 years ago, where both sides were actually trying to make laws work, rather than sabotaging successes of the other side.
enlightenment
(8,830 posts)DU gets very emotional - we're all (myself especially included) inclined to let the fervor get in the way of the facts.
As for Congress? The government, as it was designed to operate, has failed. Yes, ours is supposed to be a deliberately slow and convoluted process - but this has gone so far beyond that design that there is no other word for what is happening.
If you had asked me ten years ago if we needed a Constitutional Convention, I'd have said no, because as unwieldy as the system is, it was working. Today? Yes - we need to make some fundamental changes, and since I don't think there is any way to corral the lunatics that are currently holding our nation hostage (short of literally rounding them up, which would only exacerbate the situation), then it's time to start thinking about how we can change the system to protect against future loons.
pnwmom
(110,261 posts)
enlightenment
(8,830 posts)damn.
notadmblnd
(23,720 posts)They've had no reason to have to neglect their health. They're complaining because their costs for insurance are going up.
It doesn't make sense to me that they've been neglecting their health because they couldn't afford it? Why would they even pay for insurance if they couldn't use it? It's hasn't been mandatory until now.
And there's something else that doesn't make sense. You say that going for an annual wellness visit won't do any good because problems won't be found. But then why would one go for an annual Dr. visit if it weren't for making sure there isn't a problem?
It just doesn't make sense to me, some of these negative stories that are being relayed here. People seem to be bending over backwards to tell and others come to defend these ACA horror stories without providing proof.
DU has never been a place where someone could just throw something out into the ether here without being called on it.
We're Democrats, it's what we do.
enlightenment
(8,830 posts)but I was having a small discussion about a broader issue than what the OP posted, not the essence of what the OP said.
I grew up with military health care - that socialized stuff. I'm old enough to remember only going to military hospitals, back when they had far more of those than they do now. Every year, my family had "physicals" to see how things were going. I cannot recall a single time when a problem was identified during those annual check-ups - probably because we could and did go to the doctor when we got sick.
It's not guaranteed, but it is much more likely that regular medical care will result in a clean bill of health during an annual check-up. For people who have not had access to regular medical care, it is more likely that the first free check-up they receive will reveal a problem. That's not fantasy - just common sense.
I'm sorry that you find any discussion of real and potential problems with this program "negative". Perhaps if you tried viewing this without a political lens, you might find it looks a bit different.
notadmblnd
(23,720 posts)The argument doesn't make sense to me. If I'm not mistaken, you were arguing in defense of how terrible the ACA is for so and so. And I shouldn't just have to accept it unquestioningly or keep my questions about the argument to myself. Sorry that you construe my skepticism as negative but contrary to popular belief, everything posted on the internet is not always true.
My grandfather used to say, "don't believe anything you hear and only half of what you see". So I guess "question everything" was just programmed into my Psyche.
enlightenment
(8,830 posts)I am pointing out that there are problems and pitfalls in this program. Full stop. If you feel that criticism = rejection, I'm sorry but you really haven't got that "question everything" concept down too well.
I have no idea what what's going on with the OP's friend. I do know that there are real issues with this program that are being ignored by some on DU because it doesn't fit the 110% plus positive spin they want to put on it. Like you, I will discuss the issues as I see them.
And by the way, I'm not the one who originally used the word "negative" - you did.
notadmblnd
(23,720 posts)"I'm sorry that you find any discussion of real and potential problems with this program "negative". Perhaps if you tried viewing this without a political lens, you might find it looks a bit different.
No, you never used the word negative either. That was me..
Bless your little heart and have a good evening.
enlightenment
(8,830 posts)But please don't try to teach your granny to suck eggs - it just makes you look silly.
former9thward
(33,424 posts)pnwmom
(110,261 posts)not subject to the deductible.
dennis4868
(9,774 posts)He will get subsidies to pay his insurance. Stop only telling half truths.
MNBrewer
(8,462 posts)why? can't he keep his original policy?
mazzarro
(3,450 posts)
Sunlei
(22,651 posts)Think of the savings on normal medical expenses for your friends,family of four if they had insurance.
FreakinDJ
(17,644 posts)Currently I pay $1050 per month for a family of 4, $20 office visits, $150 a day hospital care.
davsand
(13,446 posts) 
MADem
(135,425 posts)We're supposed to boo hoo that this guy has to pay more if he (voluntarily) dumps his existing plan and decides to choose an ACA plan...
It sounds like "Cool Story, Bro" territory to me.
Response to davsand (Reply #3)
lostincalifornia This message was self-deleted by its author.
Pretzel_Warrior
(8,361 posts)and when--not if--the day came he needed comprehensive insurance to care for issues related to his children or wife or self, he'd be up shit creek without a paddle.
You know, if he doesn't think he can afford the new coverage, he has options. Now is the time to review those options. We ALL have to make tough choices in our lives. My family is going through its own hardships.
The fact of the matter is he was likely throwing money away on premiums that would not actually support him in the event of health emergency or chronic issues. Now he will be covered.
Does he work for himself? If not, Why is he pricing exchanges rather than going with employer's policy?
PoliticAverse
(26,366 posts)
meadowlark5
(2,795 posts)I'm seeing posts where people will be paying more than what they were paying. Is it not an option for them to keep their previous insurance because an employer dropped it leaving employees no choice?
robinlynne
(15,481 posts)employer. In many cases the ACA is not affordable. It really depends. Just like any program, there are holes which will need fixing..
people with more income than me get less expensive, better care through ACA . It is not a one size fits all. Single payer would be.
So stop jumping on people! I support the ACA because it will help a lot pf people. It is not perfect. It will not make it better for everyone. not even everyone who needs help. Don't attack people because they are not getting subsidized.
meadowlark5
(2,795 posts)I'm not not attacking anyone
MattBaggins
(7,948 posts)to created FUD about the ACA.
robinlynne
(15,481 posts)
Agnosticsherbet
(11,619 posts)Big companies have very specifically decided not to enter any of the markets set up y the ACA. He should check out covered California and use it to comparison shop. Going to a smaller company may be a good answer. They are not playing on Covered California and may be jacking up their prices.
Response to Agnosticsherbet (Reply #5)
lostincalifornia This message was self-deleted by its author.
Turbineguy
(40,076 posts)in the form of low premiums, but there is always a bunch of stuff that isn't covered so by taking a greater risk, you might save money. If you have something less than cancer, you are on your own. If his kid fell off a bicycle, he would probably wish he would not have been so thrifty. When I went out into the private market in 2005 I looked into it, but in the end did not get it and opted for a more expensive plan. With catastrophic coverage it's easy to go bankrupt due to an illness.
Of course as long as your health is great, it's easy to get used to the low premiums and spend the money you save on other things. If your friend does not qualify for the subsidy, then he needs to look around for coverage rather than just accepting whatever his insurance provider wants to shove down his throat. That's the whole idea behind the exchanges. Purchasing health insurance is a big ticket item and should be seen as such. I found that looking around really pays. It takes some effort but it's worth it.
It also seems that people look at it as, "well, since I'm spending all this money, I'd better get good and sick so I can get my money's worth!"
I hope your friend finds something he and his family will do OK with.
MADem
(135,425 posts)I wanna hear all about this, where an increased pool of participants results in prices going up....
What "group" are we talking about that this poor soul belongs to? The Billionaire's Bunch?
Whisp
(24,096 posts)not pointing to this particular OP, but I find it a bit curious that some (many, actually) of the very same people that hated Obamacare for all these years are the ones having this Hugh!#@ increase in their premiums!
I tell ya, that's some long reach Obama has, to pick out these particular people and make them Pay for calling him poopyhead all this time.
MADem
(135,425 posts) Response to Whisp (Reply #18)
lostincalifornia This message was self-deleted by its author.
bluestate10
(10,942 posts)A $1200 per month premium is Gold or Platinum level coverage. Those plans come with low deductibles and low out of pocket maximums, that is what the person gets for the higher premium.
Mojorabbit
(16,020 posts)
JoePhilly
(27,787 posts)Every anti-Obama OP that one writes, turns into an extra $1 in premiums for that DU member.
Which means some will have premiums of $10000000000000000000000000000 Dollars!!!!
... a month.
treestar
(82,383 posts)Now I see why!
Champion Jack
(5,378 posts)
kestrel91316
(51,666 posts)
gater
(297 posts)And another friend of mine is, ummm, The Pope! Yeah, that's the ticket!
Why do these stories always start with... "a friend of mine?", or "I heard?"
Eesh!
These kinds of "some people say," "a friend of mine" posts are totally not to be taken seriously. Unless they contain some actual content (which this one doesn't), I file them in the propaganda basket.
grammiepammie
(81 posts)I totally agree. They spout off that their friend is paying $800 more with a family of four with no subsidies. If that is the case, than he is making a decent salary as the subsidies go quite high for a family of four. Show me the proof!!!!
MADem
(135,425 posts)Response to gater (Reply #9)
lostincalifornia This message was self-deleted by its author.
datasuspect
(26,591 posts)i'm not rich, but i get more than 1/3 of my income taken in various taxes. i don't get refunds i've had to pay taxes in addition to withholding ever since W.'s presidency.
adjusted for inflation, i don't make much more than i did 20 years ago.
i don't go without, but there isn't room for anything else.
the various levels of the middle class are being turned into ATMs.
and i don't mind paying taxes - but what do i get out of it?
it's the fleecing of the biggest pool of income earners. not interest income, but wages. it's class war for the benefit of the 1%.
you think the tea party is bad, wait till people start waking up.
Amonester
(11,541 posts)Young and healthy people paying that amount of taxes also know that, if they'd have an accident, or a sudden illness, they would get all medical treatments they would need for free, or that they will get old some day, and probably have to look for medical help, so they don't bitch and moan because the governments pick more than half of their incomes in "various taxes"
Free Health Care isn't free...
Free Education isn't really free either...
Free turnpikes aren't really free too...
Free (anything else from govs) isn't... free...
Some have to pay more than others who CANNOT pay!
That's what living in a civilized society is all about!!
flamin lib
(14,559 posts)The $10,000 deductible policies do not exist anymore. All policies must now offer a set of basic coverages and free preventive care. You have to add any out of pocket expenses to the $500/month to arrive at his true medical care cost.
Response to flamin lib (Reply #11)
lostincalifornia This message was self-deleted by its author.
pnwmom
(110,261 posts)in the OP.
kestrel91316
(51,666 posts)NINETY FREAKING THOUSAND DOLLARS, even WITH a family of four, and "can't afford" medical insurance. Time to ditch the toys and vacations and man up. Jeebus.
That's well over $20k per person. I am single and don't have a home mortgage deduction to get me into itemized deduction territory, and nobody to share housing expenses with, and don't have 3 dependents to lower my tax bill further. Your "friend", if he even exists, can cry me a freakin' river. He's gonna have to start living like most Americans live now, and quit pretending he's royalty.
rbixby
(1,140 posts)and he makes too much money to get any kind of subsidy. All I can say is that he needs to re-assess his priorities, maybe stop leasing a new BMW every year, maybe cut back on some of those things, because at the end of the day, what's more important, a fancy car and a big house, or the health of your family?
mitchtv
(17,718 posts)So everything short of hospitalization is not insured. He is comparing apples and oranges. The current plan pays nothing but catastrophic illness,so he must count all medical expenses
wercal
(1,370 posts)Its Blue Cross/Blue Shield of Kansas....and its good insurance. The individual deductible is $1,500 and the family deductible is $3,000 before going 80/20.
I think there is/was a cap, but it was $100k or something like that.
So I wouldn't automatically dismiss a $500/moth policy as bad or high deductible.
BTW, for now its still offered, so I haven't 'shopped' too much on the exchanges...but the ones I found in my state (KS) has deductibles of $3-$5k so about the same/certainly not lower than my current deductible.
DevonRex
(22,541 posts)Laparoscopic surgery. One-night hospital stay. $45,000 is what they billed Blue Cross for Federal workers. Blue Cross is arguing. But still. You are only one MAJOR operation away from your cap under that plan. Then you have no coverage at all.
So don't be telling people it's good. it's not. Imagine a family in an accident while rafting together. We used to do that. Or a family who played the numbers game with their auto insurance, too, and got in a bad accident. Then what?
wercal
(1,370 posts)I will continue to contend that I have very good insurance. I am staring at my summary right now:
Deductible: $1,000 per person/$2,000 per family, does not apply to preventative care (I erroneously posted $1,500/$3,000 earlier)
Max out of pocket expense limit: $2,000 person/$4,000 family...this is above and beyond deductible, so my max out of pocket for family would be $6,000....this does exclude prescription drugs though.
I also erroneously pulled $100k out of my arse...because I knew it was a high number. It turns out that I have no limit on surgery, facilty fee, emergency medical transport, surgeon fee, physician fee, mental health services, prenatal care, home health care, rehabilitation services, durable medical equipment, or eye exams (but there is $25 copay).
The only caps and exceptions listed are: skilled nursing care not covered, hospice limited to $5k, only 15 chiropractic visits per year, and they only pay 50% of prescriptions.
Anyway its good insurance.
Now below is an explanation on how we get such good insurance:
We just have an atmosphere, as I described in the previous post, where we know that we are in a large group, and we know that our actions have direct cost consequences. I'll try to reiterate again - Blue Cross does not insure us for the first $2.2 million. We as a group of employees pool our resources, and pay our premium into a big pot of money...this money is not 'paid' to the in insurance company. It is our own pot, and it covers 100% of our expected claims. So payments to the insurance company are for two things:
1) Coverage for going beyond the $2.2 million cap. Now remember we have historically never gone beyond this cap. And really, most catastrophic medical treatments seem to top out at around $150k-$200k, so the odds of a multitude of major illnesses pushing us beyond that cap is relatively low, and the premium for that is very low.
2) Administrative fee. We are somewhere near 4% with this right now. So that's 20 bucks a month the company is paying instead of me.
All said, my $527 might be $600 if the company didn't pitch in. Now remember, I think that's high! And quite frankly, the $1,300 you describe absolutely blows my mind. Anyway, the company contribution is not at all HUGE.
As I stated before, we have a wellness program, we encourage each other to use generic drugs, frankly we dodge a bullet sometimes (one guy's wife needed a $450k liver transplant, but he had coverage from the railroad he used to work at), but most importantly...and I don't think you want to understand this completely - we self insure each other. This means that there is no overhead fee (recent news reports indicate this adds at least another 20%) or profit margin on any of the premium that comes out of my pocket. This is the power of a large group, and the power of a large group that is committed to each other, committed to not wasting each other's resources, and committed to collectively keeping our costs down. Our HR department spends months each year shopping around and negotiating our admin fee to keep it low. As I said before, part of our company culture includes a culture of fitness. This stuff takes a lot of work. But we do it.
VanillaRhapsody
(21,115 posts)a single non-smoker...putting just her gross salary in the calculator resulted in:
Household income in 2014:150% of poverty level
Unsubsidized annual health insurance premium in 2014:$5,718
Maximum % of income you have to pay for the non-tobacco premium, if eligible for a subsidy:4.02%
Amount you pay for the premium:$694 per year
(which equals 4.02% of your household income and covers 12% of the overall premium)
You could receive a government tax credit subsidy of up to:$5,024(which covers 88% of the overall premium)
KG
(28,795 posts)Because Obama!
cbdo2007
(9,213 posts)yeah that's it, they pay more so the whole thing must be bad for everyone. WAAAAAAAAH!
uponit7771
(93,532 posts)...word for it... that's disenginious at best
Sunlei
(22,651 posts)Your friend can ask for himself & someone will help him.
BKH70041
(961 posts)These stories will be heard loud and clear by the US Congress. Oh boy, will they ever be heard loud and clear. Have no doubt.
DevonRex
(22,541 posts)
Walk away
(9,494 posts)DevonRex
(22,541 posts)I see you got my drift.
pnwmom
(110,261 posts)often do.
His friend is complaining that the Exchange policies, which offer far more benefits, cost more than the catastrophic policy he has had till now.
In doing the math, he's not counting the medical expenses he's been paying out of pocket because they haven't been covered by his catastrophic policy -- like his wife's mammogram, both of their colonoscopies, his kids well-child visits, etc.
BKH70041
(961 posts)I expect over the next 15 months plus to hear many more stories like this from across the country. Both Democrats and Republicans in DC will not dismiss those families and individuals making these complaints. They will feel real pressure to act, that is if they want to survive to see another political day.
For those who doubt this, come talk to me about it around -- oh say -- August/September of 2014.
pnwmom
(110,261 posts)can't leave out all the costs he's been paying out of pocket because of only having a catastrophic plan.
We do have real problems to address, but this issue needs better P.R. more than anything else.
geek tragedy
(68,868 posts)BKH70041
(961 posts)Holy crap there's a lot of people at this site all concerned about their own Democratic Party Purity Test.
Let me make it clear to you upfront: I think people who think the Democratic Party is straying away from what it supposed to be (I've seen the name "first-way" applied to them) are unstable. On the other hand, I think people who think Obama walks on water (I've seen the name "BOG" applied to them) are also unstable.
There. Now everybody can hate me.
The first-way and BOG need to run along and have at it. Just leave me out of your little sandbox play.
geek tragedy
(68,868 posts)BKH70041
(961 posts)And I don't have 19 posts hidden on my transparency page.
You really need to open a window. Life is more than this site.
geek tragedy
(68,868 posts)how to look up transparency pages. Banned users may not return, ya know.
P.S. Your first post in this thread was transparent Republican propaganda, talking about how all the evils of Obamacare will be exposed in Congress.
BKH70041
(961 posts)Fucking Hell!! It's virtually everywhere you read here. Do you really not realize people can see the tension between these two groups here? That the names and terms you call each other are invisible to everyone but you? Are you that obtuse?
P.S. I just stated I expect there will be more stories about how some fellow Americans will be hit with sticker shock. Log off here sometimes and watch the news. You'll get to read and hear the stories, too, in the coming months. Well, that is if you want to know what's going on outside your bubble.
Now run along. I'm sure there's some first-way/third-way scuffle taking place that just demands you defend your turf.
geek tragedy
(68,868 posts)upon millions of Americans, and everyone outside the crazy liberal bubble realizes it.
It's at least entertaining when Ted Cruz peddles that crap.
Ikonoklast
(23,973 posts)Look to the usernames, and you'll understand.
They don't get what they're doing. Yet do it over and over and over....
Egalitarian Thug
(12,448 posts)to make you watch them stamp their feet and hold their breath until you admit your sin!
geek tragedy
(68,868 posts)by any person on DU so long as it's anti-Obama, anti-ACA.
Lap it up! This person could be a Republican trying to spread misinformation, but that doesn't matter! Obama sucks, everything he has ever proposed sucks, that's what's important to you!
Stand with Rand!
Egalitarian Thug
(12,448 posts)that force is the path to success.
People are going to do what they are going to do no matter how nasty or loud you get (and that's what really drives authoritarians crazy).
geek tragedy
(68,868 posts)Your comments about him are as unhinged as the ones from the Republican's Crazy Caucus. Ted Cruz ain't got nohting on you.
http://www.democraticunderground.com/10023061451#post14
At this point, if he said the sky was blue I'm going to find a window before believing him.
http://www.democraticunderground.com/?com=view_post&forum=1002&pid=3394504
http://www.democraticunderground.com/?com=view_post&forum=1002&pid=3394669
Ignore everything he has ever said and just look at what he's both done and refused to do. It shows a crystal clear picture of what he is all about.
http://www.democraticunderground.com/?com=view_post&forum=1002&pid=3396323
Last edited Fri Aug 2, 2013, 10:34 PM USA/ET - Edit history (1)
be the President (or any position of great authority), should be an automatic disqualification from ever having that power.
We just love to cling to the fantasy of some hero saving the day. I fell for it myself in 2008.
http://www.democraticunderground.com/?com=view_post&forum=1002&pid=2871986
the difference. He instead elected to double down (to use the current annoying phrase) on the failed strategy of his predecessors.
We are exactly where we were told we would be, by the ignored people that have proven themselves right time and again, if these policies and actions were taken.
He was elected to inspire and institute change, he chose to screw the people and caused 2010.
http://www.democraticunderground.com/10023240309#post2
war criminal. If we didn't have the biggest stick in the world, we would be judged a rouge nation and sanctioned by the civilized world.
http://www.democraticunderground.com/10023357502#post25
Last edited Sun Jul 28, 2013, 02:02 PM USA/ET - Edit history (1)
He lied every minute of the campaign and came in with a thoroughly corporate agenda, established the Goldman-Sachs White House, and reaped the consequences of those actions in 2010. Pretending he had no options is disingenuous at best.
Had the republicans nominated a Christie or any not-completely-batshit-crazy candidate that could reasonably be portrayed as moderate, he would have lost in 2012. How long does the Democratic Party royalty believe they can rely on the republicans to keep making the alternative so horrible that people will hold their noses, swallow the vomit, and vote for them?
I'm just so fucking sick and tired of people making excuses for his utter failure as a leader.
Then again, you're also someone who refused to help defeat Bush in 2000 but did vote against Gore.
http://www.democraticunderground.com/?com=view_post&forum=1002&pid=564731
So, yeah, we authentic Democrats can smell rats better than Nader/McKinney third party types can.
Egalitarian Thug
(12,448 posts)I am impressed however. that you care enough to dig up a few of my posts, thanks.
geek tragedy
(68,868 posts)haven't called him:
A fifth column
a war criminal
a liar
someone who chose to screw all Americans
an utter failure of a leader
Point is, you have intense personal animosity towards him, and obviously detest him as a human being.
Egalitarian Thug
(12,448 posts)I do think President Obama has made some atrocious choices and is generally a bad manager and is pushing a destructive agenda, but it's nothing personal. I neither like or dislike the man, I've never met him.
Y'all just have to keep trying to make it about personality because you can't make your case on the evidence.
Neither you nor he seem to understand that you can never out-republican the republicans and trying just loses Democrats the support they need.
DevonRex
(22,541 posts)it costs $10,000 a MONTH!!!! And they're forcing me to go on BIRTH CONTROL and my poor, poor hardworkin' husband has to pay for MATERNITY CARE! He don't need no maternity care! What a waste.
rusty fender
(3,428 posts) I needed that laugh!
These whiners are so transparent
Response to DevonRex (Reply #26)
lostincalifornia This message was self-deleted by its author.
Lint Head
(15,064 posts)Rather than kill ACA, why is the GOP not talking about specifics to improve it? It's because they want to kill it, period. There are probably several improvements that could be made. One big one is to let the ACA evolve into single payer for everyone.
kestrel91316
(51,666 posts)our entire country will benefit from that.
I still think your "friend" doesn't exist, BTW.
Pretzel_Warrior
(8,361 posts)$600 per month on his family's insurance.
winter is coming
(11,785 posts)
DevonRex
(22,541 posts)
winter is coming
(11,785 posts)Ikonoklast
(23,973 posts)And I'm a guy!!!!
DevonRex
(22,541 posts)Ikonoklast
(23,973 posts)Can't wait for my chance to give someone's Granny the big thumbs down if I can get a nice hot pastrami sandwich, sliced thin, not too lean, piled high on pumpernickel with spicy mustard and a crunchy dill pickle from Corky and Lenny's out of the deal.
Paulie
(8,464 posts)Denying grandma before lunch means......
Ikonoklast
(23,973 posts)for Granny's Famous Pastrami.
Between my ruthlessly efficient service on the Death Panels and eating habits, I figure every nursing home in this country will be empty inside of eight years.
Paulie
(8,464 posts)But heartburn may be a problem.
Ikonoklast
(23,973 posts)The heartburn is but the small price I willingly pay in service to our nation.
stevenleser
(32,886 posts)...they sterilized my brother and they are forcing me to go to a Mooslim churchthingy.
DevonRex
(22,541 posts)The bastids!! I heard Obamacare just built a Moozlim Museum, too, and it's OPEN during the gubmint shutdown. And they implanted both my cat and me with GPS and listening devices at the vet's office. Now they can hear our thoughts! Kitty has such a potty mouth, too. It's so embarrassing.
BluegrassStateBlues
(881 posts)Happy days are here again.
brush
(61,033 posts)Some people might pay more, but realize that some insurance companies are taking this as an opportunity to raise premiums, and some companies are also raising healthcare deductions and blaming it on Obamacare.
Others who maybe are in their own business and make good money will pay more.
What we need to do once all this shutdown and debt ceiling stuff is over is to began lobbying our reps to tweak the ACA to fix those that fall through the cracks of the plan. The ACA is not perfect (no major social program such as this is at first) but we need to help it get better — more towards single payer.
Far more people, who previously couldn't get coverage and who the plan was designed, are being help by Obamacare than than the number of people who are being adversely affected.
LittleBlue
(10,362 posts)to allow people in high cost-of-living areas who are just above the subsidy line to bear so much of the cost for Obamacare. In places like California or New York large salaries are eaten up by outrageous rent and food prices, leaving little remaining. Basically these people (who are barely getting by) are burdened with paying for other groups of people even though they're not rich. Like someone above said, if you're not factoring in mortgage/rent, then the largest economic stress in high-income areas isn't even being accounted for.
These people will be turned off by the whole idea.
subterranean
(3,762 posts)Whatever will he do? Shop for a cheaper plan maybe?
Also, what kind of employer pays $100K a year with no health benefits? Unless he works for a very small company, his employer will soon be required to offer him health insurance.
Roland99
(53,345 posts)Yes I have a relatively high debt load but $1,200/mo? I could buy a 2nd home at these interest rates, rent it out, and buy insurance off the profits of the rental.
BUT...why is this guy looking to dump a $500/mo policy and buy a $1,200/mo policy off the exchange? Makes NO sense.
And no details on what was being compared either. The OP reeks of misinfo/disinfo
xfundy
(5,105 posts)
SammyWinstonJack
(44,316 posts)
Schema Thing
(10,283 posts)
Ineeda
(3,626 posts)Odd. Timing is odd, too. (IMO, of course.)
taught_me_patience
(5,477 posts)seabeyond
(110,159 posts)a month. thinking that 500 is pure bullshit.
wercal
(1,370 posts)And its good insurance. Its possible to pay as little as $500...my state (KS) has a lower cost of living than other places.
seabeyond
(110,159 posts)really? we were not fools simply paying out close to 1300 a month just cause we liked to throw our money away. i do not know enough about insurance to figure out what you have, but too many people have been living unaware for a lot of years. and that is always a red flag to me.
your company paying partial? hsa?
wercal
(1,370 posts)The OP doesn't make it clear if his does or not. HSA's are available...or were, I think they are being phased out.
Please don't characterize me as naive or unaware about my insurance. I know exactly what I have and it is very good insurance. I actually think my premium is pretty darn high, at $527. I suspect the rates you are paying have something to do with not being in a large group. The larger the group, the larger baseline expense that Blue Cross knows it will not have to pay. Every year, their actuaries look at our past history and come up with a baseline number...and divide it by the number of employees. That sets our premium...and BC is reasonably sure that they willpay out zero. So we are characterized as a 'self insured' company, and BC becomes more of an administrator than an at risk insurance company. So, we are directly rewarded with lower rates if we stay healthy...and we do. There is a wellness plan, discounted gym memberships, free fruit at the door, free counseling, walking trail on the company property, many preventative tests covered.. It has worked very well for us. Its a good plan that is working - its definitely not that we have a shitastic plan and I'm too stupid to realize it.
seabeyond
(110,159 posts)really? if it is not unaware or naivety, then what is it to state you are merely paying, and it an awesome insurance, without letting us know your company is paying the rest. and making us ask the questions?
and my hubby had an employee that was near hypochondriac and was on all kinds of drugs. he was well aware that employee raised the cost for all. but what should he do? fire that employee? not pay for that employees health care? compassion does not work that way
wercal
(1,370 posts)Last edited Fri Oct 11, 2013, 04:44 PM - Edit history (1)
As I explained, we have a large group and pay premiums to match last year's actual cost. The company share pays a relatively small administrative fee to the insurance company, and a relatively small fee for catastrophic insurance in the event that we as an entire group have claims higher than our premium payout.....which has never happened, and every year it doesn't happen, that catastrophic insurance fee stays flat.
If your husband's company had a hypochondriac, that just validates my point. (I'm not sure why you insinuate that I would be against covering him/her). We just have an atmosphere, as I described in the previous post, where we know that we are in a large group, and we know that our actions have direct cost consequences. I'll try to reiterate again - Blue Cross does not insure us for the first $2.2 million. We as a group of employees pool our resources, and pay our premium into a big pot of money...this money is not 'paid' to the in insurance company. It is our own pot, and it covers 100% of our expected claims. So payments to the insurance company are for two things:
1) Coverage for going beyond the $2.2 million cap. Now remember we have historically never gone beyond this cap. And really, most catastrophic medical treatments seem to top out at around $150k-$200k, so the odds of a multitude of major illnesses pushing us beyond that cap is relatively low, and the premium for that is very low.
2) Administrative fee. We are somewhere near 4% with this right now. So that's 20 bucks a month the company is paying instead of me.
All said, my $527 might be $600 if the company didn't pitch in. Now remember, I think that's high! And quite frankly, the $1,300 you describe absolutely blows my mind. Anyway, the company contribution is not at all HUGE.
As I stated before, we have a wellness program, we encourage each other to use generic drugs, frankly we dodge a bullet sometimes (one guy's wife needed a $450k liver transplant, but he had coverage from the railroad he used to work at), but most importantly...and I don't think you want to understand this completely - we self insure each other. This means that there is no overhead fee (recent news reports indicate this adds at least another 20%) or profit margin on any of the premium that comes out of my pocket. This is the power of a large group, and the power of a large group that is committed to each other, committed to not wasting each other's resources, and committed to collectively keeping our costs down. Our HR department spends months each year shopping around and negotiating our admin fee to keep it low. As I said before, part of our company culture includes a culture of fitness. This stuff takes a lot of work. But we do it.
Now, it sounds like your quest for a lower rate consisted of making a few phone calls. I'm not going to denigrate your approach...but please don't be so dismissive of what we have been able to do at my company, when the only lens you view insurance through is shopping rates. We do more than that...a lot more than that. If all we did was price traditional insurance, we would probably be paying a lot more....but there are a lot of very smart people here, and we didn't settle for 'normal'.
A quick edit - I just got an e-mail, and the company is sponsoring a flu shot clinic. They're paying the bill, and the people with the vaccine are coming to us. So easy breezy, I've got my flue shot next week. And kids under 18 can get a free one too. Its just a small example of our emphasis on preventative care.
wercal
(1,370 posts)It depends a lot where you live. I live in a cheap state (KS).
taught_me_patience
(5,477 posts)Maybe you're only paying the employee portion of the health insurance? My wife owns a business and we've done a lot of shopping for insurance (she pays health insurance for her 5 employees), and the plans hover around 350 to 450 per person. She pays 2/3 and employees pay 1/3.
wercal
(1,370 posts)Looking at your wife's plan, it covers 6 people including herself, which might balloon to 18 people when dependents are included. If I interpreting your rate structure correctly, premiums to the insurance company would be $86,400 per year.
That is a small number, relative to the $150k that a major operation could cost. So every year, the insurance company takes on large risk with such a small group.
My situation is different, as I explain in those other posts. We have a much larger group, and we pool our own resources to pay the first $2.2 million in claims. The insurance company is only at risk if our claims exceed that. That is a much lower risk.
Honestly, there have been times when I thought my premium was so high, I explored getting it myself. There are groups you can join, which cross employer boundaries, which would probably get a better rate than a 6 person shop. Insurance of 6 people is bound to be very, very expensive.
taught_me_patience
(5,477 posts)yeah... my "share" was about $250/mo for three people. When I quit and went onto COBRA, I found out the total cost for three people was $1,500/mo. Comparing your employee share of your employment based insurance to the exchange rates is complete apples to oranges and has no relevancy to the discussion.
factsarenotfair
(910 posts)
CountAllVotes
(22,215 posts)I sure could not afford to pay out that kind of money for health care because ... I don't have it, that is why.
My two person household has an gross income of just over $20K a year, sometimes a bit more, sometimes a bit less.
I don't know how the gov't can expect a man with wife/kids to pay this sort of money every month without it having a drastic impact on their quality of life, like for example the cost of food and other necessities required to simply stay alive (like keeping a roof over your head!).
I often wonder who it is that believes that the American people as a whole are rich. Most of us are anything but "rich".
I wish I had an option to suggest for your friend except perhaps do what others have suggested, do a LOT of checking around and research, research, research.
If your friend has to settle for something less that he and his family require, well I suppose the best way it can be viewed is that something is better than nothing at all.
One medical "incident" can break you and those premiums, etc. will seem like a pittance if you happen to get hit with a huge medical disaster.
We like to view ourselves invincible but as we age, we realize that we are not and never have been "invincible".
Best of luck to your friend and his family and I hope he can find an option that will work for his family soon!
Response to CountAllVotes (Reply #57)
lostincalifornia This message was self-deleted by its author.
ScreamingMeemie
(68,918 posts)How do I know this? Because you're describing my situation.
The only thing I could "afford" was catastrophic insurance for my son.
I'm a preexister.
He's a healthy 15-year-old.
Preexisting coverage pools (high risk insurance) would only cover me (to the tune of $1400/month with a 10K deductible) and not him.
Regular insurance would not cover him on his own policy, so I had to purchase temp. This made me EXTREMELY angry at Obama and the ACA (because it isn't/wasn't perfect).
I fall into the pay or be taxed income bracket of 40-45K.
His temporary insurance was $500/quarter for no preventative care and a 15K deductible if he got sick or was injured.
My silver plans on ACA start at $175/month for both of us.
I was prepared to be as pissed as your friend. That ended up not being so.
I'm sorry, but he's pulling your leg because he really wants it to be so.
Response to ScreamingMeemie (Reply #90)
lostincalifornia This message was self-deleted by its author.
ScreamingMeemie
(68,918 posts)You should show him this thread.
bhikkhu
(10,789 posts)who makes $400 a month more than me and has no kids, but swears he can't afford the $200 a month insurance premium. I don't know what some people do with their income (and its really no business of mine, of course), but I am raising two kids on less money, and I could afford it. At 45-50 years of age, in a pretty high risk bracket (smoker, weight issues, pre-existing conditions, etc), he still doesn't want to hear that that's pennies on the dollar for actual hospital bills.
At the rates we can get on the Oregon exchange, being able to get insured is unexpectedly affordable (though not universally appreciated).
sinkingfeeling
(57,835 posts)get a subsidy.
seabeyond
(110,159 posts)paying 1200 a month. and that is with a high deductible. actually when it was raised to almost 1300 is when we went to an hsa and really high deductible with no co pay. so, whatever insurance he had just a little while ago was literally UNBELIEVABLY awesome. cause i have not seen numbers like that in so amny years, i cannot remember.
pnwmom
(110,261 posts)which, of course, could not then be "almost" the same as the Exchange policies.
seabeyond
(110,159 posts)wilt the stilt
(4,528 posts)I bought my own insurance for years. There is no family policy for $500 even catastrophic.
kestrel91316
(51,666 posts)mulsh
(2,959 posts)has your friend lost his group coverage for some reason and need to switch to the ACA group plans. What state does your friend live in, rates vary from state to state.
I need some more info before I get indignant.
SolutionisSolidarity
(606 posts)This is a reals problem guys.
d_b
(7,463 posts)i just lost my morning tea
Pathwalker
(6,603 posts) 
NYC_SKP
(68,644 posts)Damn you Obama!
patricia92243
(12,975 posts)Sarcasm
intaglio
(8,170 posts)A couple were even on DU and I think all have cited $700.
Firstly, you do not have to leave your old scheme of it is cheaper.
Secondly, assuming what you say is true (dubious) then you're friend is not factoring in the tax rebate.
BluegrassStateBlues
(881 posts)Paolo123
(297 posts)Why should he carry insurance at all?
1,200 per month X 12 = 14,400.
In any given year of normal check-ups and maybe each kid getting a cold once or twice, or even strep, his out of pocket expenses shouldn't be more than 2K at most.
Then, if someone gets cancer can't he just enroll then and start paying the 1,200?
seabeyond
(110,159 posts)i do not know.
but... we used about 500 of our 5000 deductible at this point of the year so far. all cash out of pocket. i agree, we use very little. we are a healthy lot and only have it for the big unknown.
ScreamingMeemie
(68,918 posts)If he gets cancer in, say April, he's not going to be able to enroll then. Kind of a stupid idea. Enrollment ends in March this year and is shortened from October to December in successive years. Kind of a gamble.
Paolo123
(297 posts)Stil though, there is no reason to enroll now as opposed to enrolling in march.
DebJ
(7,699 posts)he might blow the whole $12k. Have you raised children? If you have children,
have you actually looked at the cost of each doc visit, vaccinations, and the
inevitable sick visit costs? And the prescriptions?
I mean, the full costs...and the full costs charged to someone without insurance.
Your plan might pay $60 for a doc visit, and that's it.
But uninsured might be charged $150 per visit.
bettyellen
(47,209 posts)Paolo123
(297 posts)if it's a car crash or something the ER will still treat you.
bettyellen
(47,209 posts)DevonRex
(22,541 posts)One or two colds a year? Maybe if that family lives on a desert island with no other human contact.
B. Immunizations? Physicals? Dental care?
C. There are many pediatric conditions and diseases other than cancer.
D. Do you know how insurance works at ALL? Obviously not.
Paolo123
(297 posts)I don't have insurance (at the moment) and I never spend more than 1,000 per year or so on medical care including immunizations. OK, maybe it is 1,500 with dental.
C. OK, many other diseases, but that still proves my point. Why enroll now when I can just wait until they are sick?
D. I know exactly how it works. Now, it turns out there is an enrollment period. However, I will not enroll until march. Why pay the insurance until then? If there is a serious illness I can enroll then and there.
DevonRex
(22,541 posts)Paolo123
(297 posts)You have excellent debating skills.
patricia92243
(12,975 posts)ScreamingMeemie
(68,918 posts)policies are not ACA-compliant (no preventative care is provided) and therefore are done.
It is a valid concern for some. For this guy's friend. I highly doubt it because I had virtually the same situation.
haele
(15,402 posts)Family of 4, disabled spouse with high medical bills, and high rent ($1500 a month), a student loan ($275 a month) and a used car payment ($153 a month), plus all the other stuff. My office work clothes are 4 years old and barely fit correctly, and we live paycheck to paycheck. If I didn't have a disabled spouse, I wouldn't have the HSA and my insurance premium would be $600 a month less.
My employer may have changed the plan to save costs to them in a "competitive market", but they didn't drop the plan, and they tried to ensure that it remained complete affordable for most of the employees.
If his employer was going to drop insurance anyway, COBRA would be far more expensive. Unless he is one of those people who was planning on ditching his insurance altogether and gamble on nothing happening to his family until he got another job.
His employer is the cause of this problem, not the ACA. His employer is ditching providing health care, probably because of spite over a mandate, or spite because it's a Democratic plan or "Soshilism", or some other Libertarian nonsense, and is not going to raise his salary to cover the expense of going on the market, right?. Right? That's one irresponsible employer.
Tell him his medical costs, including out of pocket (post tax) premium payments are tax deductible once he hits 10% of his adjusted gross. He should change up his tax deductions to cover the premium costs, and save his receipts for the next year's taxes, which might drop his tax liability by $200 a month. That can help him some in the mean time.
I know what it feels like, and sympathies with him, because living in California is rough anyway, but from earlier posts in this thread, there's some choices that have to be made. Perhaps his wife, if she's not disabled, can go back to school, or start a low-supply cost home, or a hobby business to take in a little more money? That's what they did in the old days here in Cali.
There are (or will be, as soon as the government starts up again) SBA loans that can help a start-up.
I do feel for him, but with the cost of health care and no single-payer, not having health insurance is playing russian roulette with your family budget.
Haele
Rex
(65,616 posts)nt.
winter is coming
(11,785 posts)If you hate to say it, then don't say it.
bunnies
(15,859 posts)see: "I hate to say it, but I told you so". 
winter is coming
(11,785 posts)bunnies
(15,859 posts)Now you've got me thinking. I'm sure Ive done that before. Ill have to stop it. 
cui bono
(19,926 posts)So I put that in with a family of 4, adults both aged 40, kids under 20, all non-smokers. Used US Average since I didn't know the state.
Here is the result:
Silver = $712.50/mo.
Bronze = $574.17/mo.
Maybe he's confused and thinks that he has to pay that on top of what he's already paying? Seems like he can stay on a lesser plan, Bronze, and pay just about what he's paying now.
Household income in 2014:
382% of poverty level
Unsubsidized annual health insurance premium in 2014:
$9,700
Maximum % of income you have to pay for the non-tobacco premium, if eligible for a subsidy:
9.5%
Amount you pay for the premium:
$8,550 per year
(which equals 9.5% of your household income and covers 88% of the overall premium)
You could receive a government tax credit subsidy of up to:
$1,150
(which covers 12% of the overall premium)
Bronze Plan
The premium and subsidy amounts above are based on a Silver plan.You have the option to apply the subsidy toward the purchase of other levels of coverage, such as a Gold plan (which would be more comprehensive) or a Bronze plan (which would be less comprehensive).
For example, you could enroll in a Bronze plan for about $6,890 per year (which is 7.66% of your household income, after taking into account $1,150 in subsidies). For most people, the Bronze plan represents the minimum level of coverage required under health reform. Although you would pay less in premiums by enrolling in a Bronze plan, you will face higher out-of-pocket costs than if you enrolled in a Silver plan.
Aerows
(39,961 posts)You aren't working at McDonald's - you are working for an employer and have an employer plan. This story, and it is just that - a story - has so many holes that you can smell the bullshit through them from a mile away. You don't make 90K/year without having value to an employer and they aren't going to have said employee and their family floating around without healthcare. That's just stupid.
Edit: He's probably a shitty manager and realizes that the people he treats like shit can now go work somewhere else and he's afraid of his little tyrant empire crumbling.
RebelOne
(30,947 posts)and getting Medicare. I pay $105 per month. It is mostly a basic plan, but it is insurance and I have yet to use it as I hate going to the doctor, which I am going to have to soon.
rbixby
(1,140 posts)You don't HAVE to pick one from the exchange, you know?
valerief
(53,235 posts)
okieinpain
(9,397 posts)
fadedrose
(10,044 posts)is where I thought adjustments would be made. What are subsidies alloted for?
I'm just learning about the plan, but tax and refunds is what I thought it was all about.
matt819
(10,749 posts)You're saying that his current insurance premium is $500 and that his insurance company, reportedly because of ACA, raised his premium by 140% to $1,200 per month?
I don't buy it. Sure, there have been premium increases, and some insurance companies have chosen to attribute this to the ACA, whether true or not. But more than doubling the premium? I really find that hard to believe.
Or are you saying that the premium for an ACA marketplace policy is $1,200, and his current premium is $500? If that's the case, is your friend comparing comparable policies? If his 500 policy provides xx coverage, and the 1200 policy provides yy coverage, than that's not a fair comparison.
My problem at the moment is getting onto the ACA site. But looking at the various policies available in my state, my family would save more than $7,000 per year in premiums, without any subsidy, and for a better policy.
Response to lostincalifornia (Original post)
Name removed Message auto-removed
DevonRex
(22,541 posts) 
Ellipsis
(9,454 posts)
Rex
(65,616 posts)
Ellipsis
(9,454 posts)I. Just. Can't. Help. It.
valerief
(53,235 posts)
You don't even bother wearing a disguise.
arcane1
(38,613 posts)And have nothing but bashing to do
Kaleva
(40,365 posts)tenderfoot
(8,982 posts)
Rex
(65,616 posts)I hate to be the bearer of bad news, I hate to rain on your parade, I hate to hate.
TheDebbieDee
(11,119 posts)If your friend will pay $700/mo more with the ACA plan, then he should keep what he has......ACA is not mandatory for those who already have insurance. ACA is for people who do not currently have insurance.
Walk away
(9,494 posts)stevenleser
(32,886 posts)
melody
(12,365 posts)I have a friend and his wife in very similar circumstances. They are paying $450 per month for Covered California.
onlyadream
(2,248 posts)I'm in similar curcuma trances as the OP's friend. I guess it depends on the state.
melody
(12,365 posts)Funny, that.
onlyadream
(2,248 posts)You are in denial. I'm not making this up, and I've been around for a long time, when my old lap top stopped working I lost my info, and, since I don't post a lot, I just created a new account.
melody
(12,365 posts)I just have signed up numerous relatives and friends who don't have access to a computer. If they already have medical insurance, they don't need the ACA. They just keep what they have. If they don't have health insurance, they need to fit it into their budget. It's an essential. They will pay for it now or later. Beyond that, if they want to, just lose the tax benefit.
onlyadream
(2,248 posts)Since it doesn't meet the ACA requirements.
melody
(12,365 posts)No one plan will cover everyone, but most people will find their coverage costs radically reduced. You'll get better coverage, too. The subsidies are very helpful. My older sister Pam died because she didn't have health insurance that would cover her -- I think this is necessary. We pay almost $500 a month. It's no small consideration.
onlyadream
(2,248 posts)It was very disappointing.
Currently I pay $425 for a family of four, for hospital and well visits only, 100% no deductible. If we get sick or need a sonogram, or a procedure, which isn't done at a hospital, we are on our own.
The choices that I had from the website had premiums ranging from $800 to $1200 per month, with $3000 to $6000 deductibles, and 50% copays! Yikes!!! I'd rather keep what I have and be grateful for it.
Response to lostincalifornia (Original post)
MattBaggins This message was self-deleted by its author.
Lex
(34,108 posts)If he has to pay $1200/month under ACA, then he's making enough money to do so.
NYC_SKP
(68,644 posts)Like you, I don't buy it.
People say they'd rather just go to the clinic.
Well, the clinic ain't gonna get you through ER care or catastrophic health care needs.
The system requires participation, not excuse making.
It's designed to be affordable, not free.
Lex
(34,108 posts)but come to find out, he had a $650.00 boat payment each month for a pleasure boat (i.e. he didn't need it for work).
The judge snorted and said, "you're going to have to sell that boat, my friend."
Kablooie
(19,107 posts)With no deductibles and low copays.
You can get insurance as cheaply as $700 with higher deductibles and copays.
And if he had $500 a month insurance, I'll bet it didn't cover anything except catastrophic situations and had a huge deductible so was nearly worthless.
bluestate10
(10,942 posts)A low level Bronze policy can be had for $500. The family of three deductible is $6,300. The out of pocket maximum is $12,100. If the OP's friend is paying $1200 per month for a policy, that policy is of a Gold level and likely has low deductibles and an out of pocket maximum around $4,000. Not knowing anything else, I smell bullshit in the claim that is being made.
skip fox
(19,502 posts)Perhaps that helps us "find" lostincalifornia.
B Calm
(28,762 posts)What a load of crap!
BenzoDia
(1,010 posts)Jeff In Milwaukee
(13,992 posts)I'm SO sorry that I voted for him (twice) and there's NO WAY I'm voting for a Democrat in 2014 and 2016.
That was the response you were looking for, right?
bravenak
(34,648 posts)Try harder next time.
Or tell your 'friend' to try harder.
Roselma
(540 posts)he doesn't have an obligation to purchase the policy under the ACA.
http://money.msn.com/health-and-life-insurance/how-obamacare-penalty-will-work?page=2
cilla4progress
(26,525 posts)We were ultimately fortunate to find new affordable by joining the union! If this is an option for him, he should look into it.
I will keep him in my thoughts.
PS I understand your hating to say it...I have been royally FLAMED here when stating same! That's OK, I can take it. I hope my flamers can move on and hang with me on other issues. Time will tell.