What's your health insurance status? Will the ACA help you?

[SHRED]

Last edited Mon Nov 4, 2013, 02:07 PM - Edit history (1)

Okay, I'll start:

I'm in California.
Anthen PPO plan via my employer. My wife is on the plan also.
I am 100% covered by my employer and she is 50% covered.

I pay $450 per month from my paycheck.

This is about what I will pay per month (or less) when I retire this spring under Covered California and that is for both of us. Granted not quite the same coverage as the $1,800 per month plan I have now but well worth it since Covered California will allow me to be free (retire).

https://www.coveredca.com/shopandcompare/

ON EDIT:
The numbers:
Our total retirement income will be around $50K to $53K per year before taxes.

--

[Ohio Joe]

1. I'll be able to get insurance for the first time in years...

I'll even be able to get my pre-existing condition fixed... I can't wait

[leftstreet]

2. 75-80% of people won't be affected until 2018

The majority of Americans already have coverage through and employer, Medicare/Medicare, Vets etc

In 2018 ACA regulations state insurance plans that cost more than $10,200 for individual or $27,500 for family will be taxed an excise of 40% for every dollar exceeded

[BlueStreak]

14. And this is what the unions are angry about. I think they are misguided.

Health care -- even the most generous "Cadillac" health care should not cost $10,200 per year per individual. It only costs that much because:

a) the raping of the public by the pharma industry
b) the cost shifting to cover uninsured people showing up at the ER
c) Profits and abuses of the insurance industry
d) inefficiencies in the delivery system

We ought to be working to bring down EVERYBODY's cost of HC. And if we did that, even the most generous plans would not run $27K for a family.

[solarhydrocan]

26. You have identified the crux of the problem that the ACA does nothing about

a) the raping of the public by the pharma industry

Indeed, the ACA entrenches the present broken system for the foreseeable future.

Please allow me to recommend a book that will not get any attention in the US because the Medical and Insurance complex that now controls every citizens health care does not want to hear a thing about it.

Pharmageddon by Dr. David Healy <---click for bio
http://www.amazon.com/Pharmageddon-David-Healy/dp/0520275764/

This searing indictment, David Healy's most comprehensive and forceful argument against the pharmaceuticalization of medicine, tackles problems in health care that are leading to a growing number of deaths and disabilities. Healy, who was the first to draw attention to the now well-publicized suicide-inducing side effects of many anti-depressants,

attributes our current state of affairs to three key factors: product rather than process patents on drugs, the classification of certain drugs as prescription-only, and industry-controlled drug trials.

These developments have tied the survival of pharmaceutical companies to the development of blockbuster drugs, so that they must overhype benefits and deny real hazards. Healy further explains why these trends have basically ended the possibility of universal health care in the United States and elsewhere around the world. He concludes with suggestions for reform of our currently corrupted evidence-based medical system.

"This book shines a bright light on the pharmaceutical industry (and American healthcare) in the same way that Silent Spring called out the chemical industry and Unsafe at Any Speed called out the automobile industry. Pharmageddon is Healy's most important book to date. It will make a real contribution toward healing our sick system of pharmaceutical-driven medicine and helping doctors provide better care for their patients."--Elizabeth Siegel Watkins, author of The Estrogen Elixir and On the Pill

"In this startling book, David Healy argues that 'evidence-based' medicine--and a healthy dose of corrupt science--has led modern medicine off a cliff. His book is provocative, challenging, and informative, and ultimately it serves as a powerful manifesto for rethinking modern medicine."--Robert Whitaker, author of Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America

"Like a good detective story, Pharmageddon weaves together the history of modern medicine, the evolution of clinical trials and statistical analyses, changes in international patent laws, privatization of clinical research, blurring of the line between academics and industry, and the enabling role of medical journals. If you want to learn how to protect yourself (or your patients) from medical commercialism and how medical practice can be re-directed back toward its true mission, this book is a must read."--John Abramson, author of Overdosed America

Until this is addressed affordable health CARE will become more expensive to the point that it will be impossible.

$40 per aspirin will be considered a bargain in the future.

And apparently the TPP will further complicate matters with the Pharmaceutical industry. The worst thing that could follow the ACA.

[BlueStreak]

34. It does nothing about Pharma

And that is a huge factor in making US HC costs twice what they should be. It does a little about the other 3 factors:

b) the cost shifting to cover uninsured people showing up at the ER

This is the main goal of ACA. Unfortunately we took the slowest, most convoluted, least effective path to dealing with that. But it is better than nothing. In the very best case, it will take 5 years to substantially close the uninsured hole. For one thing we have to win another big election to deal with the damned SCOTUS and do something about the Medicaid hole. And even after practically everybody has coverage, it will take another 4 years of arm wrestling with industry to get them to stop overcharging everybody who has insurance. They have been in the habit of jacking up our costs for so long, this will not end quickly. So best case, we're talking 2018 before seeing significant results here.

c) Profits and abuses of the insurance industry

Thought the abuses had ended with the passage of this law? Wrong. Just look at what these bastards are doing canceling millions of Americans this quarter and sending out all sorts of letters intentionally trying to trick consumers not selecting expensive products that are not in consumers' best interests. The ACA law says they have to put 80% of the premiums toward HC, but they have armies of accountants and lawyers hard at work looking for ways to skin an extra 10% out of that. And even if they really did do 80%, that is crap. It should be 97%. These people aren't doctors, nurses, orderlies, researchers, or chemists. We don't need them. They don't add one damn thing to society. There is absolutely no reason why we should be spending a penny more than 3% for administration.

d) inefficiencies in the delivery system

There are a few things in the law that can actually make a difference here. I have already seen the benefit of improved electronic records up close. This may be the least appreciated part of the ACA law. And certainly the law's emphasis on dealing with health at the primary care and clinic level before it becomes an expensive ER proposition is a very good thing.

[etherealtruth]

3. I have employer sponsored insurance

It "sucks" ... but, I have it. The ACA helps me by providing the knowledge that many of those around me may have more access to healthcare than they would have prior to the ACA.

The implementation of the ACA also changed (for the better) some provisions of my employer sponsored plan (some of the preventive care aspects ...)

[SHRED]

4. And it removed the caps

Insurance companies are now obligated to pay for expensive care and not limit the total amount they will cover.

[etherealtruth]

5. YEP ... I knew I couldn't enumerate the ways i have actually benefitted

Thanks!

[GreenPartyVoter]

6. In my case not exactly. We are being moved from Medicaid to

private insurance. We should qualify for subsidies, which is great, but hubby and I are just going to pretty much stop going to the doc because we can't really afford the out of pocket stuff. We'll go back to getting cheap meds at Walmart, which will help keep current medical conditions under control, though. Kids will stay on medicaid, I think, which is a godsend. So overall it's a mixed bag for our family.

(Since people want to know financial details in these posts, we're a family of 4 in Maine, and our income is variable due to being self-employed. After write offs and all that, I guess our income is 35K to 38K range.)

[SHRED]

7. Does Maine have it's own exchange?

I punched in your numbers here in Covered California and there are real good and low out of pocket plans.

[GreenPartyVoter]

20. Our Teapublican governor turned down the expansion and state exchange. The bronze plans in my area

are $500+/mo. We only have 2 companies in the exchange.

[ScreamingMeemie]

8. Yes.

I'm in Texas.
I make about $40K a year and qualify for the subsidies.
I found a high-tier Silver (I guess that's what you'd call it) with an 1800 deductible (max for family 2900), $25 copay/$35 specialist. $1000 in lab work fully covered, $17/prescriptions with no deductible for $176.19.

I have not had health insurance for 4 years. I have RA and a heart condition. I have always paid my bills and taxes on time, and--for the first time in forever--I feel like a welcome resident of America again..instead of expendable.

[DireStrike]

9. It will help in a few extreme cases. Previous coverage: subsidized ER visits

Location: VA
29 year old non-smoker with highest or second highest level of subsidy.

Future coverage choices:

1) Low premium. Deductible so high that this will only help in cases of catastrophic health failure.
2) Painfully high premium. 30% copay and a lower (but still ridiculous) deductible. Slightly better coverage than above, at a much higher upfront cost.

Yeah, this is gonna hurt. I'm probably going to pay the penalty for the first year.

[FreeJoe]

11. PPO HDHP HSA

I've got a high deductible PPO with an HSA that covers me, my wife, and my kids. I pay about $85/month out-of-pocket for the coverage. The company pays $1,250/year into my HSA. I put an extra $5,000/year into the HSA. The only impacts I'm aware of based on the new laws are a change in how long my kids will be able to stay on my insurance (they are in middle school, so that's a distant concern) and the elimination of the lifetime maximum. My company is switching providers (technically, they are self-insured, so the provider is really the administrator) this year with the rumor being that it was somehow related to avoiding the Cadillac tax.

We have been in the HSA for a few years now and have accumulated about $16,000. Most of it is invested in a bond fund and a stock fund. Because of a quirk in the law, we pay for our share of medical expenses out-of-pocket and keep the money in the HSA. We save our receipts so that we can deduct it tax-free in the future to cover those medical expenses. By leaving the money in the HSA, it continues to grow tax free.

I should be covered by retiree medical, but I don't know the details of how that works because that is still many years away.

[Wounded Bear]

12. Not covered right now, because of a recent job change....

I was paying $30+ per week through the temp agency I worked through. Finally got my option picked up by a small company that will provide insurance at their cost. I don't know much about the plan yet, my enrollment interviews happen this month. My probation ends and coverage should start on Dec 1.

I have been getting care through the VA, so the ACA doesn't really affect me. I don't know how it will affect my upcoming employer provided plan. I plan to ask if there are any known plans to change there. The VA does bill my insurance when I have it, and charges me a co-pay based on my income, which I verify annually. They don't seem to make any health decisions based on what my insurance will 'cover,' though. I'm pretty happy with them.

Location: WA, so I'm not real worried one way or the other. My state is one of the models for success in this.

I'm 4 years out from Medicare eligibility, so there's that concern. My annual income right now is going to be in the $20-22k region, so if I'm forced onto Medicaid or the exchange for some reason, I should get generous subsidies.

[kydo]

13. I have insurance But ACA still helps me

Covered by my husband. DoD employee and retired Navy.

ACA helps me two ways. The first is if for some reason things change and I no longer have my current insurance, I will be able to get insurance. And two it helps people that were uninsured be insured and that helps me on so many levels it would take a book to even start to explain.

Even with all the short comings and glitches the ACA is a million times better then what this country had before. But it can still be improved and I am sure it will be. And that's a good thing.

[ChazII]

15. Tricare

My 83 year old dad has Tricare-For -Life and of course Medicare as well as his insurance from 30+ years with his previous employer. Dad served in the National Guard (Bushmaster) and then in the Reserves.

Tricare is his third but it has been wonderful.

[kydo]

19. champus

I remember when Tricare was called champus. I was an air force brat.

I really wish we could have done the single payer for health care. I wish we could do away with the whole health care insurance industry. That is were the scam is.

[Revanchist]

21. Same

Haven't see a doctor in quite a while, lost prime last year when I missed the bill (was still trying to get used to the system after retiring).

Out of curiosity, do you have any experience with the tricare supplemental insurances and are they worth the money?

[ChazII]

24. No, I don't have any experience.

Sorry that I could not be of more help.

[otohara]

16. It Will Help Our Son

he's 26 now and I was told that because of his line of work...he's a traveling LED operator for a band - those types of jobs were considered risky and thus "UN-insurable" - Not crazy about the high deductibles, but he won't go bankrupt if he get's sick.

[justabob]

17. will not help me directly

I am a member of the "working poor" in Texas. Without Medicaid expansion, no change in my healthcare status.

[trackfan]

18. I have PPO at work, they sent a memo - contribution to go up due to ACA.

It turns out to be a $4 per month increase. No big deal.

Out of curiousity, I checked out what would have happened with my situation two years ago. I was unemployed, and total household income of about $35,000. My wife and I were paying over $600/mo.

I went to healthcare.gov (I know I could have gone directly to coveredca.gov, but I wanted to do it as if I were completely new and unaware of the process). I was immediatly redirected to covered CA. Within a minute or two I had 30 quotes ranging from $1/mo to over $1000/mo. For a plan equivalent to what I was paying $600 for,
it would have cost me about $100-200/mo.

So, as far as I can tell. ACA works like it's supposed to.

[Puzzledtraveller]

33. I wish people with employer provided insurance who have dependents

could be eligible for subsidies, or at least be able to apply for them.

[hunter]

22. Not immediately. But my wife and I have both had trouble before because of chronic health problems.

It really sucks to be uninsurable and uninsured.

The last time we lost our insurance (a COBRA timed out) my wife eventually was accepted to our state's "high risk" plan (we were making too much money for medicare) but I got stuck out in the cold. Our family now has insurance through her employer, our young adult kids included.

But we've not caught up with medical bills since.

With ACA that's not going to happen again.

I'm certain there will be other headaches because it's not a single-payer. (I hate the health insurance companies and I'd happily see them nationalized and some of their chief executives and directors thrown in prison. I'd rather they were not involved at all in my health care.)

But even the few people whose insurance is going up will be more secure.

Before the shit fell out of the sky I thought we had "good" insurance, and I'd probably have been a little irked if something like ACA had made our insurance more expensive. But then we learned the hard way that we didn't have "good" insurance. Very few people do. People only think they do because they've not fallen off the edges of their "good" insurance into the abyss.

[denbot]

23. I'm covered by the V.A. and my wife is a Federal Officer with excellent insurance.

I pay very little for care through the V.A., and we pay just under $500 for our family of four for full coverage, vision, and dental.

The biggest benefit will be the ability to keep the kids on our plan till they are 26.

[JaneyVee]

25. I have employer/union coverage through Empire State BCBS.

[Glorfindel]

27. I have Medicare and VA, so it won't do anything for me

I am fortunate enough to be in very good health, so I have never met my Medicare deductible and I don't use the VA because it's extremely inconvenient - an 80-mile round trip in either direction. Still, I'm glad I have them AND I'm glad that the ACA is available for other people. I'm looking forward to the day when we join the civilized world and have a single-payer system.

[Broken_Hero]

28. My wife and I have real healthcare for the first time

in our lives, and I believe the ACA has helped that. My wife's employer has cut the cost of their best package by just over half. In Oct of 2010, it would cost us 850 a month, with a 2500 deductible. Now its 188 per payday(dental too), and our deductible is 3500, but we also have an account set up that takes care of the first 1k of that deductible. My wife and were walking around in a daze the past 5 days or so because it still amazes us, surprises us that we are on whiteman health insurance(we are both indian, and have had IHS our whole lives, fwiw). Our plan takes effect Jan 1 of 2014....I know we are lucky to be able to afford this, never in my life did I ever dream I'd have health insurance...

[Motown_Johnny]

29. Insured and yes, I believe it will help

I haven't finalized things yet, but from what I have seen I expect my premiums to be lower.

[Manifestor_of_Light]

30. Yes, haven't been covered in years.

Not covered since hubby got fired from his McJob in 2006, when the powers that be were busy destroying the med school he worked at.

I couldn't afford the high risk pool. Lots of pre-existing conditions. Nothing that will kill me anytime soon. Not old enough for Medicare, not poor enough for Medicaid. Not old enough for SS.

Haven't checked out my rates but they have to be much better than $1600/month for my state's high risk pool. I'm thrilled.

I am retired. I gave up on looking for a job a long time ago because I have some very good credentials (3 college degrees) and work hard, but nobody will take me seriously, because I don't suck up to the right people or something......guess I'm too honest. That is another discussion.

[Buddha_of_Wisdom]

31. My wife and I are both on Medicare BUT.... we are looking for insurance for my 4 year old son

and the insurance woman we used to work with does not want to deal with Obamacare (she is a BC/BS affiliated independent insurer). We dropped her like a fly and started looking around. The toughest part is trying to explain to the people that we are on Medicare and we want to cover our 4 year old son, and so far the insurance is pretty good, but we're trying to find the right one.

Maybe you can help? I'm in Colorado, and Connect through Colorado Heath Care has been confusing...

[Puzzledtraveller]

32. Employer provided

not bad but with money so tight I can't afford to use it for basic care. I'm single so my contribution isn't much but next year I'll be married and having a baby and the family plan will break me. Because it's employer provided I cannot get help either.