Does anyone KNOW if the "Bronze" Health Insurance Policies offered on "The Exchange" in 2014...

[bvar22]

..cover 100% of all Medical Costs after the initial Co-Pay?

[CAPHAVOC]

1. We had to pass the bill

To find out what is in it. Well we still do not know.

Medicare for all is the answer.

[Yo_Mama]

13. Yes, we do

At least basically, we do. It's just that the content is so bad that no one wants to talk about it during an election cycle.

Kaiser Health Care calculator:
http://healthreform.kff.org/SubsidyCalculator.aspx

This will allow you to enter an income and a family/single status. Say you are not eligible for employer insurance to find out what happens to you if you are forced on the exchange. Some examples:

35 year old, single, income 25K

Required bronze premium 1,726 annually, with the subsidy coming in the form of a tax credit of $2,236. How that credit works remains to be seen - here's hoping the IRS allows your withholding to change to account for it, because otherwise you'll have to cough up the entire estimated premium cost of $3,962 in the first year and get reimbursed the second year. That would effectively be impossible for many, so you would have to pay the fine and you wouldn't have insurance.

Your maximum out of pocket costs would be $3,125. This does not include the premium - that's extra. So if something bad happens you would be expected, with an income of 25K, to pay $4,851 that year before 100% coverage kicks in. On a 25K income, this makes "affordable" a total joke.

The "actuarial percentage" is 73%, which means your average copay is 27%. So if such a person had a health condition, and had $20,000 in medical bills (not extreme - one car accident will put you over, or many illnesses requiring diagnostic testing) in a year, the first 10K of medical bills would cost (on average) $2,700. The next 10K of medical bills would only cost you $425.

Same person with a 35K income:
Required bronze premium is $3,325.

Maximum out-of-pocket costs are $4,167. Thus the maximum yearly medical bill would be $7,492. The actuarial payment percentage is 70%, so if you rack up 10K of medical costs, on average you will have to pay $3,000. The next 10K each year would only cost you $1,167.

And so it goes. Family example:
Family of 4, approximately median family income of $50,000, age of primary policy holder 35.
Out of pocket premium is $3,385, plus out-of-pocket costs of $6,250.
The actuarial coverage is 73%, so on average your copay for each $100 of medical services is $27, or $2,700 for each 10K of medical services. The probability in any given year that you will have over 5K of medical services is much greater than for the single. Families who have an ill member will probably pay $5-7K in medical costs each year.

Final example to show what's going to happen to the older persons:
Single person 62, income of $40,000 (distinctly above current average wage):
Required premium is $3,800, plus out of pocket cost of $4,167. Actuarial coverage percentage is 70%, or an average copay of $30 for each 100K in medical bills.

So the total cost for one year's coverage plus 10K of medical bills is $3,800 + $3,000 = $6,800. The next 10K in medical bills costs you $1,167.

Since the older person has a much higher probability of incurring 10K in medical bills each year (consider prescription costs alone), older people will be burning right through their retirement savings before they ever retire unless they have employer-paid medical coverage.

[CAPHAVOC]

15. I rather just pay the Medicare Tax. I hate "Managed Care"

Bronze Silver and Gold Plans. Are the scams Insurance Salesman use to sell junk policies. They sold us down the river to the insurance companies. Deal with it it is the truth.

[stillwaiting]

2. I don't know bvar22, but I do remember some posters...

... throwing out percentages as low as 60%/40% at one time.

I truly hope that these insurance policies do not force people to pay 40% of their health care costs with how high our health care costs are in this country, but I will not be surprised if that turns out to be the case.

I would be shocked, and I mean shocked if these policies offer anything better than forcing people to pay 20% of health care costs.

With that said, I would LOVE to be shocked since paying even 20% of today's health care costs will continue to bankrupt many Americans.

[bvar22]

5. If these "Bronze" Policies cover only 80% of the Medical Costs,

....this will be a disaster for MILLIONS of Working Class Americans.
They will be in exactly the same position as they were before ACA (Medical Bankruptcy),
but with even LESS money in their pockets.

40 - 70 MILLION Americans are projected to be uninsured by 2014.

[woo me with science]

3. I think we can all pretty well predict the answer to that question.

The patterns are exceedingly clear by now.

[Schema Thing]

4. what do you mean by co-pay?

The maximum out of pocket expense for a Bronze plan is $5,950, so I imagine that it only pays 60% until you reach that $5,950, and then pays 100% after that?

[bvar22]

7. "The maximum out of pocket expense for a Bronze plan is $5,950"...

...is mildly reassuring.
Is that per year?
per visit?

Do you have a link for your numbers,
especially the 100% after $5,950?

[bornskeptic]

11. It is $5950 per year.

The insurance would pay all expenses beyond that, other than possibly office visit copays and prescription copays. I don't think those are included in the out-of-pocket max, but they would be considered in the assignment of actuarial value. Actually the $5950 is set to correspond to the maximum for Health Savings Accounts. It is subject to increase in the future.

This link has actuarial estimates of possible combinations of deductibles and coinsurance for various levels of coverage.
http://www.kff.org/healthreform/upload/8177.pdf
They are in a table near the middle of the file. They assume an out-of-pocket max in 2014 of $6350.

[alc]

6. regulations are still being writen

Insurance company lobbyists are still working out the details with the various federal and state agencies that will decide.

I think insurers may want to cover ALL costs and expand coverage. Because of the medical loss ratio, the best way to increase profit is to increase premiums - reducing medical costs actually reduces profit so they need medical costs to go up which means covering more. They'd rather have premiums increase than higher co-pays since they get a part of the premium but not part of the co-pay.

Insurers will turn the MLR around and say "congress told us we can charge 15-20% more than we spend on medical costs". Regulators may try to limit the increases but insurers will run a PR campaign with medical costs and the MLR details and tell us what coverage they will cut if regulators get their way. They won't mention that they could cut costs without reducing coverage and people will believe that they have Congressional approval to jack up rates. Hospitals and doctors will go along since they will get paid more and not have to reduce costs and as a result insurers will make more profit.

[Yo_Mama]

14. No, not hardly

Because the subsidy is limited on the exchanges, so insurers can only provide certain coverages.

Also, the employer coverage has two conditions - it has to cover certain things (already decided to be the average business coverage in the state) and the premium they charge to the employee can be no more than 9.5% of income. Obviously for a family policy that is hard to do, so that will sharply limit the coverage packages employers can offer.

Banks are expecting a sharp rise in credit defaults when health care reform kicks in, plus a rise in medical bankruptcies.

[bornskeptic]

8. There are many ways a bronze policy could be structured.

By "initial co-pay" do you mean deductible? A bronze policy would be actuarily rated at 60%, which means that on the average it would cover 60% of an adult's medical expenses. Total out-of-pocket costs for an individual will be limited to $5950 in a year though, so an individual needing $100,000 surgery would only be paying a very small fraction. Typically a bronze policy would have a deductible of some size, and beyond that the enrollee would pay 40% of costs up to to a limit, which might be as high as the point where the out-of-pocket max was reached. My guess is that the deductible would be around $2000, but that is just a guess. It could also be structured with a larger deductible and no out-of-pocket costs beyond that. I don't know what that deductible would be, but in would be well below $5950.

[Honeycombe8]

9. We won't know for two more years, I guess. nt

[TheKentuckian]

10. After the 6k out of pocket, it seems to. Of course 6k to those in the bronze market

may as well be tens of thousands.

I'm thinking most won't be able to deal with the co-pays and deductible and will never make it through (or even to) the out of pocket phase.

Some folks also don't seem to be able to really grasp the numbers they throw around in real life application.
Words like "poverty level", which is a rate of income markedly below full time at minimum wage. Which means that a person runs through the eligibility zone for Medicaid really quick (especially when Medicaid is being slashed and its services cut all across the nation) and folks making jack shit in this economy are on the hook pretty hard, hammered in fact. These folks will be left with a tiny disposable income, if any. These folks don't qualify for the earned income credit and have nothing to write off so they have net tax liability, have to pay up to 10% for premiums alone, at that income likely similar for liability on a beater, they have to have gas or bus fare, they have to have a roof over their heads, they have to pay utilities, and they have to eat. There is no six grand there and certainly not if you are talking yearly, which can be the case with even the need for a maintence medication that allows for an otherwise normal life. In a rubber meets the road scenario, functionally the sick at this level are no better off and the "healthy" are more squeezed. The single/childless destitute might get access to Medicaid but you have to say might looking at the national state of the program today, the states not accepting applications, and programs unable to pay vendors but the poor and working class are going to be further squeezed. Pain has not been alleviated but spread around the working class.

These are folks that gross under 20k a year, some significantly under. The best argument for this state of affairs is that it is better than nothing but is it practically? Also, is it for the rule rather than the exception? Most broke people will just be more broke and continue to self deny care because of not having the co-pays, not being able to meet deductible, and having nothing to pay coinssurance.

Patting ourselves on the back for throwing life preservers out of reach of the drowning, at their own expense is a fit of arrogance.

These are the salad days of the Wealthcare and Profit Protection Act, when pay for play features and access increased for more comfortable incomes can be sold as game changing advances before reality sets in and we look around at the same exact system we supposedly reformed with the addition of mandates and envasive poison pill landmines we allowed the TeaPubliKlans to plant, and an employer system tighter around our necks along with ever increasing costs.

[bornskeptic]

12. A single individual making $20,000 a year would have a premium cost of $85 for silver coverage,

and an out-of-pocket max of $2083 per year, with no out-of-pocket cost for preventive care, which is all many people need in any given year. What is your motive for spouting baseless hyperbole instead of just looking up the facts?
http://healthreform.kff.org/SubsidyCalculator.aspx

[CAPHAVOC]

16. This F'n ACA plan sucks!

Really sucks! I hope SCOTUS does Obama a favor and puts it out of it's misery.

[bornskeptic]

17. In other words you hope we don't get affordable healthcare for everyone within the next 20 years,

because that will be what it means if you and the Republicans get your wish.

[CAPHAVOC]

18. There is no insurance.

Health care is no longer "insurable". Like the Army it should be a government responsibility. And not for Birth Control Pills. This scam is a sell out to insurance and drug companies. Total sell out. It will only get worse.

[bornskeptic]

19. Insurance seems to work quite well in Germany, Switzerland, and the Netherlands,

all of which have mandatory privately provided insurance. Perhaps it's just a coincidence, but those countries all seem to have fairly healthy economies, while most of the "single payer" countries in Europe are drowning in debt.