Does Obamacare really care?

[SHRED]

I really love the removal of pre-exisiting conditions that allow us access to insurance coverage but here's the deal...


I am 59 and my wife is 55.
Our AGI is around $55K.
We are retired.

We have the Blue Shield PPO under the Covered California Silver plan. This plan retails for about $1,300 per month. We are paying $650 per month (based on our income).

In 2014, when we add up all of our healthcare costs (we itemized), the total was $14,000.
Last year it was $10,000+ in health care costs total.
These costs were incurred via premiums, copays, services not fully covered, and deductibles.

What is "affordable" about this?



WE NEED A UNIVERSAL HEALTH PLAN FOR OUR COUNTRY NOW!!!

--

[Jackie Wilson Said]

1. Agreed, but Obamacare didnt make your situation worse, it made it better.

So now our job is to go to the next step.

[SHRED]

2. I think further sticker shocks are yet to come

Obamacare patients sicker and pricier than expected

http://money.cnn.com/2016/03/30/news/economy/obamacare-patients-blue-cross-blue-shield/index.html

[Jackie Wilson Said]

5. Probably, but because we are allowing for profit company to interfere between

patient and provider.

It is absurd we still have health insurance companies.

[Baobab]

33. Affordable is part of the name of the bill. US trade policy is against new services

We have spent 22 years and a huge amount of work to make new public healthcare FTA-illegal, not just here but all around the world.

[lewebley3]

43. Yes. Obama cares and works

[SHRED]

52. Obamacare is working alright...

...to take thousands of dollars each year from many of us.

[redruddyred]

60. if i had to make a semi-educated guess

these patients are unnecessarily sick after having had their preventable health needs ignored for years

[Mary Mac]

75. like

[flamingdem]

3. Is that an EPO or a PPO?

PPO is a very good plan since you can access a wider network than EPO - but it all depends on who the providers are in your city.

The critical comparison here is your deductible. If you're not paying one you're doing fairly well compared to many people. I was paying over 350 dollars to Anthem before ACA and my deductible was $6500.

So that was way worse than what I have now which is Silver EPO with a very low deductible and copay, but I know what you mean even a low copay can add up.

We are paying for our health here in the USA. This is not free health care by any means. In my case I have much, much more affordable access to care though, and the best care since I can access UCLA. Before I simply didn't use my insurance and it cost more and excluded many things. Before I felt like I was dealing with the mafia, things have improved but I'd like it to be cheaper.

Let's not forget Medicare comes with costs as well, it's never going to be free imo in the USA.

[SHRED]

4. PPO...it's mentioned in my OP

[flamingdem]

13. You might get a lower price with an EPO

That's the case with Anthem in LA anyway.

At first it was a problem, doctors were hesitant to sign up since the EPO pays them less but Anthem got most UCLA doctors and many others to sign up.

Starting in August the system was pretty flooded due to people signing up for ACA. I'm glad I got set up with doctors sooner because now what's on offer is often an intern unless you can wait or if you're smart about calling for cancellations. Like I said elsewhere I am willing to pay to get quality care and imagine if it was free it would be more flooded.

[SHRED]

20. We travel so we have to have a PPO

[flamingdem]

22. I heard about that - Blue Shield Blue Card?

Does that work okay? I could see that being important since EPO is no good for other locations. Another failing of the system - in fact one that would keep me home. Plus, it would be nice to have two cities to chose from if I was a part timer somewhere.

[onecaliberal]

6. 29 million without healthcare at all

[SHRED]

7. How much due to no Medicaid expansion in redneck states?

[onecaliberal]

8. Some but not all by no means

[SHRED]

9. we need something better

[onecaliberal]

37. Yes, we do. Healthcare should NOT be a profit making endeavor for anyone.

[former9thward]

19. 2.9 million or 1 in 10, so not really that many out of the total.

?w=735&h=551&crop=1

As of the beginning of 2015, 32.3 million nonelderly people lacked health coverage in the U.S. Nationally, we estimate that nearly half (15.9 million, or 49%) of this population is eligible for financial assistance to gain coverage through either Medicaid or subsidized Marketplace coverage (Figure 1). More than a quarter are either adults eligible for Medicaid (5.7 million, or 18%) or children eligible for Medicaid or the Children’s Health Insurance Program (CHIP) (3.2 million, or 10%). Those who are Medicaid eligible include people who were previously eligible as well as those newly eligible under the ACA. About one in five (7.0 million, or 22%) of the nonelderly uninsured are eligible for premium tax credits to purchase coverage through the Marketplace.

Nearly one in ten uninsured people (2.9 million) fall into the coverage gap due to their state’s decision not to expand Medicaid, and 15% of the uninsured (4.9 million) are undocumented immigrants who are ineligible for ACA coverage under federal law.

The remainder of the uninsured either has an offer of ESI (4.9 million, or 15%) or has an income above the limit for premium tax credits but could purchase unsubsidized Marketplace coverage (3.7 million, or 12%). We cannot determine from available survey data if the offer of ESI would be considered affordable under the law, which would make the individual ineligible for a Marketplace premium subsidy.

http://kff.org/health-reform/issue-brief/new-estimates-of-eligibility-for-aca-coverage-among-the-uninsured/

[SHRED]

21. Interesting

[Maedhros]

10. The real measure of success will be whether the ACA reduces the number of medical bankruptcies.

Sure, more people are covered, but can people afford to pay for actual care?

[magical thyme]

32. well President Obama offered to pay Hunter Biden's cancer expenses

so the Biden's wouldn't have to sell their house to pay them.

So I'd be inclined to say no.

[LibDemAlways]

39. The Covered California Silver Plan has plenty of

Last edited Thu Mar 31, 2016, 01:25 AM - Edit history (1)

exclusions, which puts the ball squarely in the patient's court -- this after extremely high premiums, co-pays, and deductibles. It's a massive insurance company ripoff.

[flamingdem]

58. What are they? I should know since I'm on Anthem Silver

but so far haven't run into them.

I don't appreciate the coinsurance, it's going to cost me this year. However it was way worse before when I had to pay more for what was essentially catastrophic insurance for $360 a month and 6500 deductible. At least I use this insurance.

[LibDemAlways]

61. I am talking specifically about the Covered California

Silver Plan through Blue Shield. I do not believe it's an Anthem Plan. My mom has Anthem Blue Shield and it's good coverage. The Covered California plan is crap. A relative who signed up for it ended up heavily in debt when he had a medical emergency. $5000 out of pocket for a few hours in the ER was just the start. They used every excuse in the book to get out of paying. He owed 20K by the time they got through with him.

[flamingdem]

62. Wow, but that doesn't sound correct to me because out of pocket maximums are less

than 20k for most of the plans - not saying it's not possible though but I haven't seen this.

My out of pocket max is around 2800 - but I'm not sure if emergency is excluded, if so that seems wrong.

I've heard that people are still getting billed for out of network docs when it's not like they can ask them if they are in network when they are in an ER! I am guessing this might have happened. Gov. Brown has a bill on his desk to disallow this practice.

[SHRED]

64. Not every expense counts toward out-of-pocket

It's restrictive.

[flamingdem]

68. Can you mention an example?

I'm having to do procedures, I thought it was just a percent that I'll pay but sounds like I don't know the whole story.

[SHRED]

69. Sorry

I may have my out of pocket mixed up with my deductible.
It's late I'm tired.

[LibDemAlways]

66. The out of pocket max. is only for the services

they claim to cover. The reality is that there are big co-pays and deductibles for just about every covered service and many services they simply disallow. Plus, under the plan they only cover many services at 70%, so the patient is automatically stuck with the balance. It's a racket.

[flamingdem]

67. Ugh. Thanks because I'm about to have procedures

Was meaning to call for the codes this week. I wonder what they won't tell me and I'll find out later.

[SHRED]

74. Thanks for explaining

Last night I couldn't remember.

[Dont call me Shirley]

11. Not so much.

[questionseverything]

12. when i checked out plans

it was 8% of our agi plus 6 grand out of pocket each

which would be 30% of our income so we pay the penalty instead and pay for treatment as needed

sigh

we voted obama but got hillarycare instead

btw we will never be able to retire and are raising grandkids who used to get medicaid but that may change because of the aca

we need national healthcare NOW

[SHRED]

17. I can't put my life's savings in jeopardy

I need coverage.

[questionseverything]

25. i understand, we have no major savings but i also would hate to lose the equity in our home to

medical bills but

i don't have 30% disposable either

when everything in 08 crashed our income was cut by about 2/3, we now about up to half, trouble is very few of the expenses we had before 08 are things we can discontinue (we long ago sold off anything extra)

being self employed bernie's plan would cost us 8.4% of our income , for us it would be a god send

[mopinko]

28. if the grandkids lose their medicaid, i gotta believe

that that is your governor, not the aca. aca expanded medicaid in all the states that accepted it.
i know walker not only rejected the money, he cut badgercare.

[questionseverything]

53. i am illinois...caseworker said it was aca...because we do take them off our taxes

i don't know for sure that they will lose it, waiting but i had to do an income thing and i never had to before

January income low so maybe ok

[mopinko]

73. i doubt it was aca.

medicaid has it's own rules. aca did nothing but expand medicaid afaik.
i am in illinois as well. smells like rauner to me.
a friend up here had case worker just close up her file while she was trying to get surgery on a broken foot. (she couldnt work for 3 months) closed her kids cases, too.

if you find out, i would be curious to know.

[questionseverything]

76. i know you are illinois i followed your farm stuff with interest

the aca had 2000 pages of "details", we are just finding out about

my tax gal agreed with the case worker on it so who knows

one thing i should mention is...we only had to provide income for a one month period and January is usually horrible for construction
so the kids medical should be fine

still it is a change

one thing that i think hurts us with the whole "calculation" thing is even tho we are supporting 5 peops, since only 2 are applying for insurance they seem to figure the cost as if our income only had to support 2

does that make sense?

we have so many reoccurring medical expenses that would not be covered under aca, chiropractor, eye glasses and dental that 30% on top of those is just not doable

long as i am whining (lol)..basically by the time i even know what my income was for last year(hopefully managed to pay my taxes) and have a decent guess at this year,,,the enrollment period is over BUT i do have to calculate and include my next years penalty in my tax quarters

i am saving the state over 1200 bucks a month by not letting my grands be in the foster care system but i was a foster parent and i have seen both sides and i do not trust that system

i guess what i am trying to say is, not every case fits into a neat little box

btw i still support the aca for the good things it does for some people, i just want to be included

rauner is an ass so who knows what will be left when he gets done with us

about your friend getting kicked off

caseworkers have entirely too much power

when i first applied for the kids medical that went thru easily but i also asked about receiving monthly money (other grandparents in my grands raising grand support group told me about)

the caseworker said no, when i asked why (since they have no income and others with way more grandparent income were getting) she just said,don't question me or i will deny their medical too

<shrugs>

it is what it is

[mopinko]

78. yeesh.

yeah, caseworkers. luckily my friend had the social worker at the hospital helping her.

best of luck to your grands. you are a good soul to that them on.

[Scuba]

14. Medicare for All, including dental, optical, hearing aids and mental health services.

And yes, we can afford it.

[So Far From Heaven]

15. It's equivalent to the care you're gonna get with the TPP. (nt)

[Contrary1]

16. We're about $5,000 ahead of you in income...

My premium is $965. just for me, no dental. Almost 25% of our income goes to healthcare costs.

First time ever as an adult that I'm anxious to hit 65.

[SHRED]

18. Ouch

[redwitch]

23. I just looked at the plans available to us in NY as we will have to purchase come May 1.

Hubby and me, not yet retired. Cheapest plan we can afford will cost us $211 per month ( after the subsidized amount kicks in) and we each will have a deductible of $6800. Add in co pays for everything and cost of our prescriptions and it is going to be no great bargain. We don't make a lot of money, this is based on $50000 a year total.

[Mike__M]

24. My question is: after paying the penalty

Could I walk into an IRS office and present my colon for an exam, or do I need an appointment?

[Hoyt]

26. The honest truth is, and it's true for me too, we don't make enough to retire.

I'm older than you, and I will he working pretty much full-time for quite awhile.

[jalan48]

27. Obamacare is going to be a failure down the line.

Thinking that the insurance industry is the answer was a huge mistake, though lucrative for the insurance companies I'm sure.

[Cryptoad]

29. Obama Care didn't

force u to purchase a policy with high out of pocket cost,,,, at ur age no a wise move.

[SHRED]

30. We looked at all the levels

The one we chose was the best cost wise for us.

We looked at ALL of them available in Covered California.
My wife is a former software engineer so yeah...she knows math.
Your assumption-based victim blaming is offensive to me.

[Cryptoad]

40. not assuming nothing

I know fromm working to sign people up,,,, the silver plan has lots of out of pocket cost and not a wise choice for someone yall's age. but it seems u have it all figured out...

thx, tells me all i need to know

[SHRED]

41. What have we overlooked?

I'm open to suggestions.

[Skittles]

48. too harsh a tone, Cryptoad

they're just very worried....you sound like you are in the know - how about offering them some real advice regarding how to proceed

[SHRED]

51. Now that I'm on my computer...

...I see their avatar.

Oh well.

[peace13]

71. Aaaaa...I think they all pretty much have high deductibles.

[smiley]

31. I agree.

There's nothing affordable about the Affordable Care Act.

I managed most of my 20-some adult years without health insurance. When I needed to see a doctor for minor colds and accidents, I paid out of pocket. The costs were higher, but I was lucky enough to never need major medical care. I now get healthcare through my employer. $200 a month deducted, which covers only me. I'm glad more people are getting the care they need, but if I'm going to pay this kind of money a month, I'd rather it go towards government healthcare, not to an insurance company. Somehow that just makes sense to me.

[SHRED]

34. You are a good person to think this way

Thinking of others.

[Motown_Johnny]

35. I agree, but...

it has been my experience that Blue Care sucks.

Not all silver plans are alike.


You may need to do a better job comparing plans.

[SHRED]

36. We did.

We compared all in Covered California.

[Politicub]

38. Sorry you're having a bad experience having insurance

I consider Obamacare to be an imperfect miracle. It freed me from needing a job for insurance alone. I was able to start my own business.

[SHRED]

42. Think about this

The poorest and also the very costly 65 years and older people are not a burden (cost) to the private health insurance industry yet they are still screwing us.

A big chunk of their potential risk pool isn't there and they still raise rates every year.

[ConservativeDemocrat]

44. That doesn't have anything to do with the ACA

It has much more to do with fee for service medicine in the US, and hospitals banding together to apply collective bargaining power for the providers. Not much the ACA can do about that. It would take an entirely different law.

- C.D. Proud Member of the Reality Based Community

[SHRED]

45. I realize a bit off topic

But private carriers are what the ACA is.
We have no public option.

[ConservativeDemocrat]

54. Public option is a public INSURANCE option...

It still wouldn't affect what the providers themselves charge.

I mean sure. Insurance companies can have up to 15% overhead (it's typically much lower), whereas Medicare runs at about 3.5%-5%, depending on where you ask, but basically that's at most a 10% reduction. So even ideally, instead of $10,000, you'd be paying $9,000.

The real cost drivers these days are: 1) No limits on drug prices and artificial monopolies, 2) Absurdly high price and restrictions on medical schools restricting doctors, 3) "Cadillac" bargaining when covered by insurance, 4) Intense expense near the end of life when people are in a death spiral anyway (instead of health activities younger on). Medicare is at this point basically a charity for most doctors - it's basically not worth it, and many don't take patients due to it.

(Had a friend in Britain say all his doctor families moved to the US because salaries were 3 times higher. We pay that. And no, insurance companies, evil boo hiss, don't control that)

- C.D. Proud Member of the Reality Based Community

[Rex]

46. I think overall, that he believed that was the best deal he could broker for the American people.

We need to do away with health insurance and make it health care. Forcing all insurance companies to go non-profit would help a lot, but that will never happen.

[Turn CO Blue]

47. Similar situation. We paid in over 1/3rd of our gross income in medical premiums last year.

We are 54 and 50.

We pay in about $1500 a month.

The average 55 year old couple pays $2000 per month.

The costs for the ACA (and for all those newly insured) is carried entirely on the backs of 50-65 year olds.

The ACA is overshadowed by the 800 pound gorilla - which is that it is bankrupting an entire generation right before they will need to retire -- and it will lead to the homelessness and poverty of every single person who is now 45-65 years old.

The ACA cannot be fixed.

[questionseverything]

77. honestly i have wondered if that wasn't the plan,pretty sure that accounts for the high suicide rate

who the heck would think that people would have 30 plus percent of their income available for medical?

certainly no "regular person"

it would be one thing if we had known our whole lives, when you hit a certain age you got to pay triple..it wouldn't be fair but at least we could of tried to plan for it

[cstanleytech]

80. Nonsense, just about any program including the ACA can be fixed but it would take a Congress

with ethics that isnt beholden to the wealthy to do it.

[one_voice]

49. I'm a huge fan of President Obama..

and I think Obamacare has made some very important strides forward. No preexisting conditions, no lifetime limits, kids can stay on till 26 and more. More people are covered than before.

That being said, it didn't go far and while the cost improved for many it's did become very expensive for far too many.

Friend of mine makes 75,000 a year. They went on the marketplace. Silver plan costs them $900 dollars--they get no subsidies. They called and that was the right amount. The Bronze wasn't much lower, it was just about $800 for the shittiest plan.

That's a mortgage payment.

They made a great analogy--if they went to a bank and tried to get a mortgage for a second home they'd be laughed out of the bank. Their income wouldn't justify it. But they're expected to pay this or pay a penalty. I don't know what they're going to do. They have a car payment and a mortgage.

Some families fall into this 'hole'. I hope whoever is elected addresses it. I also hope that they improve upon what we have for our seniors.

[SHRED]

50. I think the insurance companies planned this to happen

Our representatives are suppose to protect us from abuses from the private sector.
Especially when we are legally bound to buy their product.

[ScreamingMeemie]

55. It gets us in the door (provided we can cover the co-pay for the visit).

That is something over what I had.

[flamingdem]

59. Exacty, I didn't see doctors for years because even paying $360 a month I had a 6500 deductible

So I paid cash usually.

That was horrible. Now with the same company Anthem CA I have cheap copays and low deductible but still have to pay coinsurance. Still it's a tremendous relief to have decent insurance.

[Texasgal]

56. It's not affordable..

But it is a godsend for people like my husband that is critically ill.

We'd never be able to get coverage no matter what the price without Obama Care.

[SHRED]

57. I understand

And thank you.
Best regards to you.

[snot]

63. There's only one PPO left in N. TX

and they have only 3 gynecologists in-network within 50 mis. of the largest city there.

[SHRED]

65. Ugh...where are the priorities?

Oh...that's right...regime change and the war machine getting hungry.

[Umbral18]

70. In a word, NO. I still can't get coverage, the penalty cost go up every year. It's a fucking failure

[Number9Dream]

72. This Jan. my deductible and co-pay doubled

Capital Blue Cross (PA) - Company partially pays for. Our deductible went from $1,500 to $3000. Our copay, for all but GP, went from $30 to $65. I'm not seeing any help from ACA. Hope I can make it to Medicare in a few years. Not holding my breath for national one-payer, though it would have to be better.

[HuckleB]

81. We need single payer, but...

The Affordable Care Act appears to be positively affecting the health of a nation, a new study concludes.
http://www.healthline.com/health-news/obamacare-is-a-success-researchers-say-072815