General Discussion
Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsDid you notice you didn't have to pay a copay for your annual exams the last 2 years?
That's part of the ObamaCare Act.
Zavulon
(5,639 posts)WorseBeforeBetter
(11,441 posts)Zavulon
(5,639 posts)get it back, and I can apply it to the fines I'll have to pay for not buying their services now that I've been told in no uncertain terms that I will lose my employer-sponsored coverage by the end of the year.
I'd like to know about these fines, seeing as how there's no provision in the law for actually COLLECTING these fines.
Why is your employer ending health care coverage??
Sirveri
(4,517 posts)So I'm pretty sure they'll figure out a way to do it.
NNN0LHI
(67,190 posts)Posted on March 30, 2010 , Updated on Feb. 22, 2011
: Will the IRS hire 16,500 new agents to enforce the health care law?
A: No. The law requires the IRS mostly to hand out tax credits, not collect penalties. The claim of 16,500 new agents stems from a partisan analysis based on guesswork and false assumptions, and compounded by outright misrepresentation.
Hello,
Id like to request a fact check on Ron Pauls claim regarding the enforcement of the health insurance mandate, "16,500 ARMED bureaucrats coming to make this program work." at 3:53 of this video:
I did a google search for "16,500" and there were a lot of hits on conservative websites stating something along the lines that the health care bill sets aside $10 billion for the IRS to hire up to 16,500 agents to enforce the mandate, but ARMED agents are another matter. Anyway, I couldnt find anything about this from the national news outlets, so Im just curious if this is just a scare tactic.
FULL ANSWER
This wildly inaccurate claim started as an inflated, partisan assertion that 16,500 new IRS employees might be required to administer the new law. That devolved quickly into a claim, made by some Republican lawmakers, that 16,500 IRS "agents" would be required. Republican Rep. Ron Paul of Texas even claimed in a televised interview that all 16,500 would be carrying guns. None of those claims is true.
The IRS main job under the new law isnt to enforce penalties. Its first task is to inform many small-business owners of a new tax credit that the new law grants them starting this year which will pay up to 35 percent of the employers contribution toward their workers health insurance. And in 2014 the IRS will also be administering additional subsidies in the form of refundable tax credits to help millions of low- and middle-income individuals buy health insurance.
cliffordu
(30,994 posts)Some folks could use a little LESS transparency.
Sirveri
(4,517 posts)I didn't bother to look up their claims as I was skimming the thread at the time.
But that's good info to have so thank you for providing it.
Zavulon
(5,639 posts)A LOT cheaper. Even paying the fine he'll come out ahead a little over two grand per year on every employee. Not a cent of those savings is going to any of us, either, so unless I find another job I'm going to be uninsured. I barely make ends meet as it is, certainly can't afford my own policy and for that matter a $695 fine will be crushing enough as it is. The only way I can scrape up $58 a month to pay the fine is to eat nothing but Ramen. As such, I'm sorry to say I'm not one of those who is applauding yesterday's decision and I'm really getting upset reading the posts about how this will benefit EVERY American. I know a lot of people WILL benefit, but I'm screwed.
LiberalFighter
(51,092 posts)First, that $695 doesn't go into effect until 2016. The first year the tax penalty is only $95 the first year.
If someone has difficulty allocating $58 a month for this then more than likely they are exempt from the tax.
cliffordu
(30,994 posts)I don't think that provision exists.
Honeycombe8
(37,648 posts)It's a good thing to know that you're dealing with a co. that breaks the law. That is no co. to do business with, and certainly no company on which you can rest the security of getting health care, should you get cancer.
You need to turn them in to your state's insurance commissioner, AND send an e-mail reporting them to any Democratic federal representative you have, AND send an e-mail to the White House so hopefully they can tell you who exactly you need to notify.
Zavulon
(5,639 posts)When I was charged my co-pay I asked when the co-pays were going to stop, and the receptionist who collected it said "That doesn't apply to us" followed by some line she was obviously told to recite when questioned.
I'm going to follow your advice. Sadly, those two co-pays, minimal as they were, would make a big difference. Thanks for your post, I really appreciate it.
LiberalFighter
(51,092 posts)to keep track of what they pay in copays and deductibles. That way they know when it is met. You can't trust the office people in a doctors office to get it right. Especially when they deal with many many many different insurance plans.
Honeycombe8
(37,648 posts)It would be a "well exam," a checkup, by a PRIMARY physician (not a specialist). That would be an internal med. dr. or a GP (POSSIBLY a gyn, but I'm not sure about that....I think I didn't have to pay a copay for my annual gyn well exam last year).
It doesn't apply to that lab bill we always get in the mail later. It's only the copay at the dr.'s office (or mammogram facility).
Here's the article. NOTE THAT IF THE DR INSISTS ON A COPAY BUT THE PATIENT SHOULDN'T HAVE TO PAY IT, THE PATIENT CAN REQUEST A REIMBURSEMENT/REFUND, but I'm not sure from whom. I think it's discussed in the following article.
I'm guessing that dr. soon won't be able to get away with that. Once a dr. charged me a $50 copay, when it should've been $25. When I got the statement of benefits from the ins. co., it showed the copay as $25, not $50. I called the ins. co., and they said they can't do anything about that. They said I shouldn't have paid the $50! Like I had a choice.
http://www.wbur.org/2011/11/28/free-preventive-care
When Is Preventive Care Free And When Do You Pay?
By Martha Bebinger November 28, 2011
BOSTON The still-relatively new federal health care law makes dozens of preventive tests free for patients. Doctors or hospitals are not supposed to charge patients for annual check-ups, most screening tests and a dozen other services such as tobacco cessation. This provision began taking effect more than a year ago, but there is still confusion about how it works.
Arelis Gomes, an outreach coordinator at Health Care for All, spends her days deciphering and explaining the Affordable Care Act, or ACA. For more than a year now shes been telling consumers that they will no longer have to pay anything for preventive care.
Arelis Gomes points out the free preventive care information in her Health Care for All brochure. (Martha Bebinger/WBUR)
So, when Gomes arrived at her doctors office a few weeks ago for her annual check-up, she was surprised when the receptionist asked her for a co-pay.
And I said, Actually I know for a fact that under the ACA we do not have to pay a co-pay for this visit because its a preventative visit, Gomes remembers telling the receptionist. And she said No, Im not aware of that and were not allowed to take you in today for this visit if you dont pay the co-pay.
After a frustrating back and forth, with her husband looking on, Gomes paid the co-pay.
Gomes appealed the payment with her insurer and expects to receive a rebate. As Gomes shares her story to friends and audiences, she says many people dont know they are not supposed to be charged for preventive care.
Among people who do know, there is still confusion about what is free and what is not. If you go in for an annual check-up the visit wont cost you anything but you will still have a charge for the lab work your doctor orders. And some tests may start off as a preventive screening, but then switch to a diagnostic test if a doctors finds a problem.
Take, for example, a colonoscopy. It will not cost you anything unless the doctor finds a polyp, which happens fairly often. If the doctor does find a polyp while you are lying there on the table, the test is no longer a preventive screening, its a procedure and there will be a charge.
Jill Madigan, a self-employed 57-year-old, found this out during a call to her insurer.
I said, If they bill it as routine and they find polyps, are you going to say its not routine? Madigan asked the insurance representative. And she said yes.
Some patients would just get a bill for the co-payment. But if Madigans preventive colonoscopy becomes a surgical procedure to remove polyps, shed be expected to pay the full charge about $1,500, because she has a deductible.
So is she thinking about skipping the test?
Well, yeah, Ive been thinking about it, Madigan said. The likelihood is that I probably will have the test. Im not sure Im willing to take that risk with my life and yet, the whole system is messed up.
Messed up, Madigan says, because if she declined the test but eventually needed colon surgery, it would cost much more than a colonoscopy.
Now, to be clear, before the health care law was passed, Madigan would have had to pay for the test whether it was preventive or not. But she and other patients are upset by what now feels like a bait and switch.
The option of free, preventive care is coming at a time when more and more patients have deductibles or rising co-payments.
Dr. Tom Hines, president of the Massachusetts Academy of Family Physicians, mentions the example of a woman coming in for a pap smear. If that test shows something abnormal it triggers the need for a more specialized test.
Its not an uncommon situation for a patient to delay that follow-up appointment, Hines said. If you unearth something, its important to follow up on the problem thats been unearthed.
Supporters of the law say its important not to overlook the benefits of encouraging patients to get preventive care. Employers and insurers still pay for the visits and tests, they just dont pass along any costs to the patient.
It is a clear advantage for the employee or retiree as the case may be, said Dolores Mitchell said, who runs the Massachusetts Group Insurance Commission, which covers more than 350,000 retirees, employees and their families. She says the lesson, while there is still confusion about this part of the law, is to ask a lot of questions about what your doctor is prescribing and why.
Its a good thing to be a pushy patient who asks questions, Mitchell said. There are an awful lot of procedures out there that are subject to some difference of opinion about whats preventive. It will take some shakedown time before it all gets resolved.
In the meantime, your insurance company should have a list of procedures considered preventive, for which you wont be charged. Here are the lists for some of the states largest insurers:
Blue Cross Blue Shield
Harvard Pilgrim Health Care
Tufts Health Plan
Ms. Toad
(34,092 posts)Your insurance company should have issued an EOB to you and your doctor, which listed a $0 copay. If you paid your co-pay to your doctor at the time of the visit, the doctor should have refunded it to when s/he received the EOB. (They shouldn't have collected it in the first place...but it has been taking some of them a while to get used to it.)
Honeycombe8
(37,648 posts)care, like annual well exams. For women, that includes an internal med. dr., OR a gyn OR a gp.
I plan on following up on this. Starting next year I'll lose my coverage and will have no choice but to pay the tax, so I need to get every benefit I can out of the ACA. The only upside to this so far is that I had the sense to insist in receipts for my co-pays, something not offered unless you ask for it.
mzmolly
(51,004 posts)You'll be sent a refund if your insurance company didn't spend X amount on care.
Zavulon
(5,639 posts)I'd have gotten it by now. Not trying to be snotty at all, just saying that I did have co-pays despite the promised benefit.
mzmolly
(51,004 posts)Last edited Sun Jul 1, 2012, 07:33 PM - Edit history (1)
out yet. They're not required until the end of the year, if I recall correctly? (On edit, refunds will be mailed in August.)
mzmolly
(51,004 posts)Last edited Sun Jul 1, 2012, 07:34 PM - Edit history (2)
Response.
FWIW, you may be correct in that you will not get a refund. However, according to the AARP, the checks are due out on August 1st.
http://blog.aarp.org/2012/05/02/insurance-refund-the-checks-might-be-in-the-mail/
elehhhhna
(32,076 posts)meaning your empoloyer, if that's how you're insured
mzmolly
(51,004 posts)Last edited Sun Jul 1, 2012, 07:32 PM - Edit history (2)
reports on this. Some reports say what you noted, others suggest a percentage based upon the premium you pay. I defer to Kaiser.
http://www.kff.org/healthreform/8305.cfm
... "The analysis finds that consumers and businesses are expected to receive an estimated $1.3 billion by this August in rebates from health insurers who spent more on administrative expenses and profits than allowed by the ACA. The rebates include $541 million in the large employer market, $377 million in the small business market, and $426 million for those buying insurance on their own. Rebates in the group market will generally be provided to employers, and in some cases be passed on to employees as well.Rebates are expected to go to almost one-third (31%) of consumers in the individual market. Among employers, about one-quarter (28%) of the small group market and 19% of the large group market is projected to receive rebates. The share of consumers in the individual insurance market expected to receive rebates ranges from near zero in several states to as high as 86% in Oklahoma and 92% in Texas. "
Electro
(13 posts)What are you talking about?
Welcome to DU!
Hello to yourself
ETA: I wanted to say hello and introduce myself in the Help and Welcome forum, but it won't allow me to make new posts because I am new. Usually they turn that feature off in the Introduction type forums so that new people can make new threads.
I couldn't find where it says how many posts a new person needs to make in order to post a new thread.
Anyway thanks for the welcome!
gkhouston
(21,642 posts)Ms. Toad
(34,092 posts)Mammogram and gyn exam, for women. Colonoscopy once you reach 50 (but if they find anything, that one turns into treatment and is subject to copays and coinsurance). I don't remember the entire list - but you should receive an EOB which shows a $0 copay. If the doctor collected one and didn't refund it or apply it to a future visit, go have a nice chat with him/her.
Dr Fate
(32,189 posts)nt
tridim
(45,358 posts)I just finished researching individual plans and every single one said annual exams and basic preventative care is "no cost".
Honeycombe8
(37,648 posts)That is the law.
That is NOT an exam to treat or be examined for some problem.
If you have been charged copays, it is the CARE PROVIDER who is illegally charging you, I believe. They are in essence getting money under the table.
Look at your Statement of Benefits from your ins. co. I'm gonna guess they don't credit you for any copay, because they didn't authorize one. If they did, then it was the INSURANCE COMPANY who illegally got that copay.
Now you know. It is the law that PREVENTIVE CARE well exams do not require copays. You should tell the care provider that, next time they try to charge you.
It must be a main treating physician, like an internal med. dr., a gp, and it must be an exam for wellness (as opposed to checking you out for a complaint). That includes mammograms.
That are exceptions for kinds of ins. that don't fall under the ACA, like federal government plans, military insurance, etc. The ACA doesn't apply to those, I believe.
EFerrari
(163,986 posts)EFerrari
(163,986 posts)I guess I should be glad that many DUers don't have any idea what a lot of us go through.
xmas74
(29,676 posts)For a few years I had no insurance, even when offered. (It wasn't affordable.) Even after I could afford it I didn't use it, for fear that the doctor would want to run tests that wouldn't be covered. (Been there, done that, got the t shirt.)
The court decision makes me feel a bit more comfortable about using my insurance. I'm booking an appointment with an ob/gyn for a yearly exam-something I haven't had in a decade.
EFerrari
(163,986 posts)xmas74
(29,676 posts)It is sad it say I'm a bit excited about it? I haven't had one in years and the thought of one makes me actually feel human, like I deserve that type of care, compared to the days of when I couldn't afford it and was made to feel like pond scum.
Maybe that's just me being silly.
EFerrari
(163,986 posts)freshwest
(53,661 posts)Ian David
(69,059 posts)southernyankeebelle
(11,304 posts)tricare and I pay either $25.00 for a specialist or $12.00 for my primary doctor. I love my Tricare and I wish the whole country could get this program. My poor son has terrible health insurance paying over $400 a month for his family of 4. The care is terrible. What he pays in a month I and my husband pay in a year. Before long I will be on Tricare for Life and Medicare. I will be happy.
kestrel91316
(51,666 posts)I'd have to pay $400+ a month just for myself here, but I can't afford it. Plus those stupid deductibles and copays if you actually make the mistake of getting sick or hurt.
southernyankeebelle
(11,304 posts)insurance isn't great for a family of 4. I don't know your situation but I think yours is terrible high also. But it's just me and my husband. Come Jan I go on Medicare and I will change to Tricare for Life which will bring my husbands costs down for Tricare. Tricare for Life will be my sublement to medicare. Again both are government benefits.
GObamaGO
(665 posts)The monthly bill to maintain their insurance for a family of 3 was $1800 a month.
southernyankeebelle
(11,304 posts)GObamaGO
(665 posts)Honeycombe8
(37,648 posts)cheap, by comparison to what I can get.
NickB79
(19,270 posts)$10 copays on prescriptions and doctor's visits (even urgent-care if the kid is sick in the middle of the night), no deductible, two free dental cleanings a year, eyeglasses are 50% covered, and it applies to the entire family. I could have 10 kids and they'd still be covered for the same $225/mo. My wife's entire pregnancy cost us a whopping $500, from the first sonogram to us walking out of the hospital with our new baby girl. Even the $300 breast pump was covered as reimbursable.
People really don't know what they've lost now that unions are dying out. It's a shame how people get screwed in this country when it comes to affordable health care when they don't have the power of a union to back them up against the overwhelming force of the health insurance industry.
Ms. Toad
(34,092 posts)plus a few other visits (mammogram and gyn, for example) which are considered preventative care. Your EOB should show a $0 co-pay, and you should go ask your doc for a refund for any of these $0 co-pay visits for which you paid him/her.
southernyankeebelle
(11,304 posts)stood.
Honeycombe8
(37,648 posts)to a PRIMARY DR. (an internal med. dr., or gp) for a general checkup for wellness. It includes an annual mammagram for women over a certain age (which is no copay, also).
$12 is a very cheap copay, but it is the law of the land that preventive care well exams have no copay now.
Unless your ins. falls under the kind that the ACA doesn't apply to at all (federal govt healthcare plans, military, etc.).
Consider that your son is paying for twice as many people as you and your husband, so it would be more, wouldn't it? Also consider that his plan includes coverage for children, who get sick and injured a lot. Measles, mumps, chicken pox, broken arm, etc.
sammytko
(2,480 posts)And didn't pay for my mamogram this year.
southernyankeebelle
(11,304 posts)Of course I will love Tricare for Life in January better.
SoutherDem
(2,307 posts)not something they had to do.
DURHAM D
(32,611 posts)seabeyond
(110,159 posts)xmas74
(29,676 posts)I thought the no cost preventative didn't start until another year or so.
seabeyond
(110,159 posts)xmas74
(29,676 posts)I remember having them for years and then, out of nowhere, not being able to afford them anymore, even with insurance. One year, my ob/gyn annual cost me nearly $400, according to the bill that was sent to my home. Not much was done-simple breast exam, pelvic, pap, a bit of blood work and my Depo shot. My insurance (I believe it was Coventry at the time) refused to cover any of it, since I hadn't met my deductable.
seabeyond
(110,159 posts)seabeyond
(110,159 posts)goes toward our deductable of 15k a year, lol.
LOVE my fuckin not really insurance.
intheflow
(28,504 posts)Eye care and dental. Actually had a DUer tell me once that those weren't "real" medical issues. Even though without my glasses I'm legally blind and would not be able to get to work or do the work that I do. But it's not real!
seabeyond
(110,159 posts)both my boys have really poor site. i have learned more about eyes and the HUGE issue it is. my youngest got an ulcer in one eye, could have blinded him and was a big deal. a scary deal. prior to kids with issues, i might have shrugged it off, too.
and dental is very much a health issue.
xmas74
(29,676 posts)I have EyeMed through work and my exam is covered, every twelve months. My dental, Metlife Dental, covers our preventative quite nicely.
I have decent insurance but my hope is that everyone else will have decent insurance too. I don't think it should make a difference about where (or if) you work or how much money you make-you should have the right to low cost (or free) preventative health care.
seabeyond
(110,159 posts)seabeyond
(110,159 posts)whatchu talking about.
i dont think i have ad an annual exam in the last two years, but kids have
SickOfTheOnePct
(7,290 posts)Zorra
(27,670 posts)Seriously. What annual exams are we talking about?
Our little company's insurance provider has not only jacked or stopped paying the copay on preventative checkups until after we've met the ridiculous deductible, they no longer cover some of them at all.
And that's after jacking our rates almost 40% over last year.
We're paying way more and getting way less for our money, and that was the best "deal" we could find anywhere.
Ms. Toad
(34,092 posts)your mammogram, gyn exam, colonoscopy (there is a list). Your EOB should show $0 for those visits, and your doc should refund anything you paid for them.
I found problems with my PCP annual checkup and vision screening billings, and they are the only preventive services I've had performed since our policy change went into effect.
You're correct, some basic preventive services such as the ones you listed are no charge.
Looks like August will be preventive checkup month for me.
kestrel91316
(51,666 posts)from before that part took effect, you are screwed.
It's one of the reasons it's not a perfect law.
ProSense
(116,464 posts)"IIRC this only applies to NEW policies. If you have an old pre-ObamaCares policy"
...if you change policies during an open-enrollment period.
When the exchanges are up and running, more people will benefit.
<...>
- If you're employed, and insured, you'll probably lose the free preventative care services you've enjoyed since last year. Some 54 million people took advantage of the physical exams, cancer screenings, flu shots, child immunizations, etc. that the law provides for, with no co-pay.
kestrel91316
(51,666 posts)and you can't drop an old policy because no company will write you a new one.
In 18 months that will change, of course. But people are stuck with bad policies until then.
Electro
(13 posts)I thought the pre-existing thing would be immediate...?
kestrel91316
(51,666 posts)You rally do need to read up on the law. The website is very easy to understand.
http://www.healthcare.gov/
Timeline page: http://www.healthcare.gov/law/timeline/index.html
intheflow
(28,504 posts)For instance, the cost estimator asks me my gender, age, and location, but not my income, so it quoted me a base rate of more than I make in month for a private insurance option, and no numbers at all for any of the other options. So I still don't have any idea what I'll be expected to shell out.
kestrel91316
(51,666 posts)and I was very happy to see that at my current pathetic income (self-employed and struggling in this recession) my premiums will be under $600/YEAR and copays/deductibles limited to 6% of the actual cost of care.
I wish I could find the link for you but OF COURSE I DID NOT SAVE IT, rofl.
Ms. Toad
(34,092 posts)but you have to be willing to be without insurance for 6 months.
There are PCIP plans for people with pre-existing conditions who cannot obtain health insurance. The premiums range from around $90 to around $600 a month (depending on age and geography). Most have a substantial deductible. But that premium is dirt cheap for anyone with pre-existing conditions.
If I had overpriced insurance (because it was the only thing I could get) I would consider getting 3 months worth of drugs, and any medical care I could predict, the day before I terminated my policy. Live off the drugs for 3 months, purchase the next 3 months worth out of pocket, then buy into the PCIP plan for my state. (And hope I didn't have a medical disaster during those 6 months.)
My daughter's out of pocket drug costs for 3 months come to around $2500 - so as long as I could save that much in premiums in a reasonable period of time under the new plan it would be a pretty easy decision. (With our current plan, if we were paying the premiums rather than work, it would take about 2 months to recover the out of cost drug costs in premium savings. Pretty much a no brainer.)
kestrel91316
(51,666 posts)I'd just go ahead and buy regular insurance.
frazzled
(18,402 posts)Many insurers are going ahead and implementing this aspect of the law even before it becomes mandatory for them in 2014.
Ms. Toad
(34,092 posts)and our pre-3/23/2010 plan granted us those rights in the first new plan year after enactment (which is how I read the plan at the time it was written). I'll have to go back and re-read it - my impression was that employment related plans were treated as new on the plan anniversary. Ours certainly was. But, I may be wrong as to whether that is requried.
Honeycombe8
(37,648 posts)the way ins. works is that when it is renewed every year, it is a new policy, I think. Ins. cos. are constantly updating the provisions, etc., which in essence makes a policy new.
But whatever the case, I think the law applies to existing insurance, even if you initially signed up with that ins. company years ago.
madrchsod
(58,162 posts)Matariki
(18,775 posts)My doctor is "out of network". I want single payer health care. Not blood-sucking parasitic insurance companies skimming cash from every patient/doctor transaction.
Honeycombe8
(37,648 posts)for preventive well exams.
We all want single payer. But you are glad for the millions of people that this ACA will help, I'm sure. The people who won't be kicked off their plans because they got sick (like my mother was), the people who are assured they won't hit a cap when being treating for cancer, the people who will be able to get insurance even though they have a pre-existing condition, the people who will be able to shop more easily for insurance plans.
I'm sure you're glad for others, even though you aren't aware yet of how the ACA helps you out.
Nye Bevan
(25,406 posts)Thank you Mr President.
frazzled
(18,402 posts)Mr. Frazzled and I had to go in for physicals this spring, and when we went to the desk after to find out our copays, the young woman said there would be none ... that insurance companies were already complying. Yay (except for having to go get the physical in the first place: we only needed new prescriptions, which had run out; and every time I go my doctor gives me a 10-minute harangue about getting a colonoscopy.)
RB TexLa
(17,003 posts)my HSA so I just paid out of pocket.
proud2BlibKansan
(96,793 posts)tammywammy
(26,582 posts)dflprincess
(28,082 posts)you need.
And, from personal experience, I can tell you that it can cost nearly $7,000 to find out the spot on the mammogram is benign. Lucky for me I had really good insurance at the time and only had to come up with $500 or so. If I had had the craptacular high out of pocket ("consumer driven" policy I had last year, I would have been on the hook for $5,950 of that bill (that was the maximum the law allowed for out of pockets on high deductible plans- but that limit goes up annually).
With more people getting stuck with high out of pockets there will more people skipping the "free" tests.
glowing
(12,233 posts)Ms. Toad
(34,092 posts)I thought all employment based plans, but I have to double check that.
glowing
(12,233 posts)a co-pay.. and that is a normal "well-ness" check up I thought.
Ms. Toad
(34,092 posts)The requirement is federal, so states can't exempt themselves from it. But plans existing before 3/23/2010 are apparently grandfathered in. If your plan started after that date, it is apparently exempt.
I understood that employer plans were treated as new as of the anniversary of the plan - I've was on the same plan since 2005-ish, and as of November (our plan anniversary) our co-pays for preventative care were zero. Apparently the grandfathering for some things is in the "we won't take away your plan if you have one you like" part of the bill. Nice. I need to actually look at the law, since the summary I looked at had the language about the plan year & a note about the grandfathering.
Honeycombe8
(37,648 posts)the copays.
There are some plans that the ACA doesn't apply to at all, of course. Military, govt. plans, etc.
Skittles
(153,193 posts)maryellen99
(3,789 posts)I had to pay the co-pay for my physical($20), I didn't have to pay anything for my pap smear and mammogram. I had to pay a co pay for my colonoscopy because if they to take a biopsy, ACA doesn't cover it.
Ms. Toad
(34,092 posts)If they find something during the exam they need to biopsy, it becomes a treating rather than screening event. Somehow I don't thinks "gotcha" bills was part of the plan - but that is how the insurance companies are treating it.
maryellen99
(3,789 posts)Because I was having gastro/Colon issues and U of M called me about it 2 weeks ahead of time.
Honeycombe8
(37,648 posts)found. If they had to do a biopsy, that means they found something, and the colonoscopy becomes not a preventive well exam or test, but a treatment procedure, or something like that.
Check out http://www.wbur.org/2011/11/28/free-preventive-care where that is explained.
WinkyDink
(51,311 posts)Honeycombe8
(37,648 posts)WinkyDink
(51,311 posts)Honeycombe8
(37,648 posts)At least that's my understanding.
AngryOldDem
(14,061 posts)But that said, I can't remember the last time I got a bill for my yearly mammograms.
Honeycombe8
(37,648 posts)by a primary provider.
If they find a problem, or if you make complaints that the dr. checks out, then that may turn the exam into a treatment exam, not a wellness exam.
You can apply to the ins. co. for a refund of any copay you had to pay for a preventive well exam by a primary care provider. (this doesn't apply to lab work, as usual)
That is the law.
flamingdem
(39,324 posts)That's important to those who have paid last year for instance
JNelson6563
(28,151 posts)When you're poor in America you go to the doctor if you can;t stop the bleeding and that's about it. Oh and may the gods help you if it's a dental problem. Then you are even more well & truly fucked.
Julie
MadrasT
(7,237 posts)When the premium has gone up much more than what the copay used to be.
Paying 600 dollars more per year to get "free" annual exams is not a great trade.
Proud Liberal Dem
(24,437 posts)but its nice not having to pay for the exam!
Dr Fate
(32,189 posts)nt
undeterred
(34,658 posts)I pay full price.
cbdo2007
(9,213 posts)for some pain she was feeling back there. We just got the eobs yesterday and.....no copay!! We were expecting $100 and didn't know if it would be covered as a preventative service or not since she's not over 50. Thanks President Obama!!!
Xyzse
(8,217 posts)My co-pay went down mysteriously for meds and check ups.
intheflow
(28,504 posts)and could afford a yearly exam. Seriously, this is one smug, out-of-touch OP.
Dr Fate
(32,189 posts)nt
budkin
(6,716 posts)I'd like a refund too.