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In reply to the discussion: The Mandated "Bronze" Policy on The Exchange will only cover 60% of the actual Health Care Cost? [View all]B2G
(9,766 posts)13. Read this, It ain't gonna be cheap.
http://www.acscan.org/pdf/healthcare/implementation/background/PlanLevelsStandardizationofCoverage.pdf
Example:
Juan is a 23 year old waiter with diabetes who makes $21,000 per year. He enrolls in the
lowest-cost silver plan he can find. His annual premium is $3500, but because of his income,
the government pays $2635 of that (he pays $865). Unfortunately, shortly after he signs up for
his new plan, he needs emergency surgery for a burst appendix. However, because hes eligible
for cost-sharing assistance, his out-of-pocket liability (premiums plus cost-sharing) is capped
at $3840, or 18% of his income.
Examples:
The Peters family of four earns $100,000 a year. Theyre all pretty healthy, so they purchase
a bronze plan because the premiums are relatively low, $700 per month. However, in April
their son Carl is diagnosed with a rare form of leukemia that requires aggressive treatment
and hospitalization. The bronze plan requires a deductible of $7500, as well as co-insurance
on cancer drugs of 20%. During the course of the year the Peters exhaust their deductible and
reach the out-of-pocket limit ($11,900) imposed by the law. Over the course of the year, the
Peters spend $20,300 on premiums, deductibles and other out-of-pocket costs over 20% of
their income. [Note: each plan is required to offer an annual open enrollment period, so the
Peters can, later in the year, move to a more comprehensive plan].
Sarah is a 35 year-old engineer who makes $75,000 as an independent contractor. Shes a
breast cancer survivor and signs up for a platinum plan in the exchange. Her annual premiums
are $8000, but there is no deductible and co-payments are low. During the course of the year
her breast cancer returns, requiring immediate treatment. She has numerous doctor visits,
surgery, and must start chemotherapy. Her cumulative copayments reach $500. In total she
spends $8500 on premiums and other cost-sharing combined, or 11% of her income.
Example:
Juan is a 23 year old waiter with diabetes who makes $21,000 per year. He enrolls in the
lowest-cost silver plan he can find. His annual premium is $3500, but because of his income,
the government pays $2635 of that (he pays $865). Unfortunately, shortly after he signs up for
his new plan, he needs emergency surgery for a burst appendix. However, because hes eligible
for cost-sharing assistance, his out-of-pocket liability (premiums plus cost-sharing) is capped
at $3840, or 18% of his income.
Examples:
The Peters family of four earns $100,000 a year. Theyre all pretty healthy, so they purchase
a bronze plan because the premiums are relatively low, $700 per month. However, in April
their son Carl is diagnosed with a rare form of leukemia that requires aggressive treatment
and hospitalization. The bronze plan requires a deductible of $7500, as well as co-insurance
on cancer drugs of 20%. During the course of the year the Peters exhaust their deductible and
reach the out-of-pocket limit ($11,900) imposed by the law. Over the course of the year, the
Peters spend $20,300 on premiums, deductibles and other out-of-pocket costs over 20% of
their income. [Note: each plan is required to offer an annual open enrollment period, so the
Peters can, later in the year, move to a more comprehensive plan].
Sarah is a 35 year-old engineer who makes $75,000 as an independent contractor. Shes a
breast cancer survivor and signs up for a platinum plan in the exchange. Her annual premiums
are $8000, but there is no deductible and co-payments are low. During the course of the year
her breast cancer returns, requiring immediate treatment. She has numerous doctor visits,
surgery, and must start chemotherapy. Her cumulative copayments reach $500. In total she
spends $8500 on premiums and other cost-sharing combined, or 11% of her income.
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The Mandated "Bronze" Policy on The Exchange will only cover 60% of the actual Health Care Cost? [View all]
bvar22
Nov 2012
OP
Bvar's quote is very similar to the Kaiser Family Foundation release on this
riderinthestorm
Nov 2012
#14
Have you ever had insurance? There's a lot of confusion about how health insurance works.
Politicub
Nov 2012
#68
it will shake out to benefit the insurance companies who wrote this legislation lol nt
msongs
Nov 2012
#7
A poor person with subsidized coverage is better able to afford primary care.
lumberjack_jeff
Nov 2012
#75
Wow! Its a first - usually you are all about educating us about Obama's positions and policies
riderinthestorm
Nov 2012
#24
"Since you seemed very plugged in to this Admin, I'd be grateful for help in sorting this out. "
ProSense
Nov 2012
#29
Tried. Can't find it. So you won't help us out here with a table or graph?
riderinthestorm
Nov 2012
#32
Gee, you were all over THIS thread and many others today with LOTS of helpful links
riderinthestorm
Nov 2012
#48
Here's an apparently thorough exploration from U.S. News and World Report
Small Accumulates
Nov 2012
#52
Reccing not only for critical info about the ongoing screwing of the masses through faux "reform,"
woo me with science
Nov 2012
#60
Considering my monthly premium would be about $350 (after the tax credit)...
WorseBeforeBetter
Nov 2012
#83
And Republican-controlled North Carolina wants to reduce unemployment benefits...
WorseBeforeBetter
Nov 2012
#99
I hate all this stuff there should just be one awesome health care for all
limpyhobbler
Nov 2012
#84
That covers "Premiums" paid to the Insurance Companies for the mandated policies on The Exchange.
bvar22
Nov 2012
#112
I don't see how anyone can be happy for people who can't afford decent insurance
OneTenthofOnePercent
Nov 2012
#113
Unfortunately the ACA was written assuming you'd be covered by Medicaid. If a state doesn't opt in
PoliticAverse
Nov 2012
#131
Gee, if only someone had, what do you call it, predicted this way back then.
Egalitarian Thug
Nov 2012
#132
this health care plan is such a hodge-podge, no doubt because of horse-dealing in its passage.
HiPointDem
Nov 2012
#135