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Can anyone explain how Obamacare will change things for our family (self-employed, OOP payments)


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#1 Halcyon

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Posted 25 November 2012 - 08:24 AM

Please, I don't want this to become a political thread. I am just trying to figure out how things will change for my family. DH is self-employed, no employees just works for himself. We pay about $1100 a month for pretty much catastrophic coverage. Very high deductible ($2500 a person and $7500 as a family) which we have never hit. It is very difficult for us to pay this.

Does anyone know how Obamacare might change things for us? Does one have to be uninsured to benefit? Should we 'go off' insurance (maybe to a faith based insurance) now so we can be covered under Obamacare? Will prices vary from state to state? (we're in Florida).

If anyone knows the answer to these questions, or perhaps a site that explains things better, I would appreciate it.

#2 XT578

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Posted 25 November 2012 - 08:52 AM

I can't help you because I am in the same boat! But I am so glad you asked this! I have been wondering this too. This is really close to the coverage we have now. Our premiums are higher. (One of our children has a medical condition that is currently without symptoms or issues. It could be like this his whole life, or it could require surgery and medical intervention. All we do now is a check up with a specialist and some tests twice a year.)

It's killing us. We are considering dropping insurance altogether because we just can't afford the premium which is higher than our mortgage! For the last several years, we have had to give up something to pay our premiums.
The first couple years it was easier to give up things - cable, gym membership, extra activities, but then we reached the point where we had to cut out retirement investing and other necessary things. This year not only can we not put money into savings, but we are taking it out each month to cover the short fall. There is nothing extra in the budget to cut anymore. We can't keep up much longer like this. Sorry to highjack, but I will be watching this thread with a great deal of interest!

We are looking into one of the faith based ones, but it's a little scary. We don't understand all the changes.

#3 Michelle in AL

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Posted 25 November 2012 - 09:24 AM

Here's something from the NYTimes:

If Mr. Obama is re-elected, he would step up efforts to carry out the health care law. Given the controversy over the law and the logistical challenge of setting up state insurance “exchanges” where people can shop for coverage, the transition will probably be rocky. But many doctors, hospitals and insurance companies are determined to make it work.
On Jan. 1, 2014, the requirement that most Americans have medical coverage takes effect. Private health plans will start enrolling people in October 2013. The result, according to the Congressional Budget Office, is that 30 million uninsured people will eventually gain coverage. To help them afford it, the federal government would subsidize private insurance premiums for people with incomes up to four times the federal poverty level ($92,200 for a family of four). And it would expand Medicaid to cover more poor people, including many adults without children.

From what I understand, starting in late 2013, each state will have one web site that comsumers can use to compare insurance policies. Insurance may be available across state lines too. It is hoped that this will make prices more competitive and give consumers more choices.

#4 sparrow

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Posted 25 November 2012 - 09:31 AM

:lurk5: We're in the same situation.


Here's something from the NYTimes:

If Mr. Obama is re-elected, he would step up efforts to carry out the health care law. Given the controversy over the law and the logistical challenge of setting up state insurance “exchanges” where people can shop for coverage, the transition will probably be rocky. But many doctors, hospitals and insurance companies are determined to make it work.
On Jan. 1, 2014, the requirement that most Americans have medical coverage takes effect. Private health plans will start enrolling people in October 2013. The result, according to the Congressional Budget Office, is that 30 million uninsured people will eventually gain coverage. To help them afford it, the federal government would subsidize private insurance premiums for people with incomes up to four times the federal poverty level ($92,200 for a family of four). And it would expand Medicaid to cover more poor people, including many adults without children.

From what I understand, starting in late 2013, each state will have one web site that comsumers can use to compare insurance policies. Insurance may be available across state lines too. It is hoped that this will make prices more competitive and give consumers more choices.


This sounds good. I would love to be able to compare and decide.

#5 TXMary2

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Posted 25 November 2012 - 09:58 AM

What do you mean by "covered under Obamacare?" It isn't insurance. In my family, DH is the only one insured and it is catastrophic only. Premium just for him is now going to be almost $300 a month, so $80 more a month than we are currently paying. He has a $5000 deductible. I fail to see how Obamacare is going to help my family. We don't have insurance, we don't qualify for govt programs (we make too much but not enough to afford insurance - go figure) and if we can't pay for it now we can't pay for it next year. It isn't free and it isn't going to be more affordable from what I can tell. All I hear from friends and family is how their premiums are rising. Sigh. I hope I am wrong, but I don't feel hopeful right now.

#6 transientChris

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Posted 25 November 2012 - 10:09 AM

Catastrophic only plans will not continue. Plans like Samaritan which are not considered insurance are exempt from Obamacare and will continue in the same way. Most states are not setting up the insurance exchanges, Now this will lead to more lawsuits since the way the law is written, if a state doesn't set up an insurance exchange, the feds will do so but they will not be allowed to levy penalties in that state.
In the meantime, since companies don't have to pay a penalty or provide insurance for anyone working less than 29 hours a week, that is what a lot of them will be doing. A community college in Pennsylvania just made all instructors part time to save money.

#7 QueenCath

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Posted 25 November 2012 - 10:10 AM

It means my children will be covered under our insurance until they are 26. One would not have a hard time getting covered on his own. The other has many pre-existing conditions that would have made it impossible without the Affordable Health Care Act (that's the short version name of the bill, not Obamacare). That same child is mildly disabled. Not enough to qualify for disability but enough that he will have a harder time working full time, or even getting his first job. For me, the Affordable Health Care Act brings relief as I no longer have to worry about my children getting health insurance as adults. A huge weight has been lifted off our shoulders.

Part Two: Our premiums, deductibles, etc did NOT go up for next year. Dh's company says it's because of the fact that insurance companies have to use a certain percentage of premiums for payouts so they cannot raise it higher on our plan. This is one of the components of the Affordable Health Care Act.

#8 QueenCath

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Posted 25 November 2012 - 10:14 AM

Most states are not setting up the insurance exchanges, Now this will lead to more lawsuits since the way the law is written, if a state doesn't set up an insurance exchange, the feds will do so but they will not be allowed to levy penalties in that state.


That remains to be seen. 21 are setting up exchanges. A few are doing joint partnerships. A few have exercised the right to delay the decision to mid-December.

#9 Lisbeth

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Posted 25 November 2012 - 10:31 AM

I need to read more to be extremely clear. But the individual mandate was upheld by the supreme court, right? That means the self-employed will be REQUIRED to carry self insurance. Right? Unless you don't meet a certain income level. Say you are choosing not to self insure now, or going with a very minimal plan...in 2014 you will not be allowed to do that unless you want to pay the "tax penalty." And the tax penalty increases every year, and with inflation also. I think it starts out around $95 and shoots up to $695 in 2 or 3 years, and goes up based on inflation from there.

Also, I remember hearing that the individual mandate makes you purchase a certain amount of comprehensive coverage not just catastrophic. Not sure if that is still true.

#10 dancer67

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Posted 25 November 2012 - 10:41 AM

  • If anyone here lives in MA, is Ocare going to be similar to what we have here? We are self employed and Romney put in a health care bill to make insurance affordable for all. I think for a family of 3, you can make up to $57,000 a year and you qualify for state insurance(not welfare). You pay a premium based on your income. The highest we would pay would be $77.00/mo for me and $77.00/mo for my husband, and my youngest daughter gets health insurance automatically for free. No premium. It is not catastrophic insurance. I have $10.00 co pays at primary Dr's, and $18.00 co pay for specialist. $10.00 co-pay for prescription coverage. My daughter has no co-pays at all. I do not need a referral as long as it is in network. We are slef employed and went without insurance for a long time until Romey put this in. If you do not have insurance in MA, you are penalized on your tax return.
  • If you make to much money,you can get private health insurance(BCBS, Health New England) which is very pricey, but the state will help pay your premiums.
  • I wonder if this is what Ocare is doing?(for all states)


#11 Juniper

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Posted 25 November 2012 - 10:52 AM

We are in the same boat and I am completely unsure what to do. I wish there was better information out there on how this is all going to come together (or someone who can put it into very simplified terms for me ;) ).

At this point it sounds like the penalties are a much cheaper route for me to go. I we choose to drop our insurance this year, what happens to us in the future?

#12 Lea in OK

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Posted 25 November 2012 - 10:55 AM

From what I understand, starting in late 2013, each state will have one web site that comsumers can use to compare insurance policies. Insurance may be available across state lines too. It is hoped that this will make prices more competitive and give consumers more choices.


I hope this is true. There is so much confusion and speculation out there that it is hard to know what is true. I heard that the state exchanges would only have one plan and I don't think insurance will be made available across state lines, from what I have heard. That has always been a big controversial position, with one side wanting to make it available across state lines and the other not so much, from what I understand.

We are self-insured also. I have heard/read that, if you already have insurance, this won't affect you much. But then I keep reading about insurance prices going up and companies cutting the number of employees or cutting employees hours so they are part-time to avoid having to provide insurance for them because they can't afford to provide what Obamacare says they must.. So, by the time we really see this implemented, there will likely be a lot more people without insurance.

Really, there is so much information flying around, it is hard to know what is true and what is not true and how this is going to affect everyone. It would be nice if some non-partisan group would put together a paper explaining how this is going to affect everyone, in layman's terms.

#13 Lea in OK

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Posted 25 November 2012 - 10:55 AM

double post

#14 Truscifi

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Posted 25 November 2012 - 11:05 AM

  • If anyone here lives in MA, is Ocare going to be similar to what we have here? We are self employed and Romney put in a health care bill to make insurance affordable for all. I think for a family of 3, you can make up to $57,000 a year and you qualify for state insurance(not welfare). You pay a premium based on your income. The highest we would pay would be $77.00/mo for me and $77.00/mo for my husband, and my youngest daughter gets health insurance automatically for free. No premium. It is not catastrophic insurance. I have $10.00 co pays at primary Dr's, and $18.00 co pay for specialist. $10.00 co-pay for prescription coverage. My daughter has no co-pays at all. I do not need a referral as long as it is in network. We are slef employed and went without insurance for a long time until Romey put this in. If you do not have insurance in MA, you are penalized on your tax return.
  • If you make to much money,you can get private health insurance(BCBS, Health New England) which is very pricey, but the state will help pay your premiums.
  • I wonder if this is what Ocare is doing?(for all states)


It is based on the MA model, but I don't know much more about it than that. I'm not sure how much flexibility each state is going to have in setting up the exchanges.

#15 Mrs Mungo

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Posted 25 November 2012 - 11:11 AM

This (government) site gives the full text of the law, an overview of its various pieces and a timeline to explain what will happen when:
http://www.healthcar...full/index.html

#16 Truscifi

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Posted 25 November 2012 - 11:12 AM

I hope this is true. There is so much confusion and speculation out there that it is hard to know what is true. I heard that the state exchanges would only have one plan and I don't think insurance will be made available across state lines, from what I have heard. That has always been a big controversial position, with one side wanting to make it available across state lines and the other not so much, from what I understand.

We are self-insured also. I have heard/read that, if you already have insurance, this won't affect you much. But then I keep reading about insurance prices going up and companies cutting the number of employees or cutting employees hours so they are part-time to avoid having to provide insurance for them because they can't afford to provide what Obamacare says they must.. So, by the time we really see this implemented, there will likely be a lot more people without insurance.

Really, there is so much information flying around, it is hard to know what is true and what is not true and how this is going to affect everyone. It would be nice if some non-partisan group would put together a paper explaining how this is going to affect everyone, in layman's terms.


I keep hearing about companies cutting hours as well, but dh said his company has decided not to do this because it isn't clear yet whether the insurance requirement will be based on individual hours (which every one assumes now) or total man hours. If it is based on total man hours it could actually be cheaper to increase worker hours and have fewer employees.

#17 Truscifi

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Posted 25 November 2012 - 11:13 AM

double post



#18 Juniper

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Posted 25 November 2012 - 11:19 AM

This (government) site gives the full text of the law, an overview of its various pieces and a timeline to explain what will happen when:
http://www.healthcar...full/index.html


I have spent an hour or so on there this morning and quite a bit of time over the last few months. It still is not making sense to me. Ugh! :)

#19 mommymilkies

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Posted 25 November 2012 - 11:22 AM

In the meantime, since companies don't have to pay a penalty or provide insurance for anyone working less than 29 hours a week, that is what a lot of them will be doing. A community college in Pennsylvania just made all instructors part time to save money.

All over the country they've been doing this for awhile. Dh teaches at a CC and has for years. It's so hard to find full time jobs now at them. They've been pushing for part time people because it honestly pays less than minimum wage at many colleges. Dh makes less than if he worked McDonalds to work through the summer teaching. So it's not just to save on insurance. It's also to keep unions away and pay less than a living wage.

#20 butterflymommy

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Posted 25 November 2012 - 11:42 AM

Here's my understanding. A family of four making less than about 92k a year will be eligible for subsidies for plans they select from interstate(?) exchanges. Hopefully these exchanges will allow for competitive pricing. Qualifications for medicaid will be relaxed. I don't know if they will go by family size, say if a family of 8 could make up to 180k a year and qualify. I don't think insurance costs can exceed more than X% (can't remember the number) of income. There will be standards for how much of a insurer's revenue can go to profit VS care. There are obamacare caluclators online that will figure out what you're eligible for. If you are not insured you'll pay a penalty. People with so called cadillac plans through their employers will be taxed on those plans as income.

Employers with above a certain # of employees will pay a tax for every employee insured under the exchanges vs company provided coverage. So while there isn't an outright mandate to provide coverage there is a tax if they do not. I don't think it applies to part time employees so chances are a lot of companies will keep people part time, as has been a trend.

AFAIK women cannot be asked for copays for yearly OB GYN visits (this has already started) and I'm not sure about prenatal care.

So to answer your question: you might be able to find a cheaper plan on the exchange and you might qualify for subsidies, and your total costs should not exceed a certain percentage of your income (I don't know if that is capped at a certain income limit).

Here is a calculator:

http://www.washingto...means-for-you/#

#21 Mimm

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Posted 25 November 2012 - 12:52 PM

My state has repeatedly passed measures to guard against ObamaCare. Will that protect us from having to comply with it?

#22 Wendi

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Posted 25 November 2012 - 12:55 PM

Catastrophic only plans will not continue. Plans like Samaritan which are not considered insurance are exempt from Obamacare and will continue in the same way. Most states are not setting up the insurance exchanges, Now this will lead to more lawsuits since the way the law is written, if a state doesn't set up an insurance exchange, the feds will do so but they will not be allowed to levy penalties in that state.
In the meantime, since companies don't have to pay a penalty or provide insurance for anyone working less than 29 hours a week, that is what a lot of them will be doing. A community college in Pennsylvania just made all instructors part time to save money.


That only works in some cases. If the hours worked by all the part-time employees adds up to the equivalent of 50 full-time (30 hours) employees, the company must provide insurance.

#23 butterflymommy

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Posted 25 November 2012 - 01:12 PM

My state has repeatedly passed measures to guard against ObamaCare. Will that protect us from having to comply with it?


To the best of my understanding, no. The only part the states can opt out of is medicaid expansion. If the state refuses to set up the exchange the fed gov't will do so.

#24 delaney

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Posted 25 November 2012 - 03:07 PM

It means my children will be covered under our insurance until they are 26. One would not have a hard time getting covered on his own. The other has many pre-existing conditions that would have made it impossible without the Affordable Health Care Act (that's the short version name of the bill, not Obamacare). That same child is mildly disabled. Not enough to qualify for disability but enough that he will have a harder time working full time, or even getting his first job. For me, the Affordable Health Care Act brings relief as I no longer have to worry about my children getting health insurance as adults. A huge weight has been lifted off our shoulders.

Part Two: Our premiums, deductibles, etc did NOT go up for next year. Dh's company says it's because of the fact that insurance companies have to use a certain percentage of premiums for payouts so they cannot raise it higher on our plan. This is one of the components of the Affordable Health Care Act.

Yes! and because of that we got a REFUND from our company because they did not meet the percentage! How's that for new? I think if companies are under a certain size they are not effected. All I know is I no longer have $150 in co-pays for well checks. I just used the calculator for our family and nothing should change for us except the benefits we have already received. Will the insurance company raise our rates? Probably but that is out of greed and not the healthcare bill. If we fully understood how well it can work we would be so much better off. Australia has the right idea-truly they do.

#25 QueenCath

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Posted 25 November 2012 - 03:18 PM

Yes! and because of that we got a REFUND from our company because they did not meet the percentage! How's that for new? I think if companies are under a certain size they are not effected. All I know is I no longer have $150 in co-pays for well checks. I just used the calculator for our family and nothing should change for us except the benefits we have already received. Will the insurance company raise our rates? Probably but that is out of greed and not the healthcare bill. If we fully understood how well it can work we would be so much better off. Australia has the right idea-truly they do.


Can they raise the rates? Sure but they still have to pay out a certain percentage in claims or they have to do refunds, which you mention receiving. In the long run, this will keep things stable and eventually bring rates down.

#26 Slartibartfast

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Posted 25 November 2012 - 03:21 PM

Double post

Edited by Sis, 25 November 2012 - 03:23 PM.


#27 Slartibartfast

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Posted 25 November 2012 - 03:22 PM

It means my children will be covered under our insurance until they are 26. One would not have a hard time getting covered on his own. The other has many pre-existing conditions that would have made it impossible without the Affordable Health Care Act (that's the short version name of the bill, not Obamacare). That same child is mildly disabled. Not enough to qualify for disability but enough that he will have a harder time working full time, or even getting his first job. For me, the Affordable Health Care Act brings relief as I no longer have to worry about my children getting health insurance as adults. A huge weight has been lifted off our shoulders.

Part Two: Our premiums, deductibles, etc did NOT go up for next year. Dh's company says it's because of the fact that insurance companies have to use a certain percentage of premiums for payouts so they cannot raise it higher on our plan. This is one of the components of the Affordable Health Care Act.


My son has a congenital heart defect. Now, things are ok now but his condition is progressive and there is a chance he may need a heart transplant in the future, as an adult. (he is four atm)

Before AFA his options would be to

a. Make a ton of money so he can afford a new heart someday, which would exclude most professions
b. Be denied insurance most of his life and likely be refused the expensive procedure because of inability to pay
c. Likely be bankrupt.
d. Likely not need a transplant but still never be able to get insurance. Hope nothing ever happens.

He will always have a preexisting condition.

I like that hospitals will be required to give prices for different tests procedures. If I need an MRI I do want to know how much it is.

My husband's company currently pays 100% of our insurance. They did notify us that increases in insurance costs would be passed onto us but I am ok with that. He works for a great company. They are not changing employee hours, they already offered insurance to all of their full-time employees.

Edited by Sis, 25 November 2012 - 03:39 PM.


#28 EmilyK

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Posted 25 November 2012 - 03:37 PM

My husband and I are considered self-employed, but because we are partners in firms with many employees, we participate in their health care plans.

We pay out of pocket for the full cost similar monthly amounts to the OP, but we have much better coverage, because (I'm told) we are in a large plan. So we have paid $1000-1200 a month for our family of four, but we have $20 to 25 co-pays for doctor visits, good prescription coverage, 80 to 90 percent of hospital visits covered, naturopaths covered, etc.

My understanding is that Obamacare will help erase the differences between those who can participate in a group plan and those who can't, by circumstances of their employment (or not).

#29 TranquilMind

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Posted 25 November 2012 - 05:22 PM

Please, I don't want this to become a political thread. I am just trying to figure out how things will change for my family. DH is self-employed, no employees just works for himself. We pay about $1100 a month for pretty much catastrophic coverage. Very high deductible ($2500 a person and $7500 as a family) which we have never hit. It is very difficult for us to pay this.

Does anyone know how Obamacare might change things for us? Does one have to be uninsured to benefit? Should we 'go off' insurance (maybe to a faith based insurance) now so we can be covered under Obamacare? Will prices vary from state to state? (we're in Florida).

If anyone knows the answer to these questions, or perhaps a site that explains things better, I would appreciate it.

You seem to be unclear on Obamacare. It is not insurance. It is simply a(n unconstitition imo) mandate that YOU purchase insurance, no matter how unaffordable, and no matter how little benefit you actually receive or you will be fined.

Things are so nuts that I read in the paper today that some guy is getting his weekly Testosterone shot covered by his insurance plan, whereas MY crap insurance plan (and spouse is an attorney here - it is hitting all levels of professions/trades) didn't cover a dime on my kid's antibiotic - the one time in five freaking years I needed one for him - so I paid forty dollars cash (and 45 for the appointment at a clinic) after they checked. Nice priorities there. But I don't mind paying for my rare visit and antibiotic, if everyone else would just pay for their own stuff too, so insurance rates would stay reasonable and cover all important stuff, as they always did.

My Mom died in the last decade. She rarely visited a doctor in her last few decades of life. Her month long hospital visit for surgery and other problems - totally covered. Her final week stay - totally covered my Medicare and Medigap.

Do you think any of us will have this? I don't. By sharp contrast, two days after arriving home, I got an immediate $6,000 bill out of pocket for uncovered costs last year when I was in the hospital for the first time since childhood. Many other bills followed, all under the "good" previous insurance we had. Now the company has moved to the cheaper insurance because of this ruling. The same bill today under new coverage would be in excess of $10,000 immediately upon exiting hospital.

So...all those people that are thrilled that the yearly well appointment will be covered by increasing the premiums for everyone (because nothing is free) and are happy about their "free" birth control and OB visits will not be so thrilled when they need coverage for something other than the stuff that used to be cheap, like well visits and common drugs.

I'd much rather pay for my OWN well appointments, drugs, births, ob-gyn stuff - as I always have - and let the insurance really cover the bigger, more important things that we used to be able to turn in. Now we have to carry some stupid credit card around and if you forget, too bad for you. All out of your own pocket. I can't believe people think that being given the relatively inexpensive well care appointments and birth control in exchange for good coverage of the disastrously expensive specialty care is a worthy exchange.

Kids being on the insurance until 26 is not "free" either. One site said that this adds an extra $3400 a year to the policy, and someone is paying this. All of us are paying this. And they will have the same crap coverage too, if something actually happens. Some will argue that it is better than nothing, and maybe that's true. But if you have "access" to a policy you still can't afford, then government subsidies (meaning everyone else pays) kick in so you can purchase your mandated policy. It may or may not be good insurance, and we are all covering the costs that only those to whom they applied used to have to cover. As a woman, I had to have OB-gyn coverage (which I have almost never used, especially since I had home births), but I didn't have to cover things that didn't apply to me. Now we will all shoulder those costs of all these "free" well checks, vaccines, tests, and birth control, whether or not we agree with doing this, ever need this, or want to cover it.

Nice concise blog commentary here:

Take the part that would let kids stay on their parent's health plan until age 26. Despite what the administration thinks, that coverage isn't free.
According to the Department of Health and Human Services, the cost is as much as $3,400 per kid each year.
Insurers just pass that back onto the companies giving their employees benefits. What's the outcome?
Employers stop offering it.
One of the largest union-administered health insurance funds is now dropping dependent coverage for 30,000 employees. That's thousands of children that are losing insurance, all thanks to Obamacare's "expanded coverage."
So maybe the college-age kids should turn to their schools' student health plans, but that's turning into another disaster.
Colleges across the country are giving up their student health plans.
They've calculated the higher levels of coverage required by Obamacare would increase the cost of premiums by as much as a thousand percent.
And students at some Catholic universities are losing all their insurance because the schools have a moral objection to the requirement they offer contraceptive coverage.
Think you can just buy an individual plan for your kid? Think again.
The ban on discriminating against children with pre-existing conditions has been driving insurers out of the market.
Insurers in 20 states have given up offering child-only insurance plans.



How it will help self-insured people: Well, they must get insurance but there is no guarantee that it will be any less expensive than it is now. How is this a benefit?

The gov't will subsidize those who cannot afford to purchase insurance. But remember, the governmental debt is approaching $16,000,000,000,000 (that's16 trillion ). The gov't will now spend money paying for insurance for those who cannot afford it themselves. So where is that money coming from?

The really unfair part is that those who are young and healthy who could get cheap policies (mine was like $200 a year when I was 21 and purchased my first individual policy), will now have to pay a much higher premium in order to support everyone else's premiums, because it will no longer be based on statistical risks. This benefits me, as an older pre-boomer (to the extent that there is any advantage in rising costs at all), but penalizes young, healthy, working adults. Since ever-rising premiums are entirely unaddressed by this law, many of the young and healthy will choose to pay the tax penalty, rather than unaffordable premiums, and the premiums rise even higher for everyone else who is still buying insurance.

The most important part to note is that health care costs are entirely UNCONTAINED by the legislation. Winners: Big Pharma and Medical device companies. Losers: everyone else, except for a few individuals, mainly among the extremely low income (who used to just use the ER anyway...so not necessarily much of a change).

#30 TranquilMind

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Posted 25 November 2012 - 05:24 PM

My husband's company currently pays 100% of our insurance. They did notify us that increases in insurance costs would be passed onto us but I am ok with that. He works for a great company. They are not changing employee hours, they already offered insurance to all of their full-time employees.


You do have awesome insurance. This sort of coverage is not happening for any professionals we know here. Employers are offloading more and more of the costs onto the employees. So income is dropping.

#31 TranquilMind

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Posted 25 November 2012 - 05:25 PM

Can they raise the rates? Sure but they still have to pay out a certain percentage in claims or they have to do refunds, which you mention receiving. In the long run, this will keep things stable and eventually bring rates down.


So...they raise payouts to doctors or hospitals accordingly to stay just under the requirement.

#32 54879525

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Posted 25 November 2012 - 05:33 PM

I honestly don't know. I think some of what has been said here isn't fact, just scare tactics.

I guess my biggest question is while it's great more people will be covered, I wonder if they will be able to afford to use their coverage. Sometimes I feel like we can barely afford to use our coverage. With all of the deductibles, copays, and coinsurance, it still hurts just to go for a basic visit despite paying the premiums every month. And I feel like DH makes decent money. What about someone who doesn't?

And then I wonder how many employers will continue to offer insurance. There will be a penalty, but they might be willing to pay it instead of the more costly insurance. I don't hate the idea of finally having a choice over insurance, but who knows what the choices will be like. At least now I know what I'm getting.

#33 Luckymama

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Posted 25 November 2012 - 05:42 PM

You do have awesome insurance. This sort of coverage is not happening for any professionals we know here. Employers are offloading more and more of the costs onto the employees. So income is dropping.


Not true here----my friends' insurance costs are staying steady for next year. Our insurance, with better coverage (we already had a really good plan), will cost us LESS next year. My husband works for a large international firm. Our friends are attorneys, educators, professors, engineers, research scientists, and upper-level management.

#34 54879525

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Posted 25 November 2012 - 05:46 PM

Our insurance went up $3 per pay period. Not exactly gloom and doom. That's typically the amount it increases.

#35 SJ.

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Posted 25 November 2012 - 05:54 PM

Our insurance went up $3 per pay period. Not exactly gloom and doom. That's typically the amount it increases.


Our insurance is increasing over $100 more per month with higher deductibles and less choice. The plan that was provided was a PPO where I could go to any doctor and receive total coverage (in network) or partial coverage (out of network) to an HMO where our choices are very limited and our deductibles and copays higher.

DH works for a large, profitable company with great benefits but these benefits are slowly diminishing and people are getting laid off. I know our previous health benefits were exceptional but now we are feeling the financial crunch of higher costs. I know I should count our blessings and be happy that dh is employed but it still sucks.

We are an average middle class family living an average life, not wealthy by any means.

Sorry for the sidetracking but I take exception that $3 per pay period is the typical amount out of pocket in increases people will see due to the AHCA.

#36 TranquilMind

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Posted 25 November 2012 - 06:11 PM

Not true here----my friends' insurance costs are staying steady for next year. Our insurance, with better coverage (we already had a really good plan), will cost us LESS next year. My husband works for a large international firm. Our friends are attorneys, educators, professors, engineers, research scientists, and upper-level management.


Time to change jobs for us. This is happening for no one we know...and we know a few.

#37 TranquilMind

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Posted 25 November 2012 - 06:12 PM

Our insurance went up $3 per pay period. Not exactly gloom and doom. That's typically the amount it increases.


This is in no way "typical". How did your deductibles and copays change? Ours went through the roof.

#38 Martha

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Posted 25 November 2012 - 06:14 PM

Holy cow. I went to the calculator thing a pp linked to.

This was the result for an uninsured family of 6 kids and 2 adults and an income of 65k.

Starting in 2014:
You will have the option of buying a health plan through your state's exchange. Based on your income, you probably would not qualify for federal assistance to offset the cost of that plan. Insurers can't discriminate against you for having a pre-existing condition, and can only vary rates within a narrow range.

If you do not obtain insurance coverage by 2014 you will be assessed a tax penalty. The penalty becomes progressively greater from 2014 through 2016, when it reaches full strength. At that point, assuming your current income remains the same and your household consists of 2 uninsured adults and 6 uninsured children, your family would be subject to a penalty of about $3,475. You are exempt from the penalty if the least expensive plan option in your area exceeds eight percent of your income.


Yikes. No assistance for premiums and a penalty. Tho I do think we would meet that 8% of income penalty exception.

So at best Obamacare does nothing to get us insurance and doesn't charge a penalty. At worst Obamacare does nothing to get us insurance AND charges a penalty too.

#39 Martha

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Posted 25 November 2012 - 06:19 PM

Oh and to be clear I have 10 kids but it wouldn't let me go that high. And the income is not accurate either. Bc yk. Flashing income on the net isn't smart. :)

#40 Heather in MD

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Posted 25 November 2012 - 06:20 PM

Edited - TMI

#41 deannajo

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Posted 25 November 2012 - 06:26 PM

Our insurance went up $3 per pay period. Not exactly gloom and doom. That's typically the amount it increases.


That's about what ours went up by as well, but I did notice some small negative changes in coverage/deductibles - nothing too major though.

#42 Laurel

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Posted 25 November 2012 - 06:27 PM

Oh and to be clear I have 10 kids but it wouldn't let me go that high. And the income is not accurate either. Bc yk. Flashing income on the net isn't smart. :)


I understand not wanting to put your family income on the net for all to see. However, the quote you put from the calculator (saying that it was with income of $65k) is SO completely different than what the calculator spits out at that income level, and is incredibly misleading, in essence implying that a family of 8 with an income of 65k would get no assistance with insurance premiums. In truth, this is what the calculator spits out with that info:

You will have the option of buying a health plan through your state's exchange with federal assistance. Based on your income, your annual premiums for that plan would be no more than $2,600 to $4,095. Your maximum out-of-pocket costs for deductibles and co-payments would be capped at 15 percent of the total cost.

Insurers can’t discriminate against you for having a pre-existing condition, and can only vary rates within a narrow range.

If you do not obtain insurance coverage by 2014 you will be assessed a tax penalty. The penalty becomes progressively greater from 2014 through 2016, when it reaches full strength. At that point, assuming your current income remains the same and your household consists of 2 uninsured adults and 6 uninsured children, your family would be subject to a penalty of about $2,085. You are exempt from the penalty if the least expensive plan option in your area exceeds eight percent of your income.



#43 Martha

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Posted 25 November 2012 - 06:35 PM

I understand not wanting to put your family income on the net for all to see. However, the quote you put from the calculator (saying that it was with income of $65k) is SO completely different than what the calculator spits out at that income level, and is incredibly misleading, in essence implying that a family of 8 with an income of 65k would get no assistance with insurance premiums. In truth, this is what the calculator spits out with that info:


No. I quoted EXACTLY what it spit out for for the data that I said I gave it.

I didn't give it my actual info because that is too much private info to quote and I knew I would want to quote it here.

#44 Jennifer3141

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Posted 25 November 2012 - 06:36 PM

Not true here----my friends' insurance costs are staying steady for next year. Our insurance, with better coverage (we already had a really good plan), will cost us LESS next year. My husband works for a large international firm. Our friends are attorneys, educators, professors, engineers, research scientists, and upper-level management.


This is what is happening to us too!! Although DH is self-employed and we privately purchase a really good plan from ehealthinsurance.com. I just got notice last week that our deductible is going down $1000 an our premiums are dropping $46 a month. I have been paying $464 a month for my family of four.

#45 Jennifer3141

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Posted 25 November 2012 - 06:36 PM

Not true here----my friends' insurance costs are staying steady for next year. Our insurance, with better coverage (we already had a really good plan), will cost us LESS next year. My husband works for a large international firm. Our friends are attorneys, educators, professors, engineers, research scientists, and upper-level management.


This is what is happening to us too!! Although DH is self-employed and we privately purchase a really good plan from ehealthinsurance.com. I just got notice last week that our deductible is going down $1000 an our premiums are dropping $46 a month. I have been paying $464 a month for my family of four.

#46 renmew

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Posted 25 November 2012 - 06:37 PM

I, too, am worried about what is going to happen in the future. My family is currently covered with an employer plan that I pay $740 a month for. When I entered my information into the calculator it gave me this...

Based on your income, your annual premiums for that plan would be no more than $1,400 to $2,205. Your maximum out-of-pocket costs for deductibles and co-payments would be capped at 15 percent of the total cost.

So, I already pay the "no more than $1400 to $2205" in two or three months. Does that mean my monthly premium will decrease? Who will pick up the tab? My employer or the government?

#47 whitestavern

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Posted 25 November 2012 - 06:44 PM

We just got our notice for next year, an increase of $50 a month. That covers NOTHING until we hit $10,000 which, because we are healthy, eat well, and take care of ourselves, we never come close to hitting (thankfully).

I checked the calculator and it says we will not be eligible for any assistance :(

#48 Martha

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Posted 25 November 2012 - 06:46 PM

I understand not wanting to put your family income on the net for all to see. However, the quote you put from the calculator (saying that it was with income of $65k) is SO completely different than what the calculator spits out at that income level, and is incredibly misleading, in essence implying that a family of 8 with an income of 65k would get no assistance with insurance premiums. In truth, this is what the calculator spits out with that info:


Okay. At first I thought maybe you were confused. Maybe you are. But your post reads as though you think i am lying and that rather steams. I used this link from a pp.

http://www.washingto...means-for-you/#

And what I quote is exactly what it spit out.

Here it is in its entirety:

1. Do you have health insurance?
No
Are you under 26 years old?
No
2. How many people are in your household?
8
3. What is your adjusted gross household income?
$65000.00
4. What is your marital status?
Married

And this is exactly word for word what it spit out:


Right now:
If you have been unable to obtain health insurance as a result of a pre-existing medical condition, you may be able to buy it through one of the “high risk pools” the law has set up in each state through the end of 2013. But the premiums in the pools vary and can be high.

Starting in 2014:
You will have the option of buying a health plan through your state's exchange. Based on your income, you probably would not qualify for federal assistance to offset the cost of that plan. Insurers can't discriminate against you for having a pre-existing condition, and can only vary rates within a narrow range.

If you do not obtain insurance coverage by 2014 you will be assessed a tax penalty. The penalty becomes progressively greater from 2014 through 2016, when it reaches full strength. At that point, assuming your current income remains the same and your household consists of 2 uninsured adults and 6 uninsured children, your family would be subject to a penalty of about $3,475. You are exempt from the penalty if the least expensive plan option in your area exceeds eight percent of your income.




#49 Laurel

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Posted 25 November 2012 - 06:48 PM

No. I quoted EXACTLY what it spit out for for the data that I said I gave it.

I didn't give it my actual info because that is too much private info to quote and I knew I would want to quote it here.


What you quoted is the data is spits out for a family that size with an income of $165k. That extra $100k makes a bit of a difference.

#50 Martha

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Posted 25 November 2012 - 06:51 PM

I have no idea what calculator you used but absolutely nothing like what you quoted comes out of the one I used.


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