"Affordable" Care Act vent

[ChocolateReignRemix]

We googled & my dh spoke to several.  I believe there were three he spoke to, if my memory is correct. Growing up that is what my parents had through our church denomination way back when.  It worked and was always much cheaper than any other health insurance. 

 

We had reasons we chose the one we did verses the other two that dh looked at.  At this point they are legal but it wouldn't shock me to know they get shut down.  The three that my dh investigated were all faith based. 

 

Everyone we have spoken to have had positive experiences with them and the price for us is much, much, much cheaper with FAR better coverage! 

 

Why?

[Sharpie]

Why?

 

I believe my response would violate board rules. 

[creekland]

I'm also curious to know whether they exist for members of other faiths.

 

Anyhoo - off topic, sorry.

 

I don't think so and Congress is not letting any others be formed - only those that existed before ACA can operate.   :glare:

 

That seems really, really wrong IMO.  The system works better for less cost, so more forming for cat lovers or teachers or homeschoolers or _____ with each group covering what the members want and others getting to choose their fit would seem to make sense.

 

Perhaps that it makes sense is the problem Congress can't get past?

[Amy in NH]

Before ACA our health insurance was going up and up and up every single year, while coverage went down.

 

After ACA it went from $1000/month for 2 ppl with really crappy coverage, to $160/month for 2 ppl with very good coverage, to $0/month with pretty decent coverage.

[SKL]

I don't think it should be $160 or $0 per month either.  Health insurance has value.  If the government wants to subsidize families who are unable to afford health insurance, then just do that the same way they subsidize everything else.

[Joker]

I don't think it should be $160 or $0 per month either.  Health insurance has value.  If the government wants to subsidize families who are unable to afford health insurance, then just do that the same way they subsidize everything else.

 

I mentioned upthread that we only pay $95/month and that is not subsidized through the exchange. It is through dh's employer.

[umsami]

I seriously doubt anyone is getting decreases in premiums and/or deductibles without getting decreases in coverage as well. But ok.

 

Too much money to be made to move to single payer system. And honestly, the government doesn't handle its current responsibilites very efficiently, so I wouldn't expect that to change.

The government actually does a pretty good job with Medicare....low admin costs, good coverage, providers and participants are happy. They control costs well, too.

[umsami]

I'm not so sure providers are "happy" with Medicare. They are pretty much strong-armed by the government into accepting it, and it almost never covers the entire cost of the healthcare... which is part of the reason why everyone else's cost have gone up, to make up for what Medicare won't pay. Eta: One positive thing about Medicare from a provider's perspective is that it is a guaranteed payment, albeit typically a late one.

 

I'm in a family of numerous doctors.  They are happy with Medicare (granted no insurance company is fabulous, but Medicare is fine).  Approval is generally easy, they pay well (many insurance companies base reimbursement on Medicare to some degree), there are usually no major issues.   Because so many people are covered by them, the office staff and physicians know exactly what they will cover...where the problems may be, etc. The electronic/direct deposit of payments works well.  It is definitely no worse than "normal" insurance companies for approval or reimbursement.  

What doesn't work so well are the electronic medical records.  They, at least for the specialties my family is in, are very painful to use.  Now physicians have to employ scribes.  The records are not as robust (IMHO)...but it depends on the physician.  The good news is that it does, in theory, make things more portable.  They need improvement, though.  Big time.

 

No, nobody likes the politics that goes around the fee schedules/the SGR.... every year, it's omg reimbursement rates are going to be cut by X%...but then, at the last moment, it never happens.  Another "doc fix" is passed.   Were the ophthalmologists happy when the cataract reimbursement keep going down? Of course not.  Should an easy 15-20 minute operation pay $2000? Probably not.  The time required to complete the operation has changed over time due to better techniques/equipment.  Plus, entrepreneuring docs add on costs by selling patients premium IOLs. (Not necessary, BTW.)

 

The bigger issue is with Medicaid, although one thing the ACA did (or was supposed to do) is to raise reimbursement so that it matches Medicare for many primary care services, although not for specialities or all services.  It is definitely a step in the right direction, though. 

 

When we see self pay patients, we can never charge them less then Medicare rates or else we'll get in trouble.  Actually have no problem with that, because it's usually a very fair rate for the service provided.

[4kidlets4me]

I must be really lucky. I have an ACA plan it's $280/month with a $750 deductible, loads of doctors and covers everything I need. Prior to ACA I was uninsured because my dh's employer plan would cost way too much to add me.

[Tanaqui]

When I was young and bought my own first policy (early 20's) it cost me $100 a year and everything was covered!

 

If you don't mind me asking, what year was that? I'm interested in finding out how much that'd be in today's dollars using the inflation calculator. Then we would know we have a fair comparison point.

 

 

[Rebecca in KY]

I have yet to speak with a single person who is happy with the ACA. I'm not sure where these happy people are that I hear about on these boards and on the news. Our coverage has plummeted and our premiums and deductibles have skyrocketed over the last 2 years. Before that, prices for us were holding steady. I hear the same story from everyone I talk to. Our plan for this year was to get cheap, catastrophic insurance coverage, then save a good chunk monthly for prescriptions, doctor visits, etc. Then I find out that catastrophic coverage no longer exists because those plans aren't good enough under the ACA. We can't afford health insurance today, but we also can't afford the fine if we choose to go uncovered. It's a lose/lose where our right to choose has been stolen by the powers that be.

[MomtoCandJ]

Heck at this point I would just like to login! I lost my state coverage because dh makes too much now so now we have to find a plan that covers both of us and is affordable. If I didn't need to be covered as well, dh's plan was going to almost double.

[JumpyTheFrog]

My dh is self employed and needless to say, we couldn't afford ACA.  We had much better insurance prior.  We have switched to Liberty Share (health share organization) and so far are happy.

Have you made any claims with them? We have been members of Samaritan for six years but DH isn't currently eligible to renew with them because he's agnostic right now. Do they require church attendance and a curch official's recommendation?

[JumpyTheFrog]

I've looked into health insurance this week and while plans for us start at $650 per month, all the cheaper plans are the type that don't cover much or anything out of network. I've been reading recently about many in-network hospitals hiring doctors that are out-of -network, even in the ER, so with one of those plans, we could end up basically uncovered in an emergency! Other plans have high co-insurance, plus deductibles, plus all the "only allowable charges count toward deductible" nonsense.

[umsami]

I have yet to speak with a single person who is happy with the ACA. I'm not sure where these happy people are that I hear about on these boards and on the news. Our coverage has plummeted and our premiums and deductibles have skyrocketed over the last 2 years. Before that, prices for us were holding steady. I hear the same story from everyone I talk to. Our plan for this year was to get cheap, catastrophic insurance coverage, then save a good chunk monthly for prescriptions, doctor visits, etc. Then I find out that catastrophic coverage no longer exists because those plans aren't good enough under the ACA. We can't afford health insurance today, but we also can't afford the fine if we choose to go uncovered. It's a lose/lose where our right to choose has been stolen by the powers that be.

 

I think the happiest people are those who could not access health insurance due to pre-existing conditions, or kids under 26.

 

But...do you understand the benefits you get which are better than just a catastrophic plan? No copay, no coinsurance, no need to meet your deductible before they apply.  Do you realize that your birth control is free...that your annual pap and mammo are free? That your children's well visits should be free?  That your health plan has to cover at least one drug in each class?  Certain adult immunizations? That no matter what happens, your OOP shouldn't be more than $13,200/family (that includes copays, coinsurance, and deductibles assuming you stay in-network)?

 

Pre-ACA there were no caps. That's why we had so many medical bankruptcies.  While some people may still go bankrupt with  13,200 limit....for many, that's a gigantic difference than hundreds of thousands of dollars.

[umsami]

I've looked into health insurance this week and while plans for us start at $650 per month, all the cheaper plans are the type that don't cover much or anything out of network. I've been reading recently about many in-network hospitals hiring doctors that are out-of -network, even in the ER, so with one of those plans, we could end up basically uncovered in an emergency! Other plans have high co-insurance, plus deductibles, plus all the "only allowable charges count toward deductible" nonsense.

 

It's not that hospitals purposely hire out-of-network doctors, it's that hospitals contract with say an ER group or a radiology group which may or may not take the same insurance plans as the hospital.  Ridiculous, but true.

 

I'll also add that there was one highly publicized case recently.  I am very familiar with radiology groups that contract with hospitals. It is in their best interest to be providers on at least the same plans as the hospital, preferable more (for out patient services).  Unless the reimbursement is ridiculously low, the more the merrier.  That's how you attract patients...by them knowing that they're covered by your physicians.  Having a patient who cannot pay, especially if they have insurance, does not benefit anybody.  The physician's group does not like to spend the extra time/$$ trying to deal with out of network insurance companies, billing disputes, collection agencies, or whatever.  It's not in anybody's best interest.

[JumpyTheFrog]

If you're on vacation and need emergency treatment at an out-of-network hospital, does that mean these plans don't cover it?

 

Also, regarding the 13,200 OOP max, several plans I looked at had OOPs double that if you went out-of-network, while some didn't cover anything not in network. From the brochures, it looked like that might be in addition to co-pays and co-insurance. Plus, I understand that often insurance tries to only count part of an out-of-network charge toward the deductible.

 

I was on a forum where someone talked about having some expensive $100,000 surgery. Afterward he got the bill and the hospital had tacked on another $150,000 for an out-of-network assistant surgeon he was never told about. This kind of nonsense makes it sound like all they do is try to rip people off.

[TranquilMind]

We switched to Christian Health Share (Samaritan Ministries) more than 10 years ago and I definitely have no regrets.  Every time I read one of these insurance threads or listen to stories around the lunch table I'm so thankful we switched.

 

$405/month for the whole family and coverage at 100% - any doctor, any hospital.

 

Stuff under $300 isn't covered, but we sure can pay for a ton of that in our monthly savings.  Other things not covered (abortions, drunk accidents, etc) we don't and won't need.

 

They've paid for a broken collarbone, hubby blacking out in our horse pasture, youngest's epilepsy diagnosis and treatment, my brain tumor, and now whatever other nerve thing is going on - still being determined.

 

We'd have been out thousands (literally) had we not switched.  Just in the past two years I'd have had to come up with $25,400.  That would mean my kids wouldn't be going to college to be honest.  Then too, things aren't finished yet.

 

And we were young and healthy too - with no brain tumors (or other tumors) or epilepsy in either of our backgrounds.

 

At school we're doing regular fund raisers for a co-worker with insurance.  It's been nice not needing those to be honest.  It's bad enough dealing with the issues.

 

But health shares don't work for everyone (those not Christian, those with pre-existing conditions, those needing expensive prescriptions on a regular basis), so quite honestly, something really needs to be done with health care in this country.

 

If health shares can make it work affordably, it seems other solutions should be able to as well.

Wow, that is amazing!  We have used very little health care all these years, until a couple of years ago, when I had an appendectomy and then issues related to that (thanks, Surgeon!).   We cost them nothing for nearly 30 years and then had to pay tens of thousands since. 

 

There have to be other ways, as you say. 

[TranquilMind]

I think the happiest people are those who could not access health insurance due to pre-existing conditions, or kids under 26.

 

But...do you understand the benefits you get which are better than just a catastrophic plan? No copay, no coinsurance, no need to meet your deductible before they apply.  Do you realize that your birth control is free...that your annual pap and mammo are free? That your children's well visits should be free?  That your health plan has to cover at least one drug in each class?  Certain adult immunizations? That no matter what happens, your OOP shouldn't be more than $13,200/family (that includes copays, coinsurance, and deductibles assuming you stay in-network)?

 

Pre-ACA there were no caps. That's why we had so many medical bankruptcies.  While some people may still go bankrupt with  13,200 limit....for many, that's a gigantic difference than hundreds of thousands of dollars.

The benefits you list are of no interest whatsoever to me, and they are all very inexpensive.  Let ME pay for that $40 visit or that prescription and let insurance cover anything expensive.  That should be the way. 

 

So I still consider it catastrophic.  Unless you have huge costs, there are no significant benefits.   

[umsami]

If you're on vacation and need emergency treatment at an out-of-network hospital, does that mean these plans don't cover it?

 

Also, regarding the 13,200 OOP max, several plans I looked at had OOPs double that if you went out-of-network, while some didn't cover anything not in network. From the brochures, it looked like that might be in addition to co-pays and co-insurance. Plus, I understand that often insurance tries to only count part of an out-of-network charge toward the deductible.

 

I was on a forum where someone talked about having some expensive $100,000 surgery. Afterward he got the bill and the hospital had tacked on another $150,000 for an out-of-network assistant surgeon he was never told about. This kind of nonsense makes it sound like all they do is try to rip people off.

 

Yes, the OOP is in-network as I stated.  That's nothing new (ACA or not) for insurance companies charging you less for in-network.)  If it's only double for out of network, you're still 1000x better off than before.  $26,400 vs. $100k+?  Yes, please.  

 

I cannot think of any surgery where an assistant surgeon's fees would be $150k.  I call BS.  I'm very familiar with what surgeons charge for a wide variety of operations.  Don't believe everything you read in forums.  Could his bill be $100k? Absolutely...but if he had insurance, I doubt he paid anywhere near that (nor did his insurance company).  If he did not (pre-ACA), and was not wealthy, you can usually negotiate with the hospital and pay a percentage based on your income.

 

Also...even with a ridiculous unbelievable 150k fee, with the ACA...he would have been helped by the OOP maximum. ;)  Even if the out-of-network was doubled.   

[umsami]

The benefits you list are of no interest whatsoever to me, and they are all very inexpensive.  Let ME pay for that $40 visit or that prescription and let insurance cover anything expensive.  That should be the way. 

 

So I still consider it catastrophic.  Unless you have huge costs, there are no significant benefits.   

 

 

$40 is a co-pay....not the cost of the visit.  If you wanted to pay the full price for that visit, it would be far greater than $40.

 

Same for drugs...do you have any idea what the real cost for prescriptions are?  

 

Disagree...but I hope you never need to find out how good it is to actually have real health insurance.  You have no idea what is coming down the lane. Perfectly healthy people have unexpected health crises all the time.  Or a loved one can be dx with a chronic condition...that will impact you long-term, and pre-ACA would have prevented you from getting any insurance.  

[happypamama]

What forms of birth control are covered, out of curiosity?

[SKL]

Pre-ACA there were no caps.

 

This is not true.  Every insurance plan I was ever on had caps.

 

Also it has long been standard that "well" and "preventive" services were included or had a very small co-pay, and deductibles used to generally be lower than they are now.

 

Using the word "free" for something that costs thousands (or tens of thousands) per year is not accurate.  "Included" would be more accurate.  People are paying an extra $X,000/yr but their $XX copay for a well visits has gone away.  Not very exciting.

[Sdel]

Yes, we certainly did. 

 

The company could afford better plans.  Now that it has to cover a bunch of stuff that everyone didn't want or need, the rates have gone up for less coverage in areas where it actually matters, like expensive stuff - not that once a year visit that cost you $40. 

 

We did too...and DH works for a hospital so they basically self-insure and we are primarily limited to their system providers.  It was wonderful for things like MRI, urgent care clinic visits, lab work.  Imaging cost us like $200 co-pay and that was it.  Now, it is $500 co-pay and 20%.  Urgent care clinics were $25 co-pay and 20%, now it is $150 plus 20%. DH went to urgent care for dehydration recently.  All he got was 1 bag of IV fluids.  We paid $150 co-pay plus got a bill for over $500.  Full ER visits were $125 copays, now $250 and 20%.  And we are paying a pretty penny every payday. 

 

We paid OOP for a flu vaccine at Wal-greens because it was cheaper to do it that way than to go through insurance.   Not to mention, we've been going round and round with our pedi for months over insurance not recognizing flu shots for the kids and they are insisting we pay for those OOP.

 

Also really telling:  this year was the first year ever that DH had to certify that a spouse was unable to insure themselves via their employers and that if I was able to get my own insurance and opted to be on his plan we'd have to pay an extra charge per payday.

 

More expense for less coverage all throughout the plan.  We went from *great* insurance to pretty poor, and still more expensive insurance this year. 

 

But the ACA is only part of the problem, the main problem is that the way health insurance/medicaid work is what propels the continuous health care cost increases.  Also, I'm not sure how many of you realize, but insurance companies have insurance policies for those 100+K bills. 

 

Stefanie

[Sdel]

The government actually does a pretty good job with Medicare....low admin costs, good coverage, providers and participants are happy. They control costs well, too.

 

Providers and participants are most certainly NOT happy.  Many of the doctors in my area will not accept new medicare/medicaid patients.  This forces those patients to have a very limited, and honestly, IMO very substandard choice of doctor (I generally know most of them and their abilities) and *long* wait list times before being seen.....for a general practitioner to do routine management care.  Some people even have to leave the doctor they have had relationships with because they will no longer accept medicare/medicaid.  The hospitals are NOT happy with their payment schedules that only pay out a certain amount by admitting diagnosis and not based on what goes on with the patient during treatment or what the actual cost of treatment actually is. 

 

Stefanie

[umsami]

This is not true. Every insurance plan I was ever on had caps.

 

Also it has long been standard that "well" and "preventive" services were included or had a very small co-pay, and deductibles used to generally be lower than they are now.

 

Using the word "free" for something that costs thousands (or tens of thousands) per year is not accurate. "Included" would be more accurate. People are paying an extra $X,000/yr but their $XX copay for a well visits has gone away. Not very exciting.

 

Was your cap as low as $13k for a family...especially as an individual plan? I doubt it....and if so, it wasn't the norm....hence the reason medical bankruptcies were so high in this country. (75% had some insurance, btw...it wasn't just uninsured people.) http://www.pnhp.org/new_bankruptcy_study/Bankruptcy-2009.pdf Not all plans had OOP caps, and actually many had lifetime coverage caps....yet another thing that went away. There were many predatory plans out there. Also, getting maternity covered on a self pay plan was nearly impossible.

 

ACA is not perfect...but it was a start....and unless you never faced some of the real issues it fixed, you may not appreciate the difference. As I said before, would love to see the GOP improve it. It is by no means perfect. I still think single payer, paid with a VAT or payroll tax, makes the most sense.

[SKL]

Was your cap as low as $13k for a family...especially as an individual plan? I doubt it....and if so, it wasn't the norm....hence the reason medical bankruptcies were so high in this country. (75% had some insurance, btw...it wasn't just uninsured people.) http://www.pnhp.org/new_bankruptcy_study/Bankruptcy-2009.pdf Not all plans had OOP caps, and actually many had lifetime coverage caps....yet another thing that went away. There were many predatory plans out there. Also, getting maternity covered on a self pay plan was nearly impossible.

 

ACA is not perfect...but it was a start....and unless you never faced some of the real issues it fixed, you may not appreciate the difference. As I said before, would love to see the GOP improve it. It is by no means perfect. I still think single payer, paid with a VAT or payroll tax, makes the most sense.

 

I hear about all these bankruptcies, but so far I've known zero people personally who have had this problem (and most people I know that well are working-class).  The amount of cost you'd have to reach to need to pay a ton out of pocket is something that rarely occurs with decent insurance.  My mom had colon cancer which cost hundreds of thousands of $$ to deal with.  Out of pocket amount:  $0.

 

And because catastrophic health crises are rare, the cost of stop-loss insurance should be pretty cheap.  Actually, I used to work for a third-party administrator and they put stop-loss insurance on each person.  And as you'd expect, it was indeed pretty cheap.  It used to be available & affordable to individuals as part of a HSA (I helped my nanny set one up), but from what I'm hearing, that is no longer the case.

 

Meanwhile, individual choice in doctors and treatments has eroded.

 

So, no way the so-called benefits are worth the added costs.  Not when you look at the true comprehensive picture.

[foxbridgeacademy]

DH recently switched jobs just because of the insurance.  At the previous company we could not afford the premium and opted out (no insurance for over a year) at the new company the premium is less then a third of the cost.  When he told me I cried, we could finally go to the doctor again.  ACA costs almost the same with less coverage as the old company.  I am a big supporter of many of the ACA changes; no denial for pre-existing conditions, older children could stay on parents policy, no cap for lifetime benefits, and a well visit yearly.  But it is crazy how much they charge and how little they cover.  Maybe DH had always in the past worked for companies that had good coverage for decent premiums ($1500 deductible, $20 co-pay, $300 premium for example), but I am shocked at the rates/deductibles and lack of coverage most companies offer now.

[umsami]

Providers and participants are most certainly NOT happy.  Many of the doctors in my area will not accept new medicare/medicaid patients.  This forces those patients to have a very limited, and honestly, IMO very substandard choice of doctor (I generally know most of them and their abilities) and *long* wait list times before being seen.....for a general practitioner to do routine management care.  Some people even have to leave the doctor they have had relationships with because they will no longer accept medicare/medicaid.  The hospitals are NOT happy with their payment schedules that only pay out a certain amount by admitting diagnosis and not based on what goes on with the patient during treatment or what the actual cost of treatment actually is. 

 

Stefanie

First off, there is a giagantic difference between Medicare and Medicaid and how it is viewed by physicians, hospitals, and the like.  To help you remember, think we "care" for our elderly.  Medicare is the insurance that every American over 65 has.  It's divided into parts.  Part A is hospital.  Part B is medical.  Part C is Medicare Advantage and there's also Medigap....the supplemental insurance many people buy (because Medicare does not cover everything 100%....people pay coinsurance depending on what is covered, kind of like normal insurance.)  Part D is drugs.  Medicare does not cover everything (no insurance does.)  Medicaid is insurance for low income people.  It has historically not reimbursed very well, and physicians can lose money on seeing a patient.  Dental insurance through medicaid is rarely accepted by many dentists as well.  

 

My husband is a physician...my father is a physician... my uncle is a physician... all we do is hang out socialize with physicians... and I can tell you that other than the concierge physicians I know, they all gladly accept Medicare patients.  Physicians scramble to make sure that they also accept all of the various Medicare Part C plans for their area.  The problem is with Medicaid patients, which historically have paid a much lower reimbursement.  One of the things the ACA is trying to fix is to increase the payments made to Medicaid patients for many preventative/primary care type things so that hopefully more physicians will see them.  

 

Is it perfect? Do they give doctors all the money doctors would like? Nope.  No insurance does.  Do they cover everything? Nope, no insurance does.  Medicare pissed off a lot of physicians when they recently released payment data.  Many of the top paid physicians were either vitreoretinal specialists or oncologists.  The data didn't mention that a lot of the reimbursement for retina specialists went for drugs that cost $2,000 per injection and are given monthly for AMD.  It's not like the physician collects $2,000....that goes to the drug companies.  The patient still has a 20% copay.  But, they may halt their disease and not end up blind.  Of course, there's a cheaper version of the same drug off-label, but that poses risks as one needs to use a compounding pharmacy.  One of the big issues (craziness) is that supposedly Medicare Part D cannot negotiate with Big Pharma over drug prices.  Why not? Congress says so.  Every other country's healthcare system does it...but not ours.  Thanks pharma lobbyists!  (Weirdly, Medicaid can....as can the VA).  Oncology drugs can be wicked expensive.  My Dad has been on a drug that cost 100k+/year (newly approved leukemia drug.)  Thankfully Medicare pays some...but he still has high out of pocket costs even with Part D.  Could he afford the OOP if he didn't have a good savings? Probably not.  Would it be impossible if Medicare didn't cover some of it? Yup.  

 

As for hospitals, once again, I would bet it's the rare hospital that can afford to turn away any American over 65.  Do some? Perhaps, but it would be extremely rare.  If they did, they would risk loosing their contract to handle all Medicare patients which would be extremely costly to the hospital.  They cannot insist on a Medigap policy for patients either.  

 

Even Medicaid patients are routinely cared for at many non-profit hospitals, teaching hospitals, etc.  

[umsami]

I hear about all these bankruptcies, but so far I've known zero people personally who have had this problem (and most people I know that well are working-class).  The amount of cost you'd have to reach to need to pay a ton out of pocket is something that rarely occurs with decent insurance.  My mom had colon cancer which cost hundreds of thousands of $$ to deal with.  Out of pocket amount:  $0.

 

 

I'm glad you've never known anybody...doesn't mean it doesn't happen and didn't happen.  1.7 million per year is not a small number.  

 

Did you ever think that your Mom was lucky to have good insurance?  It certainly is not the case that most people with cancer have $0 out of pocket costs before the ACA (or after).  Cancer patients are 2.65x as likely to go through a medical bankruptcy as those with a different dx.  Women are more at risk.  Younger people are more at risk.  People of color are more at risk.  (another link: http://www.nbcnews.com/id/51893912/ns/health-cancer/t/cancer-increases-bankruptcy-risk-even-insured/)  

 

I've had health insurance since the 1990s.  I've always faced issues with having to change OBs, pediatricians, etc. due to insurance plan changes.  It's frustrating and annoying (especially when we had a pediatrician we loved, and had seen since DS1 was born), but it's nothing new.  (Note having her leave our plan happened before the ACA.)  I'll also let you know that not all plans accept all physicians who want to participate.  Some close their plans after they reach a certain number of providers in an area.  So even if your physician wants to say be on BCBS, she may not be able to get them to add her.... especially if she's new to the area/practice.

 

I'll also add that a lot of the cost changes that employed people are driven by the companies they work for.  It is far cheaper to offer a high deductible plan.  It is far cheaper for them to insure for just the basics.  When the insurance rep presents the plans, they talk about the savings to the employer if they increase the employee's OOP costs....or refuse to cover spouses (not required by law like children), etc.  So, while it's great to blame the ACA, a lot of the blame belongs on the companies themselves. 

 

And now that my 4 year old who took an unplanned (and unlucky for me) nap at 6 p.m. is asleep....so can I be. :)   Good night.  I wish good health insurance and medical care for all....I don't care what it's called...or what party presents it or takes credit for it.  We can do a heck of a lot better in this country...but I don't see us doing that until we get the lobbyists money out of congress.

[umsami]

What forms of birth control are covered, out of curiosity?

 

Anything that is approved by the FDA.  http://www.webmd.com/health-insurance/aca-birth-control-coverage-faq

 

Although I'm not sure how things will change after Hobby Lobby.  If you work for a faith based company, you might be screwed. 

[SKL]

Well do you think there will be fewer bankruptcies with many, many more people having to pay thousands / tens of thousands more each year just for health insurance?  When you say "only" 13K or whatever out of pocket, you obviously aren't counting the premiums, which will add up to hundreds of thousands of $$ (maybe even in the 7 figures) for many people, before they pay out their first $ for out-of-pocket costs (which have also gone up, not down, for many).  I would rather put aside that money in case I ever need it, and have a chance of enjoying my retirement / putting my kids through college.

 

As for the bankruptcies, there is a reason they reformed the bankruptcy laws.  There is a reason most of the people who took advantage of bankruptcy were well-educated people.  It was being used by many as a way to walk away from the consequences of unwise decisions.  Maybe they had a few medical bills but they also had big mortgages etc.  It was a time when many people were flat out living beyond their means.

 

And while I wasn't impressed with the "scientific method" employed in that article you linked, I did notice that a significant % of the people in that predicament were suffering from expensive chronic issues such as MS, or people who lost income due to illness.  In cases like that, targeted relief would make more sense.  Provide more subsidies for people with chronic debilitating illnesses, provide a better stop gap for people who lose their jobs etc.  They didn't need to take away what was working well for most people.

[ChocolateReignRemix]

I believe my response would violate board rules. 

 

I suspected you didn't have anything to base that belief on.

[SKL]

Anything that is approved by the FDA.  http://www.webmd.com/health-insurance/aca-birth-control-coverage-faq

 

Although I'm not sure how things will change after Hobby Lobby.  If you work for a faith based company, you might be screwed. 

 

I understand Hobby Lobby was only opting out of two meds that were considered abortificants.  If so then there should still be plenty of covered bc options (and if you really want to use those two meds, you can always pay out of pocket).

[SKL]

I suspected you didn't have anything to base that belief on.

 

I suspect there are a number of people here who just want to stay away from the can of worms your question would open.

[ChocolateReignRemix]

I suspect there are a number of people here who just want to stay away from the can of worms your question would open.

 

If someone had a factual basis for that belief they would be able to present it.

[umsami]

Well do you think there will be fewer bankruptcies with many, many more people having to pay thousands / tens of thousands more each year just for health insurance?  When you say "only" 13K or whatever out of pocket, you obviously aren't counting the premiums, which will add up to hundreds of thousands of $$ (maybe even in the 7 figures) for many people, before they pay out their first $ for out-of-pocket costs (which have also gone up, not down, for many).  I would rather put aside that money in case I ever need it, and have a chance of enjoying my retirement / putting my kids through college.

 

As for the bankruptcies, there is a reason they reformed the bankruptcy laws.  There is a reason most of the people who took advantage of bankruptcy were well-educated people.  It was being used by many as a way to walk away from the consequences of unwise decisions.  Maybe they had a few medical bills but they also had big mortgages etc.  It was a time when many people were flat out living beyond their means.

 

And while I wasn't impressed with the "scientific method" employed in that article you linked, I did notice that a significant % of the people in that predicament were suffering from expensive chronic issues such as MS, or people who lost income due to illness.  In cases like that, targeted relief would make more sense.  Provide more subsidies for people with chronic debilitating illnesses, provide a better stop gap for people who lose their jobs etc.  They didn't need to take away what was working well for most people.

 

Premiums...hundreds of thousands or 7 figures for many people?  Where are you buying insurance?  The highest plans I've seen (and these are the platinum/gold type plans) are $2k/month.  That's 24k/year...plus, if they max out the OOP...is roughly 40k.  Where are you getting hundreds of thousands?

 

You mention putting aside money in case you ever need it... that's great.  You do know that most Americans are horrible at saving, have very little saved for retirement, and would be unlikely to have money saved for that "rainy day", right?

 

I'd love to see your facts that medical bankruptcies were not caused by actual medical bills, but by people living beyond their means.  Facts, please? 'Cause I linked to some.  Would love to see yours.

 

It wasn't working well for a gigantic portion of our population.  41-46 million were uninsured.  That's huge.  1.7 million medical bankruptcies per year.  That's huge.  Many of those were employed adults....the percentage of employers providing health insurance has been decreasing for quite some time.  Even before the ACA.  If they had any minor comorbidity, they might not be able to get any coverage.  It may have worked well for you, I'll give you that.  But many people I knew and worked with (in Fortune 50 companies, BTW), had seen increasing costs and worse coverage for some time.  It's not like the ACA created that.   You do realize that you paid for those uninsured and those bankruptcies in higher costs yourselves, don't you?  (And yes, we still have millions who are uninsured...and we will still have medical bankruptcies, but hopefully lower numbers.)

[umsami]

I understand Hobby Lobby was only opting out of two meds that were considered abortificants.  If so then there should still be plenty of covered bc options (and if you really want to use those two meds, you can always pay out of pocket).

 

 

Well, they opted out of one of the most effective birth control means, the IUD, which is also one of the most costly (I was quoted $700 when I had mine installed pre-ACA.)  And nothing they said was backed up by actual science, but who cares.

 

So yeah. you can pay out of pocket or go with a far less effective method.  Sure.  They found that when those cost barriers are reduced, 75% of women actually choose long-acting birth control. (Why? Because they work! Very little user error.)   

 

Of course, if your less effective BC fails, you can pay out of pocket.  Lovely.

[scrapbookbuzz]

Your thread title is somewhat political, something I thought we were meant to avoid.

Give the woman a break! she also says in the title that it's a VENT. Let her vent, already!

[scrapbookbuzz]

If you're on vacation and need emergency treatment at an out-of-network hospital, does that mean these plans don't cover it?

 

Also, regarding the 13,200 OOP max, several plans I looked at had OOPs double that if you went out-of-network, while some didn't cover anything not in network. From the brochures, it looked like that might be in addition to co-pays and co-insurance. Plus, I understand that often insurance tries to only count part of an out-of-network charge toward the deductible.

 

I was on a forum where someone talked about having some expensive $100,000 surgery. Afterward he got the bill and the hospital had tacked on another $150,000 for an out-of-network assistant surgeon he was never told about. This kind of nonsense makes it sound like all they do is try to rip people off.

 

First, hospitals are notorious for having 'out of network' physicians work on you, especially in the ER. I constantly have to argue with providers over this - I'm sorry, next time I have an emergency I'll make sure to STOP what I'm doing and make sure the attending physician is IN NETWORK. Seriously.

 

Second, I know someone personally who has an ACA plan on her family. Guess what? It did NOTHING to cover her daughter when she was on an internship out of state and had to receive medical care. How does that help anyone?

[Artichoke]

If you don't mind me asking, what year was that? I'm interested in finding out how much that'd be in today's dollars using the inflation calculator. Then we would know we have a fair comparison point.

Not the person you were asking but maybe this will help answer your question --

 

In 1993, I had a plan that cost $28 a month and covered everything at 100% after a $1500 deductible. We had a child that year so I still had the info with the baby things. That also included prescription coverage. In today's dollars it would be $32.86 a month. Fo those accountants out there - it was twice a month, not biweekly.

[SKL]

Premiums...hundreds of thousands or 7 figures for many people?  Where are you buying insurance?  The highest plans I've seen (and these are the platinum/gold type plans) are $2k/month.  That's 24k/year...plus, if they max out the OOP...is roughly 40k.  Where are you getting hundreds of thousands?

 

You mention putting aside money in case you ever need it... that's great.  You do know that most Americans are horrible at saving, have very little saved for retirement, and would be unlikely to have money saved for that "rainy day", right?

 

I'd love to see your facts that medical bankruptcies were not caused by actual medical bills, but by people living beyond their means.  Facts, please? 'Cause I linked to some.  Would love to see yours.

 

It wasn't working well for a gigantic portion of our population.  41-46 million were uninsured.  That's huge.  1.7 million medical bankruptcies per year.  That's huge.  Many of those were employed adults....the percentage of employers providing health insurance has been decreasing for quite some time.  Even before the ACA.  If they had any minor comorbidity, they might not be able to get any coverage.  It may have worked well for you, I'll give you that.  But many people I knew and worked with (in Fortune 50 companies, BTW), had seen increasing costs and worse coverage for some time.  It's not like the ACA created that.   You do realize that you paid for those uninsured and those bankruptcies in higher costs yourselves, don't you?  (And yes, we still have millions who are uninsured...and we will still have medical bankruptcies, but hopefully lower numbers.)

 

$40K per year becomes six figures in 2.5 years.  It becomes 7 figures in 25 years.  Many working people pay health insurance premiums for over 40 years.

 

I was expecting the "Americans are poor savers" argument.  So what?  I should be stripped of my right to save my money because some people are not good at it?

 

Your figure of 41-46 million uninsured is, I suspect, the number that includes people in the US without the legal right to be here.  So when compared to the number who could realistically buy insurance at any realistic price, it is overstated.  Besides, as you can see above, increasing the cost is not exactly making it easier for people to be insured.  Maybe it brings some people onto the rolls but it also knocks other people off, and reduces the value of "being insured" for many.

 

Your figure of 1.7million medical bankruptcies per year is a lot different from the figure in that article you linked, like 20x or something like that.  And also that study was iffy at best, and the conclusion was that the medical stuff contributed, not necessarily caused all the family's financial problems.  The article noted that the average bankrupt famly had a mortgage over $140K (and the bankruptcy laws allow you to keep your house).

[Sdel]

First off, there is a giagantic difference between Medicare and Medicaid and how it is viewed by physicians, hospitals, and the like.  To help you remember, think we "care" for our elderly.  Medicare is the insurance that every American over 65 has.  It's divided into parts.  Part A is hospital.  Part B is medical.  Part C is Medicare Advantage and there's also Medigap....the supplemental insurance many people buy (because Medicare does not cover everything 100%....people pay coinsurance depending on what is covered, kind of like normal insurance.)  Part D is drugs.  Medicare does not cover everything (no insurance does.)  Medicaid is insurance for low income people.  It has historically not reimbursed very well, and physicians can lose money on seeing a patient.  Dental insurance through medicaid is rarely accepted by many dentists as well.  

 

I have enough experience with both thank you very much.  I know how my previous employer (non profit hospital) gets reimbursed by medicare (and in many cases it isn't adequate), and I was told by my grandchild's pedi that they would no longer see him just because he was a medicaid patient and he now had to go to the only medicaid clinic in town....which I know the docs are not the best quality in town.  I also know that my doc isn't taking any new medicare or medicaid patients, my husbands doc isn't taking any either, and numerous docs my husband has talked to via work are not taking new patients.  They aren't refusing medicare/medicaid, they are just refusing *new ones* but they all cite medicare/medicaid repayment/regulation isn't worth taking on new patients for.   One complaining doc was a nephrologist (and those are limited supply) saying that medicaid wouldn't pay out if a patient's lab values didn't meet certain parameters....like the doc can enforce a patient's compliance/response with the treatment plans. 

 

Honestly, I know what I would like health insurance to work....like car insurance; ie catastrophic.  If health insurance hadn't acted like pre-paid health care for all these years I think costs would be much more manageable in general.   I'm just not sure it can act that way now or how to get it back to where it can act that way.   My DH and I are seriously considering dropping insurance and just signing back up if something happens.  My state has opted out of the exchanges, as have I believe most states have, which, according to the law make them ineligible for subsidies.

 

 

But my gripes against the ACA go much farther than just insurance premium costs and lead into the doctor/nurse rationing measures. 

 

 

Stefanie

[StephanieZ]

Providers and participants are most certainly NOT happy.  Many of the doctors in my area will not accept new medicare/medicaid patients.  This forces those patients to have a very limited, and honestly, IMO very substandard choice of doctor (I generally know most of them and their abilities) and *long* wait list times before being seen.....for a general practitioner to do routine management care.  Some people even have to leave the doctor they have had relationships with because they will no longer accept medicare/medicaid.  The hospitals are NOT happy with their payment schedules that only pay out a certain amount by admitting diagnosis and not based on what goes on with the patient during treatment or what the actual cost of treatment actually is. 

 

Stefanie

 

I think you are mixing up Medicare and Medicaid. 

 

(Nearly) all Americans over 65 are on Medicare. Elderly people eat up the vast majority of health care spending. I have never found a doctor who didn't accept Medicare. I am sure there are some. Maybe pediatricians or OB/GYNS, lol. But, I guarantee you that there are very, very few American oncologists, heart doctors, neurologists, surgeons, etc, who don't receive the vast majority of their income through Medicare. And very few hospitals who don't receive the majority of their income through it. (Again, probably not Children's hospitals, lol.)

 

My mom has seen the VERY, VERY BEST doctors in the DC region for a wide range of issues over the last decade on Medicare, and not a single one has ever had any problems accepting Medicare. In fact, we tend to walk in and out without paying a single penny, and I never get bills, either. It actually freaks me out. (She has a 200/mo supplemental Medicare Advantage plan, FWIW). She pays a good bit towards prescriptions when she is in the "donut hole" region mid-year, but other than that, her health care costs are extremely low, despite at least a dozen specialist visits in the last year (never cost a single PENNY in cash outside the insurance coverage). I love her Medicare. It's awesome. I'm nervous about the need to switch Medicare Advantage plans, and I just hope her new one in her new state is close to what she had. And, we have not yet found a doctor that didn't participate with her plan, even when I moved her out of state in the last year (and hadn't yet switched to a plan in the new area). She's had surgeries at John's Hopkins, seen a gynecologist at Georgetown Med School . . . etc . . . never a problem whatsoever. 

 

Medicare and Medicaid are completely different animals. 

[SKL]

My podiatrist uncle said he didn't accept medicare.  His patients tend to be on the older side.

[SKL]

I will say that although I have heard many complaints about Medicare, from the patient's side, it doesn't seem to be any worse than other insurers AFAIK.  Nor any better.  It's sad to see older people constantly worrying about the mistakes and unpredictability, at a time of life when everything is harder already.

[Sdel]

I think you are mixing up Medicare and Medicaid. 

 

(Nearly) all Americans over 65 are on Medicare. Elderly people eat up the vast majority of health care spending. I have never found a doctor who didn't accept Medicare. I am sure there are some. Maybe pediatricians or OB/GYNS, lol. But, I guarantee you that there are very, very few American oncologists, heart doctors, neurologists, surgeons, etc, who don't receive the vast majority of their income through Medicare. And very few hospitals who don't receive the majority of their income through it. (Again, probably not Children's hospitals, lol.)

 

My mom has seen the VERY, VERY BEST doctors in the DC region for a wide range of issues over the last decade on Medicare, and not a single one has ever had any problems accepting Medicare. In fact, we tend to walk in and out without paying a single penny, and I never get bills, either. It actually freaks me out. (She has a 200/mo supplemental Medicare Advantage plan, FWIW). She pays a good bit towards prescriptions when she is in the "donut hole" region mid-year, but other than that, her health care costs are extremely low, despite at least a dozen specialist visits in the last year (never cost a single PENNY in cash outside the insurance coverage). I love her Medicare. It's awesome. I'm nervous about the need to switch Medicare Advantage plans, and I just hope her new one in her new state is close to what she had. And, we have not yet found a doctor that didn't participate with her plan, even when I moved her out of state in the last year (and hadn't yet switched to a plan in the new area). She's had surgeries at John's Hopkins, seen a gynecologist at Georgetown Med School . . . etc . . . never a problem whatsoever. 

 

Medicare and Medicaid are completely different animals. 

 

I'm not confusing them.  I've personally been told my pedi they won't see my grandchild because he is medicaid, go to the medicaid clinic and I've seen the signs in more than several doc offices saying "not accepting new medicare patients at this time".  The ones that are typically still accepting or are at the medicaid office in the area are *NOT* our best docs.  Specialist sometimes don't have much choice though.  Several have told us payments schedules as some form of the reason why they are not/can not accept that type of patient.  And I lumped them together because BOTH are not accepting. 

[creekland]

Wow, that is amazing!  We have used very little health care all these years, until a couple of years ago, when I had an appendectomy and then issues related to that (thanks, Surgeon!).   We cost them nothing for nearly 30 years and then had to pay tens of thousands since. 

 

There have to be other ways, as you say. 

 

We also used very little health care for eons.  I only needed anything for my 3 pregnancies (all covered under hubby's employer provided insurance at the time, though we paid 20%) and a couple of visits for antibiotics (pneumonia, tick bite).

 

My two grandmothers lived to 88 and 94 respectively.

 

I watched my own sugar numbers due to diabetes running in the family.

 

We eat moderately healthy foods - far more than many of my peers to be honest.

 

We exercised fairly regularly with farm work and hikes/geocaching.  A 4 mile hike was a short one for us.

 

It kinda messes with my mind to think that I managed to get what I've gotten.

 

I'm incredibly glad we switched to Health Share and I don't have to worry about the finances.

 

For those not eligible for health shares, I REALLY recommend finding something for insurance.  One just never knows.

 

My co-worker, the one we're having regular fund raisers for, was also quite healthy and ran a 5K the month before her diagnosis.

 

Again, one never knows.

 

The benefits you list are of no interest whatsoever to me, and they are all very inexpensive.  Let ME pay for that $40 visit or that prescription and let insurance cover anything expensive.  That should be the way. 

 

So I still consider it catastrophic.  Unless you have huge costs, there are no significant benefits.   

 

My last regular doctor's ppt (last Thursday) - the kind not covered with our health share as it's a normal appt - cost me $85.  My son's epilepsy meds cost us $58/month.  His annual check up for the epilepsy cost us $87.  If it flares up again and he has issues, it's covered.  My middle son's glasses cost us about $350 every other year. Flu shots for hubby and I cost us $60 (total).  Multi-phasic blood testing we had done to keep track of numbers cost us $82 (total).

 

There are more regular tests I probably should go for due to my age, but I'm still not really a "medical" person so wouldn't do those even if they were free, unless I saw a need.

 

Considering we save at least $500/month just on premiums vs share costs, I think we're coming out ahead.

 

Then if the OOP has gone up to $13,200, we've saved that annually for at least two years now + we've saved the 20% difference we'd have had to pay with those other issues over the years.

 

As I mentioned before - we are THOUSANDS ahead of where we could be.  Thinking about where we could be makes me shudder.

 

Then we don't have to worry about networks or similar things.

 

Even the type of radiation I had at Hopkins is one they told me is not often covered by insurance.  The health share said if that's what the doctor wanted, it was covered.

 

My co-worker had to go to Pitt for special tests due to the network deal.  Hopkins is an hour and a half drive.  Pitt is four hours.

 

I can't think of one thing that would be better for US with insurance.  (Others have other needs, so insurance can be better for them.)

[TechWife]

I hear about all these bankruptcies, but so far I've known zero people personally who have had this problem (and most people I know that well are working-class).  The amount of cost you'd have to reach to need to pay a ton out of pocket is something that rarely occurs with decent insurance.  My mom had colon cancer which cost hundreds of thousands of $$ to deal with.  Out of pocket amount:  $0.

 

 

 

My son had a life threatening illness earlier this year. I can easily see how people would go bankrupt. Because he was hospitalized on 12/31 and stayed through the first week of the new year, we had deductibles and out of pocket maximums across two years apply to his care. Imagine meeting your out of pocket maximum on one day, only to have to start over the very next day - not good. Somethings - like the hospital charge, were covered the entire time because his admit date was the previous year, but all of his surgery, radiology, medication, PT and life support charges were separate and counted in the new year because they had specific dates of service. Trauma care is expensive. The ambulance ride from one facility to the children's hospital was $2,500 because it was a critical care ambulance staffed w/paramedics. Blood was $535 per unit (he had 10 units). Ventilator support was about $1K per day. It goes on and on. 

 

His surgeon did two procedures during one operation, the insurance company only wants to pay for one (the cheapest one), so we are still fighting the insurance company on that. 

 

We are blessed in that my husband has a stable job with fair pay and good insurance. We are also blessed because we have followed sound financial planning principles (for twenty years) and had an emergency fund built up that we used to pay the deductibles and OOP expenses.

 

People who do not have the ability to build up such an emergency fund could most definitely have gone bankrupt. 

 

I will tell you this, though. It is worth every penny! My son is healthy, happy and able to do all of the things a nearly 18 year old young man should be able to do. The doctors and nurses had no idea what our insurance situation was. The hospital billing department didn't come to verify our insurance coverage with us until the day of our discharge (the holiday and then the weekend played a part in that, I'm sure). One of the nurses told me that insurance information isn't even on the medical chart - they treat all patients the same. Financial information is kept completely separate. 

[Sdel]

My son had a life threatening illness earlier this year. I can easily see how people would go bankrupt. Because he was hospitalized on 12/31 and stayed through the first week of the new year, we had deductibles and out of pocket maximums across two years apply to his care. Imagine meeting your out of pocket maximum on one day, only to have to start over the very next day - not good. Somethings - like the hospital charge, were covered the entire time because his admit date was the previous year, but all of his surgery, radiology, medication, PT and life support charges were separate and counted in the new year because they had specific dates of service. Trauma care is expensive. The ambulance ride from one facility to the children's hospital was $2,500 because it was a critical care ambulance staffed w/paramedics. Blood was $535 per unit (he had 10 units). Ventilator support was about $1K per day. It goes on and on. 

 

Oh, yes, the bills can get horrendous.  Several years ago, I had an out-of-network emergency c-section and my DD was in a NICU for 3 months over the new year, 2 months of that was out-of-network.  When she was transferred to our hospital she *HAD* to be flown in.....at a total cost of $12,000.  They wouldn't let her go in an ambulance because they had a 75 mile transfer radius for ambulance.  Fortunately our plan has odd dates and everything was covered under 1 year until we were home and the only thing affected was a couple of weeks of home oxygen.  Her bill was 150K+.  Our OOP max was fairly low then, even for out-of-network and I think we paid 3k.

 

And again this year we had another catastrophic accident and one of my stepsons broke a hip and jaw, his bill was just over 100K, but now our plan isn't as good, and we have bills for over 8k.  Not to mention he has 3.5K of additional dental expenses to fix general cavities from the jaw, and another doc wants 3.5K before he'll even consider finishing (and charging more money) the cosmetic work on the actually broken teeth.   Thank goodness this year they offered additional accident insurance policies and DH took one out.  It went a long way to covering the majority of the main bill.

 

Stefanie