Is anyone using Healthcare.gov and did you get your renewal?

[NoPlaceLikeHome]

A lien is different than becoming homeless.  They can't force you to go live in the street.

Yes but they can take away the biggest thing that most folks are able to give to their kids which is pretty sad IMHO.

[Guest]

My update:

 

Because the gov website didn't update when scheduled, I shopped independently first. $12xx to $17xx with big deductibles and OOP limits.

 

Before I could sign into the gov website, it did allow me to run an estimate, which resulted in only a $47 subsidy and AWFUL plans, so it looked like the above was how it was going to be.

 

Once I could get into my actual account, it rewarded me with an approval for over $500 in subsidies (on a 6-figure income) with lower premiums than above. The plans, once I poured over them, aren't as terrible as I thought at first glance, though I had been used to better. In the end, we're looking at about $15,000/yr, give or take, instead of $32,000/yr, privately.

 

I'm not saying that will work for everyone (I know it can't work for many,) and it does vary by state, but it is NOT as dire as I believed it to be on 11/1. For our family, with our medical history, I'm almost satisfied. Sort of.

 

I have no idea how it might change when dh becomes self-employed instead of employed by someone with an outrageously expensive plan.

Just be careful if your income might go up. We had a small subsidy the first year (which shocked me as we do ok) but had to pay it back at tax time because dh's income went up. Kinda sucked, lesson learned.

[kewb]

I'm sorry if I caused you more stress. I was just remembering my own thought processes when I was briefly uninsured in the US.

 

I don't quite understand what you say about pre-existing. I'm not an expert, but I thought that insurance companies had to cover pre-existing conditions, not previous events. So you can't go to an insurance company and say: 'I had a heart attack last month and was in intensive care. Please cover not only my continuing medical costs but those incurred last month too.' I hope that someone else can correct me if I am wrong. Presumably the premiums would be much higher too if you waited to sign on until after a serious health event.

 

If you switched insurance after that heart attack all expenses related to that heart attack would be considered a pre-existing condition and insurance would not cover it. Follow up testing would not be covered. Pregnancy is considered a pre-existing condition. There have been years I had to pay for my thyroid prescription out of pocket for one year because it was a pre-existing condition.

 

The ACA made it so insurance companies could no longer deny coverage for a pre-existing condition.

Edited November 3, 2016 by kewb

[Carrie12345]

Just be careful if your income might go up. We had a small subsidy the first year (which shocked me as we do ok) but had to pay it back at tax time because dh's income went up. Kinda sucked, lesson learned.

 

That's why we've skipped it in the years they offered tiny subsidies, just to avoid the annoyance.  They do make it very clear when choosing whether or how much to take that you may have to pay some back with an income increase.

[zimom]

Thanks for replying. Maybe I need to work the "we need a payment plan issue" instead of simply asking "can I pay half now?" They ALWAYS say no. And I always end up getting a refund. I've gotten two checks in the last week! I would rather keep my money in my own pocket earning for me than in theirs, even if I don't require a pay plan for that specific procedure.

 

May or may not be helpful...  In August my daughter had surgery.  Unplanned, another $$$$$. Of course I track our medical expenses, deductibles closely so I know where we stand at every point.  Right before the surgery she had a CT so I knew going into the surgery we would have just about $900 left out of pocket.   The surgeon's office called ready to get the $900 as they had called her insurance.  When she called me I just politely told her "Well, you know after her surgery it is all going to depend who submits the bill first, your surgeon, the anesthesiologist, the hospital, and on and on.  If you don't submit first, you will be paid at 100% and you will need to refund the $900 to me.  You know my daughter has multiple medical needs and finances are stretched so I would rather not pay that $900 up front until I know who I owe it to".  Well she knew that I knew it depended on who submitted first and there was a good chance they would end up getting 100% from the insurance.  She immediately said that would be fine and we would just work it out in the end.  Of course they did.  

 

Again, polite, but be knowledgable about your healthcare and what it pays and always willing to be workable.  My husband is CLUELESS about insurance so this is my department.  

 

And to your specific comment up top, after your 'Can I pay half now?", always follow it with how much a month you are going to pay so they know you have a plan to pay it off.  

[Scarlett]

May or may not be helpful... In August my daughter had surgery. Unplanned, another $$$$$. Of course I track our medical expenses, deductibles closely so I know where we stand at every point. Right before the surgery she had a CT so I knew going into the surgery we would have just about $900 left out of pocket. The surgeon's office called ready to get the $900 as they had called her insurance. When she called me I just politely told her "Well, you know after her surgery it is all going to depend who submits the bill first, your surgeon, the anesthesiologist, the hospital, and on and on. If you don't submit first, you will be paid at 100% and you will need to refund the $900 to me. You know my daughter has multiple medical needs and finances are stretched so I would rather not pay that $900 up front until I know who I owe it to". Well she knew that I knew it depended on who submitted first and there was a good chance they would end up getting 100% from the insurance. She immediately said that would be fine and we would just work it out in the end. Of course they did.

 

Again, polite, but be knowledgable about your healthcare and what it pays and always willing to be workable. My husband is CLUELESS about insurance so this is my department.

 

And to your specific comment up top, after your 'Can I pay half now?", always follow it with how much a month you are going to pay so they know you have a plan to pay it off.

Yesterday when I was paying bills I had six different providers for dhs recent medical scare....totally about $1000. I called 3 and asked if I could pay what I wanted to pay.......the other 3 I paid on their website and just paid what I wanted. I have my own little plan.....the smallest I paid in full....the next smallest 3 I paid half....the 4 th smallest I paid a third....and the biggest one I paid $50. On the biggest one (balance about $500) I had a conversation with him and explained I had several smaller bills along with his and I would be paying more soon. He said no problem.

[TranquilMind]

A lien is different than becoming homeless.  They can't force you to go live in the street.

No, but a lien can prevent you from selling or refinancing until it is satisfied. It also has interest attached, so at some point, you could have no equity left in your home and you can be foreclosed upon, so the creditor can get whatever value remains. 

 

Anyway, it's scary. 

[Scarlett]

No, but a lien can prevent you from selling or refinancing until it is satisfied. It also has interest attached, so at some point, you could have no equity left in your home and you can be foreclosed upon, so the creditor can get whatever value remains.

 

Anyway, it's scary.

Yes life is scary in so many ways. So we dont need to make it scarier by thinking we will be homeless if we have a catastrophic medical event. Edited November 3, 2016 by Scarlett

[CinV]

 

I'm sorry if I caused you more stress.  I was just remembering my own thought processes when I was briefly uninsured in the US.

 

 

I don't quite understand what you say about pre-existing.  I'm not an expert, but I thought that insurance companies had to cover pre-existing conditions, not previous events.  So you can't go to an insurance company and say: 'I had a heart attack last month and was in intensive care.  Please cover not only my continuing medical costs but those incurred last month too.'  I hope that someone else can correct me if I am wrong.  Presumably the premiums would be much higher too if you waited to sign on until after a serious health event.

 

You are correct.  If the poster who has no insurance tried to buy it after the expensive hospital stay (I think it was 1,000,000), that stay would not be covered.  Future services related to that event could not be excluded, but that poster would be on the hook for the 60% (her estimate).

[Zinnia]

In Vermont, a family of your size would qualify for Medicaid as long as you made under $11,000 a month.

 

http://www.vtlawhelp.org/income-limits-medicaid

This seems to vary by state. Vermont uses 317% of fpl for insurance for children. Georgia uses 247%. I am sure other states have their own ideas. .

[creekland]

Yes life is scary in so many ways. So we dont need to make it scarier by thinking we will be homeless if we have a catastrophic medical event.

 

We had a tenant who lost their home (foreclosure) due to being unable to pay medical bills.  They had a bankruptcy from it too.  There was nothing at all else wrong with their credit report when we looked at it and they were awesome tenants.  Eventually they saved up enough to buy a new house, but it certainly can happen that one loses their home due to significant medical bills.

[Scarlett]

We had a tenant who lost their home (foreclosure) due to being unable to pay medical bills. They had a bankruptcy from it too. There was nothing at all else wrong with their credit report when we looked at it and they were awesome tenants. Eventually they saved up enough to buy a new house, but it certainly can happen that one loses their home due to significant medical bills.

That doesn't make sense though. Why would they go into foreclosure on their house because they couldn't pay medical bills? Why did they stop paying their mortgage just because they had huge medical bills.

[creekland]

That doesn't make sense though. Why would they go into foreclosure on their house because they couldn't pay medical bills? Why did they stop paying their mortgage just because they had huge medical bills.

 

We didn't ask those questions.  We just looked at their credit report, saw that it matched their story of why they were looking to rent somewhere, and welcomed them into our place.

[J-rap]

It is all very frustrating and a little scary.  We are fortunate in that we have insurance through an employer, and pay $7,000 total per year.  (For a family of 5 now -- 2 are no longer covered.)  But even that rate keeps going up.  It's a very good comprehensive insurance plan otherwise.  

 

And to respond to another poster, pre-existing conditions are covered now.  Insurance won't cover what happened before you had insurance.  But after you get insurance, any future care related to that event will be covered.

 

In our state, apparently state insurance carriers are limiting their enrollment numbers.  So now not only do people have the pressure of digging through everything to find the right insurance, they have the added pressure of doing it as quickly as they can.  Ugh.

 

It is all very confusing and I don't blame people for saying they don't want it and can't afford it!  Right now my dd and her dh are uninsured until Dec. 1 when their employer insurance kicks in.  They were insured through their last employer, but when my dd got a new job (with no time off in-between), her previous insurance ended at the end of the month and her new insurance won't begin for another 30 days.

 

But still, I can't imagine not having any insurance.  We were a very fit and healthy family with no health problems at all.  Then one day my dh suffered a devastating injury which would have cost us over half a million when it first happened.

[creekland]

But still, I can't imagine not having any insurance.  We were a very fit and healthy family with no health problems at all.  Then one day my dh suffered a devastating injury which would have cost us over half a million when it first happened.

 

It doesn't have to be insurance.  For those of us where Health Share works, that's a legal option and far, far less costly than insurance.  As I read about costs here and realize that could have been us (self-employed, etc), my mind is forever thankful we opted for health share over a decade ago.  We now pay $6000 per year (for all 4 of us, but that'd be the same for any size family) + basics & any ongoing prescriptions, but then we have 100% covered when something happens and no networks, etc, to worry about.  Considering some are happy to find a plan costing $1000/month, then has huge deductibles and co-pays and OOP max, etc, we have quite a bit of those "basics" we can pay OOP before we would even come close to breaking even.

 

Last year we had to pay $1300 for just youngest son for an insurance policy through his college.  He used it once for a knee injury and we still had to pay between $100 and $200 for "our share."  Had they accepted health share, we'd have paid nothing extra to have him covered and would have had no cost to us for his injury (since it was over $300).  I'm thankful that this year they DO accept his having health share!  Instant $1300 (or more?) savings to us.  He doesn't care to get a flu shot or regular checkups, so we're not even paying for those (or getting those when he had insurance).  I'd gladly pay for them though if he changed his mind and we'd still have plenty of savings left over.

[6packofun]

Reading about subsidies, it looks like she's either mistaken or just making stuff up.  She makes $40,000.  Subsidies are based on poverty level - 400% of poverty level.  A one-person household can make $47,520 before they exceed 400% of poverty level (and I'm guessing that's her whole income, not after deductions which is the income they use for subsidies).  Now, subsidies are only available through state exchanges and require silver plans.  There are restrictions to who can get subsidies (such as those who can get employer provided insurance, but don't).  But she says she gets a tiny subsidy.  Then there are tax credits that cap monthly premium.  There's a lot of complicated stuff (remember how bloated that bill was), but her numbers don't match what the law dictates.  Seriously, it looks like she shouldn't be over 9.5% of income for her premiums.

 

 

 

Who is responsible for making sure that all the tiny details are followed?  I'm just curious with all these rules about income and caps and subsidies and restrictions and tax credits, are people overpaying when they shouldn't be because they just don't realize that they have to keep track of all these things to be sure they are getting what they are supposed to be?  Is the system even equipped to know when a family's plan has reached the out of pocket max and things like that?

 

This seems 10x worse than trying to navigate Medicare and all of its idiosyncrasies. lol  Are there AHA counselors?   :confused1:   (Don't get me wrong, everyone needs to be their own advocate, but if it requires healthcare management to be a part-time job, it's overly complicated and ridiculous.  And I realize that this frustration was baked into this plan as well.)

[Spryte]

That doesn't make sense though. Why would they go into foreclosure on their house because they couldn't pay medical bills? Why did they stop paying their mortgage just because they had huge medical bills.

 

I can't answer for that couple, but I can imagine how this might happen.  

 

15ish years ago, I was diagnosed with 13 severe chronic infections (including a brain infection).  My situation was dire.  Our insurance did not fully cover treatment.  There are 2 groups of physicians who have put out peer-reviewed treatment guidelines.  One group says that I would basically suffer for the rest of my life, the other says that with more, expensive treatment - I would recover.  Guess which guidelines our insurance used?  The first.  Of course.  So DH and I footed the bill for my treatment.  At some points, in a 5 year treatment plan, it was $5K per month.  We used the equity in our home, and we used credit cards.  We are still paying for it all.

 

But - I'm well.  :)  DH feels it was worth it.  I do, too.  And I know our kids do!

 

So, sometimes people put their medical debt on a credit card, or an equity line.  And then it doesn't look so much like medical debt, but more like consumer debt.  

 

I don't think that's necessarily what happened with the family creekland mentioned, but it's one (painful) scenario.  I certainly wouldn't stop paying our mortgage over medical bills either, but who knows what could happen if someone is disabled, laid off, etc?

 

I do agree with you completely, that we shouldn't borrow stress or create more stress in worrying about losing a house over medical bills.  

[6packofun]

It doesn't have to be insurance.  For those of us where Health Share works, that's a legal option and far, far less costly than insurance.  As I read about costs here and realize that could have been us (self-employed, etc), my mind is forever thankful we opted for health share over a decade ago.  We now pay $6000 per year (for all 4 of us, but that'd be the same for any size family) + basics & any ongoing prescriptions, but then we have 100% covered when something happens and no networks, etc, to worry about.  Considering some are happy to find a plan costing $1000/month, then has huge deductibles and co-pays and OOP max, etc, we have quite a bit of those "basics" we can pay OOP before we would even come close to breaking even.

 

Last year we had to pay $1300 for just youngest son for an insurance policy through his college.  He used it once for a knee injury and we still had to pay between $100 and $200 for "our share."  Had they accepted health share, we'd have paid nothing extra to have him covered and would have had no cost to us for his injury (since it was over $300).  I'm thankful that this year they DO accept his having health share!  Instant $1300 (or more?) savings to us.  He doesn't care to get a flu shot or regular checkups, so we're not even paying for those (or getting those when he had insurance).  I'd gladly pay for them though if he changed his mind and we'd still have plenty of savings left over.

 

I have a question about health sharing.  When you go to the dr. and are billed, what happens then? Do you pay it and are reimbursed or do you submit it to the health share organization and they take care of it before the bill is overdue?  Our family has a $3000 deductible which is NOT bad for a family our size.  But we don't have even $500 in the bank or our HSA at any one time so it's a lot for us.  We CANNOT pay out of pocket and get reimbursed.  So is health sharing only going to work for those who can pay up front in the first place and just hope it is covered?  I have no idea how it works!

[CinV]

That doesn't make sense though. Why would they go into foreclosure on their house because they couldn't pay medical bills? Why did they stop paying their mortgage just because they had huge medical bills.

The medical issue that caused the huge medical bills probably resulted in significant loss of income (no sick leave, no disability, possibly even a loss of employment if the person could not continue doing their job).

[creekland]

I have a question about health sharing.  When you go to the dr. and are billed, what happens then? Do you pay it and are reimbursed or do you submit it to the health share organization and they take care of it before the bill is overdue?  Our family has a $3000 deductible which is NOT bad for a family our size.  But we don't have even $500 in the bank or our HSA at any one time so it's a lot for us.  We CANNOT pay out of pocket and get reimbursed.  So is health sharing only going to work for those who can pay up front in the first place and just hope it is covered?  I have no idea how it works!

 

This all depends upon the health sharing group (I think there are four of them?) and the medical facility.

 

We go with Samaritan Ministries, so we deal with the bills and get reimbursed two months later.  That doesn't usually mean we pay up front though.  Two hospitals and almost all doctors I deal with let us pay later if we choose to.  They like that they don't have to deal with insurance, so bend over backwards being accommodating, including self pay discounts (to help the health share save $$). The hospitals want a payment plan, so have automatically set me up to pay $10/month until we get reimbursed.

 

Then there's Johns Hopkins...  They were a bear to deal with.  At first we had to come up with a huge amount to get treated there (mid 5 digits).  Later we got about 14K of that returned to us because they overestimated...  They told me they require insurance companies to do the same because of the type of treatment (radiation) I was getting.  Apparently it's not usually covered by insurance, so the "pay first" policy is there.  Samaritans didn't blink about covering it, but we did have to really switch around our finances to come up with that up front amount.  Fortunately, we were able to.  I know most would not... 

 

For other stuff, they want a partial payment up front and will bill the rest for their Physicians.  That partial payment varies from $75 to $250 and some departments want payment for treatments too (we've paid up to $550 as a deposit getting billed for the rest later).

 

Now that we've dealt with them for 3 years and they see how health share works, the departments I've been with have no problem billing later for everything (like the MRIs and doctor visits), but when I might get sent to a different department for something, we get to start the whole thing over again - not fun.  I've had to let hubby be the one to deal with it as he has far more patience than I do.  He's learned key words to say and various codes to get what he needs.

 

We despise JH's billing system (not people - people have been awesome, often telling us we have better coverage than they do - but their system needs to figure out how to handle health share TBH and they are unlikely to do so as they have no need - they're big enough to not have to worry about it).

 

Back to my original high dollar problem... It's unlikely any insurance we'd have been with would have covered that type of radiation, so I'd have had to switch to a more common/dangerous (for brain radiation) option or paid out of pocket without getting reimbursed - or nothing.  There is no law that says one must get treatment for these sorts of things.  No money (or coverage allowed)?  You're out of luck.

 

We would have never paid for it OOP without getting reimbursed.  It was simply too much money for me to spend on something like that.  Considering the after effects I'm having from radiation now, I shudder at what could have happened if I'd have had to go with something more dangerous.  Doing nothing would have been preferable - though then one would have had to worry about continued tumor growth - which for me, would most likely have been deadly considering the tumor encases part of the left carotid artery.  If it grew inward...

 

Tough choices all around.  I'm glad finances worked out.  If JH (or other places where they have this) were to be willing to bill for it for health share, it would be a total win going that route.  I have no idea if they would consider it for others now (that they've seen health share in action) or not.  I have heard that other top places (like Mayo) are far easier to deal with financially, but that's hearsay.  I haven't gone there.

Edited November 3, 2016 by creekland

[ChocolateReignRemix]

One reminder on health share ministries - none of the health shares make any guarantees of payment.  They are also genrally not regulated as insurance and there is no requirement for reserve funds or any other protections in place that protect those who use traditional insurance. 

[zimom]

One reminder on health share ministries - none of the health shares make any guarantees of payment.  They are also genrally not regulated as insurance and there is no requirement for reserve funds or any other protections in place that protect those who use traditional insurance. 

 

And of course, they will not cover pre-existing conditions.  They would basically slam the door in my daughter's face.  

[Murphy101]

That doesn't make sense though. Why would they go into foreclosure on their house because they couldn't pay medical bills? Why did they stop paying their mortgage just because they had huge medical bills.

Oh wow. LOTS of reasons.

 

If you need meds or medical care and you can't pay for it any other way, many people will put it on credit or get loans. I've known some who even got second mortgages to cover chemo. Or more accurately, to cover living expenses due to their funds covering medical. Is that financially sound practice? Can they afford to pay that back? Probably not. But what are they supposed to do? Just not buy insulin or not get cancer treatment?

 

Cannot state clearly enough that insurance does not equal medical care. Many many people still can't afford medical care and in their efforts to scrape anything they can together to get it, they often end up screwed financially. Even at the expense of their homes and jobs.

Edited November 3, 2016 by Murphy101

[creekland]

One reminder on health share ministries - none of the health shares make any guarantees of payment.  They are also genrally not regulated as insurance and there is no requirement for reserve funds or any other protections in place that protect those who use traditional insurance. 

 

True, but with the cost differences... I'm glad we took the "risk."  In over a decade with a handful of needs under our belt now from the basic (broken collar bone) to the mid-level (youngest son developing a form of epilepsy as a teenager) and all the issues I've had related to my brain tumor, we haven't had a problem.  Even during the times when payments get pro-rated, our health share has always been there checking to make sure everything we need is covered.  I guess there's a risk, but I've seen far more issues arise from those at work who are covered by insurance.  We just raised 5K for one of the latest "needs" for someone at our school.  No one had to raise a dime for me.  (They gave me some gift cards anyway - sweet folks!)

 

I can't attest to other health shares, of course, and no one knows the future, but we'll continue "risking it."

 

And of course, they will not cover pre-existing conditions.  They would basically slam the door in my daughter's face.  

 

Yes, this is a major problem excluding many.  We, personally, are fortunate that we signed up over a decade ago and had no issues.  Some pre-existing conditions are covered now if there's been a long enough time without issues from them, but it's still a big problem overall.

 

And then there's that "must be an active Christian" part that excludes many.  I wish Congress would allow new Health Shares to be created based upon the good working models and those could easily include more people under different banners (similar to Credit Unions), but that's not legal at this point.

[Carrie12345]

  At some points, in a 5 year treatment plan, it was $5K per month.  We used the equity in our home, and we used credit cards.  We are still paying for it all.

 

But - I'm well.   :)  DH feels it was worth it.  I do, too.  And I know our kids do!

 

 

 

It's easy to forget that it's not "just a few late bills" in many cases.  When someone requires FIVE YEARS (or one, or even a couple of months) of treatment, how many doctors are going to be able to continue seeing them that long without receiving payment?  "Sorry, Doc, gotta pay my mortgage instead" may sound like a great idea, but the doctor has to pay his, too!

 

So glad you're well now!

[J-rap]

It doesn't have to be insurance.  For those of us where Health Share works, that's a legal option and far, far less costly than insurance.  As I read about costs here and realize that could have been us (self-employed, etc), my mind is forever thankful we opted for health share over a decade ago.  We now pay $6000 per year (for all 4 of us, but that'd be the same for any size family) + basics & any ongoing prescriptions, but then we have 100% covered when something happens and no networks, etc, to worry about.  Considering some are happy to find a plan costing $1000/month, then has huge deductibles and co-pays and OOP max, etc, we have quite a bit of those "basics" we can pay OOP before we would even come close to breaking even.

 

Last year we had to pay $1300 for just youngest son for an insurance policy through his college.  He used it once for a knee injury and we still had to pay between $100 and $200 for "our share."  Had they accepted health share, we'd have paid nothing extra to have him covered and would have had no cost to us for his injury (since it was over $300).  I'm thankful that this year they DO accept his having health share!  Instant $1300 (or more?) savings to us.  He doesn't care to get a flu shot or regular checkups, so we're not even paying for those (or getting those when he had insurance).  I'd gladly pay for them though if he changed his mind and we'd still have plenty of savings left over.

 

Oh absolutely!  And when I said "insurance" I really meant anything.  I think that Health Share sounds super!

[Scarlett]

Oh wow. LOTS of reasons.

 

If you need meds or medical care and you can't pay for it any other way, many people will put it on credit or get loans. I've known some who even got second mortgages to cover chemo. Or more accurately, to cover living expenses due to their funds covering medical. Is that financially sound practice? Can they afford to pay that back? Probably not. But what are they supposed to do? Just not buy insulin or not get cancer treatment?

 

Cannot state clearly enough that insurance does not equal medical care. Many many people still can't afford medical care and in their efforts to scrape anything they can together to get it, they often end up screwed financially. Even at the expense of their homes and jobs.

 

 

The specific post I was replying to had to do with 'good thing we had insurance or we would be homeless since the car accident was so catastrophic.'  My point is having insurance, not having insurance is not what determines if a person loses their home.  Someone mentioned taking out a line of credit on their house to pay for uninsured treatments.  I might do that. Staying alive is pretty important to me.  

 

But just your normal every day accident where a bunch of medical bills get wracked up sky high---that shouldn't cause anyone to be homeless.  Bankrupt maybe...but you can retain your house.  A lien on the house maybe....but you at least won't be homeless while you try to figure something out.

 

Loss of income would be a bigger reason to me why people would lose their home.  Like I said, any number of bad things can happen and when several bad things go wrong one after the other sometimes it is impossible to stay afloat with or without insurance.

[Scarlett]

The medical issue that caused the huge medical bills probably resulted in significant loss of income (no sick leave, no disability, possibly even a loss of employment if the person could not continue doing their job).

 

 

Could be.  But loss of income is something more than just having high medical bills.

[EMS83]

 

I'm sorry if I caused you more stress.  I was just remembering my own thought processes when I was briefly uninsured in the US.

 

 

I don't quite understand what you say about pre-existing.  I'm not an expert, but I thought that insurance companies had to cover pre-existing conditions, not previous events.  So you can't go to an insurance company and say: 'I had a heart attack last month and was in intensive care.  Please cover not only my continuing medical costs but those incurred last month too.'  I hope that someone else can correct me if I am wrong.  Presumably the premiums would be much higher too if you waited to sign on until after a serious health event.

 

 

Oh I see.  I'm sorry, too.  I'm just tired of the or elses.  I know it's easy to worry about them, though.

 

Cancer, or late onset illnesses, or a debilitaing accident--these are the things I was thinking of for pre-existing.  The insurance, I'm fairly sure, would have to cover any resulting issues from the initial event, even if you weren't insured when it happened.  Maybe not the bills for the event, but I just don't see how ICU for a week after a heart attack would cost a million.  $100k maybe, but not a million.  A million seems more inline with things like neuro issues, cancer treatments, and gene therapy stuff, which would be covered under pre-existing.  Well, maybe.  Some of that is still experimental and even Medicaid won't cover it.  But then I just fall back to my second point.  I don't have happy thoughts about hospitals.

 

When we actually hit the bracket where we're paying money  to the federal government instead of receiving it, we'll pay the fine.  It would still be cheaper.  If I could afford the $$$ in premiums, deductibles, and co-insurance, plus whatever insurance doesn't cover, I'd just bank it, or invest it.

[Guest]

I have a question about health sharing. When you go to the dr. and are billed, what happens then? Do you pay it and are reimbursed or do you submit it to the health share organization and they take care of it before the bill is overdue? Our family has a $3000 deductible which is NOT bad for a family our size. But we don't have even $500 in the bank or our HSA at any one time so it's a lot for us. We CANNOT pay out of pocket and get reimbursed. So is health sharing only going to work for those who can pay up front in the first place and just hope it is covered? I have no idea how it works!

Yes, we pay out of pocket. Sometimes they will allow payment plans or even delay any charges until reimbursement comes, it's just the nature of medical offices and varies a lot. Usually they're happy if I say I can pay something, haggle for a discount, and let them know a date by which the rest will come. A few providers require monthly amounts on a payment plan. Some jerks, like my allergist, offer pretty much no discount off their exorbitant prices AND require it at the time of service. That was 2k that hurt.

 

The way we manage that is put them on a specific credit card and pay it off with the reimbursement check, which is issued directly to us to then pay the provider. The balances aren't carried long so the small interest is no big deal.

 

The bleeping ACA ruined our plan and made it jump from about $400 to $1700 monthly, with 10k deductibles and still almost no coverage. We looked at the current plans and the best we could get for the bronze plan was about $2300 a month with the same stupidly high deductible, which we have paid four of five years we had the plan.

 

So yeah, I'll take my private Christian cost sharing and carrying small out of pocket expenses and meds any day. I'll even deal with the paperwork headache and carrying a credit card I don't want. It's my personal and much less financially painful penalty for not dealing with Obamacare. And yes, we have no lifetime out of pocket max, we pay a little extra to expand the catastrophic allowances in addition to the monthly fee. Worth it. The plan the ACA ruined for us was also a catastrophic plan, because we tried to be responsible and self insure our family for things we couldn't feasibly weather.

 

 

Cue more unarticulated screams and curses here.

Edited November 4, 2016 by Arctic Mama

[ktgrok]

Oh I see.  I'm sorry, too.  I'm just tired of the or elses.  I know it's easy to worry about them, though.

 

Cancer, or late onset illnesses, or a debilitaing accident--these are the things I was thinking of for pre-existing.  The insurance, I'm fairly sure, would have to cover any resulting issues from the initial event, even if you weren't insured when it happened.  Maybe not the bills for the event, but I just don't see how ICU for a week after a heart attack would cost a million.  $100k maybe, but not a million.  A million seems more inline with things like neuro issues, cancer treatments, and gene therapy stuff, which would be covered under pre-existing.  Well, maybe.  Some of that is still experimental and even Medicaid won't cover it.  But then I just fall back to my second point.  I don't have happy thoughts about hospitals.

 

When we actually hit the bracket where we're paying money  to the federal government instead of receiving it, we'll pay the fine.  It would still be cheaper.  If I could afford the $$$ in premiums, deductibles, and co-insurance, plus whatever insurance doesn't cover, I'd just bank it, or invest it.

 

That assume you could get insurance. Most employer plans only have open enrollment once a year. Same with the new health exchanges. So it could be many many months until you could enroll in one of them. You could try to get private insurance, but they don't have all the same restrictions and it could be difficult, or at least very expensive. 

[Murphy101]

The specific post I was replying to had to do with 'good thing we had insurance or we would be homeless since the car accident was so catastrophic.' My point is having insurance, not having insurance is not what determines if a person loses their home. Someone mentioned taking out a line of credit on their house to pay for uninsured treatments. I might do that. Staying alive is pretty important to me.

 

But just your normal every day accident where a bunch of medical bills get wracked up sky high---that shouldn't cause anyone to be homeless. Bankrupt maybe...but you can retain your house. A lien on the house maybe....but you at least won't be homeless while you try to figure something out.

 

Loss of income would be a bigger reason to me why people would lose their home. Like I said, any number of bad things can happen and when several bad things go wrong one after the other sometimes it is impossible to stay afloat with or without insurance.

Just to note... You can't always retain your home in bankruptcy. Usually you can, but the bank is not required to continue with you. The bank can and sometimes does decide they'd rather take the house. And also the judge has to approve the bankruptcy conditions and though most just rubber stamp it, sometimes they don't.

 

But I do agree, with or without insurance, anyone can end up bankruptcy and or homeless due to medical costs in this country. They shouldn't. Because imnsho, that just shouldn't ever happen in one of the richest countries in the world. But they do. With a nasty shameful frequency.

 

For the very many people living paycheck to paycheck, all it takes in one car wreck to toss them over the financial cliff even if they don't lose their job/income. For those people, and again there are many many of them, there is no such thing as a "normal every day accident". Keep in mind the many threads over topics discussing things like how few Americans feel they could not come up with even $500-1000 in an emergency.

 

We cannot be a nation that both has that problem and yet also a nation where so many of those same people are expected to not suffer tremendously when faced with much worse in medical bills. The math just doesn't work like that.

[EMS83]

It would help if hospitals didn't charge insanely ridiculous amounts for things.  After DD was born (natural), the postpartum nurse kept hounding me to take a Motrin.  As in several exchanges of:

"Do you want a Motrin?"  

"No."  

"Are you sure, I can go get you one."  

"No, I'm fine."  

"Really?  Are you sure?  It's no trouble."

 

Room and board charges were around $2500/night each for me and baby.  This was while I was under a COBRA plan from my dad's insurance and the premium was through the roof with a super low deductible.  I think the hospital actually got about 40% of what they asked--$9500 out of $23,000 charged for LDR, and a two night stay in postpartum and nursery.  The other two babies were covered by Medicaid, so I don't know what that transaction looked like.  I know Medicaid payers pay far lower than anyone, though-or sometimes not at all.  Office staff mention that sort of thing from time to time.  

 

Various offices aren't any better.  The disparity is unfathomable and aggravating.

Like I mentioned with the pediatric cardiologists, rates vary wildly depending on what business the're in and who they're ultimately serving.  There's no way the one office was $2,000 better than the other.  They're running and reading EKGs.  Just like there's no way one pediatrician costs $500, another costs $70, and one is $430 better than the other.

 

Or I had a test at the OB's.  The nurse told me if I paid through them, it was $7.  If I waited for the lab to bill me, it would be closer to $70.  I'm fairly sure it would have been the same lab running the test either way, though (not 100%, that was several years ago).  

 

Or why does it cost $5 to pee in a cup so a tech can take maybe 30 seconds dipping a $0.01 strip in it and reading it after x number of minutes (during which she's doing something completely unrelated to said test, so that time doesn't count).  That 30 seconds was $0.17 of her hourly wage, assuming she gets about $20/hour.  So $0.18 for labor and materials and that's a what?  Nearly a 3000% mark up?

 

Maybe someone here can explain these things to me, because they don't make any sense whatsoever.  My only guess is the more hands involved, the more salaries need to be paid, and the higher the malpractice insurance is, as well.  Medical school debt and overhead for purchasing and maintaining equipment are close seconds.

 

I'm rambling, I know.  I'm sorry.  The whole thing makes me madder than a wet hen.  It should be a free market and it's not.  Or a sliding scale payment system, at least.  Malpractice insurance shouldn't exist; it should be a criminal offense, not a litigation case, with punitive damages awarded and a loss of license.  Life-saving drugs should be cheap or free, and R&D should be crowd-funded.  Let the marketing be for whose onto the latest breakthrough.  I can see that backfiring though.  Bread and circuses.  I'll shut up now.   :svengo:

[Scarlett]

I heard a segment on NPR the other day........some huge business leader talking about the horrible system we have. He told the story of a guy he met....an entrepreneur who had gone to the doc with some heart issues....doc says you need this test ( I think it was stress test but not sure) he asks doc how much does that cost? Doc says I have no idea.....

 

So patient goes out and does his homework....get prices for 10 or so providers....ranging from 1200 to 6000. He goes back cardiologist and says I did some checking....best place is 1200 but the 1400 place is much more convenient, so I am going with that.

 

Doc says 1400 dollars!!!! He punches around on his computer ad says this patien only has a. 2% chance of I being a serious heart problem and recommend he just forget the test!

[ChocolateReignRemix]

 

 

I'm rambling, I know.  I'm sorry.  The whole thing makes me madder than a wet hen.  It should be a free market and it's not.  Or a sliding scale payment system, at least.  Malpractice insurance shouldn't exist; it should be a criminal offense, not a litigation case, with punitive damages awarded and a loss of license.  Life-saving drugs should be cheap or free, and R&D should be crowd-funded.  Let the marketing be for whose onto the latest breakthrough.  I can see that backfiring though.  Bread and circuses.  I'll shut up now.   :svengo:

 

Why on earth do you think medical mistakes should be a criminal offense?

[DawnM]

Are all of you in a position where you have your own business?  Is this why you need your own insurance?  Does your (or your spouse's) company not offer it?

 

We have never worked for ourselves and have always had company subsidized insurance.

[creekland]

Are all of you in a position where you have your own business?  Is this why you need your own insurance?  Does your (or your spouse's) company not offer it?

 

We have never worked for ourselves and have always had company subsidized insurance.

 

We are, or rather, hubby is.  We started with insurance when he started his own business and switched soon afterward when we needed something less expensive and took the risk with health share.  I am so glad we took the risk back then.

 

I think at this point I could buy into our school's policy since I've been there so many years, but having seen that policy in action - no thank you.  I'd have to buy into it, not have most of it covered like other (full time) employees.

[MaeFlowers]

Are all of you in a position where you have your own business? Is this why you need your own insurance? Does your (or your spouse's) company not offer it?

 

We have never worked for ourselves and have always had company subsidized insurance.

Dh is self employed as is most of his family. Those who are insured pay through the nose.

[DawnM]

We are, or rather, hubby is.  We started with insurance when he started his own business and switched soon afterward when we needed something less expensive and took the risk with health share.  I am so glad we took the risk back then.

 

I think at this point I could buy into our school's policy since I've been there so many years, but having seen that policy in action - no thank you.  I'd have to buy into it, not have most of it covered like other (full time) employees.

 

Really?

 

I switched from DH's to my own, since it saves us about $3000 per year.  So far I have found it to be not quite as good as his, but adequate.  

 

They pay far less for out of network care, so I am in the process of finding in-network stuff, my reg. doc was already in network but I am still going to switch (long story but if I can ONLY go to him, I will need to switch since we are personal friends with the family and it is a bit awkward.  I will keep him for the kids.)

But if you have to pay for it, it might not be worth it.  

[Carrie12345]

Are all of you in a position where you have your own business?  Is this why you need your own insurance?  Does your (or your spouse's) company not offer it?

 

We have never worked for ourselves and have always had company subsidized insurance.

 

Dh works for a national company with very few employees.  They offer 50% coverage for him on a pricey, very high deductible plan.  The kids and I could enroll with them if we pay 100%.  It's way beyond our reach.  The partners who actually use it have no or grown children and make a heck of a lot more money than dh does.