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

[Scarlett]

Medical providers, including non-profit hospitals, can place leins against a house.

 

 

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

[TechWife]

I don't want to sound like I am defending the healthcare system because yes it is bad....but remember that Obamacare does have a family cap on yearly out of pocket. I think it is 12500. Most people won't go bancrupt over that amount. I mean it would totally suck! But it is an amount that could be paid off in most cases.

The out of pocket maximum only applies to services covered by the insurance plan. There is no limit on non-covered services that are billed directly to the patient. You might be amazed at the services, supplies and medications that aren't covered.

[Zinnia]

Good stories like this make me feel better about my premiums being so high.  My brother and wife have free coverage as well and since she is going through cancer right now the coverage has been a real blessing.  My niece was able to get free care while she went through nursing school.  Friends who have a small fence building business get free medical.  So I am very happy for the people who it benefits.

 

These are great stories.  I wish I heard more.

 

I have heard of literally NO ONE in my circles that has gotten free healthcare.  They have large premiums, then pay a lot (deductibles) before the insurance actually kicks in. 

 

We have employer sponsored, and our insurance went to the high deductible/oop model as soon as the recession hit in 2007/2008.  Our family and friends didn't believe the stories I told about our costs, and my medical providers questioned me a lot about it during my last 3 pregnancies (08, 10, 12).  Now, no one questions it much anymore, but I'm sort of sad it's only because the stories have become so common.

[Scarlett]

These are great stories.  I wish I heard more.

 

I have heard of literally NO ONE in my circles that has gotten free healthcare.  They have large premiums, then pay a lot (deductibles) before the insurance actually kicks in. 

 

We have employer sponsored, and our insurance went to the high deductible/oop model as soon as the recession hit in 2007/2008.  Our family and friends didn't believe the stories I told about our costs, and my medical providers questioned me a lot about it during my last 3 pregnancies (08, 10, 12).  Now, no one questions it much anymore, but I'm sort of sad it's only because the stories have become so common.

 

 

I think a lot of it depends on the state.  The stories I mostly know of are from AR and they expanded the Medicaid there.  

[JustEm]

I think a lot of it depends on the state. The stories I mostly know of are from AR and they expanded the Medicaid there.

Where medicaid was expanded it has helped a lot of people. We are now eligible for Medicaid in our state because it was expanded, which is great to a certain extent. Where it gets tricky is if dh gets a tiny raise, then we won't be eligible anymore and any additional money that now goes to saving for non medical emergencies and our future would quickly disappear. I've run the numbers because I know sooner or later we will be ineligible for Medicaid and the numbers simply end up screwing us out of the tiny amount we can save per month now. And that is just with what we'd pay in premiums including the subsidies. That doesn't take into account the deductibles.

 

So for now we have to decide if it is more worth it to decline salary raises for the sake of staying in Medicaid. There has got to be a better way to handle healthcare that doesn't keep people stuck at lower incomes.

[Butter]

I was watching the news this morning and a woman who makes $40,000 a year was interviewed. 

 

Her payment WITH the subsidy was now $900 a month, under the ridiculous increases.  Her subsidy was a whopping $200 against her $1,100 monthly payment.  That payment exceeds my mortgage payment, by the way. 

 

So once you account for taxes, this woman must pay basically half her income just for her health insurance, under penalty of law or she will be fined. 

Nothing like fining people too poor to afford health insurance they are forced to buy. 

 

What the hell?

 

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.

 

http://obamacarefacts.com/obamacare-subsidies/

[Scarlett]

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.

 

http://obamacarefacts.com/obamacare-subsidies/

 

 

That is kind of what I was thinking but not knowing all her details it is hard to say.  

 

Edited:  Dh and I are 49 and 51 and our full premium is $1116 for both of us.  So that would only be about $550 for each of us.  It isn't a great plan...high deductible...but it is BCBS which is great insurance when you need it IME.

Edited November 1, 2016 by Scarlett

[TranquilMind]

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.

 

http://obamacarefacts.com/obamacare-subsidies/

 

It does look that way. I just saw this random woman being interviewed.  I will try to see if I can find anything about her. 

 

[mom2scouts]

I know two lower middle class friends who say their health insurance premiums are more than their mortgage payments. Another friend said his premiums are increasing by 70% this year. We were on Medicaid for a while, but we never went to the doctor because there aren't any doctors within 50 miles who will take new medicaid patients. This whole thing is going to implode at some point. Plenty of people are going to drop insurance and we'll be right back to where we started, except it will be a different group of people without insurance.

[mom2scouts]

*double post*

Edited November 1, 2016 by mom2scouts

[Guest]

I know two lower middle class friends who say their health insurance premiums are more than their mortgage payments. Another friend said his premiums are increasing by 70% this year. We were on Medicaid for a while, but we never went to the doctor because there aren't any doctors within 50 miles who will take new medicaid patients. This whole thing is going to implode at some point. Plenty of people are going to drop insurance and we'll be right back to where we started, except it will be a different group of people without insurance.

Our insurance has always been more than our mortgage. Thanks to the ACA, we aren't stuck with DH's work policy and can now shop around. I added it up once and we've paid hundreds of thousands of dollars on insurance in the past 20 years. That is why the middle class aren't saving for retirement or kid's college. Makes me freaking sick.

[ktgrok]

Yes, ours is higher than our mortgage, and has been for years. Meanwhile, the CEOs of those insurance companies are making money hand over fist, with salaries in the multi million range per year. 

[QueenCat]

I know two lower middle class friends who say their health insurance premiums are more than their mortgage payments.

 

Without knowing what their mortgage payment is, that means nothing. Plenty of people have low mortgage payments due to either less expensive homes, decent deposits on their homes, etc........... At one point, I had a mortgage payment of less than $600.

[ktgrok]

Without knowing what their mortgage payment is, that means nothing. Plenty of people have low mortgage payments due to either less expensive homes, decent deposits on their homes, etc........... At one point, I had a mortgage payment of less than $600.

 

Our mortgage is $1,013, including home owners insurance, mortgage insurance, etc. (per month). 

 

Our medical insurance is about $1,200, including dental and vision. BUT we have low deductibles this year, for the first time. Last year it was $1,100 and high deductibles. (he switched jobs/companies). 

[Guest]

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Edited September 10, 2020 by Æthelthryth the Texan

[zimom]

Scarlett (I think) has made a few great points I would like to reiterate.  Even if you have a $10,000 deductible, one day you MIGHT pay that off if you are in an accident and have $200,000 in claims.  At least $190,000 will be paid and you can slowly chip away at the $10 grand.  I am still paying off a large bill for my daughter from three years ago.  Our premiums, deductibles and quality of health insurance has really varied over the years, especially over the last 10 years since I left my career.   This year we will be looking at over $100,000 in claims but only have about $5,000 out of pocket.  We will hopefully pay that off by mid next year.  As long as we are making regular payments, the providers are happy.  

 

If you DON'T qualify for a subsidy, shop for health insurance privately.  A couple of years we purchased our policy directly from Blue Cross Blue Shield.  It was a much better policy for the money then if we had purchased directly through healthcare.gov   Fortunately we now have decent (not great, but decent) insurance through my husband's work.  

 

In Georgia alone, according to a report I read today, over 80% of enrollees can use their subsidies to purchases a plan for less then $100.   You may view this as only a 'catastrophic' plan, but it is certainly better then declaring bankruptcy and these plans all cover well visits, immunizations, mammography and many other things for zero out of pocket.  I would certainly pay $100 a month for piece of mind.  I guess it was just how I was raised but not being insured is not an option, even if I had to work a second job.  

[AmandaVT]

Medicaid is very big in Vermont. Most children in the state are covered, through Dr. Dynasaur. Almost everyone I know that doesn't have insurance through their employer qualifies for Medicaid. 

 

I wish the subsidies were a little more graduated here. If we made about $1,000 less annually, I believe we'd qualify for $600/month in subsidies. We're just over the threshold for getting a subsidy, so we have to pay full price. 

 

I don't believe that in our state, we can buy insurance anywhere except the exchange. I'd love another option though! We have BCBS, which is great insurance, but I'm not sure if we're going to be able to afford the increase in price next year. 

 

Here are our BCBS plans for next year. Our dental plan is about $240/month. I noticed that they actually lowered the OOP max for this coming year, so that's one positive! We're on the silver blue rewards health and wellness plan.

 

http://www.bcbsvt.com/wps/wcm/connect/312bad12-e87b-4ec3-a913-37af8ef3b503/2017-bcbsvt-qhps-quick-compare-group.pdf?MOD=AJPERES

[Murphy101]

I don't want to sound like I am defending the healthcare system because yes it is bad....but remember that Obamacare does have a family cap on yearly out of pocket. I think it is 12500. Most people won't go bancrupt over that amount. I mean it would totally suck! But it is an amount that could be paid off in most cases.

Hmmm. The median income in the USA is approx $51k. Even 12500 is nearly 25% of their annual income. And that presumes they had little no other debts, which is doubtful as most people need at least rent/mtg, a vehicle often has a pmt, and daycare.

 

Adding 25%+ in debts to that could easily drive anyone in the median or less income area into bankruptcy. Especially if it's combined with income loss which many very expensive medical situations tend to do.

[Murphy101]

I'm not saying whether anyone should get or should not get insurance. Do whatever they feel they can or must.

 

But do not do it just to avoid bankruptcy. The odds are against it working that way should something truely awful happens. Medical bills are the main source of bankruptcy and most people doing for that reason had insurance.

[mellifera33]

Scarlett (I think) has made a few great points I would like to reiterate.  Even if you have a $10,000 deductible, one day you MIGHT pay that off if you are in an accident and have $200,000 in claims.  At least $190,000 will be paid and you can slowly chip away at the $10 grand.  

 

 

 

But that's not the way a deductible works. The deductible is the amount you pay out of pocket *before* insurance starts paying anything. For example, the year that my daughter was born, we had a $5000 per person deductible. Maternity care and a C-section came to about $40,000. Baby's hospital stay and cardiac workup came to about $10,000. My totals were "bargained down" by the insurance company to about $8000. After we had paid $5000 of it, insurance picked up 80%, so we paid $5600 oop, insurance paid $2400. Baby's bills were bargained down to about $5000, all of which we paid because we hadn't met the deductible yet. So with insurance, our billed amount was about $50,000, the negotiated amount was about $13,000, we paid about $10,600 out of pocket, and the insurance company paid about $2,400.

[Scarlett]

But that's not the way a deductible works. The deductible is the amount you pay out of pocket *before* insurance starts paying anything. For example, the year that my daughter was born, we had a $5000 per person deductible. Maternity care and a C-section came to about $40,000. Baby's hospital stay and cardiac workup came to about $10,000. My totals were "bargained down" by the insurance company to about $8000. After we had paid $5000 of it, insurance picked up 80%, so we paid $5600 oop, insurance paid $2400. Baby's bills were bargained down to about $5000, all of which we paid because we hadn't met the deductible yet. So with insurance, our billed amount was about $50,000, the negotiated amount was about $13,000, we paid about $10,600 out of pocket, and the insurance company paid about $2,400.

 

 

I am not sure what you are trying to say here.  If you have a car accident they don't greet you in ER and ask for the 10K deductible up front.  They bill your insurance and then bill you.  

[mellifera33]

I am not sure what you are trying to say here.  If you have a car accident they don't greet you in ER and ask for the 10K deductible up front.  They bill your insurance and then bill you.  

 

The original post I referred to suggested that you might have to pay the $10,000 if you have $200,000 in medical bills. I'm just saying that the amount of the deductible is the same whether you have $10,000 in medical bills or $500,000. The deductible isn't your share of an enormous bill, it's the amount that you have to pay for health care before the insurance starts taking care of it. If you have $10,000 in medical bills every year, and a $10,000 deductible, you will then be paying $10,000 every year. It would be easy for a family to have a minor, but expensive medical issue every year and be on the hook for $10,000 each time. One year a difficult birth. The next year--knee surgery for someone. The next year--several rounds of strep and a tonsillectomy. How many middle class families could pay $10,000, plus high premiums, each year for several years in a row? 

Edited November 1, 2016 by mellifera33

[Guest]

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Edited September 10, 2020 by Æthelthryth the Texan

[TX Native]

nm

Edited November 9, 2017 by TX native

[Scarlett]

This is in no way meant to be critical of your positive viewpoint, but just the reality as I see it. I understand what you are saying, but most people I know...low end of middle class or a bit below middle class (but not low income enough to be on gov't assistance or qualify for subsidies)......do not have estimated $12,000+ for premiums each year + $12,500 for OOP max + money to pay the bills for all the things insurance does not cover that insurance used to cover. For most people in the US living paycheck to paycheck (most with other debt or no debt with only a modest emergency savings account), paying about $22,500+ in one year for medical bills might as well be $300,000 in medical bills. IMO, most people that get cancer, have a bad accident, or whatever may happen that maxes out their OOP max in one year will have ongoing medical payments for years to come. This means they will likely have to continue to come up with the expensive monthly premium payments, paying towards the high deductible up to the OOP max, plus additional medical needs that insurance no longer covers. In some cases, that person will also have loss of income due to the medical issue or accident. This can easily bankrupt someone that doesn't have a huge nest egg or make above the average middle class income. It is great if this is not the case for most people you know, but this is not the case for almost everybody I know, myself included.

 

Not that these boring details matter, but this is our life situation and why $1000+ monthly health insurance + having to pay a $10,000+ deductible or OOP max each year would eventually bankrupt us....

25% mortgage, real estate taxes, homeowner's insurance..modest home (essential)

10% giving (essential on our personal convictions, maybe questionable for some)

5% retirement (dh says essential, I say it can go if needed)

15% food (essential)

5% some type of insurance besides medical (car, life, dental, etc..)

5% household bills (water, electric, etc...)

5% other bills, some not essential (gas for cars, cheap haircuts, toiletries, Internet, phone, social things, gifts)

Average 5% or so unexpected expenses like car/home repairs, dental/vision, Murphy (essential)

5% on meds not covered by our old insurance or current medical sharing plan (essential)

 

If Murphy doesn't pay frequent visits, that leaves 25% for medical insurance premiums, deductible, OOP max, and uncovered medical needs. When our premiums alone reached that 25% coming out of dh's paycheck each month (MORE than the cost of our mortgage), something had to give! There was nothing leftover to pay for medical expenses on top of the premiums alone. We switched to medical sharing, but still have a very tight budget. We simply do not have an extra $12500 sitting around to pay for medical possible OOP expenses each year on top of expensive premiums. I guess we could stop retirement savings, not buy gifts, and go to the library for Internet if needed but that would make a tiny dent in potential medical bills if we had something catastrophic happen. A lower mortgage is not an option because the housing prices have increased since we bought. We couldn't even afford to rent our own house by today's rental prices. In comparison, before ACA our premiums were only about 10% of our income with a lower deductible, lower OOP max, and covered more things. Back in those days I could have afforded to get cancer or have a big accident with insurance and not go bankrupt.

 

Again, I so do not intend to be argumentative. I would love to hear that these high premiums, deductibles, and OOP max payments do prevent financial crises for most people who may one day face having to pay hundreds of thousands or millions if they went without insurance. Someone above said it saved their family a lot of money over time, but I am guessing that person did not have to choose between the high monthly premiums and something else essential to the monthly budget.

 

 

All sorts of terrible things can happen in people's lives.  I just don't think most people have year after year of huge medical bills.  In the old days of lower deductible it would still very difficult to pay the 20% on huge medical bills, 

 

And honestly I don't buy the insurance to prevent a future financial crisis.  I buy it because it is the law and because it gives me a little peace of mind that if we need a doctor they will actually see us and bill us later after insurance does their thing and the bill gets adjusted.  Also, I make excellent use of the provision in all the approved policies which give me a free mammo, pap  and general check up a year.  As well as a well check up for every body else in the family.  

 

I had work group insurance, dirt cheap with low deductibles my entire life.  Then my marriage blew up and my insurance went with it. I did without insurance for about 2 years and then just about that time Obamacare became law so we started buying it through the marketplace.  So I have had great medical care and insurance my entire life until now.  It is sad, but I realize so many other people have NEVER had medical insurance or regular medical care.  It is a broken system for sure.  Makes me sad for all of us.

[zimom]

But that's not the way a deductible works. The deductible is the amount you pay out of pocket *before* insurance starts paying anything. For example, the year that my daughter was born, we had a $5000 per person deductible. Maternity care and a C-section came to about $40,000. Baby's hospital stay and cardiac workup came to about $10,000. My totals were "bargained down" by the insurance company to about $8000. After we had paid $5000 of it, insurance picked up 80%, so we paid $5600 oop, insurance paid $2400. Baby's bills were bargained down to about $5000, all of which we paid because we hadn't met the deductible yet. So with insurance, our billed amount was about $50,000, the negotiated amount was about $13,000, we paid about $10,600 out of pocket, and the insurance company paid about $2,400.

 

I'm well aware of how a deductible works.  And as Scarlett also said, they don't turn you away from services until you pay/meet your deductible.  You can pay your deducible over time in just about all cases.

 

I was a healthcare provider, managed a department in a large medical practice (so knew claims inside and out) for 20 years, and am a mom to a child that regularly racks up medical bills in the six figures most years.  

 

I'm happy to discuss in network, out of network, deductibles, negotiated rates, exclusions, appeals, max out of pocket, co-pays, ICD-9, ICD-10s, CPTs and coding, bundling and unbundling, should I go on?  

[bethben]

Health insurance does not equal heath care.  I know people with very high deductibles and lower incomes.  Sure, they have health insurance, but they still question whether or not to go to the doctor because they will still be paying out of pocket for most visits.  If a child is sick, they wait to see if child is "life-threatening sick" or just "get over it in a week sick" before going to see a doctor.  I've know people who wait a few days to see if the possible broken bone is just a sprain or really broken because it's too expensive to pay for something that "may" not be broken.  It's too expensive for a lot of people to pay for stinky health insurance AND every single doctor/specialist appointment up to the high deductible before insurance even kicks in.

[Guest]

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Edited September 10, 2020 by Æthelthryth the Texan

[mellifera33]

I'm well aware of how a deductible works.  And as Scarlett also said, they don't turn you away from services until you pay/meet your deductible.  You can pay your deducible over time in just about all cases.

 

I was a healthcare provider, managed a department in a large medical practice (so knew claims inside and out) for 20 years, and am a mom to a child that regularly racks up medical bills in the six figures most years.  

 

I'm happy to discuss in network, out of network, deductibles, negotiated rates, exclusions, appeals, max out of pocket, co-pays, ICD-9, ICD-10s, CPTs and coding, bundling and unbundling, should I go on?  

 

It seems I hit a nerve here. I'm sorry that you have had to navigate the medical system as the parent of a kid with extensive medical needs.  :grouphug:

[MedicMom]

I don't mean to hijack the thread, but I have to ask, how do you get them to negotiate for non-essential services where payment is demanded up front? I will give you a for instance. Last year my dr ordered me a mammogram because I have a family history of breast cancer. The initial scan came back as questionable so the imaging center called me and told me I needed to come in for an ultrasound. I was required to pay the $500 up front for the extra ultrasound or not have the scan. It wasn't a "we will be happy to take payments" sort of situation. It was "pay us in full over the phone or don't show up for the appointment" type of conversation. I had the same conversation last month for my endoscopies. It wasn't an option to not pay in full prior to the procedure. I'm having knee surgery next week and it's the same way? So what is the secret for negotiating payments on things? I would love to know because half the time they collect payment and then end up reimbursing me a portion afterwards because insurance pays more than they anticipate.

I also have a high deductible. I have not had a problem with emergency visits, but everything else--regular appointments, walk in clinics and specialists--want payment up front. I've found hospitals willing to set up payment plans but no one else.

[StephanieZ]

Our family-of-5 premium was 1850/mo last year and would be 2500/mo this year. We aren't eligible for subsidies, so that's 30k/yr for health insurance . . .. YOIKES. I thought it was bad last year. Ha ha ha ha. 

 

Good news is that this latest premium spike energized me to re-shop group coverage for our small business. We had dropped group coverage when the ACA came out for multiple reasons -- mostly because most of our staff who used it could get big subsidies (low wage industry) on the individual market, so all in all, it was a better deal for all of us to drop the group. But, 3 years later, individual premiums have doubled (while group rates have grown at a much slower rate) . . . So, now, with the group premiums via the SHOP (small business exchange part of the ACA), we can buy a group, and the preliminary investigations I've made make it look like I'll be able to purchase a great group policy. We'll probably end up spending a bit extra each month to add back this employee benefit, but it'll be better in the end if we can manage to do it. Pre-ACA, managing a tiny-group policy was a HUGE burden of management time and staff time each year (we had to re-shop each year, meaning all employees had to fill out miles long medical history forms, etc.) but now with the ACA/SHOP, there is no pricing of individuals/health history . . . We will just plug in all their birth dates, etc, and we get a standard rate that is only impacted by the ages. This incredible annual paperwork hassle was one of the big reasons we abandoned group coverage (and the SHOP / group plans were not rolled out in time for the first year of the ACA) . . . But, now that I'm investigating it again, with the drastic simplification of the paperwork, the reasonable costs, and the federal subsidies for tiny businesses, I think it'll be feasible for us to add group coverage for our staff, which should come as a nice surprise to them. :) It may all "come out in the wash" and it'll still be a big cost to us, obviously, but I'd feel better providing coverage to our staff if we can manage it, and I think we can manage it based on what I've seen so far of the SHOP premiums and the SHOP process (about a million times easier than pre-ACA small group insurance shopping, that is for SURE). 

 

So, anyway, yes, the ACA individual premiums are through the roof. BUT, decent group coverage is available through the SHOP (for very small businesses -- under 50 employees in most places), so that's really, really good. 

 

I've been a fan of the ACA. I am still a fan, but I also believe it needs help/tweaking/improvements. It's better than life-pre-ACA was (for us and our business, and I think for many, many families and businesses), but it is still a huge headache and far from perfect. 

 

I sure hope we go to a single payer plan sometime soon. I don't mind paying my share (as an individual/family and as an employer), but, the MASSIVE time suck that managing health care has been for small businesses (and now individuals) is ridiculous, as are the total costs compared to the benefits received. 

[mellifera33]

Our family-of-5 premium was 1850/mo last year and would be 2500/mo this year. We aren't eligible for subsidies, so that's 30k/yr for health insurance . . .. YOIKES. I thought it was bad last year. Ha ha ha ha. 

 

Good news is that this latest premium spike energized me to re-shop group coverage for our small business. We had dropped group coverage when the ACA came out for multiple reasons -- mostly because most of our staff who used it could get big subsidies (low wage industry) on the individual market, so all in all, it was a better deal for all of us to drop the group. But, 3 years later, individual premiums have doubled (while group rates have grown at a much slower rate) . . . So, now, with the group premiums via the SHOP (small business exchange part of the ACA), we can buy a group, and the preliminary investigations I've made make it look like I'll be able to purchase a great group policy. We'll probably end up spending a bit extra each month to add back this employee benefit, but it'll be better in the end if we can manage to do it. Pre-ACA, managing a tiny-group policy was a HUGE burden of management time and staff time each year (we had to re-shop each year, meaning all employees had to fill out miles long medical history forms, etc.) but now with the ACA/SHOP, there is no pricing of individuals/health history . . . We will just plug in all their birth dates, etc, and we get a standard rate that is only impacted by the ages. This incredible annual paperwork hassle was one of the big reasons we abandoned group coverage (and the SHOP / group plans were not rolled out in time for the first year of the ACA) . . . But, now that I'm investigating it again, with the drastic simplification of the paperwork, the reasonable costs, and the federal subsidies for tiny businesses, I think it'll be feasible for us to add group coverage for our staff, which should come as a nice surprise to them. :) It may all "come out in the wash" and it'll still be a big cost to us, obviously, but I'd feel better providing coverage to our staff if we can manage it, and I think we can manage it based on what I've seen so far of the SHOP premiums and the SHOP process (about a million times easier than pre-ACA small group insurance shopping, that is for SURE). 

 

So, anyway, yes, the ACA individual premiums are through the roof. BUT, decent group coverage is available through the SHOP (for very small businesses -- under 50 employees in most places), so that's really, really good. 

 

I've been a fan of the ACA. I am still a fan, but I also believe it needs help/tweaking/improvements. It's better than life-pre-ACA was (for us and our business, and I think for many, many families and businesses), but it is still a huge headache and far from perfect. 

 

I sure hope we go to a single payer plan sometime soon. I don't mind paying my share (as an individual/family and as an employer), but, the MASSIVE time suck that managing health care has been for small businesses (and now individuals) is ridiculous, as are the total costs compared to the benefits received. 

 

I am very happy to hear that things are improving for owners of small businesses who provide insurance for their employees. Until recently, DH worked for a very small company, and every year they had a new, more expensive insurance plan that provided less and less coverage and demanded higher and higher deductibles. 

SaveSave

[StephanieZ]

I am very happy to hear that things are improving for owners of small businesses who provide insurance for their employees. Until recently, DH worked for a very small company, and every year they had a new, more expensive insurance plan that provided less and less coverage and demanded higher and higher deductibles. 

SaveSave

 

yup, yup. yup. That was us for a decade pre-ACA, and it took dozens to hundreds of management hours each year to make it happen, plus several hours from each employee filling out those dang forms. It was so stressful, and we always knew that if *any* of our team got truly sick, we'd suddenly be priced out of insurance completely! The ACA has ended that terrifying possibility, at the very least. I don't think any employee ever could understand just how precarious our insurance was . . . We had a "good policy", but it was only good for a year, until renewal time . . . If one of our team had, say, come up with a $1,000,000 cancer (not unusual), we'd have had to cancel the entire policy . . . and before-ACA, that meant NO insurance! It was HORRIBLE to know that we couldn't protect our staff or ourselves from bankruptcy if any of us or our dependents got truly sick . . . PLUS, we couldn't offer COBRA or anything like that, as we were too small, and thus if any employee had gotten really sick so they couldn't keep working . . . we HAD to terminate their insurance (otherwise it was insurance fraud). I always felt like such a shmuck knowing that if one of our staff got really sick, their entire family would lose coverage in a matter of months . . . We lucked out and dodged that bullet. Fingers crossed that things will improve in coming years. 

[mommytobees]

Did you check 2017 rates and premiums? Subsidies are going up. I can't imagine you wouldn't qualify as a single person"...and don't forget you can count your child as a dependent if they are still,in school.

 

Yup....that is with the one dependent. I'll look again.

 

I"m just so annoyed.

 

Kris

[mommytobees]

I have to share my frustrations with health insurance right this minute.

 

My children are both on a government run, socialized medical system as the dependents of an active duty military member. They have been for their entire lives and I was most of my adult life before my divorce. There are advantages and disadvantages. They are on the HMO variety run by UHC.

 

My daughter has been very sick, but not quite acute over the past several weeks. With a series of ups and downs...

 

4 weeks ago: PCM (a NurseP) at the AFB Ped's clinic appt.

3 weeks ago: MRI at AFB, the most horrible machine that gave awful results and just enough detail to scare the crap out of me.

Thursday: Worsening symptoms, instructed to take her to the local children's hospital. She was admitted.

Friday: Did a new MR and the images were horrifying. DX w/ MS at 15yo. (my 18yo was dx'ed with MS last year) Failed LP (lumbar puncture). But, there is something else wrong....lots of labs.

~ Released Friday with instructions to get an LP under sedation within a week (underlying threat of readmission). 

Monday: Children's hospital schedules the LP for Thursday and submits the authorization request

Tuesday: Children's hospital calls me to say: Insurance refuses to pay for LP because it wasn't submitted by the PCM

 

Okay, let's think about this for a minute: A ped's neurologist failed in an inpatient LP and SENT HER HOME to a) make the teen happy, b) save money; because she was not acute. Why keep her inpatient JUST for diagnostic testing? No, save money and send her home.

 

But, UHC is playing games and refusing a procedure that needs to be done. Thankfully, her PCM's office is tired of this and are having none of it. A NP isn't going to order an LP that a Neuro wants. The Neuro wants it and must justify it. They are trying to take care of it early enough tomorrow that she'll resolve it and we can do the outpatient procedure. This is all about money, whatever they can get out of having to pay for. 

 

If we take the health insurance company out of the equation, the socialized medicine works. (Sorry to suddenly deviate from the point of the original post.) I know people are worried about rationed healthcare, but we already have rationed healthcare. Procedures like my daughter's LP and her MR aren't going to be rationed... they were considered urgent given her age...just ones that don't require hospitalizations after the initial evaluation to make sure she wasn't decompensating. 

 

Anyway, I'm exhausted and babbling and going to bed.

Kris

 

 

Edited November 2, 2016 by mommytobees

[Murphy101]

All sorts of terrible things can happen in people's lives. I just don't think most people have year after year of huge medical bills. In the old days of lower deductible it would still very difficult to pay the 20% on huge medical bills,

 

And honestly I don't buy the insurance to prevent a future financial crisis. I buy it because it is the law and because it gives me a little peace of mind that if we need a doctor they will actually see us and bill us later after insurance does their thing and the bill gets adjusted. Also, I make excellent use of the provision in all the approved policies which give me a free mammo, pap and general check up a year. As well as a well check up for every body else in the family.

 

I had work group insurance, dirt cheap with low deductibles my entire life. Then my marriage blew up and my insurance went with it. I did without insurance for about 2 years and then just about that time Obamacare became law so we started buying it through the marketplace. So I have had great medical care and insurance my entire life until now. It is sad, but I realize so many other people have NEVER had medical insurance or regular medical care. It is a broken system for sure. Makes me sad for all of us.

I say this kindly, but I think the problem is that you seem to think $12k in medical per year is huge medical bills and bc you don't think many people have huge medical bills, this seems reasonable to you.

 

If my dh and I bought insurance, we would not be able to afford our basic medical care. Things like insulin. Things like my epi pen. Things like my grown son's inhaler. (Oh that's right. Not only is our nation got its head up its butt about what we can afford, it expects us to afford to cover adult children too. No help with making that happen though.)

 

Those three medical needs alone would cost us nearly $8k a year if we didn't buy them from out of country - which insurance wouldn't cover either.

 

And we are very healthy people overall. That's not including my dh's endocrinologist appts. Or my OB for this pregnancy. Which insurance would have only covered after we paid our portion and our portion would have still been no small amt and yes they want it up front.

 

I can easily see how not just many people, but possibly even most people, have no problems hitting $12k every year. Bc of that, I can also absolutely see how the majority of people in a nation where the median is $51k, meaning most don't make much more than that, many people would regularly be on the brink of bankruptcy for medical expenses they can't afford. Even or possibly especially if most of them have insurance.

[TX Native]

I have to share my frustrations with health insurance right this minute.

 

My children are both on a government run, socialized medical system as the dependents of an active duty military member. They have been for their entire lives and I was most of my adult life before my divorce. There are advantages and disadvantages. They are on the HMO variety run by UHC.

 

My daughter has been very sick, but not quite acute over the past several weeks. With a series of ups and downs...

 

4 weeks ago: PCM (a NurseP) at the AFB Ped's clinic appt.

3 weeks ago: MRI at AFB, the most horrible machine that gave awful results and just enough detail to scare the crap out of me.

Thursday: Worsening symptoms, instructed to take her to the local children's hospital. She was admitted.

Friday: Did a new MR and the images were horrifying. DX w/ MS at 15yo. (my 18yo was dx'ed with MS last year) Failed LP (lumbar puncture). But, there is something else wrong....lots of labs.

~ Released Friday with instructions to get an LP under sedation within a week (underlying threat of readmission).

Monday: Children's hospital schedules the LP for Thursday and submits the authorization request

Tuesday: Children's hospital calls me to say: Insurance refuses to pay for LP because it wasn't submitted by the PCM

 

Okay, let's think about this for a minute: A ped's neurologist failed in an inpatient LP and SENT HER HOME to a) make the teen happy, b) save money; because she was not acute. Why keep her inpatient JUST for diagnostic testing? No, save money and send her home.

 

But, UHC is playing games and refusing a procedure that needs to be done. Thankfully, her PCM's office is tired of this and are having none of it. A NP isn't going to order an LP that a Neuro wants. The Neuro wants it and must justify it. They are trying to take care of it early enough tomorrow that she'll resolve it and we can do the outpatient procedure. This is all about money, whatever they can get out of having to pay for.

 

If we take the health insurance company out of the equation, the socialized medicine works. (Sorry to suddenly deviate from the point of the original post.) I know people are worried about rationed healthcare, but we already have rationed healthcare. Procedures like my daughter's LP and her MR aren't going to be rationed... they were considered urgent given her age...just ones that don't require hospitalizations after the initial evaluation to make sure she wasn't decompensating.

 

Anyway, I'm exhausted and babbling and going to bed.

Kris

I am so sorry you and your children are going through all of this.

[Scarlett]

I say this kindly, but I think the problem is that you seem to think $12k in medical per year is huge medical bills and bc you don't think many people have huge medical bills, this seems reasonable to you.

 

If my dh and I bought insurance, we would not be able to afford our basic medical care. Things like insulin. Things like my epi pen. Things like my grown son's inhaler. (Oh that's right. Not only is our nation got its head up its butt about what we can afford, it expects us to afford to cover adult children too. No help with making that happen though.)

 

Those three medical needs alone would cost us nearly $8k a year if we didn't buy them from out of country - which insurance wouldn't cover either.

 

And we are very healthy people overall. That's not including my dh's endocrinologist appts. Or my OB for this pregnancy. Which insurance would have only covered after we paid our portion and our portion would have still been no small amt and yes they want it up front.

 

I can easily see how not just many people, but possibly even most people, have no problems hitting $12k every year. Bc of that, I can also absolutely see how the majority of people in a nation where the median is $51k, meaning most don't make much more than that, many people would regularly be on the brink of bankruptcy for medical expenses they can't afford. Even or possibly especially if most of them have insurance.

12500 is the max out of pocket I thought. That is why I mentioned that amount. Yes I do understand how quickly medical bills can add up. Especially with a big family.

 

I would think you would qualify for a subsidy since your family is large. And does the adult son not qualify for cheap insurance? Maybe not because I remember something about not qualifying for subsidies if you make under a certain amount.

 

I know it is a mess, but I am trying to see the good points.

[Scarlett]

I have to share my frustrations with health insurance right this minute.

 

My children are both on a government run, socialized medical system as the dependents of an active duty military member. They have been for their entire lives and I was most of my adult life before my divorce. There are advantages and disadvantages. They are on the HMO variety run by UHC.

 

My daughter has been very sick, but not quite acute over the past several weeks. With a series of ups and downs...

 

4 weeks ago: PCM (a NurseP) at the AFB Ped's clinic appt.

3 weeks ago: MRI at AFB, the most horrible machine that gave awful results and just enough detail to scare the crap out of me.

Thursday: Worsening symptoms, instructed to take her to the local children's hospital. She was admitted.

Friday: Did a new MR and the images were horrifying. DX w/ MS at 15yo. (my 18yo was dx'ed with MS last year) Failed LP (lumbar puncture). But, there is something else wrong....lots of labs.

~ Released Friday with instructions to get an LP under sedation within a week (underlying threat of readmission).

Monday: Children's hospital schedules the LP for Thursday and submits the authorization request

Tuesday: Children's hospital calls me to say: Insurance refuses to pay for LP because it wasn't submitted by the PCM

 

Okay, let's think about this for a minute: A ped's neurologist failed in an inpatient LP and SENT HER HOME to a) make the teen happy, b) save money; because she was not acute. Why keep her inpatient JUST for diagnostic testing? No, save money and send her home.

 

But, UHC is playing games and refusing a procedure that needs to be done. Thankfully, her PCM's office is tired of this and are having none of it. A NP isn't going to order an LP that a Neuro wants. The Neuro wants it and must justify it. They are trying to take care of it early enough tomorrow that she'll resolve it and we can do the outpatient procedure. This is all about money, whatever they can get out of having to pay for.

 

If we take the health insurance company out of the equation, the socialized medicine works. (Sorry to suddenly deviate from the point of the original post.) I know people are worried about rationed healthcare, but we already have rationed healthcare. Procedures like my daughter's LP and her MR aren't going to be rationed... they were considered urgent given her age...just ones that don't require hospitalizations after the initial evaluation to make sure she wasn't decompensating.

 

Anyway, I'm exhausted and babbling and going to bed.

Kris

Ugh, that is terrible! So sorry!

[Murphy101]

12500 is the max out of pocket I thought. That is why I mentioned that amount. Yes I do understand how quickly medical bills can add up. Especially with a big family.

 

I would think you would qualify for a subsidy since your family is large. And does the adult son not qualify for cheap insurance? Maybe not because I remember something about not qualifying for subsidies if you make under a certain amount.

 

I know it is a mess, but I am trying to see the good points.

The thing is, only 3 people have on going medical expenses in my household. Well really just one. My diabetic dh. Son and I don't need regular use of epi pens and inhalers, thankfully. We could be a family of three with the same income and it would still be quite the struggle if we paid for insurance and then still had to also cover those expenses.

 

One son recently got medical coverage bc he got a steady job. (Most in his career field do not. They tend to be hired as temps/contractors and this have zero benefits.)

 

My other sons are in college and are pt employees. Bc their work offers insurance, that's insanely priced out of their league, they don't qualify.

 

Bc my dh is self employed, things are a lot more complicated and still a lot not affordable.

 

Everyone thinks large families must get everything practically free. This simply is not true. Trust me, no large family is getting some bargain by having another kid. At least not in this state. When I had this baby a couple weeks ago, the hospital tried to get us set up. They said the subsidy cap for a family my size was less than $40k iirc. (And I might not beyond we made too much. Drugs surgery and sleep deprivation don't make for accurate facts sometimes.) Now granted we make a bit more than that, but even for a family a quarter my size, that's a very low cap imnsho.

Edited November 2, 2016 by Murphy101

[TX Native]

Nm

Edited November 9, 2017 by TX native

[EMS83]

what does this mean? That you carry no health insurance and pay for all things yourself? Or that you're in a health pool of self payers? Or something else?

 

The first one.  The health pool still costs money monthly, as far as I could find.  We don't pay the fine.  Not yet.  Maybe when we file for 2017.  But it would still be cheaper for us to go that route than insurance.  

 

Local hospital forgives 40% of the list price for services rendered to self-pay; the next county over forgives 60%.  

I call around for prices if I need a specialist.  Appointment at pediatric cardiologist A: $2500, appointment at pediatric cardiologist B: $500.

[Laura Corin]

The first one. The health pool still costs money monthly, as far as I could find. We don't pay the fine. Not yet. Maybe when we file for 2017. But it would still be cheaper for us to go that route than insurance.

 

Local hospital forgives 40% of the list price for services rendered to self-pay; the next county over forgives 60%.

I call around for prices if I need a specialist. Appointment at pediatric cardiologist A: $2500, appointment at pediatric cardiologist B: $500.

Cheaper except for that catastrophe. 60 percent of a million dollars is 600k.

[zimom]

I don't mean to hijack the thread, but I have to ask, how do you get them to negotiate for non-essential services where payment is demanded up front? I will give you a for instance. Last year my dr ordered me a mammogram because I have a family history of breast cancer. The initial scan came back as questionable so the imaging center called me and told me I needed to come in for an ultrasound. I was required to pay the $500 up front for the extra ultrasound or not have the scan. It wasn't a "we will be happy to take payments" sort of situation. It was "pay us in full over the phone or don't show up for the appointment" type of conversation. I had the same conversation last month for my endoscopies. It wasn't an option to not pay in full prior to the procedure. I'm having knee surgery next week and it's the same way? So what is the secret for negotiating payments on things? I would love to know because half the time they collect payment and then end up reimbursing me a portion afterwards because insurance pays more than they anticipate. 

 

Sorry for the delay.  I've just always been very pleasant but upfront.  I think I am paying about 8 providers/hospitals right now on payment plans between my daughter (6)  and myself (2).  Each one when they call me or I call them I just tell them something to the effect "our family has multiple medical bills we are juggling at any time due to my daughter's significant medical needs.  I can pay $100 up front now and I'll pay $50 a month until my bill is paid off."  I have just never had anyone say no.  I feel pretty sure they will even accept less but this is just my standard "offer".  And then I make a payment every month without fail.  I went online to start paying off one bill recently and it just automatically set me up on a $25 a month payment plan.  GREAT!  I took it.  Again, I worked for a large medical practice for 20 years as a provider (but not a MD).  The staff generally had to get approval to set up payment plans so their supervisors could review the account but it was always approved as long as the patient did not have a history of not paying their bills at our practice.  

[AmandaVT]

The thing is, only 3 people have on going medical expenses in my household. Well really just one. My diabetic dh. Son and I don't need regular use of epi pens and inhalers, thankfully. We could be a family of three with the same income and it would still be quite the struggle if we paid for insurance and then still had to also cover those expenses.

 

One son recently got medical coverage bc he got a steady job. (Most in his career field do not. They tend to be hired as temps/contractors and this have zero benefits.)

 

My other sons are in college and are pt employees. Bc their work offers insurance, that's insanely priced out of their league, they don't qualify.

 

Bc my dh is self employed, things are a lot more complicated and still a lot not affordable.

 

Everyone thinks large families must get everything practically free. This simply is not true. Trust me, no large family is getting some bargain by having another kid. At least not in this state. When I had this baby a couple weeks ago, the hospital tried to get us set up. They said the subsidy cap for a family my size was less than $40k iirc. (And I might not beyond we made too much. Drugs surgery and sleep deprivation don't make for accurate facts sometimes.) Now granted we make a bit more than that, but even for a family a quarter my size, that's a very low cap imnsho.

 

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

[Guest]

.

Edited September 10, 2020 by Æthelthryth the Texan

[EMS83]

Cheaper except for that catastrophe. 60 percent of a million dollars is 600k.

 

True and all, but don't insurance companies have to cover preexisting under the ACA?  There you go.

 

Otherwise, if the hospital wanted to wrench a million dollars of out saving my life, they can just pay for my funeral, since they're obviously in the wrong business.  That goes triple for the pharmaceutical industry.

 

ETA: I'm not trying to be boorish, but the scare stuff just does not faze me; it just irritates me.  Call it alarmist overload from the media if you'd like.  It's not personal toward you.

Edited November 3, 2016 by CES2005

[Laura Corin]

True and all, but don't insurance companies have to cover preexisting under the ACA?  There you go.

 

Otherwise, if the hospital wanted to wrench a million dollars of out saving my life, they can just pay for my funeral, since they're obviously in the wrong business.  That goes triple for the pharmaceutical industry.

 

ETA: I'm not trying to be boorish, but the scare stuff just does not faze me; it just irritates me.  Call it alarmist overload from the media if you'd like.  It's not personal toward you.

 

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.

[Carrie12345]

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.

 

[OnMyOwn]

Well, if anyone cares to understand one reason rates are increasing, just research risk corridors and the ACA. It was an act of sabotage, no conspiracy, and the result is just what was predicted. Pure politics by factions who don't give a flip about the people they serve.

Of course rates are going up. Millions of people who can pay ittle or nothing now have coverage, so those costs will now have to be squeezed out if those who can pay. Did people think we were really going to cover millions of people for free?

 

And I don't doubt the corruption of the industry, but to act as though that is the only reason costs are going up is dishonest. The costs are being shifted from one group to another.

Edited November 3, 2016 by OnMyOwn