Obamacare

[infinite monkey]

My co-pay is the same no matter who I see. Hmmm...

[Happy Monkey]

Health Care Exchange application forms: (Under Forms/April 30, 2013)

[Lamplighter]

Originally Posted by infinite monkey

My co-pay is the same no matter who I see. Hmmm...

Probably so, but my rant above was about how much your physician bills
the government (Medicare) or your insurance company when you are seen by a Medical Assistant.

You, yourself, might not see any of this until the billings exceed
the amounts Medicare or your insurance company is willing to pay for that service.

For those of us that are retired and on Medicare, we get a statement
every month from US Social Service showing the dates of medical care,
the amounts billed by the service provider, and the amounts paid by the patient.

Sometimes, the service provider charges are ridiculous
... e.g., $500 for one of our office visits was less than 30 min.
but we had paid only the co-pay of $15.

[infinite monkey]

I was thinking it should be cheaper than 25 bucks when I see the nurse and she barely looks at my throat, though I hadn't thought of that until your posts. It's just the cost for an 'office visit' I guess.

I honestly must take insurance for granted, I never thought about if it actually costs less.

And I certainly won't complain about my insurance: I've made good use of it. Then again, about 13 years ago I was paying the same premium for a 'family' plan (just me and my husband) as the guy whose wife was on baby number 10. I guess it all comes out in the wash, usually, eventually.

(Which makes me wonder what my options will be if I am soonly unemployed!) Dammit.

[Nirvana]

Your options would be stay healthy or else

[Lamplighter]

Originally Posted by infinite monkey

<snip>
(Which makes me wonder what my options will be if I am soonly unemployed!) Dammit.

Hey, we've gone full circle.... your option is: Obama care

[infinite monkey]

I know, then I would have to think about stuff, and stuff. Ugh. I'm not good at doing real life grown up stuff, like planning.

[Lamplighter]

Regardless of the mindless mindset of the GOP to shut down our government,
Obamacare will finally become a reality in people's lives next week.

It is time to truly understand what it is and how to make
it's many facets work for the BEST EFFECT on our own personal lives.

If someone is lazy and puts it off until after March 31, 2014,
they will have only themselves to blame if things don't go the way they hope/expect.

Here is an very good article that can be a gateway into understanding
the "whats-in -it-for-me" and "what-should-I-do"...

NY Times
ARA SIEGEL BERNARD
9/27/13
A Guide to the New Exchanges for Health Insurance

Given all of the rhetoric about the Obama administration’s health care law,
it’s not surprising that many consumers are confused about how
the new insurance exchanges will actually work.
Some states that oppose the law have gone as far as intentionally
limiting the information that trickles out to its residents.

But after much anticipation, the curtain will finally rise on the exchanges next week,
providing millions of consumers with an online marketplace to compare
health insurance plans and then buy the coverage on the spot.

The exchanges are likely to be most attractive to people who qualify for subsidized coverage.
Individuals with low and moderate incomes may be eligible for a tax credit,
which can be used right away, like a gift card, to reduce their monthly premiums.
People with pre-existing conditions will no longer be denied coverage
or charged more (this applies to most plans outside the exchanges, too).
And all of the plans on the exchanges will be required to cover
a list of essential services, from maternity care to mental health care.

Q. Where can I apply or get more information on the exchanges?
A. To avoid fraud artists, enter through the front door: Healthcare.gov.
From there, you can find links to the exchange offered in your state.
There may be technical glitches as the program gets started,
so alternatively, you can call 1-800-318-2596.

Q. What sort of coverage will be offered?
A. All plans will have to provide the same set of essential benefits,
including prescriptions, preventive care, doctor visits, emergency services and hospitalization
(this also applies to most individual and small-employer group plans sold outside of the exchanges).
But plans can offer additional benefits, or different numbers of services
like physical therapy, so you’ll need to do a side-by-side comparison to see what fits your needs
— or at least the needs you can anticipate.

Q. Are the plans sold on the exchange more comprehensive than plans outside?
A. There are four plan levels, each named for a precious metal.
They all generally offer the same essential benefits, but their cost structures vary.
The lower the premium, the higher the out-of-pocket costs.

The bronze level plan, for instance, has the lowest premiums,
but will require consumers to shoulder more costs out of pocket.
They generally cover 60 percent of a typical population’s out-of-pocket costs,
and include deductibles, co-payments and coinsurance.
The silver plans cover 70 percent; gold, 80 percent;
while platinum covers 90 percent (and therefore carries the highest premiums).

Q. Will I be eligible for a premium tax credit (subsidized coverage)?
A. People with income between 100 percent of the poverty line
(or about $23,550 for a family of four) and 400 percent of poverty ($94,200 for a family of four)
are eligible for a tax credit to defray premium costs.
(All income eligibility is based on your modified adjusted gross income;
the online version of this column links to a guide explaining how that is calculated).

Q. Can I get help with my out-of-pocket expenses, like deductibles?
A. People with incomes between 100 percent of the federal poverty line
($23,550 for a family of four) and 250 percent ($58,875 for a family of four)
are also eligible for cost-sharing reductions, which means you’ll pay less
for items including deductibles and co-payments, and you’ll have lower out-of-pocket maximums.

<SNIP>

etc.
etc.
etc.

[xoxoxoBruce]

Some interesting questions about Obamacare.

1. Once Obamacare goes into effect, it will be impossible to substantially cut it back. Both sides seem convinced of this -- Republicans in terror, Democrats in glee.
~snip~
Entitlements are hard to roll back, but it is clearly not impossible, because it’s been done.

[Lamplighter]

Originally Posted by xoxoxoBruce

Some interesting questions about Obamacare.

A problem is that the underlying assumption within that link (Bloomberg) is not valid,
or at least it was not the primary raison-d'etre for the Affordable Care Act.
Most the issues in that link are based on a thesis of "saving $". For example:

Here’s another interesting observation I heard the other day,
this time from a participant in the recent Brookings' papers:
it’s not clear that ACOs are going to save money.

But the primary basis of the ACA / Obamacare primarily was to insure
the (15 ?) millions of people who did not have their own health insurance,
and then to support these newly "insured" by inducing larger numbers
of relatively healthy (working younger people) to buy into their own
health insurance instead of going without.

It's a matter of POV.

[xoxoxoBruce]

AFFORDABLE Care Act.
No, the idea was to get skyrocketing medical costs under control by getting everyone covered and having more efficiency. That should have been single payer instead of the hodge-podge we got. But as I said before, it can be fixed as we go.

[Lamplighter]

I agree that getting "skyrocketing medical costs under control" is part of the ACA,
but that was proceeding under Medicare even before the ACA was passed.
My issue was with the premise of the various "observations" in the link.

We are probably in agreement also on "should have been single payer
instead of the hodge-podge we got."

But that was just one of the options being considered, but that obviously
would have been far more of a upheaval in the US economy
than the more limited transformations of the current form of the ACA.

[Lamplighter]

This editorial is from Forbes...

Forbes
Todd Essig
9/29/13

Let's Get Personal: Obamacare Really Is Good For The Young And Healthy

<snip>
What really embarrasses me is that we’re supposed to be looking out,
taking care, making it easier for those coming up to build a good life.
Instead, bloviating blowhards dispense lies, half-truths, cherry-picked facts,
distortions, and ideological flourishes all designed to confuse and mystify.<snip>

So, let’s shower the crud off ourselves before the marketplace opens
and get personal about whether the Affordable Care Act is a good thing
for people who are young and healthy.

Here are 4 reasons why the answer is “yes, it is.”

<snip>

It is left to the reader to explore this man's calmly stated
and sensible approach to health insurance...
.
.

[Adak]

Just heard on the radio that Aetna (CA's biggest medical insurer with 48% of the market), has dropped out of the exchange for ObamaCare.

This is going on in many states: Iowa (lost their largest insurer), New Hampshire and West Virginia have no health care provider, at all.

The larger health insurers are reluctant to get into this because it's unknown territory for them. On the one hand, the law prevents them from raising the rates above a certain level, but on the other hand, they have to provide a certain level of care to those that they cover.

To top it off, if the healthy people don't need to buy it (maybe paying the IRS penalty will be a better alternative for them), then the whole insurance plan idea, goes out the window. Insurance can't work that way. The risk has to be spread around an adequate base of subscribers.

The national health care plan is a good one, but I wish they would have done more planning and studying, before they decided to pass it into law. So many things - like all these exemptions, etc., they make for a very poor start for it.

[glatt]

Originally Posted by Adak

To top it off, if the healthy people don't need to buy it (maybe paying the IRS penalty will be a better alternative for them)

The way this is being phased in, the penalties for not buying insurance in the first year are relatively small. (At least the last time I looked into it several months ago.) So it's probably wise from a financial point of view to sit on the sidelines until next year when the penalties become real, and health care will be cheaper than the fine. Of course, if you pay for the health care, then you can use the health care. If you opt for the fine, you get nothing in return.

Debating Obamacare is kind of funny that way, because it's only being phased in slowly, so it will be a few years before we know exactly how it's going to pan out.