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Old 04-02-2013, 01:33 PM   #21
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For that plan, you would need $8,125 in covered medical costs (at the negotiated rates) to hit the medical OOPM. I know that DW and I haven't come close to that amount in the last few years, but we have been relatively healthy. That said, if one had any major illness you could get to the OOPM pretty quick.
That would be my plan as I currently have a $5500 deductible anyway, so I am used to rolling the dice on OOPM. I am more worried about the premium as Lipitor, Flomax, and Viagra will all be generic soon enough. What else could a typical guy currently not on meds need down the road?
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Old 04-02-2013, 02:01 PM   #22
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That would be my plan as I currently have a $5500 deductible anyway, so I am used to rolling the dice on OOPM. I am more worried about the premium as Lipitor, Flomax, and Viagra will all be generic soon enough. What else could a typical guy currently not on meds need down the road?
lipitor and flomax are already generic have been for at least two years.
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Old 04-02-2013, 04:16 PM   #23
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lipitor and flomax are already generic have been for at least two years.
That's good to know! Now I just need the other one, and I may never reach my deductible. Wait, I bet they won't even count the other one as part of my deductible.
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Old 04-02-2013, 08:41 PM   #24
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For that plan, you would need $8,125 in covered medical costs (at the negotiated rates) to hit the medical OOPM. I know that DW and I haven't come close to that amount in the last few years, but we have been relatively healthy. That said, if one had any major illness you could get to the OOPM pretty quick.
Doesn't need to be a major issue. I had carpel tunnel outpatient surgery, a 15 minute procedure. The negotiated rates for everything needed was $3500.
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Old 04-02-2013, 09:14 PM   #25
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Doesn't need to be a major issue. I had carpel tunnel outpatient surgery, a 15 minute procedure. The negotiated rates for everything needed was $3500.
Isn't that absolutely bloody ridiculous!
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Old 04-03-2013, 07:20 AM   #26
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It seems these rates are same for any age group. That does not really make sense. Most young people will then just pay the penalty/tax instead. I thought there was a rule that the ratio between highest premiums and lowest premiums by age group cannot be greater than 3 to 1. This would mean that it is acceptable and even expected that there be different costs for each age group. I wonder why VT is doing it this way instead?
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Old 04-03-2013, 08:09 AM   #27
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It seems these rates are same for any age group. That does not really make sense. Most young people will then just pay the penalty/tax instead. I thought there was a rule that the ratio between highest premiums and lowest premiums by age group cannot be greater than 3 to 1. This would mean that it is acceptable and even expected that there be different costs for each age group. I wonder why VT is doing it this way instead?
See post#4 of this thread. In short, VT is not age rated - from the BCBSVT filing it appears that the only differentiation is between kids and adults in developing head of household and family rates. The small group health insurance that I currently have is not age rated and appears that that concept is being expanded to individual insurance as well.

I'm not defending it, just explaining. I think it would be fairer to have some sort of grading so younger adults pay less.
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Old 04-03-2013, 08:31 AM   #28
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It seems these rates are same for any age group. That does not really make sense. Most young people will then just pay the penalty/tax instead. I thought there was a rule that the ratio between highest premiums and lowest premiums by age group cannot be greater than 3 to 1. This would mean that it is acceptable and even expected that there be different costs for each age group. I wonder why VT is doing it this way instead?

after i read this post i went back and priced the insurance i bought from the mass health connector as if i was 42 instead of 62.

the price per month was 220 dollars less per month.
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Old 04-03-2013, 08:34 AM   #29
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Other than the premiums, does anyone know what the specific deductibles, copays, and OPM are for the various VT plans? Also, does the deductible count as part of the OPM? In many existing individual market plans it doesn't? Another important question is how RX costs work. Is there a separate deductible, copay, and OPM? Just knowing the various plans will pay 60-90% of the actuarial value isn't really all that helpful.
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Old 04-03-2013, 08:42 AM   #30
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Other than the premiums, does anyone know what the specific deductibles, copays, and OPM are for the various VT plans? Also, does the deductible count as part of the OPM? In many existing individual market plans it doesn't? Another important question is how RX costs work. Is there a separate deductible, copay, and OPM? Just knowing the various plans will pay 60-90% of the actuarial value isn't really all that helpful.
I think you'll find a lot of that stuff in pages 39-40 of the BCBSVT filing, but my understanding is that your first costs would go to the deductibles, then once the deductible is satisfied there would be copays and once the combination of the deductible and copays reach the OOPM it would be 100% on the insurer. Rx seems to be a separate deductible but no copay. I'm not familiar with some of the terms used but at this point will just wait for the marketing materials describing the plans.
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Old 04-03-2013, 08:53 AM   #31
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Other than the premiums, does anyone know what the specific deductibles, copays, and OPM are for the various VT plans? Also, does the deductible count as part of the OPM? In many existing individual market plans it doesn't? Another important question is how RX costs work. Is there a separate deductible, copay, and OPM? Just knowing the various plans will pay 60-90% of the actuarial value isn't really all that helpful.
don't want to burst your bubble-but-based on mass the deductble will be 2000
to 2500 and the out of pocket 4000-5000 max

mass also has plans that use all sort of combinations-easier to go to mass connector than me to explain them
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Old 04-03-2013, 08:57 AM   #32
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Will be interesting for those of us (like me) in states that have elected to 'default to federal exchanges.' Guess we find out Oct 1 or before...

State Actions to Implement the Health Benefit Exchange

Health Insurance Exchanges - Kaiser State Health Facts
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File Type: png Exchanges.png (334.2 KB, 36 views)
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Old 04-03-2013, 08:59 AM   #33
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don't want to burst your bubble-but-based on mass the deductble will be 2000
to 2500 and the out of pocket 4000-5000 max

mass also has plans that use all sort of combinations-easier to go to mass connector than me to explain them
My friend, you seem to me to be stuck in a Obamacare = Romneycare rut. While Obamacare was loosely modeled on Romneycare, it is different and will not be the same so your all too frequent comparisons to Romneycare are not really helpful to the discussion.
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Old 04-03-2013, 09:10 AM   #34
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My friend, you seem to me to be stuck in a Obamacare = Romneycare rut. While Obamacare was loosely modeled on Romneycare, it is different and will not the the same so your all too frequent comparisons to Romneycare are not really helpful to the discussion.
thats a valid point-however since Romneycare is currently the only thing around to compare it too thats what i use.

there is one thing however. if you go to my original thread all insurances not subsidized in aca-the last post or so has my links to mass AND california subsidized plan sheet. on each there are copays on 200-400 but no deductibles

this is california also.

this is why i believe there will be separate subsidized plans and non subsidized and that the subsidized plans will be linked to medicaid networks.

the other thing to remember is that not all states will be the same. states have the ability to make variations as long as they meet Obamacares core requirements.

i think the states that will run closer to the federal governments formula will be those that are letting the federal government create the exchange.

those that create their own will be different
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Old 04-03-2013, 09:16 AM   #35
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Old 04-03-2013, 09:22 AM   #36
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lipitor and flomax are already generic have been for at least two years.

Viagra has been generic for years also just not in the US.
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Old 04-03-2013, 09:44 AM   #37
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Viagra has been generic for years also just not in the US.
patent in usa runs out in a couple years
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Old 04-03-2013, 09:46 AM   #38
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now ,now. you want it not to be like i'm saying so it benefits you. i'm conceding the point that Romneycare is not obamacare.


well just have to see
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Old 04-03-2013, 09:53 AM   #39
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now ,now. you want it not to be like i'm saying so it benefits you. i'm conceding the point that Romneycare is not obamacare.


well just have to see
http://www.coveredca.com/media/10745...itsSummary.pdf


go to this page from california. the 2 lowest subsidized plans on left have no deductible. the next 2 on right have 1500 and 2000 deductibles respectivly

if you will look at bottom of first page the max out of pocket is 6400 mass has somewhat higher deductbles but lower out of pockets
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Old 04-03-2013, 09:58 AM   #40
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i think the states that will run closer to the federal governments formula will be those that are letting the federal government create the exchange.

those that create their own will be different
That's profound...
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