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04-02-2013, 12:33 PM
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#21
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Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Join Date: May 2009
Posts: 9,343
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Quote:
Originally Posted by pb4uski
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.
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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?
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04-02-2013, 01:01 PM
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#22
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gone traveling
Join Date: Mar 2007
Posts: 559
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lipitor and flomax are already generic have been for at least two years.
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04-02-2013, 03:16 PM
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#23
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Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Join Date: May 2009
Posts: 9,343
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Quote:
Originally Posted by gerrym51
lipitor and flomax are already generic have been for at least two years.
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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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04-02-2013, 07:41 PM
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#24
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Thinks s/he gets paid by the post
Join Date: Feb 2012
Location: Tampa Bay Area
Posts: 1,866
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Quote:
Originally Posted by pb4uski
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.
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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.
__________________
"For the time being no discipline brings joy, but seems grievous and painful; but afterwards it yields a peaceable fruit of righteousness to those who have been trained by it." ~
Hebrews 12:11
ER'd in June 2015 at age 52. Initial WR 3%. 50/40/10 (Equity/Bond/Short Term) AA.
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04-02-2013, 08:14 PM
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#25
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Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Join Date: Nov 2010
Location: Sarasota, FL & Vermont
Posts: 36,263
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Quote:
Originally Posted by Live And Learn
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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Isn't that absolutely bloody ridiculous!
__________________
If something cannot endure laughter.... it cannot endure.
Patience is the art of concealing your impatience.
Slow and steady wins the race.
Retired Jan 2012 at age 56
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04-03-2013, 06:20 AM
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#26
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Recycles dryer sheets
Join Date: Mar 2013
Location: Scarsdale
Posts: 180
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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?
__________________
"There are no solutions...there are only trade-offs." - Thomas Sowell
Looking to retire or semi-retire by 45 based on our net worth going to $6 million outside our house.
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04-03-2013, 07:09 AM
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#27
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Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Join Date: Nov 2010
Location: Sarasota, FL & Vermont
Posts: 36,263
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Quote:
Originally Posted by kmt1972
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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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.
__________________
If something cannot endure laughter.... it cannot endure.
Patience is the art of concealing your impatience.
Slow and steady wins the race.
Retired Jan 2012 at age 56
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04-03-2013, 07:31 AM
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#28
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gone traveling
Join Date: Mar 2007
Posts: 559
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Quote:
Originally Posted by kmt1972
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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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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04-03-2013, 07:34 AM
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#29
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Thinks s/he gets paid by the post
Join Date: Aug 2006
Posts: 2,433
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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'd rather be governed by the first one hundred names in the telephone book than the Harvard faculty - William F. Buckley
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04-03-2013, 07:42 AM
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#30
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Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Join Date: Nov 2010
Location: Sarasota, FL & Vermont
Posts: 36,263
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Quote:
Originally Posted by FIRE'd@51
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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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.
__________________
If something cannot endure laughter.... it cannot endure.
Patience is the art of concealing your impatience.
Slow and steady wins the race.
Retired Jan 2012 at age 56
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04-03-2013, 07:53 AM
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#31
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gone traveling
Join Date: Mar 2007
Posts: 559
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Quote:
Originally Posted by FIRE'd@51
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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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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04-03-2013, 07:57 AM
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#32
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Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Join Date: Jan 2008
Location: NC
Posts: 21,201
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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
__________________
No one agrees with other people's opinions; they merely agree with their own opinions -- expressed by somebody else. Sydney Tremayne
Retired Jun 2011 at age 57
Target AA: 50% equity funds / 45% bonds / 5% cash
Target WR: Approx 1.5% Approx 20% SI (secure income, SS only)
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04-03-2013, 07:59 AM
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#33
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Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Join Date: Nov 2010
Location: Sarasota, FL & Vermont
Posts: 36,263
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Quote:
Originally Posted by gerrym51
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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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.
__________________
If something cannot endure laughter.... it cannot endure.
Patience is the art of concealing your impatience.
Slow and steady wins the race.
Retired Jan 2012 at age 56
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04-03-2013, 08:10 AM
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#34
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gone traveling
Join Date: Mar 2007
Posts: 559
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Quote:
Originally Posted by pb4uski
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.
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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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04-03-2013, 08:16 AM
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#35
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Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Join Date: Nov 2010
Location: Sarasota, FL & Vermont
Posts: 36,263
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__________________
If something cannot endure laughter.... it cannot endure.
Patience is the art of concealing your impatience.
Slow and steady wins the race.
Retired Jan 2012 at age 56
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04-03-2013, 08:22 AM
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#36
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Full time employment: Posting here.
Join Date: Jul 2007
Posts: 500
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Quote:
Originally Posted by gerrym51
lipitor and flomax are already generic have been for at least two years.
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Viagra has been generic for years also just not in the US.
__________________
Worked the plan and now living the Dream!
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04-03-2013, 08:44 AM
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#37
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gone traveling
Join Date: Mar 2007
Posts: 559
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Quote:
Originally Posted by fisherman
Viagra has been generic for years also just not in the US.
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patent in usa runs out in a couple years
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04-03-2013, 08:46 AM
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#38
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gone traveling
Join Date: Mar 2007
Posts: 559
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Quote:
Originally Posted by pb4uski
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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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04-03-2013, 08:53 AM
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#39
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gone traveling
Join Date: Mar 2007
Posts: 559
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Quote:
Originally Posted by gerrym51
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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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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04-03-2013, 08:58 AM
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#40
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Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Join Date: Jan 2008
Location: NC
Posts: 21,201
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Quote:
Originally Posted by gerrym51
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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That's profound...
__________________
No one agrees with other people's opinions; they merely agree with their own opinions -- expressed by somebody else. Sydney Tremayne
Retired Jun 2011 at age 57
Target AA: 50% equity funds / 45% bonds / 5% cash
Target WR: Approx 1.5% Approx 20% SI (secure income, SS only)
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