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ACA- true story for a younger person.
Old 12-05-2013, 10:23 AM   #1
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ACA- true story for a younger person.

Here's a true ACA story.

Young person in early 30's was going to qualify for work health insurance when a combination of factors beyond control led to not being eligible. Makes about $20,000 a year.

Applied at state exchange. Got a policy for $50 month after subsidy. ($170 a month with no subsidy). $1,000 deductible, 20% copayment, $6,500 limit on the copayment! then insurance pays 100%.

Just thought I would give some real life perspective to all the noise.
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Old 12-05-2013, 12:21 PM   #2
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Old 12-05-2013, 02:18 PM   #3
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The trouble with anecdotes (especially anonymous ones)....

For every one presented on one side, there is likely one to counter it. IMO, this just adds to the noise. Here is one that is high profile and verifiable:

A health care 'success story' that isn't - Lucy McCalmont - POLITICO.com


Quote:
A woman who President Barack Obama cited in remarks last month as an example of what Obamacare “is all about” says she is now facing repeated problems with her own enrollment.

Jessica Sanford, a Washington state resident and self-employed court reporter, has received numerous letters from her state’s exchange program notifying her of increased costs to her plan and tax credit miscalculations, according to CNN.


“Wow. You guys really screwed me over,” Sanford wrote on a Facebook post about the Washington state exchange website. “Now I have been priced out and will not be able to afford the plans you offer. But, I get to pay $95 and up for not having health insurance. I am so incredibly disappointed and saddened. You majorly screwed up.”

Sanford, who said the experience has been “like riding a big roller coaster,” also said she felt “embarrassed.”

“It was a huge disappointment, and especially since my story had been shared by the president,” Sanford said in an interview that aired Tuesday on CNN’s “New Day.” “I just felt really embarrassed.”

Sanford also told CNN that she is “not getting insurance.”

-ERD50
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Old 12-05-2013, 03:26 PM   #4
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Of course, the news article doesn't even include enough information in it to call it an anecdote.

It doesn't give the woman's age or income. It doesn't even give the final cost of her plan. It also doesn't say what plan she chose.

It's not even clear if her issue is actually high costs, or errors in the State exchange mistakenly disqualifying her for tax credits.

It's an article that is almost entirely devoid of useful content, which is pretty much what I've come to expect by our countries' "news" organizations.

Quote:
Originally Posted by ERD50 View Post
The trouble with anecdotes (especially anonymous ones)....

For every one presented on one side, there is likely one to counter it. IMO, this just adds to the noise. Here is one that is high profile and verifiable:

A health care 'success story' that isn't - Lucy McCalmont - POLITICO.com





-ERD50
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Old 12-05-2013, 03:29 PM   #5
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Yes, interesting generic story from the OP, but is seems what is actually happening is that the vast majority of the young are just not interested...


Few uninsured young people say they’ll sign up for Obamacare
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Old 12-05-2013, 03:33 PM   #6
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Sounds plausible. According to my state's calculator, someone with $20k of income would pay $64/month after subsidy for a silver plan.

DS makes about that but his company sponsored plan will cost him $140/month. He can't get a subsidy because his employer coverage is considered "affordable" even though it is more than twice what a person with the same income but no employer coverage would pay.

I think he would be better off if his employer didn't provide coverage.
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Old 12-05-2013, 03:34 PM   #7
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Quote:
Originally Posted by Chuckanut View Post
Here's a true ACA story.

Young person in early 30's was going to qualify for work health insurance when a combination of factors beyond control led to not being eligible. Makes about $20,000 a year.

Applied at state exchange. Got a policy for $50 month after subsidy. ($170 a month with no subsidy). $1,000 deductible, 20% copayment, $6,500 limit on the copayment! then insurance pays 100%.

Just thought I would give some real life perspective to all the noise.
It seems no thread is immune from the tales of doom and calamity.
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Old 12-05-2013, 03:59 PM   #8
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How many retirees here live on 20k a year less SS taxes? I would have thought she would be fully subsidized or on Medicaid with this low income. Where in the world is she going to get the thousand bucks for the deductible?
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Old 12-05-2013, 04:05 PM   #9
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Local PBS station did a story covering some healthcare info events. They were surprised that there were many 30 somethings, families with young kids. Most were anxious to sign up. Most didn't have insurance and their workplaces didn't offer it or they couldn't afford it.

Another take on Jessica

Debunking Obamacare sob story | Local News | The Seattle Times
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Old 12-05-2013, 04:18 PM   #10
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Except there’s a key detail none of these media outlets mentioned.

Which is: Sanford’s son was discovered to qualify for Medicaid coverage at a cost of just $30 a month. He has ADHD and, according to Sanford, it costs them $250 a month for prescription drugs alone. Which will now all be covered.
Something seems fishy here. Can the teenage son really qualify for Medicaid if the mother earns $49k a year? I thought that Medicaid eligibility was based on family income and that $49k a year of income would make them ineligible for Medicaid. And since when did Medicaid coverage have a premium cost?

Or did a bureaucrat somewhere wave a magic wand to make the political heat disappear?
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Old 12-05-2013, 05:29 PM   #11
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How is this person making $20,000 supposed to be able to pay for any real medical bills. One trip to hospital at 30K and he has to come up with 7.0K?? How does that work and how is that any different than not having insurance really for him? I can see where if he develops strep throat now he can go to a doctor and only pay the first $1,000 but will he even be able to afford that on 20K? Because of this I think young people look at this and say why even pay the 50 bucks a month, I can't afford the treatments anyway.
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Old 12-05-2013, 05:32 PM   #12
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Something seems fishy here. Can the teenage son really qualify for Medicaid if the mother earns $49k a year? I thought that Medicaid eligibility was based on family income and that $49k a year of income would make them ineligible for Medicaid. And since when did Medicaid coverage have a premium cost?
Under the Patient Protection and Affordable Care Act of 2010, there is now expanded coverage for managed care Medicaid programs for children with severe ADHD. This program only covers the child, and not the parent. Like other specialized Medicaid programs, there may be a fee involved.

Note that this is different from the general Medicaid family coverage for low income families. Like Social Security, there are many different programs under the Medicaid umbrella.

In this particular case, the mother still has to purchase coverage through the exchange.
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Old 12-05-2013, 05:35 PM   #13
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How is this person making $20,000 supposed to be able to pay for any real medical bills. One trip to hospital at 30K and he has to come up with 7.0K?? How does that work and how is that any different than not having insurance really for him? I can see where if he develops strep throat now he can go to a doctor and only pay the first $1,000 but will he even be able to afford that on 20K? Because of this I think young people look at this and say why even pay the 50 bucks a month, I can't afford the treatments anyway.
On Medicaid?
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Old 12-05-2013, 10:18 PM   #14
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How is this person making $20,000 supposed to be able to pay for any real medical bills. One trip to hospital at 30K and he has to come up with 7.0K?? How does that work and how is that any different than not having insurance really for him? I can see where if he develops strep throat now he can go to a doctor and only pay the first $1,000 but will he even be able to afford that on 20K? Because of this I think young people look at this and say why even pay the 50 bucks a month, I can't afford the treatments anyway.
I think at some lower income levels (maybe below 250% of PL? - not sure) there is much more cost sharing so less out of pocket is owed than those at higher income.

Edit: See section on cost sharing subsidies:

http://kaiserfamilyfoundation.files....01/7962-02.pdf


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On Medicaid?
No, he is talking about the person in Post 1 who made $20k a year and bought ACA coverage.
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Old 12-05-2013, 10:32 PM   #15
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I know this young person. The story is not from a news article. It is not a sob story. I just wanted to show how ACA helped one person get insurance. It is just one person's story.
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Old 12-05-2013, 10:53 PM   #16
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Originally Posted by Chuckanut View Post
Here's a true ACA story.

Young person in early 30's was going to qualify for work health insurance when a combination of factors beyond control led to not being eligible. Makes about $20,000 a year.

Applied at state exchange. Got a policy for $50 month after subsidy. ($170 a month with no subsidy). $1,000 deductible, 20% copayment, $6,500 limit on the copayment! then insurance pays 100%.

Just thought I would give some real life perspective to all the noise.
When I hear these stories, I, for one, am always curious to examine how much the entire premium for the policy is - not just the subsidee's portion - and I notice the focus of the story is never upon that number.

Seems in this case the taxpayers are paying only $1440 per year for this policy ---- this seems like pretty darned good coverage for a total of only $2k per year?

(Oh, hi everybody - long time listener, first time caller here)
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Old 12-06-2013, 06:54 AM   #17
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One of the interesting questions of individual policies, especially if subsidized, is what happens when a few monthly payments are missed. 1. What are the penalties and interest? 2. Will the provider get paid for services rendered in a lapsed policy? 3. Will the insurer have to return the subsidy to the government? I remember how aggravating it was to get the ok from the insurance company for treatment, render the treatment and then have the insurer balk at payment because the policy had lapsed in the interim. These may not sound like important questions but if they aren't addressed very few providers are going to accept individual exchange policies. How many business owners here would reach out for 5% more business if it was aggravating, costly, and cumbersome?
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Old 12-06-2013, 08:49 AM   #18
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I know this young person. The story is not from a news article. It is not a sob story. I just wanted to show how ACA helped one person get insurance. It is just one person's story.
That's fine, but I really didn't understand the point of the post. My reply was my way of expressing that.

The ACA affects many millions of people. The news would be if there weren't some anecdotes of individuals being helped by it. I don't think that even our Congress could write a bill so bad that no one was helped!

So when you say you wanted to give some real life perspective to all the noise, IMO, anecdotes are noise and do not provide perspective. To evaluate the overall effectiveness of the ACA (which can't be done yet, and certainly won't happen in this forum, which is OK), it will take a 'big picture' look.

OTOH, anecdotes are important to identify cases that fall through the cracks, or maybe get an excess of benefits, so that the law/implementation can be improved. But individual successes should be expected, and aren't very meaningful if not weighed against any failures.

Does that help?

-ERD50
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Old 12-06-2013, 08:56 AM   #19
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Originally Posted by Gatordoc50 View Post
One of the interesting questions of individual policies, especially if subsidized, is what happens when a few monthly payments are missed. 1. What are the penalties and interest? 2. Will the provider get paid for services rendered in a lapsed policy? 3. Will the insurer have to return the subsidy to the government? I remember how aggravating it was to get the ok from the insurance company for treatment, render the treatment and then have the insurer balk at payment because the policy had lapsed in the interim. These may not sound like important questions but if they aren't addressed very few providers are going to accept individual exchange policies. How many business owners here would reach out for 5% more business if it was aggravating, costly, and cumbersome?
Just guessing but I think it would be the same as other insurance from the provider's perspective since from the provider's perspective there is no difference between a subsidized policy and an unsubsidized policy - there is just insurance and how the insurer gets paid for premiums doesn't matter to the provider.

From the insured's perspective, it would also be the same in that there is a grace period for premium payment, after which notices are sent that the policy will be cancelled unless the premium is received and if the premium in arrears is not received by a certain date the policy is cancelled subject to reinstatement if the premiums in arrears are paid within a certain period and claims are only honored for insured events occurring prior to the last paid to date.

The only rub would be that the insurer would need to return any advances received for coverage after the last paid to date to the feds, but they'll work that out.
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Old 12-06-2013, 09:46 AM   #20
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The beauty of anecdotes is that you can find one to fit whatever your agenda is. I'm going to just sit back and see how this all plays out. Me, with my secure, ex-employer supplied insurance.
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