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Old 11-15-2015, 03:59 PM   #141
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You still have insurance . It's just the Dr who doesn't take it

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Old 11-15-2015, 04:15 PM   #142
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You still have insurance . It's just the Dr who doesn't take it
Yeah, but at some point it would be like auto insurance which only covers you on a smaller and smaller subset of roads and highways, and leaves you exposed to potentially unlimited liability if you accidentally stray off of a "covered" road and have an accident.
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Old 11-15-2015, 04:30 PM   #143
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Yeah, but at some point it would be like auto insurance which only covers you on a smaller and smaller subset of roads and highways, and leaves you exposed to potentially unlimited liability if you accidentally stray off of a "covered" road and have an accident.
That's not how it works. We have BCBS PPO. The doctor doesn't take insurance but our insurance covers everything else.

We pay the doctor an additional $1000 a year per person so that he can spend more time with us and thus give us better care. He is completely disconnected from insurance but we still have top level insurance for everything else including Rx.
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Old 11-15-2015, 04:35 PM   #144
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That's not how it works. We have BCBS PPO. The doctor doesn't take insurance but our insurance covers everything else.
If you have a major emergency and are "balance billed" for the portion that insurance won't pay -- even if the ACA requires payment at in-network rates -- that *is* substantially how it works. Even if you go to a facility that is in network, but unknown to you, many of the providers attending you are not.
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Old 11-15-2015, 04:39 PM   #145
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Ziggy, I must not be explaining it well enough .

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Old 11-15-2015, 04:45 PM   #146
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Ziggy, I must not be explaining it well enough .
No, I get what you are saying and I'm not disagreeing. I understand that this $1000/yr doctor is separate from insurance and basically "supplements" other insurance. You could use this PCP for most visits and use the insurance for emergencies, for prescriptions and for specialists, lab tests, imaging and the like.

But the question was, "what happens if you are admitted to a hospital?" I was largely referring to that and probably should have quoted that snippet instead, since that was really what I was getting at and answering: even with insurance, if you have to go to an ER with out of network providers (even at an in-network facility), you could face massive bills.
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Old 11-15-2015, 04:49 PM   #147
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I'm paying another $15k for BCBS so I'd expect them to cover any ER expenses

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Old 11-15-2015, 04:51 PM   #148
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I don't need an in network doctor to admit me

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Old 11-15-2015, 05:27 PM   #149
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Health care costs in the U.S. were ridiculously high before the ACA. The ACA may not have fixed this issue very well, but the high costs are not a result of the ACA.
Yep, ACA is good, yet imperfect, attempt to deal with an existing very bad mess. I'll leave it at this so as to avoid getting political...

As for me, I confess that I was insulated from long term problems of the US system because I had dirt cheap big network PPO insurance from my mini-Megacorp employer or great HMO through Big University. Between these two, I spent only a few hundred dollars in out of pocket cost over 25 years, including a fight with cancer! Although this seems like such corporate-subsidized gravy train, it did cost me decades in a salt mines of mini-Mega. So no free lunch.

Now with both DW and I in retirement, we are fully exposed (via big deductibles, high OOP, high premiums, and crappy network coverage) to all the issues discussed here. Still I'm very grateful for ACA since we couldn't have ER'd without it.

We're no longer so naive about healthcare now that we have lots of skin in the game. We have made major lifestyle modifications, including ER, to help us live better and healthier. We've developed a healthy skepticism of the entire healthcare, better named SICK-care, money complex.

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Old 11-15-2015, 05:31 PM   #150
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It is true that we spend a lot more on healthcare per capita compared to other countries. But how does shifting the cost to the government fix the problem if it turns around and taxes us more? We cannot fix a problem until we identify its source. Reducing the cost is not done by shifting it around, just to have it come back on our shoulders.
+1 Yes indeed!
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Old 11-15-2015, 05:37 PM   #151
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I don't need an in network doctor to admit me

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you two seem to be talking different areas of insurance.
you seem to be focused on your "independent" PCP that you pay more for than all my OOP for medical and dental (w/o insurance .. and included 2 crowns) [<1k for DW and myself]
and I think Ziggy is on a different line of what would happen if you ended up in an ER (your PCP might not be there... you could be out of state... or whatever) and you may have some non-network doctors or facilities or balanced billing.

I would wonder how your insurance would cover tests ordered by your non-network doctor. Say you needed an MRI. Do you need to get an in network doctor to write a script for that?

I do appreciate you description of removing all the insurance reporting reducing costs for your doctor. Likely one of many areas to help cut costs.
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Old 11-15-2015, 05:53 PM   #152
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One of our problems is that most of the health coverage was covered by employer plans where the insured had no idea of what it really costs.
+1 Agreed, but it's just not employer plans. Just after nice Megacorp plans, you can think of Medicare. Folks on ACA seem to count the days until Medicare. We know someone on Medicare who has paid only about $1K OOP of the $300K+ costs due to a very serous illness. Funny to think of Medicare as the new Gold Standard in HI as someone here suggested.
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Old 11-15-2015, 06:04 PM   #153
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+1 Agreed, but it's just not employer plans. Just after nice Megacorp plans, you can think of Medicare. Folks on ACA seem to count the days until Medicare. We know someone on Medicare who has paid only about $1K OOP of the $300K+ costs due to a very serous illness. Funny to think of Medicare as the new Gold Standard in HI as someone here suggested.
The folks on ACA might not realize that kind of coverage will cost around 350+ a month per person or 700 per couple, yes no co pay to speak of but I bet many ACA coverages are under that number.
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Old 11-15-2015, 06:12 PM   #154
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The folks on ACA might not realize that kind of coverage will cost around 350+ a month per person or 700 per couple, yes no co pay to speak of but I bet many ACA coverages are under that number.
A lot of ACA coverages are at or higher than those numbers.

And non-subsidized ACA folks face much higher deductibles than Medicare folks.

Plus having to deal with all the out-of-network nightmares.
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Old 11-15-2015, 06:14 PM   #155
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The folks on ACA might not realize that kind of coverage will cost around 350+ a month per person or 700 per couple, yes no co pay to speak of but I bet many ACA coverages are under that number.
Yes. Part B plus Part D plus deluxe supplement would be $600 to $700 per month for a couple on SS. Much more if your joint MAGI is $170k or more. You also pay a lifelong tax of 2.5% prior to coverage beginning at age 65.

Not a bad deal but not "free" as some folks think.
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Old 11-15-2015, 08:05 PM   #156
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Very valid point. I recently lost weight thanks to cleaning up our diet, exercise too. When he asked me about some of the prescriptions I had been on he appeared dumbfounded that I no longer wanted them. No doc, it took me months of not sleeping to get off of Ambian, I'm not taking any more!

Since doing that I no longer have symptoms of or take medicine to control:
Tachycardia
Hypertension
Triglycerides
GERD
Insomnia

DW has had similar sucess. Not a bad trade off in my mind!
Congrats MRG on taking control of your health. DW and I (actually more DW) improved our diet and we've both lost tons of weight. We avoided/stopped some of the same issues you listed just by diet and modest exercise.

DW and I constantly remind each other that under ACA we can no longer afford unhealthy lifestyles. The deductibles and OOP would kill us, not to mention the "lifestyle" illnesses themselves.

It's interesting that most folks here strongly advocate taking care of most/all of their own finances. Experts like lawyers, accountants, and FA should be used sparingly on an as needed basis. Well, DW and I feel the same way about our health. We want to maintain it as well as possible by diet and exercise, and also know enough to see when to call in an expert from the healthcare, I mean sick-care, money complex.

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Old 11-15-2015, 08:17 PM   #157
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And non-subsidized ACA folks face much higher deductibles than Medicare folks.

Plus having to deal with all the out-of-network nightmares.
+ 1

Right there audreyh1, our two biggest concerns in sick-care, maybe even all of ER. Actually, out-of-network is even more scary than big deductible and OOP. At least these are known & constrained evils. The out of network issues can pop up unexpectedly, and some plans have no constraint on the damage level. This defeats one of the biggest reasons for insurance: moderating or at least constraining risk.

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Old 11-15-2015, 08:23 PM   #158
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It's interesting that most folks here strongly advocate taking care of most/all of their own finances. Experts like lawyers, accountants, and FA should be used sparingly on an as needed basis. Well, DW and I feel the same way about our health. We want to maintain it as well as possible by diet and exercise, and also know enough to see when to call in an expert from the healthcare, I mean sick-care, money complex.
There are some fair points here. But at the same time, not everyone is genetically blessed and even people who do everything right can get cancer, just as people who are generally financially responsible can hit hard times through circumstances not of their own making.

I'm not sure it's really a fair point, though, to suggest that people who are "responsible" financially are not responsible when it comes to their health.
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Old 11-15-2015, 08:45 PM   #159
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The folks on ACA might not realize that kind of coverage will cost around 350+ a month per person or 700 per couple, yes no co pay to speak of but I bet many ACA coverages are under that number.
DH has been on Medicare for about 3 years now. I am not yet on Medicare. There is no question that Medicare is far cheaper. He pays a little under $300 a month (his precription drug plan is made for by the Megacorp he retired from). In the past 3 years, his out of pocket costs have been negligible. He was Plan F for his medigap coverage. Basically his out of pocket costs have been for a couple of prescriptions. (He did have an eye exam and new glasses, but those aren't covered under private insurance either). Every doctor he has wanted to see accepts Medicare. Last year he had major shoulder surgery with several months of PT, all covered. This year he had to go to the ER a couple of times, which resulted in prostate surgery. All of it was covered with no cost sharing by him.


For the upcoming year, I will be (with 2 of our kids) on an off-exchange plan. The share of the premium just for me would be about $750 a month (I'm not paying that as most of the cost is subsidized by DH's former employer). However, the family deductible is $12,800 (individual is $6400) and the family out of pocket maximum is $13,400 ($6700 individually). There are co-pays with deductible waived for generic meds and for visits with doctors (that doesn't include lab tests or imaging though). And, there is no out of network coverage except for emergencies.

If DH were to develop cancer, he could go to MD Anderson. If I were to develop cancer, I could not. Medicare seems like a significantly better deal.
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Old 11-15-2015, 08:59 PM   #160
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Medicare seems like a significantly better deal.
I haven't read any posts saying that Medicare (plus a supplement) was not a better deal than most non-Medicare policies. Although we do need to figure some way to include the 2.5% lifetime tax into the Medicare cost equation some way.......

What people, including me, are saying is that Medicare plus a supplement is going to cost upwards of $300/mo each or upwards of $600/mo for a couple. And you have to pay 2.5% of your income for life to qualify to pay that. Still, likely the best HI deal going for most geezers.

Couples just need to remember to pencil in $8k or so annually to pay for it. Somehow, the rumor that Medicare is free, or near-free, persists
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