I'm freaking out over health insurance

[redshift]

There's a Whole Foods on the big island in Hawaii, I wonder if they're hiring?[emoji16]

I wish there was! Only on Oahu and Maui at this point. We live on the Big Island part of the year.

 

[cbo111]

People are coming out in droves to let their representatives know. Why do you think so many of them are refusing to have town hall meetings?

Yes, we all need to contact our elected reps to let our expectations known. This is not a conservative or liberal issue. Health care is fundamental! You jam up your congressman's tele lines and the message gets through. Unless you are lobbyist, this is the only way to communicate.

 

[Winemaker]

Like I said in another thread, we need to make health care like a vacation plan. First class cabin, business class, coach, Greyhound. Ritz-Carlton, Hilton, Holiday Inn, Motel 6, park bench. Concierge, guided tour, audio hand set, pamphlet. Prime time, seasonal, etc. There are so many choices until there is none. Most people don't plan for health care, retirement, until it's too late or taken away by an employer.

 

[zinger1457]

The great thing about Medicare is the network covers the entire US, not just 50 square miles of some small metro area that doesn't even have certain specialists.

Is Medicare really all that great? Recall reading an article that stated 20% of doctors are refusing to accept new Medicare patients and it's only expected to get worse with all the 'baby boomers' joining the Medicare ranks.

 

[Dreaming of Freedom]

Is Medicare really all that great? Recall reading an article that stated 20% of doctors are refusing to accept new Medicare patients and it's only expected to get worse with all the 'baby boomers' joining the Medicare ranks.

I don't understand how doctors can turn away 60% of their clientele and still get by. Isn't Gen X like half the size of the boomer generation, and we won't need the doctors as much as the boomers do (until we get old ourselves).

 

[AllDone]

Is Medicare really all that great? Recall reading an article that stated 20% of doctors are refusing to accept new Medicare patients and it's only expected to get worse with all the 'baby boomers' joining the Medicare ranks.

Many older doctors don't accept new patients with any form of insurance. They have all the patients that they need to support their practices. Others accept only a limited number per year. I suspect that the 20% figure rather deceptively includes those doctors. Medicare is accepted by 90+% of doctors except in a few specialties.

Here's a Forbes article :
http://www.forbes.com/sites/howardg...ge-of-doctors-willing-take-medicare-patients/

 

[Katsmeow]

I don't understand how doctors can turn away 60% of their clientele and still get by. Isn't Gen X like half the size of the boomer generation, and we won't need the doctors as much as the boomers do (until we get old ourselves).

DH is on Medicare and he hasn't tried to see any doctor who doesn't take Medicare. I am sure there are some, but it has been easy to find those who do take it. My sense is it may be most difficult with primary care doctors. The one he ended up going to (we moved after he went on Medicare so he needed a new doctor) agreed to see him only because I was already a patient in his practice (I'm not on Medicare yet).

To the OP -- You raise a legitimate concern. I'm on retiree insurance and only 2 years from Medicare. But I have thought about the issue since retiree insurance can always change. Options I would see if there weren't good choices where I live (or there are none):

1. If there are any choices that are at all reasonable then take one and just hope for the best. Basically live with a narrow network or high premiums although this is harder to do if there is a long time to Medicare.

2. Move. It may be that it is your county that doesn't have good options but another county in your state has more options. Even more extreme -- move to another state. Even if the law changes on the ACA, different states may have better options than others. Move to wherever has the best options.


3. Get a job with benefits. That may be easier said than done, but if it can be accomplished it solves the problem. Or, look for any other options to get on a group policy (professional groups, etc.).

4. Go without insurance (or get whatever insurance you can get). I would be reluctant to do that for the obvious reasons. If I did this I would set aside enough money that I could pay for most medical problems that come up. If I got hit with a really serious condition that would be expensive to treat, then I would look to travel to another country where the costs were less and get care there. Not ideal, but possible. Another variation of this might be try to go to another country and buy insurance there (if possible).

 

[Carpediem]

4. Go without insurance (or get whatever insurance you can get). I would be reluctant to do that for the obvious reasons. If I did this I would set aside enough money that I could pay for most medical problems that come up. If I got hit with a really serious condition that would be expensive to treat, then I would look to travel to another country where the costs were less and get care there. Not ideal, but possible. Another variation of this might be try to go to another country and buy insurance there (if possible).

If you opt for option 4, I'd probably sign up with a religious health share program.

 

[ShokWaveRider]

As of today's news it seems like the New addition is really not getting any better. Instead of the outright removal of pre-existing conditions, Child inclusions till 26, diagnostics, preventative care protections and the increased costs for older folk like us, the decision is simply being shifted to the states. In my case that means "No Soup for You". . I thought that health care was REALLY IMPORTANT to EVERYONE, not the removal of existing benefits.

 

[MichaelB]

There is no new bill, just the report of a potential amendment.

 

[ShokWaveRider]

There is no new bill, just the report of a potential amendment.

OK, but the amendment still makes it a new"er" bill at the end of the day. Same results.

 

[LARS]

4. Go without insurance (or get whatever insurance you can get). I would be reluctant to do that for the obvious reasons. If I did this I would set aside enough money that I could pay for most medical problems that come up. If I got hit with a really serious condition that would be expensive to treat, then I would look to travel to another country where the costs were less and get care there. Not ideal, but possible. Another variation of this might be try to go to another country and buy insurance there (if possible).

I have not tried to wrap my head around a scenario where no insurance is to be had. Cannot imagine that will occur. Albeit, what is available could be quite expensive. If this is the case, I will be royally irritated but fork over the money because going sans-health insurance is not an option as far as I am concerned.

 

[MichaelB]

OK, but the amendment still makes it a new"er" bill at the end of the day. Same results.

The key word is "potential". It is not an amendment, just another proposal. If it does pass muster, make it into the bill, and get a spot on the legislative calendar, we can talk about it. In the meantime, there's nothing to talk about.

 

[nun]

Healthcare was a big factor in my retirement planning and I'm lucky I have two low cost options; as a state retiree I get subsidized insurance and pay $100/month for a plan with very low deductibles and as a UK citizen I can always return to Britain and get NHS treatment.

 

[Teacher Terry]

Everyone I know that is on Medicare has been very happy with it. They have not had a problem finding a doc.

 

[EastWest Gal]

Guess I'm a little surprised at the passivity I see in this thread. If you have concerns about what might be happening to the ACA, then let your elected representatives know about it. If enough folks do that, then the ACA might just get fixed in a way that will benefit us all.

Some of us aren't commenting here all the time but are writing representatives, attending town halls, etc. I've written mine several times but I get the same canned replies. I've also attended town halls and called the local and DC offices. I've explained detailed ways the ACA needs fixing but the canned replies mean I don't have a voice.

As long as there is a huge industry that makes billions off of Americans, because the system is set up for obfuscation by hospitals, doctors, drug companies, equipment companies, and insurance companies, they all overcharge on stuff they shouldn't. Insurance companies don't pay when they should. But the consumer cannot fight this alone. Anyone who thinks that one can shop for health care the same way one buys a pair of shoes is delusional.

The ACA has made changes most of us don't see. It has set up a process where fraud and waste are no longer acceptable and are less likely to occur. But without the ability to negotiate prices, especially drug prices, we can't really cut premiums.

With single payer, when a doctor or pharmacy commits insurance fraud, they will be defrauding the federal government. The consequences of that may finally frighten some into behaving better.

If we ever go to single payer, it will need to be slowly, as a huge number of paper pushers will be out of work. The effect on the economy initially will be very challenging.

Half the ads we see on television are for really expensive drugs that relatively few will use. So our premiums are not supporting research at all, which is funded by NIH and other agencies. Nope, our money is going to insurance companies and drug companies. Insurance money goes to drug companies. Drug companies funnel money to cable TV stations. And in the case of Mylan, perhaps Pharmacy Benefits Managers.

This article uses the word "rebates". I think "kickbacks" is a more appropriate term.

https://www.google.com/amp/mobile.reuters.com/article/amp/idUSKBN1752CA

 

[Katsmeow]

I have not tried to wrap my head around a scenario where no insurance is to be had. Cannot imagine that will occur. Albeit, what is available could be quite expensive. If this is the case, I will be royally irritated but fork over the money because going sans-health insurance is not an option as far as I am concerned.

Back in the day (pre-ACA) people used to get turned down for insurance all the time. There were people with plenty of money who could not buy health insurance.

If community rating goes away (which is possible) then insurers might be required to offer coverage to those with pre-existing conditions but could charge whatever they wanted to for it. Insurance for those with cancer, for example, would likely be so expensive to be unaffordable.

Another possibility is that the requirement to offer coverage to those with pre-existing conditions could go away making it possible no insurance would be available at all. Even if high risk pools were offered in the past they were so underfunded that there were often waiting lists to get on them (sometimes years long) or they excluded pre-existing conditions for a period of time (not really very helpful for someone who has a serious condition needing immediate treatment).

 

[LARS]

Back in the day (pre-ACA) people used to get turned down for insurance all the time. There were people with plenty of money who could not buy health insurance.

If community rating goes away (which is possible) then insurers might be required to offer coverage to those with pre-existing conditions but could charge whatever they wanted to for it. Insurance for those with cancer, for example, would likely be so expensive to be unaffordable.

Another possibility is that the requirement to offer coverage to those with pre-existing conditions could go away making it possible no insurance would be available at all. Even if high risk pools were offered in the past they were so underfunded that there were often waiting lists to get on them (sometimes years long) or they excluded pre-existing conditions for a period of time (not really very helpful for someone who has a serious condition needing immediate treatment).

For many years prior to ACA, a number of states required health insurance providers to offer non-medically underwritten policies. New York comes to mind in that regard. So there were states that you could move to and get HI even if you had a pre-existing condition: and you were not penalized on the cost front.

Certainly more state insurance commissions allowed medically underwritten policies than did not.

 

[Freedom56]

My wife and I pay $12,500 in premiums and another $400 or so in copay for tests ordered by the doctor not covered by the ACA preventive care. We don't get any subsidies. My advice is to stay healthy (keep your BMI below 25 and exercise regularly) and see a doctor once a year for your preventive care. My concern is the cost of prescription medication. We do not take any regular medications other than 81 mg Asprin but I have seen medications increase in price by 8 fold over the past 2 years. The only solution to this is to buy drugs from Canada. I don't see any major improvements to the ACA under this current administration.

 

[Katsmeow]

For many years prior to ACA, a number of states required health insurance providers to offer non-medically underwritten policies. New York comes to mind in that regard. So there were states that you could move to and get HI even if you had a pre-existing condition: and you were not penalized on the cost front.

Certainly more state insurance commissions allowed medically underwritten policies than did not.

That didn't mean policies were effectively available. Yes, NY required community rating pre-ACA However, my understanding was that premiums were very high and very few insurers participated.

This discusses the history:

https://www.healthinsurance.org/new_york-state-health-insurance-exchange/

This says:

“Before the ACA, there was basically no individual insurance market in New York,” Schaub said. “There was only about 23,000 people because there weren’t any subsidies and so insurance companies, knowing they were going to have to write you a policy no matter your health condition, they charged very high premiums and the vast majority of people in the individual market could not afford that.”

City & State - After Obamacare: What are New York’s options if the Affordable Care Act is repealed?

I recall on another forum I participated in back then someone from New York telling me how much the premiums were for individual coverage and it was insanely high, far beyond the means of most people.

 

[LARS]

That didn't mean policies were effectively available. Yes, NY required community rating pre-ACA However, my understanding was that premiums were very high and very few insurers participated.



This discusses the history:



https://www.healthinsurance.org/new_york-state-health-insurance-exchange/



This says:





City & State - After Obamacare: What are New Yorkâ€[emoji769]s options if the Affordable Care Act is repealed?



I recall on another forum I participated in back then someone from New York telling me how much the premiums were for individual coverage and it was insanely high, far beyond the means of most people.

They were available in NY: they weren't cheap but they were within reach. I know this for a fact as when we moved back East before ACA I specifically looked into NY as a place to relocate. In the end, we moved to a state that was medically underwritten in New England; and, HI was materially cheaper than NY.

But the point is: it was absolutely available.

 

[Fedup]

People mentioned single payer and don't necessary understand what it really means. I hear this often in the net. It's always mean the government is going to provide health insurance like the U.K. Only 4 countries are in this category.

 

[MichaelB]

That didn't mean policies were effectively available. Yes, NY required community rating pre-ACA However, my understanding was that premiums were very high and very few insurers participated.
./.
I recall on another forum I participated in back then someone from New York telling me how much the premiums were for individual coverage and it was insanely high, far beyond the means of most people.

I had one of those policies. The premiums were high, the lifetime limit was low, the networks were limited, and the policy coverage met a minimum standard but was by no means comprehensive.

 

[Alan]

People mentioned single payer and don't necessary understand what it really means. I hear this often in the net. It's always mean the government is going to provide health insurance like the U.K.

Lots of private insurance companies and clinics/hospitals in the U.K. plus the government side of things is managed by trusts who receive funding from central government.

https://en.m.wikipedia.org/wiki/Single-payer_healthcare

The British system is technically not single-payer, as it consists of a number of financially and legally autonomous trusts, and private health insurance options are also allowed. Only Canada and Taiwan have true nation-wide single-payer systems.

 

[CDRE]

As long as there is a huge industry that makes billions off of Americans, because the system is set up for obfuscation by hospitals, doctors, drug companies, equipment companies, and insurance companies, they all overcharge on stuff they shouldn't. Insurance companies don't pay when they should. But the consumer cannot fight this alone. Anyone who thinks that one can shop for health care the same way one buys a pair of shoes is delusional.

+1 This is the perfect description of the root cause!!