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Old 04-24-2013, 07:42 AM   #21
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Originally Posted by Texas Proud View Post

SOOOO, I am paying 40% more just because I live in a location that has a lot of medical facilities Not because we are sicker....
We've been getting hosed for years due to all the free loaders we end up subsidizing here in TX, which I suspect will not change anytime soon even with ACA.

My subsidized mega corp benefit costs me more than 2x what an equivalent retiree pays in the Northeast
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Old 04-24-2013, 08:11 AM   #22
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Originally Posted by Texas Proud View Post
I love this quote from the article...

"For example, in Texas someone living in Houston or Dallas with easy access to world class medical facilites currently pays about 40% more than someone living in a sparsely populated rural area in the Western part of the state."


SOOOO, I am paying 40% more just because I live in a location that has a lot of medical facilities Not because we are sicker....
I didn't see anything to support that statement, and what I have read elsewhere points to the opposite conclusion. Rural and sparsely populated areas are high health care cost while large metropolitan areas are lower cost. Exception to Hawaii and NYC.
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Old 04-24-2013, 09:06 AM   #23
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Yes.

My spouse was informed that even chewing Nicorette, without declaring it as smoking, would result in denial of benefits.
I would think it is based on the terminology of application. Some specify specifically including nicotine, while others have specifically stated smoking. The FDA just came out and recently states that it is safe to be on nicotine replacement gums/lozenges long term. My guess is it isn't about the nicotine, but the fact you are more prone to relapse and start smoking again.
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Old 04-24-2013, 09:16 AM   #24
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Originally Posted by marko

IMO, smokers should be encouraged. Statistically, they die faster and younger thus using less health care resources than a life-long healthy person who is strong enough to 'linger' through old age.

I forget the actual numbers but smokers use a lot of HC resource but for a shorter period vs a non-smoker who uses moderate resources for much, much longer including LTHC. In the end, the healthy person is more of a longer term drain to the HC system just by living much longer.

It should almost be our duty to take up smoking, exit the planet early and reduce the overall HC costs for everyone! And let's not forget the benefit of added tax revenue.

A little bit of sarcasm here, but something to think about, I think.
No, you are spot on. Many studies have concluded this and we have had a thread on it before. In the totality of healthcare costs from cradle to grave, fat people and smokers consume less. If we get more people fit and off the smokes, we will just have to build industrialized sized complex nursing homes for all the healthy people who eventually develop Alzheimer's and such. But the insurance companies know this, let the problems develop after 65 so it isn't their problem. Plus you figure in the 10 years savings of less Social Security due to early death, I do not know if our country can financially afford a society of healthy people.
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Old 04-24-2013, 09:31 AM   #25
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Eligibility for subsidy is determined using the total household income, specifically the MAGI. Each individual in the household is eligible for subsidy if the total household MAGI is between 133% and 400% of the FPL. This determines the total amount one will pay, regardless of the cost of the premium, which does vary based on location, age, and smoker or not.
I stand corrected. Further research points to healthcare subsidies will not cover any smoking surcharge. Sarah Kliff has a good article here Big tobacco and anti-cancer activists agree: Health provision goes too far
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Old 04-24-2013, 09:38 AM   #26
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You probably pay more for housing, food, auto insurance, etc in a more urban area too, based on free market prices. I guess that's the price we pay for choosing to live where we've got all the conveniences.

Actually, some of that is cheaper here than other places in Texas...

But, I do not think that the surcharge is close to 40% (except for maybe auto where there are more accidents than in the country)....
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Old 04-24-2013, 09:41 AM   #27
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I didn't see anything to support that statement, and what I have read elsewhere points to the opposite conclusion. Rural and sparsely populated areas are high health care cost while large metropolitan areas are lower cost. Exception to Hawaii and NYC.
I live in a rural area, 15 miles or so from a hospital, and 60 miles from large metro city. I plugged into ehealthinsurance a zip code in a ritzy part of the metro area near all the hospitals and compared it to my location. Oddly enough, it was the exact same quote for both locations.
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Old 04-24-2013, 09:43 AM   #28
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I didn't see anything to support that statement, and what I have read elsewhere points to the opposite conclusion. Rural and sparsely populated areas are high health care cost while large metropolitan areas are lower cost. Exception to Hawaii and NYC.

I can see where it might be true... the Medical Center is huge... it has all the latest high cost machines and also all the high paid doctors... someone is paying for all that stuff...

We also have a lot of smaller hospitals that are part of a bigger network...
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Old 04-24-2013, 09:49 AM   #29
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I can see where it might be true... the Medical Center is huge... it has all the latest high cost machines and also all the high paid doctors... someone is paying for all that stuff...
Yet at the same time, living in two different rural areas in Texas myself, I know a lot of folks with serious medical issues are sent from small, less equipped rural hospitals by ambulance or helicopter to hospitals Houston or Austin or DFW or San Antonio. That ain't cheap, and it's a significant cost that is barely (if at all) into play in the big city. Often, the only role of the smaller rural hospitals is to stabilize the patient enough to allow for transport to the city.
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Old 04-24-2013, 09:56 AM   #30
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Yet at the same time, living in two different rural areas in Texas myself, I know a lot of folks with serious medical issues are sent from small, less equipped rural hospitals by ambulance or helicopter to hospitals Houston or Austin or DFW or San Antonio. That ain't cheap, and it's a significant cost that is barely (if at all) into play in the big city. Often, the only role of the smaller rural hospitals is to stabilize the patient enough to allow for transport to the city.
+1

In addition, the cost of the world class care in DFW is likely to be more than the cost of average care in the same area, and we are talking about average cost comparisons.

I do find it very frustrating that there is no public information available to let each of us know the cost level where we live.
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Old 04-24-2013, 05:40 PM   #31
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In Arizona BCBS rates are higher for everyone (includes Phoenix), but Pima County in which Tucson is part of. Go figure.
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Old 04-24-2013, 07:54 PM   #32
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Another calculator, posted by Live And Learn in another topic (Poll: Who's going to try to get ACA subsidies by staying under the threshold?) -

National Health Care Calculator

This one allows you to calculate for one person in a couple or both. It looks like the cost to the household remains the same. The insurance cost doubles but the subsidy increases to make up the difference.
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Old 04-25-2013, 06:07 AM   #33
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I wonder how much the deductible and max out of pocket are and how smoking or non smoking fits into the calculator? Does anyone know if you pay the premium up front and then get reimbursed at tax time? If that is the case you would be giving someone a pretty hefty loan until you get your money refunded.
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Old 04-25-2013, 06:13 AM   #34
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Does anyone know if you pay the premium up front and then get reimbursed at tax time?
As I understand it, it's a little of both:

For Coverage Year 2014, the subsidy you would be granted would be based on Tax Year 2012 MAGI (because, when you're applying for coverage for 2014, you haven't even done your Tax Year 2013 taxes yet, eh?) Then in 2015, you'd file your Tax Year 2014 taxes, and your 2014 MAGI would be determined, and it would be reconciled so that how much of a subsidy you got in 2014 would be appropriate based on your 2014 MAGI (paying back excess subsidy you received, or receiving a credit for subsidy you should have received but didn't).
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Old 04-25-2013, 02:05 PM   #35
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Another calculator, posted by Live And Learn in another topic (Poll: Who's going to try to get ACA subsidies by staying under the threshold?) -

National Health Care Calculator

This one allows you to calculate for one person in a couple or both. It looks like the cost to the household remains the same. The insurance cost doubles but the subsidy increases to make up the difference.
Not necessarily. DH is on medicare and I'm not. According to this, if I was buying on an exchange just for me, I would pay the single rate but for subsidy persons would get the rate for a 2 person household.

In reality, we still have kids at home and our income is above subsidy rates. It did go up with 1 child and then up again with 2 child so this is a more fine-grained calculator that those where it makes no difference if there is one child or more children.

Right now we are still on DH's retiree insurance but I am concerned that sometime this fall we will find out that they are doing away with it...
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Old 04-26-2013, 06:48 AM   #36
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+1

In addition, the cost of the world class care in DFW is likely to be more than the cost of average care in the same area, and we are talking about average cost comparisons.

I do find it very frustrating that there is no public information available to let each of us know the cost level where we live.

This reference only applies to Texas but it probably reflects insurance company thinking across the nation. The Texas High Risk Pool rates are broken out by zip code. As an example, the lowest rates are for Area 1. Zip code 76620 is in Area 1 and it is for Lufkin which is a smaller city. Area 6 (the highest rate code) includes zip code 77020 which is in Houston. The difference in cost for a 60 year old male in Plan II ($2500 deductible) is $357/mo between the two areas.

I'll try to post the link but I frequently don't get it in where it works right.

http://www.txhealthpool.org/Regular%...s%20080112.pdf

What I am waiting for is the ACA Fed exchange to come out with rates that will effectively eliminate the Texas High Risk Pool. The people paying these rates are mostly older since I've discovered being over 50 pretty much disqualifies anyone from any other insurance policy in Texas. Health insurance companies know everyone in this plan will sign up for anything cheaper and they really don't won't these people in their "normal" risk pool.
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Old 04-28-2013, 09:16 AM   #37
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We've been getting hosed for years due to all the free loaders we end up subsidizing here in TX, which I suspect will not change anytime soon even with ACA.

My subsidized mega corp benefit costs me more than 2x what an equivalent retiree pays in the Northeast
And who will pay for all those subsidies??
Best I can tell from the websites in my area is a average family of four will pay $19K. Sure is an incentive to not sign up until a major event comes along. I suspect many will do just that, which will push the cost up further for us. Human nature.
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Old 04-28-2013, 09:22 AM   #38
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And who will pay for all those subsidies??
Best I can tell from the websites in my area is a average family of four will pay $19K. Sure is an incentive to not sign up until a major event comes along. I suspect many will do just that, which will push the cost up further for us. Human nature.
My understanding is that you can't just sign up if a major event comes along. There will be windows of time that you can sign up. If the major event occurs outside those windows, you're screwed until the next window opens.

So if you have a cardiac event outside a window and are uninsured, you're screwed until you spend all your resources and become eligible for Medicaid.

I guess if you have little saved then it is probably worth the risk - you pay medical providers what little you have and then go on medicaid. But if you have substantial savings, then probably not.
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Old 04-28-2013, 09:52 AM   #39
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And who will pay for all those subsidies??
Best I can tell from the websites in my area is a average family of four will pay $19K. Sure is an incentive to not sign up until a major event comes along. I suspect many will do just that, which will push the cost up further for us. Human nature.
One could also ask who is paying for them now. Basically employer provided health care is being subsidized because they already disallow preexisting condition per FED regulations and they get a tax break because the premiums are treated as a business expense.

I would hope there would be some type of penalty such that if you do not sign up during the enrollment period and something happens, then you get stuck with the whole bill plus a penalty.
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Old 04-28-2013, 01:02 PM   #40
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Sure is an incentive to not sign up until a major event comes along. I suspect many will do just that, which will push the cost up further for us. Human nature.
If it becomes a problem, then hopefully people will do the right thing and close the loophole.
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