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Old 03-29-2014, 09:32 AM   #41
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I'm currently under my MegaCorp health plan for retirees. I use their mail order prescription service. Next year I will go under Medicare. Will I then need to price shop prescriptions or is that part of a Medicare Part D plan?
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Old 03-29-2014, 09:45 AM   #42
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Note that for many people using their insurance prescription or mail order program DOES NOT MEAN that you are paying the lowest cost for your prescriptions. Researching our group prescription plan I found out that we were paying more than double what we now pay without using our insurance prescription program. What's up with that logic?

We were always trained to think that since we could get prescriptions at a discounted rate through our insurance plan it would be the least expensive option. Turns out that at least in our families case that wasn't reality!
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Old 03-29-2014, 09:56 AM   #43
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Note that for many people using their insurance prescription or mail order program DOES NOT MEAN that you are paying the lowest cost for your prescriptions. Researching our group prescription plan I found out that we were paying more than double what we now pay without using our insurance prescription program. What's up with that logic?

We were always trained to think that since we could get prescriptions at a discounted rate through our insurance plan it would be the least expensive option. Turns out that at least in our families case that wasn't reality!
All but one prescription are under $1 for 90 days supply including the mail. One is $30/mo. I think I will look into that one.
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Old 03-29-2014, 10:08 AM   #44
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Note that for many people using their insurance prescription or mail order program DOES NOT MEAN that you are paying the lowest cost for your prescriptions. Researching our group prescription plan I found out that we were paying more than double what we now pay without using our insurance prescription program. What's up with that logic?

We were always trained to think that since we could get prescriptions at a discounted rate through our insurance plan it would be the least expensive option. Turns out that at least in our families case that wasn't reality!
Our case as well. Mom's, that is. She was using Medco, last year we unexpectedly ran short and I needed to get a same day refill, which Medco can't so, so I used the local Target. Her typical copay went from $65 to $10. So I checked her other prescriptions, all are less expensive at Target. Medco no more...
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Old 03-29-2014, 10:13 AM   #45
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This is my fear too. Premiums could go crazy or, possibly even worse, the ACA could be repealed and those with preexisting conditions become uninsurable again. Not a fun situation to be in just starting early retirement without group health insurance.
There is zero, 0, 0.0000 chance ACA will be repealed and the old system will come back. What could happen is a gradual shift to a national health care system.

Name a large social program in the USA that has ever been repealed once implemented.
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Old 03-29-2014, 12:11 PM   #46
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There is zero, 0, 0.0000 chance ACA will be repealed and the old system will come back. What could happen is a gradual shift to a national health care system.

Name a large social program in the USA that has ever been repealed once implemented.
Good points there. Thanks.
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Old 03-29-2014, 02:16 PM   #47
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There is zero, 0, 0.0000 chance ACA will be repealed and the old system will come back. What could happen is a gradual shift to a national health care system.
I agree that it won't be repealed to exactly the old system. That's silly.

I think there is a significantly greater than zero chance it will be "repealed." At which time, a new set of "reforms" will be enacted. Some of which could be a pretty significant change in direction.

It all depends on who is elected president in 2016 and what the congress looks like then.
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Old 03-29-2014, 05:01 PM   #48
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...........I think there is a significantly greater than zero chance it will be "repealed." At which time, a new set of "reforms" will be enacted. Some of which could be a pretty significant change in direction.
..................
Although there was a lot of gnashing of teeth over the implementation of the ACA, it would nothing compared to what would happen if people were suddenly tossed back into the uninsurable due to pre-existing situation that existed pre-ACA.
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Old 03-29-2014, 06:16 PM   #49
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Although there was a lot of gnashing of teeth over the implementation of the ACA, it would nothing compared to what would happen if people were suddenly tossed back into the uninsurable due to pre-existing situation that existed pre-ACA.
Assuming even the unsubsidized policies offered through the exchanges were to disappear with the ACA, I would hate to have to choose betwen the old bare-bones policy I had before or the broader policy whose premiums rose 50% in 2 years (busting my budget) I had before. The ACA is a blessing for me.
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Old 03-30-2014, 01:38 AM   #50
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Although there was a lot of gnashing of teeth over the implementation of the ACA, it would nothing compared to what would happen if people were suddenly tossed back into the uninsurable due to pre-existing situation that existed pre-ACA.

Likely any replacement for the ACA, or major overhaul, would address the "preexisting" issue. Even the advocates for repeal know the preexisting issue must be addressed, possibly with a government subsidized high risk pool.

In passing the bill much was made of the "millions" with preexisting conditions who could not buy insurance due to preexisting conditions as well as the 30 to 40 million uninsured who desperately wanted affordable insurance. Despite these assertions, hundreds of millions of dollar spent on signing people up, financial penalties for not being insured, and multiple extensions of the sit up deadline we find that only 6 million people signed up and another 6 million already insured with individual plans lost their plans. At this point we don't know how many of the six million who lost their plans were in the 6 million who signed up. Meanwhile a huge amount of disruption and uncertainty has been inserted in the healthcare marketplace due to the arbitrary and frequent rewriting of the rules, a huge new and costly federal bureaucracy has been established, and there is no clarity yet as to how much more the new system will cost compared to the old. Discussion of "savings" is virtually absent from the current heated debate.

While a few individuals may have lowered their health care costs, thanks to subsidies, the failure of the government to release the data it has about sign ups for independent analysis suggests the net effect in the marketplace for individual plans was higher premiums, deductibles, and copays (I.e. Costs). Certainly the screams from those adversely affected have been loud and the positive stories from the government about specific individuals benefiting from the ACA have been few.

As someone in the individual market with a preexisting condition (cancer), who experienced great difficulty and high annual expense to obtain individual insurance when I left corporate America prior to ACA, I had great hopes for healthcare reform. The only plan I could find exiting COBRA was a high deductible plan $5000/$10000. For the past 2 years I've easily met the deductible. Fortunately this plan paid 100% after the deductible was met.

I was one of the six million who received a letter last fall stating my plan was not ACA compliant and was being canceled. The company offered me a similar compliant plan for a 71% increase in premiums. The new plan had higher deductibles ($6250/$12500), added a 30% copay after the deductible was met, did not include dental (old plan did), and had fewer doctors in network. None of the ACA required enhancements to my old policy (maternity, pediatric dentistry, mental health) had any value to us. I checked the exchange and found the bronze plans were more expensive and offered less than the new private plan offered by my insurer. Thanks to my years of thrift and savings, prior to early retirement, my investments generate too much income for me to qualify for a subsidy. So at this point in time, for this individual with a preexisting condition, the implementation of ACA will more than double my annual healthcare costs with a lower level of benefits. did I budget for this level of increase in healthcare costs in the years prior to Medicare eligibility? No. Can I afford the increase? I have no choice and will have to curtail other spending to achieve my annual total budget goals.

To the extent there are millions of others making a similar reallocations of spending to support higher healthcare costs there will be a net reduction in consumer demand for food, energy, and other consumer good as and services. I suspect the net effect of the ACA to be a lowering of consumer discretionary spending in 2014. Currently sluggish retail sales, retail bankruptcies, and retail mergers in Q1 are symptoms of the ACA drag on consumer spending and the economy. I have to believe the economists inside the Fed and Treasury have already performed the analysis and the political advisors to the administration and Congress have seen the results. Hence the decision to delay ACA implementation for the much larger employer subsidized insurance marketplaces until after the elections.

Stay tuned for more uncertainty and slow economic growth.
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Old 03-30-2014, 07:27 AM   #51
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..........I was one of the six million who received a letter last fall stating my plan was not ACA compliant and was being canceled......... .
I'm curious why it wasn't compliant. Did it have a yearly or lifetime cap?
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Old 03-30-2014, 08:33 AM   #52
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I'm not that familiar with "high risk pools", what were the flaws with this idea before?

This seems like a reasonable way to address the issue of people who have terminal or chronic high cost diseases and can't get health insurance.

I can't imagine that (even a subsidized) high risk pool for those I describe would be as disruptive and costly as the ACA is proving to be.
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Old 03-30-2014, 09:02 AM   #53
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Scott Gottlieb a Forbes contributor, ran the numbers and has elaborated on ACA in an article in Forbes magazine. The Headline does get attention as do the cost figures tabulated. The numbers are near the bottom of th page.

How Much Does Obamacare Rip Off Young Adults? We Ran The Numbers. Here Are The Results. - Forbes

"Obamacare is asking young adults to effectively subsidize the healthcare costs of older Americans. So far, Millennials are resisting this age-based transfer of wealth. Many are clearly opting instead to remain uninsured, or else they are buying cheaper health plans that don’t conform to Obamacare’s regulatory dictates.
My AEI colleague Kelly Funderburk and I looked at four states: Arizona, Illinois, Pennsylvania, and Texas. We then looked at a typical 30-year-old at one of six different annual income brackets: $20,000 in annual income, $25K, $30K, $35K, $40K, and $45K. "

Edit add: By the way Gottlieb is an MD.
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Old 03-30-2014, 09:28 AM   #54
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To the extent there are millions of others making a similar reallocations of spending to support higher healthcare costs there will be a net reduction in consumer demand for food, energy, and other consumer good as and services. I suspect the net effect of the ACA to be a lowering of consumer discretionary spending in 2014. Currently sluggish retail sales, retail bankruptcies, and retail mergers in Q1 are symptoms of the ACA drag on consumer spending and the economy. I have to believe the economists inside the Fed and Treasury have already performed the analysis and the political advisors to the administration and Congress have seen the results. Hence the decision to delay ACA implementation for the much larger employer subsidized insurance marketplaces until after the elections.

Stay tuned for more uncertainty and slow economic growth.
Sorry, this makes no sense to me. Furthermore, I've seen nothing whatsoever to back up your assertion that "there are millions of others making a similar reallocations of spending". And even if that were the case, there would be similarly millions who are spending less on health insurance and health care now (factoring in the increases we see every year) and would presumably be spending more elsewhere in the economy.

There is a similar balancing for health insurance companies. It sounds like they were losing money on you before the ACA. Now they're making money off of you. However, the reverse will be true for other individuals. The difference is that now, far more people can get insurance, and those who have insurance who get sick or injured will not be dropped nor driven to bankruptcy because of the banning of lifetime caps.
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Old 03-30-2014, 09:31 AM   #55
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Interesting the theory that younger people are subsidizing older people. The portion of my real estate tax that supports the local public school is over $3000. Over a 30 year span of home ownership I am paying $90,000 to support younger people and we have had no kids of our own and went to private school growing up.

Younger people are most likely to be pregnant vs older people. The example:

"Look at our numbers (laid out in the charts below) and you’ll see why so many Millennials have Obamacare sticker shock. Someone, for example, earning $25K annually in Arizona will pay $2,424 in total monthly premiums for Obamacare (10% of their annual income) and still be stuck with a $4,000 deductible and a $5,200 cap on their out of pocket costs. "

$7,424 won't even cover the cost of a few days of care for a problem during birth. It looks like prenatal care and delivery costs can range from about $9,000 to over $250,000 according to some sources.

Perhaps the older people would not like to subsidize these costs of younger people?
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Old 03-30-2014, 09:56 AM   #56
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Interesting comment on the older folks' subsidy to young ones. I have owned houses since age 23, never had any kids, have paid school taxes ever since. Hmmm, should I be upset at age 66? Or be upset about younger folks not rushing to subsidize the old?

Males do not get pregnant, yet gender discrimination is not allowed in ACA, so males pay for childbirth complications of those who do.
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Old 03-30-2014, 10:08 AM   #57
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........Males do not get pregnant, yet gender discrimination is not allowed in ACA, so males pay for childbirth complications of those who do.
Good point, although I seem to remember something about males being involved in pregnancies, but can't recall the source.
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Old 03-30-2014, 10:47 AM   #58
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Scott Gottlieb a Forbes contributor, ran the numbers and has elaborated on ACA in an article in Forbes magazine. The Headline does get attention as do the cost figures tabulated. The numbers are near the bottom of th page.

How Much Does Obamacare Rip Off Young Adults? We Ran The Numbers. Here Are The Results. - Forbes

"Obamacare is asking young adults to effectively subsidize the healthcare costs of older Americans. So far, Millennials are resisting this age-based transfer of wealth. Many are clearly opting instead to remain uninsured, or else they are buying cheaper health plans that don’t conform to Obamacare’s regulatory dictates.
Yeah, this never happened before. I want my money back from my group rates subsidizing those geezers' health insurance when I was 22, 23, 24, 25.....
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Old 03-30-2014, 10:53 AM   #59
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I'm not that familiar with "high risk pools", what were the flaws with this idea before?

This seems like a reasonable way to address the issue of people who have terminal or chronic high cost diseases and can't get health insurance.

I can't imagine that (even a subsidized) high risk pool for those I describe would be as disruptive and costly as the ACA is proving to be.
High risk pools are not a 'free for all' or 'anyone can apply' form of insurance. Depending on the implementation there may be:

1) a limited number of people allowed in the pool.
2) a wait list with some additional criteria before being accepted (for example, 'must be on Medicaid', or 'uninsured for 6 months', or a specific list of qualifying medical problems).
3) Higher cost than conventional insurance, sometimes capped by law or regulations (capped at 1.7 times higher than the average cost of the three largest plans sold on the individual market, for example). The cap constitutes the subsidy, with the state budgeting for the gap between the cap and the actual cost.

When my COBRA coverage was running out, I had been turned down for individual policies and had to look at the high risk pool here. It would have been quite expensive for me ($944/month for just me, for Major Risk Only coverage), and due to funding limits had a waiting list (around 8 months at the time). Under the rules I would have had to go without insurance for 12 months before qualifying. Oh, and there was a $75,000/year cap on benefits along with a $750,000 lifetime cap.

http://www.mrmib.ca.gov/MRMIB/MRMIP_...l-Briefing.pdf
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Old 03-30-2014, 11:39 AM   #60
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Thanks, all...

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