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Old 09-20-2015, 07:42 AM   #41
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Insurance premiums seems like a waste of money until you really need it, then that is a lifesaver. Which reminds me, my LTC insurance premium is due in a couple of months . No way would I self-insure for health insurance.
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Old 09-20-2015, 08:38 AM   #42
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Negotiated rate is FAR cheaper than full price. Even though we're out many thousand this year (on top of insurance), the price we paid was far less than the full price. Probably about half of full price. If you're having to pay-as-you-go, it's nice to have the price be negotiated lower by your insurance company. If we didn't have insurance, we'd have paid full price.
Real life example. Last year a close family member had some serious medical issues. I saw the bills. Between hospital stays and doctors visits the total charges were about 200k. Their insurance paid about 72k (the insurance negotiated rates), and the patient paid 3k. (deductible and co-insurance). That is about 125k that no-one had to pay. Makes you wonder what happens to that 125k. Write offs, tax breaks, passed on to those who don't have insurance, etc.

I "assume" that the doctors and the hospitals are still making money at the negotiated rates.

I can almost hear MR: T saying, "I pity the fool", without insurance.
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Old 09-20-2015, 08:49 AM   #43
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Real life example. Last year a close family member had some serious medical issues. I saw the bills. Between hospital stays and doctors visits the total charges were about 200k. Their insurance paid about 72k (the insurance negotiated rates), and the patient paid 3k. (deductible and co-insurance). That is about 125k that no-one had to pay. Makes you wonder what happens to that 125k. Write offs, tax breaks, passed on to those who don't have insurance, etc.

I "assume" that the doctors and the hospitals are still making money at the negotiated rates. I can almost hear MR: T saying, "I pity the fool", without insurance.


Why would you think anything happens to that $125K

It would be the same as if you went into a store and they said this item sells for $100, but we have a 50% off sale today.... so you buy it for $50.... the store records $50 of income.... the $100 is a made up number, or sticker price.... so the other $50 never existed....
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Old 09-20-2015, 08:51 AM   #44
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I only read half the thread.... but I would just buy the lowest cost bronze plan and call it a day....


OH... that is what I am doing!!! (but I do not have any other option right now)...
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Old 09-20-2015, 08:53 AM   #45
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Why would you think anything happens to that $125K

It would be the same as if you went into a store and they said this item sells for $100, but we have a 50% off sale today.... so you buy it for $50.... the store records $50 of income.... the $100 is a made up number, or sticker price.... so the other $50 never existed....
So in that analogy, to compare apples to apples, the buyer that shopped at that store and didn't have an insurance card (or discount card for the store) would have to pay full price.

You may be right, but I suspect there is something else going on behind the scenes with medical.
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Old 09-20-2015, 08:58 AM   #46
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Technically you *can* gain an open enrollment at any time by changing state residency. This could be fairly easy for someone in an RV or a person who snowbirds and already has two residences.

This would not get you out of the bike crash or car jacking expense (btw that sounds awful...did he resist or did the POS scumbag just shoot him for getting out of the car too slow?)

I guess you could couple the catastrophic plan with the residency plan, such that you could switch to a silver gold or platinum plan within a week or so if you developed an expensive condition over several months.

A lot of effort to save a portion of $1600 though.
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Old 09-20-2015, 09:12 AM   #47
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About hospital rack rates vs. insurance-negotiated rates, I read the following reason regarding how the former being so much higher. It was claimed that many individuals failed to pay, and the bills had to be sent to collection. Because of the low payment rate, they had to jack up the price to make the same amount. I don't know whether that is true or not.
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Old 09-20-2015, 10:47 AM   #48
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Ouch Rosie!

DW and I are cyclists too. Very sobering story. I hope you've made a full recovery.

If you care to share, I'm curious as to how the crash happened. Any lessons learned?


Yes, I did make a full recovery, thanks! I'm told I hit a rough patch of pavement while I was going downhill at ~ 30 mph and went over the handlebars. I remember none of it, thankfully.

But back to the topic at hand ...

The following year, when I left my j*b and started consulting, I tried to obtain health insurance on my own. By that time I had completely recovered from my injuries and had resumed all my normal activities, including bike riding.

Mind you, this was in 2010, before the ACA was implemented.

I first applied to Blue Shield CA, the company who insured me on my employer's plan. They turned me down *flat*. They said I "did not meet their underwriting criteria", and they provided a list of all the treatments I had the previous year, on account of my accident, to justify their refusal. Basically, being in an accident was tantamount to having a preexisting condition.

I applied to a couple of other insurance companies, who likewise turned me down, on account of the treatments I received the previous year due to my accident. I cannot begin to tell you how stressful this was for me.

At least Kaiser, who also turned me down initially, told me that I could request reconsideration of my application. So I trooped to all the physicians who treated me the previous year -- GP, spine doc, ophthalmologist, PT -- and they very willingly wrote letters describing my treatment and recovery, stating that I had fully recovered from my injuries, and rather subtly assuring Kaiser that my prior accident wouldn't cost them going forward. And next thing I knew, the Welcome to Kaiser packet arrived in my mailbox.

Like I mentioned, this was before the ACA went into effect. I was perfectly healthy yet I had a helluva time obtaining health insurance. If I hadn't recovered fully from my accident the previous year, or if I had any condition more serious than, say, a hangnail, I probably would have been unable to get coverage and I would have basically been screwed. Like so many others were screwed back then.

So whenever I see some politician ponderously proclaiming that he or she would repeal Obamacare, I sprout fangs & grow hair on my knuckles and flash back to all the hoops I had to jump through to get insurance pre-ACA, and how fortunate I was to finally obtain it.
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Old 09-20-2015, 11:06 AM   #49
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Going through this thread, I was slightly unclear about the exceptions to the once a year ACA enrollment.

I left MegaCorp in mid 2015 but as part of the severance package I get insurance through MegaCorp till mid 2017. Can I apply for ACA in mid-2017 or do I have to apply at the beginning of 2017 (or very late 2016)?
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Old 09-20-2015, 11:18 AM   #50
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Going through this thread, I was slightly unclear about the exceptions to the once a year ACA enrollment.

I left MegaCorp in mid 2015 but as part of the severance package I get insurance through MegaCorp till mid 2017. Can I apply for ACA in mid-2017 or do I have to apply at the beginning of 2017 (or very late 2016)?
Iirc, you get a special enrollment period and can apply for ACA up to 60 or 90 days (forgot what it was exactly) upon losing company-provided health insurance.
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Old 09-20-2015, 11:21 AM   #51
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Going through this thread, I was slightly unclear about the exceptions to the once a year ACA enrollment.

I left MegaCorp in mid 2015 but as part of the severance package I get insurance through MegaCorp till mid 2017. Can I apply for ACA in mid-2017 or do I have to apply at the beginning of 2017 (or very late 2016)?
I need the answer to this also. I left my employer in Jan 2015. We have a provision that allows us, instead of getting a lump sum for vacation and sick time, to receive the money as a regular paycheck and during that time we stay on employer insurance. We can also receive half pay for twice as long which is what I did.

So I will get paid and have insurance until Feb 2016. I assume that when I officially stop getting paid and lose my insurance in Feb, that that is an event that allows me to get insurance mid year under Obamacare?
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Old 09-20-2015, 11:22 AM   #52
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Iirc, you get a special enrollment period and can apply for ACA up to 60 or 90 days (forgot what it was exactly) upon losing company-provided health insurance.
Thanks for the clarification.
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Old 09-20-2015, 11:32 AM   #53
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Loss of employer coverage does indeed make one eligible for the special enrollment period. Individual coverage is programmed to begin on the 1st of the corresponding month and payment must be received no later that the 15th of the previous month, so candidates should begin the application process at least a month before they wish to begin coverage.

Employer based insurance usually runs through the end of each calendar month, but not always, so the exact last day of coverage should be verified in each case. This is usually directly with the insurer or the benefits manager.
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Old 09-20-2015, 11:45 AM   #54
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Losing employer coverage is a qualifying event, as described in this link

https://www.healthcare.gov/coverage-...llment-period/

Note, voluntarily dropping existing coverage is not considered a qualifying event.

Many of questions are directly answered on the healthcare.gov site
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Old 09-20-2015, 12:53 PM   #55
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Just to throw this out there--you can still buy catastrophic health insurance. Something with a $10K deductible is available for about $250/month for a family. It doesn't qualify under the ACA so you still have to pay the penalty but at least you would have catastrophic coverage.
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Old 09-20-2015, 01:05 PM   #56
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Until this year, the above was what we had, a $10K deductible plan but it cost the 2 of us $600/month. And when we started this policy with them many years ago, we had no preexisting conditions. The plan was extremely simple: under $10K we paid everything, above $10K they paid 100%. There was no copay. The $10K is also your maximum out-of-pocket (OOP) cost.

So, if you can get something like this for $250/family, it's a steal. I did not know one would have to pay a penalty to hold a policy like this. That is just terrible, because one can have as high a deductible or OOP under ACA. What is the difference? Or is the penalty exempted for continuing policies?
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Old 09-20-2015, 01:23 PM   #57
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Until this year, the above was what we had, a $10K deductible plan but it cost the 2 of us $600/month. And when we started this policy with them many years ago, we had no preexisting conditions. The plan was extremely simple: under $10K we paid everything, above $10K they paid 100%. There was no copay. The $10K is also your maximum out-of-pocket (OOP) cost.

So, if you can get something like this for $250/family, it's a steal. I did not know one would have to pay a penalty to hold a policy like this. That is just terrible, because one can have as high a deductible or OOP under ACA. What is the difference? Or is the penalty exempted for continuing policies?

"The penalty" is a watered down nothing. Just make sure you never get a refund on your tax returns and you never pay it. Nothing they can do about it. No civil penalties and no other mechanism to collect on. That being said mine is compliant until I cant afford it!


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Old 09-20-2015, 03:42 PM   #58
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Back in 2006 when we left the megacorp safety net, we were faced with getting our own health insurance. We quickly discovered how expensive it was, and also how large the premium was between the one that provided the coverage we were accustomed to and the $10K deductible mentioned above. Even with two children at home, one in late teen and one college aged, the high-deductible (HD) plan was less than $500 then.

As we had not been using much healthcare other than the annual and routine checkups, we decided to go with the HD plan, and banked the difference in premium in an HSA account. This account grew to more than $30K in 2012, when we first made big claims due to unexpected illnesses. By the time the smoke cleared in 2014, we cost our insurer around $200K.

Could we self-insure for $200K? Yes, but it turned out to cost much less to pay the monthly premium. And it could have been a lot worse than $200K. And we had no preexisting conditions, took no medicine, had no chronic problems.
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Old 09-20-2015, 05:25 PM   #59
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Until this year, the above was what we had, a $10K deductible plan but it cost the 2 of us $600/month. And when we started this policy with them many years ago, we had no preexisting conditions. The plan was extremely simple: under $10K we paid everything, above $10K they paid 100%. There was no copay. The $10K is also your maximum out-of-pocket (OOP) cost.

So, if you can get something like this for $250/family, it's a steal. I did not know one would have to pay a penalty to hold a policy like this. That is just terrible, because one can have as high a deductible or OOP under ACA. What is the difference? Or is the penalty exempted for continuing policies?

The max individual deduction is somewhere just north of $6K.... so $10K would not qualify...

The other problem with buying these short term plans is that there is no guarantee of renewal.... and they exclude preexisting conditions...

I signed up for one for a few months at the beginning of the ACA until the site worked... then found out they did not accept me, but did DW and the kids... it was really cheap... like $250 per month.... went to a $600plus plan in 2014 and now $815 this year... figure I will be closing in on $1000 per month next year....
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Old 09-20-2015, 05:48 PM   #60
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Unless I am very mistaken, the one I bought pre-ACA said nothing about being short-term. Regarding renewal, I could have continued and they could not kick me out. And the rate increase is regulated too. Yes, they do exclude preexisting conditions. I also could not be a motorcyclist. There could have been some other restrictions that I forget.
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