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Old 10-29-2014, 12:51 PM   #21
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ACA passing removed the last roadblock to our ER. We had considered various state plans for individual insurance but considered that too risky.
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Old 10-29-2014, 12:57 PM   #22
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Originally Posted by daylatedollarshort View Post
It has been a huge benefit to us. Pre-ACA our premiums alone were over 2K a month. Because of pre-existing conditions, we were captives to a post COBRA conversion policy with no caps on the premiums and very high deductibles or a small business policy also with high premiums and even worse out of pocket maximums.

I don't remember the exact final tally, but our total medical costs the year before the ACA kicked in were on the order of $40K -$50K due to premiums, out of pocket max and out of network costs.
Ouch! That is a huge $$$ hit. Hope things will indeed be better for you & yours in the future ($$ & health-wise).

Unfortunately, folks with MAGI a bit to high for subsidy are still open to financially devastating total HC costs. In my region, 2014 Exchange Silver premiums for early 60's couple are over $1,700/mo with an OOP max of $12,700 (in-network) and NO OON coverage. So a serious health issue could easily push total annual HC costs (inc. OON & non-covered services) into the $40-50+k range you had pre-ACA. That's a massive bill to try to manage on a MAGI of $55-60k/yr
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Old 10-29-2014, 01:09 PM   #23
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Ouch! That is a huge $$$ hit. Hope things will indeed be better for you & yours in the future ($$ & health-wise).

Unfortunately, folks with MAGI a bit to high for subsidy are still open to financially devastating total HC costs. In my region, 2014 Exchange Silver premiums for early 60's couple are over $1,700/mo with an OOP max of $12,700 (in-network) and NO OON coverage. So a serious health issue could easily push total annual HC costs (inc. OON & non-covered services) into the $40-50+k range you had pre-ACA. That's a massive bill to try to manage on a MAGI of $55-60k/yr
Easily solved if we go to single payer.
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Old 10-29-2014, 01:17 PM   #24
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I guess the winners under the ACA include the additional 10 million people to date, the equivalent of the entire population of Portugal, going from uninsured to having health insurance.
Actually we do not know that- at least not yet. The rough 10M figure is an estimate that includes all who enrolled in HI. That figure is likely somewhat higher than the number who were insured for the whole year. It is not known how many of those who enrolled never paid premiums or cycled out of HI by paying only a premium or 2. Regardless, some 30+ million remain uninsured.

http://www.nytimes.com/interactive/2...tml#/uninsured
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Old 10-29-2014, 01:21 PM   #25
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Insurance that actually covers very bad events that you cannot otherwise hedge or afford is worth a lot. Before the PPACA reforms, most states did not have such policies available in the individual marketplace and in those that did, massive negative selection often resulted in premiums being completely out of reach for most people in that market.
I agree. I remember that about 20 years ago, an actuary I knew who was an independent consultant told me he'd tried to get a very high deductible plan. He understood the risk but figured he could handle the smaller expenses and didn't want to pay the insurer's profit and expense loading on the additional coverage for smaller claims. He couldn't find a deductible as high as he wanted (probably $10K family at the time).

I do have concerns about the people buying High Deductible plans because that's all they can afford, when they really don't have the means to meet the out-of-pocket max. I wonder if they'll avoid getting care beyond the preventative things that are fully covered.
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Old 10-29-2014, 01:29 PM   #26
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Ouch! That is a huge $$$ hit. Hope things will indeed be better for you & yours in the future ($$ & health-wise).

Unfortunately, folks with MAGI a bit to high for subsidy are still open to financially devastating total HC costs. In my region, 2014 Exchange Silver premiums for early 60's couple are over $1,700/mo with an OOP max of $12,700 (in-network) and NO OON coverage. So a serious health issue could easily push total annual HC costs (inc. OON & non-covered services) into the $40-50+k range you had pre-ACA. That's a massive bill to try to manage on a MAGI of $55-60k/yr
I think the math favors Bronze plans for the generally healthy or very unhealthy. The premiums are lower and the OOP is the same. So one way we'd pay low premiums and very little out of pocket and the other way low premiums and the same out of pocket max as the more expensive plans.

Between financial aid for the kids' college and ACA subsidies we track our AGI really, really close these days. If we go over the 400% of FPL cliff for our family size, a dollar in extra income could cost us big time.
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Old 10-29-2014, 01:33 PM   #27
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Easily solved if we go to single payer.
Single payer is a whole 'nother (political) discussion
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Old 10-29-2014, 01:36 PM   #28
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Actually we do not know that- at least not yet. The rough 10M figure is an estimate that includes all who enrolled in HI. That figure is likely somewhat higher than the number who were insured for the whole year. It is not known how many of those who enrolled never paid premiums or cycled out of HI by paying only a premium or 2. Regardless, some 30+ million remain uninsured.

http://www.nytimes.com/interactive/2...tml#/uninsured
I believe that article actually confirms the 10 million ballpark figure. From the linked article:

"The number of Americans without health insurance has been reduced by about 25 percent this year — or eight million to 11 million people."

By 2017, the CBO's estimate is 26 million more insured. It would be 32 million if all states had expanded Medicaid. This is also from the same NY Time article link.

From Kaiser:
10 Million Newly Insured Because Of Health Law, Study Says | Kaiser Health News
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Old 10-29-2014, 01:37 PM   #29
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Easily solved if we go to single payer.

I certainly would not have a problem with that. Because at this point I do not know if this ACA insurance is better than what my underwritten plan is. This is all anecdotal of course, but I read a lot about people really struggling to find doctors who take it. I read this week in USA Today one lady had to talk to 40 doctors before one would accept her insurance. Then you run the possibility of getting treated like a Medicaid person even though you paid cash for the policy. Then increasing narrow networks can screw you over and the insurance companies take no responsibility to stay current on who is in their network.

Yes, I'm venting and I should just be happy I'm healthy. But still I can't stop thinking I am going to pay over $4500 just for the privilege to pay $6000 more? I can buy a helluva lot of BP meds, Viagra, and Flomax for that. And yes something could happen to me, but if everybody was having heart attacks, cancer, and joint replacements (and yes it is very unfortunate for those who have health problems, which I would never trivialize) our premiums would all be $5k a month. $400 a month is not the number, but there may be a number down the road where I say, no more. I'm healthy and I will take my chances to 65. Or play by the rules and use it and then drop it, and always owe taxes come filing season.

I guess it just boils down to this for me.....If a person is used to getting beat 10 times a day with a cane and it gets reduced to 5 times a day, you think, "now that wasn't so bad". But if you are used to only one and now you are getting 5 also, you think..."I'm getting the crap beat out of me." I'm that person now....


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Old 10-29-2014, 01:46 PM   #30
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This is all anecdotal of course, but I read a lot about people really struggling to find doctors who take it. I read this week in USA Today one lady had to talk to 40 doctors before one would accept her insurance.
Here is another anecdote. We like our policy and all the local doctors and the hospital we normally go to are on it and we don't have to budget for any more $50K medical cost years.

Mulligan, you have said many times you don't have a huge savings but rely a lot on your pension, think of all the people who don't have huge savings and no pension as well. Medical costs are the #1 reason for bankruptcy in the U.S. How can a middle class family making $50K a year, with preACA type faux insurance, afford to pay $40K - $50K in medical costs in one year?
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Old 10-29-2014, 01:46 PM   #31
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I agree. I remember that about 20 years ago, an actuary I knew who was an independent consultant told me he'd tried to get a very high deductible plan. He understood the risk but figured he could handle the smaller expenses and didn't want to pay the insurer's profit and expense loading on the additional coverage for smaller claims. He couldn't find a deductible as high as he wanted (probably $10K family at the time).

I do have concerns about the people buying High Deductible plans because that's all they can afford, when they really don't have the means to meet the out-of-pocket max. I wonder if they'll avoid getting care beyond the preventative things that are fully covered.
I was not actually referring to deductibles, high or otherwise. I was referring to insuring against a couple of days in intensive care, major surgery, etc.
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Old 10-29-2014, 01:50 PM   #32
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Here is another anecdote. We like our policy and all the local doctors and the hospital we normally go to are on it and we don't have to budget for any more $50K medical cost years.

And that is a good thing.... Insurance should be that way and not a game of "gotcha".


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Old 10-29-2014, 01:55 PM   #33
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IMHO, the real issue is the high cost of medical care in the USA. We have to get a handle on that. No insurance reform, no matter how good and how well managed will help much if we have to spend $80,000 for a hip replacement that a person can get for less than $20,000 in a modern facility in Europe.

I can't help but think that the controversy over the ACA has distracted us from the real problem with medical care costs.
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Old 10-29-2014, 02:06 PM   #34
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IMHO, the real issue is the high cost of medical care in the USA. We have to get a handle on that. No insurance reform, no matter how good and how well managed will help much if we have to spend $80,000 for a hip replacement that a person can get for less than $20,000 in a modern facility in Europe.

I can't help but think that the controversy over the ACA has distracted us from the real problem with medical care costs.

Your assessment Chuck, will get no argument from me....


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Old 10-29-2014, 02:32 PM   #35
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IMHO, the real issue is the high cost of medical care in the USA. We have to get a handle on that. No insurance reform, no matter how good and how well managed will help much if we have to spend $80,000 for a hip replacement that a person can get for less than $20,000 in a modern facility in Europe.

I can't help but think that the controversy over the ACA has distracted us from the real problem with medical care costs.
I think that the ACA was a necessary first step which needed to be taken before we can start to tackle medical care costs.

Also, the NYTimes article failed to mention that the provision of the ACA which abolished lifetime caps will likely lower the number of personal bankruptcy filings. Plus, the ability of people to purchase policies regardless of pre-existing conditions should help lower that figure, too. Pre-ACA, medical bills were the single biggest cause of personal bankruptcy filings, even when people had health insurance. Obviously, another benefit of the ACA is the ending of those lousy policies which didn't really do what insurance is supposed to do.
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Old 10-29-2014, 03:05 PM   #36
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I guess the winners under the ACA include the additional 10 million people to date, the equivalent of the entire population of Portugal, going from uninsured to having health insurance.
The number is greater. This website (here) has tracked enrollments (including non-payment dropouts) by state exchange and type of coverage since the rollout. They record 11m new Medicaid, 7.3M policies from exchanges, another 8M policies directly from insurers, and another 1M "other". Their estimate is between 19-25m newly insured individuals. Their spreadsheets can be downloaded.
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Old 10-29-2014, 03:25 PM   #37
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...........But still I can't stop thinking I am going to pay over $4500 just for the privilege to pay $6000 more? I can buy a helluva lot of BP meds, Viagra, and Flomax for that. .........
My nephew came home recently and found his toddler with an open bottle of Tylenol. Taking no chances, he took the kid to ER and they gave the kid a test to see if he had taken any capsules, then kept him overnight for observation. The bill was $55,000.

My point is that even a minor event can have crushing medical expenses attached.
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Old 10-29-2014, 03:33 PM   #38
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Yes, I'm venting and I should just be happy I'm healthy. But still I can't stop thinking I am going to pay over $4500 just for the privilege to pay $6000 more? I can buy a helluva lot of BP meds, Viagra, and Flomax for that.
Part of this is because healthcare services, especially hospital, lab and specialized practice, have a preferential price for insurers and a penalizing price for cash payers. It doesn't make sense, but it dramatically increases the risk of being uninsured.
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Old 10-29-2014, 03:57 PM   #39
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Part of this is because healthcare services, especially hospital, lab and specialized practice, have a preferential price for insurers and a penalizing price for cash payers. It doesn't make sense, but it dramatically increases the risk of being uninsured.
The surgery in our family last year was $150K without insurance, and under $50K with insurance company negotiated rates for most of the bills. It is a legalized scam to make the uninsured pay many times over what insurance companies pay.
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Old 10-29-2014, 04:01 PM   #40
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