ivinsfan
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
- Joined
- Feb 19, 2007
- Messages
- 9,969
SecondCor I guess the OP should have PM'd you that's a great list and pretty much says it all.
The ACA was billed as a boon to the uninsured. We see that many of those on ACA today are young retirees or full time RVers or yacht people.
Those uninsured before the availability of health insurance under the ACA remain uninsured. Hospitals still see them in the emergency rooms as unpaid clinics. They find it easier to get their healthcare that way rather than use ACA--with its high deductibles and co-payments. That's the truth.
Since I have coverage through the ACA, Medical bankruptcy isn’t a concern - that’s what the insurance is for. However, the cost of insurance is my top expense in early retirement. Some years we qualify for the subsidy, but in the years we don’t, our annual premium is more than $20k and that comes with a $6500 per person deductible. So we’d have to spend nearly $30k in order to gain a penny of coverage. The system is broken.
The stuff Sengsational brings up are really irritating. The old colonoscopy story seems to change year to year. Insurance is always muddling with ways to not pay, even if it is one of those procedures that should be covered.
Even with the current 8.5% of income cap for premiums now? I find that hard to believe unless you're making north of $200k.
I was wrong, annual premium was just under $20k, not over, but I don’t know where the premium cap of 8.5% of income is coming from. Premiums are based on the different tiers (Bronze, Silver and Gold) and have nothing to do with income. The ACA subsidy is based on income, but phases out at roughly $70k for a couple (400% of the federal poverty level, which for 2021 is $17,420 for 2 people). So if you make more than $70k, you pay the full premium, which is much more than 8.5% of $70k, even for a Bronze plan. An $18k premium is more than 25% of a $70k income.
I read the very lengthy PM the OP sent me and honestly I still don't understand what he is looking for.
You can get a 100 people to tell their HI stories and every one will be different. OP you needed cardio workup and call your insurance to figure out the coding and billing before it even happens? Get the workups let the bills come and then call if you have specific questions.
I'm getting a little bit of OCD just off the wording of these questions. And that's really hard for the OP, they have my sympathy. As we have posted make a HC line item budget make sure you have it funded for retirement . retire and enjoy your life.
I hope you figure this out as it's obviously bothering you a great deal.
"Over the past several years I have undergone extensive cancer treatment that took me to my OOP max each year, about $10k total. On top of that I have another $20k in bills that I am disputing with the insurance company. These are for procedures that were pre-authorized and I had every reason to expect would be covered but now the insurance company is denying that they were pre-authorized even though I have the actual physical letters they sent with the pre-authorization. This dispute has gone on for almost 2 years now. It is very stressful. I don't know what I could have done to avoid the mess aside from not getting sick in the first place. My doctors say I had no risk factors that I could have controlled so not getting sick also seems to have been out of my control."
I posted the same question on another forum I frequent and got this answer. This is exactly one of the things I'm afraid of with insurance.
I called insurance before the cardiologist visit because my insurance has no charge for basic tests & x-rays but charges 30% coinsurance if it's coded as an outpatient facility visit (this cardiologist office was at a big hospital). They told me "The tests like echocardiogram should be covered under specialist visit no charge, prior authorization required though." Insurance told me to tell the doctor to code it as a basic test, specialist visit and not an outpatient facility visit. Could be the difference between paying $0 and hundreds out of pocket.
I just like to be pro-active about things. After the bill comes, they may not be willing to change & resubmit the codings.
Anxiety can be reduced by focusing on things one can control and letting go of things one cannot control.
Things one can control (generally):
- how often one exercises
- the quality and quantity of food consumed
- how regularly one gets checkups, vaccines, preventive screenings, etc.
- how carefully one evaluates available health insurance and care options
- the kind and amount of health insurance purchased
- how well informed one is about their chosen health insurance
- how well one arranges their financial affairs to be able to handle financial setbacks
- how often one reads news articles which seek more to instill fear or anger rather than provide reasonable guidance or information
- one's reactions to external stimuli of any sort
- where and how one chooses to focus their thoughts, actions, and responses
Things one cannot control (generally):
- Congress
- insurance companies' behavior
- doctor's offices' behavior
- hospital billing offices' behavior
- future changes to the law
- getting hit by a bus or contracting an unusual or expensive disease or condition
- what the media chooses to publish
I posted the same question on another forum I frequent and got this answer. This is exactly one of the things I'm afraid of with insurance.
Thanks for the replies. Do you folks with ACA plans (or other health insurance) and 5-15+ years from Medicare ever worry about having to declare medical bankruptcy at some point? Medical bankruptcy is the #1 type of bankruptcy in America, and a lot of them (most?) had health insurance, which has me concerned. The story I linked in OP could be a scenario (the $60k drug).
If so, are your assets set up so they are protected in such an event?
I'm retired with Medicare BCBS Plan F. I had an Emergency Room and inpatient hospital stay out of state with zero owed. I was shocked.
You can't beat plan F. Of course, the young folks can't get it anymore.
Make appointments at the Oklahoma Surgical Center for the big stuff, their cash prices are lower than almost all deductibles.
Meanwhile, get a Direct Care Primary doc and pay 50 bucks a month for all the little stuff.
Health Sharing Ministry is also an excellent low risk low cost solution to the monopoly juggernaut of the medical industrial complex.