Have you had a hospital stay or expensive health care with health insurance?

[ocean view]

I'm 41. Thankfully I'm currently healthy and have never had a hospital stay or expensive treatment, but I was wondering about Americans here who have and had health insurance (not Medicare, Medicaid or other govt program), especially in ACA era (since 2010). How much out of pocket did you end up owing and paying? Any nightmare stories?

No nightmare stories to share, only experiences of the system working the way it was intended.

I live in CA and buy a Bronze HDHP for my family from CoveredCA (ACA), a Kaiser HMO plan. We moved to Kaiser from a PPO plan when we retired in 2015 as it was significantly cheaper. For 2022 we have an OOP max of $7K per person or $14K family. And, btw, I am still more than a handful of years from Medicare eligibility and consider myself healthy.

In May I was diagnosed with breast cancer. I reached my OOP max before I ever received treatment (so many tests!), but every penny of expense beyond $7k was covered 100%. This includes surgery, more tests, scans, radiation treatments, meds, everything. I’ve been tracking the costs and so far the rack rate is beyond $100k, the negotiated rate is about $60k. I’m thankful for the out of pocket max. Also thankful that I will complete my treatment within this calendar year so that it won’t impact next year’s OOP max also.

When I got the first bill that was $7k I called to ask about payment options. I was told that I could go on a 2 year interest free payment plan or I could even apply for 100% relief since we are “low income”. It was nice to know we had options, even though we didn’t need them.

This won’t help you in your state, but I am also thankful for the Kaiser plan because they are both the insurance provider and the health care provider there were no pre-approvals necessary. I never had to worry about in-network/out of network providers. If Kaiser medical says this is the treatment you need, then it is covered. And in breast cancer there were different surgery options available to me that would have been more costly. They didn’t just give me the bare bones treatment.

When you are looking at ACA plans, consider the total cost to you. Not just the OOP max. This includes premiums, co-pays and what is counted towards the OOP max. I may pay a lot in OOP costs in a non-major health issue year, but it is much less than the annual premium for a silver plan with co-pays in my area.

I hope that helps.

 

[RetMD21]

Cancer drugs seem to be in a class of their own.
DW is taking one that has a list price of $15,000 a month.
She is enrolled in a clinical trial where the manufacturer provides it at no charge, so I have no idea what would happen otherwise.

Off topic for this thread but $15,000/month chemo drugs are one of the reasons I wouldn't go without a medigap policy

 

[RobbieB]

My first wife died of Pancreatic cancer. We were max out of pocket for the 2 year period between diagnosis and death. Couple of surgeries and a lot of chemo drugs. We got one bill for a procedure that had her in the hospital three days for $60,000. Of course we didn't have to pay it.

I have no problem with 10 grand out of pocket a year. The alternative is like half a million.

 

[ncbill]

Off topic for this thread but $15,000/month chemo drugs are one of the reasons I wouldn't go without a medigap policy

My FIL (kidney transplant in his mis 70s, now in his early 80s) is very glad the VA provides his most expensive transplant-related medications.

 

[Bamaman]

My FIL (kidney transplant in his mis 70s, now in his early 80s) is very glad the VA provides his most expensive transplant-related medications.

Glad your FIL's transplant worked. Medicare pays out the nose to nephrologists and some specialists. But they on the other hand starve the family practice and internal medicine doctors providing day to day care to patients.

My doctor retired, and my wife's doctor dropped all Medicare patients in order to have a weight loss practice. It's not easy to find a quality physician today willing to take on new 70 year old Medicare patients--especially with complicated cases.

 

[Rianne]

My advice is to read the small print. I had a small bowel obstruction, but it took 3 ER visits for them to figure it out. My ACA plan was a skimpy bronze plan BUT in the fine print, it stated all ER visits max payment of $500.

The first ER visit included a CT scan and lots of bloodwork. The docs wrote it off as gas or indigestion or flu. The pain continued off and on for another month. That visit was $500. Went towards my $6500 deductible.

2nd ER visit was not taken seriously. Saw a couple of docs. They wrote it off again, flu or whatever digestive issue. $500 again.

3rd ER visit, the new resident took a standard X-ray of my abdomen and saw it immediately. A twist in my bowel. Talk about pain! Another CT scan, then admittance to the hospital. Another $500 ER visit. Three ER visits in less than 6 weeks only cost $1500. The fine print. I did not even meet my $6500 deductible that year. The next year they removed that $500/per ER visit benefit.

It never hurts to call the insurance company and drill them on the policy. I've done that a few times and they were more than helpful in discussing different coding procedures...like if it's this, then we code that. If it's coded that, you're covered to this amount, but if it's something else, then it's this amount. Plus the discount our insurance company gave us was great. They are a self insured conglomerate. Details!

 

[cloudeleven]

The financial side of the US medical system is horrifically broken. The best you can hope for is some fix by the time you need to use it. If you make it until 65, and you elect to use traditional Medicare plus medigap, and that stays similar or better, you're probably ok.

But this whole thing where your insurance company won't tell you how much things will cost is absurd.

Yeah, thankfully my mother has Medicare Plan F with Medigap. (That's what my 2017 post here was about Ivinsfan referenced above, trying to choose a Medicare plan for my mother).

Basically my main concern is how common are situations where people wind up being billed for a lot more than their annual out of pocket max on health insurance, due to denied claims, uncovered stuff yet was still medically necessary, hospital forgot to get prior approvals, etc.

It's comforting that some folks here had expensive healthcare where they didn't owe more than their annual out-of-pocket max. But there are stories out there (like the OP story) where people ended up with $10,000+ more than their OOP max even with health insurance.

It's not that rare for people with health insurance to still be pushed into medical bankruptcy. "Each year, nearly 650,000 people are pushed into bankruptcy by medical bills, accounting for more than 60 percent of all personal bankruptcies. It’s not just a problem for the poor or unemployed, either – the majority of people experience medical bankruptcy were employed, college-educated homeowners. More surprising, nearly 80 percent had insurance at the time they got sick."

https://www.citizen.org/article/medicare-for-all-prevents-medical-bankruptcies/#:~:text=Each%20year%2C%20nearly%20650%2C000%20people,employed%2C%20college%2Deducated%20homeowners.

I wonder if the No Surprises Act this year (i.e. out of network charges at in-network hospitals) will reduce the number of medical bankruptcies. Maybe...

The two main things I could see derailing a retirement are medical bills and a lawsuit (e.g. car accident). The lawsuit risk could be covered with an umbrella policy (and driving carefully of course, but bad accidents still can happen).

I guess I should just stop worrying and maybe a big, positive change will happen with this system. In the meantime, know my policy inside out, be ready to jump through the insurance and billing hoops, appeal denials, etc.

 

[cloudeleven]

It never hurts to call the insurance company and drill them on the policy. I've done that a few times and they were more than helpful in discussing different coding procedures...like if it's this, then we code that. If it's coded that, you're covered to this amount, but if it's something else, then it's this amount. Plus the discount our insurance company gave us was great. They are a self insured conglomerate. Details!

I called my health insurance company (Ambetter) several times earlier this year to drill them on the details, but their customer service is outsourced to India (or some other country in the region) and I could barely understand them or hear them, and they couldn't understand me sometimes. I could even hear a rooster crowing loudly in the background non-stop during one call.

I was asking similar as you about coding and benefits for a potential cardiologist visit. I didn't get satisfactory answers during my first couple of calls. Either I couldn't understand them or they didn't know the answer. I got an "OK" answer, I guess, on the third call. I think I just gave up.

 

[MichaelB]

It's not that rare for people with health insurance to still be pushed into medical bankruptcy. "Each year, nearly 650,000 people are pushed into bankruptcy by medical bills, accounting for more than 60 percent of all personal bankruptcies. It’s not just a problem for the poor or unemployed, either – the majority of people experience medical bankruptcy were employed, college-educated homeowners. More surprising, nearly 80 percent had insurance at the time they got sick."

https://www.citizen.org/article/medicare-for-all-prevents-medical-bankruptcies/#:~:text=Each%20year%2C%20nearly%20650%2C000%20people,employed%2C%20college%2Deducated%20homeowners.

I wonder if the No Surprises Act this year (i.e. out of network charges at in-network hospitals) will reduce the number of medical bankruptcies. Maybe...

The two main things I could see derailing a retirement are medical bills and a lawsuit (e.g. car accident). The lawsuit risk could be covered with an umbrella policy (and driving carefully of course, but bad accidents still can happen).

I guess I should just stop worrying and maybe a big, positive change will happen with this system. In the meantime, know my policy inside out, be ready to jump through the insurance and billing hoops, appeal denials, etc.

Looking at the link, then following their links and references brings us to data and studies dating back to 2010 to 2013. The data is not current and much has changed since then. Personal bankruptcies have declined by more than 1/3 since the ACA was fully implemented. I would suggest you look for more recent data.

If someone has an ACA compliant policy there is no reason they should be facing bankruptcy caused by medical expenses. If they cannot afford a high deductible and out of pocket, they should also be eligible for premium assistance. If their income is too high for subsidies, they should be able to afford the cost sharing. An ACA compliant policy has broad, extensive, comprehensive coverage so a medical condition requiring large expense but not covered by insurance is not likely.

There always is the possibility of an illness or condition that requires a treatment not covered by comprehensive insurance, but these are rare and very much the exception.

 

[JoeWras]

Yeah, thankfully my mother has Medicare Plan F with Medigap. (That's what my 2017 post here was about Ivinsfan referenced above, trying to choose a Medicare plan for my mother).

Basically my main concern is how common are situations where people wind up being billed for a lot more than their annual out of pocket max on health insurance, due to denied claims, uncovered stuff yet was still medically necessary, hospital forgot to get prior approvals, etc.

It's comforting that some folks here had expensive healthcare where they didn't owe more than their annual out-of-pocket max. But there are stories out there (like the OP story) where people ended up with $10,000+ more than their OOP max even with health insurance.

It's not that rare for people with health insurance to still be pushed into medical bankruptcy. "Each year, nearly 650,000 people are pushed into bankruptcy by medical bills, accounting for more than 60 percent of all personal bankruptcies. It’s not just a problem for the poor or unemployed, either – the majority of people experience medical bankruptcy were employed, college-educated homeowners. More surprising, nearly 80 percent had insurance at the time they got sick."

https://www.citizen.org/article/med...people,employed, college-educated homeowners.

I wonder if the No Surprises Act this year (i.e. out of network charges at in-network hospitals) will reduce the number of medical bankruptcies. Maybe...

The two main things I could see derailing a retirement are medical bills and a lawsuit (e.g. car accident). The lawsuit risk could be covered with an umbrella policy (and driving carefully of course, but bad accidents still can happen).

I guess I should just stop worrying and maybe a big, positive change will happen with this system. In the meantime, know my policy inside out, be ready to jump through the insurance and billing hoops, appeal denials, etc.

I think it is okay for you to do your research and learn, but you also need to relax.

You mention umbrella as if that covers you without worry. Does it? You want me to bring up some cases where an umbrella claim will be denied? I could, ya know.

Living is a risk. Be insured. Don't do anything stupid. Then relax. Could the SHTF and the plan fails? Sure. But you can also die the next time you drive a two lane road and some idiot drops their coffee and head-ons you. You'll go crazy thinking about every corner case.

 

[skipro33]

I was diagnosed with cancer at age 64 in July of 2020. My chemo treatments alone were over $125,000 each and there were two a month for 6 months. I had 3 PET scans, a bone marrow biopsy, a general surgery to remove one of the lumps, And a whole lot of other tests that included genetic as well as blood tests. All total so far, over 125 needle pokes directly related to my diagnosis. The only payments I've had to make were co-pay doctor visits. $15 for my PCP and my oncologist. Oh, and $50 each for the surgery and bone marrow biopsy since those were in the hospital and not admitted.
I've since turned 65, back last October and since then I came down with COVID pneumonia and in the ICU for 2 weeks. That cost me nothing but I was on Medicare via United Health Care Senior Advantage through my retirement. I think the only expense was $4 for an OTC Tylenol in the hospital because someone coded the med wrong. I argued and they covered it. Ha! But now my oncologist is $30 co-pay (specialist like that is $30) I see him every 3 months to follow up. Blood work prior is no charge to me.

 

[jollystomper]

But this whole thing where your insurance company won't tell you how much things will cost is absurd. They have boatloads of data on people who are facing the same medical problem you're facing, and they know all 700 pages of the policy you purchased (oh, but you don't even have access to those pages, BTW, you get a fluff summary and that's it). Anyway, they could easily give you a range of costs, based on their experience, but they don't. You must wait until AFTER the services have been administered to find out the coverage. Sure, you can get "pre-approved" for something, but that only means they'll look at the claims, not that they will pay them.

I have to agree, particularly with my career experience in data management/analysis/engineering/forecasting/etc. With that wealth of data, it likely would not be hard to create a predictive model to provide a range of costs. There are algorithms in place for many other disciplines where that is being done today. My only conclusion is that most do not see a way to profit from using that data is this way, and there is more profit in keeping folks in the dark.

My provider does, on its website, allow you to search for a procedure and find which providers in your area provide the procedure with an estimate price. But beyond simple things like "flu shot", the vast majority of results still show "contact provider for estimate".

 

[cloudeleven]

Looking at the link, then following their links and references brings us to data and studies dating back to 2010 to 2013. The data is not current and much has changed since then. Personal bankruptcies have declined by more than 1/3 since the ACA was fully implemented. I would suggest you look for more recent data.

If someone has an ACA compliant policy there is no reason they should be facing bankruptcy caused by medical expenses. If they cannot afford a high deductible and out of pocket, they should also be eligible for premium assistance. If their income is too high for subsidies, they should be able to afford the cost sharing. An ACA compliant policy has broad, extensive, comprehensive coverage so a medical condition requiring large expense but not covered by insurance is not likely.

There always is the possibility of an illness or condition that requires a treatment not covered by comprehensive insurance, but these are rare and very much the exception.

ACA was a step in the right direction, and the No Surprises Act this year was a step in the right direction.

I went hunting for some more data. I'd like to be reassured by your post, but a lot (most?) of the decrease in bankruptcies after 2010 was probably due to the economy improving after the 2008-09 recession. There was a giant drop after 2005 (due to Bush's 2005 Bankruptcy Protection Act I suppose), a big increase from 2006-2010, and then a decline until 2016 and a leveling off:

https://www.statista.com/statistics/817911/number-of-non-business-bankruptcies-in-the-united-states/

This 2021 study found in the Discussion section "Medicaid expansion under the ACA was associated with reduced medical debt overall," however "During the last decade, medical debt has become the largest source of debt in collections. The reductions in nonmedical debt in collections between 2009 and 2020 occurred simultaneously with the economic recovery from the Great Recession, consistent with the well-documented association between unemployment and loan delinquency. In contrast, total medical debt in collections decreased by a more modest amount. As a result, as of June 2020 individuals had $39 more in mean medical debt in collections than they had in mean debt in collections from all other sources combined ($429 vs $390), including credit cards, utilities, and phone bills.":

https://jamanetwork.com/journals/jama/article-abstract/2782187

I found this 2019 study in the American Journal of Public Health on the NIH website:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6366487/#

"Medical Bankruptcy: Still Common Despite the Affordable Care Act"

"Although these [ACA] reforms might attenuate the risk of medical bankruptcy, increasing medical costs and stagnant incomes could have the opposite effect."

In that study, 58% percent of a sample of people surveyed who declared bankruptcy in 2013-2016 either very much (37%) or somewhat agreed that their medical expenses contributed to it, but it leaves unclear how many people had medical expenses as the only reason for bankruptcy (usually there are multiple reasons). Or how many of them had health insurance.

A Washington Post article disputed the study and found a study that said it was closer to 30,000- 50,000 per year of bankruptcies due to hospitalization alone, although that study was using a random sample from 2003 to 2007.

https://www.washingtonpost.com/poli...s-flawed-statistic-medical-bankruptcies-year/

Kinda hard to find definitive data on how much, if any, medical bankruptcy decline was due to ACA. I hope it led to a big decline. But there are still big problems with medical debt according to that 2021 study.

This quote from someone who filed for bankruptcy in 2016 due to medical debt, despite having health insurance, rings true:

"One of the biggest hurdles you face as a patient is just the sheer confusion of the process...What are you going to do if your authorization gets denied? You don’t really have a choice to not go get care. All these processes that are in the finest of fine print. And sometimes it feels like you are literally paying for nothing."

https://www.theguardian.com/us-news/2019/nov/14/health-insurance-medical-bankruptcy-debt

 

[Bamaman]

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.

 

[Aerides]

I went hunting for some more data...

Well if you hunt you will find - whatever it is you are looking for, there will be articles to support your hypothesis.

Instead, rather than hunt, just look. Here we are a forum of thousands of early retirees and aspiring ones. Are there any threads of medical bankruptcy here? Is anyone writing about gross errors leading to financial impacts? Not that I can recall.

Sure, there's the odd "hey this didn't get billed properly" or... this was out of network and subject to a different deductible...or the price of prescriptions.

But those are things to plan for. Premiums+OOP max are known quantities. Plan for that, you'll be fine a vast majority of the time.

Or don't. Wait till you have $10m+ before retiring instead.

I know which one I picked.

 

[TripleLindy]

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?

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.

 

[pacergal]

OP--you mention "I'm pretty scared of healthcare, even just visiting a specialist office for some tests," yet also say you are healthy.
Have you been referred for specialty care for some reason and delay due to fear of cost?
That fear in itself could delay care and cause an increase in eventual costs for you.

As Aerides states above, plan for the known quantities, then go live your life.
Even staying home, worrying, doing nothing, does not guarantee no health issues. In fact, that makes your health worse!

Best wishes to you.

 

[sengsational]

If someone has an ACA compliant policy there is no reason they should be facing bankruptcy caused by medical expenses.

I agree that, in theory, everyone should be able to get covered and treated and not get gobsmacked beyond the max out of pocket. The reality, though, is that the laws are fixed and the insurance companies are always twiddling things. I think they know that they can make changes that trip-up people, and leave them holding the bag.

One specific instance was the (now outlawed) stacked deductible. The way it worked before the ACA, you had $7K individual, $14K family deductibles. If one person got to $7K, the insurance kicked in for expenses beyond that. But they silently changed that so nothing was paid until the $14K mark. There was nothing in the summary plan description that indicated the change. There was a sentence or two removed from the detailed description. The content removed was the part about how one person's costs would be covered on the individual deductible. So instead of stating how the stacked deductible would work, they remained silent. And if you say the policy holder should read the policy, not the summary, I'll say that it was simply not available to me, even after purchasing the policy. Repeated attempts to get the policy ended in frustration.

So that's an illustration that the insurance companies change the rules and get customers to make bad decisions. In the case above, it would be trivial to bypass the problem by buying one policy per person, as the chance of getting any benefit from the family deductible is negligible.

Another example, mentioned above, is pre-approval. The policy might require pre-approval. The insured provides the service provider their policy information then it's the provider that knows the diagnosis codes and procedure codes to get pre-approved. So the provider can do their best to get pre approval for everything, but the insurance company might find some undotted "I" or uncrossed "T" and doesn't pay. The insured is left holding the bag because every provider has the patient sign the guarantor form.

So those are just a few examples of how insurance companies weasel out of paying. They change the rules, complicate things and any fallout lands in the lap of the insured.

So, yes, in theory, nobody should be pushed to medical bankruptcy, but the field is full of land mines. Most of them are well marked and avoidable, but it's not risk free to cross the field.

 

[JoeWras]

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.

As for bankruptcy: let's also remember that for some people, $10k in medical bills pushes them over into bankruptcy. For others, it hurts, but maybe results in a deferred vacation or just a lower bank balance. To look at bankruptcy as the only stat is a bit dangerous.

This sounds like I'm trying to give the insurance a break. I'm not. I think it is terrible that they can dig out a clause in their "policy you can't read" that causes you to incur a $10k, $50k or $100k expense. Those expenses hit people in different ways.

 

[MichaelB]

ACA was a step in the right direction, and the No Surprises Act this year was a step in the right direction.


https://jamanetwork.com/journals/jama/article-abstract/2782187

I found this 2019 study in the American Journal of Public Health on the NIH website:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6366487/#

"Medical Bankruptcy: Still Common Despite the Affordable Care Act"

https://www.washingtonpost.com/poli...s-flawed-statistic-medical-bankruptcies-year/

Take a step back. Your OP and thread topic are about catastrophic expenses and bankruptcy caused by medical expenses. The jama link does not address that, it only looks at debts in collection.

The ncbi link does point to a study that attempts to measure this, but it too doesn’t really address your concern, for two reasons. First, it doesn’t separate people who lost their jobs because of health reasons and subsequent went bankrupt due to lack of income from outrageous health care costs that bankrupted people, which is your concern. Second, it doesn’t detect if people forced into bankruptcy had good health insurance or not. These are critical details.

The reason it is more difficult to get data on financial calamity caused by health care expenses is because they have declined. They are less common, especially among people with ACA compliant health care insurance. The one remaining and important cause of financial hardship for insured people was remedied this year with the “No surprises act”. Financial struggles resulting from abusive medical billings continue to be a problem in the US because many people still do not have comprehensive health care insurance. Amongst the insured population, however, there is no current evidence to suggest financial hardship or failure is still a reality we all face. That risk has been reduced.

"One of the biggest hurdles you face as a patient is just the sheer confusion of the process...What are you going to do if your authorization gets denied? You don’t really have a choice to not go get care. All these processes that are in the finest of fine print. And sometimes it feels like you are literally paying for nothing."

https://www.theguardian.com/us-news/2019/nov/14/health-insurance-medical-bankruptcy-debt

This relates to your OP and restates one of your concerns - something bad can happen at any time. It’s difficult to address because it is non-specific. Many threads over the years do indeed show many of us do not understand health insurance, it’s very complicated. and easy to make a mistake. Fortunately, you don’t need for everyone to understand it, as long as you do, you can minimize the risk you express and protect yourself.

 

[ivinsfan]

Well if you hunt you will find - whatever it is you are looking for, there will be articles to support your hypothesis.

Instead, rather than hunt, just look. Here we are a forum of thousands of early retirees and aspiring ones. Are there any threads of medical bankruptcy here? Is anyone writing about gross errors leading to financial impacts? Not that I can recall.

Sure, there's the odd "hey this didn't get billed properly" or... this was out of network and subject to a different deductible...or the price of prescriptions.

But those are things to plan for. Premiums+OOP max are known quantities. Plan for that, you'll be fine a vast majority of the time.

Or don't. Wait till you have $10m+ before retiring instead.

I know which one I picked.

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.

 

[SecondCor521]

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

 

[harllee]

For people on Medicare expensive drugs have been the biggest expense. DH takes a very expensive drug (Humira) and has good Part D Medicare drug coverage and still has to pay over $8000 per year for Humira. However, it looks like that is going to change in a few years. The new Medicare law recently passed will limit the amount an individual on Medicare has to pay out of pocket for prescription drugs to $2000 per year starting in 2025. A big help.

 

[cloudeleven]

Thanks for the replies. Felt like I was talked down to by a lot of folks, but I got some reassurance re: it's pretty unusual for people to be billed more than their annual out-of-pocket max due to denied claims, uncovered stuff (yet medically necessary), etc.

 

[RetMD21]

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.

Thanks for THE TRUTH. Do you have a source for this?