Venting about ACA and requesting suggestions

[Golden sunsets]

I don't have a dog in this hunt and DH and I have not had to rely on the ACA for health insurance coverage, but it seems to me, looking from the outside in, that obtaining ACA insurance is terrific if you also get a subsidy and ridiculously (disproportionately?) expensive, if you have no subsidy.


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[flintnational]

@ivansfan - There is nothing neutral about the names congress gives bills. The name routinely pushes one party's, or the other's, agenda.

[garyt]

Quote:

Originally Posted by brucethebroker Personally, I have tried using it in conversation about health care. Most people either just look confused, or say "do you mean Obamacare?"

+1

[Dtail]

Quote:

Originally Posted by Golden sunsets I don't have a dog in this hunt and DH and I have not had to rely on the ACA for health insurance coverage, but it seems to me, looking from the outside in, that obtaining ACA insurance is terrific if you also get a subsidy and ridiculously (disproportionately?) expensive, if you have no subsidy. Sent from my iPad using Early Retirement Forum

That is correct, plus it depends where one resides.

[OHjosh]

I completely understand your frustration with ACA. But for me, the true vent should be the way health care insurance is "set up" in the first place. Why should someone "traditionally" employed for a company be able to get good or excellent coverage, for no or relatively modest contribution, vis a vis those of us in early retirement, private practice, or owning our own business?

I have been self-insured 6 of the past 8 years. When I was employed, I paid $100 a month max for a very comprehensive plan. In my consulting years pre-ACA, I had to take take plans that covered nothing until I reached as much as $8,000 OOP. I am in good health but one year I reached the limit; a bout of whooping cough (my immunity ran out) led to double hernia surgery.

You seem to be losing under ACA. In retirement I gained. My 2019 subsidy allows me to get a silver plan at a slightly lower cost than last year, when I was employed. (Guess I should thank people like you). If anything, this again proves how stupid the current insurance system is.

It may be true that you (and I) are financing somebody less healthy to some extent. But for what it is worth, the services ACA plans must cover (but in your case probably will just count top the OOP) is more comprehensive.

[joeea]

Quote:

Originally Posted by samclem But, since President Obama said he welcomed that label, I think the stink is now off the term.

President Trump said about Obamacare "we have gotten rid of it".

[marko]

Quote:

Originally Posted by samclem "Obamacare" was certainly pejorative at first, and I avoid the term in polite company for that reason. But, since President Obama said he welcomed that label, I think the stink is now off the term. It is even commonly used on NPR now.

My sense is that ACA hasn't lived up to the (perhaps unrealistically) high expectations of many people.
I'd guess that if it had, it would still universally be "Obamacare".

IMO, (wearing my old marketing hat) the long threads over the past few years here here trying to clear up tons confusion show that it was a great idea that was poorly marketed, poorly explained and poorly executed.

Frankly, I would have been deservedly fired if I had had a product roll-out that created so much confusion on day one. Kind of a shame.

[gwraigty]

Quote:

Originally Posted by OHjosh I completely understand your frustration with ACA. But for me, the true vent should be the way health care insurance is "set up" in the first place. Why should someone "traditionally" employed for a company be able to get good or excellent coverage, for no or relatively modest contribution, vis a vis those of us in early retirement, private practice, or owning our own business? I have been self-insured 6 of the past 8 years. When I was employed, I paid $100 a month max for a very comprehensive plan. In my consulting years pre-ACA, I had to take take plans that covered nothing until I reached as much as $8,000 OOP. I am in good health but one year I reached the limit; a bout of whooping cough (my immunity ran out) led to double hernia surgery. You seem to be losing under ACA. In retirement I gained. My 2019 subsidy allows me to get a silver plan at a slightly lower cost than last year, when I was employed. (Guess I should thank people like you). If anything, this again proves how stupid the current insurance system is. It may be true that you (and I) are financing somebody less healthy to some extent. But for what it is worth, the services ACA plans must cover (but in your case probably will just count top the OOP) is more comprehensive.

That isn't true for everyone who is employed. It can vary widely. My husband pays over $152.10 every 2 weeks for HDHP family coverage with a $4,000 deductible. Next year it will be over $163.54 every 2 weeks. That's the discount with the employee & spouse health screening, otherwise it would be $230.05 every 2 weeks. His employer self-insures. They offered HDHP along with traditional health insurance for a few years, but now it's just HDHP. They contribute $1,800 to the employee's HSA for family coverage, lesser amounts for other coverage levels.

And I still consider it a bargain when I read of what others are paying under ACA.

[ShokWaveRider]

The ACA REALLY does need updating (Simply removing or stifling it will not work, except to make things worse, as it has.) No argument there. Fortunately it does work for some who can control their MAGI, which is a lot better than before. at least they can get HI if they have diabetes or High BP, High Chol. etc. Not like the "No HI for You" we had before.

[Fleur58]

I paid $640 for a Bronze ACA plan this year until I qualified for a subsidy in July. By the way, even Obama calls the ACA "Obamacare". After the initial doctor visit and mammogram in January, if was out of pocket for all doctor visits, labwork, xrays, and medicine. It stopped me from going to the doctor by mid year. One visit cost me $753 in doctors fees as my Primary sent me to see 2 "Specialists" during the visit. I am with Kaiser Permanente. Medicine costs at their pharmacy weren't too bad, but all other services are expensive. I like them, however, because all services and doctors are in the same building--its like a mini hospital and the staff is polite and friendly. In my state the cliff for a single is $16-46K. Under 16K you must get a Medicaid plan. I had to do a 10K Roth conversion to get me in range for a subsidy this year. I get no earned income or SS or Pension. Now I hope I don't get socked by surprise large cap gains at the end of the year.
The ACA costs are ridiculous for a Bronze Plan. Now that I get a subsidy, I have elected to pay for a Gold plan for 2019. Just a $20 copay to see my doctor. 0 deductable. I want the peace of mind of having good coverage.

[NW-Bound]

Quote:

Originally Posted by Fleur58 ... By the way, even Obama calls the ACA "Obamacare"...

I remember Obama himself said he did not mind the term "Obamacare".

And he added "Of course I care". Very astute.

[Alan]

Quote:

Originally Posted by Fleur58 Just a 20K copay to see my doctor.

Prices have really increased since I left.

[NW-Bound]

Quote:

Originally Posted by Fleur58 I paid $640 for a Bronze ACA plan this year until I qualified for a subsidy in July. By the way, even Obama calls the ACA "Obamacare". After the initial doctor visit and mammogram in January, if was out of pocket for all doctor visits, labwork, xrays, and medicine. It stopped me from going to the doctor by mid year. One visit cost me $753 in doctors fees as my Primary sent me to see 2 "Specialists" during the visit. I am with Kaiser Permanente...

Prior to ACA, I had a PPO plan with Golden Rule, a subsidiary of United Healthcare. The deductible was $10K/year. I paid everything until $10K, then they paid everything. Due to a serious illness of my son, then myself, I hit that 3 years in a row. Still would not complain, as our hospital bills were more than $200K. For years, the insurance got "free money" from us, it looked like. Then, they lost more than that.

And people call health insurers names. I don't.

PS. By the way, an office visit cost me about $90. This year, another doctor charged only $80. That's cheap.

I went to see a laryngologist 3 years ago. He charged less than $150. This year, an ophthalmology charged me $120.

[ShokWaveRider]

Quote:

Originally Posted by Alan Prices have really increased since I left.

Much better in the UK and Canada Ay? We are still thinking that as a last resort. Although I am on Medicare next year. If the UK stays in the EU, we will consider moving back to Cornwall or Devon... We noticed home prices are coming down. Maybe we really do want Brexit to go through , they may come down more if it does.

[VanWinkle]

Quote:

Originally Posted by ShokWaveRider This alone sounds like a prime reason to overwhelmingly support Medicare for all. At least for those over 50 - 55 perhaps. A Partial Medicare for some maybe?

Because it costs less when the government takes our money and then gives it back as services? They have little or no overhead? Have you recently seen the # of federal employees. And I am sure lobbyists wouldn't line someone's pockets to get preferential treatment for there services. Supply and demand can be messy, but not as unbridled as government(no matter who is in power).

The easy path is not always the best path.

VW

[jimbee]

Quote:

Originally Posted by VanWinkle Because it costs less when the government takes our money and then gives it back as services? They have little or no overhead? Have you recently seen the # of federal employees. And I am sure lobbyists wouldn't line someone's pockets to get preferential treatment for there services. Supply and demand can be messy, but not as unbridled as government(no matter who is in power). The easy path is not always the best path. VW

Medicare overhead is very low.

[ShokWaveRider]

Quote:

Originally Posted by VanWinkle Because it costs less when the government takes our money and then gives it back as services? They have little or no overhead? Have you recently seen the # of federal employees. And I am sure lobbyists wouldn't line someone's pockets to get preferential treatment for there services. Supply and demand can be messy, but not as unbridled as government(no matter who is in power). The easy path is not always the best path. VW

It could not be worse that what we have now, with or without the ACA. At least ALL would get an opportunity to get affordable care and the pool would be huge. The government could help regulate prices and NOT the insurance companies.

[Mr._Graybeard]

Quote:

Originally Posted by Fleur58 I paid $640 for a Bronze ACA plan this year until I qualified for a subsidy in July. By the way, even Obama calls the ACA "Obamacare". After the initial doctor visit and mammogram in January, if was out of pocket for all doctor visits, labwork, xrays, and medicine. It stopped me from going to the doctor by mid year. One visit cost me $753 in doctors fees as my Primary sent me to see 2 "Specialists" during the visit. I am with Kaiser Permanente. Medicine costs at their pharmacy weren't too bad, but all other services are expensive. I like them, however, because all services and doctors are in the same building--its like a mini hospital and the staff is polite and friendly. In my state the cliff for a single is $16-46K. Under 16K you must get a Medicaid plan. I had to do a 10K Roth conversion to get me in range for a subsidy this year. I get no earned income or SS or Pension. Now I hope I don't get socked by surprise large cap gains at the end of the year. The ACA costs are ridiculous for a Bronze Plan. Now that I get a subsidy, I have elected to pay for a Gold plan for 2019. Just a $20 copay to see my doctor. 0 deductable. I want the peace of mind of having good coverage.

Some politicians like to describe this as having "skin in the game."

[VanWinkle]

Quote:

Originally Posted by jimbee Medicare overhead is very low.

Medicare payments are low, not sure about the overhead, but I would need proof before I would agree. The government never cooks the books!!

[Vacation4us]

Quote:

Originally Posted by Fleur58 I paid $640 for a Bronze ACA plan this year until I qualified for a subsidy in July. By the way, even Obama calls the ACA "Obamacare". After the initial doctor visit and mammogram in January, if was out of pocket for all doctor visits, labwork, xrays, and medicine. It stopped me from going to the doctor by mid year. One visit cost me $753 in doctors fees as my Primary sent me to see 2 "Specialists" during the visit. I am with Kaiser Permanente. Medicine costs at their pharmacy weren't too bad, but all other services are expensive. I like them, however, because all services and doctors are in the same building--its like a mini hospital and the staff is polite and friendly. In my state the cliff for a single is $16-46K. Under 16K you must get a Medicaid plan. I had to do a 10K Roth conversion to get me in range for a subsidy this year. I get no earned income or SS or Pension. Now I hope I don't get socked by surprise large cap gains at the end of the year. The ACA costs are ridiculous for a Bronze Plan. Now that I get a subsidy, I have elected to pay for a Gold plan for 2019. Just a $20 copay to see my doctor. 0 deductable. I want the peace of mind of having good coverage.

Just don't get sick! Your covered with KP and their preventative care is good even great for young healthy families BUT if you get sick don't plan on the best up to date care. KP is cheap care not the best care.

Did you know that KP physicians don't have to use KP. They have KP and they have the option to go outside the plan and have a 20% co pay. No other "member" or employee is offered this option. Want a second opinion? Ok you see another KP doctor who opens your chart and agrees with whatever the last guy said.

Want to go to an expert in the field ? Go right ahead and pay for it, it will be like not having any coverage at all.