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Old 12-25-2016, 08:54 PM   #161
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Because we're not the normal folks that can't afford a $6800 deductible.
+1

What I see is folks who think they can't afford the deductible are many times the same who will roll the dice and go without. Horrible problem to have, expecially if you bet wrong.
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Old 12-25-2016, 11:18 PM   #162
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Originally Posted by ziggy29 View Post
Without a subsidy, a family at (say) 500% of FPL in a very high cost area probably can't reasonably afford decent individual health insurance and deal with all their other expenses as well. Where I live, yes, it's very doable, but in the SF Bay Area, or the NYC area, or in DC or Boston, not so easy.

I will agree that it can be harder in some places.... but since I am not there I am not hearing from these people... so I still stand by my stmt on the people I hear it from...

And like Montecfo said, $200 a month for a family of 3 should be a no brainer IMO... heck, even in the high cost areas I would think it should be a no brainer... but I can understand that costs there are high on almost everything.... then again, it might be a lifestyle choice... instead of Manhattan, move out to NJ somewhere or even LI... sure, it is a long commute, but still cheaper...
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Old 12-26-2016, 09:41 AM   #163
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$1054 per month for the very lowest cost Bronze for two, ages 57 & 59. The deductible is $13,100. We have been spoiled having worked for a corporation that provided health insurance to its employees.
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Old 12-26-2016, 09:46 AM   #164
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$1054 per month for the very lowest cost Bronze for two, ages 57 & 59. The deductible is $13,100. We have been spoiled having worked for a corporation that provided health insurance to its employees.
We cannot afford that at $57 & 63. I would have to put all our assets in a trust and use the emergency room. If that was the norm.
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Old 12-26-2016, 09:50 AM   #165
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I agree. We will play the game as long as we can and apply for tax credits. Our income will be very low for a number of years. Hopefully until Medicare. We are healthy for our ages, but anything can happen.
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Old 12-26-2016, 10:27 AM   #166
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I agree. We will play the game as long as we can and apply for tax credits. Our income will be very low for a number of years. Hopefully until Medicare. We are healthy for our ages, but anything can happen.
Medicare won't necessarily be much cheaper. You'll have to pay for Part B and then some sort of supplemental insurance and a drug plan. Just like now you'll have the choice between premiums and coverage/deductible amounts for that extra insurance. I know that my insurance costs will go up when I go onto Medicare.

Also I think we'll see change in Medicare soon and it will be interesting to see how that changes how much we are charged and how we pay for post 65 medical care.
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Old 12-26-2016, 10:51 AM   #167
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Medicare won't necessarily be much cheaper. You'll have to pay for Part B and then some sort of supplemental insurance and a drug plan. Just like now you'll have the choice between premiums and coverage/deductible amounts for that extra insurance. I know that my insurance costs will go up when I go onto Medicare.

Also I think we'll see change in Medicare soon and it will be interesting to see how that changes how much we are charged and how we pay for post 65 medical care.
We're switching over to Medicare from ACA in 2017 and can confirm the cost is not any better. However, I'm not convinced that a Supplement is required. Among other things, the Supplement policy covers the final 20% that Medicare does not cover. You know, the amount that we cheerfully accepted as our share under a good "company policy" when employed. Of course we ARE getting a supplement policy...... But I'm not sure it is necessary. There are many inequalities within Medicare that not everyone is treated equally, just like the ACA policies.

In the mean time, I will use my 1200+/ month subsidy for a bronze policy that the hospitals nearest to me are in-network. The cheapest Bronze plans' hospitals are more than 2X the distance.
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Old 12-26-2016, 12:13 PM   #168
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We're switching over to Medicare from ACA in 2017 and can confirm the cost is not any better. However, I'm not convinced that a Supplement is required. Among other things, the Supplement policy covers the final 20% that Medicare does not cover. You know, the amount that we cheerfully accepted as our share under a good "company policy" when employed. Of course we ARE getting a supplement policy...... But I'm not sure it is necessary. There are many inequalities within Medicare that not everyone is treated equally, just like the ACA policies.

In the mean time, I will use my 1200+/ month subsidy for a bronze policy that the hospitals nearest to me are in-network. The cheapest Bronze plans' hospitals are more than 2X the distance.
What you mean is the cost in not any better for your personally, you are going from subsidized plan to subsidized plan, why should it be any better?

For those of us paying full price Medicare is much better. We choose one of the best supplemental policies for my DH as he developed a condition that will need frequent monitoring and have spend no additional out of pocket money since, but I'm not sure we are ahead on that numbers game.
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Old 12-26-2016, 12:13 PM   #169
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I will agree that it can be harder in some places.... but since I am not there I am not hearing from these people... so I still stand by my stmt on the people I hear it from...
Well yeah but I hate to say it - your world is a lot smaller than the reality that many people face with the ACA. In fact I would argue that the repeal push has been driven by the folks that find it unaffordable. I don't think people would so loudly complain about the mandate (and penalty) if that were not true.
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Old 12-26-2016, 01:48 PM   #170
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Well yeah but I hate to say it - your world is a lot smaller than the reality that many people face with the ACA. In fact I would argue that the repeal push has been driven by the folks that find it unaffordable. I don't think people would so loudly complain about the mandate (and penalty) if that were not true.
I guess we will agree to disagree.... if you are making $40K a year the plans seem to be very affordable... as you had mentioned, in a few high cost areas it might not be as affordable, but that leaves a whole lot of the country with semi-affordable coverage...

The problem that I had is the high deductible... where you paid almost everything out of pocket until you paid over $6K for one person... the premiums were not a concern...
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Old 12-26-2016, 02:41 PM   #171
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Well I think the definition of affordable is different based on the value you personally place on having health insurance. I've heard folks complaining any costs to them aren't affordable. These folks aren't living in my world.
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Old 12-26-2016, 02:57 PM   #172
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Can't speak to this particular case, but I think that the general sentiment is valid that many don't think that having health care is a spending priority. When the uninsured get free care, it is off the backs of those that have already stepped up to pay for their own care.
+1 totally agree!
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Old 12-26-2016, 03:03 PM   #173
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If this is true, then Americans are being shafted. Who is supposed to be looking out for our interests so this does not happen?
The White House and Congress - alas, lobbying forces are powerful and regulations are unpopular
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Old 12-26-2016, 03:13 PM   #174
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Whether the prices in the US are a true reflection of the development costs or a product of a broken system is something that needs to be honestly investigated.
... snip.....
The prices in ANY market is a reflection of what that market will bear in that particular location, and it has little or nothing to do with where the research and development are done. The US market, becasue it can/is willing to bear the highest prices, is the most lucrative market for for ALL pharmaceutical companies, regardless of where they are located, and ALL companies will charge the maximum they can get. It's the free market system. Capitalism is good, but it is NOT perfect.
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Old 12-26-2016, 03:22 PM   #175
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We could get some mighty cheap drugs if you could not sue and testing was limited to a year or so.
But only if we were willing to get serious about tort reform. Cutting that much of the development process will absolutely lead to higher risks for the patient. Under current law, the moment the first patient is affected by a serious side-effect or even death, flocks of lawyers descend on the Pharma company claiming reckless endangerment, etc. and sue for hundreds of millions of dollars in damages.
Unfortunately, we can't have it both ways.
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Old 12-26-2016, 03:26 PM   #176
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Free has to be below cost to produce, even if you advertise there in the Georgian version of the thrifty nickel.
Well, true for that particular drug, but it is possible that Gilead can reap other benefits (research credits, higher prices for other drugs in their portfolio, etc) to make up for it.
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Old 12-26-2016, 11:34 PM   #177
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The prices in ANY market is a reflection of what that market will bear in that particular location, and it has little or nothing to do with where the research and development are done. The US market, becasue it can/is willing to bear the highest prices, is the most lucrative market for for ALL pharmaceutical companies, regardless of where they are located, and ALL companies will charge the maximum they can get. It's the free market system. Capitalism is good, but it is NOT perfect.
The drug market does not work like other markets... it is not really what the market will bear as there is not a single buyer vs a single seller...

The drug companies are gaming the system....

I was reading about one company that had a drug that 'cost' $100K... but the drug company was aware of the problem some people would have paying their share... so what did they do Reimburse that money back to the patient!!! SOOO, the patient was not out any money so was not complaining... and in fact was saying they NEEDED this drug even if the insurance company did not want to pay the high price... So, the drug company nets $80K from some people but $100K from others.... where if it were a free market it might only cost $20K... (which, IIRC, it cost overseas)....

That is what Mylan did to try and get people off their back... they did not reduce the price since they want to get the maximum from the insurance plans that pay most of the drug costs... so if you have a $20 or so copay you do not care that it cost $600...

https://www.epipen.com/copay-offer
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Old 12-27-2016, 04:03 AM   #178
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Not to mention Docs pushing brand name. My Doc pushes a brand name drug every time a new one comes out and I have to push her back to generic covered by my plan. One more thing: If a drug is a life saving drug then you will pay anything to get it. Does that make a ridicules drug price fair?
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Old 12-27-2016, 04:11 AM   #179
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Not to mention Docs pushing brand name. My Doc pushes a brand name drug every time a new one comes out and I have to push her back to generic covered by my plan. One more thing: If a drug is a life saving drug then you will pay anything to get it. Does that make a ridicules drug price fair?
Fortunately I've never seen that happen first hand though I've certainly heard about it. And in reality, in many situations unless the Rx is written to specify "name brand only", a generic can be dispensed, and usually will be (in my experience) under most health plans which will usually not cover the full cost of name brands with generic alternatives except in a few cases where medical necessity can be established.
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Old 12-27-2016, 07:15 AM   #180
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The problem that I had is the high deductible... where you paid almost everything out of pocket until you paid over $6K for one person... the premiums were not a concern...
You've got half the problem covered - high deductible. The other half you're completely missing, because I don't know how else to explain that $700-800 premiums are unaffordable. You keep saying that people should be able to get subsidies but that is 100% untrue for any single person (or family) making just over the 400% FPL cliff. And that is NOT uncommon regardless of your local experience. It's just basic math regardless of the cost of living - no single person wants to make another rent payment for health insurance when they're only making $50k a year.

I'll make it easy for you - go to healthsherpa.com and put in a single 62 year old female for zip 30126 making $50k. Tell me what you see.

These are the staff I volunteer for at my local charity, and they hate the ACA (for good reason given this issue).
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