Help me understand Obamacare (prescriptions, Nevada, Texas, monthly)

[Robyn55]

Originally Posted by gigimac

ROBYN (and others), here's the link again that will explain to you better what you don't know about the new Health Reform Law: Home | HealthCare.gov

I'd take you point by point, but you can do it just as well as me by reading what's on that website. There are tabs that take you to specific parts of the bill, to the whole bill itself, the highlights of the bill, and so on and so forth. Look all around in there.

BUT, I'll take your very first point just as an example. I'm on Medicare. My income is what I get with Social Security, period, and I am below the poverty line. You are incorrect about limits on lifetime coverage, whether on Medicare or Private Insurance or whatever insurance. "The Affordable Care Act prohibits health plans from putting a lifetime dollar limit on most benefits you receive. The law also restricts and phases out the annual dollar limits a health plan can place on most of your benefits — and does away with these limits entirely in 2014." As for "most benefits," this is stuff like how some insurance companies will put a lifetime limit on benefits not considered "essential," and other sorts of work-arounds they might do to us. You've GOT to understand that health care reform is needed to stop insurance company control of health care, to lower costs for hospitals, doctors, and patients, and to prevent loss of life on account of being dropped from insurance or being denied insurance. That's the bottom line, really, is OUR LIVES.

Another quick point that I'll take you to task on is you said something about seniors not being able to afford Medicare. Perhaps I misunderstood your point, but hon, if you get full Social Security benefits (that is, you don't retire "early"), you automatically get Medicare, which cost is automatically taken out of your Social Security monies. There is no "paying" for anything; it's all automatic. And there's one more quick thing I can throw out: You said docs will avoid the sick...that's your prediction, not reality. Doctors do what they do because they love it, they're smart enough, they want to help people, and they DO get a good salary for curing us if we must stare death in the face. GG

Since you say you're on Medicare - I hope you get to understand your coverage better. For example there has been and will be no change in terms of Medicare hospital days (they're certainly not unlimited). Medicare is not an insurance company - it's a government program.

Enrolling in Medicare Part B is not 100% automatic (one can opt out of Part B when one gets the original information from Medicare). If one does not opt out - Medicare Part B premiums will be deducted from one's social security payments.

And - if you only have basic Part A and Part B Medicare - you're liable for lots of stuff. Read here:

http://www.medicare.gov/publications/pubs/pdf/10050.pdf

Even if a person buys a Medigap policy and a Part D policy - he or she can have some pretty large out-of-pocket costs. BTW - are you sure you're on "original Medicare" as opposed to a Medicare Advantage Plan - or a Medi/Medi (Medicare/Medigap plan). Take a look at your insurance card - see what it says. Robyn

[Robyn55]

Originally Posted by livecontent

I read your fine post and that response from the person who thinks she knows much but cannot understand a simple sentence. That is why I have ceased responding to her posts. Your are wasting your time and are just talking to a blank wall.

I am very well versed in this law and that is what is in place. Lazy people will complain and dance around the issues but they do not take the effort to fully understand or even took the time to read the Congressional Bills, leading to the Consolidated Act. It was at that stage, at the time of discussions of the bill, that objections are voiced and changes are proposed but of course most were too lazy and some too ignorant to contact their representatives with their concerns; I did and suggested changes to the bills.

Livecontent

I think most of us who have spent years on the Retirement Forum know/knew and/or have learned a lot about Medicare Parts A & B - Medicare Part D - Medigap plans - and Medicare Part C - which is Medicare Advantage plans (although I don't recall a lot of discussion about Medicare/Medicaid plans - the so-called "dual eligible" plans). It is kind of a shame that some people here who aren't very knowledgeable about Medicare and related issues are confusing what will happen to non-Medicare people under the ACA (a fair amount of stuff) - and what will happen to people on Medicare (almost nothing).

I do suggest that for people seeking information specific to Medicare - that they start appropriate threads asking specific questions. Robyn

[gbpakrfan]

Ever since this fiasco of a decision by Roberts foisted this garbage upon us, most people are focusing on the insurance aspect (what kind of insurance will be available, how will it impact Medicare, questions about the state exchanges, etc.). However, keep in mind that this is ObamaCARE, not ObamaInsurance. For you purists in the crowd, the "official " name is the Affordable Care Act...not the Affordable Insurance Act.
People need to re-focus on the fact that the government will be running your health CARE, which, if it follows suit with almost everything else the government touches, will be more like health CARELESS...or more accurately, couldn't care less.

Also, keep in mind that the 2,700 page document (which we had to pass to find out what's in it) is only an outline of the plan. You can look forward to thousands of additional pages, since many of the subjects contained within the plan are at the further discretion of the Secretary of Health and Human Services. This means that as we approach 2014, Sebelius has authority to fashion the plan the way she sees fit. If she decides hospitals need to use a specific kind of bedpan, she can write up seven additional pages describing the government-approved bedpan, which will probably cost $2,500.

[gigimac]

ARIADNE & ROBYN,
Robyn, in your condescending speech to a well-informed poster, you said "those of us who spend time in the retirement forum," well, dear one, just in case you were being literal, this is the HEALTH & WELNESS DEPARTMENT. Okay?

And BOTH of you people apparently feel such a strong need to tell me I'm wrong when I'm not, and then you throw in so much incorrect trash, I don't have much choice but to "nip it in the bud" and spell out the truth "so any fool can understand it" (Mr. T), since apparently no matter how clearly I put it, you guys still don't get it. Medicare COMES OUT OF Social Security. WE are not paying for it. The GOVERNMENT pays for it, via our lifetime work input and others' inputs and general taxes used for much-needed "social" programs, those monies go into Social Security, and then Social Security takes the cost of health care out of the Social Security benefits that automatically come to you minus your Medicare plan costs. So, Social Security is paying for it.

But here's THE important point. The business about how so-and-so in SoCal has to go to Tijuana to get health care, THEY WON'T HAVE TO ANYMORE, because the BILL CHANGES the affordability of health care, by way of pools of poor people, exchanges for cheap to no-cost insurance, and even if you're on Social Security, if you ain't got enough dollars to afford to be taken out of it, then you BELONG TO THAT GROUP that is too poor to buy health insurance, in which case you ain't gotta get health care in another country. You see, that's why this bill! Before this bill, people had NO RECOURSE for getting some form of health coverage, thanks to the health care companies' absolute monopoly over health care. Before this bill, so-and-so in SoCal had to go to Mexico. But this bill FIXES that particular problem, no matter how you want to characterize who pays for the insurance, be it us, Social Security, the Government, or the Eskimos! I clarified that just because. BUT how could anyone in their right mind say they DON'T WANT FREE HEALTH CARE for those who need it? I ASK YOU THAT!

And honestly, I don't need a link to explain Medicare Parts A, B, and D to me, I know precisely what everything costs because, yes, not only am I poor and on Medicare and Social Security, I also was a cancer patient last year, I had to cough a few thousands for the 20 percent (or 10 percent and less since I was in-network) and so did a foundation to just partially cover my chemo costs, that's all I felt I should get help with. I had some savings, but nearly all is gone now. So, I thought I'd buy another AARP health coverage (like my Medicare) called "supplemental insurance," which I used to have that some years ago, and it only cost me $25 per month and they did and will pay most of those thousands I wasn't expecting to have to pay, if heaven forbid this happens to me again. Nobody expects to get cancer. But I could qualify for the "below the poverty line" group of folks who cannot afford insurance, but I thought as long as I think I can manage it, I will. Anyhow, I'm just SAYING...
GG

[Robyn55]

To get traditional Medicare Part B - you pay a premium which is deducted from your Social Security payment (assuming you are collecting Social Security):

Medicare is financed by a portion of the payroll taxes paid by workers and their employers. It also is financed in part by monthly premiums deducted from Social Security checks.

Social Security and the Medicare Program

If you are not yet receiving Social Security benefits (some people elect to wait until they're older than 65 to receive Social Security) - you will get a bill from Medicare (there are probably direct debit options as well):

If you are getting Social Security benefits, the Part B premium is taken out of your monthly Social Security payment. If you don’t get full Social Security benefits yet, Medicare will send you a bill for your Part B premium every 3 months. If you don’t get your bill by the 10th of the month, call Social Security.

http://www.medicare.gov/Publications/Pubs/pdf/11038.pdf

Note that Social Security and Medicare are separate programs - each has its own separate trust fund.

The exchanges you mention do not apply to people on Medicare. OTOH - poor people on Medicare may also be eligible for Medicaid benefits. And - if they're not eligible for Medicaid - they can buy Medicare Part C (a Medicare Advantage plan). FWIW - from a couple of things you've mentioned "like in-network" - I suspect you are/were dealing with some kind of Medicare Advantage plan (or perhaps some kind of state plan or perhaps even Medicaid). Because traditional Medicare doesn't have "networks". Robyn

[Ariadne22]

Originally Posted by gigimac

WE are not paying for it. The GOVERNMENT pays for it

One needs to understand the meaning of the word "premium."

The SS website clearly states that Part B requires a premium, paid by the enrollee - not the government.

Some people write their own checks for Part B directly to the government.

Are you saying the money in their banks accounts from which they are paying the Part B premium came from the government?

Some people choose to enroll in Part B and have their SS benefit reduced by the Part B premium.

Others do not enroll in Part B at all, and receive a higher SS benefit check as a result.

The Part B premiums can be very high - as much as $319/mo for those with high incomes. At that level, many well-to-do people might very well decide to opt out of Medicare Part B entirely and pay their own medical expenses in cash.

The Part B premium is not paid by the government - it is paid by the participant in the Part B insurance - if that participant chooses to enroll.

The automatic deduction by the government from SS benefit DOES NOT give the government carte blanche over that $100. I could easily disenroll from Part B and be $100 richer every month.

The fact that Part B is an option automatically defines the Part B premium as a cost to the participant, not money paid by the government.

Sorry you believe Robyn and I are talking trash. You need to get a better understanding of what is REALLY your money and what is not.

The guy in SoCal clearly understood that $100 Part B premium was HIS money and he chooses not to pay $100 for Part B out of HIS money - so he did not enroll in Part B - thus increasing his monthly SS benefit check by $100.

[gigimac]

R & A, I do not get Advantage. You all are mostly talking about what health care USED to be like, for example all your Part B stuff, particularly since some things simply are not addressed by the law as written. or becomes a non-issue because of new ways to pay for all those things, or that will not go into effect until two years from now. I do not believe either of you spent much time looking at the government website explaining the law as relates to your specific concerns, link provided twice now. If you have issues with how awful the bill is, do look at that website that explains how wrong or irrelevant your positions are! I mean, what in the world sources are you all checking out? And you guys never did answer my question, How can anyone be against affordable health care?? Next time you're in church, look down the pew. One of those people has no health care.

Also, a lot of the stuff you're putting are exceptions to the way I couched my points, which I clearly said several times IF YOU GET SOCIAL SECURITY, then IT COMES OUT OF THOSE BENEFITS. I don't know how else to say it. And as a matter of fact, by still harping on issues that have nothing to do with that premise, nothing to do with the point of view I have, you may think you're expressing cons, but you're not when you go off-topic from my list of ten pros, and you're not when you are incorrect, backed up by the law itself, which I did quote it and referred to it several times.

Now, I put ten points off the top of my head that are pros to the bill. You all took issue with a few, and I defended a few with references to the bill, and told you guys to check out the rest by reading relevant parts of the bill. But you guys keep wanting to challenge my post, you are now into semantics, you've left the premise on which I was willing to spend some time refuting, and you're continuing to be incorrect! Do something substantive like I did, list off the cons of the bill, and quit trying to argue with the truth as described by me. You see, I stand by what I say because I'm familiar with the bill. Thank you. GG

[Ariadne22]

Not incorrect at all, but it's best if we agree that we disagree.

Further I am not and never have been opposed to universal health care. Where did I ever say that? Stop putting words in my mouth.

The country needs it. My family needs it if my dil's employer ever drops health insurance for its employees which it very well might because it is having serious budget issues.

Present legislation has many vulnerabilities which will exclude at minimum 15 million - most egregious example being when the GOP govs can refuse money to expand Medicaid to insure the poor. So, the goal of universal coverage has not been met. But it is what it is.

It would be a good thing if Congress will put partisanship aside and work to strengthen the law and not sabotage it.

[Robyn55]

gigimac - On my part - I want a single payer system which will provide basic coverage for all people who are legally in this country. I also believe that all people must participate in that system - and pay their "fair share" (not some puny little tax if they elect to opt out). I would also allow people to buy coverage better than the basic coverage if they care to - or coverage with various co-pays/deductibles (those coverages might come from the government - or private insurance companies - I'm kind of indifferent about that - my state high risk pool - and many others - offer different levels of coverage in terms of co-pays/deductibles and the like). I would abolish Medicare altogether and put all people regardless of age into this program.

I would probably have tiered premiums - based on a combination of age and income (regardless of the source of the income - whether it's earned income - investment income - unemployment benefits - welfare benefits - etc.). Exactly how large those premiums would be - and how much they might vary - would depend on seeing what comes out of some number crunching. But everyone would sure pay a heck of lot more than that puny little Obamacare tax. I would also make all people pay at least something out of pocket whenever they got medical care. Even if it's only $10 (since even poor people in this country buy cigarettes* and lottery tickets - the overwhelming majority can afford to pay something when they see a doctor).

I would also get rid of all illegal immigrants in this country. And if the federal government refuses to deport them - it should pay for the health care that indigent illegal immigrants consume by taxing everyone everywhere in the country to pay for it. Many states do not have a problem with health care for indigent illegal immigrant health care. We in the state of Florida do. So let people who live in other states share our pain. IMO - every dollar that is spent on health care for indigent illegal immigrants here is a dollar that our state and counties could have spent on education - Medicaid for poor people who are legally entitled to be here - etc.

My main objection to the ACA is it spends too much and taxes too little. Our health care costs are currently 15%+ of GDP. To pay for that health care - every average person in this country (in terms of age and income) probably has to spend perhaps 8-10% of gross income (more if he/she has dependents) for his/her own health care (keeping in mind that younger people tend to consume less health care - and older people tend to consume more). As I wrote in another thread today - this was part of an op-ed piece that appeared in our local paper (Florida Times Union) today:

From national health care, to pensions for city employees, to family budgets, Americans are coming to terms with this rule: You can’t have it all.
You can put off the day of reckoning only so far, but a government and a family must eventually keep to a budget.
The former CEO of Mayo Clinic Jacksonville once made a wise statement that still applies about national health care.
You can have two of these three:
1. High quality.
2. Universal coverage.
3. Lower cost.
So, for instance, we can have high quality and universal coverage but not low cost.
As a nation, we have chosen to skip universal coverage in return for high quality and lower cost.
With passage and approval of the Patient Protection and Affordable Care Act, we appear to be having it all — except coming to terms with cost.

FWIW - I have been in a state high risk health pool for over 20 years. My husband was in it for almost 25 years before he went on Medicare (he became uninsurable when he was diagnosed with MS). The pool was a basket case financially after only a few years - which is why it was closed to new enrollment in the early 1990's. The last financial report I have from it (from 2009) - showed that it lost $5 million in 2009 although it only had 500 people insured under the plan - and all of us (mostly older) were paying pretty hefty premiums. FWIW - the state really didn't care - because all losses in the plan are passed on to health insurance companies (i.e., their policy holders) in Florida. It was the Chamber of Commerce and similar that put the nail in the coffin. Employer health insurance was/is expensive enough without paying for people like us. And that is where I think the ACA is heading. One big high risk pool mess. Because I think politicians are promising a chicken in every pot to people without asking them to pay for it.

So I think I have some basic understanding of what it means to cover - for example - people with medical problems/pre-existing conditions.

Can you live with my plan? If not - why not? Opinions from others would be appreciated as well. Robyn

*Clerk Gets Fired After Refusing To Sell Cigarettes To Welfare Recipient - Careers Articles

[gigimac]

A & R, I did not say anything about universal care. I think I understand you two now. While you both keep presenting stuff that is wrong with the bill, you are not against reform; you just wish the bill was BETTER. May I point out, however, that the vast majority of people who are against the bill are Republicans and think we should have NO reform. So, it is important to recognize this distinction when you all post gripes about the bill, so you won't be checked in the "I HATE OBAMA" column! It is important that we hold onto this thing with our dear lives on account of IT'S BETTER THAN NOTHING, which nothing is what we will end up with if enough people vote in Republicans in this year's general election, because Republicans will surely try to REPEAL it. And they have NO plans on reforming health care; they want to take away efforts to reduce costs and let "the free market" take care of that, many want to take Social Security and Medicare away from seniors (me), and it's really scary to me what the GOP thinks is best, which at least the new law TRIES to help folks have affordable health care! Do you see what I mean? Please consider prefacing your remarks until the election is over with something like, "I'm all for the new Health Care Bill, but I just wish it was more comprehensive," and THEN have at it. Thank you. GG