Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
Up until now, i've been a supporter of Obamacare....but this thread is starting to make me question this....So i wanted to clarify a couple of things....
I currently have free health/dental/vision through my employer for a family of 4.....I wanted to see what would happen if i had to buy insurance for me and my family on my own...so i just went on healthcare.gov and it says: for a IH Advantage 6350 plan, $600/month and 12,700 deductible. (No Charge after deductible for anything).
so.....let me get this straight: I pay 600 a month (7200 a year), and i get 'nothing' until i spend 12,700 in doctor visit/health related fees? in other words, i have to pay 19,900 a year before ANY benefits kick in. is that correct?
if so, it's very appealing to just pay the penalty (about 300 for the 4 of us for the year 2014....), have no insurance, and 'hope' that my medical expenses are less than 19,900 to break even.
Am i missing anything? is this as crazy as it's sounding to me?
I know what you are talking about and it's exactly why I started the thread. I was appalled by these same numbers. For an individual such as myself it it would be about $220/month with a $6350 deductible before insurance pays anything. The deductibles in these deductible only Bronze plans equal the out of pocket max. So for me I would pay $8990 as an individual before insurance pays for ANYTHING. Hence, the plans make no financial sense. Golfgal pushes the idea that I can get a plan for $310 which would include a deductible of $1500 or so depending on the plan with a max out of pocket of $2500 again depending on the plan. It's a much better plan, but also $1080 more per year ($90/month). That's not too much of a premium hike, but take the example that I work and make $30K, but my employer does not provide health insurance. At this income in my state I don't qualify for a subsidy, so I have to chose a healthcare.gov plan. My take home pay is $1950/month and there is a big difference in paying $220 or $310. Also, I may not usually get sick, but who knows, I might next year. I might have a baby, break my leg, get cancer, I can't predict the future. I might have a smaller illness that costs me $4K to treat. On the Bronze plan my insurance would pay nothing! What's the point of having it? I guess if I get cancer than it will matter.
I'm not advocating for insurance to be free. I think paying $300 per month for a decent plan on $40-50K income is completely doable; I think doing so on $30K is a stretch. On top of this the subsides only cover up to the Silver plan, which still carry $4500 deductibles with $6350 out of pocket max. If I'm making $30K, where exactly am I getting these thousands of dollars for care?
the 12,700 is indeed the deductible for the family (max). Per individual is 6350.
there's another one for 613/month that has a 11,000/5500 deductible.
again, this seems outrageous.....but i guess i'm too used to the free plan.
So, did i understand you right....that currently, a family plan (non obamacare) is around 600/month with about 6k max out of pocket?
Yes...the employee share is about $600/month for a group plan, on average--however, the company pays at least that much as well....
Ask your HR department, if they are paying ALL of your medical plan costs, they are paying at least $1200/month for your family and if you have no out of pocket costs at all, they are paying a heck of a lot more than that. Don't expect that to continue.
$12,700 is your out of pocket max, the $6350 is the deductible. Once you hit your deductible then you pay the 40%, 50%, 80% whatever your co-insurance is until you have written checks totaling the $12,700. There are bronze plans that have copays as well--so you pay $20 to take your kid in to see the doctor for an ear infection, not the $170 that he charges your insurance company. The broze plans are low premium/high out of pocket plans by design. They are for people that rarely go to the doctor or for those that have savings that can cover the higher out of pocket costs and want lower premiums. If you compare the total costs across all the plans, the sliver plans tend to be the most cost effective for most people--meaning that the premiums are not that much more than a bronze plan but the out of pocket costs are much less.
Also, plans for the last few years have had provisions for the ACA--these regulations have been in effect for a few years now...sounds like you have a grandfathered plan, however..but that will change next year...
the 12,700 is indeed the deductible for the family (max). Per individual is 6350.
there's another one for 613/month that has a 11,000/5500 deductible.
again, this seems outrageous.....but i guess i'm too used to the free plan.
So, did i understand you right....that currently, a family plan (non obamacare) is around 600/month with about 6k max out of pocket?
I'll be paying $700 just for myself. COBRA with my ex husbands employer is over $1k a month...just for one person. Never mind having a preexisting condition.
I'm not sure why you are so astounded but apparently you have been ignorant on this matter up until now, so at least you learned a lesson and understand why the ACA was inacted.
Yes, you are missing that you can buy an number of plans that have lower deductibles for not that much more premium. You don't have to take that ONE plan, but for a family that rarely goes to the doctor, a plan like that may be attractive because the premiums are low.
You are also missing that you are getting a 100% subsidy from your employer now and that is VERY rare. I hope you express your appreciation to your company for being so generous. $600/month for an out of pocket max of around $6000 is a very typical group plan (employee share).
Also, was that $12,700 a Deductible or what that the out of pocket max. I highly doubt it was the deductible since that is over the limit for what a deductible can be. Look at all the numbers and then report back.
According to the U.S. Census (2010) 68.2% of the country receives health insurance now from their employer. So it's not "VERY rare" as you've said in several posts. Hard to say how many will still have insurance after January 1st though.
Second, having a deductable of $6250 per person or $12,000 per family, in many cases, will guarantee that that person will not actually receive medical care at all.
Example: According to my state website and my income, I can sign up for a plan for $256 a month with a $6250 deductible. I honestly cannot afford the $256 a month to begin with (yes, that is with the subsidy), so I couldn't afford a plan with higher monthly cost and lower deductible. So this means that I will have to cut costs to afford the premium.
But what if I get sick? So in order to go to the doctor, I have to pay for it in full (until I've met the $6250 deductible.) But after paying the $256 monthly premium, there's no extra money, so I go to webmd.com or somewhere to diagnose myself.
I'm failing to see how this makes my life or health better.
According to the U.S. Census (2010) 68.2% of the country receives health insurance now from their employer. So it's not "VERY rare" as you've said in several posts. Hard to say how many will still have insurance after January 1st though.
Second, having a deductable of $6250 per person or $12,000 per family, in many cases, will guarantee that that person will not actually receive medical care at all.
Example: According to my state website and my income, I can sign up for a plan for $256 a month with a $6250 deductible. I honestly cannot afford the $256 a month to begin with (yes, that is with the subsidy), so I couldn't afford a plan with higher monthly cost and lower deductible. So this means that I will have to cut costs to afford the premium.
But what if I get sick? So in order to go to the doctor, I have to pay for it in full (until I've met the $6250 deductible.) But after paying the $256 monthly premium, there's no extra money, so I go to webmd.com or somewhere to diagnose myself.
I'm failing to see how this makes my life or health better.
First---I said having an employer pay for 100% of your insurance plan is rare, VERY rare--not that they have a plan through their company.
Second, you can't have a deductible of $12,000 so why are you worried about it. Unless you get an HSA plan, there are copays that you pay for office visits, etc. that are in the $20-40 range...the deductible would apply if you have other tests, etc. and it's not like you pay it all at once, unless you end up in the hospital..and then you make a payment plan with the hospital to pay it off, just like people do now.
Third, find a different job that gives you better benefits if you can't afford $250/month--or take on a second job so you can afford care--but if you are only getting a minimal subsidy that tells me you make ok money now.
First---I said having an employer pay for 100% of your insurance plan is rare, VERY rare--not that they have a plan through their company.
Second, you can't have a deductible of $12,000 so why are you worried about it. Unless you get an HSA plan, there are copays that you pay for office visits, etc. that are in the $20-40 range...the deductible would apply if you have other tests, etc. and it's not like you pay it all at once, unless you end up in the hospital..and then you make a payment plan with the hospital to pay it off, just like people do now.
Third, find a different job that gives you better benefits if you can't afford $250/month--or take on a second job so you can afford care--but if you are only getting a minimal subsidy that tells me you make ok money now.
The information I stated came directly from my state's ACA website. They are not made up. Looking at the plans available in my state, none of them have a $20 co-pay. If you purchase the cheaper plans, with the $6250 deductible, the doctor co-pay is $60 to $80, emergency room co-pay is $300 and if you go in the hospital, the co-pay is $600 per day.
I'm not sure why you're arguing with everyone who's experiencing the sticker shock of the ACA. Prices vary not only by state but by area within states, so I'm not seeing how you can be so positive of prices nationwide.
But since your goal in this thread has mostly been to tout ACA, I'm going to assume you're getting paid by someone to do so.
Telling someone to go get a part-time job so they can afford crappy not-worth-it health not-care is lame.
But, sorry. I'll be practicing Civil Disobedience on this issue. Just talked about it with the folks at the clinic where I will be going for health care. They're fine with me paying cash as I go instead of using any kind of insurance.
I hope most others will join me in civil disobedience. If a large number of us simply don't participate, the new system will collapse.
I would have been fine with paying into a government managed healthcare program, but I'm NOT forking over any free dough to the insurance megaliths. I practice socially responsible investing and do not allow any of my investment funds go to them, either.
The information I stated came directly from my state's ACA website. They are not made up. Looking at the plans available in my state, none of them have a $20 co-pay. If you purchase the cheaper plans, with the $6250 deductible, the doctor co-pay is $60 to $80, emergency room co-pay is $300 and if you go in the hospital, the co-pay is $600 per day.
I'm not sure why you're arguing with everyone who's experiencing the sticker shock of the ACA. Prices vary not only by state but by area within states, so I'm not seeing how you can be so positive of prices nationwide.
But since your goal in this thread has mostly been to tout ACA, I'm going to assume you're getting paid by someone to do so.
Telling someone to go get a part-time job so they can afford crappy not-worth-it health not-care is lame.
I'm arguing because you are not looking at the plans correctly or looking at all the plans available. If you qualify for a premium subsidy, did you check to see if you qualify for an out of pocket subsidy?
I'm not getting paid by anyone to tout the ACA. I'm trying to get people to understand how it works because there are a lot of people that just don't get it, or choose to listen to some radical news story that is wrong to start with and then believe everything they say.
No, telling someone to get a job isn't lame, it's called being an adult and being responsible.
Just a brief screen shot of a plan from your area--with no subsidy:
Kaiser Permanente
Deductible Silver
KP CA Silver 1250/40
MONTHLY PREMIUM
$274.00
ANNUAL DEDUCTIBLE
$1,250
MAX OUT-OF-POCKET
$6,350
PREMIUM
Family breakdown
Self: $274.00
Monthly Premium:$274.00
Your cost:$274.00
OUT PATIENT SERVICES (Per visit or procedure)
Primary care office visit$40Specialty care office visit$40Most X-rays$40 after deductibleMost lab tests$25 after deductibleMRI, CT, PET$300 after deductibleOutpatient surgery30% after deductibleMental health visit$40
INPATIENT HOSPITAL CARE
This one is a bronze plan--I can't even FIND a plan that has a 12,700 OOP max:
Kaiser Permanente
Deductible Bronze
KP CA Bronze 5000/60
MONTHLY PREMIUM
$205.21
ANNUAL DEDUCTIBLE
$5,000
MAX OUT-OF-POCKET
$6,350
ANTICIPATED PREMIUM COSTS
See if you qualify for federal financial assistance
Number of people in your household:
Your total expected taxable household income for 2014:
$
get an estimate
PREMIUM
Family breakdown
Self: $205.21
Monthly Premium:$205.21
Your cost:$205.21
OUT PATIENT SERVICES (Per visit or procedure)
Primary care office visitFirst 3 office visits $60. 1 Additional visits $60 after deductible.Specialty care office visit$70 after deductibleMost X-rays30% after deductibleMost lab tests30% after deductibleMRI, CT, PET30% after deductibleOutpatient surgery30% after deductibleMental health visitFirst 3 office visits $60.1 Additional visits $60 after deductible.
So, do you want to tell me again that you are finding no plans that have low copays and out of pocket costs? Again, these are without subsidies...since you said you qualify for one, your costs will be even lower...
But, sorry. I'll be practicing Civil Disobedience on this issue. Just talked about it with the folks at the clinic where I will be going for health care. They're fine with me paying cash as I go instead of using any kind of insurance.
I hope most others will join me in civil disobedience. If a large number of us simply don't participate, the new system will collapse.
I would have been fine with paying into a government managed healthcare program, but I'm NOT forking over any free dough to the insurance megaliths. I practice socially responsible investing and do not allow any of my investment funds go to them, either.
No, I'm not foolish enough to risk my retirement savings thanks.
Of course any clinic/hospital will be happy to take a cash payment up front...the real question is how much of your retirement savings are you willing to give to them...
If large numbers like you don't participate and the "system" collapses, you will be right back where you started and a number of people that couldn't get medical insurance before are without it again...keep in mind that less than 7% of the country really NEEDS this...the rest either have plans through their employer or choose not to take plans available to them.
The information I stated came directly from my state's ACA website. They are not made up. Looking at the plans available in my state, none of them have a $20 co-pay. If you purchase the cheaper plans, with the $6250 deductible, the doctor co-pay is $60 to $80, emergency room co-pay is $300 and if you go in the hospital, the co-pay is $600 per day.
I'm not sure why you're arguing with everyone who's experiencing the sticker shock of the ACA. Prices vary not only by state but by area within states, so I'm not seeing how you can be so positive of prices nationwide.
But since your goal in this thread has mostly been to tout ACA, I'm going to assume you're getting paid by someone to do so.
Telling someone to go get a part-time job so they can afford crappy not-worth-it health not-care is lame.
I understand what you are saying and I am seeing the same thing. For those bronze plans that do have deductibles for Dr. visits, they are limited to 2 or so per year before deductible applies. And ER copays are crazy, they are obviously discouraging people from using the ER for anything other than literally life threatening emergencies - which is a good thing I suppose in a way.
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
