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Old 09-15-2018, 10:12 PM
 
27,552 posts, read 45,018,330 times
Reputation: 14073

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Quote:
Originally Posted by middle-aged mom View Post
Short Term Plans are exempt from the ACA loss ratios which means they are wildly profitable for insurers in those states that allow them to be sold. No two plans are alike within or across states. The devil is in the details.

The reason premiums are cheaper than ACA Compliant Plans is because Short Term Plans contain significant limitations. The cheaper the premium, the greater the limitations.

Any condition that is deemed to be pre-existing is excluded. The insurer will investigate claims to determine if there is a prior diagnosis or injury. If so, they deny the claim. Once a condition is diagnosed or a serious injury incurred the plan is not renewable. The insured is SOL. Someone in this situation could enroll in an ACA- compliant plan during the next Open - Enrollment period. Timing matters.

In some states, insurers are allowed to further discriminate based on the insured’s age and gender.

Some plans exclude certain costly to treat diagnosis like Cancer, Stroke and Heart Disease. Some plans exclude all out- patient surgeries, which are most surgeries.

All exclude maternity, mental health, substance abuse treatment, prescription medications, preventative care like annual check-ups and Cancer screening. One shopping for the cheapest premium is unlikely to seek an annual physical or Cancer screenings.

Some plans impose a post diagnosis waiting period before Cancer Treatment can begin. For example, assume you pay out of pocket for Cancer screening and are diagnosed with a Cancer on 10/31. You may not begin treatment until 11/31, assuming the plan covers a portion of the cost. Your plan expires on 12/31 at which point you are uninsurable in the midst of Cancer Treatment.

All have annual and lifetime caps, often as low as $225,000 for the cheapest plan. There are often no caps on Annual out of pocket expenses.

Ambulance is often excluded. ER visits tend to cap reimbursements; some as low as $500.

Deductibles are often high. Co- Insurance is often 50-50. Some states allow tiered co-insurance, meaning the insured has to cover the deductible out of pocket and then an additional $5000-10,000 off the first $15,000 and then 50% of the costs, thereafter up to the plan’s annual/ lifetime cap.

Networks may be severely limited or non- existent meaning reimbursements are limited to out of network rates with the insured being responsible for the balance. Plans are marketed as you choose the provider you want. They don’t make clear you are going to pay an out of network rate and a 50% coinsurance

Such plans may compete with traditional ACA- compliant plans and have the potential to remove the youngest, healthiest and most ignorant from traditional plans, thus resulting in higher premiums for less healthy and or older people and/ or more knowledgeable.

Such plans are marketed to appeal to consumers who think all insurance is alike. ignorance is bliss until you need it.

Throughout his campaign, Trump made numerous promises about “replacing Obamacare with something wonderful that would take care of everybody”. Depending on the audience, he said either the government would pay for it or that premiums would be a fraction of what people currently pay.

Post inauguration, he let loose with “ nobody knew healthcare was so complicated”. It became obvious he/ his Admin had no plan to deliver on his campaign promises.

Imagine his Admin will portray Short Term Plans as delivering on campaign promises.

Think it appropriate for the Federal Government to eliminate the Federal employer 70% subsidy of traditional plans for Congress critters, cabinet members and staffers and instead apply the employer subsidy to only Short Term Plans. No reason they should not embrace the competition with open arms, eh.
Excellent explanation of differences
Probably better than ANY GOP politician can give regarding why insurance companies don't want to be held to certain standards of coverage...
The GOP has NO DESIRE to hurt any insurance company by cutting its profits
I don't know why anyone won't just admit that is the goal --- make insurance companies every more profitable then they managed to be in spite of the ACA

I think everyone should understand that no insurance company lost any significant amount of money when the ACA was put into service because what they did was basically conspire to leave markets that were unprofitable and allow (by shrinking competition) other companies to pick up the slack...

They also could do many things to actually make lower rates and higher coverage profitable--
But that would involved actually cutting grossly overpaid executives less money and other perks
And Heaven forbid the upper eschilon should have to give up any of their perks for people to have affordable insurance coverage...
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Old 09-15-2018, 11:08 PM
 
16,364 posts, read 6,107,876 times
Reputation: 6926
I am delighted those who choose catastrophic coverage have that option again.
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Old 09-15-2018, 11:37 PM
 
Location: Los Angeles
4,774 posts, read 6,940,251 times
Reputation: 6384
Well, after reading all these post, it appears medicare for all is what people want.
You do realize that medicare for all is going to cost enormous escalation of your taxes?

I think medicare for all is a socialist call from the democratic socialist, thinking it is "free" medical insurance.
Nothing is free, and that includes health insurance.

Bob.
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Old 09-15-2018, 11:53 PM
 
436 posts, read 80,071 times
Reputation: 393
Quote:
Originally Posted by CALGUY View Post
Well, after reading all these post, it appears medicare for all is what people want.
You do realize that medicare for all is going to cost enormous escalation of your taxes?

I think medicare for all is a socialist call from the democratic socialist, thinking it is "free" medical insurance.
Nothing is free, and that includes health insurance.

Bob.
Um, Trump said he would implement it during his campaign. Is he a democratic socialist?

"There's many different ways, by the way. Everybody's got to be covered. This is an un-Republican thing for me to say because a lot of times they say, 'No, no, the lower 25 percent that can't afford private'… I am going to take care of everybody. I don't care if it costs me votes or not. Everybody's going to be taken care of much better than they're taken care of now … the government's gonna pay for it."

60 Minutes September 27, 2015
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Old 09-16-2018, 01:47 AM
 
21,518 posts, read 7,172,955 times
Reputation: 7572
Quote:
Originally Posted by PCALMike View Post
And why do you have no cost at all? Are you on medicaid? You pay it in the form of lower wages if your employer pays it. And you'll lose it if you get sick and lose your job.
No.
I did pay into Medicaid for 50 years as you mention.
I don't use it so I suppose that's my gift to all those who do.
I helped make Medicaid more affordable to the millions who use it.
I never once cried about it but I don't want to be forced on to it now either.

I use the VA.
I contracted for it and paid off my part of the contract years ago.
Turns out it wasn't cheap but it was affordable at the time.
I'm a priority one with no co-pays. All my medication is no cost to me.
As it turns out.
The only medication I take is for injury's received fulfilling my part of the contract.
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Old 09-16-2018, 01:58 AM
 
21,518 posts, read 7,172,955 times
Reputation: 7572
Quote:
Originally Posted by natalie469 View Post
I’m sorry but your short term plans raises the cost for the rest of us.
The weakest argument of all, that could be made, after seeing what the ACA did to the tens of millions who had dramatic disruptions and increases in cost.
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Old 09-16-2018, 07:50 AM
 
27,552 posts, read 45,018,330 times
Reputation: 14073
Quote:
Originally Posted by J_Quayle_Higgins_III View Post
Um, Trump said he would implement it during his campaign. Is he a democratic socialist?

"There's many different ways, by the way. Everybody's got to be covered. This is an un-Republican thing for me to say because a lot of times they say, 'No, no, the lower 25 percent that can't afford private'… I am going to take care of everybody. I don't care if it costs me votes or not. Everybody's going to be taken care of much better than they're taken care of now … the government's gonna pay for it."

60 Minutes September 27, 2015
The part I like is where he said "the government's gonna pay for it"
If you believe in a God, Trump should have been struck dumb...
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Old 09-16-2018, 07:52 AM
 
27,552 posts, read 45,018,330 times
Reputation: 14073
You know--when I pronounce Barrasso's name a certain way I can get
"Bare ass o"...makes me laugh...
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Old 09-16-2018, 08:03 AM
 
21,518 posts, read 7,172,955 times
Reputation: 7572
Quote:
Originally Posted by loves2read View Post
You know--when I pronounce Barrasso's name a certain way I can get
"Bare ass o"...makes me laugh...
I noticed that right off.
Made me laugh too and reconsider if I wanted to post a thread still.

A name like that fits his line of work.
It reminded me of a product ( brasso ) I used to use to polish brass.
Maybe he uses that to polish turds in the Senate before he votes on them.
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Old 09-16-2018, 12:12 PM
 
6,774 posts, read 6,863,247 times
Reputation: 6942
Quote:
Originally Posted by middle-aged mom View Post
I don’t have an issue with so- called ACA- compliant Association Healthcare plans.

It may reduce premiums for some participants, while providing relatively decent insurance.

These plans will not however, be competitive with large Group, Employer Healthcare Plans.

Associations are voluntary and do not have the ability to guarantee premium payments the way a large employer does. Associations are not employers and don’t have the ability to subsidize member benefits nor to make payroll deductions.

ACH facilitated debiting is only as good as the debtor’s balance in the account.

Allowing trade associations to broker lower premiums is one of those common sense improvements that could have been made to the ACA if politicians were not so he’ll bent on repealing the ACA.

Extending the duration of Short Term Plans puts the Goodhouskeeping Seal on Junk Plans sold to ignorant people who persist in the belief that all insurance is alike or knowledgeable people who intend to milk the system.
Yes, this could have been a great addition to the ACA, along with allowing the premiums to be tax deductle as they are for an employer or the self employed. Theses changes could have been a great benefit to the older members of the middle class who found themselves struggling with high premiums but not eligible for subsidies. The fact is if the ACA had a modicum of support, costs would have gone down due to larger pools. Many people refused insurance for partisan reasons and a refusal to understand that being responsible means having insurance to cover the fallibility of their bodies.

I've been self employed for the majority of my adult life but have spent a few years here and there employed. I have been in the situation to need individual coverage. The options prior to the ACA were terrible. Companies would refuse or raise rates exponentially for any number of minor illnesses. The one that really struck me was refusal for anyone being on antidepressants. Doctors hand those things out like candy for minor stressors. There were many others.

I have looked at a number of short term plans over the years. Most are absolute garbage. I began my working life in HR, managing benefits. I know how to read an insurance policy. Most short term policies are barely worth looking at. Often, the premium combined with deductible adds up to very little actual coverage from the company. There would be yearly maximums that would barely cover one fall on vacation, forget about any kind of real illness requiring complicated treatment. The company decided on renewal so if you got sick, they would snatch it away. Most policies would be laugable if it weren't so sad that people bought them.

People need to very careful with these plans. Anyone who actually needs coverage should get a real ACA policy. If you must get one of these and don't understand explicitly how to read a policy, please take it to an accountant or someone else you trust. Many of these plans are little more than a scam.
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