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So far we are very pleased with our gold plan from health repubic. Going into our 2nd year with it and have zero to complain about so far.
For those with big bucks sleeping in the bank, obcare is not an issue.
and for those who need medical services regularly, obcare is acceptable and might be worth it.
but for the majority young/healthy americans who hardly visit doctors once per 5 yrs, compulsory income-linked medical contributions to the big ponzi ill run medical care system is beyond "highway robbery"....
I have employer sponsored medical benefits so I am not too much affected by this legal robbery by uncle sam, but i truly feel the pain that many obama americans experience.
when the government sees that the ailing medical care system is not sustainable into the next decade, instead of self checking the system for loop holes and bugs, they dig their hands into average americans' pockets for a bailout, as they often do...
if you followed the profit growth and financial performances of many insurance companies, you would have realized that obama has successfully deceived many americans into believing that affordable care act was set up with their rights/benefits in mind...but one year after its implementation, it is time for a reality check... the most outstanding effect that obcare had on the society is that the 0.1% grew larger and fatter by pocketing more sweat money from many struggling americans.
it is a government run ponzi, and many have been warned against it...but sadly many will continue to be sucked into it, you either pay the ridiculous contributions or pay the fine. There is no third option, isn't it?
At this point the 2% fine is still pencils out in your favor if you do the math. $50k/yr income would be looking at a $1000 fine for 2015, which is double what it was in 2014 but still far less than the estimated $3700 a year in premiums flushed down the toilet for a guy like me. Even if you make $100k it still works out better just to pay the fine. The $150/month catastrophic plans at ~$1800/yr are a far more compelling value for anybody making between $50-100k annually.
This country sometimes...I tell ya. Head so far up its rear it's comical.
For those with big bucks sleeping in the bank, obcare is not an issue.
and for those who need medical services regularly, obcare is acceptable and might be worth it.
but for the majority young/healthy americans who hardly visit doctors once per 5 yrs, compulsory income-linked medical contributions to the big ponzi ill run medical care system is beyond "highway robbery"....
I have employer sponsored medical benefits so I am not too much affected by this legal robbery by uncle sam, but i truly feel the pain that many obama americans experience.
when the government sees that the ailing medical care system is not sustainable into the next decade, instead of self checking the system for loop holes and bugs, they dig their hands into average americans' pockets for a bailout, as they often do...
if you followed the profit growth and financial performances of many insurance companies, you would have realized that obama has successfully deceived many americans into believing that affordable care act was set up with their rights/benefits in mind...but one year after its implementation, it is time for a reality check... the most outstanding effect that obcare had on the society is that the 0.1% grew larger and fatter by pocketing more sweat money from many struggling americans.
it is a government run ponzi, and many have been warned against it...but sadly many will continue to be sucked into it, you either pay the ridiculous contributions or pay the fine. There is no third option, isn't it?
SO far out of pockets have been fairly low for us. prescription coverage is excellent and compared to the fact we were paying almost 14k a year for full coverage on our old policy we came in 5k cheaper last year.
the plans are basically pay as you go. if you only see your primary doctor mostly you will do fine.
the more you use hospital facility's the more the out of pockets will hit you.
worst case scenario is still a better deal than we had. we have no subsidy .
A question on deductibles (I have Medicare so I don't know.)
With insurance coverage a doctor will bill, say, $600 for a routine visit but the insurance company will slash this down to, say, $80. A hospital will bill $40,000 for an overnight and the insurance company will slash this to $2300.
So now what happens in your "deductible" period. Does the doctor bill YOU the wishful $600 and the hospital $40,000 or does the insurance company weigh in on your behalf and get you the lower (fair) rate even though the insurance company is contributing nothing?
A question on deductibles (I have Medicare so I don't know.)
With insurance coverage a doctor will bill, say, $600 for a routine visit but the insurance company will slash this down to, say, $80. A hospital will bill $40,000 for an overnight and the insurance company will slash this to $2300.
So now what happens in your "deductible" period. Does the doctor bill YOU the wishful $600 and the hospital $40,000 or does the insurance company weigh in on your behalf and get you the lower (fair) rate even though the insurance company is contributing nothing?
"the insurance company will negotiate for a payable rate with the doctor/facility. they will pay for their portion and you pay for the rest based on the same rate. at least this is how it works with mine.
what is amazing to me is that the provider always attempts to inflate their billing like crazy to give sufficient room for the insurers to cut back. it is a bluffing game based on no rules or principles.
A question on deductibles (I have Medicare so I don't know.)
With insurance coverage a doctor will bill, say, $600 for a routine visit but the insurance company will slash this down to, say, $80. A hospital will bill $40,000 for an overnight and the insurance company will slash this to $2300.
So now what happens in your "deductible" period. Does the doctor bill YOU the wishful $600 and the hospital $40,000 or does the insurance company weigh in on your behalf and get you the lower (fair) rate even though the insurance company is contributing nothing?
with our gold plan we have a 250 deductable each. after that we pay nothing for our primary . we pay nothing for many prescriptions. i pay nothing for my diabetes testing stuff. we get 300 bucks for a gym back.
if we do pay anything it goes towards our out of pocket of 6k each . whether the deductable period or not all bills are based on what the insurer would have payed so you get the special rates.
specialists we pay 75 co-pay , it goes towards our out of pockets.
when you hit the out of pockets you pay for nothing pretty much.
but lets take going to the emergency room or going to the hospital. you pay 20% of the entire bill up to your out of pocket limit.
while it seems like alot the insurance cost and the max out of pocket is still a few thousand less than we were paying for full coverage which cost us 13-15 a year if we used it or not.
if i have an mri done at a lab it is a 75.00 co-pay. if i have it done at a hospital i pay 20% of the special rate up to my out of pocket max.
last year we saved about 5k over what we were paying..
Last edited by mathjak107; 02-13-2015 at 10:37 AM..
A question on deductibles (I have Medicare so I don't know.)
With insurance coverage a doctor will bill, say, $600 for a routine visit but the insurance company will slash this down to, say, $80. A hospital will bill $40,000 for an overnight and the insurance company will slash this to $2300.
So now what happens in your "deductible" period. Does the doctor bill YOU the wishful $600 and the hospital $40,000 or does the insurance company weigh in on your behalf and get you the lower (fair) rate even though the insurance company is contributing nothing?
When my job had a plan (Oxford) with deductibles, the doctor billed the insurance some ridiculous amount, the insurance came back with what should be paid and then the doctor billed me for what the insurance said.
Now we have a Health Republic platinum plan with no deductible but with low co-pays, and 2K max out-of-pocket, so far I am pleased with it and it seems to have a fairly wide acceptance rate (except Lenox Hill and affiliated doctors).
north shore lij started their own plan which is very very expensive. they take very few plans now as well .
but as i said we have been very happy with our health republic gold plan and since we are low users of medical services saved quite a bit over what we paid for conventional insurance.
the worst case scenario with both of us hitting our max out of pocket ,highly unlikely , is still less than the old rates we had.
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