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Here's another ACA 'gotcha' that I just discovered. I was aware that the policies had an out of pocket limit per year of $6,300 per person or $12,700 per family.
But foolish me, I thought the $6,300 applied to each person in my family, unless the total family out of pocket hits $12,700.
WRONG! Just got a $20,000 bill (after provider discounts) on one person, and my share is $9,200. Called the company, they said the $6,300 only applied to a single person insured. The family deal is a flat family limit of $12,700 out of pocket.
Oh, and now I cannot put enough money into our health savings account to cover the out-of-pocket.
Nancy Pelosi famously said, "We have to pass it to find out what's in it." I say, you won't understand it until you've been screwed. I understand it now.
If you have a bill that big though, somebody somewhere must have gone out-of-network. You would have been slammed because of that pre-Obamacare. I agree we need to work on something better, but the repeal/don't repeal thing has been a distraction.
If you have a bill that big though, somebody somewhere must have gone out-of-network. You would have been slammed because of that pre-Obamacare. I agree we need to work on something better, but the repeal/don't repeal thing has been a distraction.
Nope, all in network. My new ACA-compliant policy has $5,000 deductible and 50% coinsurance, worst terms I've ever had for health insurance, but that's what it is. If I had been willing to spend $10,000 per year more on premiums, I could have cut the out-of-pocket down by $6,000--but who would ever do that? As it is, I have never paid this much premium, $1100, for this low quality of coverage.
The repeal thing has been a distraction, along with all the reflexive ACA defenders who will brook no talk of change. Both sides suck, we need the 60% in the middle to get to work for the people.
If you have a bill that big though, somebody somewhere must have gone out-of-network. You would have been slammed because of that pre-Obamacare. I agree we need to work on something better, but the repeal/don't repeal thing has been a distraction.
Why would a medical bill that high mean he/she went out of network??
Here's another ACA 'gotcha' that I just discovered. I was aware that the policies had an out of pocket limit per year of $6,300 per person or $12,700 per family.
But foolish me, I thought the $6,300 applied to each person in my family, unless the total family out of pocket hits $12,700.
WRONG! Just got a $20,000 bill (after provider discounts) on one person, and my share is $9,200. Called the company, they said the $6,300 only applied to a single person insured. The family deal is a flat family limit of $12,700 out of pocket.
Oh, and now I cannot put enough money into our health savings account to cover the out-of-pocket.
Nancy Pelosi famously said, "We have to pass it to find out what's in it." I say, you won't understand it until you've been screwed. I understand it now.
Could we all start working on something better?
Made me think of the Obamacare divorce thread..maybe you should get divorced so your insurance is cheaper ?
This, I knew about that too. Odd that the OP didn't know about it IMO.
Quote:
Originally Posted by AeroGuyDC
Why would a medical bill that high mean he/she went out of network??
Because $9200 out of a $2000 bill is greater than 20% of what most plans would charge you for an in-network co-pay.
My aunt has a very cheap Healthspan plan from the Obamacare site and she has to pay 20% of major expenses up to her max deductible of $6300.
But every plan is different.
Luckily she is pretty healthy so I doubt she will even reach her deductible, but if so, it is great that they will cover everything after than $6300. That really isn't all that much and that's what my aunt says. She only makes $14K per y ear too and said if necessary, she would pay the $6300 and be grateful.
Just to clarify: my in-network coinsurance is 50%. My in-network deductible is $5,000. I have never been out-of-network in my life. And divorce will not help me because according to Democrats, virtually everyone is less fortunate than me and needs my help.
And if your aunt had testicles, she'd be your uncle.
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