Obamacare Survival Guide ??

[DapperButch]

Originally Posted by Elijah

Interesting, so if I did the calculation correctly, I would have to pay at least $400.00 monthly for coverage that I now pay $120.00 monthly for. Ouch.

Glad that you have such a good plan. You said you were concerned about how it would effect you. I assumed you had no insurance.

For someone who is in your financial situation who currently has no insurance, $400 a month may seem a lot cheaper than the ohhhhh, one hospital visit costing them thousands and thousands of dollars they will be paying back for years to come.

[Corkey]

True story.

I didn't have medical care (insurance) for 7 years. I could not get any medical care as I also didn't have any money. I finally get medicare and find out I had a mass the size of a basket ball in my gut. The surgery cost medicare 35 thousand dollars for a 3 day stay in a private room. I paid $400 in copay. Without insurance I would have died. I can not for the life of me understand how giving people the access to healthcare is a bad thing.

[Elijah]

No, I have health insurance through my employer. However the language I keep coming across is as follows: "If you have health insurance through an employer, you probably do not have to make any changes to your coverage.

I am not sure what that little caveat means, and that makes me apprehensive.

So far, I haven't run across under what circumstances I would have to change my coverage and what that would mean.

E.

Originally Posted by DapperButch

Glad that you have such a good plan. You said you were concerned about how it would effect you. I assumed you had no insurance.

For someone who is in your financial situation who currently has no insurance, $400 a month may seem a lot cheaper than the ohhhhh, one hospital visit costing them thousands and thousands of dollars they will be paying back for years to come.

[Corkey]

Originally Posted by Elijah

No, I have health insurance through my employer. However the language I keep coming across is as follows: "If you have health insurance through an employer, you probably do not have to make any changes to your coverage.

I am not sure what that little caveat means, and that makes me apprehensive.

So far, I haven't run across under what circumstances I would have to change my coverage and what that would mean.

E.

It means that as the ACA gets implemented insurance costs will be changing. Insurance companies will no longer be able to put a cap on lifetime coverage. They will no longer be able to discriminate as to who can get covered, nor can they deny coverage for a preexisting medical disease or condition, such as being female. It means that younger healthier people will get excellent rates and those of us who are not so young and healthy will pay a bit more for coverage. It means that insurance companies can no longer charge seniors more for their medications than the exchanges will pay. All in all good things.

[Elijah]

Right, I understand the enhancements they are making, I still don't understand under what circumstances I will have to change my insurance and what that really means in terms of cost. I have to believe that coverage cost will go up (significantly), otherwise how do they fund the massive expansions?

E.

Originally Posted by Corkey

It means that as the ACA gets implemented insurance costs will be changing. Insurance companies will no longer be able to put a cap on lifetime coverage. They will no longer be able to discriminate as to who can get covered, nor can they deny coverage for a preexisting medical disease or condition, such as being female. It means that younger healthier people will get excellent rates and those of us who are not so young and healthy will pay a bit more for coverage. It means that insurance companies can no longer charge seniors more for their medications than the exchanges will pay. All in all good things.

[Corkey]

Originally Posted by Elijah

Right, I understand the enhancements they are making, I still don't understand under what circumstances I will have to change my insurance and what that really means in terms of cost. I have to believe that coverage cost will go up (significantly), otherwise how do they fund the massive expansions?

E.

Your costs may not go up. If you have an employer that you get your insurance through chances are your costs will not change.
The massive expansion as you put it, is through exchanges that the government will in the first year pay 95% of the cost to set up, by year 3 down to 50% and then the states will be responsible. The more paying in the less the costs. The only way it doesn't work is if the Red States refuse the exchanges and then the Federal government will still set up the exchanges until the state either gets in or they stay out. If they stay out then you can expect to see an increase in your premiums. Economically the thing to do is have more people paying their fair share than having a few states gum up the works for everyone.

[easygoingfemme]

There are a lot of unknowns, but I feel pretty excited to see what will be happening.

I've only had sporadic health insurance most of my adult life. I pay for insurance for my daughter, but to pay for both of us on just my income doesn't make sense. I have seen a doctor/had medical care about once every other year for the last 20 years. I had my baby at home and paid a midwife for her services. That was my biggest expense and that was nothing compared to what it would have cost to be at a hospital. (which isn't why I chose go with homebirth/midwife, but that's a totally different story for a different discussion) Other than that I've been really fortunate to avoid big medical bills. It makes more sense for me to pay out of pocket when I do need medical care than to put out $300/month to pay for insurance that I would hardly use. I'm self employed, so getting insurance is expensive. And on top of that $300/month I'd have to go through a high deductible before tapping in to use it.

However, I'd like sometime to get base lab work done, basic screenings, that sort of thing and it's not something easily attainable without insurance. I don't like that we're being "mandated" to have insurance, but I'm glad that it looks like it will be an attainable goal without feeling like I'm dumping money into a service that I don't take much use from.

[DapperButch]

easygoingfemme, I hope that there is a policy that is preventative care (basic screenings, like you mentioned), and hospital care only. I can't even imagine trying to pay off a hospital bill. Sure, they can't send you to collections in most cases if you are even paying just $5 a month, but I can't imagine having that hanging over my head for possibly the rest of my life.

Anyway, I hope that there is something like that available.

[Corkey]

There are Tiers of coverage. People who are at or below the poverty level will get premium support to pay for the insurance, that is why the Medicaid part of the ACA is important. If you are in the group that qualifies for this you may end up paying less than $300/month.

[easygoingfemme]

Yup, I don't know where I fall on their income guidelines, but I think basic preventative care is covered. Will see. Anyway, I'm just glad to see there is something coming into place for those of us who are self employed.

I did have a hospital bill once, broke my arm. I made an arrangement with them and paid it off. Makes sense for me to pay off something like that, because I used the service! The way most insurances run, I'd have had to pay almost the same amount in deductible before they'd have picked up the tab anyway.

My daughter is, thankfully, in the same health bracket as I am. She took an antibiotic once when she was two. She is 14 now. She sees a chiropractor now and again, who takes her insurance, and we just pay a small co-pay. She sees her primary care doctor... every couple of years I guess? We don't do most immunizations and she doesn't go to school, so we're not required to do a lot of the regular stuff. I wouldn't have her go without insurance, but it's just one of those things I play out.

About 10 years ago, I looked at what I'd been paying into health insurance. It had been a little over 2,000 each year for three years. When I added up what I'd actually used in medical services, it was under $300 total in those three years.

Also, at least in NY, individual dental insurance is wicked affordable. That, I invest in. Totally worth it.

[thedivahrrrself]

Originally Posted by Elijah

No, I have health insurance through my employer. However the language I keep coming across is as follows: "If you have health insurance through an employer, you probably do not have to make any changes to your coverage.

I am not sure what that little caveat means, and that makes me apprehensive.

So far, I haven't run across under what circumstances I would have to change my coverage and what that would mean.

E.

Here's one change you WILL see - remember all that shit they used to deny you coverage for? Well, they can't do too much of that anymore.

Oh yeah, and 80% of your money has to go towards your actual medical care and NOT lining their pockets, otherwise they have to give you a rebate.

Remember how they used to just cancel people's policies when they got cancer? Those days are gone too.

And you know how they used to just set their rates in the dark and you had no way of comparing the cost to what other companies are offering without going through a whole new set of paperwork, blood test, etc... well, in most states, you can compare prices now.


And regarding the expansions, those are medicaid, not private insurance in most cases. More people insured will actually drive down hospital costs, since you and I are actually paying more for all the people who use the services and don't ever pay.


Gotta go fight my insurance company on another treatment for something they claim was "pre-existing" again. A genetic test. SMH! How are your genes pre-existing??

[ArkansasPiscesGrrl]

Thanks for the links sent. They really are helpful.

for the first time in my life, since I moved up to AR in March 2011, I have been without insurance. At 61 yrs old, that is a very scary place to be. I have also, for the last 30 years, been in the medical insurance and billing business. I have perhaps a better grasp on what this law is intended to do, and how it intends on getting there. I have done underwriting, and understand the concept of spreading the risk to obtain lower premiums. I am looking forward to the implementation of the ACA. It will help me (since ins companies can no longer deny me coverage for any pre-existing conditions, or require me to fill out a 15 page application form, asking nothing but questions on "Have you EVER had____" ) I mean, at age 61, there isn't a whole lot that I haven't had! So now, all they will be able to ask me is how much I made last year, and that is only to see if I qualify for premium assistance.

I am self employed, and have a small company (currently 6 employees), so I do not HAVE to offer them ins. I will, however, even if it is just by supplementing premiums they have to pay out of pocket. However, most of them will qualify for drastically reduced rates, if not completely covered.

My one question that I had, and I haven't been able to find an answer to it yet, and the "navigators" aren't in place yet to ask, is whether the income from last year is based on Gross or Taxable Income.

Anyone know?

APG

[Corkey]

Originally Posted by ArkansasPiscesGrrl

Thanks for the links sent. They really are helpful.

for the first time in my life, since I moved up to AR in March 2011, I have been without insurance. At 61 yrs old, that is a very scary place to be. I have also, for the last 30 years, been in the medical insurance and billing business. I have perhaps a better grasp on what this law is intended to do, and how it intends on getting there. I have done underwriting, and understand the concept of spreading the risk to obtain lower premiums. I am looking forward to the implementation of the ACA. It will help me (since ins companies can no longer deny me coverage for any pre-existing conditions, or require me to fill out a 15 page application form, asking nothing but questions on "Have you EVER had____" ) I mean, at age 61, there isn't a whole lot that I haven't had! So now, all they will be able to ask me is how much I made last year, and that is only to see if I qualify for premium assistance.

I am self employed, and have a small company (currently 6 employees), so I do not HAVE to offer them ins. I will, however, even if it is just by supplementing premiums they have to pay out of pocket. However, most of them will qualify for drastically reduced rates, if not completely covered.

My one question that I had, and I haven't been able to find an answer to it yet, and the "navigators" aren't in place yet to ask, is whether the income from last year is based on Gross or Taxable Income.

Anyone know?

APG

Don't know, good question. I would suggest you contact your states Insurance Commissioner..

[Kelt]

Originally Posted by ArkansasPiscesGrrl

<snip>

My one question that I had, and I haven't been able to find an answer to it yet, and the "navigators" aren't in place yet to ask, is whether the income from last year is based on Gross or Taxable Income.

Anyone know?

APG

I will also be interested to see how other income types (e.g. earned income, assets, etc), will effect what is and is not available to individuals.

[Martina]

I cannot wait. I cannot wait. I cannot wait. I work with some students with serious mental illness as do some of my colleagues. We see kids over 18 every day who cannot get insurance. Their illnesses go untreated and they languish. Moreover, we become their only lifeline to the world, which is scary since we are not therapists or medical professionals.

Soon, under the Affordable Care Act, these students will be able to get the medications they need. I have two such students right now. One of them has no care. The other has arranged to get medication for one year through a pharmaceutical company's charitable program, but they keep sending the medication late. When his medication is interrupted, he gets foggy and listless.

Last year, I had four such students, one routinely in crisis. One of my colleagues currently has one. The poor young woman has a long and well documented history of mental health needs, yet cannot get the medication that makes her illness manageable. In a few months, she will have it again. And her life will be immeasurably better. She is also a mother, so her daughter's life will also be better.

I am soo sooo sooo grateful for this compassionate and necessary legislation.

[ArkansasPiscesGrrl]

Originally Posted by Martina

I cannot wait. I cannot wait. I cannot wait. I work with some students with serious mental illness as do some of my colleagues. We see kids over 18 every day who cannot get insurance. Their illnesses go untreated and they languish. Moreover, we become their only lifeline to the world, which is scary since we are not therapists or medical professionals.

Soon, under the Affordable Care Act, these students will be able to get the medications they need. I have two such students right now. One of them has no care. The other has arranged to get medication for one year through a pharmaceutical company's charitable program, but they keep sending the medication late. When his medication is interrupted, he gets foggy and listless.

Last year, I had four such students, one routinely in crisis. One of my colleagues currently has one. The poor young woman has a long and well documented history of mental health needs, yet cannot get the medication that makes her illness manageable. In a few months, she will have it again. And her life will be immeasurably better. She is also a mother, so her daughter's life will also be better.

I am soo sooo sooo grateful for this compassionate and necessary legislation.

Martina, thank you so much for your comments. I wholeheartedly agree. I have extensive business dealings every day (this is my business) with the Behavioral Health field. I see patients, and their families, deal daily with insurance companies that want to limit and deny and delay, etc.

I also have heard that beginning with Jan 1, all ins policies will be mandated to offer mental health and substance abuse benefits. So there will be millions of people finally able to get the treatment they they need, and that can help to return them to a healthy, whole life. (I personally wonder if that mandate is the result in the whole Sandy Hook situation?)

[DapperButch]

Here is a good article from the Huffington Post:

http://www.huffingtonpost.com/2013/0...6pLid%3D369139

[easygoingfemme]

Martina, this is fantastic! Another perspective that is so important to see when we view these changes.

Originally Posted by Martina

I cannot wait. I cannot wait. I cannot wait. I work with some students with serious mental illness as do some of my colleagues. We see kids over 18 every day who cannot get insurance. Their illnesses go untreated and they languish. Moreover, we become their only lifeline to the world, which is scary since we are not therapists or medical professionals.

Soon, under the Affordable Care Act, these students will be able to get the medications they need. I have two such students right now. One of them has no care. The other has arranged to get medication for one year through a pharmaceutical company's charitable program, but they keep sending the medication late. When his medication is interrupted, he gets foggy and listless.

Last year, I had four such students, one routinely in crisis. One of my colleagues currently has one. The poor young woman has a long and well documented history of mental health needs, yet cannot get the medication that makes her illness manageable. In a few months, she will have it again. And her life will be immeasurably better. She is also a mother, so her daughter's life will also be better.

I am soo sooo sooo grateful for this compassionate and necessary legislation.

[*Anya*]

For those that already have health insurance, parity is required for substance use disorders and mental health illnesses now.

Mental health parity will also apply to all policies with expanded coverage related to the ACA.

Some insurances still have separate "rules" and requirements:

FAQs About The Mental Health Parity Act

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires group health plans and health insurance issuers to ensure that financial requirements (such as co-pays, deductibles) and treatment limitations (such as visit limits) applicable to mental health or substance use disorder (MH/SUD) benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits. For more information on MHPAEA, see the fact sheet.

http://www.dol.gov/ebsa/faqs/faq_con...lthparity.html