Obamacare Survival Guide ??

[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.

[DapperButch]

Originally Posted by easygoingfemme

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!

Yes, I would do the same. When I mentioned the $5 I was thinking of people who had no ability to pay. I personally would like it paid off as soon as possible!

That is great that both you and your daughter are so healthy! For me, it would be all about that potential accident that causes an admission to a hospital. Outside of one major illness I had, I rarely go to the doctor and don't get sick. However, with the illness I had that required surgery and expensive follow up care, I would have been screwed.

I am extremely fortunate that I work for a health system, who see the usefulness of good insurance. My deductible and premiums are lower than most.
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My hope is that with more people getting insurance we will see a reduction of people coming to the ER. In my experience working in a health care system (which includes two hospitals), people who don't have insurance or the ability to pay a copay to a PCP will utilize the ER when they have minor illnesses (viruses and such) because they have no other way to get treatment. Certainly the wait for them is annoying, but it can also be frustrating for people who are more ill but don't qualify for the "fast track" in our ERs. Hearing about people laying in hallways for hours who need care (to the point of getting admitted to the hospital), is disheartening. I was in that position when I had complications after surgery. The only reason I got into a room after an hour (or two?), in the hallway is that my neighbor came by who is an EMT and simply told the nurses he was putting me into a room. Great guy! I had a subsequent admission and additional surgery, but since I wasn't bleeding my guts out, I was one of those hallway people.

Anyway, I am excited about the ACA and the insurance that many will now have! It benefits ALL of us, even those that will not be using insurance. Hospitals/other physicians will also lose less money due to patients lack of ability to pay (the $5 a month example), so perhaps long term we will even see our premiums go down. You never know! Thanks, Obama!

[easygoingfemme]

Originally Posted by DapperButch

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My hope is that with more people getting insurance we will see a reduction of people coming to the ER. In my experience working in a health care system (which includes two hospitals), people who don't have insurance or the ability to pay a copay to a PCP will utilize the ER when they have minor illnesses (viruses and such) because they have no other way to get treatment. Certainly the wait for them is annoying, but it can also be frustrating for people who are more ill but don't qualify for the "fast track" in our ERs. Hearing about people laying in hallways for hours who need care (to the point of getting admitted to the hospital), is disheartening. I was in that position when I had complications after surgery. The only reason I got into a room after an hour (or two?), in the hallway is that my neighbor came by who is an EMT and simply told the nurses he was putting me into a room. Great guy! I had a subsequent admission and additional surgery, but since I wasn't bleeding my guts out, I was one of those hallway people.

That is a really good point, and so true. The lack of preventative or early treatment care does leave MANY people unable/willing to deal with their problems until they reach an emergency status.

I'm sorry to hear about your experience with your surgery too, I can't imagine the vulnerability and discomfort of being left in a hallway like that.

[Linus]

Originally Posted by DapperButch

<snip>

My hope is that with more people getting insurance we will see a reduction of people coming to the ER. In my experience working in a health care system (which includes two hospitals), people who don't have insurance or the ability to pay a copay to a PCP will utilize the ER when they have minor illnesses (viruses and such) because they have no other way to get treatment. Certainly the wait for them is annoying, but it can also be frustrating for people who are more ill but don't qualify for the "fast track" in our ERs. Hearing about people laying in hallways for hours who need care (to the point of getting admitted to the hospital), is disheartening. I was in that position when I had complications after surgery. The only reason I got into a room after an hour (or two?), in the hallway is that my neighbor came by who is an EMT and simply told the nurses he was putting me into a room. Great guy! I had a subsequent admission and additional surgery, but since I wasn't bleeding my guts out, I was one of those hallway people.

Anyway, I am excited about the ACA and the insurance that many will now have! It benefits ALL of us, even those that will not be using insurance. Hospitals/other physicians will also lose less money due to patients lack of ability to pay (the $5 a month example), so perhaps long term we will even see our premiums go down. You never know! Thanks, Obama!

Unfortunately, the part I highlighted wouldn't change. I don't think getting coverage, whether Obamacare, centralized health care or through an employer, will discourage people from using the ER. Interestingly, in Ontario that remains an issue and one that the gov't has been trying to find ways to help reduce (e.g., 24-hour 1-800 number with registered nurses, 24-hour clinics, etc.). I think it's a question of wanting to feel important and center of attention (the best I can describe it) since they get no support, love, etc. from family or community.