Obamacare Survival Guide ??

[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

[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.

[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..

[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??

[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.
---------------

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

---------------

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.

[Corkey]

http://tpmdc.talkingpointsmemo.com/2...pected.php?m=1

Talking points memo from today.

[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

[dreadgeek]

Teddy:

Unless you are in a heterosexual marriage *or* you live in a state that has already achieved marriage equality you already *do* pay taxes on the amount your employer contributes to your partner's health insurance coverage. Interestingly, the day after the SCOTUS rulings in June, my HR person came to me and asked if my honey and I were planning on going to Washington to get married (we live in Oregon). The reason is is that the minute they *could* change the withholding for spousal coverage for same-sex couples they did. They can't for Oregon since DP does not equate to marriage but once we are legally married we will no longer have to pay taxes on the amount my employer contributes to my wife's coverage.

If you are heterosexually married, of course, you already don't pay taxes on the amount your employer contributes to spousal health insurance coverage.

Cheers
Aj

Originally Posted by Teddybear

Let me tell y'all what has happened to me since the passing of this "unread" piece of #%??>.

My insurance rates have doubled. I went from paying bout $50 a week for ALL insurance that was offered for a family of 3. Now I'm paying almost $110 a week for just me.

I know ppl whose companies WON'T let them work more then 28 hrs a week so they don't have to offer it to them.

I maybe old fashion but I think before "ANY" law is voted on or passed every page, and line should be read by those voting on it and be available for more then a cpl of days for us who will be affected by the new law, everyone in this case will be.

I think we gave a long way to go before ANY of us really know what we are in for.

Has anyone noticed the new box added to ur paystub?? The one that says either benefits or fringe benefits. We are getting ready to have to pay income tax on the amount of what our company pays as their part of these benefits.

I don't mind paying my fair bur come on