Someone please explain Obamacare to me

[Freewill]

OK, due to life decisions we found ourselves without healthcare insurance.

So thinking we must have healthcare insurance I went to the Healthcare.gov site and the site of a regional heathcare provider. I got the same quotes both places. Our income, this year, is way to high for any sort of subsidy and will be next year.

I know this has been gone over and over but I don't wish to search through all the posts.

At first I was happy that the rumors of 12 thousand a year apparently were not true. The premium was going to be 756 dollars per month for me and the wife. OK, more then anyone really wants to pay but a lot less then what I thought. Then I realized that for almost everything i had to use the out of pocket deductible first. Which is 3500/year. So 756 X 12 = 9072 + 3500 = 12572 Bingo right where I thought it would be in the first place, silly me.

So, since me and the wife never go to the emergency room I thought I would go with the least co-pay for the PCP and not worry about the ER. So the PCP is 10 copay specialists are 90 and the ER is a whopping 900 dollars. That is the plan that the healthcare "adviser" suggested considering our health.

So even with the high copays I see very little chance I will go over 3500 dollars. What does the premium get me? Should I look at it like a car insurance payment which I make and never use? I do have friends that pay nothing, because they do have nothing. I guess that is fair but is it fair that someone pays full amount for the same coverage? When will there be free car insurance?

So i am asking, is there anywhere that helps a person navigate through the system? I don't mean just tells you if you are eligible or not but actually says what is best for a certain individual?

I signed up through the local healthcare provider, is that the right way to do it? Is there and advantage to signing up on Healthcare.gov? My state did not set up exchanges which apparently makes a difference.

I understand that most of those for Obamacare are for it because they have company sponsored healthcare insurance or are getting a free ride. I will say having options is better then having none but I don't see where Obamacare is saving me any money. I did ask if the premiums are deductible and they told me yes. They didn't bother mentioning that it was only after a percentage of income.

And, for those looking, you will see ads for lots of places selling healthcare insurance. They claim to be the most inexpensive but they are not. Going to healthcare.gov or directly to the provider is the cheapest I found. I think they are trolling for those who don't make enough to pay so whatever they pay doesn't really matter.

For those who oppose Omaba/SCOTUScare. It is what it is, it is what we are stuck with. You hardly hear a word about repeal any more. My opinion, it could be much better if regardless of employment status we all fell under the same system. That would make it, or should, cheaper for everyone.

 

[strollingbones]

after a lot of research i discovered that the lowly bronze plan is the best bet...high ass deductible but lower rates...if you pay the higher rates ....you will still have a deductible...and it averages out over the year....plus one thing abotu the other plans...you never stop paying....you always have a co payment of some type....by the time the bronze bleeds you dry with the deduct....they do pay 100%...

last year i hit my deduct right outta the gate....in jan....so it paid everything from that point on....but the deduct put me in debt to this day still...my husband and i are on the same plan...so the deduct is 11 k ....this year i have simply had to pay for everything myself...as i have not hit the deduct...

i am carrying debt but they paid for several surgeries for me....and then paid to have both my hubbys knees replaced...one med was 40 bucks a shot and he had to have a shot a day for 6 weeks...by the time the knees were finished i was out of pocket maybe 500 for a machine and stuff...the insurance covered the hospital bed rental ....i was impressed...

now nc did not set up a state exchange....so we got bcbs....i have not clue how 2016 will pan out

 

[JakeStarkey]

"OK, due to life decisions we found ourselves without healthcare insurance." I know you will accept your personal responsibility for your life's decisions. Be glad you are making so much money.

 

[Freewill]

after a lot of research i discovered that the lowly bronze plan is the best bet...high ass deductible but lower rates...if you pay the higher rates ....you will still have a deductible...and it averages out over the year....plus one thing abotu the other plans...you never stop paying....you always have a co payment of some type....by the time the bronze bleeds you dry with the deduct....they do pay 100%...

last year i hit my deduct right outta the gate....in jan....so it paid everything from that point on....but the deduct put me in debt to this day still...my husband and i are on the same plan...so the deduct is 11 k ....this year i have simply had to pay for everything myself...as i have not hit the deduct...

i am carrying debt but they paid for several surgeries for me....and then paid to have both my hubbys knees replaced...one med was 40 bucks a shot and he had to have a shot a day for 6 weeks...by the time the knees were finished i was out of pocket maybe 500 for a machine and stuff...the insurance covered the hospital bed rental ....i was impressed...

now nc did not set up a state exchange....so we got bcbs....i have not clue how 2016 will pan out

Thank you for the reply and sharing your information.

After the fact I thought about it and the bronze plan is the way I should have gone. But they don't tell you that and I am not really sure it will be cheaper just a different way to pay. The healthcare provider said that after the first of the year I can sign up for a Gold plan. Their business is selling expensive plans. The healthcare.gov adviser seems to me to be mostly focused on those who will get a free ride. So they were not much help other then saying what are my options. For some reason the gold wasn't available today. But in reality all I really need is a catastrophic plan. Something that will keep me from being bankrupted. In my OP I forgot that the deductible was actually twice 3500 since we are both on the same plan, big mistake on my part.

So what I think I will do next year is ask the question, how much will it cost me on a plan if I have a knee replaced, or some other operation.

 

[strollingbones]

well that is why i had to get it....jan 14 was when the first tumor was found....and i assure you that did the deduct....one nights stay and you would not believe the fees for the recovery room....i could have hired a 5 star hotel with staff..for less...

just do the math...and you will find once you take into account future co payments the cheap plan is the best plan...i hope to see some lessening of the deducts but i doubt it....

now here is a little thing to consider....what they bill me and what the bcbs allows is different...sometimes its up to 50 percent off the full price so that is a consideration....they will give you 20 % or so for paying cash...

 

[Freewill]

"OK, due to life decisions we found ourselves without healthcare insurance." I know you will accept your personal responsibility for your life's decisions. Be glad you are making so much money.

Oh I am plenty glad jake. But like my whole life decisions are made. I made the decision to work my ass off so I would have a nest egg to retire. We made the decision to take care of my father, thus cutting back on hours. All of life is about choice jake and hopefully you make the best choices for you that are within your control.

 

[Freewill]

well that is why i had to get it....jan 14 was when the first tumor was found....and i assure you that did the deduct....one nights stay and you would not believe the fees for the recovery room....i could have hired a 5 star hotel with staff..for less...

just do the math...and you will find once you take into account future co payments the cheap plan is the best plan...i hope to see some lessening of the deducts but i doubt it....

now here is a little thing to consider....what they bill me and what the bcbs allows is different...sometimes its up to 50 percent off the full price so that is a consideration....they will give you 20 % or so for paying cash...

Used to be you could say, just don't get sick, not any more.

 

[JakeStarkey]

"OK, due to life decisions we found ourselves without healthcare insurance." I know you will accept your personal responsibility for your life's decisions. Be glad you are making so much money.

Oh I am plenty glad jake. But like my whole life decisions are made. I made the decision to work my ass off so I would have a nest egg to retire. We made the decision to take care of my father, thus cutting back on hours. All of life is about choice jake and hopefully you make the best choices you that are within your control.

Indeed, and your decision to care for your dad is commendable. Many people today would not do that. I don't understand it, but I know that it happens. May all the breaks fall right for you and your family.

 

[strollingbones]

use to be...the charges were not this much....health costs have sky rocketed for really no reason....private insurance did nothing and the government refuses to engage in collective bargaining with drug companies...and dont even get me started on the ama....

 

[Billy_Kinetta]

Someone please explain Obamacare to me

"We keep you alive to serve this ship."

 

[Taz]

Obamacare is simple: since the US spends so much money on weapons and attacking other countries, it can't afford health care for its citizens, therefore, you pay for it. What's not to get?

 

[Freewill]

well that is why i had to get it....jan 14 was when the first tumor was found....and i assure you that did the deduct....one nights stay and you would not believe the fees for the recovery room....i could have hired a 5 star hotel with staff..for less...

just do the math...and you will find once you take into account future co payments the cheap plan is the best plan...i hope to see some lessening of the deducts but i doubt it....

now here is a little thing to consider....what they bill me and what the bcbs allows is different...sometimes its up to 50 percent off the full price so that is a consideration....they will give you 20 % or so for paying cash...

yeppers the old medicare/medicaid scam. They really want 100 dollars but charge 150 so they can negoitiate to 125 which sounds like a deal. Thy MIGHT drop the cost if you pay cash but I found that isn't really true because they can't. If they do they are admitting it really doesn't cost as much as they say and no, they don't do charity work for those who pay.

 

[Freewill]

use to be...the charges were not this much....health costs have sky rocketed for really no reason....private insurance did nothing and the government refuses to engage in collective bargaining with drug companies...and dont even get me started on the ama....

Why do you suppose Obama didn't do a thing about the one big expense that seems to cripple people the most, drugs? If you remember he went behind closed doors and made a pact with them. Maybe buying support?

 

[Freewill]

Someone please explain Obamacare to me

"We keep you alive to serve this ship."

I agree with one change, "Serve the ship and we will keep you alive"

 

[strollingbones]

why have none of them from either party done a thing about rising drugs costs.....because its a big business that gives them money...just like abortion.....big business...most are being done in private doctors offices with chemicals....pharms....and that is the reason abortion will never be banned...the oxy problem can be solved quickly with on uncrushable pills....but that would cost the pharms pennies per pill so they dont do it...

 

[Greenbeard]

So even with the high copays I see very little chance I will go over 3500 dollars. What does the premium get me? Should I look at it like a car insurance payment which I make and never use? I do have friends that pay nothing, because they do have nothing. I guess that is fair but is it fair that someone pays full amount for the same coverage? When will there be free car insurance?

The premium gets you access to a lot of money to finance your care once you put down $3,500 of your own. You mentioned a replacement--according to guroo, which compiles data from actual medical claims, the average price of a knee replacement nationally is $33,560. If you need one of those, or any number of other expensive procedures, you'll be pretty glad you paid your premium.

The movement right now is away from plans paying for low-cost services, in part to inject a little more consumerism into shopping for health care. There's huge price variation within markets for even basic things like imaging. With a plan like yours where you have a $3,500 deductible, it becomes important to you the consumer whether your provider is pricing a service at $500 or if he's pricing it as $2,000. For someone with a $500 deductible, what do they care?

So i am asking, is there anywhere that helps a person navigate through the system? I don't mean just tells you if you are eligible or not but actually says what is best for a certain individual?

Your state should have ACA navigators that help you to make those kinds of decisions. But ultimately the quality of those navigators will depend on how seriously your state took the program and how much effort they put into it.

I signed up through the local healthcare provider, is that the right way to do it? Is there and advantage to signing up on Healthcare.gov? My state did not set up exchanges which apparently makes a difference.

The benefit of using the website even if you're not eligible for financial assistance is that you can make side-by-side comparisons of all plans in the marketplace to make sure that you're not missing the best option for you.

I understand that most of those for Obamacare are for it because they have company sponsored healthcare insurance or are getting a free ride. I will say having options is better then having none but I don't see where Obamacare is saving me any money.

Did you have employer-based insurance before? You should be able to see what the full premium (not just the share you were responsible for but the entire thing) was on any COBRA materials you got or it should be listed on your W-2. That would at least give you a sense of how your current premium compares to your old one.

 

[Freewill]

why have none of them from either party done a thing about rising drugs costs.....because its a big business that gives them money...just like abortion.....big business...most are being done in private doctors offices with chemicals....pharms....and that is the reason abortion will never be banned...the oxy problem can be solved quickly with on uncrushable pills....but that would cost the pharms pennies per pill so they dont do it...

Truthfully, we have seen in the last 10 years, the big banks bailed out, the very large auto companies bailed out, the drug companies allowed to maintain their profit margins, and the health care industry get a giant boom from Obama/SCOTUScare.

We, the working class of America, got a rectal exam.

 

[Freewill]

So even with the high copays I see very little chance I will go over 3500 dollars. What does the premium get me? Should I look at it like a car insurance payment which I make and never use? I do have friends that pay nothing, because they do have nothing. I guess that is fair but is it fair that someone pays full amount for the same coverage? When will there be free car insurance?

The premium gets you access to a lot of money to finance your care once you put down $3,500 of your own. You mentioned a replacement--according to guroo, which compiles data from actual medical claims, the average price of a knee replacement nationally is $33,560. If you need one of those, or any number of other expensive procedures, you'll be pretty glad you paid your premium.

The movement right now is away from plans paying for low-cost services, in part to inject a little more consumerism into shopping for health care. There's huge price variation within markets for even basic things like imaging. With a plan like yours where you have a $3,500 deductible, it becomes important to you the consumer whether your provider is pricing a service at $500 or if he's pricing it as $2,000. For someone with a $500 deductible, what do they care?

So i am asking, is there anywhere that helps a person navigate through the system? I don't mean just tells you if you are eligible or not but actually says what is best for a certain individual?

Your state should have ACA navigators that help you to make those kinds of decisions. But ultimately the quality of those navigators will depend on how seriously your state took the program and how much effort they put into it.

I signed up through the local healthcare provider, is that the right way to do it? Is there and advantage to signing up on Healthcare.gov? My state did not set up exchanges which apparently makes a difference.

The benefit of using the website even if you're not eligible for financial assistance is that you can make side-by-side comparisons of all plans in the marketplace to make sure that you're not missing the best option for you.

I understand that most of those for Obamacare are for it because they have company sponsored healthcare insurance or are getting a free ride. I will say having options is better then having none but I don't see where Obamacare is saving me any money.

Did you have employer-based insurance before? You should be able to see what the full premium (not just the share you were responsible for but the entire thing) was on any COBRA materials you got or it should be listed on your W-2. That would at least give you a sense of how your current premium compares to your old one.

Thanks for the info. When we "lost" employer health care insurance there was talk about COBRA but we were sent nothing. The insurance was from the wife's employer and getting answers was not easy. We were told it was very expensive by everyone who had the same situation.

Am I wrong but since the state didn't set up exchanges does that not mean that the navigators are actually federal? One problem I had with calling the number my rep gave me is that it was PP. You may not believe this but if you call PP you hear a lot of options and the majority concern abortion. Then you get to the navigator and they cheerfully tell you to go to healthcare.gov and that is about it. That was my experience I am sure there has to be better experiences.

OK, say it is July 4th and I have had 500 dollars in out of pocket. I go for the 33,500 knee operation. So what do I pay? I pay 3000 up front then the HC provider pays the rest? Or do I pay the 3000 then the HC provider pays part of the rest? My father has the same HC provider I signed up with except his is HC medicare. He had a total knee replacement and I am guessing he didn't pay over 1000 dollars. And his premium is zero as far as I can see. Except for what SSA takes, which I think is around 110/ month. So I was happy with that. Same with the wife. We had her HC insurance and it seems to me we didn't pay more then 1000 for the whole deal.

What was a little sad to me is when my wife got her knee done there was a woman in the same room that had the same procedure with the same doctors. My wife received PT at the hospital and at home. The other woman received none of that. Her insurance was from an employer who was self insured. My wife recovered very well, in my opinion, because of the physical therapy, I am not sure how the other woman made out.

 

[gipper]

"OK, due to life decisions we found ourselves without healthcare insurance." I know you will accept your personal responsibility for your life's decisions. Be glad you are making so much money.

Oh I am plenty glad jake. But like my whole life decisions are made. I made the decision to work my ass off so I would have a nest egg to retire. We made the decision to take care of my father, thus cutting back on hours. All of life is about choice jake and hopefully you make the best choices you that are within your control.

Fakey much prefers some government bureaucrat making his life decisions. Its just easier that way and you can't expect poor Fakey to make the right decisions.

 

[JakeStarkey]

"OK, due to life decisions we found ourselves without healthcare insurance." I know you will accept your personal responsibility for your life's decisions. Be glad you are making so much money.

Oh I am plenty glad jake. But like my whole life decisions are made. I made the decision to work my ass off so I would have a nest egg to retire. We made the decision to take care of my father, thus cutting back on hours. All of life is about choice jake and hopefully you make the best choices you that are within your control.

Fakey much prefers some government bureaucrat making his life decisions. Its just easier that way and you can't expect poor Fakey to make the right decisions.

Gipped is simply unhappy he is a libertarian fool, wannabee. Poor Gipped, just unhappy he can't make right decisions.