Someone please explain Obamacare to me

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.

COBRA is expensive because you start paying the full premium for the plan you already had. People in employer-based plans are generally only paying about 25-30% of the cost of their plan; when they actually get exposed to the full premium they're usually surprised at how high it is. That premium is very likely higher, perhaps significantly so, than the options you're looking at in the open market.

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.

The federal government is funding navigators in states that don't set up their own but the programs are smaller and they serve fewer people. They're better than nothing but they're not as effective as when the state gets involved and takes ownership. I would be surprised if PP doesn't have some people on staff whose job is specifically to walk you through your options and talk about this.

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.

Every plan has an out-of-pocket maximum. That's the most you could possibly be asked to pay out of your own pocket in a given year (this doesn't include your monthly premium expense). What that is will depend on your plan, but next year that number legally cannot be higher than $6,850. It may be lower based on the plan you choose but it'll never be higher.

Plans usually have some kind of coinsurance after you've paid your deductible (unless you buy a low-end bronze plan where the deductible is the total out-of-pocket maximum--in which case once you've paid your deductible you've hit your legal limit). That's a percent of the bill you share in above the deductible. I don't know what the case is with your plan but let's imagine you have 20% coinsurance.

So let's say your provider's allowed amount for this procedure is $33,500 (which, by the way is likely a discount--an important thing you're buying when you buy an insurance plan is access to the negotiated prices they have with the health care providers in your area). That gets split up between your share and your insurer's share.

So your share is going to be your remaining calendar year deductible plus your coinsurance (with the caveat that your share can't be higher than the OOP max).

So: $3,000 + 0.2 * ($33,500 - $3,000) = $9,100. That's above your OOP max so the actual amount you're responsible for would just be your OOP max. Let's say you have the highest OOP max legally allowed: that means your share of the procedure's costs is $6,350 (since you're already paid $500 toward your OOP max in this scenario).
 
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?

The fact that Medicare is forbidden in the law that created Medicare Part D to negotiate lower prices is no accident. The drug lobby worked hard to ensure Medicare wouldn’t be allowed to cut into the profits which would flow to big Pharma thanks to millions of new customers delivered to them by Part D. Even some Republican House members (this was a GOP sponsored bill), including Rep. Walter Jones from North Carolina and Rep. Dan Burton from Indiana, were aghast at the whole process:

"The pharmaceutical lobbyists wrote the bill," says Jones. "The bill was over 1,000 pages. And it got to the members of the House that morning, and we voted for it at about 3 a.m. in the morning," (lol) remembers Jones.

Why did the vote finally take place at 3 a.m.?


"Well, I think a lot of the shenanigans that were going on that night, they didn't want on national television in primetime," according to Burton.



http://www.ncpssm.org/EntitledtoKno...ating-for-lower-drug-costs-in-medicare-part-d





How the Republicans Passed Medicare Part D






Back in 2003, the Republicans passed their version of healthcare reform, the Medicare Prescription Drug, Improvement, and Modernization Act
(often abbreviated as the MMA). I remember the outrage at the tactics used by Republicans and the sworn vows of progressives and Democrats to never forget or forgive...





COSTS AS MUCH THIS DECADE FOR THE FED GOV'T THAT OBAMACARES COSTS, BUT WITHOUT A SINGLE PENNY OF FUNDING BY THE GOP
 
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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.


Ten years huh? lol
 
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.


Just skip that "mandatory" insurance dumbass


The fee for not having coverage in 2015

If you don’t have coverage in 2015, you’ll pay the higher of these two amounts:

  • 2% of your yearly household income. (Only the amount of income above the tax filing threshold, about $10,150 for an individual, is used to calculate the penalty.) The maximum penalty is the national average premium for a Bronze plan.

  • $325 per person for the year ($162.50 per child under 18). The maximum penalty per family using this method is $975.
 
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.


Just skip that "mandatory" insurance dumbass


The fee for not having coverage in 2015

If you don’t have coverage in 2015, you’ll pay the higher of these two amounts:

  • 2% of your yearly household income. (Only the amount of income above the tax filing threshold, about $10,150 for an individual, is used to calculate the penalty.) The maximum penalty is the national average premium for a Bronze plan.

  • $325 per person for the year ($162.50 per child under 18). The maximum penalty per family using this method is $975.

You forgot the most important part: "And don't get sick!" Or get into an accident, or need a knee replacement, or...
 
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.


Oh brother.

You need to read something besides Brietbart cuz you're wrong about most of that.

US auto makers paid back their loans.

Thanks to ObamaCare, 80% of YOUR premium MUST go to YOUR care.

US hospitals and clinics have been closing their doors since Ronnie RayGun passed his SOCIALIST emtala, which forced YOU to pay other people's bills.

ObamaCare is a success. Costs are lower and more people are insured.

And so on and so on and so on.

You started this thread saying you don't know anything and wanted others to hold your hand.

Educate yourself. It just might help you and your family.
 
"Someone please explain Obamacare to me"

For starters, there is no such thing as 'Obama care.'

The ACA is neither 'health insurance' nor a 'healthcare provider.'

Health insurance is provided by private companies, healthcare is provided by private doctors, nurses, clinics, and hospitals.

For those below a certain income level, the ACA authorizes funding to help pay for insurance premiums. Those who cannot afford insurance at all are allowed to participate in their state's Medicaid program; in states that did not elect to expand Medicaid, those who can't afford health insurance go without.

Americans have the choice of either purchasing a health insurance policy or going without health insurance at all, paying instead a tax to help fund the subsidies. And those who can't afford health insurance who live in states that didn't expand Medicaid are not required to have health insurance or pay the tax.

The ACA also has provisions for pre-existing conditions, coverage for adult children, and reforms to cut waste and control increases in the cost of healthcare.

That's the essence of the Act.
 
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?

Let's see...a country can't afford health care for it's citizens......

Now, that's funny.

What do you mean afford ?
 
"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.

You must be debating (if I can use that word) with Fake Harpey. Don't waste your time. You'd have a more productive conversation with a cold bowl of oatmeal.

I have him on ignore. Saves me from wondering just how pathetic our public schools were.
 
Kasich when he get the nomination will cause Biden to say, "Well, guys, we have a real fight on our hands."
 
apply at healthcare.gov, this is the only place that can give you the subsidy if qualified....i believe if you make less than 75k a year you may qualify for some help. And if the two of you make less than 36k a year or there about next year, I believe they will come in and pay some if not all of your deductibles, emergency room at reduced rate, specialist copays reduced; and total out of pocket reduced, and things like that....Go to the Healthcare.gov site, there is a lot of information to read. You can choose the plans you want to review and see what help the gov. may offer.

Bones is wrong on choosing a bronze plan if the two of you will not be making much money next year...there is something called Cost Sharing Reductions that are in ADDITION to subsidy help....but again, ONLY if you buy in to a Silver Plan...search it when you are on the site....many of the people around here that I helped sign up at the Church, qualified for these Cost Sharing Reductions....

I just looked it up, if you and your wife combined make less than $39k next year, then you may qualify for these ADDITIONAL Cost sharing reductions.

How to save on out-of-pocket health care costs
 
"Someone please explain Obamacare to me"

For starters, there is no such thing as 'Obama care.'

The ACA is neither 'health insurance' nor a 'healthcare provider.'

Health insurance is provided by private companies, healthcare is provided by private doctors, nurses, clinics, and hospitals.

For those below a certain income level, the ACA authorizes funding to help pay for insurance premiums. Those who cannot afford insurance at all are allowed to participate in their state's Medicaid program; in states that did not elect to expand Medicaid, those who can't afford health insurance go without.

Americans have the choice of either purchasing a health insurance policy or going without health insurance at all, paying instead a tax to help fund the subsidies. And those who can't afford health insurance who live in states that didn't expand Medicaid are not required to have health insurance or pay the tax.

The ACA also has provisions for pre-existing conditions, coverage for adult children, and reforms to cut waste and control increases in the cost of healthcare.

That's the essence of the Act.

Just curious, and not saying anything you said was wrong. But do you see anything the resembles equal treatment under the law in any of what you posted?
 
apply at healthcare.gov, this is the only place that can give you the subsidy if qualified....i believe if you make less than 75k a year you may qualify for some help. And if the two of you make less than 36k a year or there about next year, I believe they will come in and pay some if not all of your deductibles, emergency room at reduced rate, specialist copays reduced; and total out of pocket reduced, and things like that....Go to the Healthcare.gov site, there is a lot of information to read. You can choose the plans you want to review and see what help the gov. may offer.

Bones is wrong on choosing a bronze plan if the two of you will not be making much money next year...there is something called Cost Sharing Reductions that are in ADDITION to subsidy help....but again, ONLY if you buy in to a Silver Plan...search it when you are on the site....many of the people around here that I helped sign up at the Church, qualified for these Cost Sharing Reductions....

I just looked it up, if you and your wife combined make less than $39k next year, then you may qualify for these ADDITIONAL Cost sharing reductions.

How to save on out-of-pocket health care costs

nope, don't qualify. That is a ridiculously low number but then again it seems that we have become a nation that honors and awards lack of initiative.
 
"Someone please explain Obamacare to me"

For starters, there is no such thing as 'Obama care.'

The ACA is neither 'health insurance' nor a 'healthcare provider.'

Health insurance is provided by private companies, healthcare is provided by private doctors, nurses, clinics, and hospitals.

For those below a certain income level, the ACA authorizes funding to help pay for insurance premiums. Those who cannot afford insurance at all are allowed to participate in their state's Medicaid program; in states that did not elect to expand Medicaid, those who can't afford health insurance go without.

Americans have the choice of either purchasing a health insurance policy or going without health insurance at all, paying instead a tax to help fund the subsidies. And those who can't afford health insurance who live in states that didn't expand Medicaid are not required to have health insurance or pay the tax.

The ACA also has provisions for pre-existing conditions, coverage for adult children, and reforms to cut waste and control increases in the cost of healthcare.

That's the essence of the Act.

Just curious, and not saying anything you said was wrong. But do you see anything the resembles equal treatment under the law in any of what you posted?
well, it is means tested as it should be, just like all other government help programs, such as food stamps, TANF etc....

so yes, it is fair....
the more you need help, the more help you will get...
the less you need help, the less help you will get.

if you and your wife were more needy, you would get the same help as the equivalent needy couple.

it would be unaffordable if the ACA subsidy help were not means tested.
 
apply at healthcare.gov, this is the only place that can give you the subsidy if qualified....i believe if you make less than 75k a year you may qualify for some help. And if the two of you make less than 36k a year or there about next year, I believe they will come in and pay some if not all of your deductibles, emergency room at reduced rate, specialist copays reduced; and total out of pocket reduced, and things like that....Go to the Healthcare.gov site, there is a lot of information to read. You can choose the plans you want to review and see what help the gov. may offer.

Bones is wrong on choosing a bronze plan if the two of you will not be making much money next year...there is something called Cost Sharing Reductions that are in ADDITION to subsidy help....but again, ONLY if you buy in to a Silver Plan...search it when you are on the site....many of the people around here that I helped sign up at the Church, qualified for these Cost Sharing Reductions....

I just looked it up, if you and your wife combined make less than $39k next year, then you may qualify for these ADDITIONAL Cost sharing reductions.

How to save on out-of-pocket health care costs

nope, don't qualify. That is a ridiculously low number but then again it seems that we have become a nation that honors and awards lack of initiative.
The $75 k to qualify for subsidy help is ridiculously low or the 39k to qualify for ADDITIONAL help is too low?

median household income in the USA is 52k.
 
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apply at healthcare.gov, this is the only place that can give you the subsidy if qualified....i believe if you make less than 75k a year you may qualify for some help. And if the two of you make less than 36k a year or there about next year, I believe they will come in and pay some if not all of your deductibles, emergency room at reduced rate, specialist copays reduced; and total out of pocket reduced, and things like that....Go to the Healthcare.gov site, there is a lot of information to read. You can choose the plans you want to review and see what help the gov. may offer.

Bones is wrong on choosing a bronze plan if the two of you will not be making much money next year...there is something called Cost Sharing Reductions that are in ADDITION to subsidy help....but again, ONLY if you buy in to a Silver Plan...search it when you are on the site....many of the people around here that I helped sign up at the Church, qualified for these Cost Sharing Reductions....

I just looked it up, if you and your wife combined make less than $39k next year, then you may qualify for these ADDITIONAL Cost sharing reductions.

How to save on out-of-pocket health care costs

nope, don't qualify. That is a ridiculously low number but then again it seems that we have become a nation that honors and awards lack of initiative.
Being poor is a lack of initiative? For that swift bit of judgement, you just stepped over into troll-land.
 

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