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This is what winning looks like.
Posted: Feb 27, 2014
Excellus Blue Cross/Blue Shield just sent every subscriber a link to this story regarding one man's experience with the ACA.
"As a small business owner, I buy health insurance for myself and my family on my own. And the rates have just been going up and up and up with no end in sight, especially over the past few years. Take last year, for instance: for my family, I was paying more than $800 per month just in premiums. And that’s with a sky-high deductible. At some point, I just said enough of this. I can’t pay anymore.
When the marketplace opened in New York last fall, I checked out my options. The whole thing was really easy, and the person assisting me was incredibly helpful. I signed my family up, and as of January 1st, I am saving a whopping $500 per month in premiums. And my deductible is almost a third of what it was just a few weeks ago.
There’s no two ways about it: Saving a fortune on health coverage is going to make a huge difference in what I do. For starters, I’ll be able to put more into my new business.
Look, I was skeptical at first. Here in New York, I think we’re born skeptical. But I just don’t understand why a person would be against giving people a chance to get decent coverage at a good rate. Now, I tell my friends that they need to stop listening to the back and forth on the news and just go and check it out for themselves. It’s worth a shot."
No wonder the Republicans have to stoop to lies.
;
huh? what lies. I just today went to the Marketplace - republady
[ In Reply To ..]and found out that their insurance was more expensive than what I was paying before and had horrific deductibles. Everyone will have their own personal experience whether good or bad.
Question for you - mbmt
[ In Reply To ..]When you went to the marketplace, did you fill out your income information? If not, you will be shown the amount that plans cost before your income is considered and subsidies are figured in. At least that was my experience. For example, my plan had around a $600 premium per month and $4500 deductible before my income and subsidies were figured in. With those things figured in, my premium is under $20 a month, and deductible is $250 per year. I am very pleased with my plan as I was without insurance for the past 8 years. Oh, and even though it is an HMO, it covers half of the State of Wisconsin and my PCP.
Thank you for that - I completely agree
[ In Reply To ..]When you actually figure in the subsidies, THAT'S when you realize what a great deal it is.
People who claim to be paying more or getting worse coverage I just don't see how that can be - I'm sorry, but the only way that would happen is if your income is very high (compared to your average MT) or you are just not figuring in the subsidies, whether willfully or unintentionally, and why that would be I have no idea, except because you just don't want to believe the ACA can be a good thing.
I am not sure about the red states and what happens there, though. Is that what is happening to these people? Are they then not eligible for subsidies because the governors are being ridiculous and depriving the poorest people of decent coverage?
But I thought they could be eligible for the federal exchanges then, and from all the figuring I have done the ACA is always much better coverage at much better rates with co-pays and true OOPs, not like the junk my current MTSO offers.
I truly hope they stop allowing the grandfathering or make them comply with what the exchanges are offering, since I believe my company still offers junk and because they offer it I can't participate in the exchanges.
Here is some information that might be helpful. - sm
[ In Reply To ..]I'm not sure what your employer offers, but here is some information on substandard policies offered by employers.
"You can purchase insurance on the exchange, but you (and your family) will not qualify for tax breaks, credits or help on up front costs unless your employer offers substandard insurance (it must offer the same benefits as the basic Bronze plan sold through ObamaCare's exchanges / marketplaces) or if your insurance costs more than 9.5% of your income.
If your employer based insurance doesn't meet the above criteria you should be eligible for subsidies. However you'll need your employer to fill out a employer coverage tool form before you can get covered.
Since the 9.5% cap is for the employee only income the total cost of a plan offered by an employer can be more than 9.5% of family income. There is no rule that says your spouse, dependents or you have to take the insurance your employer offers. The rule only states that you cannot receive cost assistance subsidies."
http://obamacarefacts.com/obamacare-subsidies.php
Thanks, I have already checked that - 9.5% thing, but
[ In Reply To ..]The problem is that the actual premiums my employer offers are pretty low, they are under that 9.5% of income cost (so that is how they get around it IMHO).
The problem is though there is a low premium you are to my mind actively discouraged from using the insurance by the fact that you have to pay cash up front for even GP visits until you reach the deductible, then when you do reach the deductible you have cost sharing, so basically whatever you have done they are going to get their piece of flesh (or maximum $) off you first. The cost in my case would be more then $100 for one doctor visit so definitely a disincentive, and to pay cash for an x-ray or specialist visit, forget it.
I truly hope all the doom and gloom predicted that employers will opt out comes true because I just can't see employers OR insurance companies coming up with anything fair and I do believe the exchanges through the ACA seem much more affordable and fairer.
The option my employer offers where you do have copays is quite a bit more expensive and more comprehensive, would certainly be over the 9.5%, but then of course they have the out with the junk option offered. So it's a lose-lose.
"deductible" can mean different things - please sm
[ In Reply To ..]Perhaps you've already checked this out, but if not, try to clarify it with your insurance plan. There are usually a bunch of services that are "covered services" that you just have a copay for.
In our plan, neither of us has met the $5000 deductible, but yet we have never had to pay more than $30 for an office visit. "Covered services" do not apply to the deductible; they don't make you pay 100% for "covered services" like office visits or labwork. At least with our plan, "deductible" means our maximum out-of-pocket expense is $5000 (of services not covered by a copay) before insurance picks up 100%.
I don't know why, with all the consultants and all the media attention, they don't make this clearer for people.
Thanks for that - I agree clarity is needed
[ In Reply To ..]Checked my plan again and it states this, so no mistake about the deductible: "You must pay all the costs up to the deductible amount before this plan begins to pay for covered services you use."
And next to covered services listed primary care visit (among others) clearly states "deductible applies first." This includes diagnostic tests, blood work, etc. Prescriptions have a copay.
After the deductible it seems better (I am responsible for 25% coinsurance), but definitely the deductible applies to everything until that point. I see what you mean by covered services but my policy pays nothing 100% after the deductible either, all cost sharing and percentages.
Come on, people, these insurance companies and employers feel we need to have some "skin in the game," right, to I guess discourage us from using health care services too much? Yeah right. They won. I am forced to use this policy for disaster only because even then I will have a massive great bill to pay no matter what happens but probably will be better than no insurance. Meh.
I would call the insurance company and specifically find out. - sm
[ In Reply To ..]My plan uses the same verbiage, but we still only pay a copay for covered services and have not yet met the deductible.
Oh, Lord, back to the days of the HMO? They stink. - I know from personal exp.
[ In Reply To ..]nm
I sympathize with those who live in red states - Blue state success
[ In Reply To ..]Here is a list of the states that did not receive the full benefit of the ACA by not expanding MA and work with the rollout. It may be the fault of the their governors or the state representatives, but hopefully the people of these states will not re-elect these politicians who do not care if they have health care.
***
Commonwealth Fund:
States That Are Not Expanding Medicaid Net Loss of Federal Funds ($ millions)
Alabama –943
Alaska –229
Florida –5,038
Georgia –2,862
Idaho –297
Kansas –950
Louisiana –1,655
Maine –294
Mississippi –431
Missouri –2,249
Nebraska –738
North Carolina –2,591
Oklahoma –1,264
South Carolina –807
South Dakota –224
Texas –9,217
Utah –719
Virginia –2,839
Wisconsin –1,848
Wyoming –166
everyone has their own personal experience - sm
[ In Reply To ..]that's why we shouldn't accuse them of lying. geez.
Not accusing anyone - of lying
[ In Reply To ..]But how can people in the same income bracket have such vastly different results? Is it just the red state thing or what?
I really don't get it, but maybe the person who claims their premiums are way up and they can't afford it, etc., has not realized about the subsidies, has not worked them in. So rather than accusing them of lying we are trying to help them figure that out. It can be confusing.
Personally, my experience has been that the subsidized premiums are much cheaper than what I am offered through my employer, or actually the same premiums will buy much better coverage - the middle plan rather than the lowest. There are copays for pretty much everything (my current insurance has none, you have to pay everything until deductible is reached, which means you just don't go to the doctor) and the out of pockets seem much more reasonable.
So when people have their personal experience and claim it is so bad, I do have doubts that a truly low income person (thanks to what has happened to our profession we are indeed low income) has such a terrible experience and just have to wonder if they are not aware of how to work in the subsidies.
I understand. I liked your post. - (poster you responded to)
[ In Reply To ..]
Winning what? Some get better plans, most stink. - What's the point of this post?
[ In Reply To ..]Still don't know what they're winning.
Who is winning? - sm
[ In Reply To ..]People who were denied health insurance due to preexisting illnesses are winning. People who went years without health insurance because they couldn't afford it are winning. Last but not least, the ACA is winning against all of the Republican party's misinformation and lies.
It's an interesting dynamic, isn't it? - sm
[ In Reply To ..]All the people who have benefited and realized the benefit of the ACA will be voting.
November Republican rhetoric bashing the ACA will be dismissed because voters will have their own personal experiences. They will be tired of the Party of No and its endless meaningless redundancy.
They will be focusing on other issues. Issues that impact their future. That's why I love being a progressive. Moving forward. The future.
More examples of who is winning. - sm
[ In Reply To ..]People with major illnesses who can no longer be canceled by their insurance companies are winning. People who will no longer be driven into bankruptcy by exorbitant medical bills and lifetime limits are winning. People who used to pay top dollar for inadequate coverage are winning. The American people who fought for and voted for healthcare reform are winning.
That's it? - That's all you got?
[ In Reply To ..]There are a lot of people asking for an apology from your friend Harry for his desperate lie from yesterday. Enjoy your "winning" while you can.
Typical chain email. Definitely written by a marketing group - sm
[ In Reply To ..]Winning what? One of the worst written copywriter ad.
For every person that got insurance, there are hundreds that lost theirs.
Nice try though.
Every time I hear "winning," I think of - Charlie Sheen's rant.
[ In Reply To ..]LOL
I checked it out for myself - Jane
[ In Reply To ..]I just went to the ACA website. My husband will be retiring in 2 years - we get our health insurance through his employer currently. However, we do know what our income would be if we retired today ($3750/month) and I used that as our income, would we be going on the website and getting health insurance. In order to get the same plan as we have now, it would cost us $1449.00 a month - that is $1000.00 deductible per year, per person - $25.00 copay. In order to get the rate down under $1000/month, I could go to the bronze plan which would be $5000 deductible per person and $40.00 copay. Our income would be too high to get any help with the premium. Now $3750 sounds like a lot of money per month, but remember, if I want good health insurance, I now have to take $1500.00 to pay for insurance. Yikes....thank goodness I don't have to worry about it right now - at least by the time we retire, we should be close to eligible for Medicare....
I have to pay husband's employer too - sm
[ In Reply To ..]Am I correct in thinking that his employer is picking up the major portion and you pay a percentage? That is how it works with ours. I admit we have a great plan.
I ran our calculation through at a retirement income of $45,000 per year (which is $3750/month) and got a premium figure of $350 per month for a silver plan that covers the both of us. What calculator did you use? Actually this is very similar to what I am paying on the employers plan.
Probably different state..... - Jane
[ In Reply To ..]Which reinforces the fact that each of us is different and each state exchange is different from the federal exchange. There is no way to compare one person to the next, and that's where controversy comes in. I am very happy for those who now have insurance that didn't have it before, but at the same time, I feel bad for those that cannot benefit from Obamacare, particularly those whose policies have been cancelled for whatever reason. Hopefully the whole thing gets ironed out soon and if that means starting over, do whatever. It isn't easy going without insurance as we did for many years before my husband got his current job. I don't want to go back to those days either.
Non-smokers, perhaps that is it - nm
[ In Reply To ..]
Why is it okay for "winners" to brag but those of us .. - see message
[ In Reply To ..]SCREWED by Obamacare are bashed here? We are NOT lying, despite what the Reid dude says.
From what I can tell it depends on your age and where you live, and what type of crappy program your employer offers (me - no copays, 7500 deductible for spouse and I before it PAYS for anything, this helps me HOW?)
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