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Heeeeeeere's Obamacare!

RandFan said:
When I priced my stomach surgery and the surgery to remove the mass on my leg, both were priced in the tens of thousands. Stomach surgery was, IIRC, about 30,000.

That was before I had insurance. The bills I got, the ones that the insurance paid, were a fraction of the cost because the Insurance company had a contract with the surgeons.
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Opposite story here.

I had two MRIs done after a car accident. The one from the hospital charged the insurance company $4500.

A year later I paid cash for an MRI at a private clinic. $515. Newer machine, better service. Same scan.

I must now wait 2 months for my first appointment after losing my insurance (it went up 90%). I will probably go pay cash so I can get my prescription refilled before I actually run out.

I have never needed public assistance until ACA. It will be temporary.
 
Karen recently spent two days in the hospital.

The bill we just got was for about $31,000.

The Bronze plan we got for her has a $6,300 deductible, which I think promises a maximum annual out-of-pocket of the same amount.

I'll let you know how it shakes out.
 
Grizzly Bear said:
And a sprain cost me almost 500 dollars.... I sprained the ankle back in July and had it checked since my trip was coming up and didn't want to be walking on the Slieve Leagues with an injury I wasn't fully assessed on... At last word they're supposed to contact my insurance so I can figure out what I owe to them, but for some reason or another the urgent care center said I didn't have insurance. I'm waiting to see when I get home this weekend if that's been sorted or not, or if it's still pending.

The fall was bad enough that although it happened about two months ago, the tendons in my ankle are still sore as a <insert favorite word here>. Nothing broken based on the x rays, just the tendons all around the whole joint got jarred (foot turned at a right angle and is sore/irritated when flexed still)... the sticker shock makes me wonder if I should even bother getting something like this checked if god forbid it happens again.

I'll report back if/when there are updates

As an aside I got to do all of my walking along the cliffs for my vacation... what had me concerned was if I needed to be worried about something that'd make it easily reinjured. It seems taking things cautiously did the trick of not aggravating it too much.
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An update here...
Apparently the issues I've been dealing with have to do with the urgent care facility somehow not logging my insurance into their files. I had to call them to have them look into it, but my insurance company hasn't made it easy to look up a summary of claims to see the amount I'll eventually need to be responsible for. I've been trying to contact them to see where I can locate the info....
 
Fudbucker said:
It may be $12,000.
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Well, on that site it lists $6,350 "maximum out of pocket" per year, which is about what we have.

And to be sure I didn't misunderstand, I looked up the definition:

"Out-of-pocket maximum: The most you will have to pay for covered medical expenses in a plan year through deductible and coinsurance before your insurance plan begins to pay 100 percent of covered medical expenses."

Looks like for 2015 it goes up to $6,600 under the ACA.

Bear in mind, before Obamacare we had a $10,000 deductible each, albeit for a much smaller premium, with no stated "maximum out of pocket" that I can recall.

Hope your wife is doing OK
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Thanks. Seems fine right now.
 
Unabogie said:
So in the end, the ACA saved you thousands of dollars, perhaps even more than $2,500?
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I hope so, in which case I can use it as an example of an ACA "win"!

I think you may be referring to the $2,500/yr extra Karen is paying now in premiums compared to before. These things are always a "gamble", and a "gamble" that put us ahead, year after year going back at least 5 years. There was never any presumption that we could not ever have a "bad" year, that would leave us wishing for better coverage - only that, over time, the savings in premiums would help cover that "bad" year. Especially if those savings had been invested in income producing investments - which they were.

I really want this whole thing to shake out for the benefit of the whole country, which I've stated repeatedly. I will be happy, years from now, to admit that in spite of a shaky start it has all been for the best. I hope that if there are rate increases gong forward - which I assume there will be, since rates rarely go down - that they are not so large as to make health insurance less affordable than it would have been without intervention.

Time will tell.
 
Kestrel said:
Reading discussions about ACA insurace on social media sites, I find it stunning how many Anericans don't understand basic insurance terms. People are being told that the Out of Pocket maximum is the maximum the insurance company will pay. Few seem to understand the difference between the individual deductible and the family deductible. Policies that waive the deductible for the first three doctor visits are described as only allowing three doctor visits.
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You must be surprised because you have never discussed progressive income tax rates with these same people. "If I earn one dollar more, I will be pushed up into another tax bracket, and loose thousands!"

Daredelvis
 
daredelvis said:
You must be surprised because you have never discussed progressive income tax rates with these same people. "If I earn one dollar more, I will be pushed up into another tax bracket, and loose thousands!"

Daredelvis
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That can happen with ACA insurance subsidies. Step over the 400% of FPL income threshold and your subsidy goes to zero.
 
Facing a similar dilemma.

In retirement, and from time to time we will take some gains in securities for extra "fun money"*.

Right off the top comes 15% capital gains tax on the gain - that's understood.

But after those proceeds are added to our income in any given year, we may lose most or all of our subsidy, raising our monthly health insurance expense by about $200.

That extra $2,400/yr almost feels like an additional tax, and seems a disincentive to take gains - gains we could otherwise use to increase our standard of living.

I know, it's an enviable position to have gains in the first place. It does complicate investment strategies, however.


*We actually have some decent gains in Polaris stock. Google "Polaris Slingshot" to see what we might earmark some of those gains for!
 
Fast Eddie B said:
Right off the top comes 15% capital gains tax on the gain - that's understood.

...

I know, it's an enviable position to have gains in the first place. It does complicate investment strategies, however.
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Never mind that nations highest in economic freedom, GDP and HDI are those that provide social safety nets. The investment of a minority is more defensible than the betterment of an entire society. Better to suffer without any social contract than benefit from living with one.
 
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Fast Eddie B said:
I hope so, in which case I can use it as an example of an ACA "win"!

I think you may be referring to the $2,500/yr extra Karen is paying now in premiums compared to before. These things are always a "gamble", and a "gamble" that put us ahead, year after year going back at least 5 years. There was never any presumption that we could not ever have a "bad" year, that would leave us wishing for better coverage - only that, over time, the savings in premiums would help cover that "bad" year. Especially if those savings had been invested in income producing investments - which they were.

I really want this whole thing to shake out for the benefit of the whole country, which I've stated repeatedly. I will be happy, years from now, to admit that in spite of a shaky start it has all been for the best. I hope that if there are rate increases gong forward - which I assume there will be, since rates rarely go down - that they are not so large as to make health insurance less affordable than it would have been without intervention.

Time will tell.
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But you most certainly made more. In fact, if your previous deductible was $10,000, even if you pay out the max this year you've saved $3,500 plus whatever percentage you'd have paid on the $30k. I doubt it was very generous, but even if they'd pay half, you'd be owing $10k +$20k/2 which is $20k out of pocket for you. With the ACA, even though your premiums went up, you will only pay $6,500. The math is easy from there, no? As for the premium increases, I'm sure you saw the report that premiums are rising very slowly in states that implemented the law in good faith?

http://www.motherjones.com/kevin-dr...rojects-very-modest-obamacare-rate-hikes-2015
 
Kestrel said:
Reading discussions about ACA insurace on social media sites, I find it stunning how many Anericans don't understand basic insurance terms. People are being told that the Out of Pocket maximum is the maximum the insurance company will pay. Few seem to understand the difference between the individual deductible and the family deductible. Policies that waive the deductible for the first three doctor visits are described as only allowing three doctor visits.
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I am not at all surprised. I know people who work for insurance companies who can't seem to understand the terms. My husband has been exposed to these things for xx years now, and can't for the life of him figure out the difference between a coinsurance and a copay.
 
Emily's Cat said:
I am not at all surprised. I know people who work for insurance companies who can't seem to understand the terms. My husband has been exposed to these things for xx years now, and can't for the life of him figure out the difference between a coinsurance and a copay.
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In your husband's defence, he doesn't really need to know. He has ready access to an expert! :)
 
Kestrel said:
That can happen with ACA insurance subsidies. Step over the 400% of FPL income threshold and your subsidy goes to zero.
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Yes,but your example is sucking from the government tit, my example was about people paying into the system through federal income taxes. There may always be small issues around the margins (on the order of a hundred bucks/month), but moving from the 28% to the 33% tax bracket does not work that way.

Daredelvis
 
Have any of the "my insurance premuim doubled due to Obamacare" horror stories being spread by ACA opponents ever stood up to a close examination?
 
Kestrel said:
Have any of the "my insurance premuim doubled due to Obamacare" horror stories being spread by ACA opponents ever stood up to a close examination?
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I'm sure some people's premiums increased by infinity percent by increasing from zero to any other number. Maybe millions of people.

But in that case it's fine.
 
ehcks said:
I'm sure some people's premiums increased by infinity percent by increasing from zero to any other number. Maybe millions of people.

But in that case it's fine.
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Ah yes, the freedom to not have insurance. Because sharing risks with other people is socialism or something.
 
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