I’m curious, Alstein (or anyone else who would know), what is the subsidy threshold? I assume you’re self employed, then, or your employer offers no group health insurance plan?
Generally to anyone who would know-- how do the subsidies work? Are they income tax credits (that wouldn’t help people who don’t pay income tax, now that I think about it, so probably not)?
Are umbrella organizations an option for people still, that as organizations buy group health plans for their members? I know those used to be a thing for some groups of self-employed people.
The health insurance industry was already moving toward a death spiral even before the ACA, unfortunately. To prevent it, penalties under the ACA for not having insurance need to be higher to get the young invincibles to sign up.–even they occasionally have to go to the ER for something or other (broke an arm falling off a bike, got injured in a car wreck, etc.). Not to mention the very few that get diagnosed with MS or some weird cancer, schizophrenia or bipolar disorder.
With the GOP firmly in control of the House, though, good luck with getting them to tweak the ACA (vs just repealing it), which to them would be tantamount to publicly taking a dump on the original copy of the Constitution on the Capitol steps. Their “replacement” of the ACA will be the same old tired BS about “selling insurance across state lines” (where insurance has always been a state-regulated thing) and health savings accounts that really only make life easier for the healthy and relatively better off.
I looked up what I would pay if I went to a Covered California policy that is close to what I have now. I did find one that was very close (Blue Shield) I cover myself, wife and a 23 year old. I think thru CC my $1,500 bill would become about $460 after the subsidy. I think that worked up to $60k per year income. Without a kid that $60k dropped to an amount that probably ends the subsidies.
In talking to my companies insurance broker (an old friend) I was told that the problem with the CC policy may be finding a doctor who would take it.
It’s around $47k. The latter, employer is small enough that no healthcare is offered (my job used to be government, now it’s contracted)
Don’t know how subsidies work- never got them. I’m currently under an exemption to the ACA because I paid for my own insurance before the ACA- that ends next year and will cause my rates to double. What I’m paying now is high but acceptable.
One tidbit- while it doesn’t help with freak accidents, if you get diagnosed with something- you can go on the exchange and they have to take you pre-existing conditions and all. that’s part of what drives things up so much.
And yes I do agree with your conclusions- I just think the best thing to hope for right now is a complete failure of the system to force something to be done. The big issue is that the brunt of the costs percentagewise are being pushed onto people like me.
The mandate never really made sense except in GOP fantasyland, where market prices are always a neutral deal so any penalty would make taking the market rate beneficial. The reality is that health insurance is a rip off if you are young, male, and healthy, unless the insurance you get is specifically tailored only to those who are young, male, and healthy. Until you get sick. Since you don’t know if you are one of the people who is going to get sick, you shouldn’t be allowed the choice of mooching off the system until you do. Everyone who isn’t buying health insurance is driving up premiums for folks like Alstein. They are using the contributions of responsible folks to subsidize their risk taking, because if something bad does happen they can get coverage then. That all makes no sense, and that’s why people shouldn’t have a choice of opting out. It needs to just be covered and paid for by taxes. Home insurance and car insurance are also a rip off if nothing ever happens. That’s why banks force you to get them when they give you loans to purchase the items: they know you can’t afford to pay the loan off if you lose the car or house, so they want to make sure you get money to pay them back with.
So I’m unsure if this is due to the ACA, but our company is switching from Anthem to Cigna, which has caught me completely by surprise.
Now, this could be a good thing as I’d heard on the news that Anthem was getting rid of the very PPO plan I was using.
Cigna’s comparable PPO plan is cheaper per paycheck, but might be slightly more for the prescriptions to be home delivered. I’m not 100% yet. Thankfully my PCP takes them (as I love the guy, so I was really scared on that one) and they cover all my prescriptions, but out of the four I take, only one isn’t generic, so that might be an added expense.
I’ve not been unhappy with Anthem, but thankfully the switch to Cigna looks to be fairly seamless in terms of my own personal coverage. Whew.
A year to two back my plan switched from BCBS PPO to Cigna, its not bad, I didn’t even have to change any of my doctors. But if your plan is similar to mine, the up front deductible (100% out of my pocket) sucks till you meet it, then the 80/20 coverage kicks in till you hit the max out of pocket cost, then its 100% covered on everything.
In Canada there is no need for a variety of plans because virtually all essential basic care is covered, including maternity. There is no advertising, and everyone receives the same level of care. The hospitals are run like a business in that they get a fixed amount from the province for each item, therefore are motivated to keep their costs down and performance incentives (bonuses) are tied to efficiency indicators. Life span in Canada is significantly longer than the US while we spend roughly half as much per capita. Doctors make the same or more. It’s the vastly simpler administration and insurance system that provides the most savings.
Just wanted to brag :). We also have serious funding sustainability issues ahead, plus people and in particular low-income people go to emergency for everything.
There is still health insurance in Canada, though it varies by province. Also, your employer often pays part of the base and extended premiums. Extended health care insurance covers vision, dental and prescription drugs as well as things like massages and medical devices. This is not part of the base, government plan.
Having spent the last month trying to explain the vagaries of insurance, retirement accounts, and paid time off to my suddenly real-ass-job-having girlfriend (who’s spent most of her dozen adult years safely ensconced in the protective bubbles of academia and my money :P), I feel your pain, and suddenly realize how little of this shit I fully understand myself.
My wife paid insurance claims for several years so she is my quick go to for questions, when I don’t want to look like a fool asking my broker friend the same question I asked a couple years ago. She is also the biggest user of our insurance and a great example of why drugs are a major drain on our budget. Legal drugs that is.
[quote=“BrianRubin, post:207, topic:73916, full:true”]
I honestly have never understood deductibles.[/quote]
[quote=“Scuzz, post:209, topic:73916”]
I handle my companies insurance and every few years I need a complete refresher on terms because they really make no sense whatsoever to me.[/quote]
Strange, I’ve always thought that their purpose was pretty clear and straightforward:
The idea is to make insurance truly about catastrophic care as opposed to a catch-all “anything medical” pot that it sort of historically has been. The insurance companies say:
“Hey, an average US person should probably only spend a couple thousand bucks each year on check-ups, routine medication, a couple of tests and maybe a visit to an ER. We’ll get you a discount on all that stuff if you go with us, but otherwise all that crap is on your own nickel. We’ll be here for you if you get into a serious car accident or develop a brain-cloud.”
The OTHER idea behind the high-deductible plans is to make the patient think twice about where they are going for treatment and ask hard questions about the various tests that the doctors tell them to take. In theory, since the costs of those tests are coming from your own pocket, you’re supposed to shop around for the best price or possibly even tell the doctor to take a hike when they say you need to take a third blood test or a “just-to-be-safe” MRI.
The problem with this second point is that few Americans are equipped to do any of that. If a doctor tells you that you need to get an MRI, chance are you’re not going to argue; she’s the doctor who studied for twelve years, and if she’s right and you’re wrong… well, you’re pretty screwed. And shopping around? In my experience there is precious little opportunity for that. I don’t know about you guys but my doctor generally hands me a sheet of paper with an address and says “go here for the brain-cloud detection test.”
I think I have mentioned this before but my accountant will actually call around and ask various places (assuming there are options) what they would take in cash for their services. He gets much better deals than if he just applies it to his deductible and pays the bill they give him.
Another reason to call around…to make sure the provider is part of your insurances accepted group. Cause if it isn’t you will pay a lot more.
And you are right, the average person doesn’t have knowledge or desire to question the “wisdom” of their doctor.
This is the fundamental, and fatal, flaw in the whole setup. Your average person is not, and can not be well versed enough in all the various areas of life to make reasonable decisions. Medical care is extremely difficult for a lay person to understand, but then again so can computers and the internet. The difference is if you screw up and bungle your computer at worst you simply don’t have it anymore, or have to wait a few weeks to call up your smart son/ daughter/ grandkid/ computer wiz neighbor.
With medical care do it wrong and you die.
So any system that relies on the public at large to be knowledgeable enough to know what and when to ask questions will fail for that reason.
My physician sent me to get lab work done. I went to the lab like most people do and one of those labs cost $2400. It was some sort of genetic test they had to send away from. Even though I went to a in-network lab they sent the lab to an out-of-network lab which shifted by then co-pay of around 15 dollars to co-insurance of around 300. I fought it and one.
Now most people will blame the lab for that or the physician, but I understand the healthcare industry to some extent. That specialty lab is doesn’t want to be in contract with any insurance company so they can balance bill. I blame the lab for that. It’s the same reason why I blame Anesthesiologist groups who often surprise surgical patients with their out-of-network separate bills or why some physicians in the NICU will be out of network costing couples with struggling newborns a fortune while couples with healthy babies get to go home with an ordinary bill.
When it comes down to it, I fought with my insurance and they covered it. When is see someone “walk in” and say bah screw this I’m healthy and won’t pay that much… it tells me 1) they don’t understand how insurance pools work and 2) that sob is gambling with their health and if they lose everyone around them is going to pay and he/she sees no problem with that. Screw that.
We need more transparency, yes. We need the high risk specialty groups to participate in the contracts and stop punishing patients who are often surprised by their bills. And we need healthy people to stop telling older and less healthy people tough shit, i’ve got mine. It comical to hear someone say something like that and then demand taxes to do what they’re trying to weasel out of.
The general subsidy level is 400% of the federal poverty level (FPL) for your state, for most places that is 47K for 1 person, 63K for two people and 90K for a family of four.
The subsidies work like a fully refundable tax credit, similar to the Earned income tax credit meaning that even if you paid $2,000 in federal income tax if you had $3,000 ACA subsidy the government will send you a check for $1,000.
However, for most people who sign up for ACA you can arrange for the subsidy to be sent directly to an insurance company. In order to do this, you have to provide the health care exchanges with information about your previous income. Then at tax time you reconcile your estimated income with your actual income and the subsidy is adjusted.
An example will probably help. Jack and Jill are a 40-year-old couple living in So Cal, they make $40K in their interior design consulting business. They are eligible for a $247/month subsidize. Luckily, they have a variety of ACA plans available ranging from $500 silver plan from a small provider to a $750 month platinum plan from Health net. They chose a blue cross silver plan which cost $567 a month the $247/month subsidy is sent to Blue Cross reducing their monthly health insurance bill to $320/month. The plan had $30 doctor visit, $15 drugs, and a $4,400 deductible and $11,400 max out of pocket expense.
Let say they have a good year and land a wealthy client and make $61,000 at tax time they lose the entire subsidy and owe Uncle Sam the additional $3,000. On the other hand if one of them gets really sick can’t work and they only make $30,000 they are eligible for an additional $1145 in subsidies. Of course, they are still faced with having to fork out $11,400 in medical payments plus another $3840 in premium on a $30,000 income and pay rent in So. Cal.
That’s 11,400 in multiple or single bills. This doesn’t take into account any Charity Care the system might offer them or Payment Plans making it highly unlikely they’d have to pay that entire amount in one year.
$11,400 is the maximum out of pocket expense in a year for the family and it is the standard for all silver plans in the country. If you go to the hospital you pay everything until you hit the 4,400 deductible and then between $4,401 and $11,400 insurance pays 80% and you pay 20% coinsurance. So if you run up $40K in hospital expense you’ve hit the max out of pocket.
While you are right they probably won’t have to pay the whole thing in a year, they still owe the money. If the illness is somewhat chronic and they have the same experience next year now they’ve run up $30K in medical bills. At which point bankruptcy is starting to look like a good option. Now mind you without insurance the bills for two years of serious illness are probably well over $100,000. But is $100K that much different than $30K?
