Question about ACA (serious ones)

Posted by: John Rougeux

Question about ACA (serious ones) - 11/08/13 03:39 AM

So, if my wife employer didn't offer health insurance, then we could get it, right?

I entered in some information on that Kaiser site and wow...out of pocket expenses are not cheap!
"Your out-of-pocket maximum for a Silver plan (not including the premium) can be no more than $12,700. "

Ouch! Ours just went up to $2500, so not sure how this is more affordable?

I don't know what premium we are paying right now, since they just changed it, but under the ACA, we would pay:
"Amount you pay for the premium:$4,112 per year"
after the tax credit.

I'll have to find out what we pay per year.

I wonder how the premiums would work if I had to claim my UI too in that?

ER visits are supposed to be limited to certain things, which is totally understandable, otherwise, you would get denied coverage and you have to pay.
Currently a person with limited means can go down to the ER for a cold or to seek drugs and never pay a dime. And if you don't think people go to the hospital to get drugs, then talk to a medical professional like a nurse who works on the floor.

How will this change things? What happens if the ACA runs out of pool money? Will rates be raised then?

I mean, that's how health care really got out of control before ACA...people go to hospital/ER for really minor stuff and never pay for it. Or they fake neck/back pain and get a free ride to the ER via ambulance and never pay. Talk about expensive! All that lost money plus other factors and we ended up in a mess.

Can someone please explain how this will be avoided with the ACA?

That's what's really scary for me.

and to add to that:
My wife met with her boss who informed her that in Kentucky, 40 hospitals will be closing in the outer areas. (rural parts of KY)
Baptist East Hospitals just gave all their LPN's 2 week notices.
Norton's Hospitals are trying not to lay anyone off yet.
Posted by: MrB

Re: Question about ACA (serious ones) - 11/08/13 12:53 PM

Sad to hear about the hospital closings. Our little town and county, Allen, in Kansas just opened its brand spanking new country hospital this month. I believe it was proposed and approved since Obama came in his first term. Hope it goes well.

I have been going to the hospital in the county south of ours. Neosho County. It's a very nice set up. All private rooms recently remodeled. Well staffed. My daughter is a RN there

Dave
Posted by: Jim_

Re: Question about ACA (serious ones) - 11/08/13 04:41 PM

Here's what out of pocket means.

Out-of-Pocket Expenses
Most health insurance plans don't pay 100% of the cost for absolutely everything related to your healthcare. Your plan probably requires you to pay part of the costs, such as a copay when you visit the doctor. All costs for covered services that you pay for are called "out-of-pocket expenses" because you pay for them out of your own pocket. These costs include copays, coinsurance, and deductibles.

Out-Of-Pocket Maximum
An Out-of-Pocket maximum is the most that you should have to pay for your healthcare during a plan period (usually one year). Before reaching the out-of-pocket maximum, you pay for part of your medical care, such as copays and coinsurance. Once you have paid the amount set by the out-of-pocket maximum, your insurance will pay 100% of the allowed amount for your covered healthcare expenses, up to a preset benefit maximum. Note that ineligible expenses -- such as elective plastic surgery -- aren't counted against your out-of-pocket maximum.

So you need to estimate if you have ever even gone over your out of pocket. The increased out of pocket only would hurt if you happened to have a span with a bunch of stuff done that wasn't covered.

Also you definitely have to know what you have been paying to see if it is a better deal. It's not going to be more affordable to every one.
Posted by: DLC

Re: Question about ACA (serious ones) - 11/08/13 05:07 PM

THAT'S what many don't realize, you can financially die from "1000 cuts" because of all the co-pays and out of pocket expenses. Few keep track of these, and this is what health Insurers count on.. you won't know the fine details... this is also why there are now "Minimum standards". Too many deceptions and junk policies where you think you're covered but then all your deductions, co-pays, and out of pocket expenses, etc kick in and you're out $1000s while you're still paying $$ for policies that minimally protect you.

I hope the American public will get educated.... I believe if they do so, they'll see how they've been scammed for years by Health Insurance companies !! mad
Posted by: Nana

Re: Question about ACA (serious ones) - 11/13/13 03:59 PM

Originally Posted By: DLC


I hope the American public will get educated.... I believe if they do so, they'll see how they've been scammed for years by Health Insurance companies !! mad


Obama admin. posts low health care signups

smirk
Posted by: garyW

Re: Question about ACA (serious ones) - 11/13/13 04:24 PM

from Wonkblog:

1. There have been 846,184 applications completed. Because many of these applications are for families, they cover 1,509,883 people. But only 106,185 have chosen an actual plan.

2. It's not quite right to say 106,856 have actually bought a plan. The White House is also counting people who have placed a plan in their shopping cart but haven't yet paid.

3. Ten percent of people who have been determined eligible to enroll have actually done so. The rate is higher in state-based marketplaces (21 percent) than in those run by the federal government (4 percent).

4. About 75 percent of the sign-ups come from the 14 state-based marketplaces. Those marketplaces have had about 79,000 people sign up, compared with the 27,000 people who have purchased coverage in the federal marketplace.

5. California's enrollment accounts for a full third of all sign-ups. The state has had just over 35,000 people sign up.

6. North Dakota has the fewest enrollees. Exactly 42 people have signed up.

7. Lots of shoppers on HealthCare.gov are turning to paper applications. Thirty-three percent of sign-ups in the federal exchange have been done offline. In states, that number stands at just 3 percent.

8. The "woodwork" effect is real. (that is, the millions who qualify for Medicaid who currently have none will enroll*)

9. The numbers would be a lot higher if HealthCare.gov worked as well as some state-based marketplaces.



* Also not mentioned are 396,261 eligible for Medicaid or CHIP.




Posted by: Nana

Re: Question about ACA (serious ones) - 11/13/13 08:18 PM

What tickles me is that the tv news both local & national as well as the local newspapers to date has not listed the phone # to apply over the phone.

I did see the number online. Which is NOT doing the millions of folks who do not have computers or have access to one. Telling them to go to the library is ridiculous. Not all towns have them. If they do, most are closed due to the depression recession.
Posted by: steveg

Re: Question about ACA (serious ones) - 11/14/13 02:52 AM

It's turning into a f'n circus because normally intelligent people suddenly demand instant gratification. Who in their right minds doesn't get that it's human nature to wait 'til the last minute. We saw enrollment barely move the needle in MA when that law went live, and then spike just before the deadline.

And now, too many congressional Dems are getting jelly-kneed over the policy cancellations and abandoning logic, history, and consistency all at once!

Yes, the website fukkup is inexcusable — but is getting fixed. Yes Obama oversimplified the "keep what you like" pitch and the Secretary of 'Splainin' Stuff just stuck his foot in Obama's mouth, thankyouverymuch. And no, the Admin did not expect so many states to refuse to set up their own exchanges.

But Jumpin' Jebus, peeps! It's only been a month and a half since this aircraft carrier-sized program has left the dock. Give it a little time to get the bilge pumps working and the nav systems keyed in. Reform on this scale is neither perfect nor nimble overnight.

I would like to say, A year from now, when the program is humming along and everyone is feeling the joy… But if nervous Dems and mercenary Repugnicans don't get a hold of their shorts, this thing is gonna implode and we'll all be screwed again. mad
Posted by: DLC

Re: Question about ACA (serious ones) - 11/14/13 07:07 AM

BO's BIGGEST mistake was assuming most voters were intelligent and logical.
Course we KNOW there's 30-35% hard core GOTP so what doe sthat say for the average intelligence ? sick
Posted by: garyW

Re: Question about ACA (serious ones) - 11/14/13 08:00 AM

Through all of this Obama seems to be the only one with a spine. He's worked with a half-baked law that a disfunctional Congress legislated and handed to him, and now refuses to fix, and refuses to support in its implementation. Even with all this, the ACA offers us all a real chance to improve the quality of our lives and improve our economy. We're just to damn stupid and full of ourselves to realize it.

The news yesterday that's reported as disasterous and shows failure of the President …. in the first month of ObamaCare, 500,000 people now have health insurance through a combination of the exchanges and Medicaid.

What the President deals with: The entire republican Congress and its House majority are actively sabotaging every effort in the rollout. 25 red states continue to sabotage the Medicaid program and ACA enactment and application process. Seems like the entire TV news media (with the exception of 2/3 of MSNBC) has jumped onboard with FoxNews and the republican talking points to misinform, hide the facts and pursade the public to avoid the ACA … without admitting a single time that there is no alternative legislation. It's a willfull anti-government propaganda campaign that's driven by ratings, corporate & lobbyist money, and hatred of a black President. Religious charlatans are damning the notion of caring for the poor and sick, a grifter half-term governor sucks the oxygen out of the room everytime she tweets or offers "news" commentary on the ACA as slavery or some reference to Stalin. Issa and his monkey trials continues to abuse his power to lead the media by the nose. Issa continues to leak edited classified documents to the media with misleading info and it's treated as fact.



And the polls show that the propaganda is working. As soon as Democrats jump ship and defend the nonsense offered by the rightwing and voters sit the elections out due to apathy and disgust in the system, then we are screwed. As the President has always said …. it's up to us.







Posted by: Celandine

Re: Question about ACA (serious ones) - 11/14/13 09:56 AM

.
What I don't understand is even the people that
have come to realize they'd been getting screwed
by Insurance Companies for YEARS if not decades,
Don't 'GET' that since the Insurance Companies
(...who've been 'Playing Folks' ferfukkinever mad )
Are Dropping Policies In Order to Turn Nervous
Policy Owners Against The ACA (and Pres.Obama)


They'd LOVE To Get-Back-To Business As Usual!
Posted by: garyW

Re: Question about ACA (serious ones) - 11/14/13 11:17 AM

And that is the obvious strategy of the GOP to convince people the longtime woes and outrages costs of health insurance policies as a new result of the ACA, rather than the reality that the ACA is fixing all that. Worked for them convinicing people that Obama crashed the economy and job numbers were rosey on Jan 20, 2009.
Posted by: steveg

Re: Question about ACA (serious ones) - 11/14/13 12:04 PM

And there you have it. Reasonable, methinks. But the right will still kvetch ad nauseum.
Posted by: garyW

Re: Question about ACA (serious ones) - 11/14/13 12:12 PM

Yes, FoxNews and the GOP will quickly blackpedal on their position because Obama did exactly what they were demanding he do yesterday.
Posted by: steveg

Re: Question about ACA (serious ones) - 11/14/13 12:19 PM

Damn straight. He should've repealed the fukker on the spot! eek
Posted by: garyW

Re: Question about ACA (serious ones) - 11/15/13 07:34 AM

Why wasn't this a lead story?*

http://www.examiner.com/article/right-wing-cyber-attacks-on-healthcare-gov-website-confirmed


* because the media couldn't blame the President for it.
Posted by: steveg

Re: Question about ACA (serious ones) - 11/15/13 08:53 AM

Amazing. If you Google cyber attack on healthcare.gov you get a slew of 2-day old links — many to major network news outlets. But I don't see word one on msnbc.com — and you'd expect them to be on it like a cheap suit! confused
Posted by: KateSorensen

Re: Question about ACA (serious ones) - 11/15/13 10:57 AM

.

That was fun. I read the first result. Obviously not written by a Republican sympasizing agency:

Quote:
The troubled Affordable Care Act website has been subject to "a handful" of hacking attempts, including at least one intended to bring the site down, a Department of Homeland Security official told lawmakers today.

But considering that some federal websites get hundreds of cyber-assaults each day, the approximately 16 reported attacks on healthcare.gov is a surprisingly small number, experts said.

Assistant Secretary Roberta Stempfley told members of the House Homeland Security Committee that her agency had received "about 16 reports" from the Department of Health and Human Services that are under investigation.

While the number of hacking attempts for such a "high profile target" may seem low, Robert Siciliano, a McAfee online security expert, told ABCNews.com that it's likely the agency is reporting only "brute force attacks."

"Little tiny ones that happen on a daily basis, like attempting to crack passwords, they may see them but they add up to nothing. They're probably reporting significant brute force attacks that could put data at risk," Siciliano said.

In comparison, the Department of Homeland Security website logged about "228,700 cyber incidents" during the last fiscal year, a DHS official told ABCNews.com, which averages out to about 626 a day "involving federal agencies, critical infrastructure, and the Department's industry partners."

The fact there was only 16 is surprising. Maybe those 16 are the documented ones," he said of healthcare.gov. "Due to the fact there are consumers punching in personal identifying info, that makes it a very attractive target."


ref link
.
Posted by: Celandine

Re: Question about ACA (serious ones) - 11/15/13 11:51 AM


Nice to know that throughout "ALL THIS"
He Hasn't Lost His Sense-Of-Humor
He said, during his "APOLOGY TOUR", that
He can't wait until it's running smoothly
so they can stop calling it "OBAMA CARE"!
laugh
Posted by: garyW

Re: Question about ACA (serious ones) - 11/15/13 01:03 PM

Originally Posted By: steveg
And there you have it. Reasonable, methinks. But the right will still kvetch ad nauseum.


What Obama said yesterday about the "fix", quote:
Quote:
We’re also requiring insurers to extend current plans to inform their customers about two things: One, that protections — what protections these renewed plans don’t include. Number two, that the marketplace offers new options with better coverage and tax credits that might help you bring down the cost.

I think the President just drank the Insurance corporation's milkshake. Insurers must inform cancelled enrollees about their junk plans, ACA's benefits, the marketplace, tax subsidies. Game Changer. That's why today's bs House vote to convolute this to the Insurance corporations benefit deserves a veto if it gets to his desk.


Posted by: steveg

Re: Question about ACA (serious ones) - 11/15/13 01:41 PM

A veto has already been promised.
Posted by: DLC

Re: Question about ACA (serious ones) - 11/15/13 03:59 PM

We ALL know this but . . this is another example WHY the Insurers should be taken out of the Healthcare equation totally !! HELLO ! Single payer !! cry
Posted by: garyW

Re: Question about ACA (serious ones) - 11/17/13 10:56 PM

Originally Posted By: John Rougeux

I entered in some information on that Kaiser site and wow...out of pocket expenses are not cheap!
"Your out-of-pocket maximum for a Silver plan (not including the premium) can be no more than $12,700. "

Ouch! Ours just went up to $2500, so not sure how this is more affordable?


From my experience on the CA exchange, Kaiser is way of line and almost twice as expensive as plans offered by Blue Cross, Blue shield or HealthNet.

For all the Silver Plans I looked at, maximum out of pocket is $6350 per individual. The $12,700 is for the two of you combined. The maximum out of pocket includes premiums and deductibles as well as copays & percentages paid for hospitial stays and ER.


Quote:


I don't know what premium we are paying right now, since they just changed it, but under the ACA, we would pay:
"Amount you pay for the premium:$4,112 per year"
after the tax credit.

I'll have to find out what we pay per year.

I wonder how the premiums would work if I had to claim my UI too in that?


If UI you mean Unemployment Insurance payments? When you complete the personal financial section of the application it will ask for "other" forms of income. That's probably where you plug that in.

Quote:
ER visits are supposed to be limited to certain things, which is totally understandable, otherwise, you would get denied coverage and you have to pay.
Currently a person with limited means can go down to the ER for a cold or to seek drugs and never pay a dime. And if you don't think people go to the hospital to get drugs, then talk to a medical professional like a nurse who works on the floor.

How will this change things? What happens if the ACA runs out of pool money? Will rates be raised then?


The ACA cut $400B from Medicare abuse and overcharges (without touching benefits) and puts that money toward the states to pay for Medicaid for the uninsured to keep them out of ERs. If just 10 million sign up for it (they say there's 30 million nationally that would qualify) then there's the outrageous price inflations won't be charged to taxpayers… or used to keep everyone's premiums sky high.

The reports from the nonpartican Congressional Budget Office states that the ACA will save $800B over 10 years.

Of course Red States are doing everything they can to f*ck this up. I don't know how that imbalance will mess up the financing of this, but that the GOP's goal to inflict maximum damage is a serious problem. Can you imagine if all states were acting as competent as California and succeeding in making this thing work seamlessly?



Quote:
I mean, that's how health care really got out of control before ACA...people go to hospital/ER for really minor stuff and never pay for it. Or they fake neck/back pain and get a free ride to the ER via ambulance and never pay. Talk about expensive! All that lost money plus other factors and we ended up in a mess.

Can someone please explain how this will be avoided with the ACA?


The ACA enacted pricing regulations on hospitals and ERs back in 2010 with a 2014 deadline to have them in place or pay penalties. The ACA regulates price gouging by the insurance companies, the hospitals and the medical device suppliers.

Posted by: DLC

Re: Question about ACA (serious ones) - 11/18/13 09:32 AM

Yeah the same with CDC... they had several 100,000 hacking attempts each year. We had to change our passwords every 60 days AND we could not use any previous one or part of one for the last 20 PWs !! SO If I put in 12810WindingOak one time and then tried to use WindingOak12810 in the next 20 PWs, it's a NO GO ! sees the similarity and kicks it out !!

so 16 hacking attempts is laughable and insignificant !! laugh