Currently covered by former employers PPO insurance. Premiums alone are costing me 28% of my gross income, making it unaffordable according to PPACA (no shit.) On top of the premiums it’s suck ass 70/30(silver equivalent) coverage, with hefty co-pays for office visits, tests and for prescriptions and a $200 deductible per year too. AND they allow any healthcare vendor to charge me via something called a patient liability waiver, the difference between the insurance company’s contracted rate and whatever arbitrary retail rate the vendor/contractor wishes to use. These waiver charges aren’t covered by the $5000 out of pocket maximum either. It’s all I can do to pay the premiums every month. There’s nothing left to cover the other $5200 per year and certainly not enough left to pay the waiver money. So I have insurance but I can’t afford to use it. What a business model, eh? Cash those checks every month baby!
Under the PPACA, I won’t get any subsidies because my income is over 299% of the 2014 poverty rate, but it’s less than 400%. The way I understand it the maximum charge for silver coverage, without subsidies to lower it, is 9.8% of my gross income.
If I possibly can afford it, I will try to get platinum coverage.
Specifically, New York apparently requires nondiscrimination against those with pre-existing conditions, but no individual mandate, which has apparently resulted in exactly the sort of death spiral you get if you do one without the other: healthy people don’t buy insurance, so the rates go up because the pool being covered is sicker than average, which forces more semi-healthy people out, which causes the pool to be sicker, on average, which causes the rates to go up still more.
So the introduction of Obamacare in NY, with mandate, widens the risk pool and makes it a much healthier group, which lowers the rates way down.
I’m healthy 29 year old guy in Illinois. I buy my own insurance and currently pay $100/month for a plan with a $5000 deductible. If I can find a better deal, I’ll switch. Otherwise, I’ll hopefully be able to keep what I have.
It runs in my mind that, to qualify for withe subsidy or even participation, one had to be NOT ELIGIBLE for coverage, not just NOT COVERED.
Check that out for your state (although I suspect such a rule would be Federal).
Especially, before you withdraw from an employer-paid/provided policy and then be told to use your employer’s policy…
I’m worried I will be told “You have Medicare; you don’t qualify”. I get Part A as part of Disability. I am sincerely hoping that, since Part A covers only hospital - no office visits, no lab, no MD of any kind, it will not be considered adequate.
What I will do if they tell me to go buy the rest of Medicare, I don’t know.
The big selling point on these policies is the Deductible - for singles, I think the most for CA is $2500 for Bronze and $1500 for Silver. No deductible for Gold or Platinum
The part about “eligible for” seem to be to keep out all those retirees who, back when the US owned every market in the world (and healthcare was not yet the mess it is) were promised healthcare for life by their contracts.
.
That’s thousands and thousands of people who spent their working lives in some really nasty conditions, and more than a few are quite sick.
The exchanges don’t want to start with all those folks jumping on board.
I was afraid of that - I will now spend a few weeks trying to drop Medicare.
It may be considered adequate, but providers aren’t exactly happy to see Medicare patients. I use UCDavis - it’s main site has a list of insurance providers they accept - Medicare is not listed. I called and asked if they anticipated accepting ACA (Is it on the List?). In the course of the chat, she revealed that “we do accept most forms of Medicare”
I’m hoping that the freebie Part A (I don’t have B or D or gap) does not, by itself, constitute “having Medicare” for the purpose of ACA
Unless you have at least one common law employee, you will no longer qualify for small business coverage. Owner only groups are out at their renewal after 1/1/14.
I’m going to need to see actual numbers for costs, and details of what will be covered before I can make any kind of decision, but my current insurance sucks donkey balls and actually prevents me from getting medical care that I need, so in all likelihood I’m in. I may qualify for the Medicaid expansion, but there seems to be little info on that. I have no idea what that will cover, as it seems it currently only covers costs of breeding if you are a woman, which is not something I care about or need. I also don’t know if that would mean I can’t get an exchange plan, either because the rules won’t let me or the costs are too high. At this point the $95 no-insurance fee is cheaper than my existing premiums, so there’s that too, and then I’d qualify for sliding-scale medical fees, at least.
I have an individual HDHP plus HSA, but since I’m the only one funding it, I basically can’t afford to see a doctor and have it only for catastrophic coverage and because up til now dropping it would have screwed me on the pre-existing condition clauses that are now (thankfully) not legal. If I’d dropped it before now, I never would have gotten anyone to give me coverage ever again.
I’m afraid that, as a “Medicare Patient” I will be at the very back of the bus - I once proposed “what would happen if I switched to Medicare?”.
My doc sighed and said “well, I’m your doctor, so…”.
He wasn’t looking forward.
Neither am I.
And, pretty much anything is better than a $6,000 deductible PPO at $504/mo which doesn’t allow a brand name drug ($120/mo) even if my doc writes a letter explaining how this is not only medically indicated, but the current situation is harmful.
I’m also not looking forward to the time when I need the $2500/week drug or start having transfusions on a routine basis.
There are only 3 drugs which do this, and my insurance only pays for 1 of them.
I’m a notorious outlier (in medicine an other ways) - I guess we’re supposed to hope it works for everyone.
Come the first, I’ll submit an application and see what happens. If denied, it’s of to the Social Security office. They gave me the stuff - they can have it back.,
My wife was on disability and Medicare, and we didn’t have any problems with doctor and hospital care. Prescriptions were more restricted than her HMO though.
My company provides good-but-not-Cadillac health care. We’ve always been awash in coverage (wife’s job, kids job, my job) but the best option is to cover all but the eldest under my plan. Eldest (24) has had his own employer plan since 19, and it always worked out better for him keep it as a single-dude, rather than being on mine. (Mine either has 1 kid, or many kids as options, with “many” being kinda costly)
I don’t think it works that way. After you have received Social Security disability for 24 months, you get Medicare Part A and Part B automatically. I think you can decline Part B, but not Part A.
Oh, I realize that…the company I work for pulled a lot of strings to get me on their policies - I’m not technically an employee - and I’m sure those strings can be “unpulled” easily…should’ve explained that in my post when I was talking about dropping the employer based coverage
I did nothing to indicate I wanted Medicare - the card I have came without request.
It shows, under the "This entitled to :
HOSPITAL (PART A)
BENEFITS ONLY
According to the Medicare site, if had I Part B (or any other plan), it would have been listed under the Plan A line.
ISTR being invited to buy Part B at some time or times, but am not certain.
If I can get a card issued by my current carrier, I’d much rather flash that at the desk than the Medicare card.
For instance: my PCP (and, I suspect the Specialists) know I’ve been SS Disability since 2007, They are undoubtedly aware that I have part A, yet none have inquired, nor have their offices. Looks like they don’t look forward to dealing with it, either.
II found ways to dis-enroll from so-called “Medicare Advantage” (which are private plans built aroud a Medicare core) and from Part B (must receive lots of counseling, fill out and sign form in person (it is not available online, just to make it difficult to dis-enroll). This is to be done at or through your local SS Office.
Does anyone know if vision and/or dental is included in the minimum-acceptable standards for insurance under Obamacare? I could stand a visit to both, but can’t afford it out-of-pocket, of course.
Figures. Who the fuck decided that vision/dental weren’t essential for adults? My astigmatic eyes beg to differ – I didn’t suddenly gain perfect vision when I turned 18.