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Post by angel97701 on Jun 8, 2016 21:15:01 GMT
Medical insurance vent . . . we were one of the families that got dropped because of the Affordable Card Act, (AKA Obama Care), which I found out today will give free yearly physicals to children.
We opted to use Medi-share, because we are healthy and didn't want to pay for the increased costs associated with getting an ACA approved plan. Basically double what we were paying.
DS#2 needs a physical to go to Cub Scout resident camp, and our medical provider estimated $300-$400 b/c we haven't had yearly exams. We would pay for these yearly exams out-of-pocket, and for a healthy kid that has all his vaccinations, I see no reason! Thankfully an urgent care will do the physical for $45. Other wise he wouldn't be going to camp!
What a scam, just fed up with insurance and how ACA DOESN'T work for the self-employed small business owners. We have neighbors that take their child to the Dr. for every little thing, all on the dime of the Oregon Health Plan. I know that there those out there that have benefited and DON'T abuse the system, but it is just annoying from where I stand.
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Post by littlemama on Jun 8, 2016 21:22:32 GMT
You chose not to purchase insurance that would have covered the physical. The ACA does work. You have to purchase the coverage in order for it to work.
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sweetpeasmom
Pearl Clutcher
Posts: 2,652 
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Post by sweetpeasmom on Jun 8, 2016 21:25:54 GMT
I hear you loud and clear. At the beginning of the year, ds had cut his finger pretty bad and we weren't sure if it needed stitches. Since it was the first of the year, of course the deductible hadn't been met (never is). The new plan (3rd one in 3 years) didn't cover either of the previous 2 drs we had been using. Urgent care wasn't covered (because the deductible hadn't been met). So I was facing having to pay close to $200 or more just to see if he needed stitches. I finally had a friend look at it for me and she didn't think it did. It was so very frustrating. Luckily, dh's company had gotten bought out at the beginning of the year and we got new insurance at the beginning of April. It's really good insurance, less than what we were paying on Obama Care and things are actually covered.
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Deleted
Posts: 0
Oct 7, 2024 17:25:24 GMT
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Post by Deleted on Jun 8, 2016 21:28:46 GMT
You were able to find a less expensive alternative. Seems like a good thing to me.
We participate in Samaritan Healthcare (somewhat similar to Medishare)...so I do get it but I wouldn't trade what we have for any other system of coverage.
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perumbula
Pearl Clutcher
Posts: 3,439
Location: Idaho
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Post by perumbula on Jun 8, 2016 21:31:49 GMT
You chose not to purchase insurance that would have covered the physical. The ACA does work. You have to purchase the coverage in order for it to work. You did see the part where the ACA insurance was twice as much as what she was paying which means that in order to get "free physicals" she would have to pay at least $300/month more (probably more than that.) So much for good coverage. The ACA did make it so more Americans could have health insurance at the cost of everyone's health coverage being brought down to a lower level. We don't have employer provided insurance either and it stinks. |
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rutabagapie
Shy Member
Posts: 13
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Post by rutabagapie on Jun 8, 2016 21:53:48 GMT
The ACA does not work for everyone. Take it from me, a person that was and is very much for universal health care. I know people that the ACA has truly helped and I'm glad for that. When you fall into the demographic that does not qualify for subsidies and yet cannot afford a second mortgage each month with an additional 13K yearly deductible..it does not work. It's not a matter of choosing not to purchase.
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Post by mlynn on Jun 8, 2016 22:08:49 GMT
I feel trapped. I am not working and I am covered under expanded medi-caid. If I get a job, are they going to go back and say "hey, you had too much income to be covered by this. You need to pay $XXXX" either for the premium or for the covered expenses I had. After all, if you are receiving subsidies and your income ends up being higher than you estimated for the year, they can go back and recalculate your premiums. And if they do, do you then have to go back and recalculate all of your deductibles and co-pays and have to pay more on those as well?
When I was working, it was on the cusp of ACA going into effect. I only worked part-time at $15/hour. If I had worked full-time, the premiums plus 1/12 of my deductible would have been over $1,000 per month. And being diabetic, you can rest assured that my deductible would have been met.
My husband is on Medicare. We cannot keep up with his deductible and co-pays. I think we are up to about $20,000 in debt on that. He is on Medicare because he is disabled, not because of age. Because of his age, he cannot get those plans that help with co-pays, etc.
We live modestly. Housing with insurance and taxes is $630/month. We eat out of the food banks. We have a ton of medical debt but no other debt (aside from housing). We go to the movies once every few years. DH has swallowing issues so we NEVER go to restaurants. And yet I cannot afford underwear. We desperately need more income, but opportunities are limited. And I cannot afford to go without insulin as well as other meds. So ACA has me quite trapped.
My niece and her family have low enough income that she would qualify for expanded medi-caid. However, the rules state that if there is insurance available through an employer, you have to take it. Unfortunately, the insurance at her husband's insurance is expensive with an extremely high deductible. As a result, she cannot afford the doctor visits to keep her insulin prescription current. ACA is not working for her.
Many employers have quit offering health insurance because employees can get insurance through ACA. But the everyday Joe cannot afford the premiums and deductibles involved. Even with the "subsidies". And there are so many goofy variables that ACA can result in financial ruin as well. I know many people who used to be able to go to the doctor but now they cannot. ACA is not working for them either.
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Post by mnmloveli on Jun 8, 2016 22:16:28 GMT
I feel for you. Lucky we are healthy, but ACA is crazy expensive. Before ACA we had coverage thru Healthy New York which was soooo much better. Paid less money per month and my deductible / maximum out-of-pocket was $1,500 per person (my husband and I only). Now, being forced into ACA, we pay about $300 more per month and our deductible per person is $2800 and the maximum out of pocket per son is $6500. WHAT A DIFFERENCE for the same coverage.
The news commentators are always quoting sign-up numbers but I would really like to know the enrollment numbers for the people who ended up on Medicaid vs the enrollees who are actually paying for their medical.
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basketdiva
Pearl Clutcher
Posts: 3,649
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Post by basketdiva on Jun 8, 2016 22:22:51 GMT
The ACA does not work for everyone. Take it from me, a person that was and is very much for universal health care. I know people that the ACA has truly helped and I'm glad for that. When you fall into the demographic that does not qualify for subsidies and yet cannot afford a second mortgage each month with an additional 13K yearly deductible..it does not work. It's not a matter of choosing not to purchase. I've been saying this all along. Even if someone can afford the premium, it doesn't mean they can afford the deductibles - BUT they have insurance. |
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Post by birukitty on Jun 8, 2016 22:37:51 GMT
It's certainly not perfect. My problem with ACA is that there is no competition like there is when you buy car insurance so these health care plans can basically charge what they want and we are stuck paying it. In Maryland we get a choice of 5 or 6 health care companies. 2 are great, the other 3 are crap. DH is in IT and works on a contract basis so he usually has a new job every 18 months. We have had every kind of health care insurance company there is-Blue Cross, Aetna, United, and so on.
Luckily for us the ACA came along at just the right time because with his newer contracts the companies had the worst health care insurance plans ever. With the ACA suddenly we could choose our own and it wasn't tied to his job. Freedom! I had a lot of health problems back then so we chose a plan that was one of the most expensive ones but had a zero deductible. We paid $1,200.00 a month (for 2 adults and yest it is a real struggle) but since it had a zero deductible we knew for us it was the right plan. My prescriptions were very expensive-migraine meds and anti depressants. Yeah, we could have chosen a plan that cost us $70.00 a month like my sister did, but she ended up with Kaiser Permante (sp?) and when her back started giving her serious problems she had to travel 50 minutes for every test to their center, but she takes no prescriptions. She complained A LOT that summer.
It is what it is-a boy do I hate that saying with a passion! It is simply a clearing house of different health insurance companies for sale. The problem isn't really the ASA itself. The problem is with the way we sell health insurance in this country. It should be sold like we sell call insurance. There should be real competition-every company should be offered in every state. The way we are doing it the health insurance premiums keep going up every year and the deductible keep going up, but the benefits keep going down.
This year that same policy is now $1,300.00 a year with a $600.00 deductible, $200 for prescriptions( which I covered with one migraine med prescription) and it covers less. So I hear you. But I think the ACA has done a lot of good. No longer is our health care tied to our employment-it never should have been. And lots of people are now covered that never were before.
Debbie in MD.
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Post by birukitty on Jun 8, 2016 22:41:52 GMT
PS. You want to hear a vent-when that insurance company we are paying so much for tells you they've decided not to cover a particular medication your doctor has prescribed at all. In reality "it's too expensive". That's their decision and there is nothing you can do about it-you have to pay for it out of pocket. You think to yourself-"What the hell am I doing paying you $1,300.00 every month for, except you've had this sinus infection for 7 months now and you need this medication to finally cure it. Fing insurance companies! $200.00 dollars gone out of your pocket later you walk away with the medication thinking to yourself, well at least it wasn't more expensive.
Debbie in MD.
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freebird
Drama Llama
'cause I'm free as a bird now
Posts: 6,927
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Post by freebird on Jun 8, 2016 22:46:23 GMT
You were able to find a less expensive alternative. Seems like a good thing to me. We participate in Samaritan Healthcare (somewhat similar to Medishare)...so I do get it but I wouldn't trade what we have for any other system of coverage.
Christian healthcare ministries here. $300 mo for the two of us. Our share is $500 per event and I don't even have to pay that if I can talk the bill down. For an extra $40/year we get unlimited coverage.
It has a few down sides, but at least we have coverage. And it qualifies under ACA.
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Post by angel97701 on Jun 9, 2016 1:05:17 GMT
You chose not to purchase insurance that would have covered the physical. The ACA does work. You have to purchase the coverage in order for it to work. You did see the part where the ACA insurance was twice as much as what she was paying which means that in order to get "free physicals" she would have to pay at least $300/month more (probably more than that.) So much for good coverage. The ACA did make it so more Americans could have health insurance at the cost of everyone's health coverage being brought down to a lower level. We don't have employer provided insurance either and it stinks. Thank you Perumbula for your complete reading of my post. AS SELF EMPLOYED we paid $600 a month for just major medical. So for my colonscopy it was $9,000 out of pocket . . . . when I needed a minor day surgery, out of pocket was $18,000. My son's ear tube surgery lasting all of 15 minutes $6,000 out of pocket. When we were cancelled I shopped around, and the best I could do was $1200 / month and it didn't met the ACA guidelines so there was no guarantee that we wouldn't be fined. For ACA approved it would have been $1500 / month. SO Littlemama DO YOU HAVE AN EXTRA $1500 a month in your budget to pay for coverage? We didn't, so we did chose another path. Littlemama you did not completely read the post and had a knee jerk reaction. Just read the other stories below. In reality everyone pays more so more people can have coverage. In my post I mention a neighbor who has taken his child to the doctor about 5 times in the last school year for minor ailments, allergies was the diagnosis on the last one, and he was prescribed benadryl . . . all on the taxpayer's dime. This is why I am fed up. |
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Post by littlemama on Jun 9, 2016 1:18:01 GMT
You chose not to purchase insurance that would have covered the physical. The ACA does work. You have to purchase the coverage in order for it to work. You did see the part where the ACA insurance was twice as much as what she was paying which means that in order to get "free physicals" she would have to pay at least $300/month more (probably more than that.) So much for good coverage. The ACA did make it so more Americans could have health insurance at the cost of everyone's health coverage being brought down to a lower level. We don't have employer provided insurance either and it stinks. Correct. And in making that choice, she chose to absorb the full cost of any needed care. If you choose not to pay the premiums, you can't really expect not to have to pay for care either. |
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quiltz
Drama Llama
Posts: 6,840
Location: CANADA
Jun 29, 2014 16:13:28 GMT
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Post by quiltz on Jun 9, 2016 1:25:33 GMT
I didn't realize how expensive and restricted health insurance was in the USA.
I am so glad for OHIP (Ontario). It isn't free, as we are taxed heavily for this and it doesn't cover meds, dental but does cover xrays, blood tests and similar. There is a longer wait time for specialist doctors and surgical dates, but it is covered.
I pay for additional health insurance ($195./single/monthly) hich covers optical, dental, medicine, physiotherapy & similar with the some co - payment, however, these costs can be used as an deduction (not 100%) on my CRA (IRS) filing.
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shawallapea
Full Member
Posts: 108
Jun 28, 2014 21:28:33 GMT
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Post by shawallapea on Jun 9, 2016 2:30:54 GMT
We are losing our group coverage in a few days so we ended up with a Providence plan which was by far the least expensive. It's $1100 per month for two adults and three children with a $13,000 deductible. We're hoping it's only for a few months  Soooo painful. |
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Post by freecharlie on Jun 9, 2016 3:22:59 GMT
I feel trapped. I am not working and I am covered under expanded medi-caid. If I get a job, are they going to go back and say "hey, you had too much income to be covered by this. You need to pay $XXXX" either for the premium or for the covered expenses I had. After all, if you are receiving subsidies and your income ends up being higher than you estimated for the year, they can go back and recalculate your premiums. And if they do, do you then have to go back and recalculate all of your deductibles and co-pays and have to pay more on those as well?
When I was working, it was on the cusp of ACA going into effect. I only worked part-time at $15/hour. If I had worked full-time, the premiums plus 1/12 of my deductible would have been over $1,000 per month. And being diabetic, you can rest assured that my deductible would have been met.
My husband is on Medicare. We cannot keep up with his deductible and co-pays. I think we are up to about $20,000 in debt on that. He is on Medicare because he is disabled, not because of age. Because of his age, he cannot get those plans that help with co-pays, etc.
We live modestly. Housing with insurance and taxes is $630/month. We eat out of the food banks. We have a ton of medical debt but no other debt (aside from housing). We go to the movies once every few years. DH has swallowing issues so we NEVER go to restaurants. And yet I cannot afford underwear. We desperately need more income, but opportunities are limited. And I cannot afford to go without insulin as well as other meds. So ACA has me quite trapped.
My niece and her family have low enough income that she would qualify for expanded medi-caid. However, the rules state that if there is insurance available through an employer, you have to take it. Unfortunately, the insurance at her husband's insurance is expensive with an extremely high deductible. As a result, she cannot afford the doctor visits to keep her insulin prescription current. ACA is not working for her.
Many employers have quit offering health insurance because employees can get insurance through ACA. But the everyday Joe cannot afford the premiums and deductibles involved. Even with the "subsidies". And there are so many goofy variables that ACA can result in financial ruin as well. I know many people who used to be able to go to the doctor but now they cannot. ACA is not working for them either.
I don't know if this would be a possibility for you, buy could you get a job at a local hospital/medical system? Dh works for one and all the employees, no matter their position, get the same benefits For a family plan we pay something like 300-350 per month and have a deductible of 250 per person. Office visits are co-pays of 30 for reg, 40 for specialist. But the best thing for us is that dh's diabetic care and supplies are covered 100% |
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Post by PNWMom on Jun 9, 2016 3:25:15 GMT
I work in discharge planning as an RN at a trauma center in Seattle. There are thousands upon thousands of people in my state alone that now have insurance, where they did not in the past. Yes, a lot of you are paying more. Some, a bunch more. Yes, there are huge issues with the ACA. But when someone gets hit by a truck, they are much more likely now to either have insurance or be eligible to get insurance (WA Medicaid) to cover their $$$ hospital stay. My hospital has been bursting at the seams with people over the last 6 or 7 months, partly because people are choosing to come to the hospital. We do a ton of elective surgery as well as trauma care, so it is a huge mix of patients. I have patients who are flying home to another state first class at discharge, and they are right next to the homeless guy who needed spine surgery for his chronic pain. Both get excellent care.
We do well over $100 million in charity care a year at my hospital alone. We do amazing work. And the ACA allows us to do more for more people. It is a step in the right direction, but not nearly enough. Single payer all the way, baby!
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luckyexwife
Pearl Clutcher
Posts: 3,069
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Post by luckyexwife on Jun 9, 2016 3:57:33 GMT
You did see the part where the ACA insurance was twice as much as what she was paying which means that in order to get "free physicals" she would have to pay at least $300/month more (probably more than that.) So much for good coverage. The ACA did make it so more Americans could have health insurance at the cost of everyone's health coverage being brought down to a lower level. We don't have employer provided insurance either and it stinks. Correct. And in making that choice, she chose to absorb the full cost of any needed care. If you choose not to pay the premiums, you can't really expect not to have to pay for care either. Sometimes it's not a choice. Our insurance was dropped when the ACA started, and the first year on the ACA plan our premium more than doubled. It is now close to triple what we were paying before. And, yes, every year we had rate increases, but not near as steep as we do now. If it goes up again next year, I don't think we will be able to comfortably afford it. Our premium is more than our mortgage! |
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Post by gale w on Jun 9, 2016 5:04:33 GMT
I feel your pain. Before the aca we had a high deductible plan (11k) and paid around $750 per month. After the aca the cheapest plan we could get has a $12k deductible and cost us almost $1400 per month (now almost $1600 after premium increases) . It's hard coming up with those extra dollars every month.
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Post by gmcwife1 on Jun 9, 2016 5:05:34 GMT
I'm sorry.
I'm not sure how insurance is causing the cost difference between the exam costs though. That is the doctor setting the price.
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Soooo painful.
