Author Topic: What comes after the ACA?  (Read 724160 times)

EnjoyIt

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Re: What comes after the ACA?
« Reply #4650 on: July 23, 2018, 08:30:58 PM »
And, residencies are funded by CMS which dictates how many spots are available.  You need to be approved/funded for more spots.

So, it costs money.  Now, we've gone full circle.

Yup, it is all about money which is why I think we need to do everything possible to try and decrease the cost of administrating care.  We have discussed it ad nauseam in this thousand plus post thread.  Cost is the number 1 problem to our healthcare system.  If the cost was lower it would be cheaper to insure against. Just as it would be cheaper to train residents.  See, so simple.  Just lower cost and everything else will follow.  I even support a low cost public health care system for 100% of the citizens and immigrants of the US.  A no frills cheap system that uses government leverage to negotiate prices while providing non cutting edge but cheap and effective medicine to the public. This in conjunction with a free market transparent service to those who are willing to pay for it.  I think this is the best way to control costs but still reward those who are willing to pay for private rooms, robotics surgeries, latest drugs and better meals while in patient in the hospitals, nursing homes, and rehab facilities. 

We can even start lowering costs today just by creating transparency and allowing the government to negotiate prices.

katsiki

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Re: What comes after the ACA?
« Reply #4651 on: July 24, 2018, 09:32:00 PM »

I have a PhD and I would support legislation to make it a lot easier for people with PhDs in the exact same field as me to immigrate to the USA. We used to be able to skim off the best and brightest from the whole world, now we're trying to actively discourage that same process. *shrug*

Also, I believe the suggestion was to increase the supply of trained nurses and MDs through immigration* which would naturally cause costs to come down by ameliorating shortages that currently require different hospitals to bid against each other just to fill their critical positions. It's hard to see how increasing the number of trained nurses and MDs available in the country would lead to a worse shortage of those positions.

*Although to really do this effectively, this strategy would probably require allowing doctors from at least other first world countries to practice medicine without going through a whole second residency. This both is a big discouragement to immigration since you have to both lose social status and income for a number of years if you want to come to the USA and also means that bringing in more doctors from overseas really doesn't do anything to increase the supply, since the number of residency slots available each year is an even stronger bottleneck on the total number of new MDs produced each year than the number of medical school slots (both are capped and neither has kept up with population growth).

I'm saying that immigration alone hasn't fixed the problem, and hoping to bring down wages by bringing in foreign labor (sol's statement) isn't going to do anything to address the labor shortage problem. The US still accepts foreign Dr's and RNs and we still have a major issue. Simply taking a person from another country (Many of whom have attended school for nearly free since other places value healthcare and education as a common good) does nothing but leave a shortage in that country.

States are slowly trying to deal with the residency issue, but I agree it's too little too late. I am just appalled that in the medical field people think a labor shortage should constitute lower instead of higher wages.

Pretty sure this is wrong, unless by "accept" you mean we allow them to come here and take the USMLE, then go through residency, and then take the last phase of the USMLE.

That is my understanding as well.  In talking to a few friends that are foreign doctors, my take is that you nearly start over.  It takes many years to become a "US Doctor" with foreign education and credentials.

Can anyone expand on this or clarify?

EnjoyIt

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Re: What comes after the ACA?
« Reply #4652 on: July 24, 2018, 09:40:39 PM »

I have a PhD and I would support legislation to make it a lot easier for people with PhDs in the exact same field as me to immigrate to the USA. We used to be able to skim off the best and brightest from the whole world, now we're trying to actively discourage that same process. *shrug*

Also, I believe the suggestion was to increase the supply of trained nurses and MDs through immigration* which would naturally cause costs to come down by ameliorating shortages that currently require different hospitals to bid against each other just to fill their critical positions. It's hard to see how increasing the number of trained nurses and MDs available in the country would lead to a worse shortage of those positions.

*Although to really do this effectively, this strategy would probably require allowing doctors from at least other first world countries to practice medicine without going through a whole second residency. This both is a big discouragement to immigration since you have to both lose social status and income for a number of years if you want to come to the USA and also means that bringing in more doctors from overseas really doesn't do anything to increase the supply, since the number of residency slots available each year is an even stronger bottleneck on the total number of new MDs produced each year than the number of medical school slots (both are capped and neither has kept up with population growth).

I'm saying that immigration alone hasn't fixed the problem, and hoping to bring down wages by bringing in foreign labor (sol's statement) isn't going to do anything to address the labor shortage problem. The US still accepts foreign Dr's and RNs and we still have a major issue. Simply taking a person from another country (Many of whom have attended school for nearly free since other places value healthcare and education as a common good) does nothing but leave a shortage in that country.

States are slowly trying to deal with the residency issue, but I agree it's too little too late. I am just appalled that in the medical field people think a labor shortage should constitute lower instead of higher wages.

Pretty sure this is wrong, unless by "accept" you mean we allow them to come here and take the USMLE, then go through residency, and then take the last phase of the USMLE.

That is my understanding as well.  In talking to a few friends that are foreign doctors, my take is that you nearly start over.  It takes many years to become a "US Doctor" with foreign education and credentials.

Can anyone expand on this or clarify?

To have a physician license in the US you must finish an US accredited internship.  To be board certified you need to finish a US accredited residency. To be fair, I have worked in residency with doctors from other countries who have come to the US to do training and it is clearly evident that not all foreign training is the same.  Some is downright pitiful. I'm sure you can understand that it is impossible for a licensing agency to accredit every residency program around the world.

katsiki

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Re: What comes after the ACA?
« Reply #4653 on: July 24, 2018, 09:45:07 PM »

That is my understanding as well.  In talking to a few friends that are foreign doctors, my take is that you nearly start over.  It takes many years to become a "US Doctor" with foreign education and credentials.

Can anyone expand on this or clarify?

To have a physician license in the US you must finish an US accredited internship.  To be board certified you need to finish a US accredited residency. To be fair, I have worked in residency with doctors from other countries who have come to the US to do training and it is clearly evident that not all foreign training is the same.  Some is downright pitiful. I'm sure you can understand that it is impossible for a licensing agency to accredit every residency program around the world.

Thanks for the response.  I agree it would be challenging.  It seems that we could setup a reciprocity program fairly easy.  ie these dozen countries are "approved".  I would imagine much (all?) of Europe and other parts of the world have good medical training.

jim555

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Re: What comes after the ACA?
« Reply #4654 on: July 25, 2018, 05:39:35 AM »
The Trump administration is resuming the ACA risk adjustment program...

https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/CMS-9920-F-7-24-18-final.pdf

chasesfish

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Re: What comes after the ACA?
« Reply #4655 on: July 25, 2018, 06:10:11 AM »
I'm going to post something positive on this thread...

United Healthcare / Anthem are seeing pretty nice earnings increases and their benefit / expense ratio is starting to decline.  This should mean ACA plans don't increase as much next year (or even decrease) and the big insurers start going back into markets they abandoned.

This matters to me because my hometown I could domicile my address in and go nomadic doesn't have a single Big 4 provider and the local network plan has some serious issues getting to see specialists.

Jrr85

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Re: What comes after the ACA?
« Reply #4656 on: July 25, 2018, 09:03:30 AM »

I have a PhD and I would support legislation to make it a lot easier for people with PhDs in the exact same field as me to immigrate to the USA. We used to be able to skim off the best and brightest from the whole world, now we're trying to actively discourage that same process. *shrug*

Also, I believe the suggestion was to increase the supply of trained nurses and MDs through immigration* which would naturally cause costs to come down by ameliorating shortages that currently require different hospitals to bid against each other just to fill their critical positions. It's hard to see how increasing the number of trained nurses and MDs available in the country would lead to a worse shortage of those positions.

*Although to really do this effectively, this strategy would probably require allowing doctors from at least other first world countries to practice medicine without going through a whole second residency. This both is a big discouragement to immigration since you have to both lose social status and income for a number of years if you want to come to the USA and also means that bringing in more doctors from overseas really doesn't do anything to increase the supply, since the number of residency slots available each year is an even stronger bottleneck on the total number of new MDs produced each year than the number of medical school slots (both are capped and neither has kept up with population growth).

I'm saying that immigration alone hasn't fixed the problem, and hoping to bring down wages by bringing in foreign labor (sol's statement) isn't going to do anything to address the labor shortage problem. The US still accepts foreign Dr's and RNs and we still have a major issue. Simply taking a person from another country (Many of whom have attended school for nearly free since other places value healthcare and education as a common good) does nothing but leave a shortage in that country.

States are slowly trying to deal with the residency issue, but I agree it's too little too late. I am just appalled that in the medical field people think a labor shortage should constitute lower instead of higher wages.

Pretty sure this is wrong, unless by "accept" you mean we allow them to come here and take the USMLE, then go through residency, and then take the last phase of the USMLE.

That is my understanding as well.  In talking to a few friends that are foreign doctors, my take is that you nearly start over.  It takes many years to become a "US Doctor" with foreign education and credentials.

Can anyone expand on this or clarify?

To have a physician license in the US you must finish an US accredited internship.  To be board certified you need to finish a US accredited residency. To be fair, I have worked in residency with doctors from other countries who have come to the US to do training and it is clearly evident that not all foreign training is the same.  Some is downright pitiful. I'm sure you can understand that it is impossible for a licensing agency to accredit every residency program around the world.

I don't think anybody is looking to let all (or maybe even any) foreign trained doctors just come in and be licensed based solely on their foreign training.  Maybe there are some countries where we can be comfortable that their doctors are adequately trained.  But surely there are a lot of countries where at the least, we can provide some sort of testing to ensure competence and not require them to just repeat training regardless of their prior level of training. 

rantk81

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Re: What comes after the ACA?
« Reply #4657 on: August 01, 2018, 12:43:26 PM »

Latest headline -

"Trump administration clears way for cheap short-term health plans to compete with Obamacare"

https://www.cnbc.com/2018/08/01/trump-clears-way-for-health-plans-to-compete-with-obamacare.html

Sounds like it's going to be legal again for health insurance companies to offer shorter term, non-comprehensive plans, with large lists of exclusions, and discriminate with respect to folks who have pre-existing conditions.

These plans will offer cheaper plans, no doubt (to folks who are healthy), but when their health is no longer so good, some of these folks will have unexpected surprises with claims being denied for excluded services or limits on coverage.  Plus, folks who use the older 'ACA Compliant' plans will probably end up having much higher premiums...

This is a big step toward dismantling the ACA, IMO.

pecunia

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Re: What comes after the ACA?
« Reply #4658 on: August 01, 2018, 04:34:12 PM »

Latest headline -

"Trump administration clears way for cheap short-term health plans to compete with Obamacare"

https://www.cnbc.com/2018/08/01/trump-clears-way-for-health-plans-to-compete-with-obamacare.html

These plans will offer cheaper plans, no doubt (to folks who are healthy), but when their health is no longer so good, some of these folks will have unexpected surprises with claims being denied for excluded services or limits on coverage.  Plus, folks who use the older 'ACA Compliant' plans will probably end up having much higher premiums...

This is a big step toward dismantling the ACA, IMO.


I can understand why the Republican Representatives are out to get Obamacare.  They are paid by their donors to do so and have hopes of retaining their seats.  The people don't really keep a keen eye to these sorts of things so they can get away with it.

I do not understand why Mr. Trump is so set against removing this program that helps many of the people who voted for him.  Is it just the nature of blue blooded aristocrats to want to make the peasants suffer?

I live in a heavy right wing area.  All of this talk about health care prompted me to go to a health care meeting put on by a doctor who will run against the incumbent GOP representative.  I was surprised that it was standing room only.  I was also surprised that there was basically no nay-sayers who were against him supporting Universal Health care.  Note - after reading many of these posts, I didn't learn a whole lot.

Some items

- The recent Koch brothers study was noted where the country will save 2 trillion dollars over ten years with universal health care.

- It was noted drug companies spend 3X more on advertising than research

- The doctor noted that even the price of standard prescriptions is going up a lot faster than inflation

- There have been recent HSA changes to make it possible to save more money for health care.  The doctor noted that many of the people he sees are in no position to contribute.

SugarMountain

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Re: What comes after the ACA?
« Reply #4659 on: August 01, 2018, 05:24:55 PM »
Interesting Twitter thread on off exchange non-ACA plans.
https://twitter.com/larry_levitt/status/1024627898848817152?s=19

chasesfish

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Re: What comes after the ACA?
« Reply #4660 on: August 01, 2018, 06:15:56 PM »
Interesting Twitter thread on off exchange non-ACA plans.
https://twitter.com/larry_levitt/status/1024627898848817152?s=19

That was a great read.  There are pros and cons to having another option instead of just the Health Sharing Ministries, which are already doing the Cherry Picking

rantk81

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Re: What comes after the ACA?
« Reply #4661 on: August 01, 2018, 06:30:48 PM »
Editorial Comment:  I'm not looking forward to potentially going back to a "system" in this country whereby if you have a pre-existing condition, and do not have access to an employer-sponsored/group-plan, essentially being told "shell out almost all of the cost of it out of your pocket, or else go get fucked and die."
« Last Edit: August 01, 2018, 06:35:14 PM by rantk81 »

sol

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Re: What comes after the ACA?
« Reply #4662 on: August 01, 2018, 08:24:08 PM »
go get fucked and die.

This is a great GOP campaign slogan for 2020.  It's really only a minor modification of "repeal and replace".

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4663 on: August 07, 2018, 07:12:27 AM »
Here's clownish behavior from health insurer Anthem Blue Cross and Blue Shield

"It wasn’t until after the second round of treatment that Brough’s oncologist informed her Anthem wasn’t covering the injections, sticking her with the staggering cost of $7,000 for each shot.
As if that weren’t devastating enough, Anthem’s reasoning was downright absurd.
Yes, the drug had been pre-approved, but only if Brough bought it herself through the online pharmacy Express Scripts, and only if she gave herself the shots.
“It just made no sense,” Darrell Brough, Michele’s husband, told me. “They covered everything else, all the drugs, all the doctor’s visits. But not this?”
There was nothing in Anthem’s approval letter that said anything about buying it exclusively from Express Scripts or handling your own shots."

http://www.latimes.com/business/lazarus/la-fi-lazarus-cancer-chemo-insurance-denial-20180807-story.html

And here's the way things should work:

"We think that Medicaid expansion is helping to provide medications for people with diabetes, especially early stage diabetes," said study author Rebecca Myerson.
"Medicaid expansion also appears to help increase access to newer medications, ensuring all patients have access to the same quality of medications," she added

https://www.upi.com/Health_News/2018/08/06/Access-to-diabetes-drugs-improved-under-Affordable-Care-Act-Study/2691533605145/

SugarMountain

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Re: What comes after the ACA?
« Reply #4664 on: August 07, 2018, 01:50:15 PM »
I've been looking at various options for healthcare post FIRE and posted it on my journal. I thought it made sense to post it here. Since it's not clear what will be there post ACA, this just looks at things available today.  They are based on a 51 y.o. couple in Denver.

----------
Rather than just whining about the healthcare situation, I figured I'd actually do a little research and throwdown some numbers.

Option 1: ACA Plan (2018 numbers, I thought I had seen 2019, but maybe not)
Cigna Bronze: $961.14 per month for the two of us
Deductible: $6700 per person
Max cost: $7,350 per person
EPO only no coverage out of network
$50 PCP visits
50% coinsurance after deductible (which is kind of hilarious, you're only in the co-insurance phase from $6700 to $7,350)

I checked what this would be if we were 10 years older and it's $1450/month.  Everything else is the same.  If we're 5 years older, its ~$1100/month.

A Silver plan is available for $200 more/month, deductible is $4,000 per person and copay is 30% after deductible is hit.  If we end up in the $5k-6k spending window this might be a slightly better option.  I think we'd go bronze.

Option 2: "Short term" plans
---------
This is the new workaround to the ACA that I mentioned previously.  You can now get 1 year "short term" plans and that is extending to 3 years next year.  Except, it turns out, not in Colorado.  Here, plans are limited to 6 months.  You can "renew", but that is restarting on essentially a new plan, so if you get sick in the first 6 months you might get rejected in the 2nd due to "pre-existing conditions", or if treatment is ongoing you are probably screwed.  This makes it somewhat of a non-starter for me. 

Option 3: Ministry Health Sharing
----------
I looked at the details of Liberty (https://www.libertyhealthshare.org/content/sharing-guidelines.pdf.)

The good:
$135 annual dues, $400/month "sharing cost", $24 monthly admin fee, $1750 deductible for a couple, $1 MM per incident (maybe, see below). 

The bad:
- Need to sign paperwork that says you're religious
- You get checks from other members when you are getting paid.  That means you can get a bunch of checks and you need to track it.  It's not clear what happens if a member doesn't pay (other than they get kicked out, but it's not clear if you would still get paid).
- Trips to the ER are not covered if it's not an emergency.  I read some reports of issues where someone thinks they're having a heart attack.  Turns out it was a panic attack, so it wasn't an emergency and it's not covered.  Same with ambulance coverage if it turns out it wasn't a life threatening situation.
- Injuries due to "hazardous" activity. An activity is hazardous if it is an activity which is characterized by a constant or recurring threat of danger or risk of bodily harm. Examples of hazardous hobbies include, but are not limited to, rock/cliff climbing, spelunking, skydiving, or bungee jumping.  Note the "not limited to".  This seems like another big hole where they decide whether to cover it after the issue. Skiing? Hiking in the mountains? Riding an ATV?
- Pre-existing conditions are not covered initially.  Some coverage after 3 months, full coverage after 37 months...maybe.  They can request a permanent waiver that basically says nothing related to the pre-existing condition or any side effects due to treatment are ever covered.
- The cost per month is actually variable.  They can raise it at any time with 60 days notice.
- Similarly the payouts are variable.  If they have a period of time where outgoing payments are too big, they basically ration the coverage. 

So I think this is probably out.  I'm just not that comfortable with the gaps and how it works.

Option 4: This is actually a new one I thought of yesterday.  The local colleges offer (actually force you to buy) health insurance.  It's super cheap, $2200 per person for great coverage.  Basically no deductibles or copays.  You have to be registered for at least 6 credit hours per semester, which costs $2800 for residents.  It's not clear if you can buy coverage for a spouse.  If you can, this might be a great stopgap for certain phases.  I've thought about taking classes as something I might do in retirement anyway.

Option 5: Portugal Golden Visa.

Buy real estate for 500k+ Euros and you can get a 1 year residency visa, which is renewable. $5k to get the visa, $2k renewal.  After 5 years you can get a permanent visa.

Being a resident will get you access to Portugal's NHS.  You can also buy private insurance. 

Greece and Spain have similar programs.
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Exflyboy

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Re: What comes after the ACA?
« Reply #4665 on: August 07, 2018, 02:40:16 PM »
The ACA plans have effectively zero out of network coverage for emergency care despite what they claim.. Big minus, but if you can manipulate your income down you can get them cheap on a bronze plan.

This issue probably comes up with employer based plans as well.. i.e not limited to just the ACA.

Mr. Green

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Re: What comes after the ACA?
« Reply #4666 on: August 07, 2018, 03:20:17 PM »
The ACA plans have effectively zero out of network coverage for emergency care despite what they claim.. Big minus, but if you can manipulate your income down you can get them cheap on a bronze plan.

This issue probably comes up with employer based plans as well.. i.e not limited to just the ACA.
Something I've just confirmed, specifically to Blue Cross Blue Shield insurance is that we can go anywhere in any state that is in network for the local BCBS organization and it's treated as in network for our insurance. This is a HUGE relief to me, as we plan to travel a lot and  BCBS has networks all over the country. I've already used my North Carolina based insurance in Maryland and paid the in network $20 copay for a specialist visit. I would recommend everyone verify this is the case with their own local BCBS insurance if it's available but this is a big plus for choosing a BCBS plan IMO.

Exflyboy

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Re: What comes after the ACA?
« Reply #4667 on: August 07, 2018, 03:26:26 PM »
absolutely it is.

We have effectively kyboshed any US road travel/vacations due to this issue. Sadly BCBS is not available to us in our area.

Paul der Krake

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Re: What comes after the ACA?
« Reply #4668 on: August 07, 2018, 03:52:03 PM »
absolutely it is.

We have effectively kyboshed any US road travel/vacations due to this issue. Sadly BCBS is not available to us in our area.
Time to get on I-5 of your socialist hellhole that is the People's Republic of Hurrrgyn. Drive north to Washington, where  insurance markets are more expansive, taxes more regressive, and generally further away from California.

DreamFIRE

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Re: What comes after the ACA?
« Reply #4669 on: August 07, 2018, 04:16:12 PM »
The ACA plans have effectively zero out of network coverage for emergency care despite what they claim.. Big minus, but if you can manipulate your income down you can get them cheap on a bronze plan.

This issue probably comes up with employer based plans as well.. i.e not limited to just the ACA.
Something I've just confirmed, specifically to Blue Cross Blue Shield insurance is that we can go anywhere in any state that is in network for the local BCBS organization and it's treated as in network for our insurance. This is a HUGE relief to me, as we plan to travel a lot and  BCBS has networks all over the country. I've already used my North Carolina based insurance in Maryland and paid the in network $20 copay for a specialist visit. I would recommend everyone verify this is the case with their own local BCBS insurance if it's available but this is a big plus for choosing a BCBS plan IMO.

There's one BCBS silver plan listed for my location.  It's a PPO while the other insurer is an HMO.  I don't know about cross country coverage, though.  I'm still about a year out, at a minimum, before I have to make a decision on healthcare.

Edit:  The BCBS plan also shows 30%-50% coverage (after deductible) for various out of network services where my other insurer simply says not covered except for emergency care.
« Last Edit: August 07, 2018, 08:03:02 PM by DreamFIRE »

Exflyboy

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Re: What comes after the ACA?
« Reply #4670 on: August 07, 2018, 04:21:56 PM »
absolutely it is.

We have effectively kyboshed any US road travel/vacations due to this issue. Sadly BCBS is not available to us in our area.
Time to get on I-5 of your socialist hellhole that is the People's Republic of Hurrrgyn. Drive north to Washington, where  insurance markets are more expansive, taxes more regressive, and generally further away from California.

hmm.. 9% State income tax feels pretty darned regressive to me.. Mind you our weather is better compared to Puget Sound..:)

Monkey Uncle

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Re: What comes after the ACA?
« Reply #4671 on: August 07, 2018, 06:55:08 PM »
The ACA plans have effectively zero out of network coverage for emergency care despite what they claim.. Big minus, but if you can manipulate your income down you can get them cheap on a bronze plan.

This issue probably comes up with employer based plans as well.. i.e not limited to just the ACA.
Something I've just confirmed, specifically to Blue Cross Blue Shield insurance is that we can go anywhere in any state that is in network for the local BCBS organization and it's treated as in network for our insurance. This is a HUGE relief to me, as we plan to travel a lot and  BCBS has networks all over the country. I've already used my North Carolina based insurance in Maryland and paid the in network $20 copay for a specialist visit. I would recommend everyone verify this is the case with their own local BCBS insurance if it's available but this is a big plus for choosing a BCBS plan IMO.

Same here.  Although technically it is treated as if you were in the "away" network, not in-network for your own plan (or at least that's the way mine is worded).  So if I get sick in Montana, I pay whatever the BCBS insureds in Montana are paying for in-network care, not what BCBS insureds in my home state are paying.  Not sure if it makes any real difference; I guess I'd have to get sick while traveling to really find out how it works.  But I'm sure it's a hell of a lot better than getting balance-billed under some other plan that offers no out of network coverage outside the plan area.

EnjoyIt

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Re: What comes after the ACA?
« Reply #4672 on: August 07, 2018, 07:07:46 PM »
The ACA plans have effectively zero out of network coverage for emergency care despite what they claim.. Big minus, but if you can manipulate your income down you can get them cheap on a bronze plan.

This issue probably comes up with employer based plans as well.. i.e not limited to just the ACA.
Something I've just confirmed, specifically to Blue Cross Blue Shield insurance is that we can go anywhere in any state that is in network for the local BCBS organization and it's treated as in network for our insurance. This is a HUGE relief to me, as we plan to travel a lot and  BCBS has networks all over the country. I've already used my North Carolina based insurance in Maryland and paid the in network $20 copay for a specialist visit. I would recommend everyone verify this is the case with their own local BCBS insurance if it's available but this is a big plus for choosing a BCBS plan IMO.

Same here.  Although technically it is treated as if you were in the "away" network, not in-network for your own plan (or at least that's the way mine is worded).  So if I get sick in Montana, I pay whatever the BCBS insureds in Montana are paying for in-network care, not what BCBS insureds in my home state are paying.  Not sure if it makes any real difference; I guess I'd have to get sick while traveling to really find out how it works.  But I'm sure it's a hell of a lot better than getting balance-billed under some other plan that offers no out of network coverage outside the plan area.

The same procedure will be reimbursed differently across state lines.  I believe it may even be different in different counties of the same state but I am not sure about that.

Paul der Krake

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Re: What comes after the ACA?
« Reply #4673 on: August 07, 2018, 07:10:41 PM »
Kaiser, another large west coast insurer, says go where you gotta go in an emergency, but you must notify us within 24 hours of admission, and we will work with whoever you end up to stabilize you before making you go to one of our own hospitals where we know what's going on. Sounds reasonable to me.

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Re: What comes after the ACA?
« Reply #4674 on: August 07, 2018, 07:23:35 PM »
Kaiser, another large west coast insurer, says go where you gotta go in an emergency, but you must notify us within 24 hours of admission, and we will work with whoever you end up to stabilize you before making you go to one of our own hospitals where we know what's going on. Sounds reasonable to me.

Interesting.  Will they offer ambulance transport?  What if you are hundreds of miles away from a Kaiser facility?

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Re: What comes after the ACA?
« Reply #4675 on: August 07, 2018, 07:43:29 PM »
Kaiser, another large west coast insurer, says go where you gotta go in an emergency, but you must notify us within 24 hours of admission, and we will work with whoever you end up to stabilize you before making you go to one of our own hospitals where we know what's going on. Sounds reasonable to me.

Interesting.  Will they offer ambulance transport?  What if you are hundreds of miles away from a Kaiser facility?
The way it is worded suggests that they will do what makes the most sense based on your state. I can't see them requiring you to be flown back to, say, California, if you're hanging on for dear life after being trampled by a moose in Maine. Depending on the specific circumstances they may arrange for transportation once stabilized, or just deal with the out-of-network provider directly.

Exflyboy

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Re: What comes after the ACA?
« Reply #4676 on: August 07, 2018, 08:01:08 PM »
Kaiser, another large west coast insurer, says go where you gotta go in an emergency, but you must notify us within 24 hours of admission, and we will work with whoever you end up to stabilize you before making you go to one of our own hospitals where we know what's going on. Sounds reasonable to me.

Interesting.  Will they offer ambulance transport?  What if you are hundreds of miles away from a Kaiser facility?
The way it is worded suggests that they will do what makes the most sense based on your state. I can't see them requiring you to be flown back to, say, California, if you're hanging on for dear life after being trampled by a moose in Maine. Depending on the specific circumstances they may arrange for transportation once stabilized, or just deal with the out-of-network provider directly.

What do they care if they are only going to pay what they will for an in-network facility?.. You're going to be balance billed for the rest..

Paul der Krake

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Re: What comes after the ACA?
« Reply #4677 on: August 07, 2018, 08:27:51 PM »
Kaiser, another large west coast insurer, says go where you gotta go in an emergency, but you must notify us within 24 hours of admission, and we will work with whoever you end up to stabilize you before making you go to one of our own hospitals where we know what's going on. Sounds reasonable to me.

Interesting.  Will they offer ambulance transport?  What if you are hundreds of miles away from a Kaiser facility?
The way it is worded suggests that they will do what makes the most sense based on your state. I can't see them requiring you to be flown back to, say, California, if you're hanging on for dear life after being trampled by a moose in Maine. Depending on the specific circumstances they may arrange for transportation once stabilized, or just deal with the out-of-network provider directly.

What do they care if they are only going to pay what they will for an in-network facility?.. You're going to be balance billed for the rest..
So you're always at risk of being balance-billed every time you go out of network, right? That sucks, no way around it.

Here is what you have going for you though:
- Kaiser actively works with the hospital to either be informed of the next steps, or work toward getting you somewhere where they have a better control of the costs. Maybe it's not even to one of their facilities, but to a hospital with less shitty billing practices.
- It's emergency, which means they will pay something. Now this may not be as much as the out of network hospital would like, but if it goes to arbitration or even court, you can just be like "they paid for something that resembles normal prices, if you don't agree show us what in-network providers pay for these procedures", and voila you have numbers to work with for further negotiation.
- It's medical billing, which is a complete scam, but you can pretend to make progress towards your bills. Worst case scenario, you pay the fuckers $20/month until you die to prevent it from going to collections.

Or maybe I'm just naively optimistic about the whole thing.

Monkey Uncle

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Re: What comes after the ACA?
« Reply #4678 on: August 08, 2018, 05:05:24 AM »
So you're always at risk of being balance-billed every time you go out of network, right? That sucks, no way around it.

It's been discussed in this thread before, but it bears repeating: balance billing is a risk with virtually all insurance plans in the U.S., not just ACA insurance.

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Re: What comes after the ACA?
« Reply #4679 on: August 08, 2018, 10:45:01 AM »
DH likes to go off hiking with buddies in the wild wilderness mountains far far from home. Ever since I read a scary thread on this forum about the aftermath of billing for one of our own MMM members who was helicoptered out after a bad accident, DH has been purchasing a travel insurance policy for US travel that includes med-evac.  He buys them from, I think, AAA before he heads out for each 10-day-long jaunt. Since mountains are far away from the southern swamps, he only gets to do this maybe twice a year. The policies  are surprisingly affordable at around $30. Anyway, they also include a chunk of general medical coverage as well. We have narrow network ACA insurance with emergency-only out of network coverage.  I have been toying with the idea of getting one of these for each of us before going on future out of state road trips.  Has anyone used these/researched them? @Exflyboy maybe spending some money on these might be better than never doing a US road trip.
« Last Edit: August 08, 2018, 10:46:33 AM by GillyMack »

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Re: What comes after the ACA?
« Reply #4680 on: August 08, 2018, 10:49:29 AM »
DH likes to go off hiking with buddies in the wild wilderness mountains far far from home. Ever since I read a scary thread on this forum about the aftermath of billing for one of our own MMM members who was helicoptered out after a bad accident, DH has been purchasing a travel insurance policy for US travel that includes med-evac.  He buys them from, I think, AAA before he heads out for each 10-day-long jaunt. Since mountains are far away from the southern swamps, he only gets to do this maybe twice a year. The policies  are surprisingly affordable at around $30. Anyway, they also include a chunk of general medical coverage as well. We have narrow network ACA insurance with emergency-only out of network coverage.  I have been toying with the idea of getting one of these for each of us before going on future out of state road trips.  Has anyone used these/researched them? @Exflyboy maybe spending some money on these might be better than never doing a US road trip.

If the mountains are in Colorado, hunting and fishing licenses come with search & rescue insurance, so that's another cheap way to get insured for that.

Exflyboy

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Re: What comes after the ACA?
« Reply #4681 on: August 08, 2018, 10:50:51 AM »
DH likes to go off hiking with buddies in the wild wilderness mountains far far from home. Ever since I read a scary thread on this forum about the aftermath of billing for one of our own MMM members who was helicoptered out after a bad accident, DH has been purchasing a travel insurance policy for US travel that includes med-evac.  He buys them from, I think, AAA before he heads out for each 10-day-long jaunt. Since mountains are far away from the southern swamps, he only gets to do this maybe twice a year. The policies  are surprisingly affordable at around $30. Anyway, they also include a chunk of general medical coverage as well. We have narrow network ACA insurance with emergency-only out of network coverage.  I have been toying with the idea of getting one of these for each of us before going on future out of state road trips.  Has anyone used these/researched them? @Exflyboy maybe spending some money on these might be better than never doing a US road trip.

At $30 I'd buy that in a heartbeat, providing they actually give you some actual coverage.

Do you have a link??

Exflyboy

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Re: What comes after the ACA?
« Reply #4682 on: August 08, 2018, 10:54:15 AM »
Kaiser, another large west coast insurer, says go where you gotta go in an emergency, but you must notify us within 24 hours of admission, and we will work with whoever you end up to stabilize you before making you go to one of our own hospitals where we know what's going on. Sounds reasonable to me.

Interesting.  Will they offer ambulance transport?  What if you are hundreds of miles away from a Kaiser facility?
The way it is worded suggests that they will do what makes the most sense based on your state. I can't see them requiring you to be flown back to, say, California, if you're hanging on for dear life after being trampled by a moose in Maine. Depending on the specific circumstances they may arrange for transportation once stabilized, or just deal with the out-of-network provider directly.

What do they care if they are only going to pay what they will for an in-network facility?.. You're going to be balance billed for the rest..
So you're always at risk of being balance-billed every time you go out of network, right? That sucks, no way around it.

Here is what you have going for you though:
- Kaiser actively works with the hospital to either be informed of the next steps, or work toward getting you somewhere where they have a better control of the costs. Maybe it's not even to one of their facilities, but to a hospital with less shitty billing practices.
- It's emergency, which means they will pay something. Now this may not be as much as the out of network hospital would like, but if it goes to arbitration or even court, you can just be like "they paid for something that resembles normal prices, if you don't agree show us what in-network providers pay for these procedures", and voila you have numbers to work with for further negotiation.
- It's medical billing, which is a complete scam, but you can pretend to make progress towards your bills. Worst case scenario, you pay the fuckers $20/month until you die to prevent it from going to collections.

Or maybe I'm just naively optimistic about the whole thing.

More like you'll get sued and when they find out you're worth over a million $ outside your retirement accounts you'll get your assets seized.

GillyMack

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Re: What comes after the ACA?
« Reply #4683 on: August 08, 2018, 12:40:57 PM »
@Exflyboy , Here is a link https://www.autoclubmo.aaa.com/travel/travel-insurance.html

The little brochure I have says $500,000 emergency med transportation, $25,000 Emergency medical and dental with no deductible.  Existing conditions covered if you buy insurance within 14 days of making trip reservation.  There may be other policies out there that have something different.  I know there are different prices.

@SugarMountain - that's interesting about Colorado Search and Rescue.  Will pass the info along.  This summer, they're in Idaho, I believe.


Exflyboy

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Re: What comes after the ACA?
« Reply #4684 on: August 08, 2018, 01:57:10 PM »
Thankyou.. I will check that out

SugarMountain

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Re: What comes after the ACA?
« Reply #4685 on: August 08, 2018, 02:14:44 PM »

@SugarMountain - that's interesting about Colorado Search and Rescue.  Will pass the info along.  This summer, they're in Idaho, I believe.

Interestingly, it doesn't cover as much as I thought, i.e. medical transport doesn't look like it's covered.
https://cpw.state.co.us/Documents/Boating/SearchAndRescueFAQ.pdf

Exflyboy

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Re: What comes after the ACA?
« Reply #4686 on: August 08, 2018, 07:13:21 PM »
I found what appears to be an amazing deal for medical coverage for our trip to Eastern Europe. $54 for BOTH of us (56 and 53). Includes $1M in emergency evacuation and $50k in medical. Runs for about 6 weeks of travel.

Most other policies were in the $200 range.

It is underwritten by Berkshire Hathaway

https://www.bhtp.com/

EnjoyIt

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Re: What comes after the ACA?
« Reply #4687 on: August 08, 2018, 11:24:04 PM »
I found what appears to be an amazing deal for medical coverage for our trip to Eastern Europe. $54 for BOTH of us (56 and 53). Includes $1M in emergency evacuation and $50k in medical. Runs for about 6 weeks of travel.

Most other policies were in the $200 range.

It is underwritten by Berkshire Hathaway

https://www.bhtp.com/

Nice, thanks for sharing the info.

Every now and again this ridiculous thread has some real useful info.

Mr. Green

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Re: What comes after the ACA?
« Reply #4688 on: August 09, 2018, 09:00:39 AM »
I found what appears to be an amazing deal for medical coverage for our trip to Eastern Europe. $54 for BOTH of us (56 and 53). Includes $1M in emergency evacuation and $50k in medical. Runs for about 6 weeks of travel.

Most other policies were in the $200 range.

It is underwritten by Berkshire Hathaway

https://www.bhtp.com/

Nice, thanks for sharing the info.

Every now and again this ridiculous thread has some real useful info.
Ditto! I bookmarked their website for future use.

Exflyboy

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Re: What comes after the ACA?
« Reply #4689 on: August 09, 2018, 09:09:09 AM »
Note the standard policy comes with a $25k medical and $0.5M emergency evacuation.

The higher coverages you have have to select but its only $12 difference.

Candace

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Re: What comes after the ACA?
« Reply #4690 on: August 09, 2018, 09:23:11 AM »
I found what appears to be an amazing deal for medical coverage for our trip to Eastern Europe. $54 for BOTH of us (56 and 53). Includes $1M in emergency evacuation and $50k in medical. Runs for about 6 weeks of travel.

Most other policies were in the $200 range.

It is underwritten by Berkshire Hathaway

https://www.bhtp.com/

Nice, thanks for sharing the info.

Every now and again this ridiculous thread has some real useful info.
Ditto! I bookmarked their website for future use.
+1 Thank you Exflyboy!

swampwiz

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Re: What comes after the ACA?
« Reply #4691 on: August 09, 2018, 05:05:38 PM »
Kaiser, another large west coast insurer, says go where you gotta go in an emergency, but you must notify us within 24 hours of admission, and we will work with whoever you end up to stabilize you before making you go to one of our own hospitals where we know what's going on. Sounds reasonable to me.

Interesting.  Will they offer ambulance transport?  What if you are hundreds of miles away from a Kaiser facility?
The way it is worded suggests that they will do what makes the most sense based on your state. I can't see them requiring you to be flown back to, say, California, if you're hanging on for dear life after being trampled by a moose in Maine. Depending on the specific circumstances they may arrange for transportation once stabilized, or just deal with the out-of-network provider directly.

What do they care if they are only going to pay what they will for an in-network facility?.. You're going to be balance billed for the rest..
So you're always at risk of being balance-billed every time you go out of network, right? That sucks, no way around it.

Here is what you have going for you though:
- Kaiser actively works with the hospital to either be informed of the next steps, or work toward getting you somewhere where they have a better control of the costs. Maybe it's not even to one of their facilities, but to a hospital with less shitty billing practices.
- It's emergency, which means they will pay something. Now this may not be as much as the out of network hospital would like, but if it goes to arbitration or even court, you can just be like "they paid for something that resembles normal prices, if you don't agree show us what in-network providers pay for these procedures", and voila you have numbers to work with for further negotiation.
- It's medical billing, which is a complete scam, but you can pretend to make progress towards your bills. Worst case scenario, you pay the fuckers $20/month until you die to prevent it from going to collections.

Or maybe I'm just naively optimistic about the whole thing.

More like you'll get sued and when they find out you're worth over a million $ outside your retirement accounts you'll get your assets seized.

Yet another reason to always keep oneself in an easily bankruptable financial condition.  Oh, $20K for my 1 hour at your emergency room?  Tell it to the Trustee!

DreamFIRE

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Re: What comes after the ACA?
« Reply #4692 on: August 09, 2018, 08:15:24 PM »
More like you'll get sued and when they find out you're worth over a million $ outside your retirement accounts you'll get your assets seized.

Yet another reason to always keep oneself in an easily bankruptable financial condition.  Oh, $20K for my 1 hour at your emergency room?  Tell it to the Trustee!

Over half of my stash is in taxed brokerage accounts.  An annuity can provide some of the same protections as a 401K or IRA depending on the state, but not in my state.  Fortunately, the balance billing protections are among the better ones in my state.

Paul der Krake

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Re: What comes after the ACA?
« Reply #4693 on: August 09, 2018, 08:42:12 PM »
Of interest to lazy immigrants like your truly planning on using the ACA:

https://www.nbcnews.com/politics/immigration/now-trump-administration-wants-limit-citizenship-legal-immigrants-n897931

My guess is that the rule will look at the amount of subsidies received. I used the ACA in 2014 but didn't receive any, so it's probably a-okay with them? We'll see when I apply for naturalization next year.

Exflyboy

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Re: What comes after the ACA?
« Reply #4694 on: August 09, 2018, 09:31:30 PM »
Of interest to lazy immigrants like your truly planning on using the ACA:

https://www.nbcnews.com/politics/immigration/now-trump-administration-wants-limit-citizenship-legal-immigrants-n897931

My guess is that the rule will look at the amount of subsidies received. I used the ACA in 2014 but didn't receive any, so it's probably a-okay with them? We'll see when I apply for naturalization next year.

This is EXACTLY the sort of draconian measure that persuaded me to go get my citizenship! And yes I did receive benefits while a lowly green card holder.

Bateaux

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Re: What comes after the ACA?
« Reply #4695 on: August 09, 2018, 09:58:23 PM »
@Exflyboy , Here is a link https://www.autoclubmo.aaa.com/travel/travel-insurance.html

The little brochure I have says $500,000 emergency med transportation, $25,000 Emergency medical and dental with no deductible.  Existing conditions covered if you buy insurance within 14 days of making trip reservation.  There may be other policies out there that have something different.  I know there are different prices.

@SugarMountain - that's interesting about Colorado Search and Rescue.  Will pass the info along.  This summer, they're in Idaho, I believe.

I'm a southern swamp dweller who also gets out to the mountains for backpacking on occasion.  I've purchased a Colorado fishing license in winter just for the evac policy.

rantk81

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Re: What comes after the ACA?
« Reply #4696 on: August 10, 2018, 07:22:47 AM »
Of interest to lazy immigrants like your truly planning on using the ACA:

https://www.nbcnews.com/politics/immigration/now-trump-administration-wants-limit-citizenship-legal-immigrants-n897931

My guess is that the rule will look at the amount of subsidies received. I used the ACA in 2014 but didn't receive any, so it's probably a-okay with them? We'll see when I apply for naturalization next year.

I'm just hoping that someone else gets elected in 2020, and whoever that is, has been keeping an itemized list of everything that has been done by the current administration, so it can be undone in short order.

EnjoyIt

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Re: What comes after the ACA?
« Reply #4697 on: August 10, 2018, 07:54:43 AM »
As of today unemployment is low and the market is way up. Unless the market tanks between now and election time, history dictates that Trump will have a 2nd term.  Frankly the last 18 months have been very positive for most of the staches on this forum.

geekette

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Re: What comes after the ACA?
« Reply #4698 on: August 10, 2018, 08:04:06 AM »
As of today unemployment is low and the market is way up. Unless the market tanks between now and election time, history dictates that Trump will have a 2nd term.  Frankly the last 18 months have been very positive for most of the staches on this forum.
The size of my stache isn't the most important thing to me. 

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4699 on: August 10, 2018, 08:40:05 AM »
Size your stashe won't match up to an ineffective health insurance plan in which the plan capriciously decides not to pay for your cancer treatments (substitute whatever illness might strike you).