Author Topic: What comes after the ACA?  (Read 857280 times)

DreamFIRE

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Re: What comes after the ACA?
« Reply #5200 on: December 30, 2018, 09:03:06 AM »
I think as far as surgery and approved treatments, Medicare is good. It is when they can't diagnose the problem quickly and a hospital stay for a person who isn't actually dying, they want that person out. They are very afraid the person will meet the requirements of the three night stay which will allow nursing care for rehab in a nursing facility. The time limit is 100 days but the person has to show continued improvement in the facility or they will cut that off too! During that stay in the rehab, they monitor the patient and report back to Medicare on I assume a weekly basis. Then they meet with the patient and relative to discuss their stay and improvement or no improvement. Once no improvement is established, you need to decide what to do with the patient. If they need nursing care you have to decide to bring them home, put them in the nursing home. Medicare doesn't cover anything after that except doctors, treatments, surgeries. Nursing home care is 100% at the cost of the patient. 5 years ago my Mom was in a nursing home in rehab. She didn't improve and we were facing what to do. The cost per month back then was $12,000 per month. She passed before we had to decide what to do.

Yeah, I've experienced the same thing with family.  And Medicare doesn't pay healthcare facilities enough for what they do cover, either.  It's crazy how they will literally put people out on the street to avoid additional coverage.  What a way to cut costs!

Threshkin

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Re: What comes after the ACA?
« Reply #5201 on: December 30, 2018, 09:43:07 AM »
I think as far as surgery and approved treatments, Medicare is good. It is when they can't diagnose the problem quickly and a hospital stay for a person who isn't actually dying, they want that person out. They are very afraid the person will meet the requirements of the three night stay which will allow nursing care for rehab in a nursing facility. The time limit is 100 days but the person has to show continued improvement in the facility or they will cut that off too! During that stay in the rehab, they monitor the patient and report back to Medicare on I assume a weekly basis. Then they meet with the patient and relative to discuss their stay and improvement or no improvement. Once no improvement is established, you need to decide what to do with the patient. If they need nursing care you have to decide to bring them home, put them in the nursing home. Medicare doesn't cover anything after that except doctors, treatments, surgeries. Nursing home care is 100% at the cost of the patient. 5 years ago my Mom was in a nursing home in rehab. She didn't improve and we were facing what to do. The cost per month back then was $12,000 per month. She passed before we had to decide what to do.

Yeah, I've experienced the same thing with family.  And Medicare doesn't pay healthcare facilities enough for what they do cover, either.  It's crazy how they will literally put people out on the street to avoid additional coverage.  What a way to cut costs!

My mom was in a nursing home for two years before she passed.  At about $8,500 per month it completely decimated her savings.  Once her assets dropped below $2,000 she was able to go on Medicaid which does help pay for nursing home expenses (if the home takes Medicaid, check!).  Unfortunately my mom passed two weeks after being approved for Medicaid so they paid nothing.

JLee

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Re: What comes after the ACA?
« Reply #5202 on: December 30, 2018, 09:52:14 AM »
Medicare A is only for hospitalization. So unless you plan to go to the hospital a lot, Medicare A is not going to help you as far as doctor bills. Also, hospitals try not to ever admit you and keep you on observation status. You need to be ADMITTED in the hospital 3 nights to be transferred to a rehab facility. If you are not admitted 3 nights, they will NOT pay for you to go to rehab or a nursing facility. It is a nightmare. I went thru this with my Mom and they want to throw people into the street rather than keep them in the hospital. Medicare rules.

Medicare B is for doctor appointments and tests. That costs as of 2019 $135.50 a month per person.

Medicare D, prescription drugs costs anywhere from $35 to $72ish per month. The less you pay the higher deductibles you pay. So, I pay $72 per mo. and have no deductibles, HOWEVER, some of my drugs are on the odd ball list and I have to pay around $35 per mo. on top of the $72 a month.

Part B has a $185 deductible per year per person.

If you go to the hospital, the deductible for Part A Medicare is $1,364 per year and if you are admitted more than one time it could be another $1,364 within some time frame.

Medicare pays 80% you pay 20% if you don't have a supplement.

It is NOT cheap. I have a supplement which pays for Part A and Part B deductibles plus the 20% but I pay thru the nose for the supplement.

There are Medicare Advantage plans which are cheaper but I am sure, you will pay thru the nose somehow.

So bottom line, if people think Medicare for all is going to be affordable, I want it too!

My health insurance is $718/mo (employer contribution + my contribution) and I have a $1350 deductible / out of pocket max.

$207.50/mo with a $185 deductible sounds pretty cheap to me!

Roadrunner53

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Re: What comes after the ACA?
« Reply #5203 on: December 30, 2018, 10:15:30 AM »
Medicare A is only for hospitalization. So unless you plan to go to the hospital a lot, Medicare A is not going to help you as far as doctor bills. Also, hospitals try not to ever admit you and keep you on observation status. You need to be ADMITTED in the hospital 3 nights to be transferred to a rehab facility. If you are not admitted 3 nights, they will NOT pay for you to go to rehab or a nursing facility. It is a nightmare. I went thru this with my Mom and they want to throw people into the street rather than keep them in the hospital. Medicare rules.

Medicare B is for doctor appointments and tests. That costs as of 2019 $135.50 a month per person.

Medicare D, prescription drugs costs anywhere from $35 to $72ish per month. The less you pay the higher deductibles you pay. So, I pay $72 per mo. and have no deductibles, HOWEVER, some of my drugs are on the odd ball list and I have to pay around $35 per mo. on top of the $72 a month.

Part B has a $185 deductible per year per person.

If you go to the hospital, the deductible for Part A Medicare is $1,364 per year and if you are admitted more than one time it could be another $1,364 within some time frame.

Medicare pays 80% you pay 20% if you don't have a supplement.

It is NOT cheap. I have a supplement which pays for Part A and Part B deductibles plus the 20% but I pay thru the nose for the supplement.

There are Medicare Advantage plans which are cheaper but I am sure, you will pay thru the nose somehow.

So bottom line, if people think Medicare for all is going to be affordable, I want it too!

My health insurance is $718/mo (employer contribution + my contribution) and I have a $1350 deductible / out of pocket max.

$207.50/mo with a $185 deductible sounds pretty cheap to me!

Yes, it would be cheap, however, I buy a Medicare supplement that costs $248.75 a month on top of $207.50. That brings it to $456.25 and then the spouse has the same coverage so multiply that by 2 you are talking $912.50 a month. Multiplied by 12 months is $10,950 a year. Quite the bargain.

DreamFIRE

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Re: What comes after the ACA?
« Reply #5204 on: December 30, 2018, 10:42:26 AM »
Medicare A is only for hospitalization. So unless you plan to go to the hospital a lot, Medicare A is not going to help you as far as doctor bills. Also, hospitals try not to ever admit you and keep you on observation status. You need to be ADMITTED in the hospital 3 nights to be transferred to a rehab facility. If you are not admitted 3 nights, they will NOT pay for you to go to rehab or a nursing facility. It is a nightmare. I went thru this with my Mom and they want to throw people into the street rather than keep them in the hospital. Medicare rules.

Medicare B is for doctor appointments and tests. That costs as of 2019 $135.50 a month per person.

Medicare D, prescription drugs costs anywhere from $35 to $72ish per month. The less you pay the higher deductibles you pay. So, I pay $72 per mo. and have no deductibles, HOWEVER, some of my drugs are on the odd ball list and I have to pay around $35 per mo. on top of the $72 a month.

Part B has a $185 deductible per year per person.

If you go to the hospital, the deductible for Part A Medicare is $1,364 per year and if you are admitted more than one time it could be another $1,364 within some time frame.

Medicare pays 80% you pay 20% if you don't have a supplement.

It is NOT cheap. I have a supplement which pays for Part A and Part B deductibles plus the 20% but I pay thru the nose for the supplement.

There are Medicare Advantage plans which are cheaper but I am sure, you will pay thru the nose somehow.

So bottom line, if people think Medicare for all is going to be affordable, I want it too!

My health insurance is $718/mo (employer contribution + my contribution) and I have a $1350 deductible / out of pocket max.

$207.50/mo with a $185 deductible sounds pretty cheap to me!

My insurance through work costs me about $52/mo (net being tax advantaged) and has a $100 deductible.  The employer subsidizes the cost.

When I FIRE, ACA will increase my costs if it's still around then.  Per previous posts, it's been ruled unconstitutional, so we have to wait for the appeal process.  Without ACA, I'll probably have to delay FIRE.

And long term, I don't look forward to Medicare's lack of coverage and total Medicare out of pocket costs Roadrunner refers to, and don't forget the additional $1,364 out of pocket for each hospital visit and the 20% part B out of pocket cost if you don't have a supplemental to cover it.  So to get yourself fairly fully covered, I would loosely figure about $11,000/yr for a couple.
« Last Edit: December 30, 2018, 10:49:41 AM by DreamFIRE »

Roadrunner53

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Re: What comes after the ACA?
« Reply #5205 on: December 30, 2018, 11:32:16 AM »
Medicare A is only for hospitalization. So unless you plan to go to the hospital a lot, Medicare A is not going to help you as far as doctor bills. Also, hospitals try not to ever admit you and keep you on observation status. You need to be ADMITTED in the hospital 3 nights to be transferred to a rehab facility. If you are not admitted 3 nights, they will NOT pay for you to go to rehab or a nursing facility. It is a nightmare. I went thru this with my Mom and they want to throw people into the street rather than keep them in the hospital. Medicare rules.

Medicare B is for doctor appointments and tests. That costs as of 2019 $135.50 a month per person.

Medicare D, prescription drugs costs anywhere from $35 to $72ish per month. The less you pay the higher deductibles you pay. So, I pay $72 per mo. and have no deductibles, HOWEVER, some of my drugs are on the odd ball list and I have to pay around $35 per mo. on top of the $72 a month.

Part B has a $185 deductible per year per person.

If you go to the hospital, the deductible for Part A Medicare is $1,364 per year and if you are admitted more than one time it could be another $1,364 within some time frame.

Medicare pays 80% you pay 20% if you don't have a supplement.

It is NOT cheap. I have a supplement which pays for Part A and Part B deductibles plus the 20% but I pay thru the nose for the supplement.

There are Medicare Advantage plans which are cheaper but I am sure, you will pay thru the nose somehow.

So bottom line, if people think Medicare for all is going to be affordable, I want it too!

My health insurance is $718/mo (employer contribution + my contribution) and I have a $1350 deductible / out of pocket max.

$207.50/mo with a $185 deductible sounds pretty cheap to me!

My insurance through work costs me about $52/mo (net being tax advantaged) and has a $100 deductible.  The employer subsidizes the cost.

When I FIRE, ACA will increase my costs if it's still around then.  Per previous posts, it's been ruled unconstitutional, so we have to wait for the appeal process.  Without ACA, I'll probably have to delay FIRE.

And long term, I don't look forward to Medicare's lack of coverage and total Medicare out of pocket costs Roadrunner refers to, and don't forget the additional $1,364 out of pocket for each hospital visit and the 20% part B out of pocket cost if you don't have a supplemental to cover it.  So to get yourself fairly fully covered, I would loosely figure about $11,000/yr for a couple.

The cost of the Supplement we have sucks but all our costs/deductibles are covered. Drugs are still not covered completely by the $72 a month. I have an oddball generic that I have to pay around $60 every three month and another that I have to pay $99 for a 3 month supply. That is on top of the $72 a month. I get most of our drugs from the warehouse option except for one that is cheaper at CVS. The price on this particular weird ass generic changes all the time and changes manufacturer too. I try to get all generic drugs but this generic is falls out of the low cost category.

Spouse had some radiation treatments that were super expensive only a few months after he got on Medicare. With the Medicare supplement, we never got one bill. You can be cheap and opt out of the supplements but when some expensive treatment come up, you will be screwed. Then if you want to buy a supplement later on you are subject to underwriting and if you have some disease or illness they can reject you. So they suggest you get a supplement when you are first eligible for Medicare. Like they say pay me now or pay me later but you will pay!

JLee

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Re: What comes after the ACA?
« Reply #5206 on: December 30, 2018, 12:06:52 PM »
Medicare A is only for hospitalization. So unless you plan to go to the hospital a lot, Medicare A is not going to help you as far as doctor bills. Also, hospitals try not to ever admit you and keep you on observation status. You need to be ADMITTED in the hospital 3 nights to be transferred to a rehab facility. If you are not admitted 3 nights, they will NOT pay for you to go to rehab or a nursing facility. It is a nightmare. I went thru this with my Mom and they want to throw people into the street rather than keep them in the hospital. Medicare rules.

Medicare B is for doctor appointments and tests. That costs as of 2019 $135.50 a month per person.

Medicare D, prescription drugs costs anywhere from $35 to $72ish per month. The less you pay the higher deductibles you pay. So, I pay $72 per mo. and have no deductibles, HOWEVER, some of my drugs are on the odd ball list and I have to pay around $35 per mo. on top of the $72 a month.

Part B has a $185 deductible per year per person.

If you go to the hospital, the deductible for Part A Medicare is $1,364 per year and if you are admitted more than one time it could be another $1,364 within some time frame.

Medicare pays 80% you pay 20% if you don't have a supplement.

It is NOT cheap. I have a supplement which pays for Part A and Part B deductibles plus the 20% but I pay thru the nose for the supplement.

There are Medicare Advantage plans which are cheaper but I am sure, you will pay thru the nose somehow.

So bottom line, if people think Medicare for all is going to be affordable, I want it too!

My health insurance is $718/mo (employer contribution + my contribution) and I have a $1350 deductible / out of pocket max.

$207.50/mo with a $185 deductible sounds pretty cheap to me!

Yes, it would be cheap, however, I buy a Medicare supplement that costs $248.75 a month on top of $207.50. That brings it to $456.25 and then the spouse has the same coverage so multiply that by 2 you are talking $912.50 a month. Multiplied by 12 months is $10,950 a year. Quite the bargain.

lol okay, so $456.25 then.  That's 63.5% of the cost of my insurance.  You're at $5,425/year per person vs my $8616/year.

I have single coverage, so I'm not sure why your spouse's insurance costs are relevant to this particular comparison.  If by "It is NOT cheap" you meant "health care is not cheap", then sure. :)

DreamFIRE

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Re: What comes after the ACA?
« Reply #5207 on: December 30, 2018, 01:34:00 PM »
Medicare A is only for hospitalization. So unless you plan to go to the hospital a lot, Medicare A is not going to help you as far as doctor bills. Also, hospitals try not to ever admit you and keep you on observation status. You need to be ADMITTED in the hospital 3 nights to be transferred to a rehab facility. If you are not admitted 3 nights, they will NOT pay for you to go to rehab or a nursing facility. It is a nightmare. I went thru this with my Mom and they want to throw people into the street rather than keep them in the hospital. Medicare rules.

Medicare B is for doctor appointments and tests. That costs as of 2019 $135.50 a month per person.

Medicare D, prescription drugs costs anywhere from $35 to $72ish per month. The less you pay the higher deductibles you pay. So, I pay $72 per mo. and have no deductibles, HOWEVER, some of my drugs are on the odd ball list and I have to pay around $35 per mo. on top of the $72 a month.

Part B has a $185 deductible per year per person.

If you go to the hospital, the deductible for Part A Medicare is $1,364 per year and if you are admitted more than one time it could be another $1,364 within some time frame.

Medicare pays 80% you pay 20% if you don't have a supplement.

It is NOT cheap. I have a supplement which pays for Part A and Part B deductibles plus the 20% but I pay thru the nose for the supplement.

There are Medicare Advantage plans which are cheaper but I am sure, you will pay thru the nose somehow.

So bottom line, if people think Medicare for all is going to be affordable, I want it too!

My health insurance is $718/mo (employer contribution + my contribution) and I have a $1350 deductible / out of pocket max.

$207.50/mo with a $185 deductible sounds pretty cheap to me!

My insurance through work costs me about $52/mo (net being tax advantaged) and has a $100 deductible.  The employer subsidizes the cost.

When I FIRE, ACA will increase my costs if it's still around then.  Per previous posts, it's been ruled unconstitutional, so we have to wait for the appeal process.  Without ACA, I'll probably have to delay FIRE.

And long term, I don't look forward to Medicare's lack of coverage and total Medicare out of pocket costs Roadrunner refers to, and don't forget the additional $1,364 out of pocket for each hospital visit and the 20% part B out of pocket cost if you don't have a supplemental to cover it.  So to get yourself fairly fully covered, I would loosely figure about $11,000/yr for a couple.

The cost of the Supplement we have sucks but all our costs/deductibles are covered. Drugs are still not covered completely by the $72 a month. I have an oddball generic that I have to pay around $60 every three month and another that I have to pay $99 for a 3 month supply. That is on top of the $72 a month. I get most of our drugs from the warehouse option except for one that is cheaper at CVS. The price on this particular weird ass generic changes all the time and changes manufacturer too. I try to get all generic drugs but this generic is falls out of the low cost category.

Spouse had some radiation treatments that were super expensive only a few months after he got on Medicare. With the Medicare supplement, we never got one bill. You can be cheap and opt out of the supplements but when some expensive treatment come up, you will be screwed. Then if you want to buy a supplement later on you are subject to underwriting and if you have some disease or illness they can reject you. So they suggest you get a supplement when you are first eligible for Medicare. Like they say pay me now or pay me later but you will pay!

Yeah, Medicare coverage isn't necessarily going to be 100% for everything, even with supplements.   It looks like I need to plan that my future Medicare premiums will be about 9X what I'm currently paying through my employer sponsored coverage.  It's crazy.  That's not something I look forward to and certainly wouldn't prefer over my current plan.

And I think it was mentioned earlier that Medicare A is only "free" if you paid into it for at least 40 quarters.  Otherwise, Medicare part A for 2019 is $437/mo on top of the costs already mentioned.  If you paid into Medicare 30 to 39 quarters, it's $240/mo on top of the other costs.

JLee

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Re: What comes after the ACA?
« Reply #5208 on: December 30, 2018, 02:19:00 PM »
Medicare A is only for hospitalization. So unless you plan to go to the hospital a lot, Medicare A is not going to help you as far as doctor bills. Also, hospitals try not to ever admit you and keep you on observation status. You need to be ADMITTED in the hospital 3 nights to be transferred to a rehab facility. If you are not admitted 3 nights, they will NOT pay for you to go to rehab or a nursing facility. It is a nightmare. I went thru this with my Mom and they want to throw people into the street rather than keep them in the hospital. Medicare rules.

Medicare B is for doctor appointments and tests. That costs as of 2019 $135.50 a month per person.

Medicare D, prescription drugs costs anywhere from $35 to $72ish per month. The less you pay the higher deductibles you pay. So, I pay $72 per mo. and have no deductibles, HOWEVER, some of my drugs are on the odd ball list and I have to pay around $35 per mo. on top of the $72 a month.

Part B has a $185 deductible per year per person.

If you go to the hospital, the deductible for Part A Medicare is $1,364 per year and if you are admitted more than one time it could be another $1,364 within some time frame.

Medicare pays 80% you pay 20% if you don't have a supplement.

It is NOT cheap. I have a supplement which pays for Part A and Part B deductibles plus the 20% but I pay thru the nose for the supplement.

There are Medicare Advantage plans which are cheaper but I am sure, you will pay thru the nose somehow.

So bottom line, if people think Medicare for all is going to be affordable, I want it too!

My health insurance is $718/mo (employer contribution + my contribution) and I have a $1350 deductible / out of pocket max.

$207.50/mo with a $185 deductible sounds pretty cheap to me!

My insurance through work costs me about $52/mo (net being tax advantaged) and has a $100 deductible.  The employer subsidizes the cost.

When I FIRE, ACA will increase my costs if it's still around then.  Per previous posts, it's been ruled unconstitutional, so we have to wait for the appeal process.  Without ACA, I'll probably have to delay FIRE.

And long term, I don't look forward to Medicare's lack of coverage and total Medicare out of pocket costs Roadrunner refers to, and don't forget the additional $1,364 out of pocket for each hospital visit and the 20% part B out of pocket cost if you don't have a supplemental to cover it.  So to get yourself fairly fully covered, I would loosely figure about $11,000/yr for a couple.

The cost of the Supplement we have sucks but all our costs/deductibles are covered. Drugs are still not covered completely by the $72 a month. I have an oddball generic that I have to pay around $60 every three month and another that I have to pay $99 for a 3 month supply. That is on top of the $72 a month. I get most of our drugs from the warehouse option except for one that is cheaper at CVS. The price on this particular weird ass generic changes all the time and changes manufacturer too. I try to get all generic drugs but this generic is falls out of the low cost category.

Spouse had some radiation treatments that were super expensive only a few months after he got on Medicare. With the Medicare supplement, we never got one bill. You can be cheap and opt out of the supplements but when some expensive treatment come up, you will be screwed. Then if you want to buy a supplement later on you are subject to underwriting and if you have some disease or illness they can reject you. So they suggest you get a supplement when you are first eligible for Medicare. Like they say pay me now or pay me later but you will pay!

Yeah, Medicare coverage isn't necessarily going to be 100% for everything, even with supplements.   It looks like I need to plan that my future Medicare premiums will be about 9X what I'm currently paying through my employer sponsored coverage.  It's crazy.  That's not something I look forward to and certainly wouldn't prefer over my current plan.

And I think it was mentioned earlier that Medicare A is only "free" if you paid into it for at least 40 quarters.  Otherwise, Medicare part A for 2019 is $437/mo on top of the costs already mentioned.  If you paid into Medicare 30 to 39 quarters, it's $240/mo on top of the other costs.

Lol yep, health care is a massive benefit from an employer. My $718/mo coverage costs me $58.50/mo.

maizeman

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Re: What comes after the ACA?
« Reply #5209 on: December 30, 2018, 02:24:14 PM »
Yeah, Medicare coverage isn't necessarily going to be 100% for everything, even with supplements.   It looks like I need to plan that my future Medicare premiums will be about 9X what I'm currently paying through my employer sponsored coverage.  It's crazy.  That's not something I look forward to and certainly wouldn't prefer over my current plan.

Lol yep, health care is a massive benefit from an employer. My $718/mo coverage costs me $58.50/mo.

+1

So in other words: "I'd prefer my current employer to still pay me a significant portion of my total compensation after I retire. Switching to a new, still subsidized plan that doesn't require to me to work isn't quite as desirable."

I would also like my employer to continue to pay me a chunk of my total comp after I retire (whether paying most of my healthcare premiums or straight cash, I can be flexible).

DreamFIRE

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Re: What comes after the ACA?
« Reply #5210 on: December 30, 2018, 02:42:02 PM »
Medicare A is only for hospitalization. So unless you plan to go to the hospital a lot, Medicare A is not going to help you as far as doctor bills. Also, hospitals try not to ever admit you and keep you on observation status. You need to be ADMITTED in the hospital 3 nights to be transferred to a rehab facility. If you are not admitted 3 nights, they will NOT pay for you to go to rehab or a nursing facility. It is a nightmare. I went thru this with my Mom and they want to throw people into the street rather than keep them in the hospital. Medicare rules.

Medicare B is for doctor appointments and tests. That costs as of 2019 $135.50 a month per person.

Medicare D, prescription drugs costs anywhere from $35 to $72ish per month. The less you pay the higher deductibles you pay. So, I pay $72 per mo. and have no deductibles, HOWEVER, some of my drugs are on the odd ball list and I have to pay around $35 per mo. on top of the $72 a month.

Part B has a $185 deductible per year per person.

If you go to the hospital, the deductible for Part A Medicare is $1,364 per year and if you are admitted more than one time it could be another $1,364 within some time frame.

Medicare pays 80% you pay 20% if you don't have a supplement.

It is NOT cheap. I have a supplement which pays for Part A and Part B deductibles plus the 20% but I pay thru the nose for the supplement.

There are Medicare Advantage plans which are cheaper but I am sure, you will pay thru the nose somehow.

So bottom line, if people think Medicare for all is going to be affordable, I want it too!

My health insurance is $718/mo (employer contribution + my contribution) and I have a $1350 deductible / out of pocket max.

$207.50/mo with a $185 deductible sounds pretty cheap to me!

My insurance through work costs me about $52/mo (net being tax advantaged) and has a $100 deductible.  The employer subsidizes the cost.

When I FIRE, ACA will increase my costs if it's still around then.  Per previous posts, it's been ruled unconstitutional, so we have to wait for the appeal process.  Without ACA, I'll probably have to delay FIRE.

And long term, I don't look forward to Medicare's lack of coverage and total Medicare out of pocket costs Roadrunner refers to, and don't forget the additional $1,364 out of pocket for each hospital visit and the 20% part B out of pocket cost if you don't have a supplemental to cover it.  So to get yourself fairly fully covered, I would loosely figure about $11,000/yr for a couple.

The cost of the Supplement we have sucks but all our costs/deductibles are covered. Drugs are still not covered completely by the $72 a month. I have an oddball generic that I have to pay around $60 every three month and another that I have to pay $99 for a 3 month supply. That is on top of the $72 a month. I get most of our drugs from the warehouse option except for one that is cheaper at CVS. The price on this particular weird ass generic changes all the time and changes manufacturer too. I try to get all generic drugs but this generic is falls out of the low cost category.

Spouse had some radiation treatments that were super expensive only a few months after he got on Medicare. With the Medicare supplement, we never got one bill. You can be cheap and opt out of the supplements but when some expensive treatment come up, you will be screwed. Then if you want to buy a supplement later on you are subject to underwriting and if you have some disease or illness they can reject you. So they suggest you get a supplement when you are first eligible for Medicare. Like they say pay me now or pay me later but you will pay!

Yeah, Medicare coverage isn't necessarily going to be 100% for everything, even with supplements.   It looks like I need to plan that my future Medicare premiums will be about 9X what I'm currently paying through my employer sponsored coverage.  It's crazy.  That's not something I look forward to and certainly wouldn't prefer over my current plan.

And I think it was mentioned earlier that Medicare A is only "free" if you paid into it for at least 40 quarters.  Otherwise, Medicare part A for 2019 is $437/mo on top of the costs already mentioned.  If you paid into Medicare 30 to 39 quarters, it's $240/mo on top of the other costs.

Lol yep, health care is a massive benefit from an employer. My $718/mo coverage costs me $58.50/mo.

Yeah, definitely, and then I have just a $100 deductible to boot.  It's not the easiest thing to walk away from.  Even on an ACA plan that I've browsed on the marketplace, it's $200 or so per month in premiums and a few thousand deductible (some variation depending on the plan).  But it beats the alternative of FIRE without ACA.

DreamFIRE

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Re: What comes after the ACA?
« Reply #5211 on: December 30, 2018, 02:45:49 PM »
Yeah, Medicare coverage isn't necessarily going to be 100% for everything, even with supplements.   It looks like I need to plan that my future Medicare premiums will be about 9X what I'm currently paying through my employer sponsored coverage.  It's crazy.  That's not something I look forward to and certainly wouldn't prefer over my current plan.

Lol yep, health care is a massive benefit from an employer. My $718/mo coverage costs me $58.50/mo.

+1

So in other words: "I'd prefer my current employer to still pay me a significant portion of my total compensation after I retire. Switching to a new, still subsidized plan that doesn't require to me to work isn't quite as desirable."

I would also like my employer to continue to pay me a chunk of my total comp after I retire (whether paying most of my healthcare premiums or straight cash, I can be flexible).

That sounds like the deal a friend of mine just got as a retired state worker.  Sweet pension and healthcare benefits.  No such deal for most of us.

EnjoyIt

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Re: What comes after the ACA?
« Reply #5212 on: December 30, 2018, 03:38:58 PM »
Medicare A is only for hospitalization. So unless you plan to go to the hospital a lot, Medicare A is not going to help you as far as doctor bills. Also, hospitals try not to ever admit you and keep you on observation status. You need to be ADMITTED in the hospital 3 nights to be transferred to a rehab facility. If you are not admitted 3 nights, they will NOT pay for you to go to rehab or a nursing facility. It is a nightmare. I went thru this with my Mom and they want to throw people into the street rather than keep them in the hospital. Medicare rules.

Medicare B is for doctor appointments and tests. That costs as of 2019 $135.50 a month per person.

Medicare D, prescription drugs costs anywhere from $35 to $72ish per month. The less you pay the higher deductibles you pay. So, I pay $72 per mo. and have no deductibles, HOWEVER, some of my drugs are on the odd ball list and I have to pay around $35 per mo. on top of the $72 a month.

Part B has a $185 deductible per year per person.

If you go to the hospital, the deductible for Part A Medicare is $1,364 per year and if you are admitted more than one time it could be another $1,364 within some time frame.

Medicare pays 80% you pay 20% if you don't have a supplement.

It is NOT cheap. I have a supplement which pays for Part A and Part B deductibles plus the 20% but I pay thru the nose for the supplement.

There are Medicare Advantage plans which are cheaper but I am sure, you will pay thru the nose somehow.

So bottom line, if people think Medicare for all is going to be affordable, I want it too!

My health insurance is $718/mo (employer contribution + my contribution) and I have a $1350 deductible / out of pocket max.

$207.50/mo with a $185 deductible sounds pretty cheap to me!

@JLee, that $718/month is your money.  Instead of dollars you get paid in health insurance subsidies, but it is still your money


I don't know about medicare rules.  Any big organization has some bad rules.  I pose health insurance companies as one example.  It doesn't seem too hard to find examples of health insurance companies having some bad bureaucratic rules as you peruse the pages of these posts.  A government run program will be no exception.  It's run by people.

Medicare is very popular.  That popularity has to be based on reasons.  The reasons are based on results.

My personal reason is that it saved my mom's life about 20 - 25 years ago.  Mom is gone now, but she never would have been able to afford the heart operation she needed if not for medicare.  An old woman did not have to fight an insurance company.  I feel medicare gave my mom at least another 20 good years of life.

I just don't like these health insurance companies edging in to medicare to "privatize" it so they can sneak off with a piece of the pie.  From my long view, it just looks like an unnecessary layer is being wedged into the program.  I see nothing wrong with people being able to augment their medicare with private insurance, but the underlying program should be sound without these folks and their "help."  I get a bad feeling.  These are the same companies that have been commented on for 100+ pages herein.

Yup, and every year they add more and more bullshit that costs somebody more money making health insurance more expensive.  Keep in mind, that what Medicare/Medicaid does, private insurance follows shortly afterwards.  I agree though that private companies should not be getting in the middle of this.  Why do we need to pay a third party to profit of this transaction.  Healthcare does not need a bookie. 

maizeman

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Re: What comes after the ACA?
« Reply #5213 on: December 30, 2018, 03:44:04 PM »
I agree though that private companies should not be getting in the middle of this.  Why do we need to pay a third party to profit of this transaction.  Healthcare does not need a bookie.

Quite the effective line there, nice!

JLee

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Re: What comes after the ACA?
« Reply #5214 on: December 31, 2018, 08:56:31 AM »
Medicare A is only for hospitalization. So unless you plan to go to the hospital a lot, Medicare A is not going to help you as far as doctor bills. Also, hospitals try not to ever admit you and keep you on observation status. You need to be ADMITTED in the hospital 3 nights to be transferred to a rehab facility. If you are not admitted 3 nights, they will NOT pay for you to go to rehab or a nursing facility. It is a nightmare. I went thru this with my Mom and they want to throw people into the street rather than keep them in the hospital. Medicare rules.

Medicare B is for doctor appointments and tests. That costs as of 2019 $135.50 a month per person.

Medicare D, prescription drugs costs anywhere from $35 to $72ish per month. The less you pay the higher deductibles you pay. So, I pay $72 per mo. and have no deductibles, HOWEVER, some of my drugs are on the odd ball list and I have to pay around $35 per mo. on top of the $72 a month.

Part B has a $185 deductible per year per person.

If you go to the hospital, the deductible for Part A Medicare is $1,364 per year and if you are admitted more than one time it could be another $1,364 within some time frame.

Medicare pays 80% you pay 20% if you don't have a supplement.

It is NOT cheap. I have a supplement which pays for Part A and Part B deductibles plus the 20% but I pay thru the nose for the supplement.

There are Medicare Advantage plans which are cheaper but I am sure, you will pay thru the nose somehow.

So bottom line, if people think Medicare for all is going to be affordable, I want it too!

My health insurance is $718/mo (employer contribution + my contribution) and I have a $1350 deductible / out of pocket max.

$207.50/mo with a $185 deductible sounds pretty cheap to me!

@JLee, that $718/month is your money.  Instead of dollars you get paid in health insurance subsidies, but it is still your money

Exactly, that was my point -- Medicare is not expensive when compared to private insurance.

pecunia

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Re: What comes after the ACA?
« Reply #5215 on: December 31, 2018, 09:15:55 AM »

- KA SNIP -

Exactly, that was my point -- Medicare is not expensive when compared to private insurance.

So - This Socialized medicine (semi Socialized) is cheaper when applied to the old people of the United States and the Socialized medicine in all of those other countries is also less.  It also seems to get the job done at least as well or better in most cases.

Any kind of Socialized medicine is a tough sell on the Federal level.  Could it work on a state level at least to some degree?  Does it already work on a state level to some degree?  The cost of medicine can vary greatly throughout the United States as one moves from place to place.

maizeman

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Re: What comes after the ACA?
« Reply #5216 on: December 31, 2018, 09:27:35 AM »

- KA SNIP -

Exactly, that was my point -- Medicare is not expensive when compared to private insurance.

So - This Socialized medicine (semi Socialized) is cheaper when applied to the old people of the United States and the Socialized medicine in all of those other countries is also less.  It also seems to get the job done at least as well or better in most cases.

That's not an apples to apples comparison though. In the above post they are looking only at the costs to the beneficiary of medicare. Much of the cost of the services provided by medicare are paid from dedicated payroll taxes and from the us general fund (supported by income taxes).

That's not inherently a good or bad thing. But comparing the all in unsubsidized cost of private health insurance to only the beneficiaries contribution of a socialized health insurance system doesn't tell you anything either way about the relative costs of the two systems.

JLee

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Re: What comes after the ACA?
« Reply #5217 on: December 31, 2018, 09:41:21 AM »

- KA SNIP -

Exactly, that was my point -- Medicare is not expensive when compared to private insurance.

So - This Socialized medicine (semi Socialized) is cheaper when applied to the old people of the United States and the Socialized medicine in all of those other countries is also less.  It also seems to get the job done at least as well or better in most cases.

That's not an apples to apples comparison though. In the above post they are looking only at the costs to the beneficiary of medicare. Much of the cost of the services provided by medicare are paid from dedicated payroll taxes and from the us general fund (supported by income taxes).

That's not inherently a good or bad thing. But comparing the all in unsubsidized cost of private health insurance to only the beneficiaries contribution of a socialized health insurance system doesn't tell you anything either way about the relative costs of the two systems.

That is true..if you take the $8616/yr for my private health insurance and then add my/employer's ~$3240 in medicare taxes, I'm covering barely over the average (~114%) health care costs for one person.

https://www.pbs.org/newshour/health/new-peak-us-health-care-spending-10345-per-person

The US health care system as a whole is broken - other countries spend half (or less) of what we do and have healthier populations. Simply switching to Medicare for all / etc will not fix that.
« Last Edit: December 31, 2018, 09:44:43 AM by JLee »

EnjoyIt

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Re: What comes after the ACA?
« Reply #5218 on: December 31, 2018, 09:53:22 AM »

- KA SNIP -

Exactly, that was my point -- Medicare is not expensive when compared to private insurance.

So - This Socialized medicine (semi Socialized) is cheaper when applied to the old people of the United States and the Socialized medicine in all of those other countries is also less.  It also seems to get the job done at least as well or better in most cases.

That's not an apples to apples comparison though. In the above post they are looking only at the costs to the beneficiary of medicare. Much of the cost of the services provided by medicare are paid from dedicated payroll taxes and from the us general fund (supported by income taxes).

That's not inherently a good or bad thing. But comparing the all in unsubsidized cost of private health insurance to only the beneficiaries contribution of a socialized health insurance system doesn't tell you anything either way about the relative costs of the two systems.

That is true..if you take the $8616/yr for my private health insurance and then add my/employer's ~$3240 in medicare taxes, I'm covering barely over the average (~114%) health care costs for one person.

https://www.pbs.org/newshour/health/new-peak-us-health-care-spending-10345-per-person

The US health care system as a whole is broken - other countries spend half (or less) of what we do and have healthier populations. Simply switching to Medicare for all / etc will not fix that.

Finally, more people are getting it and speaking up.  The problem isn't who is paying for our healthcare.  The problem is that we are paying too much for it.  Our system is so complex and convoluted with a fistful of corruption lobbying, no wonder we pay more than any other country in the world.

Medicare for all isn't the panacea people believe it to be.

JLee

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Re: What comes after the ACA?
« Reply #5219 on: December 31, 2018, 12:25:03 PM »

- KA SNIP -

Exactly, that was my point -- Medicare is not expensive when compared to private insurance.

So - This Socialized medicine (semi Socialized) is cheaper when applied to the old people of the United States and the Socialized medicine in all of those other countries is also less.  It also seems to get the job done at least as well or better in most cases.

That's not an apples to apples comparison though. In the above post they are looking only at the costs to the beneficiary of medicare. Much of the cost of the services provided by medicare are paid from dedicated payroll taxes and from the us general fund (supported by income taxes).

That's not inherently a good or bad thing. But comparing the all in unsubsidized cost of private health insurance to only the beneficiaries contribution of a socialized health insurance system doesn't tell you anything either way about the relative costs of the two systems.

That is true..if you take the $8616/yr for my private health insurance and then add my/employer's ~$3240 in medicare taxes, I'm covering barely over the average (~114%) health care costs for one person.

https://www.pbs.org/newshour/health/new-peak-us-health-care-spending-10345-per-person

The US health care system as a whole is broken - other countries spend half (or less) of what we do and have healthier populations. Simply switching to Medicare for all / etc will not fix that.

Finally, more people are getting it and speaking up.  The problem isn't who is paying for our healthcare.  The problem is that we are paying too much for it.  Our system is so complex and convoluted with a fistful of corruption lobbying, no wonder we pay more than any other country in the world.

Medicare for all isn't the panacea people believe it to be.

Nope, it's definitely not. It's also not the catastrophically expensive end of the world that people believe it to be.  As a society, we are already paying over $10k/yr per person in the US.  Access to preventative care will likely end up reducing overall health care costs, so the common complaint of "I don't want my tax dollars to be providing health care for someone else" is somewhat irrelevant because 1) costs should go down with a healthier population, and 2) society as a whole is already paying for this in some fashion or other, and businesses pass costs to consumers so in the end we all pay regardless.

pecunia

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Re: What comes after the ACA?
« Reply #5220 on: December 31, 2018, 01:53:19 PM »

- SSSSSSSSNIP -

Nope, it's definitely not. It's also not the catastrophically expensive end of the world that people believe it to be.  As a society, we are already paying over $10k/yr per person in the US.  Access to preventative care will likely end up reducing overall health care costs, so the common complaint of "I don't want my tax dollars to be providing health care for someone else" is somewhat irrelevant because 1) costs should go down with a healthier population, and 2) society as a whole is already paying for this in some fashion or other, and businesses pass costs to consumers so in the end we all pay regardless.

So, if the health care was fixed, it would be cheaper.  Yeh, I get that.  Now, if I work for a company that pays my health care and it was cheaper, wouldn't it save money for the company?  Wouldn't it save a LOT of money?  Wouldn't that be just like one of those tax cuts they pay our Congressmen to give them?  So, if the additional burden of paying for employee health care was lifted from said businesses, wouldn't that make them more competitive?  Do you think they've figured that out yet?

JLee

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Re: What comes after the ACA?
« Reply #5221 on: December 31, 2018, 02:10:06 PM »

- SSSSSSSSNIP -

Nope, it's definitely not. It's also not the catastrophically expensive end of the world that people believe it to be.  As a society, we are already paying over $10k/yr per person in the US.  Access to preventative care will likely end up reducing overall health care costs, so the common complaint of "I don't want my tax dollars to be providing health care for someone else" is somewhat irrelevant because 1) costs should go down with a healthier population, and 2) society as a whole is already paying for this in some fashion or other, and businesses pass costs to consumers so in the end we all pay regardless.

So, if the health care was fixed, it would be cheaper.  Yeh, I get that.  Now, if I work for a company that pays my health care and it was cheaper, wouldn't it save money for the company?  Wouldn't it save a LOT of money?  Wouldn't that be just like one of those tax cuts they pay our Congressmen to give them?  So, if the additional burden of paying for employee health care was lifted from said businesses, wouldn't that make them more competitive?  Do you think they've figured that out yet?

It wasn't until the ACA that large businesses were mandated to provide insurance options to employees. It's not really a burden so much as a benefit, which is part of the employee's overall compensation package (like salary, life insurance, disability, HSA contributions, vacation/sick time, etc).  Employers who do not offer health insurance aren't going to have many people wanting to work for them, though.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #5222 on: January 01, 2019, 12:19:22 PM »
Access to preventative care will likely end up reducing overall health care costs, so the common complaint of "I don't want my tax dollars to be providing health care for someone else" is somewhat irrelevant because 1) costs should go down with a healthier population, and 2) society as a whole is already paying for this in some fashion or other, and businesses pass costs to consumers so in the end we all pay regardless.

Prevention can include encouraging the usual things like diet and exercise, but also to help those with chronic health problems like diabetes to better manage their care and improve compliance.

maizeman

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Re: What comes after the ACA?
« Reply #5223 on: January 01, 2019, 01:31:48 PM »
Just an anecdote to support the point above:

A year of dialysis costs $50-75k/year. You can afford an awful lot of preventative medicine and health interventions for an awful lot of diabetics if you can successfully prevent even a few of them from developing kidney failure.

DaMa

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Re: What comes after the ACA?
« Reply #5224 on: January 01, 2019, 01:52:46 PM »
I would like to see any national healthcare legislation to include something that says the employers have to raise employee pay by the amount  they claim they contribute to our health care benefits.  (I'm dreaming, I know.)

Exflyboy

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Re: What comes after the ACA?
« Reply #5225 on: January 01, 2019, 02:10:05 PM »
I think the one (small) ray of hope I see is that anecdotally people seem to be getting more pissed off about the cost of HC generally.

I think if we taxed HC benefits provided by employers we'd have riots in the streets, so of course that is not going to happen.

As the issue is coming to the fore in the public conscience (hitting more people in the wallet) maybe we'll start to see some movement after the next election.

One can hope.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #5226 on: January 01, 2019, 06:40:45 PM »
Healthcare was an issue that galvanized voters to turn out in favor of the Democrats, which led to the sweeping change of power in the House. At least in states where voters were allowed to be counted, but probably not in Georgia.

pecunia

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Re: What comes after the ACA?
« Reply #5227 on: January 01, 2019, 09:38:26 PM »
Healthcare was an issue that galvanized voters to turn out in favor of the Democrats, which led to the sweeping change of power in the House. At least in states where voters were allowed to be counted, but probably not in Georgia.

Do you think that the health care companies will get a more favorable deal when they purchase the elected Democratic politicians?  I don't see a lot of movement by traditional elected Democrats, but I guess they need time.

EnjoyIt

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Re: What comes after the ACA?
« Reply #5228 on: January 01, 2019, 10:15:33 PM »
Nope, it's definitely not. It's also not the catastrophically expensive end of the world that people believe it to be.  As a society, we are already paying over $10k/yr per person in the US.  Access to preventative care will likely end up reducing overall health care costs, so the common complaint of "I don't want my tax dollars to be providing health care for someone else" is somewhat irrelevant because 1) costs should go down with a healthier population, and 2) society as a whole is already paying for this in some fashion or other, and businesses pass costs to consumers so in the end we all pay regardless.

You are right about that especially if Medicare existed and all those expensive costs were passed down to the consumer.  And I agree, society is already paying for everyone's healthcare.  Some by taxes, some via higher costs to those who do pay.

So, if the health care was fixed, it would be cheaper.  Yeh, I get that.  Now, if I work for a company that pays my health care and it was cheaper, wouldn't it save money for the company?  Wouldn't it save a LOT of money?  Wouldn't that be just like one of those tax cuts they pay our Congressmen to give them?  So, if the additional burden of paying for employee health care was lifted from said businesses, wouldn't that make them more competitive?  Do you think they've figured that out yet?

Interesting thought especially for those large companies that have thousands of employees. But, maybe the company saving a few million on insurance premiums is not worth the lobbying costs to make changes.  Who knows.

Healthcare was an issue that galvanized voters to turn out in favor of the Democrats, which led to the sweeping change of power in the House. At least in states where voters were allowed to be counted, but probably not in Georgia.

Do you think that the health care companies will get a more favorable deal when they purchase the elected Democratic politicians?  I don't see a lot of movement by traditional elected Democrats, but I guess they need time.

That same healthcare issue I believe is what got Trump elected also. The population is pissed off.  Premiums are through the roof, complexity has increased, out of pocket expenses continue to rise.  Something has to give. Unfortunately I do not see an improvement in sight from the democratic leaders either.  Still no push towards reducing cost of delivering healthcare.  I really believe it is going to have to get a whole lot worse before it gets better.  I don't think I see enough people rilled up to make a difference.  Also, too many people are covered by their employer and the costs of healthcare are sort of hidden unless one chooses to look for it or has some sort of health issues requiring significant out of pocket expenses. Change is coming. Just not soon enough.

maizeman

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Re: What comes after the ACA?
« Reply #5229 on: January 02, 2019, 06:13:12 AM »
So, if the health care was fixed, it would be cheaper.  Yeh, I get that.  Now, if I work for a company that pays my health care and it was cheaper, wouldn't it save money for the company?  Wouldn't it save a LOT of money?  Wouldn't that be just like one of those tax cuts they pay our Congressmen to give them?  So, if the additional burden of paying for employee health care was lifted from said businesses, wouldn't that make them more competitive?  Do you think they've figured that out yet?

Interesting thought especially for those large companies that have thousands of employees. But, maybe the company saving a few million on insurance premiums is not worth the lobbying costs to make changes.  Who knows.

If healthcare cost less, companies (in industries that actually have competitive labor markets) would be able to offer higher salaries to poach employees from each other without increasing their spending on total compensation.

I suspect the result of major reforms that reduced the cost of healthcare significantly would be more money going to employees rather than more profit for employers.

sol

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Re: What comes after the ACA?
« Reply #5230 on: January 02, 2019, 07:13:14 AM »
I suspect the result of major reforms that reduced the cost of healthcare significantly would be more money going to employees rather than more profit for employers.

I suspect the exact opposite.  Why would it be any different than the recent corporate tax cut?  That money went to stock buybacks, and wages didn't budge.

I mean I like your optimism, but corporations don't just decide to increase their salary costs because they save money somewhere else.  They seek profit, and higher wages mean less profit.

maizeman

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Re: What comes after the ACA?
« Reply #5231 on: January 02, 2019, 07:30:22 AM »
I suspect the result of major reforms that reduced the cost of healthcare significantly would be more money going to employees rather than more profit for employers.

Why would it be any different than the recent corporate tax cut?

The corporate tax cut didn't result in any change in how much it cost to hire an employee since companies are only taxed on their profits and money spent on salary or fringe benefits is by definition not profit and therefore not taxed.

If anything the corporate tax cut may have driven wages down a bit, since, before the cut, giving an employee an extra $10,000 in salary only required giving up $6,500 in after tax profits for the owners and now, after the cut, giving the same employee the same extra $10,000 salary increase would require giving up $7,900 in after tax profits for the owners.

pecunia

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Re: What comes after the ACA?
« Reply #5232 on: January 02, 2019, 08:40:44 AM »

- SNIP SNIP -

The corporate tax cut didn't result in any change in how much it cost to hire an employee since companies are only taxed on their profits and money spent on salary or fringe benefits is by definition not profit and therefore not taxed.

If anything the corporate tax cut may have driven wages down a bit, since, before the cut, giving an employee an extra $10,000 in salary only required giving up $6,500 in after tax profits for the owners and now, after the cut, giving the same employee the same extra $10,000 salary increase would require giving up $7,900 in after tax profits for the owners.

You are right.  These folks are interested in maximizing profits for the stockholders (& CEO).  So, if companies didn't have the health care benefit (burden), this could be taken as increased profit.  It also gives them a competitive advantage over foreign competition in helping to price a product more competitively.  Although, I think they are at a disadvantage now, since they have to directly pay for their employees healthcare and their foreign competition may have a different sort of health care system in their country.  Their foreign competition would not have to pay the health care benefit costs.

EnjoyIt

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Re: What comes after the ACA?
« Reply #5233 on: January 02, 2019, 09:15:49 AM »
Everyone wins if we start looking at decreasing the cost of providing healthcare. Well, everyone except those people who profit from bureaucracy and complexity. There are a lot of jobs involved in that bullshit. Ohh and every year more bullshit is added, not removed. Itís amazing how expensive bullshit could be.

maizeman

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Re: What comes after the ACA?
« Reply #5234 on: January 02, 2019, 09:21:10 AM »

- SNIP SNIP -

The corporate tax cut didn't result in any change in how much it cost to hire an employee since companies are only taxed on their profits and money spent on salary or fringe benefits is by definition not profit and therefore not taxed.

If anything the corporate tax cut may have driven wages down a bit, since, before the cut, giving an employee an extra $10,000 in salary only required giving up $6,500 in after tax profits for the owners and now, after the cut, giving the same employee the same extra $10,000 salary increase would require giving up $7,900 in after tax profits for the owners.

You are right.  These folks are interested in maximizing profits for the stockholders (& CEO).  So, if companies didn't have the health care benefit (burden), this could be taken as increased profit.  It also gives them a competitive advantage over foreign competition in helping to price a product more competitively.  Although, I think they are at a disadvantage now, since they have to directly pay for their employees healthcare and their foreign competition may have a different sort of health care system in their country.  Their foreign competition would not have to pay the health care benefit costs.

So this is a quite valid point that the discussion I'm having is specifically about companies with significant domestic competition. In that situation they cannot take the extra money as profit, because then their competitor will use a little of the savings to raise salaries and hire away their best people (increasing the competitor's profits and decreasing their own). They could respond by using a bit more of the healthcare savings to raise salaries even more and lure those people back and so on until we're back in the exact same equilibrium we're in now, except that less money is going from employers to insurance companies and an approximately equal amount more money is going from employers to employees.

In cases where a company faces ONLY foreign competition and employs a lot of people with skills that are not that transferable to other industries (a good example might be Boeing whose only competitor in the large airplane space is Airbus and requires a lot of specialized aerospace engineering skillsets), the reduction in healthcare costs could indeed translate into more profits directly and/or more competitive pricing would would also lead to more profits (but also more employment in the USA).

EnjoyIt

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Re: What comes after the ACA?
« Reply #5235 on: January 02, 2019, 09:33:46 AM »
Starting yesterday, January 1st, hospitals must post all fees and charges.

https://www.healthindustrywashingtonwatch.com/2018/10/articles/other-health-policy-developments/other-cms-developments/cms-sheds-light-on-cy-2019-hospital-price-transparency-rules/

This is a good start though I think this law must be spread to doctors and pharmacies as well. Transparency of cost is the beginning. Hey, something positive coming from Trumpís office.

https://www.washingtonexaminer.com/policy/healthcare/hospitals-to-post-prices-online-under-new-trump-administration-rule

I canít imagine even the hardest of liberals disagreeing with this. Just like Medicare for all isnít the panacea if fixing healthcare, neither is price transparency but it is a step in the right direction.  As I said before, if we lower the cost of delivering healthcare we may just have enough money to provide healthcare to everyone.

Edit: I just checked out my hospitalís charge list. What a jumbled mess. Not clear or easy to understand at all to the average consumer. I hope CMS enforces increased clarity on this. For now I am a little disappointed. But again, a good start.
« Last Edit: January 02, 2019, 09:54:32 AM by EnjoyIt »

Roadrunner53

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Re: What comes after the ACA?
« Reply #5236 on: January 02, 2019, 10:12:23 AM »
Starting yesterday, January 1st, hospitals must post all fees and charges.

https://www.healthindustrywashingtonwatch.com/2018/10/articles/other-health-policy-developments/other-cms-developments/cms-sheds-light-on-cy-2019-hospital-price-transparency-rules/

This is a good start though I think this law must be spread to doctors and pharmacies as well. Transparency of cost is the beginning. Hey, something positive coming from Trumpís office.

https://www.washingtonexaminer.com/policy/healthcare/hospitals-to-post-prices-online-under-new-trump-administration-rule

I canít imagine even the hardest of liberals disagreeing with this. Just like Medicare for all isnít the panacea if fixing healthcare, neither is price transparency but it is a step in the right direction.  As I said before, if we lower the cost of delivering healthcare we may just have enough money to provide healthcare to everyone.

Edit: I just checked out my hospitalís charge list. What a jumbled mess. Not clear or easy to understand at all to the average consumer. I hope CMS enforces increased clarity on this. For now I am a little disappointed. But again, a good start.

Where are you finding the charges on the hospital website? I looked at about 4 different hospitals in my area and am not finding anything to do with charges or fees.

toganet

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Re: What comes after the ACA?
« Reply #5237 on: January 02, 2019, 10:17:46 AM »
Starting yesterday, January 1st, hospitals must post all fees and charges.

https://www.healthindustrywashingtonwatch.com/2018/10/articles/other-health-policy-developments/other-cms-developments/cms-sheds-light-on-cy-2019-hospital-price-transparency-rules/

This is a good start though I think this law must be spread to doctors and pharmacies as well. Transparency of cost is the beginning. Hey, something positive coming from Trumpís office.

https://www.washingtonexaminer.com/policy/healthcare/hospitals-to-post-prices-online-under-new-trump-administration-rule

I canít imagine even the hardest of liberals disagreeing with this. Just like Medicare for all isnít the panacea if fixing healthcare, neither is price transparency but it is a step in the right direction.  As I said before, if we lower the cost of delivering healthcare we may just have enough money to provide healthcare to everyone.

Edit: I just checked out my hospitalís charge list. What a jumbled mess. Not clear or easy to understand at all to the average consumer. I hope CMS enforces increased clarity on this. For now I am a little disappointed. But again, a good start.

Depending on your definition of "liberal" you will get different opinions ;)  From a Neo-liberal point of view, posting prices is good as it should allow the magic of the Free Market to work -- price transparency should create increased market efficiency, etc.  For a progressive liberal, I can't think of a reason why anyone would object to price transparency, they would probably just be skeptical that it would have the desired effect, due to the other side of the market's coin -- inelasticity of demand.

BUT, it looks like from what you're saying that the prices are not exactly transparent, or at least not in a useful way.

bacchi

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Re: What comes after the ACA?
« Reply #5238 on: January 02, 2019, 11:07:55 AM »
Quote from: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Downloads/FAQs-Req-Hospital-Public-List-Standard-Charges.pdf
Q. Do the requirements apply to all items and services provided by the hospital?
A. The current requirements apply to all items and services provided by the hospital.   

Does this include charges from the non-staff, potentially out-of-network, anesthesiologist (radiologist, pathologist, etc.)?

Or can you still get hit with a large, surprise, medical bill even if you price compare what an aspirin costs?

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #5239 on: January 02, 2019, 11:25:23 AM »
A price list? That conjures up the saying, "to know the price of everything and the value of nothing."
What good is a price list for complicated procedures where not only is price a factor but so is the quality of the physician, the benefit of a procedure, the safety and hygiene of the facility? Moreover knowing the price of a procedure does not solve the issue, one also has to weigh whether that procedure could provide a better outcome than that of another hospital that offers a different procedure. The idea that a pricelist is useful for complex decision making for life altering medical procedures seems outright ridiculous.

Paul der Krake

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Re: What comes after the ACA?
« Reply #5240 on: January 02, 2019, 12:00:02 PM »
A price list? That conjures up the saying, "to know the price of everything and the value of nothing."
What good is a price list for complicated procedures where not only is price a factor but so is the quality of the physician, the benefit of a procedure, the safety and hygiene of the facility? Moreover knowing the price of a procedure does not solve the issue, one also has to weigh whether that procedure could provide a better outcome than that of another hospital that offers a different procedure. The idea that a pricelist is useful for complex decision making for life altering medical procedures seems outright ridiculous.
There are no guarantees in medicine, we're never going to have perfect information. It's not a good reason to not disclose as much as possible. Price transparency doesn't benefit just end consumers, it opens up the door to industry wide price analysis.

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Re: What comes after the ACA?
« Reply #5241 on: January 02, 2019, 12:42:45 PM »
Starting yesterday, January 1st, hospitals must post all fees and charges.

https://www.healthindustrywashingtonwatch.com/2018/10/articles/other-health-policy-developments/other-cms-developments/cms-sheds-light-on-cy-2019-hospital-price-transparency-rules/

This is a good start though I think this law must be spread to doctors and pharmacies as well. Transparency of cost is the beginning. Hey, something positive coming from Trumpís office.

https://www.washingtonexaminer.com/policy/healthcare/hospitals-to-post-prices-online-under-new-trump-administration-rule

I canít imagine even the hardest of liberals disagreeing with this. Just like Medicare for all isnít the panacea if fixing healthcare, neither is price transparency but it is a step in the right direction.  As I said before, if we lower the cost of delivering healthcare we may just have enough money to provide healthcare to everyone.

Edit: I just checked out my hospitalís charge list. What a jumbled mess. Not clear or easy to understand at all to the average consumer. I hope CMS enforces increased clarity on this. For now I am a little disappointed. But again, a good start.

Where are you finding the charges on the hospital website? I looked at about 4 different hospitals in my area and am not finding anything to do with charges or fees.

Also, in the article it said: "While the format used is the hospitalís choice as long as the information represents the hospitalís current standard charges as reflected in its chargemaster..."  The chargemaster isn't necessarily the price you would be charged since the price you are charged can vary depending upon which insurance carrier you have - that's in the contract between the insurance carrier and the provider.   

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #5242 on: January 02, 2019, 05:50:33 PM »
The people who will benefit from a price list are those people who don't have insurance because they're the only ones who are going to billed these hospital charges. The insurance companies don't pay these prices. Those prices are all inflated, the only people who pay them are those that don't have insurance.
So for example if you're going to have an elective hernia repair it would be useful to compare the prices at two different hospitals if you don't have insurance assuming the quality is equivalent. You have to look into the quality of the doctors.

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Re: What comes after the ACA?
« Reply #5243 on: January 02, 2019, 06:29:21 PM »
The people who will benefit from a price list are those people who don't have insurance because they're the only ones who are going to billed these hospital charges. The insurance companies don't pay these prices. Those prices are all inflated, the only people who pay them are those that don't have insurance.
So for example if you're going to have an elective hernia repair it would be useful to compare the prices at two different hospitals if you don't have insurance assuming the quality is equivalent. You have to look into the quality of the doctors.

People on Medicare and Medicaid aren't going to pay these prices either, nor is Medicaid or Medicare on their behalf, and neither are many of the other people with no insurance - they might not pay anything.

I just tried to look up colonoscopy on the website of a hospital where I know they perform them, and it wasn't even in the list.  But at least I could find the cost of some single dose medications.  Not too helpful.

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Re: What comes after the ACA?
« Reply #5244 on: January 02, 2019, 11:46:17 PM »
It has only been 2-3 days.  I hope that over the next few months this data will become better.  Again, this is a good start and needs to spread not just the hospitals but to doctors office's, clinics, urgent cares, pharmacies, and everything healthcare related.  We need to see the transparency of what is going on with insurance billing and and what they pay.  We also need to see what other people pay out of pocket and not just the charge master prices which seams to practically come out of thin air.

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Re: What comes after the ACA?
« Reply #5245 on: January 03, 2019, 05:27:54 AM »
I think transparency is a good thing, of course, but I don't see this particular change doing much to lower costs.  As has been pointed out, the vast majority of health care transactions are between the provider and an insurer, and they negotiate their prices outside the chargemaster. 

In my opinion, a much more consequential change would be eliminating the ACA requirement that insurance companies spend 80% of the money they collect on care, and use the other 20% for all of their costs (including their profit).  While the rule was well-intentioned, it takes away the insurance company's incentive to negotiate lower prices, because they have to refund the savings to consumers instead of keeping it to boost their profits.  On the other hand, if the providers raise their prices and the insurer has to pay out more than 80% of their revenue, the insurer can raise its prices to keep up.  And it gets to keep 20% of the higher price.  So the only way they get to make more money is to increase their total revenue, which can only be done by letting providers raise their prices.  Seems like a textbook case of unintended consequences. 

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Re: What comes after the ACA?
« Reply #5246 on: January 03, 2019, 07:47:13 AM »
Access to preventative care will likely end up reducing overall health care costs...

If you want to get really, really upset about our health care system, and understand why the above statement is almost certainly not true, check out the book "Doctoring Data" or read the author's blog:

https://drmalcolmkendrick.org/

The current article is very interesting.  It points up a fundamental fallacy that has been exploited to the utmost:  1) you can use statistics to prove just about anything, 2) if you show a correlation between Risk Factor A and Disease B, it does not necessarily mean that modifying Risk Factor A will reduce the risk of Disease B. This has a lot to do with the fact that the people/companies who stand to benefit financially are often the ones who sponsor the studies that are used to make blanket primary prevention recommendations.

Aelias

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Re: What comes after the ACA?
« Reply #5247 on: January 03, 2019, 08:07:04 AM »
I'm angry and don't really have anywhere else to vent this, so here goes:

Our family is on my husband's health insurance.  I recently got my IUD taken out because we want a third child.  We got a call today that we should gotten that procedure "pre-approved" by our insurance because . . . I have no idea why.  Now, they need documentation from my doctor about how the procedure was done (spoiler alert: a PA put her hands up my pussy and pulled it out).  It was uneventful.  It took less than 5 minutes.  With a glass of wine to relax beforehand, I'm pretty sure I could have done it myself.  Note that we did  not need any kind of approval to put it in.

Now, if they are not satisfied by whatever documentation my doctor provides on this procedure, they're going to charge us $207. 

The tinfoil hat conspiracist in me thinks they just want a heads up that there may be another dependent in the pipeline and more time to figure out how to overcharge us for prenatal care and birth.  What bugs me the most is that the decision to have a child is so intensely personal and getting preapproval for this kind of thing feels wildly invasive.

I don't know if Medicare for All would change something like this.  All I know is the current system is fucked up and I'm so fucking tired of it.




Paul der Krake

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Re: What comes after the ACA?
« Reply #5248 on: January 03, 2019, 08:30:16 AM »
I'm angry and don't really have anywhere else to vent this, so here goes:

Our family is on my husband's health insurance.  I recently got my IUD taken out because we want a third child.  We got a call today that we should gotten that procedure "pre-approved" by our insurance because . . . I have no idea why.  Now, they need documentation from my doctor about how the procedure was done (spoiler alert: a PA put her hands up my pussy and pulled it out).  It was uneventful.  It took less than 5 minutes.  With a glass of wine to relax beforehand, I'm pretty sure I could have done it myself.  Note that we did  not need any kind of approval to put it in.

Now, if they are not satisfied by whatever documentation my doctor provides on this procedure, they're going to charge us $207. 

The tinfoil hat conspiracist in me thinks they just want a heads up that there may be another dependent in the pipeline and more time to figure out how to overcharge us for prenatal care and birth.  What bugs me the most is that the decision to have a child is so intensely personal and getting preapproval for this kind of thing feels wildly invasive.

I don't know if Medicare for All would change something like this.  All I know is the current system is fucked up and I'm so fucking tired of it.
I understand your frustration, but it's best not to think of insurers as people, you just need to embrace the clinical detachment when interacting with them. By all means be nice to their reps, but to the machine you're just a number spitting out a bunch of claim codes at semi-random intervals. They couldn't care less whether someone touched your pussy or your big toe, it's all codes and procedures to them. They've seen it all.

JLee

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Re: What comes after the ACA?
« Reply #5249 on: January 03, 2019, 09:17:22 AM »
Access to preventative care will likely end up reducing overall health care costs...

If you want to get really, really upset about our health care system, and understand why the above statement is almost certainly not true, check out the book "Doctoring Data" or read the author's blog:

https://drmalcolmkendrick.org/

The current article is very interesting.  It points up a fundamental fallacy that has been exploited to the utmost:  1) you can use statistics to prove just about anything, 2) if you show a correlation between Risk Factor A and Disease B, it does not necessarily mean that modifying Risk Factor A will reduce the risk of Disease B. This has a lot to do with the fact that the people/companies who stand to benefit financially are often the ones who sponsor the studies that are used to make blanket primary prevention recommendations.

I guess the CDC must be wrong, then.

https://www.cdc.gov/healthcommunication/toolstemplates/entertainmented/tips/PreventiveHealth.html

Quote
Chronic diseases, such as heart disease, cancer, and diabetes, are responsible for 7 of every 10 deaths among Americans each year and account for 75% of the nationís health spending. These chronic diseases can be largely preventable through close partnership with your healthcare team, or can be detected through appropriate screenings, when treatment works best.