The Money Mustache Community
Learning, Sharing, and Teaching => Ask a Mustachian => Topic started by: jp on February 28, 2014, 12:32:05 PM
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We currently have a $10k/person $20k/family deductible. We are a family of 4 with 2 kids (5 & 7). My current plan runs less than $250 per month and we have never had more than $1000 in medical expenses in a year in our lives.
I just got a cancellation notice, which I have been expecting. I checked out some plans, and the very cheapest policy is $900 per month. I flat out will not pay that, in all seriousness, I will not pay that.
I looked at putting the kids on a catastrophic plan and then the wife and I on a bronze plan (we can't because we are over 30), it is still like $750. So, to hell with that.
I have read about health sharing ministries. I haven't looked to see if that is available in my area. (See here: http://www.cnbc.com/id/100935430 )
If I understand the current law, I can just enroll in the open enrollment period in any year? So even if I get cancer in June, I just have to survive until open enrollment in January? Is that right?
I am not a political person, this isn't a left/right thing. The law is passed, I just want to know how to get out of it if anyone has figured it out. Ideas?
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You can still buy non-ACA compliant policies and pay the penalty for not having an ACA-compliant policy. For the next year or two, that may save you a significant amount of money.
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You can still buy non-ACA compliant policies and pay the penalty for not having an ACA-compliant policy. For the next year or two, that may save you a significant amount of money.
Thanks, I didn't know that. If only my policy was not being cancelled, I would just stay on that for a few years and pay the penalty. Are there a lot of insurers offering these plans?
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You can still buy non-ACA compliant policies and pay the penalty for not having an ACA-compliant policy. For the next year or two, that may save you a significant amount of money.
Thanks, I didn't know that. If only my policy was not being cancelled, I would just stay on that for a few years and pay the penalty. Are there a lot of insurers offering these plans?
Why don't you ask your current insurance company?
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You can still buy non-ACA compliant policies and pay the penalty for not having an ACA-compliant policy. For the next year or two, that may save you a significant amount of money.
Thanks, I didn't know that. If only my policy was not being cancelled, I would just stay on that for a few years and pay the penalty. Are there a lot of insurers offering these plans?
Why don't you ask your current insurance company?
That's a good idea. Honestly, I don't know the number of insurance companies offering non-ACA compliant plans. I do know there's still a decent market for short-term insurance policies, which may be another option for you. They also are not ACA-compliant, but may save you money -- although you'll have to re--do it at least every 330 days or something.
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You can still buy non-ACA compliant policies and pay the penalty for not having an ACA-compliant policy. For the next year or two, that may save you a significant amount of money.
Thanks, I didn't know that. If only my policy was not being cancelled, I would just stay on that for a few years and pay the penalty. Are there a lot of insurers offering these plans?
Why don't you ask your current insurance company?
I did. The only have these fixed benefit things, which are the opposite of what I need/want. I can cover my own needs, unless it is something catastrophic. I don't need insurance for a $100 check up. It seems these are the only non ACA compliant policies that my current carrier provides. The local insurance agent was no help.
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Have you been on healthcare.gov or your state's website? Have you investigated if you eligible for a subsidy?
Consumer Reports ran an article in December how companies are canceling policies and shoehorning people into more expensive policies then what they could find on the exchange.
Good luck!
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Thanks for the post. I am going to have an issue similar to yours in the future. I am still grandfathered into my plan for this year but after that I will be stuck. I currently pay a total $450 for the 4 of us (similar make up as you) to each have HI with a $1,200 deductible. Other than my wife having a baby we have been no where near hitting this amount. My research on the new plans shows that similar coverage is around $1,000 a month. That just does not make sense as it only cost about 3-4k to have a baby. I could not imagine something that could happen to me that would justify these costs. So I thought about a dropping to Bronze but then that shows $550 a month and around a 10K deductible. After reviewing this I also have to scratch my head and say this does not make much sense. If you can find a place that just gives you catastrophic for a good price please share. As I agree that with the penalty might be the best option.
I keep hoping that they extend the grandfather rule which I read they might so I don't have to start thinking about dropping HI which really scares me.
Good Luck!
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Have you been on healthcare.gov or your state's website? Have you investigated if you eligible for a subsidy?
Consumer Reports ran an article in December how companies are canceling policies and shoehorning people into more expensive policies then what they could find on the exchange.
Good luck!
Yeah, I checked all that. I am not eligible for a subsidy. I have checked the websites and also talked to an agent who found me the "cheap" plan of $900/mo.
There aren't going to be any affordable ACA policies, that's a fact. So I am just looking for some way around the issue now. Right now, the religious co-op medishare thing seems to be the only real option- or possibly a non-compliant policy (but I haben't been able to find a decent one yet).
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Thanks for the post. I am going to have an issue similar to yours in the future. I am still grandfathered into my plan for this year but after that I will be stuck. I currently pay a total $450 for the 4 of us (similar make up as you) to each have HI with a $1,200 deductible. Other than my wife having a baby we have been no where near hitting this amount. My research on the new plans shows that similar coverage is around $1,000 a month. That just does not make sense as it only cost about 3-4k to have a baby. I could not imagine something that could happen to me that would justify these costs. So I thought about a dropping to Bronze but then that shows $550 a month and around a 10K deductible. After reviewing this I also have to scratch my head and say this does not make much sense. If you can find a place that just gives you catastrophic for a good price please share. As I agree that with the penalty might be the best option.
I keep hoping that they extend the grandfather rule which I read they might so I don't have to start thinking about dropping HI which really scares me.
Good Luck!
I should have been grandfathered in, but apparently Assurant is dropping my plan, don't know why. If I find something I will post it, but I am not having a lot of luck. Your State sounds like it has better plans (or maybe you are quoting me your price with the subsidy- which I am not eligible for).
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I am in PA and it might be based on age, I am 30. I researched the Christian exchange ones and they seemed like a huge pain. I think they said you are treated as you have no insurance when you go to the doctor and you have to negotiate a better rate. Also there is no guarantee on some of them that you will get paid. I think the best option may be like you mentioned and get a non compliant penalty, pay the 2.5% of income and buy a noncompliant plan that actually makes financial sense. I hope/expect that next year when all the plans expire these strategies start to emerge and more people start selling the plans.
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I am in PA and it might be based on age, I am 30. I researched the Christian exchange ones and they seemed like a huge pain. I think they said you are treated as you have no insurance when you go to the doctor and you have to negotiate a better rate. Also there is no guarantee on some of them that you will get paid. I think the best option may be like you mentioned and get a non compliant penalty, pay the 2.5% of income and buy a noncompliant plan that actually makes financial sense. I hope/expect that next year when all the plans expire these strategies start to emerge and more people start selling the plans.
Well I am only 36. I don't think that it would make that much of a difference. I will keep looking for a non-compliant policy.
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I am in PA and it might be based on age, I am 30. I researched the Christian exchange ones and they seemed like a huge pain. I think they said you are treated as you have no insurance when you go to the doctor and you have to negotiate a better rate. Also there is no guarantee on some of them that you will get paid. I think the best option may be like you mentioned and get a non compliant penalty, pay the 2.5% of income and buy a noncompliant plan that actually makes financial sense. I hope/expect that next year when all the plans expire these strategies start to emerge and more people start selling the plans.
Well I am only 36. I don't think that it would make that much of a difference. I will keep looking for a non-compliant policy.
What state are you in? I've done some research on ehealthinsurance.com for these sorts of plans, but I don't know how good they are in other states.
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This isn't a great option, but at this point it doesn't sound like you have any of those, so...
Can you move to, or at least establish residency in, a different state? Establishing residency may not be enough if the only health plans available to you don't cover a lot out-of-state.
FWIW I checked eHealthInsurance with your family's approximate ages in my zip code (Seattle) and got the cheapest bronze plan at $655/mo (deductibles $4k individual, $8k family). 5 of the 10 "featured plans" are below $700. It might be interesting to do the same check for various different places to see how much variation there is.
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UPDATE:
my agent says that I can get a short term family plan for about the same as I pay now (less than $250 per month) and that this will allow me to avoid paying the penalty for noncompliance. The downside is that we will have to requalify every 6 months. Apparently I can do this up to 4x before I have to do something else, which works out, because it will be 2016 by then and ACA will be in full effect (of, fingers crossed, repealed).
Just thought I'd let you guys know about this option in case anyone else is in the same boat
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I don't know where you are or exactly how old you and your wife are, but in my state on the exchange a family of 4 with adults aged 33 and 35 and kids 5 and 7 can get coverage for $420/mo. Also--and I believe this is true everywhere--"If your individual insurance plan has been cancelled and you believe other Marketplace plans aren't affordable, you can apply for a hardship exemption. This will allow you buy a catastrophic plan."
https://www.healthcare.gov/can-i-buy-a-catastrophic-plan/
Also in my state, prices like what you're quoting ($920/mo or thereabouts) will get you a gold plan with a $2000 family deductible ($1000 individual), and that's an HMO so you get $10 doctor visits, $40 specialist visits, $175 ER visits and $8 prescriptions from day 1, without needing to ht your deductible.
So I can't help but wonder, is your state on some other planet, are you and your wife far older than I was guesstimating (like 45??) or did you not search the exchange correctly?
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I don't know where you are or exactly how old you and your wife are, but in my state on the exchange a family of 4 with adults aged 33 and 35 and kids 5 and 7 can get coverage for $420/mo. Also--and I believe this is true everywhere--"If your individual insurance plan has been cancelled and you believe other Marketplace plans aren't affordable, you can apply for a hardship exemption. This will allow you buy a catastrophic plan."
https://www.healthcare.gov/can-i-buy-a-catastrophic-plan/
Also in my state, prices like what you're quoting ($920/mo or thereabouts) will get you a gold plan with a $2000 family deductible ($1000 individual), and that's an HMO so you get $10 doctor visits, $40 specialist visits, $175 ER visits and $8 prescriptions from day 1, without needing to ht your deductible.
So I can't help but wonder, is your state on some other planet, are you and your wife far older than I was guesstimating (like 45??) or did you not search the exchange correctly?
Congratulations, you live in a low cost of health care area. How does this help the OP, who has told you what the lowest priced plan on the exchange is?
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I don't know where you are or exactly how old you and your wife are, but in my state on the exchange a family of 4 with adults aged 33 and 35 and kids 5 and 7 can get coverage for $420/mo. Also--and I believe this is true everywhere--"If your individual insurance plan has been cancelled and you believe other Marketplace plans aren't affordable, you can apply for a hardship exemption. This will allow you buy a catastrophic plan."
https://www.healthcare.gov/can-i-buy-a-catastrophic-plan/
Also in my state, prices like what you're quoting ($920/mo or thereabouts) will get you a gold plan with a $2000 family deductible ($1000 individual), and that's an HMO so you get $10 doctor visits, $40 specialist visits, $175 ER visits and $8 prescriptions from day 1, without needing to ht your deductible.
So I can't help but wonder, is your state on some other planet, are you and your wife far older than I was guesstimating (like 45??) or did you not search the exchange correctly?
Congratulations, you live in a low cost of health care area. How does this help the OP, who has told you what the lowest priced plan on the exchange is?
I know two people who complained that all they could find was $X/month, and then when I went and looked for them, turned out they had somehow misunderstood something and lower-cost plans were available to them. So I was wondering if that's what happened with the OP.
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I don't know where you are or exactly how old you and your wife are, but in my state on the exchange a family of 4 with adults aged 33 and 35 and kids 5 and 7 can get coverage for $420/mo. Also--and I believe this is true everywhere--"If your individual insurance plan has been cancelled and you believe other Marketplace plans aren't affordable, you can apply for a hardship exemption. This will allow you buy a catastrophic plan."
https://www.healthcare.gov/can-i-buy-a-catastrophic-plan/
Also in my state, prices like what you're quoting ($920/mo or thereabouts) will get you a gold plan with a $2000 family deductible ($1000 individual), and that's an HMO so you get $10 doctor visits, $40 specialist visits, $175 ER visits and $8 prescriptions from day 1, without needing to ht your deductible.
So I can't help but wonder, is your state on some other planet, are you and your wife far older than I was guesstimating (like 45??) or did you not search the exchange correctly?
If I had to guess, his state is California, where a silver plan for a family of 4 runs $12,000 a year unsubsidized. Is it another planet? Sometimes it sure seems like.
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I don't know where you are or exactly how old you and your wife are, but in my state on the exchange a family of 4 with adults aged 33 and 35 and kids 5 and 7 can get coverage for $420/mo. Also--and I believe this is true everywhere--"If your individual insurance plan has been cancelled and you believe other Marketplace plans aren't affordable, you can apply for a hardship exemption. This will allow you buy a catastrophic plan."
https://www.healthcare.gov/can-i-buy-a-catastrophic-plan/
Also in my state, prices like what you're quoting ($920/mo or thereabouts) will get you a gold plan with a $2000 family deductible ($1000 individual), and that's an HMO so you get $10 doctor visits, $40 specialist visits, $175 ER visits and $8 prescriptions from day 1, without needing to ht your deductible.
So I can't help but wonder, is your state on some other planet, are you and your wife far older than I was guesstimating (like 45??) or did you not search the exchange correctly?
If I had to guess, his state is California, where a silver plan for a family of 4 runs $12,000 a year unsubsidized. Is it another planet? Sometimes it sure seems like.
He's not shopping for a silver plan. He wants the barest-bones, cheapest policy he can find. I just randomly ran the numbers for Contra Costa County (it's a CA zip code I have memorized) for the same family of four described earlier (parents aged 33 and 35, two kids) and the cheapest plan is indeed way more expensive than in my state, but still not the $900+ he was talking about or the $12k/yr you describe. It's a $744/mo ($8928/yr) bronze plan that you can combine with an HSA.
And like any non-employer-sponsored health plan, the cost of premiums is a tax-deductible medical expense (to the extent your medical expenses exceed 10% of your AGI).
Anyone have thoughts on why some states are much more expensive than others?
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I don't know where you are or exactly how old you and your wife are, but in my state on the exchange a family of 4 with adults aged 33 and 35 and kids 5 and 7 can get coverage for $420/mo. Also--and I believe this is true everywhere--"If your individual insurance plan has been cancelled and you believe other Marketplace plans aren't affordable, you can apply for a hardship exemption. This will allow you buy a catastrophic plan."
https://www.healthcare.gov/can-i-buy-a-catastrophic-plan/
Also in my state, prices like what you're quoting ($920/mo or thereabouts) will get you a gold plan with a $2000 family deductible ($1000 individual), and that's an HMO so you get $10 doctor visits, $40 specialist visits, $175 ER visits and $8 prescriptions from day 1, without needing to ht your deductible.
So I can't help but wonder, is your state on some other planet, are you and your wife far older than I was guesstimating (like 45??) or did you not search the exchange correctly?
If I had to guess, his state is California, where a silver plan for a family of 4 runs $12,000 a year unsubsidized. Is it another planet? Sometimes it sure seems like.
Or New York. We got a rate of $10,000/yr for an unsubsidized silver plan. For two. We're 25 and 28.
You're young enough to get catastrophic plans (for way, way way less $), if you want.
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Or New York. We got a rate of $10,000/yr for an unsubsidized silver plan. For two. We're 25 and 28.
You're young enough to get catastrophic plans (for way, way way less $), if you want.
In the states where I've looked (small sample size of 2), the catastrophic plans are 80-95% of the cost of a bronze plan. Neither of those were New York, though, and it appears you need to register to find the price of plans there.
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He's not shopping for a silver plan. He wants the barest-bones, cheapest policy he can find. I just randomly ran the numbers for Contra Costa County (it's a CA zip code I have memorized) for the same family of four described earlier (parents aged 33 and 35, two kids) and the cheapest plan is indeed way more expensive than in my state, but still not the $900+ he was talking about or the $12k/yr you describe. It's a $744/mo ($8928/yr) bronze plan that you can combine with an HSA.
And like any non-employer-sponsored health plan, the cost of premiums is a tax-deductible medical expense (to the extent your medical expenses exceed 10% of your AGI).
Anyone have thoughts on why some states are much more expensive than others?
Because health care costs vary a lot by state, just like everything else. I just ran a calculation for Palo Alto for a family of four and the cheapest plan was $834 a month, so I don't doubt that it could be 8% higher somewhere else.
If he's ineligible for subsidies, he's unlikely to hit 10% of AGI unless he has significant non-insurance health costs in a year.
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Daleth - it occurs to me that I only partially answered your question, and that a full answer would require answering the question, "why do health care costs vary so much by state?"
I think the answer to that is: salaries, price of land, and taxes. And it's a nonlinear response because every step is affected by the others.
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I don't know where you are or exactly how old you and your wife are, but in my state on the exchange a family of 4 with adults aged 33 and 35 and kids 5 and 7 can get coverage for $420/mo. Also--and I believe this is true everywhere--"If your individual insurance plan has been cancelled and you believe other Marketplace plans aren't affordable, you can apply for a hardship exemption. This will allow you buy a catastrophic plan."
https://www.healthcare.gov/can-i-buy-a-catastrophic-plan/
Also in my state, prices like what you're quoting ($920/mo or thereabouts) will get you a gold plan with a $2000 family deductible ($1000 individual), and that's an HMO so you get $10 doctor visits, $40 specialist visits, $175 ER visits and $8 prescriptions from day 1, without needing to ht your deductible.
So I can't help but wonder, is your state on some other planet, are you and your wife far older than I was guesstimating (like 45??) or did you not search the exchange correctly?
If I had to guess, his state is California, where a silver plan for a family of 4 runs $12,000 a year unsubsidized. Is it another planet? Sometimes it sure seems like.
Or New York. We got a rate of $10,000/yr for an unsubsidized silver plan. For two. We're 25 and 28.
You're young enough to get catastrophic plans (for way, way way less $), if you want.
I'm well aware of that. The cost is still borderline madness comapred to other parts of the country. A catastrophic plan with a $12,700 deductible costs, minimum, $360/month. And the physician network is dreadful.
MMM is paying $470/month for his family of 3, on a plan with a $10,000 deductible. The closest equivalent policy in my area on the exchange is $720/month, for a family of two people who are younger than him and his wife.
Difference is NY doesn't allow different pricing by age. If you're 60 you pay the same rate as if you're 25.
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Difference is NY doesn't allow different pricing by age. If you're 60 you pay the same rate as if you're 25.
Yowza. Has NY always had that rule about health insurance? I know they've always been a bit weird when it came to health insurance, but am unclear on the details.
I wonder why they're doing it that way. It's not like it's helping old folks on social security, since those folks are all on Medicare anyway. It seems particularly unfair since your average 25yo is not only less in need of medical care than your average 55yo, but also less wealthy.
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NY State's health insurance market has been so batshit overregulated for so long (back in the 90's they forced insurers to accept everyone regardless of medical condition and most private insurers left the state as a result) that our costs actually dropped post-ACA.
Oh. So for all the New Yorkers here, their options are:
(1) continue having insurance (assuming you had it before) but pay less, although still a ton; or
(2) don't have insurance, and only pay the penalty IF the cost of insurance exceeds 8% of your income--in other words, if you're looking at $10k for the lowest-cost plan for your family size, your income would have to exceed $125k in order for you to pay the penalty. If you earn less than $125k, no penalty. For the under-30s, though, I'm guessing the lowest-cost plan they consider for penalty purposes is the catastrophic plan, so you'd have to be earning less than $54k to avoid the penalty.
Your other option is to move to a state where they let insurers charge people different rates based on age:
New Jersey: Move across the river from NYC and boom, you two as 25 and 28yo can get a silver policy with a $1350 deductible ($2700 family) for $520/mo, or $6240/yr. Catastrophic plans in NJ seem to be about the same price as NY, $350-ish.
PA: Move across the PA border and you can get catastrophic plans for $184/mo (that's for both of you!), or a silver plan with a $1000 deductible ($2000 family) for $372/mo. Heck, you can get a $0 deductible platinum plan for $481/mo!
I predict that NY will lose some good people because of their refusal to let insurers differentiate by age...
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So I can't help but wonder, is your state on some other planet, are you and your wife far older than I was guesstimating (like 45??) or did you not search the exchange correctly?
I searched the plans. I also had 2 separate agents search for me.
I live in Indiana. I am 36, my wife is 35, and my kids are 5 and 7. My income is over the $94k subsidy threshold.
FWIW, there are couple new plans since I looked that in the $800s, which is still way way more than I am going to pay.
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You can still buy non-ACA compliant policies and pay the penalty for not having an ACA-compliant policy. For the next year or two, that may save you a significant amount of money.
Thanks, I didn't know that. If only my policy was not being cancelled, I would just stay on that for a few years and pay the penalty. Are there a lot of insurers offering these plans?
Why don't you ask your current insurance company?
That's a good idea. Honestly, I don't know the number of insurance companies offering non-ACA compliant plans. I do know there's still a decent market for short-term insurance policies, which may be another option for you. They also are not ACA-compliant, but may save you money -- although you'll have to re--do it at least every 330 days or something.
I somehow missed this when you posted it the first time... so thanks for the suggestion. For whatever reason, my agent (who may well be wrong) is telling me that I won't have to pay the penalty if I go this route (at least until 2016).
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You can still buy non-ACA compliant policies and pay the penalty for not having an ACA-compliant policy. For the next year or two, that may save you a significant amount of money.
Thanks, I didn't know that. If only my policy was not being cancelled, I would just stay on that for a few years and pay the penalty. Are there a lot of insurers offering these plans?
Why don't you ask your current insurance company?
That's a good idea. Honestly, I don't know the number of insurance companies offering non-ACA compliant plans. I do know there's still a decent market for short-term insurance policies, which may be another option for you. They also are not ACA-compliant, but may save you money -- although you'll have to re--do it at least every 330 days or something.
I somehow missed this when you posted it the first time... so thanks for the suggestion. For whatever reason, my agent (who may well be wrong) is telling me that I won't have to pay the penalty if I go this route (at least until 2016).
No problem! I think your agent is right, just like I was back in February. In between, the penalty for having a noncompliant plan was delayed until 2016 (http://blogs.marketwatch.com/health-exchange/2014/03/05/non-compliant-health-plans-given-2-year-extension-not-one/)
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No problem! I think your agent is right, just like I was back in February. In between, the penalty for having a noncompliant plan was delayed until 2016 (http://blogs.marketwatch.com/health-exchange/2014/03/05/non-compliant-health-plans-given-2-year-extension-not-one/)
Thanks for the link. I don't really keep up with these changes, so it is nice to have some support for her statement.
I feel good. I just saved $11k.
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We just went through this last year. I have a chronic medical condition and always hit the upper limits for everything. I'm still on COBRA from my former employer's plan. This is more cost effective than my husband's employer sponsored plan. We pay $1515 per month in medical and dental premiums for the family. (43, 41, 11 and 9). $4k individual OOP and $6k OOP family in network. $5/7k out of network. Total out of pocket = $24k. On my husbands employer plan this amount is $35k if we have to go out of network (most anesthesiologists are out of network and I have several procedures each year requiring anesthesia).
I went directly to two different insurance companies, through the exchange and through the American Bar Association. This was the best deal knowing that I would max out. We don't qualify for any subsidies. I won't qualify for COBRA beyond December of this year. Which freaks me out because, holy hell, it's bad enough now let alone piling on another $11k.
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Just to verify, is your MAGI still over the $94k threshold? That's one thing that threw me for a loop. I kept thinking subsidies were based on gross income, but they're actually based on MAGI. You can view some information at:
http://laborcenter.berkeley.edu/healthcare/MAGI_summary13.pdf
It might not help in your situation, but I figured I'd mention it just in case.
thanks for the info, but yeah, I am still over that. A good problem to have in the scheme of things
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We just went through this last year. I have a chronic medical condition and always hit the upper limits for everything. I'm still on COBRA from my former employer's plan. This is more cost effective than my husband's employer sponsored plan. We pay $1515 per month in medical and dental premiums for the family. (43, 41, 11 and 9). $4k individual OOP and $6k OOP family in network. $5/7k out of network. Total out of pocket = $24k. On my husbands employer plan this amount is $35k if we have to go out of network (most anesthesiologists are out of network and I have several procedures each year requiring anesthesia).
I went directly to two different insurance companies, through the exchange and through the American Bar Association. This was the best deal knowing that I would max out. We don't qualify for any subsidies. I won't qualify for COBRA beyond December of this year. Which freaks me out because, holy hell, it's bad enough now let alone piling on another $11k.
What would the total cost be if you got the cheapest ACA plan and hit the max out of pocket every year?
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IIRC, the medical premiums would be less (around $900ish) but max out of pocket would be $26k ish and not all of my doctors were in the network. Then I'd have to add dental on top of it.
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IIRC, the medical premiums would be less (around $900ish) but max out of pocket would be $26k ish and not all of my doctors were in the network. Then I'd have to add dental on top of it.
Does the max out of pocket apply to out of network too? So the 26K would be more than under COBRA (yipes!) but potentially still better than under your husband's plan.
Also, thanks for humoring my curiosity.
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I'm not totally clear on what's going on here, but are you only looking at bronze plans? From what I understand, bronze plans are not eligible for subsidies.
Try a silver or gold plan and you might save a lot of money if you meet the income requirements. I think some people might be getting sticker shock because they are only looking at bronze plans, which they think are the cheapest -- but if you can get a subsidy they actually can be the most expensive.
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I'm not totally clear on what's going on here, but are you only looking at bronze plans? From what I understand, bronze plans are not eligible for subsidies.
Try a silver or gold plan and you might save a lot of money if you meet the income requirements. I think some people might be getting sticker shock because they are only looking at bronze plans, which they think are the cheapest -- but if you can get a subsidy they actually can be the most expensive.
This is false. The subsidy is based on the price of the second cheapest silver plan, but the subsidy is valid on bronze, silver, gold, and platinum plans.
Here's one source: http://www.valuepenguin.com/understanding-aca-subsidies
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IIRC, the medical premiums would be less (around $900ish) but max out of pocket would be $26k ish and not all of my doctors were in the network. Then I'd have to add dental on top of it.
Does the max out of pocket apply to out of network too? So the 26K would be more than under COBRA (yipes!) but potentially still better than under your husband's plan.
Also, thanks for humoring my curiosity.
Yes. The $26k plus the premiums would put us at $35k out of pocket total which is more than my COBRA. It's horrible. Then again, I hit my individual OOP max on January 8th, if that gives you an idea as to my medical issues.
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IIRC, the medical premiums would be less (around $900ish) but max out of pocket would be $26k ish and not all of my doctors were in the network. Then I'd have to add dental on top of it.
The max out of pocket for a family plan that's ACA compliant is $12,700 for all family members combined. I think you were misreading the out of pocket max as applying to each individually - it doesn't.
https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/
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jp why don't ask you Obama how you are going to pay for it? According to him, his health care law makes health care "affordable" for everyone in America. Maybe a magical fairy will come to your house each month and drop $900 from the sky.
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jp why don't ask you Obama how you are going to pay for it? According to him, his health care law makes health care "affordable" for everyone in America. Maybe a magical fairy will come to your house each month and drop $900 from the sky.
I have it, I just don't want to spend it on health insurance.
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IIRC, the medical premiums would be less (around $900ish) but max out of pocket would be $26k ish and not all of my doctors were in the network. Then I'd have to add dental on top of it.
The max out of pocket for a family plan that's ACA compliant is $12,700 for all family members combined. I think you were misreading the out of pocket max as applying to each individually - it doesn't.
https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/
No I wasn't misreading it. I have the chronic condition but based on my family's past few years we hit the OOP max for everyone. Not just me. I have to be prepared to hit all OOP maximums, including out of network,but thank you anyway. The out of network maximums are not reported on healthcare.gov but if you read the summary docs closely you should find it there..
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I really appreciated the president telling people like me that the insurance we were losing was lousy anyway. That's like someone running over your bicycle and then claiming that, well, it wasn't a really nice bike anyway and now you're free to buy a more expensive one!
haha, that is a most excellent analogy. and a super fucked up situation. as is the "health insurance costs the same no matter how old you are" rule... what the fuck?! sorry to all of you who are in this situation!
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IIRC, the medical premiums would be less (around $900ish) but max out of pocket would be $26k ish and not all of my doctors were in the network. Then I'd have to add dental on top of it.
The max out of pocket for a family plan that's ACA compliant is $12,700 for all family members combined. I think you were misreading the out of pocket max as applying to each individually - it doesn't.
https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/
No I wasn't misreading it. I have the chronic condition but based on my family's past few years we hit the OOP max for everyone. Not just me. I have to be prepared to hit all OOP maximums, including out of network,but thank you anyway. The out of network maximums are not reported on healthcare.gov but if you read the summary docs closely you should find it there..
Ok, yeah that makes sense. I had been thinking it was a mis-read since the amount you quoted was about exactly double the in-network OOP max. Is there a reason you can't find providers in network though? I know it's hard finding specialists who you trust, but an extra $13,000 is a big price to pay.
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IIRC, the medical premiums would be less (around $900ish) but max out of pocket would be $26k ish and not all of my doctors were in the network. Then I'd have to add dental on top of it.
The max out of pocket for a family plan that's ACA compliant is $12,700 for all family members combined. I think you were misreading the out of pocket max as applying to each individually - it doesn't.
https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/
No I wasn't misreading it. I have the chronic condition but based on my family's past few years we hit the OOP max for everyone. Not just me. I have to be prepared to hit all OOP maximums, including out of network,but thank you anyway. The out of network maximums are not reported on healthcare.gov but if you read the summary docs closely you should find it there..
Ok, yeah that makes sense. I had been thinking it was a mis-read since the amount you quoted was about exactly double the in-network OOP max. Is there a reason you can't find providers in network though? I know it's hard finding specialists who you trust, but an extra $13,000 is a big price to pay.
I need anesthesia and those people don't take insurance and aren't in any networks. I have no problem switching like my normal doc or allergist or dermatologist or whatever. Spine surgeon? Yeah, no. Not taking chances there.
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I also have a massively expensive chronic condition.
I still have employer health care that's pretty good, but I was wondering whether or not it might make sense for someone who knows they'll always hit OOP maximums and is getting an ACA plan to get one plan just for themself, and a spearate one for the rest of the family.
I'm assuming that OOP maxes go up with the number of people on the plan, and that you could lower your overall costs this way.
Failing that, it's just a matter of calculating the lowest cost combination of premiums and OOP max. From what I hear from others with my condition, it's going to be really expensive for people with pre-existing conditions to get coverage. After ACA, this is not because there's any sort of discrimination, but just because OOP maxes are high and premiums are high. My current OOP max is $2500, but I've heard figures 4-5 times higher for ACA plans.
Being sick is really awesome.
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Where do you live? We're a family of four on the Bronze Kaiser plan and it's only $530 a month. We've had the same plan for three years now and when we started it was only $250, that's what really pisses me off. I'm not sure what justified that kind of rise in only a couple of years.
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I am not getting the impression that the ACA is going to make health insurance/care any more affordable than it was in the past (the one exception being those who were previously uninsurable). DH gets subsidized health insurance as a retiree, but they can drop it any time they want to. We pay $710/mo. for the two of us in an HMO so it's not exactly what I would call a cadillac plan. I am praying that his company doesn't dump retirees before we can get on Medicare. Oh the joys of early retirement.
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Here's a thought I haven't seen here: In the old health care system, people with higher incomes generally have had their costs subsidized by employers, so they were not paying the full premiums, let alone paying for the care itself. People with worse jobs or who were unemployed paid out of pocket or went without care at all. People in the latter group with "preexisting conditions" were uninsurable and got sicker -- and many people have died because they lacked care that was available to those in the first group.
The new system is an attempt to spread the costs out more equitably and insure more people. Those in the top income group should be grateful they can afford to pay their share. Life is not always about paying the least possible for everything.
If for some reason my husband and I need to buy health insurance before we are 65, my rough calculation (based on our current income) is to allot about $10,000 a year for it. In the big scheme of things (if, say, you have a MAGI of ~$100k), why is that so outrageous? Without life and good health, what do you have? Insurance as a concept sucks, but it's the way our society is structured and we're stuck with it for the foreseeable future.
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jp why don't ask you Obama how you are going to pay for it? According to him, his health care law makes health care "affordable" for everyone in America. Maybe a magical fairy will come to your house each month and drop $900 from the sky.
If $900 is only 8% of your income, it is affordable. If it's more than 8% and you can't find a cheaper plan, you don't have to have insurance (i.e. there's no penalty for not having it). The fact you don't want to spend 7.9% of your income on health insurance doesn't make it unaffordable.
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The max out of pocket for a family plan that's ACA compliant is $12,700 for all family members combined. I think you were misreading the out of pocket max as applying to each individually - it doesn't.
https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/
No I wasn't misreading it. I have the chronic condition but based on my family's past few years we hit the OOP max for everyone. Not just me. I have to be prepared to hit all OOP maximums, including out of network,but thank you anyway. The out of network maximums are not reported on healthcare.gov but if you read the summary docs closely you should find it there..
Is there not a plan available that would include the place you go that's currently out of network, as in network?
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The max out of pocket for a family plan that's ACA compliant is $12,700 for all family members combined. I think you were misreading the out of pocket max as applying to each individually - it doesn't.
https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/
No I wasn't misreading it. I have the chronic condition but based on my family's past few years we hit the OOP max for everyone. Not just me. I have to be prepared to hit all OOP maximums, including out of network,but thank you anyway. The out of network maximums are not reported on healthcare.gov but if you read the summary docs closely you should find it there..
Is there not a plan available that would include the place you go that's currently out of network, as in network?
The kicker for us in that the anesthesiologists aren't on anyone's network, so they are always out of network. I have regular, ongoing procedures requiring anesthesia each time. So, no. I can't.
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Lexie, we are in the same boat-paying 730 for 2 of us & also hope we reach medicare age before we lose this insurance. It has helped people who could not get insurance or young people that were in jobs without it.
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For a family of 4 making $8000/mo, the maximum premium for a silver ACA plan is $800/mo. Choose the bronze instead, the premium would be $100 or so less /mo.
For a family of 4 making more than $8000/mo and bitching, STFU.
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For a family of 4 making $8000/mo, the maximum premium for a silver ACA plan is $800/mo. Choose the bronze instead, the premium would be $100 or so less /mo.
For a family of 4 making more than $8000/mo and bitching, STFU.
Exactly.
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For a family of 4 making $8000/mo, the maximum premium for a silver ACA plan is $800/mo. Choose the bronze instead, the premium would be $100 or so less /mo.
For a family of 4 making more than $8000/mo and bitching, STFU.
Exactly.
And why is that, exactly? It's equivalent to saying people making over a certain dollar amount each month should be charged double for cell phone service than those making less than the threshold. Just because one is able to pay doesn't mean that there is a corresponding willingness to spend.
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For a family of 4 making $8000/mo, the maximum premium for a silver ACA plan is $800/mo. Choose the bronze instead, the premium would be $100 or so less /mo.
For a family of 4 making more than $8000/mo and bitching, STFU.
Exactly.
And why is that, exactly? It's equivalent to saying people making over a certain dollar amount each month should be charged double for cell phone service than those making less than the threshold. Just because one is able to pay doesn't mean that there is a corresponding willingness to spend.
No one is saying you HAVE TO spend 8% of your income or that people who earn $200k/yr have to spend twice as much as (or even 1% more than) people who earn $100k. Get the cheapest plan you can find, if you want, which may be 2%, who knows. All they're saying is that everyone's got to have insurance unless they can't find insurance that is affordable--and affordable is defined as 8% of your income (not gross income but MAGI, which for most people is about the same as their AGI).
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No one is saying you HAVE TO spend 8% of your income or that people who earn $200k/yr have to spend twice as much as (or even 1% more than) people who earn $100k. Get the cheapest plan you can find, if you want, which may be 2%, who knows. All they're saying is that everyone's got to have insurance unless they can't find insurance that is affordable--and affordable is defined as 8% of your income (not gross income but MAGI, which for most people is about the same as their AGI).
Maybe that's what you're saying but thats certainly not the point of socals
For a family of 4 making more than $8000/mo and bitching, STFU.
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For a family of 4 making $8000/mo, the maximum premium for a silver ACA plan is $800/mo. Choose the bronze instead, the premium would be $100 or so less /mo.
For a family of 4 making more than $8000/mo and bitching, STFU.
Apparently asking for help on the forum is not allowed if you make a high income
You really don't seem to be getting it, do you? Plenty of people on this forum make good salaries. But you're the only one who insists that your entire lifestyle, complete with crashingly expensive house, private schools for the kids, a country club membership, landscaping and domestic staff, etc. is utterly non-negotiable while at the same time asking for advice and complaining that anyone who gives it to you isn't understanding you properly.
Are my lifestyle decisions the reason the OP was told to STFU?
It's your general whining, flounciness, bad behavior and generally bratty attitude over the forum I'm addressing, and you know full well your commentary was part of that. Plenty of people of high income have been posting on here, some for years, without being told to STFU, because they're aren't incredibly ugly personalities.
What does that have to do with the OP being attacked for making a high income?
No one's being attacked for making a high income. That's not our style on this board, at all. They're being criticized for whining about expenses they can easily afford, particularly when the expenses they're whining about are something most families need; self-insuring for your health care costs is not wise for people with merely upper middle class/lower upper class incomes--one serious car accident, premature baby or case of cancer needing chemo, and your retirement gets wiped out.
Whining is particularly annoying to some of us in the ACA context, since the way any kind of insurance works is that it's only economically viable (both for customers and for insurers) if many low to average risk people buy it to balance out the fewer higher risk people, so requiring the whiner and others in that demographic to buy health insurance is in fact what makes it possible for millions of their "working poor" fellow Americans to afford health insurance.
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If this behavior continues we will considering temporary bans as our next course of action. This kind of petty behavior makes our entire community look foolish and immature.
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jp why don't ask you Obama how you are going to pay for it? According to him, his health care law makes health care "affordable" for everyone in America. Maybe a magical fairy will come to your house each month and drop $900 from the sky.
If $900 is only 8% of your income, it is affordable. If it's more than 8% and you can't find a cheaper plan, you don't have to have insurance (i.e. there's no penalty for not having it). The fact you don't want to spend 7.9% of your income on health insurance doesn't make it unaffordable.
I agree with this. But then again I spent 25% of my income on COBRA when I aged out of my mom's insurance and could not be covered pre-ACA for ANY amount of money.
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It is beyond tacky for high-earning, genetic-lottery-winning people to complain about having to pay more for health insurance than the actuarial value of providing a risk-underwritten policy. It is the equivalent of seeking advice on tax evasion.
The young, healthy, and wealthy pay more for insurance so that the old, sick, and poor can pay less. Some day, everyone will be old or sick or poor.
The key benefit is guarantee-issue insurance where the 64 year-old can be charged no more than 3x the premium of an 18 year-old. Even cold, put-upon rich people should realize the real value in having access to guarantee-issue price-constrained health insurance.
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It is beyond tacky for high-earning, genetic-lottery-winning people to complain about having to pay more for health insurance than the actuarial value of providing a risk-underwritten policy. It is the equivalent of seeking advice on tax evasion.
Who in this thread is doing that?
I see two people who have been asking for advice. One is looking to continue their catastrophic-type health insurance. This is widely accepted as the most efficient type of insurance, but the ACA prevents such plans from being issued to most people over the age of 30. The other person to comment on their insurance premiums stated outright that their family is a high consumer of health care, to the point that the only sensible price comparison for them involves adding the premiums and total yearly out of pocket maxima (in and out of plan).
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Guarantee-issue catastrophic-only health insurance costs very nearly the same premium as bronze plans from the health insurance exchange.
The original poster is looking for what he had in 2013 which is very different. He had risk-underwritten catastrophic-only health insurance. Such a plan, for the young genetic-lottery winners, was indeed half the price or less than the current bronze plans. And rightly so, because the product you are buying now is different -- GUARANTEE ISSUE.
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Guarantee-issue catastrophic-only health insurance costs very nearly the same premium as bronze plans from the health insurance exchange.
The original poster is looking for what he had in 2013 which is very different. He had risk-underwritten catastrophic-only health insurance. Such a plan, for the young genetic-lottery winners, was indeed half the price or less than the current bronze plans. And rightly so, because the product you are buying now is different -- GUARANTEE ISSUE.
1) The price depends on the state. Where I am the cheapest bronze plans are about 25% more than the catastrophic coverage.
2) Guarantee issue is not the only new feature. The new catastrophic plans are required to cover at least 1 preventive care visit and 3 primary care visits. There are other differences that necessarily raise the cost compared to old plans (some of which are good changes, in my view, but not all).
3) The maximum deductible of ACA compliant plans is 6350 for an individual and 12700 per family. Before the ACA, and individual could purchase policies with higher deductibles for a smaller monthly premium.
4) Even then, the OP is not eligible to purchase catastrophic coverage for himself or his wife. No one over the age of 30 is without a waiver. (I will note that implementation of fines in the OP's case has been waived until 2016)
Yes, guarantee issue is a good and necessary addition to health care coverage in the United States, and yes, this will increase the price compared to old policies. Few people are complaining about that, and I don't think anyone in this thread is. However, the ACA has changed the insurance landscape in other ways, many of which reduce the freedom to choose the type of insurance best for you.
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Everything else besides guarantee-issue (w/ 3x pricing old vs. young) represents an immaterial cause of the original poster's higher 2014 premiums. Complaints about the higher prices in 2014 is just a complaint that you want to keep getting risk underwritten policies that don't kick in a dime for care of sicker Americans. Don't hide the ugly side. You don't want your premiums to help sick & poor get high quality care.
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Sure it sucks to pay more in premiums than we want to, but it's tough when you get dealt a bad hand in the genetic lottery and have health issues from birth or chronic problems through life. I also agree that we need to share the burden of health care costs.
Anyone know if there provisions in the ACA for people to be charged more if they're overweight, obese or smoke, etc?
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Sure it sucks to pay more in premiums than we want to, but it's tough when you get dealt a bad hand in the genetic lottery and have health issues from birth or chronic problems through life. I also agree that we need to share the burden of health care costs.
Anyone know if there provisions in the ACA for people to be charged more if they're overweight, obese or smoke, etc?
I thought there was something about smoking, but I haven't paid that close of attention since I have employer health insurance.
the weight one is so tricky because there is definitely a weight range that is healthy for some people, but not for others. it's not a straightforward relationship between weight and health/disease risk.
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Sure it sucks to pay more in premiums than we want to, but it's tough when you get dealt a bad hand in the genetic lottery and have health issues from birth or chronic problems through life. I also agree that we need to share the burden of health care costs.
Anyone know if there provisions in the ACA for people to be charged more if they're overweight, obese or smoke, etc?
I thought there was something about smoking, but I haven't paid that close of attention since I have employer health insurance.
the weight one is so tricky because there is definitely a weight range that is healthy for some people, but not for others. it's not a straightforward relationship between weight and health/disease risk.
The ACA allows the following variability on premiums:
up to a 50% surcharge for smokers
up to a 3:1 price ratio for age (that is, a 64.5 year old can pay no more than 3x an 18 year old).
There are no surcharges allowed for weight, no matter how high or caused by what.
Also, some states don't allow the smoking or age surcharges. E.g. New York has pure community rating, so everyone pays the same rate for a given policy, period.
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Within a state, further limited pricing variability is permitted by location. This is heavily restricted to prevent pricing shenanigans & racial/income discrimination.
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Everything else besides guarantee-issue (w/ 3x pricing old vs. young) represents an immaterial cause of the original poster's higher 2014 premiums. Complaints about the higher prices in 2014 is just a complaint that you want to keep getting risk underwritten policies that don't kick in a dime for care of sicker Americans. Don't hide the ugly side. You don't want your premiums to help sick & poor get high quality care.
This is offensive and inaccurate. I provided a list of reasons why price went up, and guarantee issue is only one of them.
If you want to respond to my points, I'm happy to continue this discussion. If you're going to make offensive and inaccurate ad hominem comments, then I see no point in continuing.
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You providing a list of reasons is sort of like the Republican "and replace" alternative to the ACA. A list of seemingly-valid talking points that muddy up the discussion to give the appearance of a 50/50 argument.
The comparison at issue here is the insurance policy for a young & healthy family in 2013 that is based upon risk-underwriting where the premium is based upon the actuarial expectations of healthcare expenses for this young & healthy family vs. a 2014 ACA policy that is guarantee-issue where the premium is based upon the actuarial expectations of healthcare expenses for the entire pool of covered people. The key driver for the higher costs in the latter vs. former is the removal of underwriting in 2014.
Your attempt to argue that the 2014 policy really has higher premiums because the insurer has to pay an internist $100/yr for a physical and the insurer has to kick-in 100% coverage at a $6K out--of-pocket annual cap rather than a $10K cap is unpersuasive & illogical. An extra $10/mo in preventative care benefits will raise premiums in the competitive ACA marketplaces an immaterial $10/mo. The lower annual out-of-pocket cap is wholly irrelevant to the young & healthy family as they are getting no where near the cap.
The lower out-of-pocket cap is an intentional feature of the guarantee-issue-3x structure of 2014 health insurance ACA marketplaces. Everyone pays the pro-rata costs for an insurer to pay benefits and make a profit in a system that limits the maximum individual downside for people who get sick. Bitching about the lower cap is the same complaint as the original poster -- you don't want to have to pay for insurance benefits that won't benefit you in 2014 (fingers crossed) and instead want sick people to have higher healthcare expenses with a higher cap.
Immoral, Ayn Randian, Paul Ryanism, Charles Trevelyanian, short-sighted selfishness.
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The comparison at issue here is the insurance policy for a young & healthy family in 2013 that is based upon risk-underwriting where the premium is based upon the actuarial expectations of healthcare expenses for this young & healthy family vs. a 2014 ACA policy that is guarantee-issue where the premium is based upon the actuarial expectations of healthcare expenses for the entire pool of covered people. The key driver for the higher costs in the latter vs. former is the removal of underwriting in 2014.
The OP is not eligible for any ACA-compliant plan anything remotely resembles their old plan plus guaranteed issue. Your continued insistence on this suggests that you're completely missing the point.
And, just out of morbid curiosity, are you calling me all of those names, the OP, or anyone who expresses an opinion contrary to yours?
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The fact that one-third of the price increase the OP is facing for ACA-compliant policies can be found at https://www.coveredca.com/ Compare for yourself the price difference between minimum coverage and the bronze level plan, then realize the OP is not eligible for a catastrophic coverage plan because of age.
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The original poster is definitely eligible for a 2014 bronze plan that is substantially similar to the same as his 2013 catastrophic, with the exception of the added costs for guarantee-issue 3x community-rating pricing and other features designed to more broadly spread the cost of covering sick people (i.e. a low $6K out-of-pocket cap, everyone pays for maternity - even men, stupid liberals, don't know men can't get pregnant).
As a Californian, I am very familiar with CoveredCA. A high-earning 20 y/o will pay the same ~$100/mo for either bronze or catastrophic, 29 y/o will pay the same ~$175/mo for either bronze or catastrophic, 30 y/o will pay ~$180/mo for bronze. Proof that bronze coverage costs an insurance company about the same as catastrophic in 2014. The original poster's lack of access to catastrophic coverage that twenty-somethings have access to in 2014 is a meaningless semantic distinction, worthy of the world's smallest violin.
Glad you have abandoned defense of the obscurity that a $100 preventative annual physical is the cause of the premium increase. It gets old having to keep swatting down such nonsense and of course the opposing side never apologizing for making such a stupid argument in the first place.
Immoral, Ayn Randian, Paul Ryanism, Charles Trevelyanian, short-sighted selfishness are apt descriptions of anyone complaining about the ACA because they don't believe they should be forced to pay one dime more for insurance that benefits someone else. Wanting to go back to your 2013 policy that was priced low based upon your lottery-winning-genes and good health luck is insanely immoral.
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The original poster is definitely eligible for a 2014 bronze plan that is substantially similar to the same as his 2013 catastrophic, with the exception of the added costs for guarantee-issue 3x community-rating pricing and other features designed to more broadly spread the cost of covering sick people (i.e. a low $6K out-of-pocket cap, everyone pays for maternity - even men, stupid liberals, don't know men can't get pregnant).
As a Californian, I am very familiar with CoveredCA. A high-earning 20 y/o will pay the same ~$100/mo for either bronze or catastrophic, 29 y/o will pay the same ~$175/mo for either bronze or catastrophic, 30 y/o will pay ~$180/mo for bronze. Proof that bronze coverage costs an insurance company about the same as catastrophic in 2014. The original poster's lack of access to catastrophic coverage that twenty-somethings have access to in 2014 is a meaningless semantic distinction, worthy of the world's smallest violin.
This is a good start. However, instead of cherry picking the numbers, I suggest putting in the OP's situation - family of 4, 2 kids. You'll find that bronze coverage no longer equals catastrophic.
Immoral, Ayn Randian, Paul Ryanism, Charles Trevelyanian, short-sighted selfishness are apt descriptions of anyone complaining about the ACA because they don't believe they should be forced to pay one dime more for insurance that benefits someone else. Wanting to go back to your 2013 policy that was priced low based upon your lottery-winning-genes and good health luck is insanely immoral.
Good, so none of those things apply to me. Continue tilting at windmills.
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the added costs for guarantee-issue 3x community-rating pricing and other features designed to more broadly spread the cost of covering sick people (i.e. a low $6K out-of-pocket cap, everyone pays for maternity - even men, stupid liberals, don't know men can't get pregnant).
Last I heard it was men who get women pregnant. I certainly hope no one here is so short-sighted as to argue that women should be charged more for insurance (i.e., women should bear the entire cost of pregnancy instead of splitting the extra premiums 50-50 with men) because they're the ones who get pregnant. In response to such an argument I would be forced to say something like, "Man up! Grow a pair! It takes two to make a baby, so both those two should pay."
Heck, if any gender should pay the entire cost, it's men, since pregnancy and childbirth costs you exactly nothing physically or medically--women shoulder that burden 100%.
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If you're self-employed in any way - with a Sch C or S-corp/partnership, make sure you're getting your self-employed health insurance deduction on the front page (line 29) of your tax return. This is far superior to trying to make the 10% threshold for the itemized deduction on medical expenses. You can do this as long as you have a profit.
In fact, if you're self-employed and can pick up a plan that allows an HSA, you essentially ensure all of your medical costs are deductible.
If you have a partnership and S-corp, the entity needs to reimburse you for you health insurance premiums.
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Heck, if any gender should pay the entire cost, it's men, since pregnancy and childbirth costs you exactly nothing physically or medically--women shoulder that burden 100%.
Huh? Because women carry the baby, that means they shouldn't have to pay any of the financial costs?
That type of viewpoint just reinforces the belief that women are caregivers, men a paycheck.
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Heck, if any gender should pay the entire cost, it's men, since pregnancy and childbirth costs you exactly nothing physically or medically--women shoulder that burden 100%.
Huh? Because women carry the baby, that means they shouldn't have to pay any of the financial costs?
That type of viewpoint just reinforces the belief that women are caregivers, men a paycheck.
My point was that it should be shared 50-50. I added that last remark as an aside because while making one gender pay 100% for the costs of childbirth is totally unfair--I think we both agree on that--if the system is going to be set up to put 100% of the financial costs on only one gender, then it would actually be MORE unfair to choose women as that gender because women are already "paying" the 100% of the physical and medical "costs" by virtue of the fact that pregnancy and childbirth happens exclusively in women's bodies.
In other words, the financial costs should be shared 50-50, but if you consider more than the financial costs, women are already bearing 100% of the physical burden of pregnancy and childbirth so if you're going to stick one gender with 100% of the financial costs, it should be men so that they can at least carry SOME of the burden.
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In other words, the financial costs should be shared 50-50, but if you consider more than the financial costs, women are already bearing 100% of the physical burden of pregnancy and childbirth so if you're going to stick one gender with 100% of the financial costs, it should be men so that they can at least carry SOME of the burden.
Biology isn't fair/equal so we should make the financial aspect unfair too?
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Have we gotten to single payor yet?
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Cost control won't happen until our society acknowledges the rising use of extremely expensive, marginally more effective treatments. At an oncology conference I attended, a presenter noted that adding a fourth chemotherapy agent (bevacizumab, if anyone's interested) increased the cost for treatment of colorectal cancer from $10k to $30-40k. Improvement in survival is on the order of a few months. There are many examples of this, since research in medicine has matured enough that the low-hanging fruits have been picked. In addition, many of the other diseases afflicting us are in part self-induced. It's cheaper to prevent them, but as anyone who exercises regularly knows, quite hard. If we value that cutting-edge, fix-problems-later, no-holds-barred treatment strategy as a society (which clearly we do!), we will have to accept that healthcare will be an ever-larger part of our spending. The ACA is great for individuals who didn't have insurance, and to some extent hospitals/physicians. But it will definitely not help decrease costs significantly.
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Anyone know if there provisions in the ACA for people to be charged more if they're overweight, obese or smoke, etc?
there are a couple factors:
where you live, age, smoker/non, family size (who is on your tax return), household income.
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Immoral, Ayn Randian, Paul Ryanism, Charles Trevelyanian, short-sighted selfishness are apt descriptions of anyone complaining about the ACA because they don't believe they should be forced to pay one dime more for insurance that benefits someone else. Wanting to go back to your 2013 policy that was priced low based upon your lottery-winning-genes and good health luck is insanely immoral.
I left the thread after I got my solution. I didn't want to turn this into an ideological debate about whether the ACA is good or bad. But now that my moral character has been attacked for wanting to save money...
I disagree with your assessment. I don't want to pay more than I have to. I am not complaining or whining about the law. I just don't want to pay more than is necessary. Yes, there is a price at which I would put my kids on a catastrophic plan and the wife and I would opt out. That is just me not thinking the product is worth the price. I have the money, what does that have to do with anything? I have the money to other things that are overpriced too.
As for not wanting to pay for someone else's health problems. I am sorry that the charity you think is the most important is not the same as the charity I think is the most important. I like helping others, but being called selfish because I don't want to subsidize health care... well that is a bit of an oversimplification isn't it? After all, I do have finite resources, so every dollar that goes to healthcare...
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I had sticker shock the first time I looked the plans up too. I don't qualify for subsidies but was curious what they were. The good news is in retirement when my income is more inline with my expenses it will be very affordable.
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As for not wanting to pay for someone else's health problems. I am sorry that the charity you think is the most important is not the same as the charity I think is the most important. I like helping others, but being called selfish because I don't want to subsidize health care... well that is a bit of an oversimplification isn't it? After all, I do have finite resources, so every dollar that goes to healthcare...
By design, insurance has you paying for other people's health problems. That's how insurance works.
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As for not wanting to pay for someone else's health problems. I am sorry that the charity you think is the most important is not the same as the charity I think is the most important. I like helping others, but being called selfish because I don't want to subsidize health care... well that is a bit of an oversimplification isn't it? After all, I do have finite resources, so every dollar that goes to healthcare...
By design, insurance has you paying for other people's health problems. That's how insurance works.
Yes, exactly (and vice versa--others pay for yours, when you need it).
If you don't want to pay for other people's medical care, don't get health insurance. If you don't want to pay for other peoples house fires, dog bites, lawsuits over falls on icy sidewalks, etc., don't get homeowner's insurance. If you don't want to pay for other people's car accidents, don't get car insurance. Paying for other people's problems is what insurance IS.
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As for not wanting to pay for someone else's health problems. I am sorry that the charity you think is the most important is not the same as the charity I think is the most important. I like helping others, but being called selfish because I don't want to subsidize health care... well that is a bit of an oversimplification isn't it? After all, I do have finite resources, so every dollar that goes to healthcare...
By design, insurance has you paying for other people's health problems. That's how insurance works.
Yes, exactly (and vice versa--others pay for yours, when you need it).
If you don't want to pay for other people's medical care, don't get health insurance. If you don't want to pay for other peoples house fires, dog bites, lawsuits over falls on icy sidewalks, etc., don't get homeowner's insurance. If you don't want to pay for other people's car accidents, don't get car insurance. Paying for other people's problems is what insurance IS.
jp seems to have it right (see line highlighted above). Insurance is not charity. Insurance is something you buy (or not, as you choose) from a company who is looking to make a profit on your purchase. Of course they profit by paying less on average than they take in, but that is how any business profits.
A homeowner may well be liable to pay when his dog bites someone, but that is independent of whether he writes a check, or the insurance company writes a check, to the one bitten.
Related but separate is the concept of a right to healthcare. If I have a right to it, that implies some doctor has an obligation to provide it - and that just doesn't seem fair to the doctor.
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The ACA equivalent to our current employer sponsored health plan is
a silver plan for over $1300/month. That's for parents + 4 kids.
There is no way we could afford that.
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The ACA equivalent to our current employer sponsored health plan is
a silver plan for over $1300/month. That's for parents + 4 kids.
There is no way we could afford that.
The maximum silver-plan premium for a family of 4 making up to ~$8000/mo is ~$750/mo.
http://obamacarefacts.com/obamacare-subsidies.php
The Affordable Care Act gives every American access to affordable, quality health care. Millions of Americans previously had no such access. You will pay more than $750/mo if and only if you make more than $8000/mo, in which case your appeal for internet sympathy for your unaffordable plight is easily dismissed when weighed against the real, life-saving good being delivered to millions of Americans.
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"Related but separate is the concept of a right to healthcare. If I have a right to it, that implies some doctor has an obligation to provide it - and that just doesn't seem fair to the doctor."
I will never understand Americans. Of course people have a right to healthcare but that obligation falls on society as a whole not any individual doctor.
Also I urge you to read this:
The U.S.: We Are Number 27 in Health!
http://delong.typepad.com/sdj/2013/07/the-us-we-are-number-27-in-health.html#more
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Anyone know if there provisions in the ACA for people to be charged more if they're overweight, obese or smoke, etc?
In DC the ACA premium is based only on age. When I first tried to apply, there was a question on smoking, but it was permanently toggled to "smoker" with no way to change it. Within a week, the DC Exchange updated its site and that question was removed completely. It was never meant to show up, but the Exchange modified an existing web form and it carried over into the new application.
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"Related but separate is the concept of a right to healthcare. If I have a right to it, that implies some doctor has an obligation to provide it - and that just doesn't seem fair to the doctor."
I will never understand Americans. Of course people have a right to healthcare but that obligation falls on society as a whole not any individual doctor.
Also I urge you to read this:
The U.S.: We Are Number 27 in Health!
http://delong.typepad.com/sdj/2013/07/the-us-we-are-number-27-in-health.html#more
If you ever do understand Americans, please let us know - there are 300 million of us and I can't figure us out either.
But to the main points of your note:
- I appreciate the perspective on societal obligation. In the end, however, it becomes not the undefined "they" who provide healthcare, but individuals. At least I don't understand how one can be given a right to the work output of others without simultaneously imposing an obligation on those others to produce that work output.
- Thanks for the link. It and the study published in JAMA on which the article is based do make interesting reads.
A couple more articles on the issue of US health care, one presumably liberal: http://libecon.wordpress.com/2013/03/15/time-magazine-on-the-cost-of-health-care/ (http://libecon.wordpress.com/2013/03/15/time-magazine-on-the-cost-of-health-care/), and the other presumably conservative: http://www.forbes.com/sites/chrisconover/2013/03/04/5-myths-in-steven-brills-opus-on-health-costs-part-1/ (http://www.forbes.com/sites/chrisconover/2013/03/04/5-myths-in-steven-brills-opus-on-health-costs-part-1/), go into more details (and say things better) than I can here.
I suspect that most of the 300 million Americans would agree that "something" should be done to improve at least some facet of healthcare here. Where we find large differences is defining what that "something" should be.
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Hi folks,
All I want to say is you should really consider moving to Canada.
I make ~$100k a year, and pay about $30k in income tax. But that income tax provides me, and my wife, and my future daughter with $0 deductable health coverage. And even if I lose my job, I still have coverage.
If your plans are seriously ~$1500 a month, with $6k deductables you are potentially paying nearly as much as me for healtcare as I pay in income taxes for the year.
Canada is always looking for highly motivated, educated, wealthy individuals! You could even try it out for a year by using the NAFTA exemption.
Good luck.
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" I appreciate the perspective on societal obligation. In the end, however, it becomes not the undefined "they" who provide healthcare, but individuals. At least I don't understand how one can be given a right to the work output of others without simultaneously imposing an obligation on those others to produce that work output."
This is a strawman my friend. I am not suggesting enslaving medical professionals and forcing them to work 23 hours a day in underground health care mines. I am suggesting that society has a responsibility to the health of its members. Doctors, nurses and so on will individually provide services because the wish to do so for the money or the personal satisfaction. There will be no need to impose an obligation on any individual but I suspect you know that already.
"A couple more articles on the issue of US health care, one presumably liberal: http://libecon.wordpress.com/2013/03/15/time-magazine-on-the-cost-of-health-care/, and the other presumably conservative: http://www.forbes.com/sites/chrisconover/2013/03/04/5-myths-in-steven-brills-opus-on-health-costs-part-1/, go into more details (and say things better) than I can here."
Sorry articles in the popular press don't carry much weight with me.
"I suspect that most of the 300 million Americans would agree that "something" should be done to improve at least some facet of healthcare here. Where we find large differences is defining what that "something" should be."
That "something" should be the exact same something that works in every other developed country in the world. Socialized medical care.
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Actually it's not a strawman and no I don't know that already - but you are welcome to your beliefs.
Two Churchill quotes seem apt, the first more favorable to my position and the second more favorable to yours (in other words, you may be right but so far I'm not sure):
- "The inherent vice of capitalism is the unequal sharing of blessings; the inherent virtue of socialism is the equal sharing of miseries."
- "You can always count on Americans to do the right thing—after they’ve tried everything else."
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That "something" should be the exact same something that works in every other developed country in the world. Socialized medical care.
Either you mean something different by socialized medical care, or this is wrong. I thought it was pretty well established that Switzerland has the world's best healthcare, and that is most definitely not socialized.
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"Either you mean something different by socialized medical care, or this is wrong. I thought it was pretty well established that Switzerland has the world's best healthcare, and that is most definitely not socialized. "
That all depends on what you mean by socialized but I am happy to use another term if you like. Let us just say that access to healthcare is guaranteed by the government.
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Either you mean something different by socialized medical care, or this is wrong. I thought it was pretty well established that Switzerland has the world's best healthcare, and that is most definitely not socialized.
I don't think it's well established that the Switzerland has the best healthcare...
France and Italy are typically at the top of the list. Switzerland is good, above the US, but even not in the top 5.
Switzerland's system is not socialized like France's, but it does mandate insurance (that sounds familiar...) and insurance companies cannot profit on the basic plans. Citizens are given subsidies if the premium is over 8% of income.
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"Either you mean something different by socialized medical care, or this is wrong. I thought it was pretty well established that Switzerland has the world's best healthcare, and that is most definitely not socialized. "
That all depends on what you mean by socialized but I am happy to use another term if you like. Let us just say that access to healthcare is guaranteed by the government.
Ah, okay. In that case, we're getting there. The ACA enabled coverage for practically everyone legally in the country. There are still some holes - for example, in the states that didn't expand Medicaid there's a gap between being eligible for Medicaid and being eligible for subsidies on the exchange. But if we fixed those holes, and increased the penalty for not having insurance to more than he insurance premium (like the Netherlands does), or automatically enrolled people (like Switzerland does), we'd get very close to their numbers.
P.S. Most of the time "socialized medicine" means systems in which either the government pays for all basic health care (Canada) or actually runs the whole health care system (the UK). The term I'd be more comfortable with here is "universal health care"
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Either you mean something different by socialized medical care, or this is wrong. I thought it was pretty well established that Switzerland has the world's best healthcare, and that is most definitely not socialized.
I don't think it's well established that the Switzerland has the best healthcare...
France and Italy are typically at the top of the list. Switzerland is good, above the US, but even not in the top 5.
Switzerland's system is not socialized like France's, but it does mandate insurance (that sounds familiar...) and insurance companies cannot profit on the basic plans. Citizens are given subsidies if the premium is over 8% of income.
Most of the systems that rank France #1 include cost as a consideration. I thought I saw that Switzerlands system was best regardless of the cost, but I can't find a link right away. I'll keep looking. In any case, my point was that there are plenty of countries that provide universal health care without having socialized health care.
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Here's a report that ranked the Netherlands #1 and Switzerland #2 in 2013:
http://www.healthpowerhouse.com/files/ehci-2013/ehci-2013-summary.pdf
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"P.S. Most of the time "socialized medicine" means systems in which either the government pays for all basic health care (Canada) or actually runs the whole health care system (the UK). The term I'd be more comfortable with here is "universal health care""
Not to get into an argument about definitions of what "socialism" means but I think you are taking a very narrow view of the word here. However if you are more comfortable with the term universal healthcare I don't have a problem with that.
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"P.S. Most of the time "socialized medicine" means systems in which either the government pays for all basic health care (Canada) or actually runs the whole health care system (the UK). The term I'd be more comfortable with here is "universal health care""
Not to get into an argument about definitions of what "socialism" means but I think you are taking a very narrow view of the word here. However if you are more comfortable with the term universal healthcare I don't have a problem with that.
Perhaps, but I'm not alone: http://www.merriam-webster.com/dictionary/socialized%20medicine
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Oh please. There is a reason why most university classes don't allow citations from dictionaries when writing papers as they are, by their very nature, reductionist. However, like I said I have no urge to argue definitions with you. If you prefer universal healthcare that is fine with me.
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Oh please. There is a reason why most university classes don't allow citations from dictionaries when writing papers as they are, by their very nature, reductionist. However, like I said I have no urge to argue definitions with you. If you prefer universal healthcare that is fine with me.
Really? The dictionary isn't a good resource for someone perusing this forum who didn't know what someone meant by "socialized medicine?"
Oh, and if this were a scholarly work, here you go:
1. http://onlinelibrary.wiley.com/doi/10.1002/9781118410868.wbehibs479/abstract;jsessionid=1A8A47BAF42F1D67403AAE152FD5B2D5.f04t04?deniedAccessCustomisedMessage=&userIsAuthenticated=false
2. http://books.google.com/books?id=W5fvMTqCSywC&lpg=PA163&dq=uwe%20reinhardt%20socialized%20medicine&pg=PA163#v=onepage&q=uwe%20reinhardt%20socialized%20medicine&f=false
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As for not wanting to pay for someone else's health problems. I am sorry that the charity you think is the most important is not the same as the charity I think is the most important. I like helping others, but being called selfish because I don't want to subsidize health care... well that is a bit of an oversimplification isn't it? After all, I do have finite resources, so every dollar that goes to healthcare...
By design, insurance has you paying for other people's health problems. That's how insurance works.
Yes, exactly (and vice versa--others pay for yours, when you need it).
If you don't want to pay for other people's medical care, don't get health insurance. If you don't want to pay for other peoples house fires, dog bites, lawsuits over falls on icy sidewalks, etc., don't get homeowner's insurance. If you don't want to pay for other people's car accidents, don't get car insurance. Paying for other people's problems is what insurance IS.
And if you don't want to get health insurance, then can we leave people by the side of the road and not force hospitals to treat you, if you can't pay and chose not to have insurance? That would drop the costs in the hospital.
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You really have 2 choices: revoke EMTALA, or accept that medicine is, for all practical purposes, already "socialized". You will get treatment at the ER (and elsewhere) regardless of ability to pay, which means that everyone else pays via insurance premiums and/or taxes. Socialized. But in a very dumb way.
So decide: do you want to leave people (including children/elderly/etc) to die if they can't pay, or do you want to reform the setup so that at least the "socialized" system is administered intelligently?
The whole socialized medicine argument is ridiculous. We have it now. But we do it very, very badly. The debate should be about how best to fix it, not whether society has an obligation to provide health care. That debate is, for all practical purposes, over.
-W
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You really have 2 choices: revoke EMTALA, or accept that medicine is, for all practical purposes, already "socialized". You will get treatment at the ER (and elsewhere) regardless of ability to pay, which means that if everyone else pay via insurance premiums and/or taxes. Socialized. But in a very dumb way.
So decide: do you want to leave people (including children/elderly/etc) to die if they can't pay, or do you want to reform the setup so that at least the "socialized" system is administered intelligently?
The whole socialized medicine argument is ridiculous. We have it now. But we do it very, very badly. The debate should be about how best to fix it, not whether society has an obligation to provide health care. That debate is, for all practical purposes, over.
-W
excellent post! damn near impossible to argue, though suppose the knuckle draggers will claim "repeal & replace" is better than the ACA, without ever feeling the need to vote on the "replace" legislation that taxes & funds care for the poor while reforming the insurance industry to prevent cherry-picking of genetic-lottery & health-good-luck winners.
Opposing the ACA without offering your specific, funded, scored solution that provides care to the same number of Americans as the ACA is pathetic. Truly pathetic. Can't see how such persons will not be forever embarrased to post at this site, knowing everyone can read their documented history of intellectual laziness.
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Oh betlim, betlim, betlim. Did you read the second of the two references you just put up? You really should have as it proves my point that "socialized medicine" can mean many different things to different people. To specifiy:
You said: " Most of the time "socialized medicine" means systems in which either the government pays for all basic health care (Canada) or actually runs the whole health care system (the UK).""
You say that Canada has socialized medicine (I would agree with that by the way). However your second references says this:
"...one would not call Canada's system "socialized medicine""
Thank you for demonstrating my point that people use the term socialism in different ways to mean different things. So can we stop arguing about this now?
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Oh betlim, betlim, betlim. Did you read the second of the two references you just put up? You really should have as it proves my point that "socialized medicine" can mean many different things to different people. To specifiy:
You said: " Most of the time "socialized medicine" means systems in which either the government pays for all basic health care (Canada) or actually runs the whole health care system (the UK).""
You say that Canada has socialized medicine (I would agree with that by the way). However your second references says this:
"...one would not call Canada's system "socialized medicine""
Thank you for demonstrating my point that people use the term socialism in different ways to mean different things. So can we stop arguing about this now?
Well, let's see. I've given three sources. You've intimated that the dictionary isn't a valid source for looking up definitions of words, and that one of my sources using an even more restrictive definition supports your usage of a broader definition.
Yes, I think we're done arguing about this.
Did you have any comments on my main point?
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You had a point? I just thought you were arguing (poorly) about definitions.
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When people ask me why I will remain a UK Citizen while residing in the USA.... This conversation is exactly why.
My Dad sees a cardiologist evry couple of months for free.
NOBODY in the UK knows what medical bankruptcy is.. NO ONE!
Frank
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Insurance is not charity. Insurance is something you buy (or not, as you choose) from a company who is looking to make a profit on your purchase.
If you have a car, you don't have a choice about whether to buy car insurance.
If you have a mortgage, you don't have a choice about whether to buy homeowner's insurance.
Even renters may not have the option of not buying renter's insurance. I require my commercial tenants to have at least $1 million in renter's liability insurance naming me as additional insured--and that's not just me, it's very standard for commercial leases--and all my tenants, residential and commercial, sign a waiver spelling out that they can't come after me for any property damage that could've been covered by them getting renter's property insurance. Reading this waiver makes most of them get renter's insurance.
Long story short, there's nothing unusual about being required to have insurance.
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Insurance is not charity. Insurance is something you buy (or not, as you choose) from a company who is looking to make a profit on your purchase.
If you have a car, you don't have a choice about whether to buy car insurance.
If you have a mortgage, you don't have a choice about whether to buy homeowner's insurance.
Even renters may not have the option of not buying renter's insurance. I require my commercial tenants to have at least $1 million in renter's liability insurance naming me as additional insured--and that's not just me, it's very standard for commercial leases--and all my tenants, residential and commercial, sign a waiver spelling out that they can't come after me for any property damage that could've been covered by them getting renter's property insurance. Reading this waiver makes most of them get renter's insurance.
Long story short, there's nothing unusual about being required to have insurance.
Those examples only translate to healthcare if the healthcare providers themselves were the ones requiring you to have insurance in order to be treated. Since that's not the case, you're comparing apples to oranges.
The sheer fact of the matter is that the concept of "insurance" has been completely distorted by those trying to force the ACA onto others. Insurance, by it's very definition, is a method of risk management. Being insured means that you're managing that risk by joining a pool of others who are also making an effort to manage the same risk in their lives. Just like you wouldn't want to share a risk pool with a pyromaniac when insuring your home, it would financially insane to want to share a risk pool with someone who is a far greater risk to incur major healthcare related expenses in your health insurance pool. The ACA attempts to defy the theories of risk management by forcing low risk people to pool their risk with high risk people. It was, and still is, doomed to fail from the get go. Then again, I think it was intentionally designed to fail in the first place so that a universal system could be forced onto the American people, which would be a moral tragedy in itself.
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Those examples only translate to healthcare if the healthcare providers themselves were the ones requiring you to have insurance in order to be treated. Since that's not the case, you're comparing apples to oranges.
Things do not have to be identical in order to be comparable, and in any case I don't see why the proper analogy here would be health insurance being required by healthcare providers. The government of your state is who requires you to have car insurance. It is not that big a stretch to say the government of your state or country could require you to buy some other kind of insurance, such as health insurance. That's what Massachusetts did under Governor Romney, after all.
And since my point was that buying insurance is not always a choice--it may be required--that point remains true.
Being insured means that you're managing that risk by joining a pool of others who are also making an effort to manage the same risk in their lives. Just like you wouldn't want to share a risk pool with a pyromaniac when insuring your home, it would financially insane to want to share a risk pool with someone who is a far greater risk to incur major healthcare related expenses in your health insurance pool. The ACA attempts to defy the theories of risk management by forcing low risk people to pool their risk with high risk people.
It would be financially insane for an insurance company NOT to pool higher-risk and lower-risk people together. If you put all the higher-risk people together the insurance company is looking at a major loss. If you put all the lower-risk people together, the insurance company would love that--you'd be making them rich by paying more than you should relative to the pool's overall risk--but fortunately the ACA took that option away from insurance companies because it harms both the low-risk people (by charging them more than they actually need to pay relative to the overall risk) and high-risk people (by not covering them at all, or only in different plans with exorbitant prices).
It was, and still is, doomed to fail from the get go. Then again, I think it was intentionally designed to fail in the first place so that a universal system could be forced onto the American people, which would be a moral tragedy in itself.
It was actually designed to be very similar to the Swiss system, which has been going strong for decades and has shown no sign of moving towards government-provided healthcare (which is what I assume you mean by "a universal system").
Here's a 2011 article from Forbes magazine: "Why Switzerland Has the World's Best Health Care System"
http://www.forbes.com/sites/theapothecary/2011/04/29/why-switzerland-has-the-worlds-best-health-care-system/
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Here's a 2011 article from Forbes magazine: "Why Switzerland Has the World's Best Health Care System"
http://www.forbes.com/sites/theapothecary/2011/04/29/why-switzerland-has-the-worlds-best-health-care-system/
Daleth, thanks for that link - it's a good read and worth the time. Two paragraphs in particular that caught my eye:
"99.5% of Swiss citizens have health insurance. Because they can choose between plans from nearly 100 different private insurance companies, insurers must compete on price and service, helping to curb health care inflation. Most beneficiaries have complete freedom to choose their doctor, and appointment waiting times are almost as low as those in the U.S., the world leader."
"Indeed, the fact that both liberals and conservatives would find objectionable elements to Switzerland is a large part of its appeal. It achieves the policy priorities of liberals (universal coverage; regulated insurance market) and of conservatives (low government health spending; privately-managed health care). Both sides could declare victory, and yet also have plenty to complain about."
As for choice and comparisons to other forms of insurance ("If you have a car, you don't have a choice about whether to buy car insurance. If you have a mortgage, you don't have a choice about whether to buy homeowner's insurance. Even renters may not have the option of not buying renter's insurance."), there are a few things.
- Not all states require auto insurance. More importantly, nobody is required to have a car.
- You aren't required to have a home, nor to have a mortgage if you do have a home.
- As noted, in many cases a renter does have a choice. One can debate the options, but the choice is there.
Speaking of choice, and when it may or may not (side discussion: any difference between "may" vs. "may not"?) apply, I wish the ACA "was actually designed to be very similar to the Swiss system". A big problem with the ACA is the lack of choice - people in many places have limited options and can't "choose between plans from nearly 100 different private insurance companies."
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Those examples only translate to healthcare if the healthcare providers themselves were the ones requiring you to have insurance in order to be treated. Since that's not the case, you're comparing apples to oranges.
Things do not have to be identical in order to be comparable, and in any case I don't see why the proper analogy here would be health insurance being required by healthcare providers. The government of your state is who requires you to have car insurance. It is not that big a stretch to say the government of your state or country could require you to buy some other kind of insurance, such as health insurance. That's what Massachusetts did under Governor Romney, after all.
And since my point was that buying insurance is not always a choice--it may be required--that point remains true.
Being insured means that you're managing that risk by joining a pool of others who are also making an effort to manage the same risk in their lives. Just like you wouldn't want to share a risk pool with a pyromaniac when insuring your home, it would financially insane to want to share a risk pool with someone who is a far greater risk to incur major healthcare related expenses in your health insurance pool. The ACA attempts to defy the theories of risk management by forcing low risk people to pool their risk with high risk people.
It would be financially insane for an insurance company NOT to pool higher-risk and lower-risk people together. If you put all the higher-risk people together the insurance company is looking at a major loss. If you put all the lower-risk people together, the insurance company would love that--you'd be making them rich by paying more than you should relative to the pool's overall risk--but fortunately the ACA took that option away from insurance companies because it harms both the low-risk people (by charging them more than they actually need to pay relative to the overall risk) and high-risk people (by not covering them at all, or only in different plans with exorbitant prices).
It was, and still is, doomed to fail from the get go. Then again, I think it was intentionally designed to fail in the first place so that a universal system could be forced onto the American people, which would be a moral tragedy in itself.
It was actually designed to be very similar to the Swiss system, which has been going strong for decades and has shown no sign of moving towards government-provided healthcare (which is what I assume you mean by "a universal system").
Here's a 2011 article from Forbes magazine: "Why Switzerland Has the World's Best Health Care System"
http://www.forbes.com/sites/theapothecary/2011/04/29/why-switzerland-has-the-worlds-best-health-care-system/
I don't think you understand how insurance works. Before the ACA, insurance companies had the option to NOT offer insurance to high risk people, or to offer it at a price that prevented a loss to the insurance company (which would likely have made it unaffordable to high risk patients). That made good business sense, as they're not a charity; they're in business to turn a profit. Low risk members want to share that risk with other low risk members so as to keep costs down. By introducing high risk members into the risk pool, you are always, always, always without a single outlier, failure, or anomaly, going to drive the cost of insurance up for those who are in the lower risk pool. This is quite clearly backed up by the increase in premiums that young and healthy individuals have experienced as a result of the ACA.
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Getting back to bronze vs silver. Did a little research and it appears that it IS the case that only silver plans are eligible for subsidies. I just read a university report on the ACA in Pennsylvania and they state very clearly there that bronze plans are NOT eligible for subsidy. Other sources:
https://www.healthcare.gov/will-i-qualify-to-save-on-out-of-pocket-costs/
http://www.healthsubsidy.net/Which_Plans_Eligible_For_Health_Subsidy.html#sthash.t7EqoVF2.dpbs
http://www.healthreformbeyondthebasics.org/cost-sharing-charges-in-marketplace-health-insurance-plans-part-2/
(Skim down to "Would it ever make sense for someone eligible for cost-sharing reductions to buy a bronze plan instead of a silver plan?")
Quote:
"If a person with income below 250 percent of the poverty line enrolls in a bronze plan instead of a silver plan, he would not be eligible for cost-sharing reductions. He would have to pay whatever out-of-pocket charges are required under the bronze plan. In most cases, it will make the most sense for people at the lower end of the income scale to pick a silver plan and receive cost-sharing reductions. But the choice will depend on an individual’s situation and preferences."
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You're conflating subsidies (lower premiums) with cost sharing (lower deductibles and out of pocket).
Yes, it's confusing.
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Yep, Geekette is right. Go right to the source: https://www.healthcare.gov/will-i-qualify-to-save-on-monthly-premiums/
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Those examples only translate to healthcare if the healthcare providers themselves were the ones requiring you to have insurance in order to be treated. Since that's not the case, you're comparing apples to oranges.
Things do not have to be identical in order to be comparable, and in any case I don't see why the proper analogy here would be health insurance being required by healthcare providers. The government of your state is who requires you to have car insurance. It is not that big a stretch to say the government of your state or country could require you to buy some other kind of insurance, such as health insurance. That's what Massachusetts did under Governor Romney, after all.
And since my point was that buying insurance is not always a choice--it may be required--that point remains true.
Being insured means that you're managing that risk by joining a pool of others who are also making an effort to manage the same risk in their lives. Just like you wouldn't want to share a risk pool with a pyromaniac when insuring your home, it would financially insane to want to share a risk pool with someone who is a far greater risk to incur major healthcare related expenses in your health insurance pool. The ACA attempts to defy the theories of risk management by forcing low risk people to pool their risk with high risk people.
It would be financially insane for an insurance company NOT to pool higher-risk and lower-risk people together. If you put all the higher-risk people together the insurance company is looking at a major loss. If you put all the lower-risk people together, the insurance company would love that--you'd be making them rich by paying more than you should relative to the pool's overall risk--but fortunately the ACA took that option away from insurance companies because it harms both the low-risk people (by charging them more than they actually need to pay relative to the overall risk) and high-risk people (by not covering them at all, or only in different plans with exorbitant prices).
It was, and still is, doomed to fail from the get go. Then again, I think it was intentionally designed to fail in the first place so that a universal system could be forced onto the American people, which would be a moral tragedy in itself.
It was actually designed to be very similar to the Swiss system, which has been going strong for decades and has shown no sign of moving towards government-provided healthcare (which is what I assume you mean by "a universal system").
Here's a 2011 article from Forbes magazine: "Why Switzerland Has the World's Best Health Care System"
http://www.forbes.com/sites/theapothecary/2011/04/29/why-switzerland-has-the-worlds-best-health-care-system/
I don't think you understand how insurance works. Before the ACA, insurance companies had the option to NOT offer insurance to high risk people, or to offer it at a price that prevented a loss to the insurance company (which would likely have made it unaffordable to high risk patients). That made good business sense, as they're not a charity; they're in business to turn a profit. Low risk members want to share that risk with other low risk members so as to keep costs down. By introducing high risk members into the risk pool, you are always, always, always without a single outlier, failure, or anomaly, going to drive the cost of insurance up for those who are in the lower risk pool. This is quite clearly backed up by the increase in premiums that young and healthy individuals have experienced as a result of the ACA.
Expect within large group plans, which is what the ACA plans are modeled after. Yes, this means the price is higher on the open market but this means that people can get a similar plan as their employers and therefore not be tied to their employer. I would think people who want to be FIRE would LIKE this. ACA allowed my mother to retire years prior than she wold have been able to with out it.
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I don't think you understand how insurance works. Before the ACA, insurance companies had the option to NOT offer insurance to high risk people, or to offer it at a price that prevented a loss to the insurance company (which would likely have made it unaffordable to high risk patients). That made good business sense, as they're not a charity; they're in business to turn a profit. Low risk members want to share that risk with other low risk members so as to keep costs down. By introducing high risk members into the risk pool, you are always, always, always without a single outlier, failure, or anomaly, going to drive the cost of insurance up for those who are in the lower risk pool. This is quite clearly backed up by the increase in premiums that young and healthy individuals have experienced as a result of the ACA.
Are you seriously lamenting the lost golden age when Americans with health problems could not get insurance unless they had jobs that offered group insurance? If you have health problems, no self employment or early retirement for you--too bad, so sad, better luck next life?
If so, we have nothing further to discuss since our basic values are fundamentally different.
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If so, we have nothing further to discuss since our basic values are fundamentally different.
This is what it boils down to. There are seriously people who think if you don't have cash or insurance, then you should not get medical treatment. Or they're fine with the treatment, but they expect you to pay for it...I guess with imaginary dollars?
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I think it's more of a cognitive dissonance/low information issue. I can't imagine more than 5-10% of the US would really support repealing EMTALA (if they knew what it was), and once you've made that decision, you're pretty much stuck ending up at universal health care/mandated insurance of some kind unless you just want to flush money down the toilet treating people in the ER.
It's the same as asking people if the government is too big, then asking what they want to get rid of - it turns out they like 95% of it but would like to get rid of "waste" in the abstract.
-Walt
If so, we have nothing further to discuss since our basic values are fundamentally different.
This is what it boils down to. There are seriously people who think if you don't have cash or insurance, then you should not get medical treatment. Or they're fine with the treatment, but they expect you to pay for it...I guess with imaginary dollars?
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I don't think you understand how insurance works. Before the ACA, insurance companies had the option to NOT offer insurance to high risk people, or to offer it at a price that prevented a loss to the insurance company (which would likely have made it unaffordable to high risk patients). That made good business sense, as they're not a charity; they're in business to turn a profit
Yeah, those were bad days if you weren't an insurance company, or if you happened to be anything but young, rich, or healthy. And sooner or later, none of us are young, rich, and healthy any more.