Doctors that don't take ACA - Does it factor into your FIRE Plans?

[David]

Right from the start I saw the problems; medical practitioners refusing to cover my wife and me; we had been a group plan through BC previously, but when we switched to an individual plan, our providers informed us that we wouldn't be covered any more. If you are in a large group plan, most providers will happily take on the business, otherwise, it can be a real problem. As someone mentioned earlier in the thread, the closest providers under ACA-like plans can be 50+ miles away.

We quickly elected to change plans and get back into a large group plan. Now we get to see all our providers like we could before.

This seems to be the case in CA.  I don't personally know anyone with an exchange plan but I called a few doctors listed as in-network for an exchange plan and most said they do not take exchange plans or not accepting new patients.    This means I need to work longer just for the health benefits. I'm researching where I want to work in the future with as few hours necessary to receive health benefits.  Not the FIRE plan I envisioned but better to find out now.

That might be the case

[forummm]

How the hell would they know you are using an ACA plan? It's just a healthplan. Unless it's Medicaid, it's a plan from a major insurer. Unless they don't accept the major insurer, then it's none of their business.

Insurers offer many different plans. United might have 25 different plans in a states. Some of them have a higher reimbursement rate than other plans. So some providers will be in network for some plans and not for others.

The nomenclature however is unfortunate in that it gives a false sense that Silver is better than Bronze; Gold better than Silver, and Platinum better than Gold. There is no difference in the actual coverage or the care that you are receiving. The difference essentially is do you want to pay now or pay later.

There's no consistent correlation between paying more for healthcare and getting higher quality outcomes. Sometimes the more expensive providers do a worse job.

I work in the medical field.  We don't take any insurance at our office.  Reimbursement is too low to make it work.  Too much paperwork.  Too much intrusion by insurance company.  We see plenty of medicaid patients who just pay out of pocket.  If you want to see a mental health provider who takes insurance you will be waiting months.

Are you in the mental health area? That's one of the only kinds of medical care where I can imagine people getting enough business without taking insurance. There are concierge docs that serve the wealthy. And alternative medicine or therapy places that insurers frequently don't cover.

[obstinate]

I'm not really stressed about it. Folks on medicare and medicaid have just as good risk-adjusted outcomes as those on private health insurance plans. That must mean that some doctors are seeing them.

[goatmom]

I work in the medical field.  We don't take any insurance at our office.  Reimbursement is too low to make it work.  Too much paperwork.  Too much intrusion by insurance company.  We see plenty of medicaid patients who just pay out of pocket.  If you want to see a mental health provider who takes insurance you will be waiting months.

Are you in the mental health area? That's one of the only kinds of medical care where I can imagine people getting enough business without taking insurance. There are concierge docs that serve the wealthy. And alternative medicine or therapy places that insurers frequently don't cover.
[/quote]

Yes, I am in the mental health field.  And yes, we are currently closed to new patients and have a waiting list.

[goatmom]

I work in the medical field.  We don't take any insurance at our office.  Reimbursement is too low to make it work.  Too much paperwork.  Too much intrusion by insurance company.  We see plenty of medicaid patients who just pay out of pocket.  If you want to see a mental health provider who takes insurance you will be waiting months.

Sounds like you work in a crappy office.  Seriously, complaining about "too much paperwork"?  Sounds lazy and more interested in ripping off patients to me.  I haven't had any problems finding excellent doctors that take my BCBS insurance plan.  When I needed surgery last year, it was no problem at all having excellent care at a nearby hospital that was covered by insurance (with a relatively tiny deductible).

No, it is not a crappy office filled with lazy doctors.  Lol. Do you know how much paperwork is required by many insurance companies?  We would have to hire people just to do the paperwork.  And to file claims. Instead, we keep our overhead low and pass the savings on to our patients.  As I mentioned above, we have a waiting list.  We also see a percentage of patients on a sliding scale or for free - not something doctors can do if they are being controlled by contracts with insurance companies.  In my area, there are very few psychs that take insurance. 

[EnjoyIt]

The whole process of dealing with Medicare/Medicaid and private insurance is a massive expense and a huge hassle. Just about every physician I talk to would love to remove themselves from dealing with those organizations.

[cchrissyy]

Does it factor into your FIRE Plans?

No, I don't think it should unless somebody is already FIRE'd or within a couple years of it

The ACA is very new. It obviously needs improvement and probably will change. Don't plan your life around today's market conditions and today's implementations of the law, or even the law itself. It is all too likely to change.

[The Happy Philosopher]

Does it factor into your FIRE Plans?

No, I don't think it should unless somebody is already FIRE'd or within a couple years of it

The ACA is very new. It obviously needs improvement and probably will change. Don't plan your life around today's market conditions and today's implementations of the law, or even the law itself. It is all too likely to change.

Yes, healthcare law is almost certain to change in 5, 10 20 years. The best thing about the ACA in my opinion is that anyone can get insurance - not great or cheap insurance always, but basically anyone that can pay the premiums gets a catastrophic policy no matter their health status. This is a great benefit to those that are in poor health. Before the ACA some people just couldn't get health insurance.

That being said, there are structural problems with medicine today and it is hard to imagine a system in 10 years that is less expensive or one that provides better access to care. I think it will play out like social security, in order to pay for expanding benefits someone has to pay for it. This is already happening: Higher copays, narrow networks that make finding a provider more difficult, higher deductibles, more restrictive drug plans, etc. Plan for higher medical costs in the future unless there is something disruptive on the horizon that no one sees coming.

An interesting idea is to lower eligibility for medicare to 50 or 55 shifting people from private insurance to CMS, although this would probably have the unintended side effect of making doctors that take medicare much more scarce and tough to see (unless reimbursement in increased, which is can't because then the program would be impossible to fund). This would be great for FIRE because it would significantly shorten the gap between private insurance and medicare.

When you retire at 35 nobody thinks of health care, because most 35 year olds are pretty healthy, even the ones that abuse their bodies (within reason). It is that 50-to-medicare time frame that can be an absolute nightmare. This is when things can really go wrong with health, even in people that have lived a very health life.

Also I don't know many docs that restrict insurance because they are lazy or greedy. Many can not afford to sign a certain contract with an insurance company because they would lose money on it. The overhead to run a clinic or hospital is pretty huge. Insurance contracts are usually pretty terrible, hundreds of pages written by lawyers for insurance companies that are designed to shift at much liability and cost to physicians as possible. Don't underestimate the amount of friction that has been introduced into the system in terms of paperwork, per-authorization and compliance over the past decade or so.

[lauraah]

I did some research and found that they considered leaving NC, but as of last week, have "announced their intent" to stay.  Interesting Op-Ed article by the BCBSNC CEO here.

Heh, I work there.  And it's funny this was quoted because when I started reading the thread I was thinking about how different our situation is.  When the ACA first started, I heard of doctors not accepting ACA patients initially because of their own political reasons and because of some initial things that weren't 100% worked out at that point but since have been (people could sign up, not pay their premium, and then it wasn't clear who was on the hook for the bill).  But I haven't heard of anything like that since.  Any employer group can buy an ACA product (not on the exchange, just get the same type of product), and many do.  From the doctor's perspective, it shouldn't be different than any other member. 

And as for member's not paying their deductibles...  for the poorest folk, there are not only subsidies, there are cost share reduction reimbursements from the government- which essentially means they pay next to nothing in cost share and the government reimburses the insurance company.  This still could be somewhat of a problem for doctors, but I do not believe it is a large problem.  In fact, several of the largest hospital systems here have had record breaking profits since the ACA was implemented. 

I can only guess that in other states, some plans do have truly different reimbursement levels for ACA versus non ACA products.  This is not something I was aware of before, so it's my guess that this currently is not the norm.  If it's effective at reducing costs though, it's possible it could spread.

Disclaimer: any opinions stated above are my own and not that of BCBSNC.

[Altons Bobs]

It's not surprising that hospitals are making big bucks because insurance companies have to accept everybody.  BCBS in my state had lost over $1Bil in 2014 and 2015 paying those bills that made record breaking earnings for hospitals.  But how many billions of dollars can they lose before they go belly up?!  That are just the losses in my state, and the parent company of this BCBS operates in 5 states and they had lost billions already.

The system used to work better here.  We had a state health risk pool, EVERYBODY could get insurance, no one would be denied.  The state health risk pool was for people with medical conditions that couldn't get insurance through a regular health insurance company, so they'd go to the risk pool funded by the state.  Now the risk pool is gone, the whole ACA is the risk pool and everybody has to pay more.

[Sibley]

It's not surprising that hospitals are making big bucks because insurance companies have to accept everybody.  BCBS in my state had lost over $1Bil in 2014 and 2015 paying those bills that made record breaking earnings for hospitals.  But how many billions of dollars can they lose before they go belly up?!  That are just the losses in my state, and the parent company of this BCBS operates in 5 states and they had lost billions already.

The system used to work better here.  We had a state health risk pool, EVERYBODY could get insurance, no one would be denied.  The state health risk pool was for people with medical conditions that couldn't get insurance through a regular health insurance company, so they'd go to the risk pool funded by the state.  Now the risk pool is gone, the whole ACA is the risk pool and everybody has to pay more.

Altons Bobs - so, I work for BCBS, based in Chicago. I'm thinking we work for the same company?

[forummm]

The system used to work better here.  We had a state health risk pool, EVERYBODY could get insurance, no one would be denied.  The state health risk pool was for people with medical conditions that couldn't get insurance through a regular health insurance company, so they'd go to the risk pool funded by the state.  Now the risk pool is gone, the whole ACA is the risk pool and everybody has to pay more.

Someone has to pay. Before, everyone was paying more through their taxes (that's what the state budget comes from). Now, some people are paying more through premiums, others less (due to tax credits). The ACA is not a perfect system. Your state's old system is also not perfect. I don't know which state it was, but it probably had a double digit uninsured rate for working age adults before the ACA. And I don't know for sure, but I bet the insurance in the state high risk pool was pretty expensive. The state (i.e. taxpayers) could have subsidized that cost a lot though, so hard to say.

[Altons Bobs]

forummm: I'm in TX, the state risk pool was funded by the state who got the tax money from corporations here.  There is no state income tax.  So instead of corporations funding the state risk pool, now me along with other Texans have to pay for everybody.   Since we don't have Medicaid extension here, there are still a lot of uninsureds.  The only people benefiting from the ACA are the people who are within the FPL to take advantage of the subsidies, not the really low income people who really need the help.  They're just moving people from paying a regular premium to paying less with subsidies, they're not increasing the insureds like they thought they were.

Sibley: I don't work for BCBS, but I do know quite a few people who do work for BCBS of TX.

[Spork]

forummm: I'm in TX, the state risk pool was funded by the state who got the tax money from corporations here.  There is no state income tax.  So instead of corporations funding the state risk pool, now me along with other Texans have to pay for everybody.   Since we don't have Medicaid extension here, there are still a lot of uninsureds.  The only people benefiting from the ACA are the people who are within the FPL to take advantage of the subsidies, not the really low income people who really need the help.  They're just moving people from paying a regular premium to paying less with subsidies, they're not increasing the insureds like they thought they were.

Sibley: I don't work for BCBS, but I do know quite a few people who do work for BCBS of TX.

FWIW: I had approximately the same insurance plan in Texas both before and after ACA.  My premiums (after subsidy applied) are more than double what my premiums were before ACA when subsidies didn't exist.  It was a pretty predictable economics exercise. 

I am sure there is a slice of the population that came out cheaper.  It's not average Joe Consumer that qualifies for subsidies though.

[brooklynguy]

FWIW: I had approximately the same insurance plan in Texas both before and after ACA.  My premiums (after subsidy applied) are more than double what my premiums were before ACA when subsidies didn't exist. 

Was your pre-ACA insurance plan an individual insurance policy that you purchased on the open market, or was it coverage under an employer-sponsored group insurance policy?

It's not average Joe Consumer that qualifies for subsidies though.

Sure it is.  Both the median and the mean U.S. household incomes are low enough to qualify for subsidies (despite the fact that the latter is skewed upward by our unequal and top-heavy income distribution).

[Spork]

FWIW: I had approximately the same insurance plan in Texas both before and after ACA.  My premiums (after subsidy applied) are more than double what my premiums were before ACA when subsidies didn't exist. 

Was your pre-ACA insurance plan an individual insurance policy that you purchased on the open market, or was it coverage under an employer-sponsored group insurance policy?

Yes, my pre-ACA plan was a BCBS plan purchased on the open market very similar to the current BCBS bronze plans.

It's not average Joe Consumer that qualifies for subsidies though.

Sure it is.  Both the median and the mean U.S. household incomes are low enough to qualify for subsidies (despite the fact that the latter is skewed upward by our unequal and top-heavy income distribution).

I wasn't wording that clearly... and quoting it alone there is taking it out of context.  Let me try to say it better. 

I am sure there is a slice of the population that came out cheaper.  It's not average Joe Consumer that qualifies for subsidies that is coming out cheaper.

*edit because I damn well butchered all the quoting. 

[jim555]

In NY, pre-ACA plans were much higher than current non-subsidized ACA plans.  This was due to state regulations on how insurance could be created.
With subsidies current plans are MUCH cheaper.

[forummm]

forummm: I'm in TX, the state risk pool was funded by the state who got the tax money from corporations here.  There is no state income tax.  So instead of corporations funding the state risk pool, now me along with other Texans have to pay for everybody.   Since we don't have Medicaid extension here, there are still a lot of uninsureds.  The only people benefiting from the ACA are the people who are within the FPL to take advantage of the subsidies, not the really low income people who really need the help.  They're just moving people from paying a regular premium to paying less with subsidies, they're not increasing the insureds like they thought they were.

So you talked about how great the TX high risk pool was. Well, Texas had the highest uninsured rate in the nation before the ACA (32.7% of adults 18-64 were uninsured in 2013). So I'm not sure how great that plan was if so many people either couldn't or didn't get into it.

[randymarsh]

The only people benefiting from the ACA are the people who are within the FPL to take advantage of the subsidies, not the really low income people who really need the help. 

I think I've benefited from staying on a parents' plan. It made the post college job search less stressful and of course I have more take home income to pay student loans with.

Tons of low income people in medicaid expansion states have also seen an improvement. The fact that certain states (who have some of the unhealthiest people) are putting politics above public health doesn't change that.

[Gin1984]

The only people benefiting from the ACA are the people who are within the FPL to take advantage of the subsidies, not the really low income people who really need the help. 

I think I've benefited from staying on a parents' plan. It made the post college job search less stressful and of course I have more take home income to pay student loans with.

Tons of low income people in medicaid expansion states have also seen an improvement. The fact that certain states (who have some of the unhealthiest people) are putting politics above public health doesn't change that.

I've benefited because I no longer need COBRA which was 28% of my income because I had a small pre-existing condition. 

[Altons Bobs]

forummm: I'm in TX, the state risk pool was funded by the state who got the tax money from corporations here.  There is no state income tax.  So instead of corporations funding the state risk pool, now me along with other Texans have to pay for everybody.   Since we don't have Medicaid extension here, there are still a lot of uninsureds.  The only people benefiting from the ACA are the people who are within the FPL to take advantage of the subsidies, not the really low income people who really need the help.  They're just moving people from paying a regular premium to paying less with subsidies, they're not increasing the insureds like they thought they were.

So you talked about how great the TX high risk pool was. Well, Texas had the highest uninsured rate in the nation before the ACA (32.7% of adults 18-64 were uninsured in 2013). So I'm not sure how great that plan was if so many people either couldn't or didn't get into it.

I never said that, that was just you putting words in my mouth.  That was just a response to a PP who said that not everyone could get insurance, he/she didn't say "afford".  The risk pool was expensive but if you really wanted insurance regardless of how sick you were, you could get it, it wasn't that it was unavailable.  Moving the population from the risk pool to ACA is not a solution, that's all I'm saying.

[forummm]

forummm: I'm in TX, the state risk pool was funded by the state who got the tax money from corporations here.  There is no state income tax.  So instead of corporations funding the state risk pool, now me along with other Texans have to pay for everybody.   Since we don't have Medicaid extension here, there are still a lot of uninsureds.  The only people benefiting from the ACA are the people who are within the FPL to take advantage of the subsidies, not the really low income people who really need the help.  They're just moving people from paying a regular premium to paying less with subsidies, they're not increasing the insureds like they thought they were.

So you talked about how great the TX high risk pool was. Well, Texas had the highest uninsured rate in the nation before the ACA (32.7% of adults 18-64 were uninsured in 2013). So I'm not sure how great that plan was if so many people either couldn't or didn't get into it.

I never said that, that was just you putting words in my mouth.  That was just a response to a PP who said that not everyone could get insurance, he/she didn't say "afford".  The risk pool was expensive but if you really wanted insurance regardless of how sick you were, you could get it, it wasn't that it was unavailable.  Moving the population from the risk pool to ACA is not a solution, that's all I'm saying.

The system used to work better here.  We had a state health risk pool, EVERYBODY could get insurance, no one would be denied.  The state health risk pool was for people with medical conditions that couldn't get insurance through a regular health insurance company, so they'd go to the risk pool funded by the state.  Now the risk pool is gone, the whole ACA is the risk pool and everybody has to pay more.

Here are your words. It sounded like you were saying the risk pool was a good situation. Maybe you object to the word "great". OK, fair enough.

But my point was that it couldn't have been that much better a situation if TX had the worst uninsured rate in the country. I don't have any idea what premiums were. But if they were $30k/year (to make up a number), that's almost the same (for most people) as not having any policy be available. Now anyone can get coverage and it's "affordable" (meaning 9.5% of income or less, unless you're a pretty decent income earner). It will definitely be more expensive for some people. But it does provide better protections all around--can't be denied, even if you move to a different state, no annual or lifetime maximum, no exclusions for prior conditions, strong benefit levels with comprehensive coverage, etc. I don't love the ACA, but it's generally better than what we had. Some people will pay more, but they get more too.

[opnfld]

I like that Obamacare has standardized the way that health plans are presented. Prior to Obamacare is was difficult to compare plans. Now, you can easily compare the plans apples-to-apples. The nomenclature however is unfortunate in that it gives a false sense that Silver is better than Bronze; Gold better than Silver, and Platinum better than Gold. There is no difference in the actual coverage or the care that you are receiving. The difference essentially is do you want to pay now or pay later. If you believe with a high degree of likelihood that you will have considerable medical expenses, the more expense plans might make sense, but for most people I think Bronze is the way to go.

If your income is between 100-250% the federal poverty level, be sure to take into account the Cost Sharing Reduction subsidy only provided on Silver Plans http://obamacarefacts.com/insurance-exchange/cost-sharing-reduction-subsidies-csr/.  This is in addition to the tax credit.

See GoCurryCracker http://www.gocurrycracker.com/obamacare-optimization-early-retirement/

[Rezdent]

forummm: I'm in TX, the state risk pool was funded by the state who got the tax money from corporations here.  There is no state income tax.  So instead of corporations funding the state risk pool, now me along with other Texans have to pay for everybody.   Since we don't have Medicaid extension here, there are still a lot of uninsureds.  The only people benefiting from the ACA are the people who are within the FPL to take advantage of the subsidies, not the really low income people who really need the help.  They're just moving people from paying a regular premium to paying less with subsidies, they're not increasing the insureds like they thought they were.

So you talked about how great the TX high risk pool was. Well, Texas had the highest uninsured rate in the nation before the ACA (32.7% of adults 18-64 were uninsured in 2013). So I'm not sure how great that plan was if so many people either couldn't or didn't get into it.

I never said that, that was just you putting words in my mouth.  That was just a response to a PP who said that not everyone could get insurance, he/she didn't say "afford".  The risk pool was expensive but if you really wanted insurance regardless of how sick you were, you could get it, it wasn't that it was unavailable.  Moving the population from the risk pool to ACA is not a solution, that's all I'm saying.

In regards to the sentence I bolded above.  Sure, you could get it...eventually, if you qualified and hadn't died in the interim.

IIRC, it wasn't that someone could decide they wanted to buy through the Texas risk pool.  They first had to prove that they had been denied by multiple companies.  Going through multiple applications, waiting for denials, and then finally applying to the risk pool and waiting for their review and approval in order to get a rather expensive plan.

[Beriberi]

In my parents' state, you had to be uninsured to apply to the high-risk pool.  So, my mother was paying $500/month for catastrophic insurance (no coverage until 10k out of pocket, no out-of-pocket maximum, poor coverage for 10k-50k in expenses).  However, she couldn't apply to the high-risk pool unless she let her insurance lapse, which she was unwilling to do.  The pools were very poorly utilized.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3024120/

Before Obamacare, states were capping the number that were allowed to enter the pools, imposing waiting periods, or flat-out closed enrollment in them.  It was not a good solution.

[Altons Bobs]

In regards to the sentence I bolded above.  Sure, you could get it...eventually, if you qualified and hadn't died in the interim.

IIRC, it wasn't that someone could decide they wanted to buy through the Texas risk pool.  They first had to prove that they had been denied by multiple companies.  Going through multiple applications, waiting for denials, and then finally applying to the risk pool and waiting for their review and approval in order to get a rather expensive plan.

Actually it was that simple, I knew several people who would not qualify for regular insurance then, they applied to a regular insurance company, and then they applied with the Risk Pool with the decline letter from the insurance company, they got accepted by the risk pool.  There were quite a few of them, it wasn't like what you mentioned.  Maybe I just knew lucky people or just a minority.

[Altons Bobs]

Here are your words. It sounded like you were saying the risk pool was a good situation. Maybe you object to the word "great". OK, fair enough.

But my point was that it couldn't have been that much better a situation if TX had the worst uninsured rate in the country. I don't have any idea what premiums were. But if they were $30k/year (to make up a number), that's almost the same (for most people) as not having any policy be available. Now anyone can get coverage and it's "affordable" (meaning 9.5% of income or less, unless you're a pretty decent income earner). It will definitely be more expensive for some people. But it does provide better protections all around--can't be denied, even if you move to a different state, no annual or lifetime maximum, no exclusions for prior conditions, strong benefit levels with comprehensive coverage, etc. I don't love the ACA, but it's generally better than what we had. Some people will pay more, but they get more too.

There is no assistance for anyone making less than 100% of the FPL in TX, and I know several people like that.  So they're not getting any help at all, they can't get health insurance (premiums before ACA were lower but now they're too high for them to afford).  And of the people who have at least one spouse with coverage with a company but the overall income is greater than the 9.66% threshold for the individual premium, the rest of the family could not get subsidy. How is that helping them?! And for the rest of us, our premiums are sky high. I don't know of anyone around me that this ACA is helping except a few, maybe like less than 3% of the people I know. It's not working very well in TX in my opinion, maybe it is in other areas/other states.

[Rezdent]

In regards to the sentence I bolded above.  Sure, you could get it...eventually, if you qualified and hadn't died in the interim.

IIRC, it wasn't that someone could decide they wanted to buy through the Texas risk pool.  They first had to prove that they had been denied by multiple companies.  Going through multiple applications, waiting for denials, and then finally applying to the risk pool and waiting for their review and approval in order to get a rather expensive plan.

Actually it was that simple, I knew several people who would not qualify for regular insurance then, they applied to a regular insurance company, and then they applied with the Risk Pool with the decline letter from the insurance company, they got accepted by the risk pool.  There were quite a few of them, it wasn't like what you mentioned.  Maybe I just knew lucky people or just a minority.

It has been a long while so I might not remember every detail correctly.

I had to provide 3 letters of denial - which meant scheduling with 3 agents, making the application, and waiting for them to turn around the denials (several weeks).  I can't remember which company made me get a physical even though they acknowledged they were going to deny - what a horrid waste of time.  If someone applied to the pool with the 3 denials then they were put on the list to qualify to apply - not accepted; put on the list.

Luckily for me, I landed a job with benefits - because the cost to have healthcare through the risk pool would have equaled half my salary at the time.

So, no.  Not the simple, affordable process you are implying here.  IMHO it sucked.

[MoonShadow]

Today I went to see a dermatologist.  When I was completing the paperwork I read in capital letters – WE DO NOT ACCEPT COVERED CALIFORNIA OR ANY HEALTH PLANS ON THE EXCHANGE.  My children’s pediatrician also as a sign in his office that says he doesn't accept exchange plans. 

Those of use with a background in Economics, even a little, warned this forum that this wasn't going to work out the way the ACA was sold to the public.  It's basic law of supply & demand stuff; in order for more people to get coverage while the overall cost to the public to decrease, the providers were going to have to get squeezed.  This is one reason that the insurance industry was involved, they wanted to make sure that it wasn't them that got squeezed.  And who is on the other side of the negotiation table from the insurance agencies?  The hospitals & doctors' networks.  So this is what you end up with; a private insurance market that has been gutted by regulations, counter balanced by semi-public medical plans that technically provide for a great deal, but functionally has no providers for the difficult stuff.  Dentistry aside, I dare to try & find out what hospitals or doctors in your network have experience with cancer care.  My suggestion is that you find an HSA plan, on the exchange or otherwise, and build up that balance.  You are going to need it, regardless of how good your subsidy is in the future.

[Altons Bobs]

It has been a long while so I might not remember every detail correctly.

I had to provide 3 letters of denial - which meant scheduling with 3 agents, making the application, and waiting for them to turn around the denials (several weeks).  I can't remember which company made me get a physical even though they acknowledged they were going to deny - what a horrid waste of time.  If someone applied to the pool with the 3 denials then they were put on the list to qualify to apply - not accepted; put on the list.

Luckily for me, I landed a job with benefits - because the cost to have healthcare through the risk pool would have equaled half my salary at the time.

So, no.  Not the simple, affordable process you are implying here.  IMHO it sucked.

I want to say it was within the 10-12 years before ACA started.  Maybe they improved the process since you applied?!  They only needed one decline, and the people I knew got accepted right away, they weren't put on a waitlist like you said.

[forummm]

Here are your words. It sounded like you were saying the risk pool was a good situation. Maybe you object to the word "great". OK, fair enough.

But my point was that it couldn't have been that much better a situation if TX had the worst uninsured rate in the country. I don't have any idea what premiums were. But if they were $30k/year (to make up a number), that's almost the same (for most people) as not having any policy be available. Now anyone can get coverage and it's "affordable" (meaning 9.5% of income or less, unless you're a pretty decent income earner). It will definitely be more expensive for some people. But it does provide better protections all around--can't be denied, even if you move to a different state, no annual or lifetime maximum, no exclusions for prior conditions, strong benefit levels with comprehensive coverage, etc. I don't love the ACA, but it's generally better than what we had. Some people will pay more, but they get more too.

There is no assistance for anyone making less than 100% of the FPL in TX, and I know several people like that.  So they're not getting any help at all, they can't get health insurance (premiums before ACA were lower but now they're too high for them to afford).  And of the people who have at least one spouse with coverage with a company but the overall income is greater than the 9.66% threshold for the individual premium, the rest of the family could not get subsidy. How is that helping them?! And for the rest of us, our premiums are sky high. I don't know of anyone around me that this ACA is helping except a few, maybe like less than 3% of the people I know. It's not working very well in TX in my opinion, maybe it is in other areas/other states.

Yes, because TX has intentionally decided to screw the poor and not let them have the free insurance coverage that the federal government is paying for, those under 100% FPL are possibly worse off today. But that's not how the ACA was intended to work. And it took a pretty radical lawsuit and surprising SCOTUS decision to break the ACA in that way. The issue of affordability of employer-based coverage for families is another unintended snag. The wording could be a little bit off from what was intended in a huge bill like that. In a normal situation Congress would just fix that language. But of course fixing anything in the ACA is a nonstarter due to politics. So the Republicans will let people in that situation get screwed rather than letting something get fixed in the ACA until such time as the Republicans can achieve their goal of repealing the entire law.

[MoonShadow]

Here are your words. It sounded like you were saying the risk pool was a good situation. Maybe you object to the word "great". OK, fair enough.

But my point was that it couldn't have been that much better a situation if TX had the worst uninsured rate in the country. I don't have any idea what premiums were. But if they were $30k/year (to make up a number), that's almost the same (for most people) as not having any policy be available. Now anyone can get coverage and it's "affordable" (meaning 9.5% of income or less, unless you're a pretty decent income earner). It will definitely be more expensive for some people. But it does provide better protections all around--can't be denied, even if you move to a different state, no annual or lifetime maximum, no exclusions for prior conditions, strong benefit levels with comprehensive coverage, etc. I don't love the ACA, but it's generally better than what we had. Some people will pay more, but they get more too.

There is no assistance for anyone making less than 100% of the FPL in TX, and I know several people like that.  So they're not getting any help at all, they can't get health insurance (premiums before ACA were lower but now they're too high for them to afford).  And of the people who have at least one spouse with coverage with a company but the overall income is greater than the 9.66% threshold for the individual premium, the rest of the family could not get subsidy. How is that helping them?! And for the rest of us, our premiums are sky high. I don't know of anyone around me that this ACA is helping except a few, maybe like less than 3% of the people I know. It's not working very well in TX in my opinion, maybe it is in other areas/other states.

Yes, because TX has intentionally decided to screw the poor and not let them have the free insurance coverage that the federal government is paying for, those under 100% FPL are possibly worse off today. But that's not how the ACA was intended to work. And it took a pretty radical lawsuit and surprising SCOTUS decision to break the ACA in that way

It wasn't all that much of a surprise.  They just upheld the literal wording of the law as passed.  Whether or not you agree that was the intent of Congress or not is irrelevant.  Anyone with any sense knew that there was no wiggle room for SCOTUS on this one, or they would have wiggled.  The plain language of the law prohibited the federal government from creating a federal exchange for states that refused to set up a state exchange.

[beltim]

Here are your words. It sounded like you were saying the risk pool was a good situation. Maybe you object to the word "great". OK, fair enough.

But my point was that it couldn't have been that much better a situation if TX had the worst uninsured rate in the country. I don't have any idea what premiums were. But if they were $30k/year (to make up a number), that's almost the same (for most people) as not having any policy be available. Now anyone can get coverage and it's "affordable" (meaning 9.5% of income or less, unless you're a pretty decent income earner). It will definitely be more expensive for some people. But it does provide better protections all around--can't be denied, even if you move to a different state, no annual or lifetime maximum, no exclusions for prior conditions, strong benefit levels with comprehensive coverage, etc. I don't love the ACA, but it's generally better than what we had. Some people will pay more, but they get more too.

There is no assistance for anyone making less than 100% of the FPL in TX, and I know several people like that.  So they're not getting any help at all, they can't get health insurance (premiums before ACA were lower but now they're too high for them to afford).  And of the people who have at least one spouse with coverage with a company but the overall income is greater than the 9.66% threshold for the individual premium, the rest of the family could not get subsidy. How is that helping them?! And for the rest of us, our premiums are sky high. I don't know of anyone around me that this ACA is helping except a few, maybe like less than 3% of the people I know. It's not working very well in TX in my opinion, maybe it is in other areas/other states.

Yes, because TX has intentionally decided to screw the poor and not let them have the free insurance coverage that the federal government is paying for, those under 100% FPL are possibly worse off today. But that's not how the ACA was intended to work. And it took a pretty radical lawsuit and surprising SCOTUS decision to break the ACA in that way

It wasn't all that much of a surprise.  They just upheld the literal wording of the law as passed.  Whether or not you agree that was the intent of Congress or not is irrelevant.  Anyone with any sense knew that there was no wiggle room for SCOTUS on this one, or they would have wiggled.  The plain language of the law prohibited the federal government from creating a federal exchange for states that refused to set up a state exchange.

Two misses with one swing: that's an impressive amount of concentrated being wrong.

1) The case forummm was talking about was National Federation of Independent Business v. Sebelius which allowed states to "opt out" of Medicaid expansion under the ACA and was widely considered a surprise.

2) The case King v. Burwell confirms the ability of the federal government to create an exchange for states that refused to set up a state exchange.

[MoonShadow]

Two misses with one swing: that's an impressive amount of concentrated being wrong.

Well, I suppose that it's good that is unusual.  Otherwise you'd never benefit from my wisdom, as I would too often just agree with you.

[BudgetSlasher]

to the original concern: Do the plans in question allow for you to file for reimbursement, so that you could pay out of pocket and subsequently be paid back?

[forummm]

Two misses with one swing: that's an impressive amount of concentrated being wrong.

Don't look at his post history unless you want to be really impressed.

[MoonShadow]

Two misses with one swing: that's an impressive amount of concentrated being wrong.

Don't look at his post history unless you want to be really impressed.

Beltim has a much greater right to call me to task when I err than you do Forummm.

[GetItRight]

I don't worry about it as I'm a long way from ER and hopefully ACA will be dead and gone by then. I also don't go to doctors unless I wake up there, which is covered under just about any insurance as initial ER treatment. For surgery not paid for by someone who has injured me I figure I'd go to that pay cash hospital run by doctors in Oklahoma that doesn't take insurance, reasonable prices and top notch service from what I've heard. I want nothing to do with health insurance as it currently exists in this country under ACA, negotiate price and pay on a card for 2% discount is my preferred method.

[mjs111]

I'm guessing you mean this hospital. Interesting:

http://surgerycenterok.com/about/

[EnjoyIt]

I'm guessing you mean this hospital. Interesting:

http://surgerycenterok.com/about/

More and more providers are going this route and even more wish they did also, but don't have the balls to try it out on your own.

All over the country over the last few years free standing emergency departments and urgent care centers are popping up that don't take medicare and medicaid and are extremely successful. 

The way I see it, Insurance companies are no different than bookies who take a cut on every transaction while the government is making the practice of medicine more difficult though bureaucratic red tape and regulations.  Every 3-6 months I see new regulations that make physician's workload more difficult and more time consuming with little to no patient benefit and sometimes even patient harm.

Simple human nature and economics will dictate that as the process continues and worsens, more and more physicians will stop accepting health insurance as well as medicare/medicaid.

It is a sad state of affairs that has only worsened over the last few years.

Yeah, more people have health insurance but still can't pay the deductible which means they aren't paying their bill or going into debt for repayment. But hey, at least they have insurance right? 

[jim555]

I don't worry about it as I'm a long way from ER and hopefully ACA will be dead and gone by then. I also don't go to doctors unless I wake up there, which is covered under just about any insurance as initial ER treatment. For surgery not paid for by someone who has injured me I figure I'd go to that pay cash hospital run by doctors in Oklahoma that doesn't take insurance, reasonable prices and top notch service from what I've heard. I want nothing to do with health insurance as it currently exists in this country under ACA, negotiate price and pay on a card for 2% discount is my preferred method.

You are going to get hit with the penalty for "non credible" coverage going this route.  Hope you have a lot of money.

[Beriberi]

 It is a bit unrealistic to think that the only healthcare you will need is elective surgery or emergency care related to trauma. Young healthy people get hospitalized for things they can't control all the time. They have a pneumonia and require breathing support.  They get influenza and are placed in an intensive care unit. They have gallbladder or kidney stone attacks, which often cannot be fully treated in an emergency department and may require surgery or other expensive procedures. And while emergency departments (freestanding and otherwise) take all comers, they do bill you for the services.  If you have no assets, the bill is no problem. However, if you have $1 million sitting in a bank account, you can fully expect the hospital to try to collect for services rendered.

[MrsPete]

We seem to be creating “have” and “have nots” related to healthcare at least where I live.

I have two family members who work in insurance, and they say that's exactly the situation towards which we're heading.  They say the next thing that's coming is "boutique medicine", which will be small groups of doctors who'll require "membership" in their group and won't accept insurance.

I personally don't have enough insight into the nuances of ACA to have an opinion. 

[GetItRight]

I don't worry about it as I'm a long way from ER and hopefully ACA will be dead and gone by then. I also don't go to doctors unless I wake up there, which is covered under just about any insurance as initial ER treatment. For surgery not paid for by someone who has injured me I figure I'd go to that pay cash hospital run by doctors in Oklahoma that doesn't take insurance, reasonable prices and top notch service from what I've heard. I want nothing to do with health insurance as it currently exists in this country under ACA, negotiate price and pay on a card for 2% discount is my preferred method.

You are going to get hit with the penalty for "non credible" coverage going this route.  Hope you have a lot of money.

The word you're looking for is tax. Whether I pay the tax or pay the mandated direct subsidy to a private business depends mostly on which is cheaper. Even if it's only marginally more expensive to pay for a service I have zero interest in having or using I may go that route so as not to give the money to government goons.

In any event, hopefully this ACA nonsense will be over and done with by the time I ER. If not, it's just another expense to plan for. The tax savings from relocating out of a high COL big government police state to a LCOL relatively free state once ER will be far greater than the tax for not complying with the government mandate. So just on taxes it's still a net decrease in taxes paid, not even considering everything else being cheaper.

[jim555]

The ACA is the one of the best things to happen for early retirees, I don't understand the hostility.  The system is very easy to game if you know the ins and outs.  Pre ACA you have no way game anything, and many couldn't get insurance at any reasonable price.

[iris lily]

I don't worry about it as I'm a long way from ER and hopefully ACA will be dead and gone by then. I also don't go to doctors unless I wake up there, which is covered under just about any insurance as initial ER treatment. For surgery not paid for by someone who has injured me I figure I'd go to that pay cash hospital run by doctors in Oklahoma that doesn't take insurance, reasonable prices and top notch service from what I've heard. I want nothing to do with health insurance as it currently exists in this country under ACA, negotiate price and pay on a card for 2% discount is my preferred method.

You are going to get hit with the penalty for "non credible" coverage going this route.  Hope you have a lot of money.

The word you're looking for is tax. Whether I pay the tax or pay the mandated direct subsidy to a private business depends mostly on which is cheaper. Even if it's only marginally more expensive to pay for a service I have zero interest in having or using I may go that route so as not to give the money to government goons.

In any event, hopefully this ACA nonsense will be over and done with by the time I ER. If not, it's just another expense to plan for. The tax savings from relocating out of a high COL big government police state to a LCOL relatively free state once ER will be far greater than the tax for not complying with the government mandate. So just on taxes it's still a net decrease in taxes paid, not even considering everything else being cheaper.

And you only pay the tax from your income tax refund. If you have no refund, no tax to pay.

In other words, even though the tax is to be collected through the IRS the IRS has no power to bill you. It can only keep money in its possession.

I am pretty sure this is correct but if I'm wrong, you MMMErs will let me know!

[iris lily]

The ACA is the one of the best things to happen for early retirees, I don't understand the hostility.  The system is very easy to game if you know the ins and outs.  Pre ACA you have no way game anything, and many couldn't get insurance at any reasonable price.

Sure, its good for me, and in a few months as an early retiree I will jump on that ACA bandwagon. But is it good overall? No. Is it good for some people? Sure. Is it a mismash of convoluted laws? Yep.

Now someone will come on to remind us all in a ponderous way that the ACA is really a tool of the Republicans because its the only thing the Democrats could push through Congress. Yet, Republicans did not vote for it to pass. It is quaint thinking that the ACA is a Republican effort, it is not.

[mjs111]

It seems the best thing for many people would be to shop around for a plan that covers the doctors you want to go to and don't assume that a plan will cover any services by default.  If you can't find a plan that will be very usable in your area, buy the cheapest bronze plan that's available in order to have some basic coverage for unplanned catastrophic injuries/illnesses and have cash available for the various services the plan won't cover.

Mike

[MoonShadow]

We seem to be creating “have” and “have nots” related to healthcare at least where I live.

I have two family members who work in insurance, and they say that's exactly the situation towards which we're heading. They say the next thing that's coming is "boutique medicine", which will be small groups of doctors who'll require "membership" in their group and won't accept insurance.

I personally don't have enough insight into the nuances of ACA to have an opinion.

Next thing?  That is exactly how my doctor works.  She doesn't accept any form of insurance, and a monthly membership fee is expected.  I also get my regular meds at wholesale through her office as a membership benefit.  The markup on common meds is incredible.

[forummm]

Two misses with one swing: that's an impressive amount of concentrated being wrong.

Don't look at his post history unless you want to be really impressed.

Beltim has a much greater right to call me to task when I err than you do Forummm.

Thanks for proving my point.