Wellness

[kittymomNC]

On 12/4/2014 lab mommy said: Yes...it is a disaster. The premium is high but good gosh the deductible you have to meet is absolutely ridiculous. Plus be prepared to lose your doctor. I can almost bet that will happen. You people that say it's good to have insurance may not be on it. Good luck.

As with a lot of things, some people are affected negatively more than others, but I definitely wouldn't call it a disaster. It may feel like a disaster to a particular person depending on their circumstances, but everyone hasn't lost their doctors, and everyone hasn't had their rates go through the roof, and everyone doesn't have a huge deductible. My son worked for one of the 100 best companies in the country to work for (in the top 10 for several years), but his deductible was $3,500, he had no coverage for certain things because the company "supposedly" covered them in other ways, and we didn't even know he wasn't covered for those things until he went on COBRA. Companies and insurance companies control more than anyone realizes, and it's not necessarily the fault of the ACA.

He could not have gotten coverage at all when his COBRA ended if it weren't for the ACA, but he is covered by a plan through the ACA now (and it covers those things he had no coverage for before), he doesn't have that high a deductible or out-of-pocket, he can see pretty much any doctor he wants to see, and he can see a specialist without a referral. It's much better than what he had with that "top 100" company.

And yes, with his health problems, it IS good to have insurance.

[gabstoomuch]

ccassaday, I recently found something out regarding the "enrollment" deadlines. 90% (if not 100%) of insurance companies have what they call "life events" enrollment, in which people can enroll at any time, regardless if it is the enrollment period.

It is specifically for people who have exactly what it says....a life event that changes their circumstances. Examples of that would be getting married and having to add a wife; adding a new child to your family and needing to add the child; people on COBRA get to the end of the time allowed, and needing to enroll at an different time (outside the bounds of enrollment period); and *pay attention parents*.. when a child turns 26 and they no longer are allowed to be on their parents policy. All these (and more that I can't even think of) 'life happenings' that are beyond your control. Hence the name "life events".

I found this out by calling my own health insurance company when my son turned 26 (and beware, kids are tossed off parental plans at the stroke of midnight on the date of their birth). He turned 26 at a time when it was not 'open enrollment' at his own company, and I was very concerned that he would be uninsured, having to wait for open enrollment.

The insurance lady was very, very nice and she is the one that told me about most insurance company's policy of 'life events'. It is not for people who just missed the deadlines. It was put into place for all the different changes individuals or families go through that are very valid events, and timing is beyond anyone's control.

I was extremely happy I called, because I had never heard of that being widely published. She said most, and by now, all, insurance companies follow the same protocol for this. You sign up for the incoming insurance, and get it all lined up. It is all ready to kick in at midnight on the day you will lose whatever you had (or the night you marry, the day you adopt, give birth, COBRA ends, etc.).

That way there is no gap in coverage, no fear of not having insurance. You just never know when something could happen, and one certainly doesn't want to be non-insured.

You would think they would be putting more information about this out to the public huh?

[NYC Susan]

On 12/3/2014 kittymomNC said:

For those calling the A*C*A a total disaster, there are about 9 million people who would disagree with you, including me!

Absolutely! It's flawed, for sure, but so are a lot of things when they're new. I think it's definitely a giant step in the right direction & I have several friends & family members who would have been in a great deal of financial trouble if this hadn't been available to them.

A lot of people are all too ready to jump on this administration without actually educating themselves. Not all the deductibles are high - It depends which plan you choose, and you do get to choose. Nothing is forced on anyone. All kinds of preventative care & testing are covered, and pre-existing conditions have no bearing on eligibility or cost.

Anyone who doesn't like it can continue to get health insurance however they were getting it before. Just because it doesn't benefit someone directly doesn't mean it's a total disaster!

[NYC Susan]

On 12/4/2014 gabstoomuch said:

ccassaday, I recently found something out regarding the "enrollment" deadlines. 90% (if not 100%) of insurance companies have what they call "life events" enrollment, in which people can enroll at any time, regardless if it is the enrollment period.

It is specifically for people who have exactly what it says....a life event that changes their circumstances. Examples of that would be getting married and having to add a wife; adding a new child to your family and needing to add the child; people on COBRA get to the end of the time allowed, and needing to enroll at an different time (outside the bounds of enrollment period); and *pay attention parents*.. when a child turns 26 and they no longer are allowed to be on their parents policy. All these (and more that I can't even think of) 'life happenings' that are beyond your control. Hence the name "life events".

I found this out by calling my own health insurance company when my son turned 26 (and beware, kids are tossed off parental plans at the stroke of midnight on the date of their birth). He turned 26 at a time when it was not 'open enrollment' at his own company, and I was very concerned that he would be uninsured, having to wait for open enrollment.

The insurance lady was very, very nice and she is the one that told me about most insurance company's policy of 'life events'. It is not for people who just missed the deadlines. It was put into place for all the different changes individuals or families go through that are very valid events, and timing is beyond anyone's control.

I was extremely happy I called, because I had never heard of that being widely published. She said most, and by now, all, insurance companies follow the same protocol for this. You sign up for the incoming insurance, and get it all lined up. It is all ready to kick in at midnight on the day you will lose whatever you had (or the night you marry, the day you adopt, give birth, COBRA ends, etc.).

That way there is no gap in coverage, no fear of not having insurance. You just never know when something could happen, and one certainly doesn't want to be non-insured.

You would think they would be putting more information about this out to the public huh?

I think this information HAS been known to the public. I've known about it for awhile, and when my son signed up for coverage last year thru the Affordable Care Act, he was told the same thing. I guess I thought it was public knowledge - We've been talking about this at work for years.

It's good you posted, though, for those who may not have been aware.

[granny me]

On 12/4/2014 NYC Susan said:

On 12/3/2014 kittymomNC said:

For those calling the A*C*A a total disaster, there are about 9 million people who would disagree with you, including me!

Absolutely! It's flawed, for sure, but so are a lot of things when they're new. I think it's definitely a giant step in the right direction & I have several friends & family members who would have been in a great deal of financial trouble if this hadn't been available to them.

A lot of people are all too ready to jump on this administration without actually educating themselves. Not all the deductibles are high - It depends which plan you choose, and you do get to choose. Nothing is forced on anyone. All kinds of preventive care & testing are covered, and pre-existing conditions have no bearing on eligibility or cost.

Anyone who doesn't like it can continue to get health insurance however they were getting it before. Just because it doesn't benefit someone directly doesn't mean it's a total disaster!

I am not sure how a person can argue when the pricing is there to see. I entered a 50k income based on our ages for household of 2 and the deductible was from 7k to 12,700 and that was for the bronze plan. Again, how can anyone pull 12k plus premium out of their bank account based on a 50k income?

And if you have a recurring health issue you are doing this year after year, it's not possible to recover to build any type of savings.

For us to have the type of insurance we have right now through our employer it would be a 2k monthly based on the ACA pricing guide. That's crazy.

[kittymomNC]

On 12/4/2014 granny me said:

On 12/4/2014 NYC Susan said:

On 12/3/2014 kittymomNC said:

For those calling the A*C*A a total disaster, there are about 9 million people who would disagree with you, including me!

Absolutely! It's flawed, for sure, but so are a lot of things when they're new. I think it's definitely a giant step in the right direction & I have several friends & family members who would have been in a great deal of financial trouble if this hadn't been available to them.

A lot of people are all too ready to jump on this administration without actually educating themselves. Not all the deductibles are high - It depends which plan you choose, and you do get to choose. Nothing is forced on anyone. All kinds of preventive care & testing are covered, and pre-existing conditions have no bearing on eligibility or cost.

Anyone who doesn't like it can continue to get health insurance however they were getting it before. Just because it doesn't benefit someone directly doesn't mean it's a total disaster!

I am not sure how a person can argue when the pricing is there to see. I entered a 50k income based on our ages for household of 2 and the deductible was from 7k to 12,700 and that was for the bronze plan. Again, how can anyone pull 12k plus premium out of their bank account based on a 50k income?

And if you have a recurring health issue you are doing this year after year, it's not possible to recover to build any type of savings.

For us to have the type of insurance we have right now through our employer it would be a 2k monthly based on the ACA pricing guide. That's crazy.

I don't know how old you are or what state you're in, but I can't sleep tonight and out of curiosity I just ran numbers based on 2 people, 50K income, age 40 and 41. You would possibly qualify for a subsidy of $190.00 in my state. I looked at bronze, silver and gold plans, and premiums ranged from $200+ per month to $500+, with deductibles ranging from $5,400 up to about $13,000. One bronze plan was $330 a month and $5,400 deductible.

I ran it again using ages 50 and 51, and the subsidy would be about $453 per month. Looking at only gold, there are plans ranging from premiums of $800-$880 per month, with deductibles as low as $200 up to $2000, and out-of-pocket as low as $8,000.

There was only one platinum plan (at the 50 and 51 ages) with premium of $1,047, deductible of $1,000, and out-of-pocket $3,000.

At age 60 and 61, there are 3 platinum plans, with premiums ranging from $858 to $1,359 a month, and deductibles from $500 to $1,000. Your subsidy would be about $859 a month.

I've been through this process before with my son, so I do know what I'm looking at. But I have no idea where you're getting your numbers, unless it's due to the state you live in and the companies offering plans in your state, or your ages. Or if either of you are smokers, that would make some difference.

As you go from the bronze (which has the lowest premiums but higher deductibles) to silver, gold or platinum, your premium goes up but your deductibles go down considerably, and none of the ones I ran gave a premium over $1,359 a month, for the platinum plan, PPO, which was the best of all of them.

And my state did not set up its own exchange, which means we have fewer companies and plans to choose from, in fact only 3 companies. They've added one since my son signed up.

So, as you say, the numbers don't lie. I just don't know how you got the numbers you gave. If you can enlighten me, or show me how I'm wrong, please feel free to do that. I don't have a problem with being proven wrong if it's valid. But if I'm right, then I don't like seeing something like the ACA slammed for being so bad. There's already been too much of that.

[terrier3]

On 12/4/2014 lab mommy said: Yes...it is a disaster. The premium is high but good gosh the deductible you have to meet is absolutely ridiculous. Plus be prepared to lose your doctor. I can almost bet that will happen. You people that say it's good to have insurance may not be on it. Good luck.

You don't have a clue.

There are many options, from high deductible plans to plans with ZERO deductibles.

There are plans where you have to see a doctor in the insurance company's "network" (like many employer sponsored plans) and POS plans where you can be seen by any doctor in the country who accepts that insurance company's plan.

I would buy from an established, reputable company - not from a fly by night new to the business.

Yes, I may be "biased" because I have ACA insurance and also now sell it on a seasonal basis.

I have enrolled MANY new ACA members to date. Most are people in the lower middle class - people who have gone w/o insurance for years and are very grateful to finally be able to see a doctor and to be covered. One man was getting insurance for the first time in 30 years - he worked two jobs - at a big box store and a supermarket - and never qualified for insurance.

I also have enrolled a lot of young freelancers - photographers, journalists, even a party planner. Young people creating jobs for themselves in a tight business market who wanted a basic plan to cover them if they had an emergency, like appendicitis.

I have also enrolled a LOT of people who own their own business, make a good living, but due to conditions like diabetes, had no chance of getting affordable insurance in the past. They don't qualify for premium credits or any assistance, but the ACA makes insurance affordable for people with pre-existing conditions too.

[terrier3]

Re: high deductible bronze plans.

In NY state, many bronze plans have services NOT subject to any deductible. We have a plan that has $5 visits to your PCP, with $10 generics. So if you have the flu or a sore throat, you WILL see the doc for just $5. The HI companies WANT you to stay healthy and well...they set the $5 doctor visit to make sure people will see a doc when they need to.

Plus EVERY plan has a basic core of 50 screening and preventative tests - not subject to fees or deductibles. Annual well visit exams, mammos, colonoscopies, women's GYN exam, flu, tetanus and other shots, etc. - all are covered in EVERY plan - at no extra charge.

The average HEALTHY person will save money with a bronze plan. But since many people have chronic conditions or other issues, there are other levels of premiums with lower deductibles available too.

[terrier3]

Re: original question.

If you are having trouble negotiating the exchange, you can always have a person from the insurance company you choose help you fill out the application.

Or you can get a list of navigators - people trained by the exchange to assist people.

The number you called for assistance also should have customer service people who will walk you through the whole process. It takes about an hour.