justme
Senior Associate
Joined: Feb 10, 2012 13:12:47 GMT -5
Posts: 14,618
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Post by justme on Oct 15, 2013 17:05:00 GMT -5
The Affordable in the ACA is a misnomer. It wasn't designed to make insurance overall cheaper, or to necessarily be cheaper than employer plans. It's whole design is to bring individual health insurance into the same range of costs as employer health insurance because employer pooled costs over everyone while individual plans were priced on you and your health (and ultimately your cost). I was looking around and found one similar to my current insurance for a bit less (probably because I'm 27). Though, question to those who may know. It says $1900 deductible, 0% coinsurance (pay nothing after deductible), but $6,350 OOP max. If I pay nothing after my deductible shouldn't OOP equal the deductible? The only thing I can see is it says that non-preferred brand prescriptions is 50% after deductible - so that's the only thing counting between $1900 and $6350? ETA: For curiosities sake I looked up a few of my doctors, only one accepted that plan though. Justme, even after you have met your deductible, you will have to pay whatever co-pays your plan specifies. Such as the 50% co-pay on prescriptions or $25 per Dr. visit, etc. After you've spent $6,350, even the co-pay goes away. By the way, I agree that affordable is a bit of a misnomer. We like to interpret affordable as cheaper. Or, at least, hope that is true. But, for many, the affordable part of ACA doesn't translate into cheaper. Or even the same cost. By the time many peope get done subsidizing medical care for others, the ACA turns out to be more expensive. There are no copays for the plan. Co-insurance is 0% once you meet the deductible. The only thing I can find that's not 0% after you meet the deductible is non-preferred prescriptions if you buy it retail (mail order it's 0%). I just thought I was missing something because it's odd to have a $6350 OOP max when after you meet the deductible of $1900 the only thing you may pay for is non-preferred brand rxs (so Tier 4 rxs in the normal rhetoric). So that's $4450 difference that's only going to be spent on very specific rxs (not even specialty rxs, which I think most chemo would fall under, that's 0%)? It just seems like I'm missing something but can't find anything.
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tskeeter
Junior Associate
Joined: Mar 20, 2011 19:37:45 GMT -5
Posts: 6,831
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Post by tskeeter on Oct 15, 2013 17:10:27 GMT -5
Justme, even after you have met your deductible, you will have to pay whatever co-pays your plan specifies. Such as the 50% co-pay on prescriptions or $25 per Dr. visit, etc. After you've spent $6,350, even the co-pay goes away. By the way, I agree that affordable is a bit of a misnomer. We like to interpret affordable as cheaper. Or, at least, hope that is true. But, for many, the affordable part of ACA doesn't translate into cheaper. Or even the same cost. By the time many peope get done subsidizing medical care for others, the ACA turns out to be more expensive. There are no copays for the plan. Co-insurance is 0% once you meet the deductible. The only thing I can find that's not 0% after you meet the deductible is non-preferred prescriptions if you buy it retail (mail order it's 0%). I just thought I was missing something because it's odd to have a $6350 OOP max when after you meet the deductible of $1900 the only thing you may pay for is non-preferred brand rxs (so Tier 4 rxs in the normal rhetoric). So that's $4450 difference that's only going to be spent on very specific rxs (not even specialty rxs, which I think most chemo would fall under, that's 0%)? It just seems like I'm missing something but can't find anything. Sounds to me like the extra $4450 would be just for non-preferred RX, then. I know it sounds like a lot, but it depends on what you have going on. I remember Dad telling me that Mom's rx co-pays after her stroke ran over $1K a month.
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justme
Senior Associate
Joined: Feb 10, 2012 13:12:47 GMT -5
Posts: 14,618
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Post by justme on Oct 15, 2013 17:18:46 GMT -5
There are no copays for the plan. Co-insurance is 0% once you meet the deductible. The only thing I can find that's not 0% after you meet the deductible is non-preferred prescriptions if you buy it retail (mail order it's 0%). I just thought I was missing something because it's odd to have a $6350 OOP max when after you meet the deductible of $1900 the only thing you may pay for is non-preferred brand rxs (so Tier 4 rxs in the normal rhetoric). So that's $4450 difference that's only going to be spent on very specific rxs (not even specialty rxs, which I think most chemo would fall under, that's 0%)? It just seems like I'm missing something but can't find anything. Sounds to me like the extra $4450 would be just for non-preferred RX, then. I know it sounds like a lot, but it depends on what you have going on. I remember Dad telling me that Mom's rx co-pays after her stroke ran over $1K a month. Yeah, I suppose. I'm just going by how my plan classifies it since it seemed that way in their writing. Like a lot of the cancer drugs fall under specialty not non-preferred. Where as the non-preferred is something like Treximet - it's a pill that combines Imitrex and Naproxen, it's non-preferred because it's cheaper for me (and my insurance) to purchase them separately.
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zibazinski
Community Leader
Joined: Dec 24, 2010 16:12:50 GMT -5
Posts: 47,865
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Post by zibazinski on Oct 15, 2013 19:07:31 GMT -5
Am I the only one who is freaked out by an agency and corrupt and inefficient as the IRS is in charge of a lot of your personal health info?
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Sum Dum Gai
Senior Associate
Joined: Aug 15, 2011 15:39:24 GMT -5
Posts: 19,892
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Post by Sum Dum Gai on Oct 15, 2013 19:47:29 GMT -5
They aren't in charge of your health info. They just run your name through a database to see if you have insurance and charge a penalty if you don't. The only agencies with your medical info are the private insurance companies, hospitals, and doctors that have always had it.
Seriously, do you have to put effort into remaining this clueless? Seeking out obscure sources of misinformation to drown out common sense and the real info out there?
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Rocky Mtn Saver
Junior Associate
Joined: Dec 23, 2010 9:40:57 GMT -5
Posts: 7,461
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Post by Rocky Mtn Saver on Oct 16, 2013 16:57:59 GMT -5
Am I the only one who is freaked out by an agency and corrupt and inefficient as the IRS is in charge of a lot of your personal health info? I might be more concerned if that were actually true.
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movingforward
Junior Associate
Joined: Sept 15, 2011 12:48:31 GMT -5
Posts: 8,358
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Post by movingforward on Oct 16, 2013 17:05:15 GMT -5
We have no information yet. I expect any changes in premiums to be made at the first of the year. It's sad we can't get real information about it as the repubs are scared sh****less it is going to be successful. What a shame in that something that really needs reformed and affordable for people is being manipulated for political purposes. Hopefully in time it will work. And the software should be workable and sounds like it isn't, not surprising though. I feel like there are bound to be glitches with almost anything in the beginning. We are contemplating getting a new database at work and it really is a big decision because we know it will be a work in progress for the first few months. We want things customized to our liking and it will take a few months to get there. I can imagine anything as large as universal health care is going to have issues in the beginning. As for the repubs scared of it working - I couldn't agree more. Anything that has generated this much opposition, not to mention blatant fear tactics to the general public, makes it completely transparent that are scared to death it is actually going to work.
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Rocky Mtn Saver
Junior Associate
Joined: Dec 23, 2010 9:40:57 GMT -5
Posts: 7,461
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Post by Rocky Mtn Saver on Oct 16, 2013 17:09:08 GMT -5
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zibazinski
Community Leader
Joined: Dec 24, 2010 16:12:50 GMT -5
Posts: 47,865
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Post by zibazinski on Oct 16, 2013 17:22:08 GMT -5
The threat is because a lot of people still don't want it and they make their wishes known. I, of course, am going to try to vote every incumbent out of office next election. I won't be successful because the incumbent has a huge advantage but I am still going to try to do it.
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saveinla
Junior Associate
Joined: Dec 19, 2010 2:00:29 GMT -5
Posts: 5,225
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Post by saveinla on Oct 16, 2013 17:59:01 GMT -5
Does the OOP include out-of-network providers' expenses? There was a separate out-of-network deductible and OOP max. It specifically said in-network $6350 OOP max. How about emergency room, urgent care etc. etc. Are they also covered 100% or is it a lower percent, so your it will count towards your OOP max?
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Miss Tequila
Distinguished Associate
Joined: Dec 19, 2010 10:13:45 GMT -5
Posts: 20,602
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Post by Miss Tequila on Oct 16, 2013 19:48:16 GMT -5
We have no information yet. I expect any changes in premiums to be made at the first of the year. It's sad we can't get real information about it as the repubs are scared sh****less it is going to be successful. What a shame in that something that really needs reformed and affordable for people is being manipulated for political purposes. Hopefully in time it will work. And the software should be workable and sounds like it isn't, not surprising though. So...why can't the democrats give you real information?
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