ethical question on health insurance from the market pace

[Deleted]

If a person had some money saved up and were in decent shape and could easily work, what would you think he should do for health insurance?  I think the price would be very low to buy it, because the market place bases price on income and he would have no income.  Is it wrong for him to buy insurance for so cheap if he can or should he voluntarily pay more for it because he is choosing to be so low income?  Assume he is paying the rest of his bills out of savings.  Also assume he is doing everything legally and by the books.

[Deleted]

I'm in that position and I'm against it. I retired last year at age 62. DH was 76 and had been on my employer's policy. We got him into Medicare, of course. I didn't even bother looking at the Exchanges. From what I'd read, networks were typically more restricted (my regular doc takes my private Coventry policy but not the Coventry plan on the Exchange). I have some control over my taxable income by timing realized capital gains, withdrawing from a Roth, etc. but I'm still not sure if I'd qualify.  We can't control the timing of DH's SS, my pension or capital gain distributions form mutual funds. 

Despite having zero wage income for the first time this year, we're blessed and I try not to take advantage of things that were clearly meant for poor people, not millionaires who can structure their income to meet the criteria.

[Deleted]

Aug 9, 2015 13:39:49 GMT -5 @athena53 said:

I'm in that position and I'm against it. I retired last year at age 62. DH was 76 and had been on my employer's policy. We got him into Medicare, of course. I didn't even bother looking at the Exchanges. From what I'd read, networks were typically more restricted (my regular doc takes my private Coventry policy but not the Coventry plan on the Exchange). I have some control over my taxable income by timing realized capital gains, withdrawing from a Roth, etc. but I'm still not sure if I'd qualify.  We can't control the timing of DH's SS, my pension or capital gain distributions form mutual funds. 

Despite having zero wage income for the first time this year, we're blessed and I try not to take advantage of things that were clearly meant for poor people, not millionaires who can structure their income to meet the criteria.

I respect that opinion and maybe agree with it.  But what do you say to those who would counter by asking about millionaire's who take government subsidies?   It is often argued that those people are doing nothing illegal and are just using what is freely offered.  I am particularly thinking of the solar power companies that got big grants.

Thank you for the reply.

[whoami]

I dont see how its an ethical question. If the powers that be wanted the subsidy to be based on net worth, they would have written the law that way.

How many times have we heard the Caddy driving, Coach carrying food stamp user could have bought that stuff prior to being food stamp eligible....

There is also a big difference between "could" work and actually working. Some people vastly over value their work worth especially if they arent actually doing anything. 

[Mardi Gras Audrey]

I wonder how all this will shake out the next few years, especially in states that expanded Medicaid.  In those states, having "no income" gets you put on Medicaid if you go through the exchanges.  You don't even have the option to take the max subsidy and go with one of the private exchange plans, you have to go to Medicaid.

Although, it looks like our govt is going to getting more people on social programs that they previously didn't qualify for. One is the Medicaid issue.  I think they have also removed the "net worth" factor (only go with income) for SNAP.  Soon, it will be like that for Section 8 or other programs...

[Deleted]

Aug 9, 2015 14:44:35 GMT -5 Mardi Gras Audrey said:

I wonder how all this will shake out the next few years, especially in states that expanded Medicaid.  In those states, having "no income" gets you put on Medicaid if you go through the exchanges.  You don't even have the option to take the max subsidy and go with one of the private exchange plans, you have to go to Medicaid.

Although, it looks like our govt is going to getting more people on social programs that they previously didn't qualify for. One is the Medicaid issue.  I think they have also removed the "net worth" factor (only go with income) for SNAP.  Soon, it will be like that for Section 8 or other programs...

What is the main differences between being on Medicaid and getting private insurance?  Is medicaid more of a charity?

[The Walk of the Penguin Mich]

Aug 9, 2015 14:51:53 GMT -5 @hickle said:

Aug 9, 2015 14:44:35 GMT -5 Mardi Gras Audrey said:

I wonder how all this will shake out the next few years, especially in states that expanded Medicaid.  In those states, having "no income" gets you put on Medicaid if you go through the exchanges.  You don't even have the option to take the max subsidy and go with one of the private exchange plans, you have to go to Medicaid.

Although, it looks like our govt is going to getting more people on social programs that they previously didn't qualify for. One is the Medicaid issue.  I think they have also removed the "net worth" factor (only go with income) for SNAP.  Soon, it will be like that for Section 8 or other programs...

What is the main differences between being on Medicaid and getting private insurance?  Is medicaid more of a charity?

The main difference is that you lose your choice of doctor/treatment.  Many simply will not accept Medicaid patients due to poor reimbursement, and those that do frequently put limits on the number of Medicaid patients that they will see in their practice.  This makes getting into see a doctor difficult, and impossible for certain specialists.

In Medicaid, you pay nothing (from what I understand).  Private insurance, you usually pay a copay, deductible or both.  

[Mardi Gras Audrey]

Aug 9, 2015 14:51:53 GMT -5 @hickle said:

Aug 9, 2015 14:44:35 GMT -5 Mardi Gras Audrey said:

I wonder how all this will shake out the next few years, especially in states that expanded Medicaid.  In those states, having "no income" gets you put on Medicaid if you go through the exchanges.  You don't even have the option to take the max subsidy and go with one of the private exchange plans, you have to go to Medicaid.

Although, it looks like our govt is going to getting more people on social programs that they previously didn't qualify for. One is the Medicaid issue.  I think they have also removed the "net worth" factor (only go with income) for SNAP.  Soon, it will be like that for Section 8 or other programs...

What is the main differences between being on Medicaid and getting private insurance?  Is medicaid more of a charity?

 
Medicaid is run by the govt, private insurance is run by a private company (Cigna, United Heath, Anthem, BCBS, Aetna,  etc).

They are totally different types of insurance.

As Mich mentioned, with Medicaid, you usually have no copays, no deductible, no premiums, etc.  Over The counter medications may be covered by your insurance at no cost because, presumably you are "poor" and make no money (That's why the govt is paying for you to have coverage).  You may also get the "plan" to pay for transportation to doctor's appts, etc.

Private insurance usually involves deductibles (The cheapest plans may have a $6k deductible), copays (after the deductable is met... usually 20%), don't pay for OTC medications or transportation, and require that you pay a monthly premium for your insurance.  

When you get "insurance" on the exchange, they may place you with Medicaid or with a private insurer (depending on if your state expanded Medicaid and what your income is).  While the exchange may give you a subsidy to help pay the private insurer, you usually have to still pay something.  The tax dollars are going to the private insurer along with what you pay for your premium, vs Medicaid where all the $$ stays with the govt and they pay for your treatments).

More doctors won't take Medicaid, either because reimbursement is very low and a lot of times doesn't even cover the cost of care.  So, while you may "have insurance" when you have Medicaid, you won't get care because no providers will take it.

[whoami]

So basically people will do what they have been doing for years....roll into the ER because their kid has the sniffles and the taxpayers foot the $1000 bill....

ETA..it would be cheaper to just give these people a card to swipe at CareNow or whatever doc in a box is close to you, then to continue seeing them at the ER. 

[Mardi Gras Audrey]

Aug 9, 2015 15:47:38 GMT -5 whoami said:

So basically people will do what they have been doing for years....roll into the ER because their kid has the sniffles and the taxpayers foot the $1000 bill....

Yup, although now it's worse because they "have Medicaid" so the hospital doesn't have the option of going after them and sending them to collections.  Also, they may be more apt to go because they know that they won't have to pay anything. Before, a lot of people who could pay some of it would either wait until it was worse (treat at home) or go to an Urgent Care center, that would be cheaper because they didn't want to come up with the $$ or be sent bills from the ER.

Now, no reason not to go... your co-pay is $0.  (With private insurance, your copay would usually be like $100 unless you are admitted to the hospital, depending on the plan.  This serves as a motivator to get people thinking "Is this an emergency?  IS this worth $100 to go?)

    

[whoami]

My last visit to the ER was for a horrible case of food poisoning....as in I laid on the floor in front of the toilet for hours barfing until I didnt even have the energy to get my head into the toilet.  DH gave me the option to get in the car or he was calling an ambulance.  I could barely get up. I paid about $400 copay of the $2500 ER bill. 

My last trip to CareNow was for a piece of wire or glass in my foot.  It was driving me nuts but they never could dig it out and it wasnt showing up on Xrays. I think they billed about $150 and we paid maybe $40. Had I gone to the ER, Im pretty sure my insurance would have denied the bill and stuck me with whatever it cost..as they should have. Not an emergency. 

I dont know how the whole medicaid ACA thing works in Texas, but in a few mile radius around me, there are at least 6-8 new stand alone ERs that have gone up in the last 2 years. I have no idea what the requirement is for treating non emergency patients especially ones who have "insurance" from the government. I have no idea how they will stay open if they have to spend time treating patients they are getting virtually no reimbursements for. 

[Deleted]

I have a neighbor who has roughly $500,000 in the bank from inheritances, is still working part-time at a low wage job b/c she refuses to learn 2015 job skills, and signed up for the ACA to avoid the penalty.  Then she sold some valuable real estate which made her AGI super high and had to refund the subsidy    In the meantime she still chose to use income-based clinics b/c the ACA policies have networks, copays and deductibles and she could get her healthcare closer and cheaper at local clinics who didn't ask about assets or worry about the $200,000+ she got the next month.  I think she's a sleaze and have distanced myself from her.  Legal yes - right, hell no! 

[Deleted]

Aug 9, 2015 16:56:49 GMT -5 whoami said:

I dont know how the whole medicaid ACA thing works in Texas, but in a few mile radius around me, there are at least 6-8 new stand alone ERs that have gone up in the last 2 years. I have no idea what the requirement is for treating non emergency patients especially ones who have "insurance" from the government. I have no idea how they will stay open if they have to spend time treating patients they are getting virtually no reimbursements for. 

Ah, that would explain why a lot have sprung up around us in KS/MO, too. One woman write a Letter to the Editor and said she went there to get her granddaughter's sore throat treated, not realizing it was a freestanding ER with ER prices. They got stuck with a boatload out-of-pocket. I guess people on Medicaid can use it for very little out-of-pocket. Today I went to a Doc in the Box to get treated for poison ivy and very specifically chose a Walgreen's Clinic rather than a closer "Care Spot" affiliated with a large hospital chain.  You have a $6K deductible, you're careful about these things.

Hickle, as for corporate tax benefits- my feeling is that most tax benefits, deductions, subsidies, etc. are created to encourage certain behavior or serve some need.  I have no problem taking a mortgage interest or property tax deduction.  The government keeps them to encourage home ownership.  I own a home.  To me, health insurance subsidies are there to make it affordable for the poor.  I am not poor so I don't even try for it.

There's a lot of criticism of companies behaving in whatever way minimizes their taxes.  As long as they're following the laws, it's OK with me.  (Even if I got a capital gain I didn't want when Medtronic changed its structure and redomesticated to Ireland to get a lower tax rate.)  If the tax provisions are too generous, change the tax laws.

[Mardi Gras Audrey]

Aug 9, 2015 22:00:26 GMT -5 @southernsusana said:

Health care bills are terrifying, and it simply shouldn't be like that.  Although there are some stuff you can do to be healthier, often it simply isn't enough.

DH is the baby of a family cursed with high cholesterol/heart conditions.  He has dealt with this since his 50s.  He eats right (145 on a 6-foot plus frame) and does everything else right.

But his health bills would bankrupt us if I wasn't working.  And I am lucky . . . I have good insurance.  What if I didn't?

It isn't really fair that some people win the healthcare lottery . . . good health or good insurance or both.  What did they do again to deserve this?

I get angry every time I look at an EOB from the hospital.  $250,000 reduced to $25,000 because of "negotiated rates."  And then the insurance pays it (with the help of Medicare).

I am grateful, but it so unfair.  The person WITHOUT insurance needs the negotiated rate worse than the person WITH insurance.

Our system is simply WRONG.  Period.

The uninsured person will probably get a discount off the list price.  In my experience, no one pays "list price" for medical care.

I had some outpatient medical services done at a for-profit hospital system in March.  I had to pay the full negotiated rate because I hadn't met my deductible. The hospital sent me the bill and indicated the "list price" and the negotiated rate.  It also mentioned that if I didn't have insurance, I would get 20% off right off the top (I just had to tell them I was uninsured).  I could get another 20% off for paying in 30 days (They accepted credit cards for payment).

The negotiated rate was like 80% (Had private insurance). I would have SAVED money by being uninsured.  Between the higher price and the premiums I paid for insurance that month, I was behind.  If i would have gone without insurance, I would have saved the premium costs and gotten 40% off...  

The hospital can bill you for a trillion dollars but they know you aren't going to pay it, especially if you are uninsured.  If you call them and ask, you can get a discount. 

[muttleynfelix]

Aug 9, 2015 12:06:37 GMT -5 @hickle said:

If a person had some money saved up and were in decent shape and could easily work, what would you think he should do for health insurance?  I think the price would be very low to buy it, because the market place bases price on income and he would have no income.  Is it wrong for him to buy insurance for so cheap if he can or should he voluntarily pay more for it because he is choosing to be so low income?  Assume he is paying the rest of his bills out of savings.  Also assume he is doing everything legally and by the books.

The exchange can provide a subsdiy only of your income is high enough and low enough. If you fall below the low end, the exchange will kick you out and tell you that have to go on medicaid. If your state did not expand medicaid, there is a gap between the high end of medicaid and the low end of of the exchange. Also, they want proof of your income. Fortunately, I got a new job, so hubby and the kids were only on the exchange for 3 months, but as soon as it kicked in, they wanted proof of hubby's income. Except DH is a SAHD. We thought about sending in my income as proof, but since we were going off it, we didn't find out if that would fly or not.

Going on the exchange and coming off is a PITA. We actually were never able to cancel. DH tried calling a couple times and couldn't get through. That is the only way to cancel other than just stop paying (which is what we did). Our taxes are going to suck next year.

[The Walk of the Penguin Mich]

That is the only way to cancel other than just stop paying (which is what we did). 

I'd try to find some way to resolve this other than not paying.  You may find yourself on the hook for the rest of the year's premiums otherwise.

[muttleynfelix]

We got a letter stating it is cancelled. We may still be on the hook for an extra month and will probably have to pay back part of the subsidy but that will be due to the increase in income. My husband didn't try as hard as he could to call to cancel, but he did try more than once and every time the system was down. He did hold off because he didn't have a doctor on the new insurance yet and needed his meds renewed. We are going to get screwed on the meds after the fact, but he has agreed that anything we have to pay will come from the sale of his mom's house. Not ideal, but it keeps me from killing him. But it is cancelled as of the end of April and we paid the last premium of March. I wish I could have handled it, but I wasn't on the account.

[teen persuasion]

Aug 10, 2015 15:10:47 GMT -5 muttleynfelix said:

Aug 9, 2015 12:06:37 GMT -5 @hickle said:

If a person had some money saved up and were in decent shape and could easily work, what would you think he should do for health insurance?  I think the price would be very low to buy it, because the market place bases price on income and he would have no income.  Is it wrong for him to buy insurance for so cheap if he can or should he voluntarily pay more for it because he is choosing to be so low income?  Assume he is paying the rest of his bills out of savings.  Also assume he is doing everything legally and by the books.

The exchange can provide a subsdiy only of your income is high enough and low enough. If you fall below the low end, the exchange will kick you out and tell you that have to go on medicaid. If your state did not expand medicaid, there is a gap between the high end of medicaid and the low end of of the exchange. Also, they want proof of your income. Fortunately, I got a new job, so hubby and the kids were only on the exchange for 3 months, but as soon as it kicked in, they wanted proof of hubby's income. Except DH is a SAHD. We thought about sending in my income as proof, but since we were going off it, we didn't find out if that would fly or not.

Going on the exchange and coming off is a PITA. We actually were never able to cancel. DH tried calling a couple times and couldn't get through. That is the only way to cancel other than just stop paying (which is what we did). Our taxes are going to suck next year.

Does your state have its own site, or use the federal one?

We attempted to sign up last year when DH was between jobs, and our state's site is maddening.  You must get everything just right the first time or it just gives up.  Going back to change info (because you misunderstood the vague instructions) makes it worse.  Calling and talking to a rep is a mixed bag - the first person I got clearly didn't know the income rules, and was not going to sign us up from her terminal, she just gave (bad) advice.  I'm not really sure how (or at the time, if) I ever got us actually signed up.  I know I had to upload info to verify things, and I received cards for DD3 and DS5, but not DS4, and not DH or myself.  

We never had cause to try to use any medical care for the two months before DH found another job.  After our new insurance kicked in, I tried to update info online to cancel it, but again the site was impossible, so I called them.  This time the rep was much more helpful.  She offered to do it for me or walk me thru it.  I wanted to learn the correct way to do things, so asked her to walk me thru it.  The screens and options she said I should see were not there for me, or it wouldn't act the way she said it should, so she still ended up doing it for me.  She also said I should receive a letter for our taxes (after the new year), but that never arrived, either.

Altogether, if I ever have to go thru the exchange again, I plan to use an advocate.  I'm pretty computer savvy, but that state site is a boondoggle.

[muttleynfelix]

My former state did not have it's own site and I don't think my new state does either. We called in and had an agent with us to go through. That is the only way to do it. Even though our agent was a kook, he did help. Cancelling was another story.

[Deleted]

so no one here thinks it is wrong to get the subsidized insurance if you qualify for it?  That is my view.  Sometimes I worry that my view is wrong though.

Thank you to everyone for the answers.

[muttleynfelix]

I think the thing with the subsidy is that if you try to cheat the system to get it, you will have to pay it back at tax time. You also can't just quit your job and get it because you have to show some income. Basically if you want to jump through hours of hoops then go for it. But if you don't actually qualify, enjoy the tax bill next April.

[Deleted]

Aug 11, 2015 16:34:46 GMT -5 muttleynfelix said:

I think the thing with the subsidy is that if you try to cheat the system to get it, you will have to pay it back at tax time. You also can't just quit your job and get it because you have to show some income. Basically if you want to jump through hours of hoops then go for it. But if you don't actually qualify, enjoy the tax bill next April.

does the income have to be from a job or could a rental house income count ?

[NomoreDramaQ1015]

our new insurance kicked in, I tried to update info online to cancel it, but again the site was impossible

I am having the same problem onyl I didn't even sign up!  Our state doesn't have it's own web site so I tried to go thru the federal one. I just wanted to look at plans, it told me I had to fill out an application.  OKay. It booted me out telling me we had to go on medicaid.  I tried several more times and it said the same thing.

Okay, fine.   We put ourselves on DH's insurance and put the kids on medicaid.  Two months later I get this job and we are now on my insurance.

I get a call at least once a week from the feds telling me I haven't finished my application.  

I've TRIED!  It boots me out telling me to apply for medicaid and I haven't figure out how to withdraw an application.  I was never approved for anything so WTF is going on?!

I will never take employer provided health insurance for granted again as long as I live, especially affordable employer provided health insurance.

Our taxes are going to be so much fun, our preparer is definetly going to earn her fee this year.

[muttleynfelix]

Aug 11, 2015 16:39:21 GMT -5 @hickle said:

Aug 11, 2015 16:34:46 GMT -5 muttleynfelix said:

I think the thing with the subsidy is that if you try to cheat the system to get it, you will have to pay it back at tax time. You also can't just quit your job and get it because you have to show some income. Basically if you want to jump through hours of hoops then go for it. But if you don't actually qualify, enjoy the tax bill next April.

does the income have to be from a job or could a rental house income count ?

I don't remember what they wanted drom us as proof of income. I don't know off the top of my head.

[Deleted]

This is one area in which calling is still better. Just too many large systems trying to run coordinate for the fed website to be functional...

[Angel!]

Aug 9, 2015 22:11:12 GMT -5 Mardi Gras Audrey said:

Aug 9, 2015 22:00:26 GMT -5 @southernsusana said:

Health care bills are terrifying, and it simply shouldn't be like that.  Although there are some stuff you can do to be healthier, often it simply isn't enough.

DH is the baby of a family cursed with high cholesterol/heart conditions.  He has dealt with this since his 50s.  He eats right (145 on a 6-foot plus frame) and does everything else right.

But his health bills would bankrupt us if I wasn't working.  And I am lucky . . . I have good insurance.  What if I didn't?

It isn't really fair that some people win the healthcare lottery . . . good health or good insurance or both.  What did they do again to deserve this?

I get angry every time I look at an EOB from the hospital.  $250,000 reduced to $25,000 because of "negotiated rates."  And then the insurance pays it (with the help of Medicare).

I am grateful, but it so unfair.  The person WITHOUT insurance needs the negotiated rate worse than the person WITH insurance.

Our system is simply WRONG.  Period.

The uninsured person will probably get a discount off the list price.  In my experience, no one pays "list price" for medical care.

I had some outpatient medical services done at a for-profit hospital system in March.  I had to pay the full negotiated rate because I hadn't met my deductible. The hospital sent me the bill and indicated the "list price" and the negotiated rate.  It also mentioned that if I didn't have insurance, I would get 20% off right off the top (I just had to tell them I was uninsured).  I could get another 20% off for paying in 30 days (They accepted credit cards for payment).

The negotiated rate was like 80% (Had private insurance). I would have SAVED money by being uninsured.  Between the higher price and the premiums I paid for insurance that month, I was behind.  If i would have gone without insurance, I would have saved the premium costs and gotten 40% off...  

The hospital can bill you for a trillion dollars but they know you aren't going to pay it, especially if you are uninsured.  If you call them and ask, you can get a discount. 

 We accidently got a bill for my son's surgery because their system screwed up & had us as uninsured.  It had a large discount off the top & a letter explaining we received an discount because we were uninsured.  I also once had a $1500 bill that insurance refused to cover.  When I called to ask for a payment plan, they dropped the bill to $25 total.  I hadn't even asked for a discount & they reduced it by over 95%.

[teen persuasion]

Aug 11, 2015 16:47:59 GMT -5 NomoreDramaQ1015 said:

our new insurance kicked in, I tried to update info online to cancel it, but again the site was impossible

I am having the same problem onyl I didn't even sign up!  Our state doesn't have it's own web site so I tried to go thru the federal one. I just wanted to look at plans, it told me I had to fill out an application.  OKay. It booted me out telling me we had to go on medicaid.  I tried several more times and it said the same thing.

Okay, fine.   We put ourselves on DH's insurance and put the kids on medicaid.  Two months later I get this job and we are now on my insurance.

I get a call at least once a week from the feds telling me I haven't finished my application.  

I've TRIED!  It boots me out telling me to apply for medicaid and I haven't figure out how to withdraw an application.  I was never approved for anything so WTF is going on?!

I will never take employer provided health insurance for granted again as long as I live, especially affordable employer provided health insurance.

Our taxes are going to be so much fun, our preparer is definetly going to earn her fee this year.

Ah, so the Fed site is no better than  NY's site.  You can't just poke around and try stuff out - as soon as you begin entering numbers, you are applying.  Another part of the problem is that the rules for Medicaid and subsidies are different.  Medicaid is based on monthly income, while subsidies are based on annual.  It seems like they would prefer to put people on Medicaid, so they ask for income info in such a way that they test first for Medicaid eligibility, and for subsidies only after Medicaid is out of the question.  By expected AGI we should have been eligible for subsidies, but they asked for that month's income, and my income alone was low.

The one thing I did learn: you are expected to apply before losing coverage.  If your application is approved before the 15th of the month, coverage may begin on the first of the next month.  If after the 15th, coverage is delayed until the first of the month following the next month.  You are also expected to schedule dropping coverage in the future.  I waited until I knew our new insurance was in force before updating our info on the website.  Putting a past date as the date of our new coverage was what hung the site up - the error message was something about the date cannot be before today.  Once I'd entered that date, I couldn't change it.



 Obviously the people who designed these websites never had my professors.  They taught us (the hard way) to make sure our programs could handle bad data and weird edge conditions, by trying to break them.

[muttleynfelix]

Yes the Fed website is designed to kick you to medicaid ASAP. I made $65k a year and the Feds said my kids qualified for medicaid. No they didn't. Not even close. But the fed website wouldn't let me move on with the kids. It sucked.

[NomoreDramaQ1015]

The same thing happened to me and I was inputting both DH and my income.  When we are both working there is no way we qualify for medicaid.  I tried just putting DH and myself in when I was unemployed and it booted me out telling me I needed to go on Medicaid.

Which is why I don't get them calling me constantly.  No matter what numbers I used you booted me out telling me I had to go on medicaid so why would I keep trying to apply?

[Deleted]

With the ACA and Medicaid in CA -

I can no longer go anywhere other than my regular doctor's office or ER and have it covered. You can't just "go to a clinic somewhere" any longer.

If I travel to my parent's house in another county and get sick, I have no coverage unless I go to ER.

My doc went from being able to see patients a week or two out to being booked for months. I just rebooked an appt from July and am not able to be seen now until October.

Fun times...