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  1. #21
    Mega Poster mom3girls's Avatar
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    Quote Originally Posted by Spacers View Post
    Sorry, but I would dispute the claim that theirs was a "solid, reasonable plan." It carries a $4,000 deductible per person, a $40 copay for doctor visits (including preventive care) after the deductible is met, a $150 emergency room visit fee and 30% coinsurance for hospital stays after the deductible is met. The out-of-pocket maximum is $5,600 per person. They could easily be out close to $26,000 if they both get sick or injured. Compare that to the "platinum" plan available through Kaiser under Covered California, I entered their ages & I Googled them to find their own zip code. Yes, they'll pay a much higher premium, $538 per person per month so not quite double, but they will have free preventive care, $25 co-pays for pretty much everything else, no deductible, and a $2500 out-of-pocket maximum per person. How anyone is arguing that this is NOT a better plan than what they had is beyond me.

    That plan sounds like what my in-laws had, they have been canceled. The knew exactly how much they would have to pay if one year all hell broke loose, and they have that money in savings if they needed it. The liked having the lower premiums, less out of pocket a month. My FIL is really amazing with investments and that money they saved made them a lot of money over the years. They should have that option.
    AlyssaEimers and GloriaInTX like this.
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  2. #22
    Posting Addict GloriaInTX's Avatar
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    Quote Originally Posted by AlyssaEimers View Post
    Another story of people being lost in the cracks. Obamacare is broken, and needs to be fixed. I think a delay until the problems can be fixed is reasonable.

    A Stage-4 Gallblader Cancer Survivor Says: I Am One of ObamaCare's Losers - WSJ.com
    I read that story and it is heartbreaking. No one should have to give up their oncologist and face death because they lose their coverage due to Obamacare. It sure sounds like she had good coverage that she was happy with.

    You would think it would be simple to find a health-exchange plan that allows me, living in San Diego, to continue to see my primary oncologist at Stanford University and my primary care doctors at the University of California, San Diego. Not so. UCSD has agreed to accept only one Covered California plan—a very restrictive Anthem EPO Plan. EPO stands for exclusive provider organization, which means the plan has a small network of doctors and facilities and no out-of-network coverage (as in a preferred-provider organization plan) except for emergencies. Stanford accepts an Anthem PPO plan but it is not available for purchase in San Diego (only Anthem HMO and EPO plans are available in San Diego).

    So if I go with a health-exchange plan, I must choose between Stanford and UCSD. Stanford has kept me alive—but UCSD has provided emergency and local treatment support during wretched periods of this disease, and it is where my primary-care doctors are.

    Before the Affordable Care Act, health-insurance policies could not be sold across state lines; now policies sold on the Affordable Care Act exchanges may not be offered across county lines.

    What happened to the president's promise, "You can keep your health plan"? Or to the promise that "You can keep your doctor"? Thanks to the law, I have been forced to give up a world-class health plan. The exchange would force me to give up a world-class physician.

    For a cancer patient, medical coverage is a matter of life and death. Take away people's ability to control their medical-coverage choices and they may die. I guess that's a highly effective way to control medical costs. Perhaps that's the point.
    Last edited by GloriaInTX; 11-07-2013 at 02:26 AM.
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  3. #23
    Posting Addict GloriaInTX's Avatar
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    I guess this health policy expert is just another person that is too stupid to know that her plan was no good, right?

    As a health policy expert, Hadley Heath has warned about the problems with Obamacare for years. Now, like so many other Americans, she’s facing the real-life consequences of the law.

    Speaking to Fox News’s Greta Van Susteren, Heath said her current health care plan is no longer an option. The $113 per month she pays for that plan includes hospitalization, preventive care, immunization, X-rays, and “all the basic things that someone might want in a health insurance plan.” Her deductible was $2,700 per year.

    But because of Obamacare, Heath said the most affordable plan available to her now through the Washington, D.C., exchange would double her insurance premium, and her new deductible would be about $3,500 per year.

    “I can’t believe that would be better for me or something that I would choose to do on my own,” Heath said. “That’s why I imagine they have a mandate making this mandatory.”

    Heath, who is a senior policy analyst with the Independent Women’s Forum, warned Obamacare will hit young people hard.

    “Obamacare is about redistributing costs and, in this case, it’s from younger, healthier people onto people who utilize the health care system more,” she said.

    Heath added: “I think my experience is representative of the experience of what will be millions of people who buy their own health insurance, especially young Americans. I’ve seen studies that estimate that women’s premiums might double and young men’s might triple.”
    Health Policy Expert's Insurance Gets Cancelled by Obamacare
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  4. #24
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    EPO plans follow the PPO network which is pretty large in California. They just don't have out of network benefits (which can really make a patient's costs soar as it typically has a higher deductible, coinsurance and since out of network docs don't accept insurance rates they can balance bill.


    For example, you have a surgery that they charge 18,000 for. Anthem may pay someone in network 10,000. You have to pay your deductible (Let's say it's 2000.00) and then you have to pay 40% after that (typical coinsurance amount). On top of that you have to pay 8,000 MORE to cover the rest of the bill. Going out of network is not a great idea financially.


    Also, as far as I'm aware, most BCBS plans have a set plan in place that if you are already undergoing care with a provider they will approve that provider until care is done. My daughter has it for her ABA. Her ABA provider is not in the network for my plan and they are approved because she started care with them before insurance started.
    Mom to Elizabeth (6) and Corinne (4)

  5. #25
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    Costs for many people are doubling and even tripling. Yes, it is going down for some people, but way up for others. Many doctors and hospitals are not participating so if people sign up they will loose their doctors. I think those things are terrible but it does not change the fact that they are trying to roll out a plan that is not ready. Hurting innocent people in the process.

    ~Bonita~

  6. #26
    Posting Addict KimPossible's Avatar
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    Had our open enrollment meeting today.

    Just to throw into the mix of experiences...

    Our company offers one plan and will be keeping it. It is a platinum plan. I will have an increase of about 35 - 46 dollars per month. It used to include vision, but now doesn't. That will be offered separate now, at about 5 a month for individuals 13 for families.

    The changes above are for families.

    Individuals will begin cost sharing now (previously they were not)...but only 10% of the premium where typical is 25-35%


    ETA: For further reference, the increase i experienced was about 13% or so.
    Last edited by KimPossible; 11-07-2013 at 01:09 PM.

  7. #27
    Posting Addict GloriaInTX's Avatar
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    Quote Originally Posted by KimPossible View Post
    Had our open enrollment meeting today.

    Just to throw into the mix of experiences...

    Our company offers one plan and will be keeping it. It is a platinum plan. I will have an increase of about 35 - 46 dollars per month. It used to include vision, but now doesn't. That will be offered separate now, at about 5 a month for individuals 13 for families.

    The changes above are for families.

    Individuals will begin cost sharing now (previously they were not)...but only 10% of the premium where typical is 25-35%


    ETA: For further reference, the increase i experienced was about 13% or so.
    That is only what increased on your side. I wonder how much more your employer is paying? I'm sure there are a lot of employers that aren't going to eat that increased cost.
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  8. #28
    Posting Addict KimPossible's Avatar
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    Quote Originally Posted by GloriaInTX View Post
    That is only what increased on your side. I wonder how much more your employer is paying? I'm sure there are a lot of employers that aren't going to eat that increased cost.
    They told us, but it was in a slide of the presentation that I did not capture. They also told us how much the plan icnreased overall...and also said there was a 4% increase in cost attributed directly to the ACA, the rest of the increase was not.

    I was told the presentation file would be available to us later today.

    ETA: And yes i realize that my company is good to us when it comes to health care coverage. Only thing that would be nice would be if the offered an alternative to the platinum plan we have.
    Last edited by KimPossible; 11-07-2013 at 03:04 PM.

  9. #29
    Posting Addict KimPossible's Avatar
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    Quote Originally Posted by GloriaInTX View Post
    That is only what increased on your side. I wonder how much more your employer is paying? I'm sure there are a lot of employers that aren't going to eat that increased cost.
    Looked at the presentation again. The overall cost of the plan went up by 13.1% with ~4% ACA fees & mandates. The cost sharing remains the same for families. I pay 40%.

  10. #30
    Posting Addict GloriaInTX's Avatar
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    Quote Originally Posted by KimPossible View Post
    Looked at the presentation again. The overall cost of the plan went up by 13.1% with ~4% ACA fees & mandates. The cost sharing remains the same for families. I pay 40%.
    At least until the Cadillac plan tax hits. Those with good coverage will be penalized too.

    'Cadillac' Health Plans Taxed By Obamacare - Business Insider
    Obamacare Tax Aimed At 'Cadillac Plans' Will Hurt Ordinary Workers: Report
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    I never consider a difference of opinion in politics, in religion, in philosopy, as a cause for withdrawing from a friend. --Thomas Jefferson

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