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Posted: 7/27/2013 1:36:02 PM EDT
[#1]
The ACA will destroy the system we have now which is what it is meant to do. Socialism is coming.
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Posted: 7/27/2013 1:36:27 PM EDT
[#2]
Holly Shit, Obama and the Democrats told me it was free!
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Posted: 7/27/2013 1:39:40 PM EDT
[#3]
Quote HistoryQuoted: I think, for clarification, you should just say you have to pay the percentage you own on your plan, in addition to your monthly premiums (because a presumption could be made by others that you would have to pay the premium amount as a deductibel for every claim. "Deductible" =/= "premium" normally (unless they redefined it in the ACA...I don't know the answer to that, BTW), but the 40% does = deductible = copay But I have some questions, and that I am not 100% sure of the answers to: - Are the insurers in the exchanges not private insurance companies? - If a person goes through the exchange to purchase insurance from one of these private companies, will there be no variation in the insurance policies (i.e. covered claims, deductible amounts, etc.) you can choose from? I can't find the answer anywhere, and all I ever read about is the bronze, silver, gold, platinum plans. Well, if all the insurance companies are offering the same 4 plans, what the hell is the purpose of having an exchange? Quote HistoryQuoted: Quoted: Quoted: What does a bronze plan mean in real terms? How much coverage? I'll comply with the mandate if it falls in line with what I already want to do, which is catastrophic-only. If not, I'll still get catastrophic-only, and just pay the penalty. And if they fuck the system up badly enough that I CAN'T buy catastrophic only... then I'm just going to break the law. Fuck it. Platinum Plan pays 90% you pay 10% Gold Plan pays 80% you pay 20% Silver Plan pays 70% and you pay 30% Bronze Plan pays 60% and you pay 40% Obamacare doesn't start paying until you have paid your deductible (Premium) and the percentage you owe on your plan. If you have the Bronze 60/40 plan and have a $20,000 operation. You have to pay, IIRC 40% of that ($8,000) plus your premium, which in my case is $7,800. So I would pay $15,800 out of pocket before Obamacare would kick in. If you had some serious $200,000 surgery, then you would be paying $120,000 + $7,800 ($127,800) out of pocket. ETA: I'm sure there are some insurance guys on the board that can correct me if I'm wrong and clarify / add to this. I think, for clarification, you should just say you have to pay the percentage you own on your plan, in addition to your monthly premiums (because a presumption could be made by others that you would have to pay the premium amount as a deductibel for every claim. "Deductible" =/= "premium" normally (unless they redefined it in the ACA...I don't know the answer to that, BTW), but the 40% does = deductible = copay But I have some questions, and that I am not 100% sure of the answers to: - Are the insurers in the exchanges not private insurance companies? - If a person goes through the exchange to purchase insurance from one of these private companies, will there be no variation in the insurance policies (i.e. covered claims, deductible amounts, etc.) you can choose from? I can't find the answer anywhere, and all I ever read about is the bronze, silver, gold, platinum plans. Well, if all the insurance companies are offering the same 4 plans, what the hell is the purpose of having an exchange? |
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Posted: 7/27/2013 1:47:28 PM EDT
[#4]
Quote HistoryQuoted:
Family of two: $11,547 What a Deal!  I'll trade with you. Family of 2. $21,599.00 |
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Posted: 7/27/2013 2:20:25 PM EDT
[#5]
Applicable graphic for participation/non-participating states.
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Posted: 7/27/2013 2:27:26 PM EDT
[#6]
Obama care 20,000 pages. "Just pass it". They say
"We'll figure it out later" They say I tell you this, We'll all be part time workers. Then they will included part time workers. We'll all be unemployed..........I say |
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Posted: 7/27/2013 2:38:55 PM EDT
[#7]
Quote HistoryQuoted:
All I got was not eligible for subsidies because employ offers healthcare. We will find out next year, I suppose. Posted Via AR15.Com Mobile |
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Posted: 7/27/2013 2:42:58 PM EDT
[#8]
Quote HistoryQuoted: Applicable graphic for participation/non-participating states. http://www.advisory.com/~/media/Advisory-com/Daily-Briefing/2012/11/DB_medicaid_map_lg.jpg |
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Posted: 7/27/2013 2:49:49 PM EDT
[#9]
Quote HistoryQuoted: What does a bronze plan mean in real terms? How much coverage? I'll comply with the mandate if it falls in line with what I already want to do, which is catastrophic-only. If not, I'll still get catastrophic-only, and just pay the penalty. And if they fuck the system up badly enough that I CAN'T buy catastrophic only... then I'm just going to break the law. Fuck it. |
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Posted: 7/27/2013 3:52:03 PM EDT
[#10]
Wow.
I mean, it wasn't all that long ago you could buy a plan with 2 mil coverage that covered EVERYTHING after the first 10,000. For 60 to 80 dollars a month. So a young person could have 10,000 in the bank for their rainy day fund and not get totally wiped out if they got in a car wreck. And that was even WITH a heavily regulated fucked up (but still pre-Obamacare) system. Government... turning everything it touches to shit since 1791. |
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Posted: 7/27/2013 4:00:06 PM EDT
[#11]
Quote HistoryQuoted:
Wtf am I doing wrong? It won't let me add anyone to exchange because I have employer coverage. But it won't let me submit without selecting someone on exchange. I put in the same info, it did let me put in one adult, and it say it won't cost me shit. 
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Posted: 7/27/2013 4:24:28 PM EDT
[#12]
Age discriminating fucking bastards.
Wife and I at 30 years old = $8,564 Wife and I at 63 years old = $22, 273 Fuck, fuck, fuck, fuck. 
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Posted: 7/27/2013 4:33:40 PM EDT
[#13]
Quote HistoryQuoted:
Age discriminating fucking bastards. Wife and I at 30 years old = $8,564 Wife and I at 63 years old = $22, 273 Fuck, fuck, fuck, fuck. you seriously don't know why? 
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Posted: 7/27/2013 4:37:04 PM EDT
[#14]
Quote HistoryQuoted: Age discriminating fucking bastards. Wife and I at 30 years old = $8,564 Wife and I at 63 years old = $22, 273 Fuck, fuck, fuck, fuck. Hang on till medicare... So far medicare is still in business. |
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Posted: 7/27/2013 4:39:57 PM EDT
[#15]
I guess Obama's definition of "Rich" is now coming to light..
 How in the world can the government MAKE you buy something and penalize you for it if you don't???? I hate to see what's next. |
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Posted: 7/27/2013 4:49:08 PM EDT
[#16]
Quote HistoryQuoted: Wow. I mean, it wasn't all that long ago you could buy a plan with 2 mil coverage that covered EVERYTHING after the first 10,000. For 60 to 80 dollars a month. So a young person could have 10,000 in the bank for their rainy day fund and not get totally wiped out if they got in a car wreck. And that was even WITH a heavily regulated fucked up (but still pre-Obamacare) system. Government... turning everything it touches to shit since 1791. The thing is this is all irrelevant talking about plan prices. With no exemption of pre existing conditions it is a matter of time until everyone realizes it's cheaper to pay the fine until they get cancer or something then buy coverage to treat it and then drop coverage. Meanwhile unplanned stuff like emergency room visits you can continue to just skip the bill on. There wont be any insurance that people can afford within a decade. Then demiocrats will ride in to blame the free market hoping to set up true single payer rather than the backdoor single payer they are already creating. |
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Posted: 7/27/2013 4:59:50 PM EDT
[#17]
I have insurance through my employer.
I've worked there nearly seven years. I'm single with no dependents. My portion has gone up from $25 a paycheck in 2006 to $100 a paycheck now. I think we've only stayed with one insurance company for two years, otherwise, always switching every year to attempt to get a better rate. |
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Posted: 7/27/2013 7:36:27 PM EDT
[#18]
Quote HistoryQuoted: I guess Obama's definition of "Rich" is now coming to light.. How in the world can the government MAKE you buy something and penalize you for it if you don't???? I hate to see what's next.It's not a penalty, it's a tax. Fuck you Roberts! And I hope your insurance doesn't cover anal fissures. 
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Posted: 7/27/2013 7:50:13 PM EDT
[#19]
Quote HistoryQuoted:
Family of two: $11,547 What a Deal! This is insane! This country will go berserk. Who the hell can afford this? |
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Posted: 7/27/2013 7:52:42 PM EDT
[#20]
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Probably the same as not paying your taxes since the IRS is going to enforce this... Quote HistoryQuoted:
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So what happens when tens of thousands of people can't pay this? How? Throw us all in jail? Blood will flow. |
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Posted: 7/28/2013 4:20:43 AM EDT
[#21]
Quote HistoryQuoted:
This is insane! This country will go berserk. Who the hell can afford this? Quote HistoryQuoted:
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Family of two: $11,547 What a Deal! This is insane! This country will go berserk. Who the hell can afford this? This is what I asked in an earlier thread. Many people simply can not pay this kind of cost. Not because they will not but because they can not. If the big bad IRS swoops in and forces payment or jail, the prisons will be overflowing with people. 
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Posted: 7/28/2013 4:28:44 AM EDT
[#22]
If we weren't covered by our employers plans the wife and I would pay $20.143 total.
What a total clusterfuck. Just a welfare plan. For example, if I use the stats for my brother and his wife who did not do as well as we did financially. Their costs would be $18,000 total but they would receive a refundable tax credit of roughly $12,000. So their net cost would only be $6,000. Of course, the wife and I receive no credits. More FUCKING WELFARE.
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Posted: 7/28/2013 4:30:17 AM EDT
[#23]
Quote HistoryQuoted:
How? Throw us all in jail? Blood will flow. Quote HistoryQuoted:
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So what happens when tens of thousands of people can't pay this? How? Throw us all in jail? Blood will flow. Nah, they'll just garnish your wages. |
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Posted: 7/28/2013 4:31:41 AM EDT
[#24]
Quote HistoryQuoted:
This is what I asked in an earlier thread. Many people simply can not pay this kind of cost. Not because they will not but because they can not. If the big bad IRS swoops in and forces payment or jail, the prisons will be overflowing with people. Quote HistoryQuoted:
Quoted:
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Family of two: $11,547 What a Deal! This is insane! This country will go berserk. Who the hell can afford this? This is what I asked in an earlier thread. Many people simply can not pay this kind of cost. Not because they will not but because they can not. If the big bad IRS swoops in and forces payment or jail, the prisons will be overflowing with people. That might be why they bought all those millions of rounds and ar15s.they know the shit will hit the fan. |
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Posted: 7/28/2013 4:32:51 AM EDT
[#25]
Quote HistoryQuoted:
Many people simply can not pay this kind of cost. Not because they will not but because they can not. If the big bad IRS swoops in and forces payment or jail, the prisons will be overflowing with people. This is why I think the system will crash, that and when people who did support this crap go to get some care for family or themselves and told they can not no matter what they pay or who they are. People will not stand for it and chaos in the system will result. People can only be pushed so far and simply removing the tax base by incarcerating everyone or taxing you until you have nothing will result in outrage. The politicians (especially the white house) know its doomed to fail and want to push in off until after at least the midterms so they can stay in power. Nothing more nothing less. |
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Posted: 7/28/2013 4:43:34 AM EDT
[#26]
I've been thinking about the whole bronze, silver, gold, platinum plans, with their 40, 30, 20, 10 % deductibles. Say some guy and his family make 300% of poverty level, so they get some govt. subsidy toward their premiums, but since he's "rich", it's "only" a couple hundred a month in subsidies, so he still has to come up with $18,000 a year, and getting the bronze plan cuz that's all he can afford (with his 60" tv, BMW, and 3,500 sf house payments).
So he's scraping by, and then his kid falls off her bike, hits her head, and racks up $100,000 in bills. The insurance company pays $60,000 and he has to come up with $40,000. Turnip=no blood. Yeah, at least it's not $100,000, but $18,000 is a lot of money to pay every year for preventative care, when any significant event is going to put you in the poor house anyway. My point is that people are going to be in the same boat they were before...broke and paying a large percentage out of pocket, and looking for the govt to help them out. The people that can afford the care already have their 6 covered, I think. But I guess WE already know this. 
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Posted: 7/28/2013 4:44:17 AM EDT
[#27]
Quote HistoryQuoted:
Nah, they'll just garnish your wages. Quote HistoryQuoted:
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So what happens when tens of thousands of people can't pay this? How? Throw us all in jail? Blood will flow. Nah, they'll just garnish your wages. I figure its gonna cost me and the wife 270.00 a week! Thats 4.5 times what we are paying now.if the goverment starts garnishing wages over this.I see very bad times coming. |
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Posted: 7/28/2013 5:02:21 AM EDT
[#28]
Self employed, personal policy for me and family, 14K a year already. If this goes up I may just file for disability (defective spine) and get my "free" insurance, right ? That's how it works ?
My brother said if I did this I would have to start voting democrat. In all serious, I do have a bad back which is severely limiting my ability to do my job (electrical). But because I have a sense of duty I carry on. |
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Posted: 7/28/2013 5:17:05 AM EDT
[#29]
This whole ObamaCare thing is just a way of getting us to a single payer system, where the feds pay for and completely control the healthcare in the US. All the doctors will be low paid with poor skills. All insurance companies are going out of business and taxes are going thru the roof- our government can do nothing efficiently!
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Posted: 7/28/2013 5:51:43 AM EDT
[#30]
Hmmm.... my family premiums will roughly double.
Hate to say "I told you so,"... but.... |
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Posted: 7/28/2013 6:22:23 AM EDT
[#31]
I expect bullets to fly if obamacare is implemented as written.
I hope government employees engaged in this theft are willing to accept the losses. Might be time to look for a marriage with benefits. 
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Posted: 7/28/2013 6:26:11 AM EDT
[#32]
Is my social security payment considered income for Obamacare purposes??
It is not considered income for tax reporting to the IRS but I have no idea what healthcare considers as income? As it stands now my premium would be 97.5% of my income. How do they decide I must pay that and not have money for food? Or, is that their way of starving me to death? Wulfmann |
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Posted: 7/28/2013 6:28:06 AM EDT
[#33]
Quote HistoryQuoted:
Is my social security payment considered income for Obamacare purposes?? It is not considered income for tax reporting to the IRS but I have no idea what healthcare considers as income? As it stands now my premium would be 97.5% of my income. How do they decide I must pay that and not have money for food? Or, is that their way of starving me to death? Wulfmann I imagine you have to include SS benefits but are you sure you don't get refundable credits? |
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Posted: 7/28/2013 6:31:18 AM EDT
[#34]
Quote HistoryQuoted: Is my social security payment considered income for Obamacare purposes?? It is not considered income for tax reporting to the IRS but I have no idea what healthcare considers as income? As it stands now my premium would be 97.5% of my income. How do they decide I must pay that and not have money for food? Or, is that their way of starving me to death? Wulfmann |
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Posted: 7/28/2013 6:36:50 AM EDT
[#35]
Quote HistoryQuoted:
I would like to believe that Obamacare can be held at bay, but I wouldn't bet on it. It is going to be rammed down our throats and everyone that has a job is now going to be considered "rich". We (including OK) are going to be getting a royal screwing. Quote HistoryQuoted:
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I expect no effect here in OK. There can be no penalties assessed against us because we don't have a state exchange and our AG is suing to prevent the IRS from illegally giving credits to federal exchanges. http://www.nationalreview.com/articles/328523/irs-has-gone-rogue-michael-f-cannon I would like to believe that Obamacare can be held at bay, but I wouldn't bet on it. It is going to be rammed down our throats and everyone that has a job is now going to be considered "rich". We (including OK) are going to be getting a royal screwing. And it will continue until such time as "we" hit the streets and raise holy Hell. |
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Posted: 7/28/2013 6:38:09 AM EDT
[#36]
Quote HistoryNah, they'll just garnish your wages. But our paychecks are already garnished for taxes,ss and fica. and no one does anything about that
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Posted: 7/28/2013 6:40:24 AM EDT
[#37]
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Do you have medicare or medicade? Quote HistoryQuoted:
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Is my social security payment considered income for Obamacare purposes?? It is not considered income for tax reporting to the IRS but I have no idea what healthcare considers as income? As it stands now my premium would be 97.5% of my income. How do they decide I must pay that and not have money for food? Or, is that their way of starving me to death? Wulfmann Not until May 2014. I will turn 65 and will start Medicare then and that will drop my SS check payouts. Florida is not participating so how does that affect what I have to do? Wulfmann |
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Posted: 7/28/2013 6:50:37 AM EDT
[#38]
I see the huge penalties for the admittedly risky behavior of tobacco use, but where are the huge penalties for much riskier behaviors like skydiving, rapelling, bungee jumping, motorcycle riding, alcohol consumption, homosexual behavior (highest rates of AIDS and other STD's), drug use, overeating, driving while texting, and so on?
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Posted: 7/28/2013 6:52:22 AM EDT
[#39]
Quote HistoryQuoted:
This whole ObamaCare thing is just a way of getting us to a single payer system, where the feds pay for and completely control the healthcare in the US. All the doctors will be low paid with poor skills. All insurance companies are going out of business and taxes are going thru the roof- our government can do nothing efficiently! Bullshit. I was told that government healthcare is going to be sunshine and rainbows. Everyone will receive free healthcare and it will be of the highest quality. Look at how great it is in Canada and over in Europe! We are living in the dark ages, it's time to join the rest of the world. |
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Posted: 7/28/2013 7:12:05 AM EDT
[#40]
Quote HistoryQuoted:
Wtf am I doing wrong? It won't let me add anyone to exchange because I have employer coverage. But it won't let me submit without selecting someone on exchange. It let me and here's the results. results In general, employees who are offered insurance through work are not eligible for subsidized exchange coverage, so long as their insurance meets specified requirements. You would only be eligible for subsidized exchange coverage if your income is between 1 and 4 times the federal poverty level and you would have to pay more than 9.5% of your household income for your own coverage through the insurance offered by your employer. |
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Posted: 7/28/2013 7:13:49 AM EDT
[#41]
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I really think someone with an insurance background needs to chime in and let us know what is actually happening. I am trying to sort through this mess myself. Quote HistoryQuoted:
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What does a bronze plan mean in real terms? How much coverage? I'll comply with the mandate if it falls in line with what I already want to do, which is catastrophic-only. If not, I'll still get catastrophic-only, and just pay the penalty. And if they fuck the system up badly enough that I CAN'T buy catastrophic only... then I'm just going to break the law. Fuck it. Platinum Plan pays 90% you pay 10% Gold Plan pays 80% you pay 20% Silver Plan pays 70% and you pay 30% Bronze Plan pays 60% and you pay 40% Obamacare doesn't start paying until you have paid your deductible (Premium) and the percentage you owe on your plan. If you have the Bronze 60/40 plan and have a $20,000 operation. You have to pay, IIRC 40% of that ($8,000) plus your premium, which in my case is $7,800. So I would pay $15,800 out of pocket before Obamacare would kick in. If you had some serious $200,000 surgery, then you would be paying $120,000 + $7,800 ($127,800) out of pocket. ETA: I'm sure there are some insurance guys on the board that can correct me if I'm wrong and clarify / add to this. I think, for clarification, you should just say you have to pay the percentage you own on your plan, in addition to your monthly premiums (because a presumption could be made by others that you would have to pay the premium amount as a deductibel for every claim. "Deductible" =/= "premium" normally (unless they redefined it in the ACA...I don't know the answer to that, BTW), but the 40% does = deductible = copay But I have some questions, and that I am not 100% sure of the answers to: - Are the insurers in the exchanges not private insurance companies? - If a person goes through the exchange to purchase insurance from one of these private companies, will there be no variation in the insurance policies (i.e. covered claims, deductible amounts, etc.) you can choose from? I can't find the answer anywhere, and all I ever read about is the bronze, silver, gold, platinum plans. Well, if all the insurance companies are offering the same 4 plans, what the hell is the purpose of having an exchange? Insurance expert here and implementing this has been my life for 6+ months.
Plans that will be offered in 2014 look similar to plans that exist today. They have various combinations of deductibles, copays, coinsurance, and out of pocket limits. The metallic tiers relates to the concept of pooling. Suppose enough people buy gold plans that provide $100 million in revenue. The design of the plans is such that the insurance carrier is then expected to cover approximately $80 million of the cost of medical services for these folks who purchased these plans. Like everything in insurance however, there are no guarantees. Each individual situation will be different. You don't meet the deductible, you could have 100% of the cost to bear. You are hospitalized for a long period of time and have $2 million in claims for yourself, you might have to bear 0.3% of the cost. I have seen a number of multimillion dollar claims in a short career.
The exchange is composed of private carriers. These include standard insurers and health co-ops. The latter have been provided a fair amount of federal "loans"... There will also be variations in the plans. Each carrier has different structures, particularly with provider networks. The idea behind a silver plan is to provide comparable options. It would be like shopping for a mid-level sedan from auto companies. The general public knows a Camry, Accord, Fusion/Taurus, etc. are all about the same. Silver plans will all provide about the same level of coverage, so one can comparison shop. The plans also have a minimum benefit coverage, known as the Essential Health Benefit. No plan can go under the benefit, but some could exceed it, which will result in potentially higher costs... I could spend hours writing about the law
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Posted: 7/28/2013 7:28:55 AM EDT
[#42]
Quote HistoryQuoted:
Platinum Plan pays 90% you pay 10% Gold Plan pays 80% you pay 20% Silver Plan pays 70% and you pay 30% Bronze Plan pays 60% and you pay 40% Obamacare doesn't start paying until you have paid your deductible (Premium) and the percentage you owe on your plan. If you have the Bronze 60/40 plan and have a $20,000 operation. You have to pay, IIRC 40% of that ($8,000) plus your premium, which in my case is $7,800. So I would pay $15,800 out of pocket before Obamacare would kick in. If you had some serious $200,000 surgery, then you would be paying $120,000 + $7,800 ($127,800) out of pocket. ETA: I'm sure there are some insurance guys on the board that can correct me if I'm wrong and clarify / add to this. Quote HistoryQuoted:
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What does a bronze plan mean in real terms? How much coverage? I'll comply with the mandate if it falls in line with what I already want to do, which is catastrophic-only. If not, I'll still get catastrophic-only, and just pay the penalty. And if they fuck the system up badly enough that I CAN'T buy catastrophic only... then I'm just going to break the law. Fuck it. Platinum Plan pays 90% you pay 10% Gold Plan pays 80% you pay 20% Silver Plan pays 70% and you pay 30% Bronze Plan pays 60% and you pay 40% Obamacare doesn't start paying until you have paid your deductible (Premium) and the percentage you owe on your plan. If you have the Bronze 60/40 plan and have a $20,000 operation. You have to pay, IIRC 40% of that ($8,000) plus your premium, which in my case is $7,800. So I would pay $15,800 out of pocket before Obamacare would kick in. If you had some serious $200,000 surgery, then you would be paying $120,000 + $7,800 ($127,800) out of pocket. ETA: I'm sure there are some insurance guys on the board that can correct me if I'm wrong and clarify / add to this. I don't think that's correct. There are out of pocket maximums. I found this; The new law also requires that plans cap the maximum out-of-pocket costs for enrollees, based on the out-of-pocket limits in high-deductible plans that are eligible to be paired with a Health Savings Account. The current limits are $5,950 for an individual and $11,900 for a family, and will be adjusted over time after 2014 based on increases in premiums. Thus, for example, a single person with a silver plan that covers 70% of expenses will pay 30% of covered expenses out of his or her own pocket through some combination of deductibles, copays, and coinsurance, up to a maximum of no more than $5,950 per year. http://www.nolo.com/legal-encyclopedia/what-obamacare-means-the-self-employed.html |
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Posted: 7/28/2013 7:31:15 AM EDT
[#43]
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I don't think that's correct. There are out of pocket maximums. I found this; The new law also requires that plans cap the maximum out-of-pocket costs for enrollees, based on the out-of-pocket limits in high-deductible plans that are eligible to be paired with a Health Savings Account. The current limits are $5,950 for an individual and $11,900 for a family, and will be adjusted over time after 2014 based on increases in premiums. Thus, for example, a single person with a silver plan that covers 70% of expenses will pay 30% of covered expenses out of his or her own pocket through some combination of deductibles, copays, and coinsurance, up to a maximum of no more than $5,950 per year. http://www.nolo.com/legal-encyclopedia/what-obamacare-means-the-self-employed.html Quote HistoryQuoted:
Quoted:
Quoted:
What does a bronze plan mean in real terms? How much coverage? I'll comply with the mandate if it falls in line with what I already want to do, which is catastrophic-only. If not, I'll still get catastrophic-only, and just pay the penalty. And if they fuck the system up badly enough that I CAN'T buy catastrophic only... then I'm just going to break the law. Fuck it. Platinum Plan pays 90% you pay 10% Gold Plan pays 80% you pay 20% Silver Plan pays 70% and you pay 30% Bronze Plan pays 60% and you pay 40% Obamacare doesn't start paying until you have paid your deductible (Premium) and the percentage you owe on your plan. If you have the Bronze 60/40 plan and have a $20,000 operation. You have to pay, IIRC 40% of that ($8,000) plus your premium, which in my case is $7,800. So I would pay $15,800 out of pocket before Obamacare would kick in. If you had some serious $200,000 surgery, then you would be paying $120,000 + $7,800 ($127,800) out of pocket. ETA: I'm sure there are some insurance guys on the board that can correct me if I'm wrong and clarify / add to this. I don't think that's correct. There are out of pocket maximums. I found this; The new law also requires that plans cap the maximum out-of-pocket costs for enrollees, based on the out-of-pocket limits in high-deductible plans that are eligible to be paired with a Health Savings Account. The current limits are $5,950 for an individual and $11,900 for a family, and will be adjusted over time after 2014 based on increases in premiums. Thus, for example, a single person with a silver plan that covers 70% of expenses will pay 30% of covered expenses out of his or her own pocket through some combination of deductibles, copays, and coinsurance, up to a maximum of no more than $5,950 per year. http://www.nolo.com/legal-encyclopedia/what-obamacare-means-the-self-employed.html 5950 is outdated, the value for 2013 is 6250 and the value for 2014 is 6350. Note these values are for single coverage, family coverage is two times. |
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Posted: 7/28/2013 11:42:37 AM EDT
[#44]
Quote HistoryQuoted: I don't think that's correct. There are out of pocket maximums. I found this; The new law also requires that plans cap the maximum out-of-pocket costs for enrollees, based on the out-of-pocket limits in high-deductible plans that are eligible to be paired with a Health Savings Account. The current limits are $5,950 for an individual and $11,900 for a family, and will be adjusted over time after 2014 based on increases in premiums. Thus, for example, a single person with a silver plan that covers 70% of expenses will pay 30% of covered expenses out of his or her own pocket through some combination of deductibles, copays, and coinsurance, up to a maximum of no more than $5,950 per year. http://www.nolo.com/legal-encyclopedia/what-obamacare-means-the-self-employed.html Quote HistoryQuoted: Quoted: Quoted: What does a bronze plan mean in real terms? How much coverage? I'll comply with the mandate if it falls in line with what I already want to do, which is catastrophic-only. If not, I'll still get catastrophic-only, and just pay the penalty. And if they fuck the system up badly enough that I CAN'T buy catastrophic only... then I'm just going to break the law. Fuck it. Platinum Plan pays 90% you pay 10% Gold Plan pays 80% you pay 20% Silver Plan pays 70% and you pay 30% Bronze Plan pays 60% and you pay 40% Obamacare doesn't start paying until you have paid your deductible (Premium) and the percentage you owe on your plan. If you have the Bronze 60/40 plan and have a $20,000 operation. You have to pay, IIRC 40% of that ($8,000) plus your premium, which in my case is $7,800. So I would pay $15,800 out of pocket before Obamacare would kick in. If you had some serious $200,000 surgery, then you would be paying $120,000 + $7,800 ($127,800) out of pocket. ETA: I'm sure there are some insurance guys on the board that can correct me if I'm wrong and clarify / add to this. I don't think that's correct. There are out of pocket maximums. I found this; The new law also requires that plans cap the maximum out-of-pocket costs for enrollees, based on the out-of-pocket limits in high-deductible plans that are eligible to be paired with a Health Savings Account. The current limits are $5,950 for an individual and $11,900 for a family, and will be adjusted over time after 2014 based on increases in premiums. Thus, for example, a single person with a silver plan that covers 70% of expenses will pay 30% of covered expenses out of his or her own pocket through some combination of deductibles, copays, and coinsurance, up to a maximum of no more than $5,950 per year. http://www.nolo.com/legal-encyclopedia/what-obamacare-means-the-self-employed.html Thanks for the info. I am trying to understand and any input is appreciated. |
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Posted: 7/28/2013 11:42:54 AM EDT
[#45]
Quote HistoryQuoted: Insurance expert here and implementing this has been my life for 6+ months. Plans that will be offered in 2014 look similar to plans that exist today. They have various combinations of deductibles, copays, coinsurance, and out of pocket limits. The metallic tiers relates to the concept of pooling. Suppose enough people buy gold plans that provide $100 million in revenue. The design of the plans is such that the insurance carrier is then expected to cover approximately $80 million of the cost of medical services for these folks who purchased these plans. Like everything in insurance however, there are no guarantees. Each individual situation will be different. You don't meet the deductible, you could have 100% of the cost to bear. You are hospitalized for a long period of time and have $2 million in claims for yourself, you might have to bear 0.3% of the cost. I have seen a number of multimillion dollar claims in a short career. The exchange is composed of private carriers. These include standard insurers and health co-ops. The latter have been provided a fair amount of federal "loans"... There will also be variations in the plans. Each carrier has different structures, particularly with provider networks. The idea behind a silver plan is to provide comparable options. It would be like shopping for a mid-level sedan from auto companies. The general public knows a Camry, Accord, Fusion/Taurus, etc. are all about the same. Silver plans will all provide about the same level of coverage, so one can comparison shop. The plans also have a minimum benefit coverage, known as the Essential Health Benefit. No plan can go under the benefit, but some could exceed it, which will result in potentially higher costs... I could spend hours writing about the law Quote HistoryQuoted: Quoted: Quoted: Quoted: Quoted: What does a bronze plan mean in real terms? How much coverage? I'll comply with the mandate if it falls in line with what I already want to do, which is catastrophic-only. If not, I'll still get catastrophic-only, and just pay the penalty. And if they fuck the system up badly enough that I CAN'T buy catastrophic only... then I'm just going to break the law. Fuck it. Platinum Plan pays 90% you pay 10% Gold Plan pays 80% you pay 20% Silver Plan pays 70% and you pay 30% Bronze Plan pays 60% and you pay 40% Obamacare doesn't start paying until you have paid your deductible (Premium) and the percentage you owe on your plan. If you have the Bronze 60/40 plan and have a $20,000 operation. You have to pay, IIRC 40% of that ($8,000) plus your premium, which in my case is $7,800. So I would pay $15,800 out of pocket before Obamacare would kick in. If you had some serious $200,000 surgery, then you would be paying $120,000 + $7,800 ($127,800) out of pocket. ETA: I'm sure there are some insurance guys on the board that can correct me if I'm wrong and clarify / add to this. I think, for clarification, you should just say you have to pay the percentage you own on your plan, in addition to your monthly premiums (because a presumption could be made by others that you would have to pay the premium amount as a deductibel for every claim. "Deductible" =/= "premium" normally (unless they redefined it in the ACA...I don't know the answer to that, BTW), but the 40% does = deductible = copay But I have some questions, and that I am not 100% sure of the answers to: - Are the insurers in the exchanges not private insurance companies? - If a person goes through the exchange to purchase insurance from one of these private companies, will there be no variation in the insurance policies (i.e. covered claims, deductible amounts, etc.) you can choose from? I can't find the answer anywhere, and all I ever read about is the bronze, silver, gold, platinum plans. Well, if all the insurance companies are offering the same 4 plans, what the hell is the purpose of having an exchange? Insurance expert here and implementing this has been my life for 6+ months. Plans that will be offered in 2014 look similar to plans that exist today. They have various combinations of deductibles, copays, coinsurance, and out of pocket limits. The metallic tiers relates to the concept of pooling. Suppose enough people buy gold plans that provide $100 million in revenue. The design of the plans is such that the insurance carrier is then expected to cover approximately $80 million of the cost of medical services for these folks who purchased these plans. Like everything in insurance however, there are no guarantees. Each individual situation will be different. You don't meet the deductible, you could have 100% of the cost to bear. You are hospitalized for a long period of time and have $2 million in claims for yourself, you might have to bear 0.3% of the cost. I have seen a number of multimillion dollar claims in a short career. The exchange is composed of private carriers. These include standard insurers and health co-ops. The latter have been provided a fair amount of federal "loans"... There will also be variations in the plans. Each carrier has different structures, particularly with provider networks. The idea behind a silver plan is to provide comparable options. It would be like shopping for a mid-level sedan from auto companies. The general public knows a Camry, Accord, Fusion/Taurus, etc. are all about the same. Silver plans will all provide about the same level of coverage, so one can comparison shop. The plans also have a minimum benefit coverage, known as the Essential Health Benefit. No plan can go under the benefit, but some could exceed it, which will result in potentially higher costs... I could spend hours writing about the law Thanks! |
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Posted: 7/28/2013 6:59:29 PM EDT
[#46]
So if someone currently doesn't have insurance right now, should they get a cheap high deductible plan(which covers nothing until the deductible is met) before years end or wait until next year?
Edit: I don't need/want coverage for every day shit because I'm healthy. I only want coverage for if I electrode myself while fixing a printer or some other [freak] accident.
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Posted: 7/28/2013 7:34:15 PM EDT
[#47]
Y'all are truly fucked.
Good luck. |
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Posted: 7/28/2013 10:54:14 PM EDT
[#48]
Quote HistoryQuoted: So if someone currently doesn't have insurance right now, should they get a cheap high deductible plan(which covers nothing until the deductible is met) before years end or wait until next year? Edit: I don't need/want coverage for every day shit because I'm healthy. I only want coverage for if I electrode myself while fixing a printer or some other [freak] accident. |
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Posted: 7/28/2013 10:56:17 PM EDT
[#49]
Quote HistoryQuoted: Insurance expert here and implementing this has been my life for 6+ months. Plans that will be offered in 2014 look similar to plans that exist today. They have various combinations of deductibles, copays, coinsurance, and out of pocket limits. The metallic tiers relates to the concept of pooling. Suppose enough people buy gold plans that provide $100 million in revenue. The design of the plans is such that the insurance carrier is then expected to cover approximately $80 million of the cost of medical services for these folks who purchased these plans. Like everything in insurance however, there are no guarantees. Each individual situation will be different. You don't meet the deductible, you could have 100% of the cost to bear. You are hospitalized for a long period of time and have $2 million in claims for yourself, you might have to bear 0.3% of the cost. I have seen a number of multimillion dollar claims in a short career. The exchange is composed of private carriers. These include standard insurers and health co-ops. The latter have been provided a fair amount of federal "loans"... There will also be variations in the plans. Each carrier has different structures, particularly with provider networks. The idea behind a silver plan is to provide comparable options. It would be like shopping for a mid-level sedan from auto companies. The general public knows a Camry, Accord, Fusion/Taurus, etc. are all about the same. Silver plans will all provide about the same level of coverage, so one can comparison shop. The plans also have a minimum benefit coverage, known as the Essential Health Benefit. No plan can go under the benefit, but some could exceed it, which will result in potentially higher costs... I could spend hours writing about the law Quote HistoryQuoted: Quoted: Quoted: Quoted: Quoted: What does a bronze plan mean in real terms? How much coverage? I'll comply with the mandate if it falls in line with what I already want to do, which is catastrophic-only. If not, I'll still get catastrophic-only, and just pay the penalty. And if they fuck the system up badly enough that I CAN'T buy catastrophic only... then I'm just going to break the law. Fuck it. Platinum Plan pays 90% you pay 10% Gold Plan pays 80% you pay 20% Silver Plan pays 70% and you pay 30% Bronze Plan pays 60% and you pay 40% Obamacare doesn't start paying until you have paid your deductible (Premium) and the percentage you owe on your plan. If you have the Bronze 60/40 plan and have a $20,000 operation. You have to pay, IIRC 40% of that ($8,000) plus your premium, which in my case is $7,800. So I would pay $15,800 out of pocket before Obamacare would kick in. If you had some serious $200,000 surgery, then you would be paying $120,000 + $7,800 ($127,800) out of pocket. ETA: I'm sure there are some insurance guys on the board that can correct me if I'm wrong and clarify / add to this. I think, for clarification, you should just say you have to pay the percentage you own on your plan, in addition to your monthly premiums (because a presumption could be made by others that you would have to pay the premium amount as a deductibel for every claim. "Deductible" =/= "premium" normally (unless they redefined it in the ACA...I don't know the answer to that, BTW), but the 40% does = deductible = copay But I have some questions, and that I am not 100% sure of the answers to: - Are the insurers in the exchanges not private insurance companies? - If a person goes through the exchange to purchase insurance from one of these private companies, will there be no variation in the insurance policies (i.e. covered claims, deductible amounts, etc.) you can choose from? I can't find the answer anywhere, and all I ever read about is the bronze, silver, gold, platinum plans. Well, if all the insurance companies are offering the same 4 plans, what the hell is the purpose of having an exchange? Insurance expert here and implementing this has been my life for 6+ months. Plans that will be offered in 2014 look similar to plans that exist today. They have various combinations of deductibles, copays, coinsurance, and out of pocket limits. The metallic tiers relates to the concept of pooling. Suppose enough people buy gold plans that provide $100 million in revenue. The design of the plans is such that the insurance carrier is then expected to cover approximately $80 million of the cost of medical services for these folks who purchased these plans. Like everything in insurance however, there are no guarantees. Each individual situation will be different. You don't meet the deductible, you could have 100% of the cost to bear. You are hospitalized for a long period of time and have $2 million in claims for yourself, you might have to bear 0.3% of the cost. I have seen a number of multimillion dollar claims in a short career. The exchange is composed of private carriers. These include standard insurers and health co-ops. The latter have been provided a fair amount of federal "loans"... There will also be variations in the plans. Each carrier has different structures, particularly with provider networks. The idea behind a silver plan is to provide comparable options. It would be like shopping for a mid-level sedan from auto companies. The general public knows a Camry, Accord, Fusion/Taurus, etc. are all about the same. Silver plans will all provide about the same level of coverage, so one can comparison shop. The plans also have a minimum benefit coverage, known as the Essential Health Benefit. No plan can go under the benefit, but some could exceed it, which will result in potentially higher costs... I could spend hours writing about the law |
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Posted: 7/28/2013 11:27:13 PM EDT
[#50]
so then, if you just let it go and pay the fine/tax, do you then get healthcare coverage from Big Brother?
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