Bronze and Silver Obamacare Program are GARBAGE - Liberals let’s not forget this.

[Care4all]

MERRY CHRISTMAS BEAGLE!

 

[debbiedowner]

It's not that they didn't accept an ACA plan it's they were not in the network for the particular insurance company. If they had have been in network they would have been required by their contract with that insurance company to accept it.

. Why wouldn't a renown specialist not be in the network ?? Charge to much for his specialized services maybe ?? So other words now we get into death panels because if a patient has to opt for the cheaper care, then doesn't that place that patient in danger of dying because she can't get the care that might save her life or in the case of not dying to at least make her life more tolerable and less painful ?

See above, he might have known his trade but not his contracts.

. Again, didn't Obama say that people were going to be able to keep their plans and their doctors ?? Was that a lie of epic proportions or what ???

If they accepted off exchange they were under contract to accept it on exchange.

I'm lost..

Ok, a provider has signed a contract to accept X plan that can be purchased on healthcare.gov and you receive a subsidy. If you do not qualify for a subsidy you purchase the exact same plan either from an agent from that insurance company or direct with the company (off exchange). Because it is the exact same plan and he has signed a contract to accept that plan he or she cannot differentiate and say no they won't accept it if you purchased it through healthcare.gov (on exhange)

Had to come back and edit after thinking about what some agents said in CA and a handful of other states that they may not accept it if bought on exchange, but that is not the norm. Maybe a couple of other agents on this board can clarify for you.

 

[debbiedowner]

when you look for a plan on the exchange, customers have tools to help them see if the plan works for them....some plans don't cover out of network doctors, some cover only 50% of the cost or 60% of the cost if you see an out of network doctor, some plans may not cover the medications you use, some plans may not have the doctors you use in their network....

Thus the exchange....it gives you the tools to check and see if your medications are covered under the plan, the tools to see if the kind of doctors you anticipate using are in the network...

Health Insurance is much more complicated than one would think. I spent hours sometimes with elderly couples but not 65 yet, trying to choose a plan that was best for them....

It's so much easier to just pick a plan from your work benefit offered....by just trusting your HR department to have picked the most universal plan coverage....either way, you just have the choice of what they offer you if you want the benefit.

While I agree, do you know most of the provider lookup was wrong? Every year during oep we received bulletins that their providers were showing wrong, that is why you use an agent.

No, I did not know that.... was that the case in every state?

Up here in Maine, there are so few choices for the customers....only 2 providers when they first opened, and I believe they increased their providers by 50%, meaning they now have 3 providers....the silver plans in this State, are only 5 plans to choose from....hopefully they got it right???

I'm in the south, but I understand from the insurance forums and agents across the nation this was the case just about everywhere and some meds were listed that were not covered also.

 

[LoneLaugher]

I already have.

Your neighbor's wife did not buy a plan on the ACA exchange only to be refused medical care. There is no such thing as an ACA approved plan that isn't any good.

. So your saying that medical facilities that provide specialized care for specific problems aren't telling a person with an ACA plan that they don't accept that insurance ?? Because that's what took place, and then his wife had to go to a facility or Doctor that did take the insurance, but they felt that the care would be far less on what they were hoping for, and it was far less than they were hoping for.

Now what ?

So they can't see the specialist of choice right ? Kind of like "you can keep your plan or doctor" right ?? That was a proven huge lie wasn't it ?? So where am I lying now ??

It's not that they didn't accept an ACA plan it's they were not in the network for the particular insurance company. If they had have been in network they would have been required by their contract with that insurance company to accept it.

. Why wouldn't a renown specialist not be in the network ?? Charge to much for his specialized services maybe ?? So other words now we get into death panels because if a patient has to opt for the cheaper care, then doesn't that place that patient in danger of dying because she can't get the care that might save her life or in the case of not dying to at least make her life more tolerable and less painful ?

See above, he might have known his trade but not his contracts.

. Again, didn't Obama say that people were going to be able to keep their plans and their doctors, and that their premiums weren't going to be higher than $2,500.00 dollars ?? Was that a lie of epic proportions or what ??? The ACA has a network contract or contracts ?? Thought it would be honored everywhere if it was subsidized by the government as a way to help people get the care and specialized care that even the affluent among us receive ?? If not then the networks basically equate to network death panels ?? If a specialized care is out of network, then your option is death if you can't obtain the specialized care needed through the network you have ??

For the millionth time, Obama meant that when he said it. And for 95%+ of Americans who had insurance before the ACA were able to keep their plans and their doctors.

Amazingly, every USMB conservative fell into the 5% who had shit plans or got screwed by their insurance company or a politically butthurt boss.

 

[debbiedowner]

Merry Christmas.

 

[debbiedowner]

. So your saying that medical facilities that provide specialized care for specific problems aren't telling a person with an ACA plan that they don't accept that insurance ?? Because that's what took place, and then his wife had to go to a facility or Doctor that did take the insurance, but they felt that the care would be far less on what they were hoping for, and it was far less than they were hoping for.

Now what ?

So they can't see the specialist of choice right ? Kind of like "you can keep your plan or doctor" right ?? That was a proven huge lie wasn't it ?? So where am I lying now ??

It's not that they didn't accept an ACA plan it's they were not in the network for the particular insurance company. If they had have been in network they would have been required by their contract with that insurance company to accept it.

. Why wouldn't a renown specialist not be in the network ?? Charge to much for his specialized services maybe ?? So other words now we get into death panels because if a patient has to opt for the cheaper care, then doesn't that place that patient in danger of dying because she can't get the care that might save her life or in the case of not dying to at least make her life more tolerable and less painful ?

See above, he might have known his trade but not his contracts.

. Again, didn't Obama say that people were going to be able to keep their plans and their doctors, and that their premiums weren't going to be higher than $2,500.00 dollars ?? Was that a lie of epic proportions or what ??? The ACA has a network contract or contracts ?? Thought it would be honored everywhere if it was subsidized by the government as a way to help people get the care and specialized care that even the affluent among us receive ?? If not then the networks basically equate to network death panels ?? If a specialized care is out of network, then your option is death if you can't obtain the specialized care needed through the network you have ??

For the millionth time, Obama meant that when he said it. And for 95%+ of Americans who had insurance before the ACA were able to keep their plans and their doctors.

Amazingly, every USMB conservative fell into the 5% who had shit plans or got screwed by their insurance company or a politically butthurt boss.

He did mean you can keep your doctor's and plans if you like because the plans were grandfathered. What he didn't know or count on is how this insurance thing works. Doctor's have contracts and do not have to renew them. He also didn't know a handful of insurance companies would terminate their grandfathered plans. Guess those insurance companies saw a windfall of money coming from the government in the form of subsidies and were going to take advantage btw 2 of the same companies that don't sell in many states right now. I still have grandfathered plans on the books. But they are rising in rates.

 

[debbiedowner]

. So your saying that medical facilities that provide specialized care for specific problems aren't telling a person with an ACA plan that they don't accept that insurance ?? Because that's what took place, and then his wife had to go to a facility or Doctor that did take the insurance, but they felt that the care would be far less on what they were hoping for, and it was far less than they were hoping for.

Now what ?

So they can't see the specialist of choice right ? Kind of like "you can keep your plan or doctor" right ?? That was a proven huge lie wasn't it ?? So where am I lying now ??

It's not that they didn't accept an ACA plan it's they were not in the network for the particular insurance company. If they had have been in network they would have been required by their contract with that insurance company to accept it.

. Why wouldn't a renown specialist not be in the network ?? Charge to much for his specialized services maybe ?? So other words now we get into death panels because if a patient has to opt for the cheaper care, then doesn't that place that patient in danger of dying because she can't get the care that might save her life or in the case of not dying to at least make her life more tolerable and less painful ?

See above, he might have known his trade but not his contracts.

. Again, didn't Obama say that people were going to be able to keep their plans and their doctors, and that their premiums weren't going to be higher than $2,500.00 dollars ?? Was that a lie of epic proportions or what ??? The ACA has a network contract or contracts ?? Thought it would be honored everywhere if it was subsidized by the government as a way to help people get the care and specialized care that even the affluent among us receive ?? If not then the networks basically equate to network death panels ?? If a specialized care is out of network, then your option is death if you can't obtain the specialized care needed through the network you have ??

For the millionth time, Obama meant that when he said it. And for 95%+ of Americans who had insurance before the ACA were able to keep their plans and their doctors.

Amazingly, every USMB conservative fell into the 5% who had shit plans or got screwed by their insurance company or a politically butthurt boss.

I am thinking that this 5% either went it alone without a local agent from their area or called the marketplace.

I also don't blame for bitching about the rates if one does not receive a subsidy or between 300-400% of FPL with very little subsidy and the ones over 400%, the rates are outrageous.

 

[BluesLegend]

Co-pays: 60/40 bronze (so after you pay $6500 out of pocket you had to cover 40% of the cost)

No, that's not how that works. Once you hit your out-of-pocket limit, you paying nothing further out-of-pocket (your insurer pays 100% of expenses from that point forward).

That's why it's called an out-of-pocket limit.

The maximum out of pocket limit for 2017 is $7,150 for an individual or $14,300 for a family. So in this example the individual pays 100% out of pocket up front for the deductible of $6,500, then 40% until the remaining $600 of the maximum out of pocket per year is paid, then the insurance company pays 100%. Of course they also have to pay their premiums so monthly premiums plus up to $7,150 per year.

Okay, but you didnt finish your thought. Compare those expenses to all of it being out of pocket. Maybe use a compound fracture of the leg requiring surgery and physical therapy. Estimated cost: $50,000.

Your point is?

Uh...kinda hard to miss...one number is much larger than the other...

So some far fetched one in a million injury should be the baseline? What if some liberal needs a brain transplant that would probably cost $100 billion.

 

[Dale Smith]

Just for chucks and grins, I looked up a plan on the Barrypuppetcare website and the cheapest one for someone that was 50 years old with no pre-existing conditions was 600 dollars a month

You are a shameless little liar, Dale. You never looked up anything. Here are the prices (subtract about $100/month tax credit, if you only make $40K/year):

Health insurance plans & prices | HealthCare.gov

Nope, I looked it up right after that sham of a website finally started working and for someone of my age and the amount of money I made (60 K) was 600 per month with a 6K deductible and 80% was the cheapest plan offered here in Michigan. So, go pound sand up your ass, dipshit.

 

[beagle9]

. Why wouldn't a renown specialist not be in the network ?? Charge to much for his specialized services maybe ?? So other words now we get into death panels because if a patient has to opt for the cheaper care, then doesn't that place that patient in danger of dying because she can't get the care that might save her life or in the case of not dying to at least make her life more tolerable and less painful ?

See above, he might have known his trade but not his contracts.

. Again, didn't Obama say that people were going to be able to keep their plans and their doctors ?? Was that a lie of epic proportions or what ???

If they accepted off exchange they were under contract to accept it on exchange.

I'm lost..

Ok, a provider has signed a contract to accept X plan that can be purchased on healthcare.gov and you receive a subsidy. If you do not qualify for a subsidy you purchase the exact same plan either from an agent from that insurance company or direct with the company (off exchange). Because it is the exact same plan and he has signed a contract to accept that plan he or she cannot differentiate and say no they won't accept it if you purchased it through healthcare.gov (on exhange)

Had to come back and edit after thinking about what some agents said in CA and a handful of other states that they may not accept it if bought on exchange, but that is not the norm. Maybe a couple of other agents on this board can clarify for you.

. Not sure what happened in their case, but the specialist they desired wouldn't accept the ACA plan or the ACA plan wouldn't accept them as a medical provider. I was told the plan wouldn't be accepted by the specialist, and the plan wouldn't accept the specialist due to them being out of network. So much for choice right ?? Does it make sense ?

 

[beagle9]

Just for chucks and grins, I looked up a plan on the Barrypuppetcare website and the cheapest one for someone that was 50 years old with no pre-existing conditions was 600 dollars a month

You are a shameless little liar, Dale. You never looked up anything. Here are the prices (subtract about $100/month tax credit, if you only make $40K/year):

Health insurance plans & prices | HealthCare.gov

Nope, I looked it up right after that sham of a website finally started working and for someone of my age and the amount of money I made (60 K) was 600 per month with a 6K deductible and 80% was the cheapest plan offered here in Michigan. So, go pound sand up your ass, dipshit.

. 80/20 is great these days isn't it ? The $600.00 a month is high I think. That's $150.00 a week for single coverage right ??

A single coverage plan in a great pool designed for groups that fit the plan shouldn't be no more than around $35.00 to $40.00 dollars a week right ? That's $120.00 to $140.00 a month. Why can't insurance companies do well with these kinds of rates, otherwise having rates that would draw huge pools of people that are young, middle aged and older for whom could easily afford such rates ??

 

[flacaltenn]

Silver plans are fine. Better than what was available to middle class workers pre-ACA.

Bullshit. Any professional group plan for self-employed was FAR better in terms of out of pocket money. Obama OUTLAWED them. Including mine. Tossed me and most lawyers, dentists, accounts, restaurant owners, consultants, veterinarians - --- into the cess POOL. Any poor person from the "medicaid expansion" into the pool is gonna be financially RUINED if they ever get seriously ill.. It's crap. Poor people ADDED to the pool from Medicaid are getting screwed. Includes a BUNCH of lower middle class folks who now qualify for Medicaid but end up holding these useless policies..

Whoa! You've blown me away with your emotional response. You were tossed into the CESSPOOL!

Poor baby! How did you survive? Did ya pull yourself up by the bootstraps? I'll bet you did! You da man!

Oh yeah.. It's hysterical ain't it? I had a professionally managed and brokered plan with about 150 years of insurance experience to negotiate for me and answer questions. NOW -- I got a broken ass website that looks like it was designed by morons and a "HealthCare Navigator" on a 40 minute hold who was pushing a Hot Dog cart in Brooklyn last week. Guy has NO CLUE what insurance terminology means or how to use a fucking calculator.

It's a blast Laugh it up. Folks are gonna go bankrupt if they ever need to USE this junk insurance. I can AFFORD the deductibles and out of pocket, but they DOUBLE my medical insurance and expenses every year.

Funny shit ain't for a leftist...

. Sounds like all of it is just another hidden wealth redistribution scheme when talk about the bankrupting part of it. Hmmmm.

Don't believe that charlatan.... health insurance doesn't bankrupt anyone, NOT having health insurance bankrupts people.

Oh no.. Of COURSE not genius. . So you give a low wage family a shitty O'Care for nearly free. Maybe they pay 15% of the outrageous premium. Say $220/month. Has an 80/20 benefit. With a $2500 individual deductible. $4000 per family. Kid breaks a clavicle has a mild concussion. Hospital and ER and follow up bills after "negotiated payment adjustment" is $6500. You're a genius -- give me that YEARLY cost of that "medical insurance" and care. You can round to the nearest $100.

THEY -- cannot afford it. If you can't calculate it, maybe you shouldn't be calling people charlatans --- if you get the number wrong.

BTW --- Family income is just under $40K. That's where I got the 85% discount on their monthly premium. They're gonna be eating ALPO because they NEEDED to use the "insurance".. Charlatan...

 

[flacaltenn]

Silver plans are fine. Better than what was available to middle class workers pre-ACA.

Bullshit. Any professional group plan for self-employed was FAR better in terms of out of pocket money. Obama OUTLAWED them. Including mine. Tossed me and most lawyers, dentists, accounts, restaurant owners, consultants, veterinarians - --- into the cess POOL. Any poor person from the "medicaid expansion" into the pool is gonna be financially RUINED if they ever get seriously ill.. It's crap. Poor people ADDED to the pool from Medicaid are getting screwed. Includes a BUNCH of lower middle class folks who now qualify for Medicaid but end up holding these useless policies..

Whoa! You've blown me away with your emotional response. You were tossed into the CESSPOOL!

Poor baby! How did you survive? Did ya pull yourself up by the bootstraps? I'll bet you did! You da man!

Oh yeah.. It's hysterical ain't it? I had a professionally managed and brokered plan with about 150 years of insurance experience to negotiate for me and answer questions. NOW -- I got a broken ass website that looks like it was designed by morons and a "HealthCare Navigator" on a 40 minute hold who was pushing a Hot Dog cart in Brooklyn last week. Guy has NO CLUE what insurance terminology means or how to use a fucking calculator.

It's a blast Laugh it up. Folks are gonna go bankrupt if they ever need to USE this junk insurance. I can AFFORD the deductibles and out of pocket, but they DOUBLE my medical insurance and expenses every year.

Funny shit ain't for a leftist...

. Sounds like all of it is just another hidden wealth redistribution scheme when talk about the bankrupting part of it. Hmmmm.

Well the O'care plan IN PART was a giant "hide the pickle" exercise. In that the "medicaid expansion" was a way to get the POOL to subsidize new "marginally qualified" poorer families. That way there was NEED to "PAY" for Medicare expansion. Just distribute the "redistribution" amongst the folks flung into the cesspool.

 

[LoneLaugher]

Bullshit. Any professional group plan for self-employed was FAR better in terms of out of pocket money. Obama OUTLAWED them. Including mine. Tossed me and most lawyers, dentists, accounts, restaurant owners, consultants, veterinarians - --- into the cess POOL. Any poor person from the "medicaid expansion" into the pool is gonna be financially RUINED if they ever get seriously ill.. It's crap. Poor people ADDED to the pool from Medicaid are getting screwed. Includes a BUNCH of lower middle class folks who now qualify for Medicaid but end up holding these useless policies..

Whoa! You've blown me away with your emotional response. You were tossed into the CESSPOOL!

Poor baby! How did you survive? Did ya pull yourself up by the bootstraps? I'll bet you did! You da man!

Oh yeah.. It's hysterical ain't it? I had a professionally managed and brokered plan with about 150 years of insurance experience to negotiate for me and answer questions. NOW -- I got a broken ass website that looks like it was designed by morons and a "HealthCare Navigator" on a 40 minute hold who was pushing a Hot Dog cart in Brooklyn last week. Guy has NO CLUE what insurance terminology means or how to use a fucking calculator.

It's a blast Laugh it up. Folks are gonna go bankrupt if they ever need to USE this junk insurance. I can AFFORD the deductibles and out of pocket, but they DOUBLE my medical insurance and expenses every year.

Funny shit ain't for a leftist...

. Sounds like all of it is just another hidden wealth redistribution scheme when talk about the bankrupting part of it. Hmmmm.

Don't believe that charlatan.... health insurance doesn't bankrupt anyone, NOT having health insurance bankrupts people.

Oh no.. Of COURSE not genius. . So you give a low wage family a shitty O'Care for nearly free. Maybe they pay 15% of the outrageous premium. Say $220/month. Has an 80/20 benefit. With a $2500 individual deductible. $4000 per family. Kid breaks a clavicle has a mild concussion. Hospital and ER and follow up bills after "negotiated payment adjustment" is $6500. You're a genius -- give me that YEARLY cost of that "medical insurance" and care. You can round to the nearest $100.

THEY -- cannot afford it. If you can't calculate it, maybe you shouldn't be calling people charlatans --- if you get the number wrong.

BTW --- Family income is just under $40K. That's where I got the 85% discount on their monthly premium. They're gonna be eating ALPO because they NEEDED to use the "insurance".. Charlatan...

I'm convinced. You are motivated by concern for low income people. That is absolutely believable. If only everyone were a moron, you'd be king.

 

[dblack]

For the millionth time, Obama meant that when he said it. And for 95%+ of Americans who had insurance before the ACA were able to keep their plans and their doctors.

Yes. This is the nature of statists programs. They take care of the 95% by fucking the 5%.

 

[Greenbeard]

Oh no.. Of COURSE not genius. . So you give a low wage family a shitty O'Care for nearly free. Maybe they pay 15% of the outrageous premium. Say $220/month. Has an 80/20 benefit. With a $2500 individual deductible. $4000 per family. Kid breaks a clavicle has a mild concussion. Hospital and ER and follow up bills after "negotiated payment adjustment" is $6500. You're a genius -- give me that YEARLY cost of that "medical insurance" and care. You can round to the nearest $100.

THEY -- cannot afford it. If you can't calculate it, maybe you shouldn't be calling people charlatans --- if you get the number wrong.

This exercise is pretty straightforward using healthcare.gov. Say, a family in Nashville of two mid-30-somethings with two young kids making 39K.

They could get a zero premium bronze plan and be on the hook for only out-of-pocket costs (not advisable). Or they could buy a silver plan and get cost-sharing reductions that drop their deductibles and OOP maxes (advisable!).

So they buy the cheapest silver plan (Cigna Connect 800-3) for $82/month.

If they had a $6,500 hospital bill for one of the kids, they'd pay a $800 deductible and then 10% coinsurance on the rest [(0.1 * ($6,500 - $800)) = $570].

So $984 in premiums for the year and $1,370 out of pocket is about $2,350 on health expenses for the year. About 6% of their income and well below the actual costs they incurred that year.

(I should say I actually think in your example their out-of-pocket would really only be the $250 ER copay in that plan but I'm just going with the worst-case scenario.)

 

[GHook93]

I have a buddy who is a small business owner. He selected a provider on Obamacare (it was maybe 3 yrs back).

He paid I believe $750 for him and his wife. To his dismay, he discovered that not one Healthcare provider accepted his insurance. By not one, I mean no one. It was useless. The Government made an exception to the open enrollment period and allowed him to select a new more expense insurer, but it took 90 days to fix the problem and 60 days to get a new insurer. Ridiculous


Sent from my iPhone using USMessageBoard.com

 

[dblack]

I have a buddy who is a small business owner. He selected a provider on Obamacare (it was maybe 3 yrs back).

He paid I believe $750 for him and his wife. To his dismay, he discovered that not one Healthcare provider accepted his insurance. By not one, I mean no one. It was useless. The Government made an exception to the open enrollment period and allowed him to select a new more expense insurer, but it took 90 days to fix the problem and 60 days to get a new insurer. Ridiculous

The salient point here is that, under ACA, government is the "decider". That's the goal of greenbeard and the rest of the insurance industry shills here on the board. They know that it's easier to manipulate regulation than to satisfy customers.

 

[debbiedowner]

I have a buddy who is a small business owner. He selected a provider on Obamacare (it was maybe 3 yrs back).

He paid I believe $750 for him and his wife. To his dismay, he discovered that not one Healthcare provider accepted his insurance. By not one, I mean no one. It was useless. The Government made an exception to the open enrollment period and allowed him to select a new more expense insurer, but it took 90 days to fix the problem and 60 days to get a new insurer. Ridiculous

The salient point here is that, under ACA, government is the "decider". That's the goal of greenbeard and the rest of the insurance industry shills here on the board. They know that it's easier to manipulate regulation than to satisfy customers.

The Government is the decider of what?

 

[beagle9]

Oh no.. Of COURSE not genius. . So you give a low wage family a shitty O'Care for nearly free. Maybe they pay 15% of the outrageous premium. Say $220/month. Has an 80/20 benefit. With a $2500 individual deductible. $4000 per family. Kid breaks a clavicle has a mild concussion. Hospital and ER and follow up bills after "negotiated payment adjustment" is $6500. You're a genius -- give me that YEARLY cost of that "medical insurance" and care. You can round to the nearest $100.

THEY -- cannot afford it. If you can't calculate it, maybe you shouldn't be calling people charlatans --- if you get the number wrong.

This exercise is pretty straightforward using healthcare.gov. Say, a family in Nashville of two mid-30-somethings with two young kids making 39K.

They could get a zero premium bronze plan and be on the hook for only out-of-pocket costs (not advisable). Or they could buy a silver plan and get cost-sharing reductions that drop their deductibles and OOP maxes (advisable!).

So they buy the cheapest silver plan (Cigna Connect 800-3) for $82/month.

If they had a $6,500 hospital bill for one of the kids, they'd pay a $800 deductible and then 10% coinsurance on the rest [(0.1 * ($6,500 - $800)) = $570].

So $984 in premiums for the year and $1,370 out of pocket is about $2,350 on health expenses for the year. About 6% of their income and well below the actual costs they incurred that year.

(I should say I actually think in your example their out-of-pocket would really only be the $250 ER copay in that plan but I'm just going with the worst-case scenario.)

. Ok, in respect to people that can only purchase employer offered plans, is it fair that the employees of companies pay for these high cost plans with very high deductibles, and worse these 70/30 splits ? Isn't it true that if a company offers health insurance that these workers aren't allowed to join up for a plan in the ACA, and if were able to join up, wouldn't they be subjected to rates or plans based on their incomes in which would place them right back into the very same situation they had at work with those plans offered ?? So otherwise there isn't any relief for the working class, but if one is poor by choice as we have seen in many cases, then a person or family comes out looking like bandits in their Healthcare savings and plans offered them ??????