Is a $5,000 deductible Obamacare policy fair to the poor?

[MeBelle]

As it should be

Single women can't get pregnant without single males

You think they should pay less for coverage?

How much does a condom cost?

What does that have to do with the cost of women's health insurance?

Do you think women should have to pay more for their insurance?

Only if it is demonstrated their costs are significantly more.

They are.....women get pregnant

Guess who gets them pregnant? The same ones you believe should pay lower rates

I had all three of my kids when insurance was not necessary, and a man could pay his bills without it.

With my last child, I had no insurance. The cost was $2000. I set up a payment plan with the hospital..

 

[Greenbeard]

If I was to choose to buy a better plan

I suppose I don't really get your conundrum. You don't pay any premium, which means you're liable for costs only if you get sick or injured--which, on its face, is relatively fair, I would think we can agree.

If you're a single person, by law the most you can spend out of pocket is $6,600 this year. Not an insignificant sum, to be sure, but if you've exhausted that amount of cost-sharing that means you've incurred health expenses in excess of that. Perhaps significantly above that. Maybe you incur $100,000 in hospital bills and are liable for only that $6,600, I don't know. The point is, you're protected.

So what is a "better plan"? If you pay that individual OOP max because you have considerable health expenses, that's the equivalent of $550/month.

I gather (perhaps incorrectly) you're not a particularly young guy. If you're looking at the full premium of a health plan--with no employer subsidy--coupled with the assumption that you're going to max out whatever out-of-pocket limit your plan has, it's every unlikely you're going to find a better deal than what you've got.

Frankly, the people who are supposed to be complaining under the current system are people like me--those who use virtually none of their deductible in any given year because they don't incur any health expenses (knock on wood!) but still have to pay premiums anyway. Not people like you, who don't pay any premiums but expect to use or even max out their deductibles and cost-sharing because they have health issues.

 

[hortysir]

If I was to choose to buy a better plan

I suppose I don't really get your conundrum. You don't pay any premium, which means you're liable for costs only if you get sick or injured--which, on its face, is relatively fair, I would think we can agree.

If you're a single person, by law the most you can spend out of pocket is $6,600 this year. Not an insignificant sum, to be sure, but if you've exhausted that amount of cost-sharing that means you've incurred health expenses in excess of that. Perhaps significantly above that. Maybe you incur $100,000 in hospital bills and are liable for only that $6,600, I don't know. The point is, you're protected.

So what is a "better plan"? If you pay that individual OOP max because you have considerable health expenses, that's the equivalent of $550/month.

I gather (perhaps incorrectly) you're not a particularly young guy. If you're looking at the full premium of a health plan--with no employer subsidy--coupled with the assumption that you're going to max out whatever out-of-pocket limit your plan has, it's every unlikely you're going to find a better deal than what you've got.

Frankly, the people who are supposed to be complaining under the current system are people like me--those who use virtually none of their deductible in any given year because they don't incur any health expenses (knock on wood!) but still have to pay premiums anyway. Not people like you, who don't pay any premiums but expect to use or even max out their deductibles and cost-sharing because they have health issues.

My main gripe is that my employer-paid plan used to have a 500 deductible followed by 80/20 with $25 doctor visits. Max out-of-pocket, annually, was $2000

My President told me that I could keep that plan.

I haven't shopped around real intensively, but I'm quite confident that a plan of that nature would cost much more than I could afford. Even if it's "only" $200 more per month.

Like most working class Americans I live from paycheck to paycheck with only a small portion left over.

Like I said, earlier, I was paying $25 dollars for Dr visits. Now, next Monday, I'm going to have to fork over $100. Reason for Dr visit is recent back injury that I went to ER for a couple days ago. My old plan had a $150 copay for ER. This one, nope...... Can't wait to see that bill.
Good news is it'll probably be pretty damned close to meeting my deductible. Bad news is, how the fuck am I supposed to afford it?

 

[Care4all]

I know way too many people who are going elsewhere for their medical/dental treatment because the places they go accept cash (lots less than expected here) for care. Like lawyers, doctors in this country expect a multi-million dollar home and a Mercedes for their "service".

Hard for the poor here to go to Mexico.

Insurance now means they cannot see the doctor, as many were dropped from Medicaid and told to pay to play.

What they now have is catastrophic coverage at a very high rate.

You are simply wrong on ALL accounts on this roadrunner.

there is no $5000 deductible plans for the poor on the Exchange. If they are poor, they must select a Silver Plan in order to get extra help and then the government will come in and pay, (in addition to their Premium Help), their Deductibles and Out of Pocket Expenses. All of the poor, below 300% or so of the poverty level get ADDITIONAL assistance by the Government called:

Cost Sharing Reduction.

So this woman you know, may have chosen a bronze level plan with a high deductible or high out of pocket expense because the premium was lower...but by doing that, it made her ineligible for the Cost Sharing Reduction plan. She has to choose a Silver Plan in order to get the extra help.

In addition to this,

ALL PLANS include doctor visits, at least 1 a year for herself and her children, and most all, if not all....?plans include cheap copayments for doctor's visits, like $10 to $40 a visit that do not have to come out of your deductible first....

this friend of yours, needs to find out if she was eligible for cost sharing reductions, CSR, if she chose a Silver Plan instead of the Bronze plan she more than likely took out....PLEASE convey this to her...

"
You are simply wrong on ALL accounts on this roadrunner.

there is no $5000 deductible plans for the poor on the Exchange. If they are poor, they must select a Silver Plan in order to get extra help and then the government will come in and pay, (in addition to their Premium Help), their Deductibles and Out of Pocket Expenses. All of the poor, below 300% or so of the poverty level get ADDITIONAL assistance by the Government called:"


Never use the word all, there are many who get a subsidy that do not get cost sharing.

Please NOTE what I actually SAID Antares, (those on the exchange) and...are below a certain level of the (federal) poverty level, MUST buy a silver plan in order to be eligible for the cost sharing reduction assistance.

In no way did I say that ALL of the people going to the exchange to buy their health care insurance qualify for the cost sharing reductions, but the poor left on the exchange and not pushed to Medicaid, DO...the others above this certain level of poverty, get subsidy help alone. (if they qualify)

In his beginning op, he implied this woman is POOR with children and is already on the exchange, so we know she meets the exchange qualifications.

You are correct in that IF they qualify for Cost Sharing they MUST select Silver but without it they can choose whatever plan or metal level they want.

yep, if they are not the poor who qualify for the CSR, then they can purchase any plan they want.

"ALL PLANS include doctor visits, at least 1 a year for herself and her children, and most all, if not all....?plans include cheap copayments for doctor's visits, like $10 to $40 a visit that do not have to come out of your deductible first...."

No,not all plans have co-pays.

Yep, as I had said "most all, if not all...." so this did leave some room for a family that has no copays at all because the CSR comes in and pays the entirety or because a handful of plans in some states may not have cheap copays available and their deductible has to be paid first I would suppose(?), but the customer KNOWS this upfront, when they buy the policy.

SEE ABOVE drop down for other replies in blue!

 

[Greenbeard]

My main gripe is that my employer-paid plan used to have a 500 deductible followed by 80/20 with $25 doctor visits. Max out-of-pocket, annually, was $2000

My President told me that I could keep that plan.

It's very hard to speak to a particular situation with partial information. If you had that plan in March 2010 when the ACA passed, then it was grandfathered in and it was exempt from most regulatory changes implemented by the law.

Beyond that, again it depends. Most people tend to work for larger companies, and so most people have insurance arrangements where their employer is actually their health insurer (they still have an insurance card from some health insurer, like Blue Cross or whoever, because they buy administrative services and access to a health care provider network, etc from that insurer). In those cases, they're under different rules than people buying "real" health insurance products--none of those particular plans are subject to any kinds of benefit mandates and so forth. But those people have also tended to have certain protections--and they tended to have generous insurance plans anyway--even before the ACA came about.

If you work for a smaller company, then that company probably does buy an insurance product from a health insurer and it's possible its costs went up because its benefits got richer and it added consumer protections under the ACA. But again, if you're in a position where you're regularly maxing out your deductible, those protections likely benefit you. The "losers" in this situation are the people who don't consume any health services and have insurance just in case. It doesn't sound like that's you.

Anyway, if you don't pay any of the premium it's probably tough for you to gauge how the actual costs of the plan have changed--all you're really exposed to is how much of it your employer transfers to you. In general, premium growth has moderated in the past few years.

I haven't shopped around real intensively, but I'm quite confident that a plan of that nature would cost much more than I could afford. Even if it's "only" $200 more per month.

I think you're right to be confident. $200/month is just not what it costs to insure an older person who regularly consumes health services. Not in the U.S. anyway. Like I said, it may or may not seem like it but it sounds like you're getting a pretty decent deal.

Good news is it'll probably be pretty damned close to meeting my deductible. Bad news is, how the fuck am I supposed to afford it?

I can't answer that for you. But I guess my question to you would be: it sounds like you don't pay any premiums, it sounds like you don't want to pay much of a deductible or copays, yet it also sounds like you consume a fair amount of health services. So what do you think you should pay when you get health care? Nothing?

 

[gallantwarrior]

That is what we used to call "catastrophic coverage".

My friend, a single mom, working as a bank teller can't even take her kids to the doctor now that the bank dumped them all onto Obamacare.

She tells me she struggles to pay the premium, and still can't see the doc.

I didn't ask what the premium is, will try to remember when I go to the bank today.

What kind of working class people can handle a $5,000 deductible.

That in itself is a catastrophe.

Mine, through the evil Blue Cross/Blue Shield is $300.

certainly not

it is cruel

obamacares already figured out what they can afford to pay

according to their income

so they pay 50 - a hundred maybe 150 dollars month for a premium

with nothing left over to pay for deductibles or co pays for office visits

the ones that really reap the benefit of obamacares is the big insurance companies

besides taking every available dollar from the poor ( pay or face serious consequences from the government)

big insurance gets several hundred dollars in subsidies for each of those poor folks enrolled

Ding! Ding! Ding! And the man (woman) gets the prize. Only insurers and pols reap the "benefits" here. Poor, middle-class, whatever... We only get higher deductibles and poorer care. Those who can, will go overseas for major medical procedures...you know, where it's "pay-as-you-go"? Just another formerly American exception off-shored.

 

[jon_berzerk]

I know way too many people who are going elsewhere for their medical/dental treatment because the places they go accept cash (lots less than expected here) for care. Like lawyers, doctors in this country expect a multi-million dollar home and a Mercedes for their "service".

Hard for the poor here to go to Mexico.

Insurance now means they cannot see the doctor, as many were dropped from Medicaid and told to pay to play.

What they now have is catastrophic coverage at a very high rate.

You are simply wrong on ALL accounts on this roadrunner.

there is no $5000 deductible plans for the poor on the Exchange. If they are poor, they must select a Silver Plan in order to get extra help and then the government will come in and pay, (in addition to their Premium Help), their Deductibles and Out of Pocket Expenses. All of the poor, below 300% or so of the poverty level get ADDITIONAL assistance by the Government called:

Cost Sharing Reduction.

So this woman you know, may have chosen a bronze level plan with a high deductible or high out of pocket expense because the premium was lower...but by doing that, it made her ineligible for the Cost Sharing Reduction plan. She has to choose a Silver Plan in order to get the extra help.

In addition to this,

ALL PLANS include doctor visits, at least 1 a year for herself and her children, and most all, if not all....?plans include cheap copayments for doctor's visits, like $10 to $40 a visit that do not have to come out of your deductible first....

this friend of yours, needs to find out if she was eligible for cost sharing reductions, CSR, if she chose a Silver Plan instead of the Bronze plan she more than likely took out....PLEASE convey this to her...

"
You are simply wrong on ALL accounts on this roadrunner.

there is no $5000 deductible plans for the poor on the Exchange. If they are poor, they must select a Silver Plan in order to get extra help and then the government will come in and pay, (in addition to their Premium Help), their Deductibles and Out of Pocket Expenses. All of the poor, below 300% or so of the poverty level get ADDITIONAL assistance by the Government called:"


Never use the word all, there are many who get a subsidy that do not get cost sharing.

You are correct in that IF they qualify for Cost Sharing they MUST select Silver but without it they can choose whatever plan or metal level they want.

"ALL PLANS include doctor visits, at least 1 a year for herself and her children, and most all, if not all....?plans include cheap copayments for doctor's visits, like $10 to $40 a visit that do not have to come out of your deductible first...."

No,not all plans have co-pays.

this is based on a person making less then 14 k a year age 55

DAKOTACARE · Dakota Reserve 6000
-1" style="font-family: 'Open Sans', sans-serif; font-size: 1.5em; margin: 4px 0px 0px; font-stretch: normal; -webkit-font-smoothing: antialiased; max-width: 100%; padding: 0px;"> Compare

• Bronze HMO
• National Provider Network
• Plan ID: 62210SD1450003

ESTIMATED MONTHLY PREMIUM
$5

• Premium before tax credit: $390

ESTIMATED DEDUCTIBLE
$6,000Estimated individual total

ESTIMATED OUT-OF-POCKET MAXIMUM
$6,000Estimated individual total

COPAYMENTS / COINSURANCE

• Primary doctor:No charge after deductible
• Specialist doctor:No charge after deductible
• Emergency room care:No charge after deductible
• Generic drugs:No charge after deductible

PEOPLE COVERED

• Person Number1 (Age 55): Covered

MORE INFORMATION

• Summary of Benefits
• Plan brochure
• Provider directory
• List of

---------------------------------------------------

Avera Health Plans · Avera MyPlan $5,000 / 30% Coinsurance, Pediatric Dental
-1" style="font-family: 'Open Sans', sans-serif; font-size: 1.5em; margin: 4px 0px 0px; font-stretch: normal; -webkit-font-smoothing: antialiased; max-width: 100%; padding: 0px;"> Compare

• Bronze PPO
• Plan ID: 60536SD0020023

ESTIMATED MONTHLY PREMIUM
$11

• Premium before tax credit: $396

ESTIMATED DEDUCTIBLE
$5,000Estimated individual total

ESTIMATED OUT-OF-POCKET MAXIMUM
$6,350Estimated individual total

COPAYMENTS / COINSURANCE

• Primary doctor:30% Coinsurance after deductible
• Specialist doctor:30% Coinsurance after deductible
• Emergency room care:30% Coinsurance after deductible
• Generic drugs:$25

----------------------------------

Sanford Health Plan · Sanford Simplicity-$5,000 HDHP
-1" style="font-family: 'Open Sans', sans-serif; font-size: 1.5em; margin: 4px 0px 0px; font-stretch: normal; -webkit-font-smoothing: antialiased; max-width: 100%; padding: 0px;"> Compare

• 
  
  
  • Bronze HMO
  • National Provider Network
  • Plan ID: 31195SD0080003

ESTIMATED MONTHLY PREMIUM
$37

• 
  
  
  • Premium before tax credit: $423

ESTIMATED DEDUCTIBLE
$5,000Estimated individual total

ESTIMATED OUT-OF-POCKET MAXIMUM
$6,350Estimated individual total

COPAYMENTS / COINSURANCE

• 
  
  
  • Primary doctor:40% Coinsurance after deductible
  • Specialist doctor:40% Coinsurance after deductible
  • Emergency room care:40% Coinsurance after deductible
  • Generic drugs:40% Coinsurance after deductible

PEOPLE COVERED

• 
  
  
  • Person Number1 (Age 55): Cov

there are several more

You probably qualify for a Special Enrollment Period

I have no idea what you are after here.

that this statement is complete bullshit

"there is no $5000 deductible plans for the poor on the Exchange. If they are poor, they must select a Silver Plan in order to get extra help"

i helped several "poor" people get on the exchange and there are several plans with huge deductibles

huge out of pocket and 50 percent co pays

the three plans listed have between the deductible and out of pocket at least 11000 that the insurened is responsible for

not including 50 percent co pays and such

 

[jon_berzerk]

That is what we used to call "catastrophic coverage".

We can still call it that. Not sure what you're getting at--do you think the option to buy it should be taken away?

Option?
When did ACA become optional?

Most people don't buy the highest deductible plans. But you can if you like, they generally have the lowest premiums.

What to do, what to do?

Go without insurance, and disobey the law, or, buy the plan your monthly income allows, and get jack-shit benefits?

Ain't PP/ACA wonderful!

--Indeed

 

[Roadrunner]

Hard for the poor here to go to Mexico.

Insurance now means they cannot see the doctor, as many were dropped from Medicaid and told to pay to play.

What they now have is catastrophic coverage at a very high rate.

You are simply wrong on ALL accounts on this roadrunner.

there is no $5000 deductible plans for the poor on the Exchange. If they are poor, they must select a Silver Plan in order to get extra help and then the government will come in and pay, (in addition to their Premium Help), their Deductibles and Out of Pocket Expenses. All of the poor, below 300% or so of the poverty level get ADDITIONAL assistance by the Government called:

Cost Sharing Reduction.

So this woman you know, may have chosen a bronze level plan with a high deductible or high out of pocket expense because the premium was lower...but by doing that, it made her ineligible for the Cost Sharing Reduction plan. She has to choose a Silver Plan in order to get the extra help.

In addition to this,

ALL PLANS include doctor visits, at least 1 a year for herself and her children, and most all, if not all....?plans include cheap copayments for doctor's visits, like $10 to $40 a visit that do not have to come out of your deductible first....

this friend of yours, needs to find out if she was eligible for cost sharing reductions, CSR, if she chose a Silver Plan instead of the Bronze plan she more than likely took out....PLEASE convey this to her...

.




"
You are simply wrong on ALL accounts on this roadrunner.

there is no $5000 deductible plans for the poor on the Exchange. If they are poor, they must select a Silver Plan in order to get extra help and then the government will come in and pay, (in addition to their Premium Help), their Deductibles and Out of Pocket Expenses. All of the poor, below 300% or so of the poverty level get ADDITIONAL assistance by the Government called:"


Never use the word all, there are many who get a subsidy that do not get cost sharing.

You are correct in that IF they qualify for Cost Sharing they MUST select Silver but without it they can choose whatever plan or metal level they want.

"ALL PLANS include doctor visits, at least 1 a year for herself and her children, and most all, if not all....?plans include cheap copayments for doctor's visits, like $10 to $40 a visit that do not have to come out of your deductible first...."

No,not all plans have co-pays.

this is based on a person making less then 14 k a year age 55

DAKOTACARE · Dakota Reserve 6000
-1" style="font-family: 'Open Sans', sans-serif; font-size: 1.5em; margin: 4px 0px 0px; font-stretch: normal; -webkit-font-smoothing: antialiased; max-width: 100%; padding: 0px;"> Compare

• Bronze HMO
• National Provider Network
• Plan ID: 62210SD1450003

ESTIMATED MONTHLY PREMIUM
$5

• Premium before tax credit: $390

ESTIMATED DEDUCTIBLE
$6,000Estimated individual total

ESTIMATED OUT-OF-POCKET MAXIMUM
$6,000Estimated individual total

COPAYMENTS / COINSURANCE

• Primary doctor:No charge after deductible
• Specialist doctor:No charge after deductible
• Emergency room care:No charge after deductible
• Generic drugs:No charge after deductible

PEOPLE COVERED

• Person Number1 (Age 55): Covered

MORE INFORMATION

• Summary of Benefits
• Plan brochure
• Provider directory
• List of

---------------------------------------------------

Avera Health Plans · Avera MyPlan $5,000 / 30% Coinsurance, Pediatric Dental
-1" style="font-family: 'Open Sans', sans-serif; font-size: 1.5em; margin: 4px 0px 0px; font-stretch: normal; -webkit-font-smoothing: antialiased; max-width: 100%; padding: 0px;"> Compare

• Bronze PPO
• Plan ID: 60536SD0020023

ESTIMATED MONTHLY PREMIUM
$11

• Premium before tax credit: $396

ESTIMATED DEDUCTIBLE
$5,000Estimated individual total

ESTIMATED OUT-OF-POCKET MAXIMUM
$6,350Estimated individual total

COPAYMENTS / COINSURANCE

• Primary doctor:30% Coinsurance after deductible
• Specialist doctor:30% Coinsurance after deductible
• Emergency room care:30% Coinsurance after deductible
• Generic drugs:$25

----------------------------------

Sanford Health Plan · Sanford Simplicity-$5,000 HDHP
-1" style="font-family: 'Open Sans', sans-serif; font-size: 1.5em; margin: 4px 0px 0px; font-stretch: normal; -webkit-font-smoothing: antialiased; max-width: 100%; padding: 0px;"> Compare

• 
  
  
  • Bronze HMO
  • National Provider Network
  • Plan ID: 31195SD0080003

ESTIMATED MONTHLY PREMIUM
$37

• 
  
  
  • Premium before tax credit: $423

ESTIMATED DEDUCTIBLE
$5,000Estimated individual total

ESTIMATED OUT-OF-POCKET MAXIMUM
$6,350Estimated individual total

COPAYMENTS / COINSURANCE

• 
  
  
  • Primary doctor:40% Coinsurance after deductible
  • Specialist doctor:40% Coinsurance after deductible
  • Emergency room care:40% Coinsurance after deductible
  • Generic drugs:40% Coinsurance after deductible

PEOPLE COVERED

• 
  
  
  • Person Number1 (Age 55): Cov

there are several more

You probably qualify for a Special Enrollment Period

I have no idea what you are after here.

that this statement is complete bullshit

"there is no $5000 deductible plans for the poor on the Exchange. If they are poor, they must select a Silver Plan in order to get extra help"

i helped several "poor" people get on the exchange and there are several plans with huge deductibles

huge out of pocket and 50 percent co pays

the three plans listed have between the deductible and out of pocket at least 11000 that the insurened is responsible for

not including 50 percent co pays and such

She voted for Obama simply because he was black, she can live with the consequences.

And since she works, she is considered lower middle class, not poor, and thus slated for economic extinction anyway.

 

[jon_berzerk]

That is what we used to call "catastrophic coverage".

My friend, a single mom, working as a bank teller can't even take her kids to the doctor now that the bank dumped them all onto Obamacare.

She tells me she struggles to pay the premium, and still can't see the doc.

I didn't ask what the premium is, will try to remember when I go to the bank today.

What kind of working class people can handle a $5,000 deductible.

That in itself is a catastrophe.

Mine, through the evil Blue Cross/Blue Shield is $300.

certainly not

it is cruel

obamacares already figured out what they can afford to pay

according to their income

so they pay 50 - a hundred maybe 150 dollars month for a premium

with nothing left over to pay for deductibles or co pays for office visits

the ones that really reap the benefit of obamacares is the big insurance companies

besides taking every available dollar from the poor ( pay or face serious consequences from the government)

big insurance gets several hundred dollars in subsidies for each of those poor folks enrolled

Ding! Ding! Ding! And the man (woman) gets the prize. Only insurers and pols reap the "benefits" here. Poor, middle-class, whatever... We only get higher deductibles and poorer care. Those who can, will go overseas for major medical procedures...you know, where it's "pay-as-you-go"? Just another formerly American exception off-shored.

yup

 

[rightwinger]

They are.....women get pregnant

Guess who gets them pregnant? The same ones you believe should pay lower rates

I had all three of my kids when insurance was not necessary, and a man could pay his bills without it.

When was the last time you had surgery or were in a hospital?

What business is that of yours?

You are making the claim that you haven't needed insurance. Trying to see if it is true

I suspect, given your age group, that it is not

Don't be a dumb fuckin' ass.

I said I did not have insurance or need it when my kids were being born.

I'm 66, on Medicare I paid for for years, whether I want to be or not.

So other taxpayers are paying for your healthcare

I can see why you want to deprive it to others

 

[rightwinger]

If I was to choose to buy a better plan

I suppose I don't really get your conundrum. You don't pay any premium, which means you're liable for costs only if you get sick or injured--which, on its face, is relatively fair, I would think we can agree.

If you're a single person, by law the most you can spend out of pocket is $6,600 this year. Not an insignificant sum, to be sure, but if you've exhausted that amount of cost-sharing that means you've incurred health expenses in excess of that. Perhaps significantly above that. Maybe you incur $100,000 in hospital bills and are liable for only that $6,600, I don't know. The point is, you're protected.

So what is a "better plan"? If you pay that individual OOP max because you have considerable health expenses, that's the equivalent of $550/month.

I gather (perhaps incorrectly) you're not a particularly young guy. If you're looking at the full premium of a health plan--with no employer subsidy--coupled with the assumption that you're going to max out whatever out-of-pocket limit your plan has, it's every unlikely you're going to find a better deal than what you've got.

Frankly, the people who are supposed to be complaining under the current system are people like me--those who use virtually none of their deductible in any given year because they don't incur any health expenses (knock on wood!) but still have to pay premiums anyway. Not people like you, who don't pay any premiums but expect to use or even max out their deductibles and cost-sharing because they have health issues.

My main gripe is that my employer-paid plan used to have a 500 deductible followed by 80/20 with $25 doctor visits. Max out-of-pocket, annually, was $2000

My President told me that I could keep that plan.

I haven't shopped around real intensively, but I'm quite confident that a plan of that nature would cost much more than I could afford. Even if it's "only" $200 more per month.

Like most working class Americans I live from paycheck to paycheck with only a small portion left over.

Like I said, earlier, I was paying $25 dollars for Dr visits. Now, next Monday, I'm going to have to fork over $100. Reason for Dr visit is recent back injury that I went to ER for a couple days ago. My old plan had a $150 copay for ER. This one, nope...... Can't wait to see that bill.
Good news is it'll probably be pretty damned close to meeting my deductible. Bad news is, how the fuck am I supposed to afford it?

Did Obama order you to change your plan or did your employer?

 

[jon_berzerk]

You are simply wrong on ALL accounts on this roadrunner.

there is no $5000 deductible plans for the poor on the Exchange. If they are poor, they must select a Silver Plan in order to get extra help and then the government will come in and pay, (in addition to their Premium Help), their Deductibles and Out of Pocket Expenses. All of the poor, below 300% or so of the poverty level get ADDITIONAL assistance by the Government called:

Cost Sharing Reduction.

So this woman you know, may have chosen a bronze level plan with a high deductible or high out of pocket expense because the premium was lower...but by doing that, it made her ineligible for the Cost Sharing Reduction plan. She has to choose a Silver Plan in order to get the extra help.

In addition to this,

ALL PLANS include doctor visits, at least 1 a year for herself and her children, and most all, if not all....?plans include cheap copayments for doctor's visits, like $10 to $40 a visit that do not have to come out of your deductible first....

this friend of yours, needs to find out if she was eligible for cost sharing reductions, CSR, if she chose a Silver Plan instead of the Bronze plan she more than likely took out....PLEASE convey this to her...

.




"
You are simply wrong on ALL accounts on this roadrunner.

there is no $5000 deductible plans for the poor on the Exchange. If they are poor, they must select a Silver Plan in order to get extra help and then the government will come in and pay, (in addition to their Premium Help), their Deductibles and Out of Pocket Expenses. All of the poor, below 300% or so of the poverty level get ADDITIONAL assistance by the Government called:"


Never use the word all, there are many who get a subsidy that do not get cost sharing.

You are correct in that IF they qualify for Cost Sharing they MUST select Silver but without it they can choose whatever plan or metal level they want.

"ALL PLANS include doctor visits, at least 1 a year for herself and her children, and most all, if not all....?plans include cheap copayments for doctor's visits, like $10 to $40 a visit that do not have to come out of your deductible first...."

No,not all plans have co-pays.

this is based on a person making less then 14 k a year age 55

DAKOTACARE · Dakota Reserve 6000
-1" style="font-family: 'Open Sans', sans-serif; font-size: 1.5em; margin: 4px 0px 0px; font-stretch: normal; -webkit-font-smoothing: antialiased; max-width: 100%; padding: 0px;"> Compare

• Bronze HMO
• National Provider Network
• Plan ID: 62210SD1450003

ESTIMATED MONTHLY PREMIUM
$5

• Premium before tax credit: $390

ESTIMATED DEDUCTIBLE
$6,000Estimated individual total

ESTIMATED OUT-OF-POCKET MAXIMUM
$6,000Estimated individual total

COPAYMENTS / COINSURANCE

• Primary doctor:No charge after deductible
• Specialist doctor:No charge after deductible
• Emergency room care:No charge after deductible
• Generic drugs:No charge after deductible

PEOPLE COVERED

• Person Number1 (Age 55): Covered

MORE INFORMATION

• Summary of Benefits
• Plan brochure
• Provider directory
• List of

---------------------------------------------------

Avera Health Plans · Avera MyPlan $5,000 / 30% Coinsurance, Pediatric Dental
-1" style="font-family: 'Open Sans', sans-serif; font-size: 1.5em; margin: 4px 0px 0px; font-stretch: normal; -webkit-font-smoothing: antialiased; max-width: 100%; padding: 0px;"> Compare

• Bronze PPO
• Plan ID: 60536SD0020023

ESTIMATED MONTHLY PREMIUM
$11

• Premium before tax credit: $396

ESTIMATED DEDUCTIBLE
$5,000Estimated individual total

ESTIMATED OUT-OF-POCKET MAXIMUM
$6,350Estimated individual total

COPAYMENTS / COINSURANCE

• Primary doctor:30% Coinsurance after deductible
• Specialist doctor:30% Coinsurance after deductible
• Emergency room care:30% Coinsurance after deductible
• Generic drugs:$25

----------------------------------

Sanford Health Plan · Sanford Simplicity-$5,000 HDHP
-1" style="font-family: 'Open Sans', sans-serif; font-size: 1.5em; margin: 4px 0px 0px; font-stretch: normal; -webkit-font-smoothing: antialiased; max-width: 100%; padding: 0px;"> Compare

• 
  
  
  • Bronze HMO
  • National Provider Network
  • Plan ID: 31195SD0080003

ESTIMATED MONTHLY PREMIUM
$37

• 
  
  
  • Premium before tax credit: $423

ESTIMATED DEDUCTIBLE
$5,000Estimated individual total

ESTIMATED OUT-OF-POCKET MAXIMUM
$6,350Estimated individual total

COPAYMENTS / COINSURANCE

• 
  
  
  • Primary doctor:40% Coinsurance after deductible
  • Specialist doctor:40% Coinsurance after deductible
  • Emergency room care:40% Coinsurance after deductible
  • Generic drugs:40% Coinsurance after deductible

PEOPLE COVERED

• 
  
  
  • Person Number1 (Age 55): Cov

there are several more

You probably qualify for a Special Enrollment Period

I have no idea what you are after here.

that this statement is complete bullshit

"there is no $5000 deductible plans for the poor on the Exchange. If they are poor, they must select a Silver Plan in order to get extra help"

i helped several "poor" people get on the exchange and there are several plans with huge deductibles

huge out of pocket and 50 percent co pays

the three plans listed have between the deductible and out of pocket at least 11000 that the insurened is responsible for

not including 50 percent co pays and such

She voted for Obama simply because he was black, she can live with the consequences.

And since she works, she is considered lower middle class, not poor, and thus slated for economic extinction anyway.

i didnt even get into the silver plans and how asinine they are for the poor and working poor

 

[Geaux4it]

That is what we used to call "catastrophic coverage".

My friend, a single mom, working as a bank teller can't even take her kids to the doctor now that the bank dumped them all onto Obamacare.

She tells me she struggles to pay the premium, and still can't see the doc.

I didn't ask what the premium is, will try to remember when I go to the bank today.

What kind of working class people can handle a $5,000 deductible.

That in itself is a catastrophe.

Mine, through the evil Blue Cross/Blue Shield is $300.

It was probably more fair to have us pay the tab like before. It was a win for the poor as they did not have to pony up the deductible and could be treated anyway. Now they will have a mandatory must pay bill to deal with.

Yes, those who elected to have insurance pre-Obamacare paid the tab.

I was good with that

-Geaux

 

[jon_berzerk]

Is a $5,000 deductible Obamacare policy fair to the poor?

i just noticed the op question

with these policies for the poor

there is a deductible and out of pocket and cost sharing per visit or procedure

so it is much more then just five grand

if it a "poor family" double those numbers

 

[jon_berzerk]

a heart angioplasty will still cost the "poor" 50 grand or more

 

[Roadrunner]

I had all three of my kids when insurance was not necessary, and a man could pay his bills without it.

When was the last time you had surgery or were in a hospital?

What business is that of yours?

You are making the claim that you haven't needed insurance. Trying to see if it is true

I suspect, given your age group, that it is not

Don't be a dumb fuckin' ass.

I said I did not have insurance or need it when my kids were being born.

I'm 66, on Medicare I paid for for years, whether I want to be or not.

So other taxpayers are paying for your healthcare

I can see why you want to deprive it to others

Oh fuck yourself.

I paid for a Medicare premium for 25 years before I went on Medicare.

Why are you parasites such dishonest fucks?

I also pay for a supplemental plan.

Why do you always argue from such a lying, dishonest POV?

 

[Roadrunner]

That is what we used to call "catastrophic coverage".

My friend, a single mom, working as a bank teller can't even take her kids to the doctor now that the bank dumped them all onto Obamacare.

She tells me she struggles to pay the premium, and still can't see the doc.

I didn't ask what the premium is, will try to remember when I go to the bank today.

What kind of working class people can handle a $5,000 deductible.

That in itself is a catastrophe.

Mine, through the evil Blue Cross/Blue Shield is $300.

It was probably more fair to have us pay the tab like before. It was a win for the poor as they did not have to pony up the deductible and could be treated anyway. Now they will have a mandatory must pay bill to deal with.

Yes, those who elected to have insurance pre-Obamacare paid the tab.

I was good with that

-Geaux

I like the way the libs ignore the fact that those of us on Medicare paid every month for 20-30 years before we got on the plan, and then claim "the taxpayers" pay for our healthcare.

Shit, we ARE the taxpayers.

 

[rightwinger]

When was the last time you had surgery or were in a hospital?

What business is that of yours?

You are making the claim that you haven't needed insurance. Trying to see if it is true

I suspect, given your age group, that it is not

Don't be a dumb fuckin' ass.

I said I did not have insurance or need it when my kids were being born.

I'm 66, on Medicare I paid for for years, whether I want to be or not.

So other taxpayers are paying for your healthcare

I can see why you want to deprive it to others

Oh fuck yourself.

I paid for a Medicare premium for 25 years before I went on Medicare.

Why are you parasites such dishonest fucks?

I also pay for a supplemental plan.

Why do you always argue from such a lying, dishonest POV?

Why do you think we have Medicare? It is because of people like you who think...I have mine and I don't want to pay for others

Which group is the last group insurers want to cover? Those over 65
Which group consumes more healthcare than any other? Those over 65
Which group would pay through the nose for insurance if not for Medicare? Those over 65

You paid premiums your whole life, but those premiums do not cover the cost of major healthcare for seniors. Cancer, Heart surgery, Joint repairs, blood diseases....can all run up bills of $500,000 to $1 million. More than you paid your whole life

 

[Care4all]

You are simply wrong on ALL accounts on this roadrunner.

there is no $5000 deductible plans for the poor on the Exchange. If they are poor, they must select a Silver Plan in order to get extra help and then the government will come in and pay, (in addition to their Premium Help), their Deductibles and Out of Pocket Expenses. All of the poor, below 300% or so of the poverty level get ADDITIONAL assistance by the Government called:

Cost Sharing Reduction.

So this woman you know, may have chosen a bronze level plan with a high deductible or high out of pocket expense because the premium was lower...but by doing that, it made her ineligible for the Cost Sharing Reduction plan. She has to choose a Silver Plan in order to get the extra help.

In addition to this,

ALL PLANS include doctor visits, at least 1 a year for herself and her children, and most all, if not all....?plans include cheap copayments for doctor's visits, like $10 to $40 a visit that do not have to come out of your deductible first....

this friend of yours, needs to find out if she was eligible for cost sharing reductions, CSR, if she chose a Silver Plan instead of the Bronze plan she more than likely took out....PLEASE convey this to her...

.




"
You are simply wrong on ALL accounts on this roadrunner.

there is no $5000 deductible plans for the poor on the Exchange. If they are poor, they must select a Silver Plan in order to get extra help and then the government will come in and pay, (in addition to their Premium Help), their Deductibles and Out of Pocket Expenses. All of the poor, below 300% or so of the poverty level get ADDITIONAL assistance by the Government called:"


Never use the word all, there are many who get a subsidy that do not get cost sharing.

You are correct in that IF they qualify for Cost Sharing they MUST select Silver but without it they can choose whatever plan or metal level they want.

"ALL PLANS include doctor visits, at least 1 a year for herself and her children, and most all, if not all....?plans include cheap copayments for doctor's visits, like $10 to $40 a visit that do not have to come out of your deductible first...."

No,not all plans have co-pays.

this is based on a person making less then 14 k a year age 55

DAKOTACARE · Dakota Reserve 6000
-1" style="font-family: 'Open Sans', sans-serif; font-size: 1.5em; margin: 4px 0px 0px; font-stretch: normal; -webkit-font-smoothing: antialiased; max-width: 100%; padding: 0px;"> Compare

• Bronze HMO
• National Provider Network
• Plan ID: 62210SD1450003

ESTIMATED MONTHLY PREMIUM
$5

• Premium before tax credit: $390

ESTIMATED DEDUCTIBLE
$6,000Estimated individual total

ESTIMATED OUT-OF-POCKET MAXIMUM
$6,000Estimated individual total

COPAYMENTS / COINSURANCE

• Primary doctor:No charge after deductible
• Specialist doctor:No charge after deductible
• Emergency room care:No charge after deductible
• Generic drugs:No charge after deductible

PEOPLE COVERED

• Person Number1 (Age 55): Covered

MORE INFORMATION

• Summary of Benefits
• Plan brochure
• Provider directory
• List of

---------------------------------------------------

Avera Health Plans · Avera MyPlan $5,000 / 30% Coinsurance, Pediatric Dental
-1" style="font-family: 'Open Sans', sans-serif; font-size: 1.5em; margin: 4px 0px 0px; font-stretch: normal; -webkit-font-smoothing: antialiased; max-width: 100%; padding: 0px;"> Compare

• Bronze PPO
• Plan ID: 60536SD0020023

ESTIMATED MONTHLY PREMIUM
$11

• Premium before tax credit: $396

ESTIMATED DEDUCTIBLE
$5,000Estimated individual total

ESTIMATED OUT-OF-POCKET MAXIMUM
$6,350Estimated individual total

COPAYMENTS / COINSURANCE

• Primary doctor:30% Coinsurance after deductible
• Specialist doctor:30% Coinsurance after deductible
• Emergency room care:30% Coinsurance after deductible
• Generic drugs:$25

----------------------------------

Sanford Health Plan · Sanford Simplicity-$5,000 HDHP
-1" style="font-family: 'Open Sans', sans-serif; font-size: 1.5em; margin: 4px 0px 0px; font-stretch: normal; -webkit-font-smoothing: antialiased; max-width: 100%; padding: 0px;"> Compare

• 
  
  
  • Bronze HMO
  • National Provider Network
  • Plan ID: 31195SD0080003

ESTIMATED MONTHLY PREMIUM
$37

• 
  
  
  • Premium before tax credit: $423

ESTIMATED DEDUCTIBLE
$5,000Estimated individual total

ESTIMATED OUT-OF-POCKET MAXIMUM
$6,350Estimated individual total

COPAYMENTS / COINSURANCE

• 
  
  
  • Primary doctor:40% Coinsurance after deductible
  • Specialist doctor:40% Coinsurance after deductible
  • Emergency room care:40% Coinsurance after deductible
  • Generic drugs:40% Coinsurance after deductible

PEOPLE COVERED

• 
  
  
  • Person Number1 (Age 55): Cov

there are several more

You probably qualify for a Special Enrollment Period

I have no idea what you are after here.

that this statement is complete bullshit

"there is no $5000 deductible plans for the poor on the Exchange. If they are poor, they must select a Silver Plan in order to get extra help"

i helped several "poor" people get on the exchange and there are several plans with huge deductibles

huge out of pocket and 50 percent co pays

the three plans listed have between the deductible and out of pocket at least 11000 that the insurened is responsible for

not including 50 percent co pays and such

She voted for Obama simply because he was black, she can live with the consequences.

And since she works, she is considered lower middle class, not poor, and thus slated for economic extinction anyway.

I know way too many people who are going elsewhere for their medical/dental treatment because the places they go accept cash (lots less than expected here) for care. Like lawyers, doctors in this country expect a multi-million dollar home and a Mercedes for their "service".

Hard for the poor here to go to Mexico.

Insurance now means they cannot see the doctor, as many were dropped from Medicaid and told to pay to play.

What they now have is catastrophic coverage at a very high rate.

You are simply wrong on ALL accounts on this roadrunner.

there is no $5000 deductible plans for the poor on the Exchange. If they are poor, they must select a Silver Plan in order to get extra help and then the government will come in and pay, (in addition to their Premium Help), their Deductibles and Out of Pocket Expenses. All of the poor, below 300% or so of the poverty level get ADDITIONAL assistance by the Government called:

Cost Sharing Reduction.

So this woman you know, may have chosen a bronze level plan with a high deductible or high out of pocket expense because the premium was lower...but by doing that, it made her ineligible for the Cost Sharing Reduction plan. She has to choose a Silver Plan in order to get the extra help.

In addition to this,

ALL PLANS include doctor visits, at least 1 a year for herself and her children, and most all, if not all....?plans include cheap copayments for doctor's visits, like $10 to $40 a visit that do not have to come out of your deductible first....

this friend of yours, needs to find out if she was eligible for cost sharing reductions, CSR, if she chose a Silver Plan instead of the Bronze plan she more than likely took out....PLEASE convey this to her...

"
You are simply wrong on ALL accounts on this roadrunner.

there is no $5000 deductible plans for the poor on the Exchange. If they are poor, they must select a Silver Plan in order to get extra help and then the government will come in and pay, (in addition to their Premium Help), their Deductibles and Out of Pocket Expenses. All of the poor, below 300% or so of the poverty level get ADDITIONAL assistance by the Government called:"


Never use the word all, there are many who get a subsidy that do not get cost sharing.

You are correct in that IF they qualify for Cost Sharing they MUST select Silver but without it they can choose whatever plan or metal level they want.

"ALL PLANS include doctor visits, at least 1 a year for herself and her children, and most all, if not all....?plans include cheap copayments for doctor's visits, like $10 to $40 a visit that do not have to come out of your deductible first...."

No,not all plans have co-pays.

this is based on a person making less then 14 k a year age 55

DAKOTACARE · Dakota Reserve 6000
-1" style="font-family: 'Open Sans', sans-serif; font-size: 1.5em; margin: 4px 0px 0px; font-stretch: normal; -webkit-font-smoothing: antialiased; max-width: 100%; padding: 0px;"> Compare

• Bronze HMO
• National Provider Network
• Plan ID: 62210SD1450003

ESTIMATED MONTHLY PREMIUM
$5

• Premium before tax credit: $390

ESTIMATED DEDUCTIBLE
$6,000Estimated individual total

ESTIMATED OUT-OF-POCKET MAXIMUM
$6,000Estimated individual total

COPAYMENTS / COINSURANCE

• Primary doctor:No charge after deductible
• Specialist doctor:No charge after deductible
• Emergency room care:No charge after deductible
• Generic drugs:No charge after deductible

PEOPLE COVERED

• Person Number1 (Age 55): Covered

MORE INFORMATION

• Summary of Benefits
• Plan brochure
• Provider directory
• List of

---------------------------------------------------

Avera Health Plans · Avera MyPlan $5,000 / 30% Coinsurance, Pediatric Dental
-1" style="font-family: 'Open Sans', sans-serif; font-size: 1.5em; margin: 4px 0px 0px; font-stretch: normal; -webkit-font-smoothing: antialiased; max-width: 100%; padding: 0px;"> Compare

• Bronze PPO
• Plan ID: 60536SD0020023

ESTIMATED MONTHLY PREMIUM
$11

• Premium before tax credit: $396

ESTIMATED DEDUCTIBLE
$5,000Estimated individual total

ESTIMATED OUT-OF-POCKET MAXIMUM
$6,350Estimated individual total

COPAYMENTS / COINSURANCE

• Primary doctor:30% Coinsurance after deductible
• Specialist doctor:30% Coinsurance after deductible
• Emergency room care:30% Coinsurance after deductible
• Generic drugs:$25

----------------------------------

Sanford Health Plan · Sanford Simplicity-$5,000 HDHP
-1" style="font-family: 'Open Sans', sans-serif; font-size: 1.5em; margin: 4px 0px 0px; font-stretch: normal; -webkit-font-smoothing: antialiased; max-width: 100%; padding: 0px;"> Compare

• 
  
  
  • Bronze HMO
  • National Provider Network
  • Plan ID: 31195SD0080003

ESTIMATED MONTHLY PREMIUM
$37

• 
  
  
  • Premium before tax credit: $423

ESTIMATED DEDUCTIBLE
$5,000Estimated individual total

ESTIMATED OUT-OF-POCKET MAXIMUM
$6,350Estimated individual total

COPAYMENTS / COINSURANCE

• 
  
  
  • Primary doctor:40% Coinsurance after deductible
  • Specialist doctor:40% Coinsurance after deductible
  • Emergency room care:40% Coinsurance after deductible
  • Generic drugs:40% Coinsurance after deductible

PEOPLE COVERED

• 
  
  
  • Person Number1 (Age 55): Cov

there are several more

You probably qualify for a Special Enrollment Period

You have simply chosen the WRONG plan, you've chosen a BRONZE plan and there is no Cost Sharing Reduction available if you go with a Bronze plan....you must select one of the Silver plans, which have lower deductibles and out of pocket expenses in general, than these lower level providing insurance plans such as the Bronze plans.

Put in that same info that you used for the 55 year old, and pick the lowest level SILVER plan, then print that info above again and show us what it is pretty please.

It will show you a silver plan which has a 30%/70% ratio, but if you are poor it will be 10%/90% coverage or 20%/80% coverage, your yearly wellness visit is free, and you will have low co payments for any doctor's visit of $10 to $30...
and if the deductible on the silver plan is $2000 and out of pocket is $5200, the Cost Sharing Reduction plan will come in and say your deductible is maybe $400 for the year and your out of pocket maximum will be $1500.

If the Health Care agent on the exchange does not lead these poor people in to taking out a Silver plan and leads them in to these lower level Bronze insurance coverage, they should be SHOT! (figuratively speaking)