"The Obamacare implosion is worse than you think"

[syrenn]

I would still write your insurance commissioner. Something is not right. Why not get someone to look into it?

she and her husband would have to do that..... but i will make the suggestion to them.

its just not right. A lot of people are getting screwed to the wall with this thing...... I personaly would have had no idea about any of this unless it was not happening to my sister and my best friend. I am getting horror stories from both of them.

Granted, for people with nothing, no money, no income and will get all of it for free....this is a great deal. For just about everyone else......it is one fucked up deal.

 

[william the wie]

I would still write your insurance commissioner. Something is not right. Why not get someone to look into it?

she and her husband would have to do that..... but i will make the suggestion to them.

its just not right. A lot of people are getting screwed to the wall with this thing...... I personaly would have had no idea about any of this unless it was not happening to my sister and my best friend. I am getting horror stories from both of them.

Granted, for people with nothing, no money, no income and will get all of it for free....this is a great deal. For just about everyone else......it is one fucked up deal.

I disagree. Given Network size and MediCal reimbursement Covered California is shaping up as a disaster of epic proportions for everyone.

 

[Antares]

Here is another good one...

my sister had a brain tumor removed which had wrapped itself around her optic nerve at the beginning of the year.... Her care from here on is going to be extensive.

Her husband changed jobs and along with that, their insurance...... so hello obamacare and you cant be denied coverage for pre existing conditions...

well well well... the loop hole to that is ....sure they will accept you and not deny you coverage.....but they will cover your for almost nothing in regards to that condition... to bad so sad...it was a pre existing condition. The idea is ...they will cover a small fraction but not all or most of it.

and.... imagine that.... they wont cover the drugs she is taking either.

Then the new Group insurance is not compliant and they were given another year to become so.

Were it me I would buy an individual plan at Market Price just to be covered.
ALL new individual policies will cover her from Day 1.

yes...all plans will cover her. The loop hole is how much they cover. Paying 1% of the bill leaving her paying 99% of the bill..... is still covering her.

That also does not go into or cover the issue with non generic and specialty drugs.

Nope.

ALL compliant plans will cover her 100% after her out of pocket maximum is hit...this includes meds.

The federal mandate is 6350, if the plan isn't doing this it is not compliant.

 

[Amelia]

Then the new Group insurance is not compliant and they were given another year to become so.

Were it me I would buy an individual plan at Market Price just to be covered.
ALL new individual policies will cover her from Day 1.

yes...all plans will cover her. The loop hole is how much they cover. Paying 1% of the bill leaving her paying 99% of the bill..... is still covering her.

That also does not go into or cover the issue with non generic and specialty drugs.

Nope.

ALL compliant plans will cover her 100% after her out of pocket maximum is hit...this includes meds.

The federal mandate is 6350, if the plan isn't doing this it is not compliant.

I'm pretty sure that's not the case. I thought all bets were off with out-of-network care and with certain drugs.

 

[Antares]

yes...all plans will cover her. The loop hole is how much they cover. Paying 1% of the bill leaving her paying 99% of the bill..... is still covering her.

That also does not go into or cover the issue with non generic and specialty drugs.

Nope.

ALL compliant plans will cover her 100% after her out of pocket maximum is hit...this includes meds.

The federal mandate is 6350, if the plan isn't doing this it is not compliant.

I'm pretty sure that's not the case. I thought all bets were off with out-of-network care and with certain drugs.

You can buy a plan from me today that is complaint...the moment you hit your out of pocket maximum in or out of network EVERYTHING is taken care of at 100%.

This is true of ALL compliant individual plans.

 

[Antares]

Basic EPO
Customer Reviews: Not Yet Rated


Plan Type EPO
Metal Level Bronze
Office Visit for Primary Doctor
Find Doctors $60 for first 3 visits prior to deductible, then $60 after deductible
Office Visit for Specialist $70 Copay after deductible
Office Visit for Other Practitioner (Nurse, Physician Assistant) $60 Copay after deductible
Annual Deductible Individual: $5,000
Separate Prescription Drugs Deductible Medical Plan Deductible Applies
Coinsurance 30%
Retail Prescription Drugs Generic Drugs: $19 Copay after deductible
Brand Name Drugs: $50 Copay after deductible
Non-Formulary Drugs: $75 Copay after deductible
Specialty Drugs: 30% Coinsurance after deductible
Annual Out-of-Pocket Limit Individual: $6,350
Includes deductible
Lifetime Maximum Unlimited


Annual Out-of-Pocket Limit Individual: $6,350
Includes deductible



Basic EPO - California Health Insurance - Blue Shield of California

 

[Amelia]

Nope.

ALL compliant plans will cover her 100% after her out of pocket maximum is hit...this includes meds.

The federal mandate is 6350, if the plan isn't doing this it is not compliant.

I'm pretty sure that's not the case. I thought all bets were off with out-of-network care and with certain drugs.

You can buy a plan from me today that is complaint...the moment you hit your out of pocket maximum in or out of network EVERYTHING is taken care of at 100%.

This is true of ALL compliant individual plans.

So even if they have to go to a specialist who is out of network, they won't owe more than $6350 out-of-pocket?

 

[Antares]

I'm pretty sure that's not the case. I thought all bets were off with out-of-network care and with certain drugs.

You can buy a plan from me today that is complaint...the moment you hit your out of pocket maximum in or out of network EVERYTHING is taken care of at 100%.

This is true of ALL compliant individual plans.

So even if they have to go to a specialist who is out of network, they won't owe more than $6350 out-of-pocket?

Yes ma'am.....I posted a Cali plan on purpose.

 

[LoneLaugher]

Thanks, Gramps.

 

[Amelia]

You can buy a plan from me today that is complaint...the moment you hit your out of pocket maximum in or out of network EVERYTHING is taken care of at 100%.

This is true of ALL compliant individual plans.

So even if they have to go to a specialist who is out of network, they won't owe more than $6350 out-of-pocket?

Yes ma'am.....I posted a Cali plan on purpose.

I know you're a professional, but I simply don't believe that. I'll try to keep an open mind about it though. I hope it's true.

 

[Antares]

So even if they have to go to a specialist who is out of network, they won't owe more than $6350 out-of-pocket?

Yes ma'am.....I posted a Cali plan on purpose.

I know you're a professional, but I simply don't believe that. I'll try to keep an open mind about it though. I hope it's true.

I need to be clear, she is on Group Plan and I am talking of Individual plans.
As I said, if it were me I'd buy an individual plan and be happy with my 6350.

 

[LoneLaugher]

Yes ma'am.....I posted a Cali plan on purpose.

I know you're a professional, but I simply don't believe that. I'll try to keep an open mind about it though. I hope it's true.

I need to be clear, she is on Group Plan and I am talking of Individual plans.
As I said, if it were me I'd buy an individual plan and be happy with my 6350.

Something that she can, in fact, do......since preexisting conditions are no longer cause for denial.

 

[Antares]

I know you're a professional, but I simply don't believe that. I'll try to keep an open mind about it though. I hope it's true.

I need to be clear, she is on Group Plan and I am talking of Individual plans.
As I said, if it were me I'd buy an individual plan and be happy with my 6350.

Something that she can, in fact, do......since preexisting conditions are no longer cause for denial.

Precisely.

 

[Spoonman]

I swear this mess was designed to fail.

How Much Does Obamacare Rip Off Young Adults? We Ran The Numbers. Here Are The Results. - Forbes

 

[william the wie]

$12,700 out of pocket for a couple is not chump change but that is not the real problem. Specialists and drug companies are not required to accept Ocare. Demanding cash in advance and letting the patient worry about reimbursement has been the case for Medicare for 48 years and still is. $6,350 or $12,700 is plain BS. Obama does not have nor will he or his successors ever have the votes to change that. This especially applies to CA.

 

[LoneLaugher]

$12,700 out of pocket for a couple is not chump change but that is not the real problem. Specialists and drug companies are not required to accept Ocare. Demanding cash in advance and letting the patient worry about reimbursement has been the case for Medicare for 48 years and still is. $6,350 or $12,700 is plain BS. Obama does not have nor will he or his successors ever have the votes to change that. This especially applies to CA.

You get cancer......you want to drop $6350 or $63,500?

Think.

 

[Jroc]

Obamacare Forcing Another Michigan Hospital To Cut Budget And Fire Staff



[ame="https://www.youtube.com/watch?v=6Bdjcl_X5Nk"]https://www.youtube.com/watch?v=6Bdjcl_X5Nk[/ame]

 

[asterism]

Yes ma'am.....I posted a Cali plan on purpose.

I know you're a professional, but I simply don't believe that. I'll try to keep an open mind about it though. I hope it's true.

I need to be clear, she is on Group Plan and I am talking of Individual plans.
As I said, if it were me I'd buy an individual plan and be happy with my 6350.

Are you sure she can buy an individual plan on the exchange if she's eligible for group coverage? I don't think she can. BCBS may offer off exchange plans with the same limits but I don't know the California market.

 

[Antares]

I know you're a professional, but I simply don't believe that. I'll try to keep an open mind about it though. I hope it's true.

I need to be clear, she is on Group Plan and I am talking of Individual plans.
As I said, if it were me I'd buy an individual plan and be happy with my 6350.

Are you sure she can buy an individual plan on the exchange if she's eligible for group coverage? I don't think she can. BCBS may offer off exchange plans with the same limits but I don't know the California market.

The only thing being eligible for Group coverage prohibits is the qualifying for a Subsidy to help pay premiums.

Everyone is free to purchase their own plans.

 

[william the wie]

Obamacare Forcing Another Michigan Hospital To Cut Budget And Fire Staff



https://www.youtube.com/watch?v=6Bdjcl_X5Nk

International and internal talent flight is a characteristic of any and all national healthcare systems at least initially. The real dangers for ACA include but are probably not limited to:

Non-exchange policies sinking in costs relative to exchange policies: less adverse selection.

Non-exchange MDs and prescriptions requiring full payment in advance for medicare/medicaid patients.

State insurance commissioners not permitting higher rates for exchange as opposed to non-exchange policies.

Since internal talent flight is protected by case law involving the Okies and Arkies in the 1930s Doctors will accumulate in some states while medicare/medicaid will accumulate and since perversity tends toward the maximum at least one state will end up with both fewer healthcare workers and medicare/mediaid patients but I have no prediction on which one or even that there will be only one such case.