Be Careful When Selecting a New Health Plan

[TucsonJim]

OP NOTE: Please respect my post by not giving a political response here!

I retired last month at the age of 59, and won't have Medicare for a little over five years. I have been able to set up an account on Healthcare.gov and shop the policies that were available to me. Most of the prices are about what I'd expect to pay.

However, if any of you are shopping the exchanges, please exercise caution. Some of the HMO policies exclude emergency care outside of the HMO network. Read the small print before you sign up for one of these policies. If you are traveling out of your network and have an emergency situation, you could be saddled with 100% of the cost. There were alternatives available that covered emergency care out of network, but you will pay a little more for them. Just be sure to read the details before you sign up.

Forewarned is forearmed.

[2freelife]

I have also experienced the fact that the plans do not offer very good coverage at an affordable rate. We have a middle class income so we do not get a subsidy. The market place worker told me if someone takes the subsidy & they get any tax money back it will be taken to cover the subsidy cost. Insurance is still a dilemma. AHC doesn't seem to be the answer yet.

[covetsthesun]

TucsonJim wrote:

Gale Hawkins wrote:
If true no national health care network it will be negative for some.

Thanks Gale. That really illustrates my point.

Jim

x2. I discovered this point awhile back. I found only two insurors who had "national networks"...sorta. One was United Healthcare and the other was Aetna. They were restricted however. It's ok for folks who do not travel. Ever.

cts

[bob_nestor]

TucsonJim, I'm curious why you even went to the Healthcare.gov site in the first place. You retired from an employer that offers subsidized insurance to retirees. In your case (and mine) it is an HSA with UnitedHealth. The amount of the subsidy is more before you are eligible for Medicare, but with your years of service it should cover most if not all you insurance premiums. Even though we both retired from the same company at the same time, the legacy companies we started with were different, so your benefits and mine may not be exactly the same. The subsidy goes way down when we reach 65 and become eligible for Medicare, but again, most of the cost of Part B & D should be covered.

[wny_pat1]

PatStab wrote:
But of course it would have
to review last year, the highest earning year we have ever had because I sold a little 25 acre farm to buy our retirement home and owed a bunch of capital gains.

Don't you get a one time exemption on that? Or did they change it?

And ADA -yourself - if your are on Medicare, you don't have to get ADA.

[Gale_Hawkins]

Do not know validity of source. Thought tax on medical devices was killed?

[Gale_Hawkins]

PatStab hope all of these changes work for you. I am the legal guardian for a 70 year old (made a promise to his mom who I did not know was near death) and have similar concerns for the payment of his needs and got the letter the state is reviewing his case as well. I have family to see that he has a guardian thankful if I should die first.

Helping with this gentleman for the past 22 years has been an awesome experience and some today still do not understand but I could care less. A commitment is a commitment. He still works some at the care home where he lives and had been saving for a grave marker for him and his mom. They set it last week and he is so excited. He is not mentally handicapped but was deaf for most of his life so has no speech and never had any schooling and next to no health care and food was very limited most of the time. The misuse and abuse is another story.

Being non verbal he communicates with pics a lot and the daughter took his photo and we had it placed in the grave marker and it meant so much to him. I researched birth/death records put his genealogy on the back of the stone since it was unknown by anyone today so the stone can speak for him after he is gone.

Again all of the changes in health care has many of us concerned and do wish the the best for your daughter in this time of cost cutting.

[PatStab]

Our DD has been mentally challenged from birth. She has had Medicaid from age 18 and the last few years medicare and Medicaid because I took SS. She is 42.
Now I'm getting a letter from Indiana saying she will be reviewed under our income I guess to see if she is eligible for Medicaid still. I read under one part that says she is traditional Medicaid so is eligible, I called the number
on the letter and the lady didn't know. But I found out from another person I know that is uninsurable that we will be able to buy insurance if she is deemed not eligible. She said she can get the premium plan for about $468 a month or lessor for $260 something, she gets $678 SSI. I'm not complaining, we will pay it as she was just in the hospital a week and it cost $40,000. We had to pay $1184 deductible. But it looks like if she does her money that comes from the
government will mostly go back to the government. But of course it would have
to review last year, the highest earning year we have ever had because I sold a little 25 acre farm to buy our retirement home and owed a bunch of capital gains.

Indiana also did not sign up for the new allowed Medicaid dollars, I'm not sure if that is effecting us or not. We just moved back and got her under Indiana Medicaid less then a year ago.

I do see this as a way for the government to get some money back from taxpayers, but I also dread what we may have to pay. What will she do when
we are no longer here. That's another long story on what we are trying to do. The worries never end.

[Gale_Hawkins]

True but to discuss fine details will close the thread. I just plan to wait a few years and I am sure the master plan will become clear.

[PennyPA]

What I don't understand...this is supposed to be AFFORDABLE Healthcare but if people couldn't afford to pay for insurance in the past, how are they going to be expected to afford the high deductibles??

And I'm still not sure what right the government had to tell insurance companies what they HAVE to pay for? There are millions who where happy with the health plans they had and now they're dropped because their plans didn't cover what obamacare said they had to cover.

[Gale_Hawkins]

I think there has been a lot of wasteful spending by hospitals. Ours over built and sent many home. Some others with desirable skill sets quit and now work at other regional hospitals.

ADA has been a cost factor since 2010 for admin and increased spending requirements by hospitals.

We are just in uncharted waters but thinks will work out in the end for some.

[wny_pat1]

Yep, we just had a local hospital file bankruptcy and are closing their doors Jan 1st, 2014. State and Feds gave them several million dollars last year to prevent them from going under. The Board doesn't have any idea where all the aid money went! They say that they are going under because the patients have not paid their bills. Guess none of them had any insurance. Can't blame it on the ADA because it isn't here yet!

[Gale_Hawkins]

Stephen this observation is what has hospitals on edge across the country. At one point in time if you came in with health care insurance most often they would still get a good chunk of money even if you never paid your part.

Now they are getting concerned.

[Stephen_W]

I was just looking thru the healthcare.gov site (Florida)and was surprised (vs the promises) at the lack of real early dollar coverage provided by the lower tier plans. Most of them required the full $6,250.00 individual deductible to satisfied before covering any part of a Dr. visit, prescription, hospital, ER, etc., then the copay would be 40% for Bronze and 30% for Silver. I read the detailed summary pages and think I am right about that, + they were all EPO's or HMO's. So, it seems not much help for the ones that can only afford these lower tier plans until their out-of pocket expenses reach the deductible level. Am I not understanding this correctly? It looks like even a small medical event could really hurt someone with these plans. The Bronze plan would pay $2,250.00 on a $10,000 bill: $10,000 - 6,250.00 deductible = $3,750.00 x 60% (Bronze coverage) = $2,250.00 (22.5% of a $10,000 bill). The success of this plan is dependent on getting young people to enroll and I suspect most of them don't have the deep pockets to easily handle having the plan pay only 22.5% of the first $10,000.00. The higher tier plans do have much better coverage. Scary stuff.

[Gjac]

Like Gale I went with BCBS because we spend 2-3 mos out of state in the winter. For 2014 I went with a cheaper plan, (Well-care) after much thought, because it had a provision for ER and walk-in clinics out of state. Also if you had to be admitted to the hospital because of you problem it would cover that also.