ObamaCare Plans Come on the Market October 1st. Get Ready

cuda.1973

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This is a bit o/t, but goes to show how screwed up things are, without the gubbament making it worse.

A month ago, we had to go to Pittsburgh, to bury Mom. Up there, the stinking Univ. of Pgh. owns most of the hospitals. For reasons that were not made clear, somehow Pitt and BCBS got into some kind of knock-down drag-out. It had something to do with Pitt not accepting BCBS. So, BCBS retaliated by buying all the hospitals that Pitt did not own. And locked out all the doctors that had privileges at any of Pitt's hospitals. Which effectively meant most doctors would end up losing their patients! They could not see BCBS at Pitt hospitals, and were not allowed in the BCBS ones.

I found all this out watching the TV. Ads being run, showing how much money you can save at one of the BCBS hospitals, as opposed to the ones Pitt ran.

Of course, the fact BCBS owned all those competing hospitals was not disclosed in any of the ads.............

So, in the short term, it will lead to a price war. Eventually, they will kiss and make up. Then jack all the prices back up.

Oh, also led to my RN stepsister having her job eliminated. (Yeah, she worked at a Pitt one, and she is also over 50.)
 

chanson78

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If one has to accept less choice or no choice, then yes one is giving up freedom for a cheaper price. I can't imagine many leaving their employer-sponsored insurance (voluntarily) for such.
Just as an aside, while you are proclaiming the sanctity of choice, how many people that are employed actually "choose" to not go with their employee subsidized health care? I get it, its not so much about exercising the choice, its about having a choice at all. And the fact that for people not to pay a penalty they must participate in a plan that meets the ACA standards removes some of that choice.

So technically there is still a choice, you could conceivably pay the penalty, and not get insurance. Or pay the penalty and buy the same old catastrophic insurance that you had before. Or you could stick with your current employers plan that you have been on (assuming they didn't change it to save money) and not have to worry about it. So what it boils down to is probably more likely a dislike of a new "tax" that is being levied upon you if you choose to get a non standard or no health care package.
 

Tide1986

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Just as an aside, while you are proclaiming the sanctity of choice, how many people that are employed actually "choose" to not go with their employee subsidized health care? I get it, its not so much about exercising the choice, its about having a choice at all. And the fact that for people not to pay a penalty they must participate in a plan that meets the ACA standards removes some of that choice.

So technically there is still a choice, you could conceivably pay the penalty, and not get insurance. Or pay the penalty and buy the same old catastrophic insurance that you had before. Or you could stick with your current employers plan that you have been on (assuming they didn't change it to save money) and not have to worry about it. So what it boils down to is probably more likely a dislike of a new "tax" that is being levied upon you if you choose to get a non standard or no health care package.
I have lots of choices for where I work. Even with my current employer, I have health plan choices. And within my chosen health plan, I have lots of choices for where and from whom I receive services.
 

chanson78

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I have lots of choices for where I work. Even with my current employer, I have health plan choices. And within my chosen health plan, I have lots of choices for where and from whom I receive services.
As long as those plans meet the minimum requirements, and possibly even if they don't as long as you were enrolled in it last year, I think you can continue to use the same plans without any issue.

Is your worry that these new plans will tell you who to see, where to go etc? I see you are in Alabama, BCBSAL covers most of the state, as long as you go with them it shouldn't be an issue. Are you concerned that due to ACA, BCBSAL will change its plans specifically for the ACA?
 

cuda.1973

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Oh, boy................

1.) A lot of companies are throwing retirees off of their health care plan.
2.) And the part-time employees.
3.) Some plans are being eliminated, by the evil insurance companies. Usually forcing you to go to a much more expensive one.

Now, if you are in #1, it means going on to Medicare. "So what?", you say.

Ah.........in all cases, it does mean a loss of choice.

At the present, I can see any doctor I want (provided I can pay the bill), and he can do any procedure or prescribe any drug, without having to justify it, to any insurance company. Works fine for me. But, if I was forced to go onto Medicare.............I no longer will have any choices.

My doctor will have to run all the needless tests that are mandated, to get the proper diagnosis code, in order to do what he deems is appropriate. (Private insurance does the same crap, so this is not unique to Medicare, or even Obamacare.) But, there is one HUGE difference.

Let's say I had insurance, and they denied what we thought I needed, for whatever reason. (In my case, it would be because there are really no approved treatments, for an unspecified immune disorder.) So, I would have 2 choices: do without, or foot the bill. Should come as no surprise I foot my own bill. (Just like the good ol' days!)

But if I was on MediScare, I would no longer have my choice.

If they deny it, you don't get it. PERIOD. There is no "pay your own freight" option. There is no doctor shopping, by going to see a doctor that does not accept MediScare. Both are considered to be breach of contract, and no doctor is going to put his livelihood on the line, to deal with my obtuse immune disorder.

Ah............but it does not only affect oddballs like me..................it affects all "old people", even the normal ones.

A few years ago, Mom was sick one Saturday afternoon. (I took care of Mom, in her latter years.) Called the first clinic, that was close to the house, and had Saturday hours. Made an appointment, and all seemed well.

"Oh, does your Mom have Medicare?"
"Uh, yeah.........why?"
"We do not accept Medicare, so we can not see her."
"Even if I pay cash."
"We can not see her, period. At no time, for any reason."

Eventually, I found a place that was open, and took Medicare. It wasn't easy. But it was cheaper, and she saw a doctor, a lot faster than if I dragged her to the ER.

Since y'all paid the bill for the ER, I guess I should have done what most other people would have done. Especially since I did not have to pay for it. And subject her to a needless battery of expensive tests, since that is the protocol the ER would have followed.

Only one option made sense. Choices limited, by gubbament edict.

It is only going to get worse, once this crap takes effect. You can choose to believe the sunshine pumpers. Or you can believe the folks who have already seen the seedy underside of gubbament interference. Or you can just use common sense, and see what a mess it will be.

There are problems with our health care system, and I know all about them, the hard way. But, there are other ways to deal with them, without the gubbament enforcing a top-down system, that has no chance of working. Of course, that is the idea. When it fails, they are counting on the sheeple yelling "Someone needs to do something about it!" They will. The idiots who created the problem will "fix it", by totally taking control of it. Which will be administered by those evil insurance companies. The gubbament will pay them, x% over cost, to run it. (Just like the way large corporations provide insurance do at present.) They will get a guaranteed rate of return. Someone else will provide the algorithms that decide how much to pay, for what, and when. They will get performance bonuses, for coming in under projections. (Just like they now do, for all those big evil corporations.)

Just 2 big differences................

1.) When the say "Claim denied", the "pay your own freight" option will not exist. (The whole goal is wealth redistribution, so get ready.)
2.) When you kvetch: "Well that is what the gubbament sez. It is isn't us who are denying your claim. That is the law. We all have to abide by the law."

The Dude abides..........even if he doesn't want to!
 

Tide1986

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As long as those plans meet the minimum requirements, and possibly even if they don't as long as you were enrolled in it last year, I think you can continue to use the same plans without any issue.

Is your worry that these new plans will tell you who to see, where to go etc? I see you are in Alabama, BCBSAL covers most of the state, as long as you go with them it shouldn't be an issue. Are you concerned that due to ACA, BCBSAL will change its plans specifically for the ACA?
The ACA, particularly through the use of the "Cadillac Tax", is forcing negative changes [from the consumer's perspective] to employer-sponsored health plans: costs to employees are going up and benefits are being reduced to avoid this tax. Pretty much no one will be able to "keep their health insurance" as was once indicated in order to gain passage of the ACA.

As a note, my previous comments about "choice" were in response to a discussion about limited provider choices for those who choose to purchase the cheapest plans through an Exchange. Since minimum benefits are mandated, the primary way insurers are controlling costs is through reduced/limited provider networks.
 

cuda.1973

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Ok, one more o/t diversion.............

Older doctors, say my generation..............when you go to one, they ask questions. They want to know about you, your family medical history, your lifestyle. They listen, use their experience and knowledge, and get close to what is wrong. Let's say they get to within 75-80% of what is wrong. If so, they do not have to run every test known to mankind to get the diagnosis.

But the younger doctors...........and this is how they are being trained............will dispense with a lot of that, and just order up a battery of tests. Then, they will diagnose by algorithm, looking at the test results.

Should not take a rocket scientist to realize one method is screwed up. Costly, wrong diagnosis..........just an approach that is all wrong. But, that is how they are training them, and is accepted practice. Really sad and pathetic.

A lot of this crap had its roots in the 80s. When AIDS hit, it threw the medical profession for a loop. Everyone I knew, who worked in it, said medical care was going to be forever changed, and not for the good, simply because they did not know how to deal with AIDS. So, the concept of running a battery of tests became the norm, since they were not sure what they were looking or for. Or, more importantly, what they might miss. The scepter of malpractice played a large role in this.

So...............sort of back to topic.................if I have to find a new doctor, and they try to diagnose what is wrong, simply by going on test results.............

"Omigod this guy has AIDS!!!!!!!!!!!! He must be screened for HIV, immediately!!!!!!!!!!!"

And my "permanent record" would forever tag me as someone suspected of having AIDS. Which I obviously do not have, as I would have not lived for close to 40 years, with blood tests that mimic what someone with AIDS would look like.

So, now you know why I am not looking forward to being that guy who falls in the crack.

Oh, and one last point..................

Thanks to AIDS, all research into immune disorders has been, shall we say, re-directed into dealing with AIDS. The research into the type of problems I have no longer exist, by edict of the fascist FDA, since none of those programs would be useful in battling AIDS. A lot more AIDS patients than weirdos like me, so no research that is not effective against AIDS. Too bad none of them work on me, since there is no viral cause.

Thank you, gubbament!
 

Tider@GW_Law

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Sep 16, 2007
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Oh, boy................

1.) A lot of companies are throwing retirees off of their health care plan.
2.) And the part-time employees.
3.) Some plans are being eliminated, by the evil insurance companies. Usually forcing you to go to a much more expensive one.

Now, if you are in #1, it means going on to Medicare. "So what?", you say.

Ah.........in all cases, it does mean a loss of choice.

At the present, I can see any doctor I want (provided I can pay the bill), and he can do any procedure or prescribe any drug, without having to justify it, to any insurance company. Works fine for me. But, if I was forced to go onto Medicare.............I no longer will have any choices.

My doctor will have to run all the needless tests that are mandated, to get the proper diagnosis code, in order to do what he deems is appropriate. (Private insurance does the same crap, so this is not unique to Medicare, or even Obamacare.) But, there is one HUGE difference.

Let's say I had insurance, and they denied what we thought I needed, for whatever reason. (In my case, it would be because there are really no approved treatments, for an unspecified immune disorder.) So, I would have 2 choices: do without, or foot the bill. Should come as no surprise I foot my own bill. (Just like the good ol' days!)

But if I was on MediScare, I would no longer have my choice.

If they deny it, you don't get it. PERIOD. There is no "pay your own freight" option. There is no doctor shopping, by going to see a doctor that does not accept MediScare. Both are considered to be breach of contract, and no doctor is going to put his livelihood on the line, to deal with my obtuse immune disorder.

Ah............but it does not only affect oddballs like me..................it affects all "old people", even the normal ones.

A few years ago, Mom was sick one Saturday afternoon. (I took care of Mom, in her latter years.) Called the first clinic, that was close to the house, and had Saturday hours. Made an appointment, and all seemed well.

"Oh, does your Mom have Medicare?"
"Uh, yeah.........why?"
"We do not accept Medicare, so we can not see her."
"Even if I pay cash."
"We can not see her, period. At no time, for any reason."

Eventually, I found a place that was open, and took Medicare. It wasn't easy. But it was cheaper, and she saw a doctor, a lot faster than if I dragged her to the ER.

Since y'all paid the bill for the ER, I guess I should have done what most other people would have done. Especially since I did not have to pay for it. And subject her to a needless battery of expensive tests, since that is the protocol the ER would have followed.

Only one option made sense. Choices limited, by gubbament edict.

It is only going to get worse, once this crap takes effect. You can choose to believe the sunshine pumpers. Or you can believe the folks who have already seen the seedy underside of gubbament interference. Or you can just use common sense, and see what a mess it will be.

There are problems with our health care system, and I know all about them, the hard way. But, there are other ways to deal with them, without the gubbament enforcing a top-down system, that has no chance of working. Of course, that is the idea. When it fails, they are counting on the sheeple yelling "Someone needs to do something about it!" They will. The idiots who created the problem will "fix it", by totally taking control of it. Which will be administered by those evil insurance companies. The gubbament will pay them, x% over cost, to run it. (Just like the way large corporations provide insurance do at present.) They will get a guaranteed rate of return. Someone else will provide the algorithms that decide how much to pay, for what, and when. They will get performance bonuses, for coming in under projections. (Just like they now do, for all those big evil corporations.)

Just 2 big differences................

1.) When the say "Claim denied", the "pay your own freight" option will not exist. (The whole goal is wealth redistribution, so get ready.)
2.) When you kvetch: "Well that is what the gubbament sez. It is isn't us who are denying your claim. That is the law. We all have to abide by the law."

The Dude abides..........even if he doesn't want to!
You doctor simply needs to appeal any denial on the basis of medical necessity. It sounds like it would be approved on appeal.

In October of 2014, ICD-10 will be (almost certainly) be going into effect, so there will absolutely be a diagnosis code for whatever your PCP believes is your condition. Your doctor can already most likely submit the ICD-10 code to the payor along with the mapped ICD-9 just in case.

It takes extra work on behalf of the practice to get this sorted out, but it is also troubling dealing with payors for treatments of patients with rare diseases and conditions.

On a side note, have you had your genome sequenced yet? Payors are moving towards genetic approaches for rare conditions. Kaiser sequenced my genome and I'm not even sick with anything yet.
 

cuda.1973

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You doctor simply needs to appeal any denial on the basis of medical necessity. It sounds like it would be approved on appeal.
Wrong...............

We just bypass it.

In October of 2014, ICD-10 will be (almost certainly) be going into effect, so there will absolutely be a diagnosis code for whatever your PCP believes is your condition. Your doctor can already most likely submit the ICD-10 code to the payor along with the mapped ICD-9 just in case.
Wrong.................there is one..............it falls under "other/unspecified/non-specific", or some language as that.

It takes extra work on behalf of the practice to get this sorted out, but it is also troubling dealing with payors for treatments of patients with rare diseases and conditions.
You assume there is a treatment. News flash: there isn't! We have found treatments that do work, but they are not for what they think is wrong.

Actually, if the stinking FDA had not stopped research into these problems (and don't try to tell me they didn't, because you are not involved in it), that would have helped. See my comments on AIDS.

On a side note, have you had your genome sequenced yet? Payors are moving towards genetic approaches for rare conditions. Kaiser sequenced my genome and I'm not even sick with anything yet.
No. That would have to be done on my dime. It seems to be a congenital problem, from my paternal grandmother. (Who lived to be 90-something, with all of her weird problems. Sick every day that I knew her.)

But, since you brought that up.............you mentioned once before you take statins. Find something better! I am serious. They are bad news. I would not wish them on anyone, even someone that I do not know, and probably would not be my best buddy. Use that genome stuff to find something better. I really do wish you good health. I know a lot about poor health.
 

twofbyc

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Calculator doesn't seem to work...if it is accurate, I quit filing taxes and they can put me in jail. It was said that up to 400% (440%?) of the poverty level is eligible for subsidy - we fall below that, but it shows 0 subsidy.
I will be looking to join a class action suit as I could not afford to pay the premiums it says I will have to pay.
 

seebell

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Calculator doesn't seem to work...if it is accurate, I quit filing taxes and they can put me in jail. It was said that up to 400% (440%?) of the poverty level is eligible for subsidy - we fall below that, but it shows 0 subsidy.
I will be looking to join a class action suit as I could not afford to pay the premiums it says I will have to pay.
Sorry you had a problem. I believe the amount of subsidy is based on family size. As is the poverty level. you can play with the numbers-i.e. change number of children and see the change. Income of $85,000 has to have 6 children before subsidy kicks in.

By all means go to www.healthcare.gov after October 1st to see the reality.
 
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twofbyc

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Sorry you had a problem. I believe the amount of subsidy is based on family size. As is the poverty level. you can play with the numbers-i.e. change number of children and see the change. Income of $85,000 has to have 6 children before subsidy kicks in.
Just me and the wife, kids are grown. And we sure (insert rest of idiom here) ain't rich, just cannot afford $500 a month for a silver plan with 30% copay. We could easily be looking, at our age, at 7-10 grand a year OOP. Ain't happenin. I will reserve judgement until the actual plans are up and running, but it ain't lookin too good for the home team.
 
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chanson78

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Just me and the wife, kids are grown. And we sure (insert rest of idiom here) ain't rich, just cannot afford $500 a month for a silver plan with 30% copay. We could easily be looking, at our age, at 7-10 grand a year OOP. Ain't happenin. I will reserve judgement until the actual plans are up and running, but it ain't lookin too good for the home team.
Please forgive me for being nosy, but it would seem as if you already have coverage that is affordable currently. If this is the case, why would you change? Has your health care insurance provider given you indication that you must move to one of the new ACA plans?
 

seebell

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Just me and the wife, kids are grown.
Same here. I'm a little too young for Medicare and we buy our own insurance. I'm almost 63 and my wife is 60. We each have BCBS Classic Blue and it costs us about 320 per month each. I don't want to pay any more. We live fairly well but my income is just a little bit above the median but our debt is very low. I don't think I will get a subsidy.

I'm going to see what's available on October 1st. I'm a little apprehensive.
 
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twofbyc

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Please forgive me for being nosy, but it would seem as if you already have coverage that is affordable currently. If this is the case, why would you change? Has your health care insurance provider given you indication that you must move to one of the new ACA plans?
Have no insurance currently and can't get it due to preexisting condition.
 

twofbyc

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Same here. I'm a little too young for Medicare and we buy our own insurance. I'm almost 63 and my wife is 60. We each have BCBS Classic Blue and it costs us about 320 per month each. I don't want to pay any more. We live fairly well but my income is just a little bit above the median but our debt is very low. I don't think I will get a subsidy.

I'm going to see what's available on October 1st. I'm a little apprehensive.
60 and 54, high debt due to business closing. Wife would not accept bankruptcy, so we struggle to keep our heads above water. Current job offers no insurance, salary is about 80% of what I was making with my last employer, although wife's salary went up about 60% (her job offers no insurance either). Could find enough money to pay a lower premium by the time we have to, just not as much as what's being quoted. And if we have to sell our house and relocate because of this, I'd just as soon I go to jail where the government can pick up the tab on my upcoming potentially-massive medical bills.
 

chanson78

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You might be interested in http://money.cnn.com/2013/06/24/news/economy/obamacare-help/index.html

Above Article said:
The helpline, 800-318-2596, is available 24/7 and can provide assistance in 150 languages. There is also a new live-chat feature on HealthCare.gov.
It would seem that there might be some options available, and if they can't help you there, they might be able to point you towards someone with specific information regarding insurance where you live.
 

Bama Reb

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I've always been self-reliant and self-sustaining person. I've never been one to rely on the government for anything. But now the government has seen fit to interject itself into the private market and tell us that we must buy health insurance. OK, fine, so now they can deal with the consequences.
I just turned 64, so I'm not going to bother with it. I'll be able to enroll in Medicare this time next year and that will prevent me from having to pay a penalty at the end of the year. Let them pay for my medical care for the rest of my life.
 

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