you can be pretty sure that the people on the bottom end of the economic spectrum aren't going to be seeking much health care. No damn wonder the ins. cos. went along with Obama on this one. Giving up pre-existing condition exclusions and covering young people until 26 on their parents' policies was a small price to pay for what they are reaping through ACA.

It's just using it that's unaffordable.

And still, it's somewhat better than what a lot of people had.

And the income cutoff for not being eligible for subsidies is WAY too low.

Older people (pre-Medicare) especially get nailed.

for the average family coverage in employer provided group plan (the employee portion is $4,236, employer portion is $11,237).

Kaiser subsidy calculator site: income $49,000; family: 2 adults, 2 children; silver plan. Don't know what the out-of-pocket costs are for the typical family silver plan.

http://kff.org/interactive/subsidy-calculator/#state=&zip=&income-type=dollars&income=49000&employer-coverage=0&people=4&alternate-plan-family=individual&adult-count=2&adults%5B0%5D%5Bage%5D=21&adults%5B0%5D%5Btobacco%5D=0&adults%5B1%5D%5Bage%5D=21&adults%5B1%5D%5Btobacco%5D=0&child-count=2&child-tobacco=0

kaiser site for average premiums under employer provided group family plans: http://kff.org/other/state-indicator/family-coverage/#table


I also don't know what level of income for family of 2 adults and 2 children is to recieve Medicaid, but depending on your definition of "low income" they might qualify for Medicaid.

that doesn't mean the care is affordable. So that bypass is gonna cost you $40,000 instead of $100,000, maybe.

My husband's employed switched last fall from a good plan with reasonable co-pays to one with a $4000 deductible. It is difficult to find the money in our budget. I need a colonoscopy this spring and don't know where the money is going to come from.

in corporate plans. He said that when he worked at Cigna, they were all forced to go to a high-deductible plan. The insurance companies wanted every company to go this route.

I do hope you can get the medical attention you need.

deductibles. It's one of the preventive services mandated under ACA to be delivered with no-deductible.

One thing I find confusing is the across the board services (mostly preventive) that ACA mandates coverage for. In other words, separating out the things ACA does.

If anyone here can clarify, that would be helpful.

I'm going to send a question to Jackie Schechner (sp?) who appears on Stephanie Miller's show to talk about this. She's very knowledgeable.

In my case, it's a pre-existing condition because I have a family history of colon cancer as well as a tendency to develop pre-cancerous polyps. They found one in 2012 and said I should have another colonoscopy in two years because of it.

a few years ago my friend discovered that her UnitedHealth Group policy covered the test but did not cover the sedation. She volunteered to give UHG's CEO a sedation-less colonoscopy.

On the other hand, I know my insurance does cover all the expenses involved so yours may as well.

I guess that means I'd have to scrape up the money for sedation.

for sedation.

Anyone who doesn't think that is part of the cost of this test must be very young and/or has never even thought about having one.

Pun intended.

I've heard stories of people who went in for a "covered" colonoscopy, and the doctor burned off polyps during the procedure. That is great for your future health, but not so great for your wallet when they re-classify a routine colonoscopy as surgery -- mid-procedure.

And need a two night stay, I'll be out 16,000, a third of my gross, half of my net. This is what I got for voting for candidate Public Option

...but the ANNUAL deductible in some cases is 50% higher than usual...

who make just over the FPL limits and do not qualify for subsidies.

Go to your state exchange, or federal exchange... type in couple age 60, age 61, age 62, age 63, age 64 with just over the FPL limits. Or a single person age 60, 61, 62, 63, 64 who makes one penny over the FPL limits and doesn't qualify for a subsidy.

The PPACA allows insurance companies to charge older people three times what they charge a younger person.

The rates ARE NOT affordable for older people who don't qualify for subsidies.

They're not.

...I don't qualify for a subsidy so I didn't think about putting in for older ages...that is scary stuff

premiums, before you have paid one penny toward your deductible.

Deductibles and co-pays under ACA are abominable and have gone way, way up.

OTOH, I do believe many services (esp. preventive) are now required to be provided at no charge under ACA?

I hope someone knowledgeable here will help us out!

I've messaged Jackie Schechner (health expert who appears on Stephanie Miller's show) and waiting to hear back.

Probably can google it!

and there may be NO CAP on out of network expenses.

http://www.democraticunderground.com/111643792#post57

"And while the Affordable Care Act generally caps what consumers must spend out of pocket when using providers within their plan’s network, it doesn’t. protect consumers from large bills from outside providers"

Like losing your home and every penny of your life savings because you get sick and can't get insurance at any price.
My brother and his wife are poster children for the ACA. He's a self-employed cancer survivor. She has serious health problems (a lot more serious than his right now) but has managed to work all these years to keep the family covered on her work plan. There is a great possibility that she will have to go on disability soon. Under the old way, no insurer would touch either of them for any amount of $$ and they would lose everything with 1 illness. Now they can sleep at night knowing they could get covered if/when she can't work anymore. I cried tears of relief when the ACA passed and again when SCOTUS let it stand.

3 years ago I had a VERY MINOR surgery done. I had coverage thru my employer, with a $3k annual deductible and 20% co-pay.
After it was all said & done, I was on the hook for close to $5k. It took me TWO YEARS to pay it off.

Now imagine having a $6k deductible - annually - with repeated or chronic medical issues. You will literally be making payments on that FOREVER.

""And while the Affordable Care Act generally caps what consumers must spend out of pocket when using providers within their plan’s network, it doesn’t protect consumers from large bills from outside providers"

Nice little scam there....narrow the networks....force people to go out of network....caps don't apply to out of network. VOILA! More profit for the insurance companies.

who may hit the deductible every year. (And the law does allow for the deductible to increase every year.)

lots of concerns... the Country really needs single payer!!

example even in Vermont (we are working slowly towards single payer)... very rough figures... if medical care is needed (max)

a single person making $30,000/year...
$260 subsidy
Platinum policy with max out of pocket $1200.... costs $350 after subsidy
averaged high end... health care (including insurance) will cost approx. $500/month 20% of income


a single person making $30,000/year...
Silver Plan... high deductible
$260 subsidy
max out of pocket $5100.... $167 after subsidy averaged high.... health care (including insurance) will cost approx. $600/month approx. 25% of income

so no subsidy.

subsidies are available for up to 400% of the FPL... so a person at that point will pay approx. $8500 out of pocket for platinum... still about 20% of income


or bit more for Silver plan

who gets no subsidy.

Run it for an older couple who make $1 more than the 400% FPL for a couple.

Throw in the deductible in addition to the premiums.

no matter how the numbers go... if a person uses the insurance most will pay approx. 20% of their income for health care... the high deductible is the real enemy here!!!

(btw- I am one of old people not yet on Medicare)

single person: 400% of the FPL is $45,960

couple: 400% of the FPL is $62,920

Then add in the deductibles.

It's the PREMIUMS AND THE DEDUCTIBLES.

until you do the math and find out that for a single person it equals less that $15,000/year.

for single person is $11,490 therefore...

150% of FPL is $17,235

200% of FPL is $22,980

400% of FPL is $45,960

if I make $15,000 a year, I get a subsidy of approx. $418 making my premium cost only $22.00 a month

(subsidies are available for up to 400% of the FPL... so if I make $30,000 per year I get $260 towards my premium)

I think the premiums are not the problem with the ACA... it is the high deductible on most all insurance plans... it is absurd

we need single payer for all!!

I was confused and thinking of what the limit is for a person to qualify for Medicaid under the new rules. That is somewhere between 14K and 15K.

Premiums can be a problem even with subsidies as they drop as income rises and I don't think you're other living expenses are considered. If a person is just over the income limit for any help, coming up with another $418/month wouldn't be easy - and then there's all the out of pockets you can still be stuck with.

Single payer is exactly what we need.

nt

You create the obamabot by closing discussion before it happens.

As does my increase in taxes by almost 4% because Of ACA, but I still support it because I am an Obama cheerleader.

Bound to be some friction there

affects the rich minimally, enriches the corporations, and clobbers the middle class.

My work plan annual deductibles and so forth went from 500 to 8300. that's a de facto 7800 pay cut. If I can just stay perfectly healthy for 8 years until Medicare kicks in, we'll be out of danger.