Affordable Care ACT
 

Before anyone gets upset or offended at the title "I'm not slamming the president or inciting a political debate" but wanted to share my recent experience with this new plan.

A little history: I've been on my employers insurance plan or COBRA for the last year. I am so extremely grateful for this plan and for the kindness of my employer! However, my COBRA benefits will run out in in August and it is very expensive so I thought possibly with the new healthcare plan that I could save some money and switch over. OMG was I shocked.. not only are the prices higher than what I am paying, the deductibles are 7K-12K and out of pocket more than quadruples what I currently pay per year AND not one plan will allow me to stay with my current doctors and that ****** me off more than anything. I consulted with every single PM doctor who has an understanding of CRPS II/Causalgia within a 4 hour radius of where I live who I felt would work well with the rest of my medical team. My team involves doctors from several different big hospitals including one at our states University and NOT ONE of the 8 physicians are covered under any of the plans. I am so angry.. then I decided to see what medicaid offered because I would qualify for that but wanted to stay with private insurance for better options in care.. again NOT ONE doctor is accepting medicaid patients and if I sign up I would have to go to whomever 'they' decide I should see. Utterly stupid!

Have you looked at the gold and platinum plans? I have found that they have no deductible and the plan is actually better then what I get from work, and cheaper too. The companies were all the same ones work places offer (Anthem, Blue Shield, Kaiser, etc).

My DH was complaining about it. The plans he was looking at were the catastropic plans. You don't need that.

Maybe it's the difference in our state or something. I'm in CA.

It is different in every state and county and then it also depends on age I am only 45 and we don't have children living at home. There weren't any plans with a zero deductible .. and I need a PPO to keep my current doctors. My plan from work is incredible so I doubt I would find that anywhere but something close.. without huge out of pocket charges. After doing the math and calling my doctors for amounts of cash payments it would be cheaper to pay cash and add catastrophic insurance just in case cancer raises its ugly head again.

So Sorry
 

So sorry this happened to you. I am just waiting for the shoe to drop on me too as I have had an individual policy for nearly 40 years. I am just hoping to hang on for the next two years. I have said many many times, it does not matter how great the coverage if your doc and hospital do not accept it or vice versa.

I know what you mean about waiting for the shoe to drop.. I actually heard through our company grapevine that BCBSIL may cancel our policies.. the thing is many of them also don't show (except in the fine print) the many things they don't cover. Like vision and dental for adults, off label prescriptions and even chiropractic care. I know many people don't believe in chiro.. but mine has been helping me and knows more about CRPS II than many of the PM's I consulted with.. I had it with my old plan I should have it with my new plan.

I actually made several calls today to find out how much it would cost on a cash basis.. and now I am thinking about going that route with a catastrophic plan for major issues if one arises. Here is an example of what one doctor would cost me with cash vs. billing an insurance company.

Currently I pay a $25 co-pay to my PM.
He bills BCBSIL $356.00 for a 20 min. basic visit
BCBSIL pays him $156.00 after the contract discount

If I pay cash I would only be charged $82.50.. SHOCKING.. really!! Think I'm going cash.. my reasoning.. being that there is no cure or real treatment other than medications and I won't be having surgery unless it is life/death situation due to the CRPS II and I can't have MRI's because of my SCS.. unless I cancer raises its ugly head again or something else catastrophic I am better off paying cash in the long run I would be about $400+ dollars ahead every month.

Ugh.. it is just another stress to our already stressful lives.

Cash may be good option
 

I so understand what you are saying. CASH may be the only thing that will be accepted soon and in many cases will be the cheaper way to go. No one seems to know or feel secure about all the chaos with health care and health insurance at the moment. A lot of people that are currently covered under their employers, are healthy, and think none of the current turmoil affects them may soon find themselves in a similar boat. We here with health issues are more aware as we are affected first.

I only hope that when all the dust settles, everyone comes out of all this without too much harm but I fear that will not be the case.

Wishing you the best and hope we can keep our docs. Nothing is more important to me than being able to choose who I trust with my life and health. I don't just want a doctor, .... I want MY doctors. It IS MY life that is in their hands.

Well said Hopeless! That is exactly how I feel. Unfortunately being that we suffer from a disease that not many are aware of and it is also a 'chronic pain' condition I fear that we will be under cared for or brushed off if we aren't able to choose or stay with qualified physicians.

Like you.. I hope when the dust settles the picture I see currently has a whole different look. Praying for those who are already being affected by this mess. They really should have waited and researched the medical/treatment maze through people who it affects on a daily basis!

Wishing you well,
Tessa

I removed my last comment. I don't want to get into a political debate either, and I feel this just opens the door for one. Thanks.

Understand
 

I have tried very hard not to state any "opinion" or political issue, just some fears and realities that are happening to people that have chronic health issues.

Yes, it is difficult not to talk about such a "hot" topic without expressing some things that may not be allowed or would possibly offend.

I hope I have not offended you or anyone else. I am just afraid of my future and my relationship with my physicians.

I must admit that I am now curious as to what your comment might have been. :)

Are you saying that using Medicaid for Healthcare would cost you MORE than you are paying with your COBRA plan ?

I understand how frustrating it can be to get adequate care for RSD even when living near a major medical hub. There have been many posters here though who don't have ANY pm docs who understand RSD within a 4 hour commute.

The "they" who decide which doctors Medicaid patients can see are usually not the administrators of the Medicaid plans......the "they" who decide which doctors Medicaid patients can see are usually the doctors themselves who refuse to accept those patients because they feel the reimbursement rates are far too low.

I am grateful that we live in a country where it is possible to get decent health care for many conditions (it's obvious from this forum that so many with RSD are NOT getting great treatment for THIS condition :o ) I just wish it all didn't cost so dang much !

I'm not offended. I just feel bad for what you are all going through and am frustrated that I can't help offer any solutions to you. That's all. I hope things will eventually work out for all of you. Take care and hope you have a better day today. It's about four in the morning here and I still can't sleep. I have to go to the root canal dentist this morning and I have a terrible headache. Well at least I'll get to see the sun come up. Bye for now.

I have changed the title of this thread as that sets a tone that can lead to political argument, which we do not allow here.

Discussing the pros and cons of the new healthcare law is ok and relevant here....but if the discussion takes a negative political turn we will have to close it.

Hi Finz,

No, what I was saying was that I didn't want to go on medicaid because, I wanted to stay with my current doctors who have been treating me during the last 2 years. A head on collision caused multiple injuries throughout my body, I endured 12 major surgeries and though I am somewhat healed from the orthopedic side of things I am still suffering (and will continue to) from a TBI and CRPS II/Causalgia. The plans offered through the exchange as well as the private plans will cost me way more than what I pay for my current COBRA plan. With Medicaid much of my care will not be covered but more importantly I won't be able to keep my doctors that know my medical history. That is also true if I were to enroll through the exchange. In my opinion medical care is the best when the patient and the medical professionals treating them have a good relationship and trusting both ways. Switching now would be harmful to me in many ways both physically and financially and that is my concern. The financial burden is secondary.. that is why though I qualify for medicaid I have not gone on it.

There is much more to it than just that a doctor doesn't want to accept this lower fee. But, that isn't my gripe so I will forgo commenting any further on that.

I realize that there are many posters who don't have a PM within a 4 hour radius who understands CRPS and I am extremely grateful that there is one in my area but, that goes back to my point.. I would NOT be able to see this doctor if I chose the health care plans offered through the exchanges for ACA or on medicaid. That fact alone tells me that this whole system is still flawed.

I wish it didn't cost so dang much also.. but I would rather pay a higher amount for the doctors I have, than pay $5 for a doctor who is forced to see me and doesn't have the slightest clue what my diagnosis is or what it means for my future.

I haven't looked through the website yet. Mostly because of all the news saying there are problems, as well as the pre existing clause isn't in effect until January 1st.

The main thing at this point I an say is I am SO excited that I would will actually be able to get insurance with preexisting conditions!! I'm still waiting on a hearing for SSDI ( so no Medicare) Because of my income from my long term disability the only Medicaid I can get is for catastrophic basically my deductible is nearly my entire income so I'd I'm hospitalized they may pay for it.

I paid $820 for my COBRA until I could no longer afford it. My insurance was amazing then. Low copay, cheap RX coverage. Just amazing coverage. When I was working my insurance was paid 100% by the city whose Police department I worked for.

I can say paying cash for months now it is very stressful. I haven't seen my Rheumatologist for 6 months or more. I have to figure out a way to afford it this month. My PMD would like me to be in every 4 weeks, but when I lost my insurance he agreed I could do every 8 weeks. I can't afford the injections I was getting on top of the $75 office visit (which is only $75 if you pay cash, no credit, check,etc.). He would like to try medication I simply can't afford. I had my primary doctor switch my blood pressure to a medication on my pharmacy savings plan. I'm paying over $200 a month for prescriptions. But I did get approved for Cymbalta assistance ( no way I could afford it. I'm waiting to see if I can get assistance for my migraine medicine which generic is still nearly $300 for 6 doses! When I had insurance I was on a medication ( name escaping me right now) That was $800 a month.

Basically this long ramble is paying cash is quite difficult and in my experience you miss out on medications and treatment you need.

I think there are some obvious growing pains with the affordable health care act. Its unfortunate that we ended up with this instead of what was originally wanted by the president, but its what we have. I think there is all kinds of issues with costs of care and prescriptions. The prices are incredibly inflated comparatively speaking.

My take home point of the original post. Something that I believe many of us overlook simply because the idea of having healthcare when one might have not been able to in the past regardless of pre-existing conditions can cloud our vision to the fine print.

Healthcare coverage does not equal access to healthcare. Physicians have to be willing to see patients. If medicaid or healthcare coverage through the exchange does not pay well enough to give incentive to the physicians to see patients, or if some other barrier stands in the way of helping the patients on these plans - then it is of no use to obtain healthcare coverage that doesn't get you healthcare!

For me- a no cost preventative visit does me no good. I need a specialist who is so dedicated to his/her patients that they keep up on the latest medical advances and treatment options for numerous diseases and the effects that chronic illness has on the body.

zookester, If you qualify for medicaid, why is your subsidy so low through the exchange? Are you in a state that does not support the ACA? When you were plugging in the numbers on the exchange site, did it indicate to you what the subsidy will be and if so did you feel it was low?

The reason I ask this is I've found sometimes it seems folks are not seeing the subsidy for some reason. The other is a state issue, where the state is not going along with the ACA. This, I believe will change because at this time it does not cost the state to participate, or as I understand it the state's contribution is minimal. Its more of a political issue with some states.

My experience paying out of pocket for my wife's care, because we lost our coverage after the company I worked for during the economic downturn went out of business, we did not qualify for COBRA because there was no company to draw from. I paid out of pocket for nearly three years that cost us well over $100,000.

Hello JimKing,

The subsidy is determined in part by household size, income, the state you live in, the county you live in and your age. In my case I live in WA which is considered a higher income state, our children are all grown and having children on their own so it is just my husband and I or a 2 person household. The ACA exchanges are geared more for single mom's and families of 4 and so our subsidies are much lower. In a two person home if either one makes 65K or more the subsidy is between $0-$20 and with higher out-of-pocket deductibles and co-insurance payments (mine came up with 35% after insurance paid its portion and after the $7K-$12K deductible was met). But, as I have said it isn't just about cost it was that through the exchange or medicaid I would have to switch every single one of my doctors. The switching itself would be costly for me since it would be managed through a new PCP costing me at that appointment and then every appt after while getting the new team up to speed on my current condition(s). Additional driving to and from these new physicians, time away from work for my husband and still with a high cost attached on what was supposed to be less expensive and better coverage.. so far this is not the case at least for me. If I was a bit older, had children and lived in a different state then maybe that would be different.

I know paying out of pocket is not for everyone. For me it might be better only because there really is no other treatment available for me (unless medical advances offer one) with the exception of medication or the need for my SCS to be replaced which hopefully won't happen for many years. I have additional policies in place for accidents, cancer and critical care that would cover much of the out of pocket expenses. At least for now while I am still healthy other than the horrid affects of CRPS II and issues resulting from the TBI I don't need any care. Prior to my accident I hadn't been to a doctor in over 5 years and wouldn't go now if it weren't for the need for medications to help manage symptoms of CRPS.

Sadly.. I am not scared of the risk of other diseases afflicting me since it would likely relieve me of the daily pain from CRPS.. I want to live don't get me wrong but if something else takes me then that would be a blessing. Sorry that was a little off track.

I just think it is more important for anyone to choose their own physicians especially if they have already established a good relationship.

I agree. When my wife became eligible for medicare, her doctor told us she does not except medicare, so I continued to pay out of pocket. But not for the meds-my wife used medicare p-D for that because of the large expense. Because of this her doctor still dumped her because even though we paid out of pocket for visits the using of medicare for the scripts was something the doctor would not except. The advantage plan my wife uses through medicare has only 6 doctors to choose from throughout the DC area. That to my wife was not acceptable. Those doctors treated her like a drug seeker. So she now suffers, but without the stress, she's not doing bad at all compared to 5 years ago. So your choice of doctors is extremely important.

Your wife is very lucky to have you on her side and I applaud your efforts in doing whatever you can to help her!! Be blessed :)

Yes, changing doctors is scary and will cause a trickle down effect only to add to peoples suffering. For instance - when you see a new doctor they don't generally 'accept' another doctors diagnosis but take that into consideration as they put you through there own diagnostic process mainly for liability reasons. So.. they will recommend testing, treatments etc., in order for them to take on the diagnosis for themselves and then treat accordingly. Medications may change because often government funded programs don't allow for 'preferred or off label medications' and cutting edge treatments will also likely be hard to come by as advances in medicine are made.

When a specialist is needed to treat a more complex disease/condition having any type of "managed plan" (ie., medicaid, medicare, HMO, L&I, etc.,) makes for less treatment options and much more time spent suffering than for those on a PPO or a plan gives freedom to choose providers themselves.

I fully understand that there were many so called 'junk' policies out there but those that chose them chose them willingly. Even now.. what looks pretty at first glance with a low or no monthly premium might still be junk if it doesn't provide you with the care you need but, the choice was still there. Now.. where it irks me is when I'm spending my money I can choose the plan but.. when I am spending the money after it went into there pockets (after the bill was paid) suddenly, I lose the right to choose what is best for me.. and only I know my body! Call me suspicious but that does seem a little backwards; doesn't it?

Would you be able to keep the drs you have now by going "out of network"?
Is that still an option in the ACA plans?

Some plans in the exchange do not cover out of network providers and some do but at 65% after your deductible is paid, which in that case it would be less expensive to pay cash. Then it all depends on the plan you pick whether or not your doctor will now except that plan even in the out-of-network category. My advice before picking a plan if you want to keep your doctors is to check which ones they will be accepting after Jan. 1, 2014. I've learned not to trust much of the information provided on hospital websites and private practice websites because the information posted may not reflect what will change after the first of the year. Call.. first before you sign up if that is a concern for you.

Also, if you travel out of state or internationally and decide to go through the exchange policies for coverage be careful to read the fine print regarding coverage for that as many do not cover any physicians across state lines or internationally.

I don't mind paying out-of-network as long as the fee is the same or less than what I would pay if paying cash. When I did the calculations based on what the standard bill is for insurance at 65% + deductible it was $73.00 more expensive to use out-of-network insurance billing. I save money there and then I will also save money when I file my taxes so actually it is an incredible difference to do it this way for me.

I hope you are all having an easier time getting your insurance. I heard on tv today that three young computer men are working on fixing the glitches in the computer system for the healthcare. I hope they can fix it completely soon, so that we can all have access our insurance information with ease. My thoughts are with all of you.

Hi,

Catastrophic Health plans are more expensive than the Bronze plans because they are not eligible for tax subsidies. .
When the site starts working, check on the Bronze plans.
https://www.healthcare.gov/can-i-buy...strophic-plan/

BTW, COBRA is a law from 1984 -- signed by Pres President Ronald Reagan

The gov web site is supposed to be in better shape by the end of the November. Wait until the site has clear information about whether you are eligible for a tax credit and how much.

http://www.irs.gov/uac/The-Premium-Tax-Credit



M

Hello Mari and thank you.

Yes, I understand that catastophic plans don't allow for subsidies that wasn't what my primary concern was. My main concern was being able to keep my team of doctors and going through the market place that isn't an option for me. Also, with the bronze, gold etc., even though the monthly premium amount may seem low there is still a high deductible and a minimum of 35% coinsurance amount so doing the math only by the monthly premium doesn't calculate the entire cost. Even on these plans if I can't keep my doctors then it does me no good, so that is why I would consider the catastrophic plan through a non-exchange insurer unless things change over the next few months. ** the low rates of $141-150 are not what is being quoted in Washington state, at least in my county, with a household of 2 (only one seeking coverage).

Regarding COBRA - I understand what COBRA is and am thankful everyday for this plan!

I will continue to look at what is being offered through the exchanges. Again the subsidies or tax credits aren't the issue (anyone who files taxes can deduct medical expenses) my concern is for my health and my ability to continue to see the physicians that have been caring for me.

.. would you sign up for a free/low cost cell phone plan if the service provided only gave you 1 bar, 100 miles away, with a 1 mile radius and even then it was choppy?

Examples
 

Be careful when choosing plans (this text was copied directly from the Kaiser Subsidy Calculator from the link provided above):

For most people, the Bronze plan represents the minimum level of coverage required under health reform. Although you would pay less in premiums by enrolling in a Bronze plan, you will face higher out-of-pocket costs than if you enrolled in a Silver plan.

A Silver plan has an actuarial value of 70%. This means that for all enrollees in a typical population, the plan will pay for 70% of expenses in total for covered benefits, with enrollees responsible for the rest. If you choose to enroll in a Bronze plan, the actuarial value will be 60%, meaning your out-of-pocket costs when you use services will likely be higher. Regardless of which level of coverage you choose, deductibles and copayments will vary from plan to plan, and out-of-pocket costs will depend on your health care expenses. Preventive services will be covered with no cost sharing required.

The premium amounts above are based on a Silver plan. You could purchase other levels of coverage, such as a Gold plan (which would be more comprehensive) or a Bronze plan (which would be less comprehensive).

.. End quoted text .. LinkOut: http://kff.org/interactive/subsidy-c...hild-tobacco=0

In the example above my premiums given on the Silver plan came out to be $307.00/month + 30% + deductible + co-pays etc., this adds up to over 12K year and still doesn't cover Vision, Dental or my current doctors. To me that math doesn't make sense. A cheaper plan (like the Bronze) would still cost 40% after the insurance pays its portion and the premiums weren't much less than that of the silver plan. None of them offered vision or dental and looking at the preferred drug list I can only assume my medications will be switches as well if I were to choose one of these plans.

It just doesn't make sense on how the premiums are calculated for people living in what some would call a higher income state/county, not to mention 2 person homes. Just because I live in a higher income state doesn't mean I am one of the higher earners and I whether or not we have children living at home shouldn't matter.. we shouldn't pay more just because we don't. That is just my opinion and it isn't about politics it is merely about he plans being offered so far.

Another thing to keep in mind is that doctors switch which insurance they accept. Over the years I have had it happen plenty of times.

I guess since I've been paying out of pocket and have not only had this unexpected condition dropped onto me, but multiple others I fear not having coverage ad know how costly it can be. I mean $5,000 for a minor trip to the ER...that adds up fast.