Reflex Sympathetic Dystrophy (RSD and CRPS) Reflex Sympathetic Dystrophy (Complex Regional Pain Syndromes Type I) and Causalgia (Complex Regional Pain Syndromes Type II)(RSD and CRPS)


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Old 11-08-2013, 06:11 PM #21
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Originally Posted by Jo*mar View Post
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.
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Old 11-09-2013, 11:44 PM #22
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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.
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Old 11-10-2013, 01:34 AM #23
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Originally Posted by zookester View Post
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.
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/

Quote:
Yet bronze plans start at $151. And the differences among insurers can make the range even narrower.
Kaiser Permanente, for example, lists a catastrophic plan at $144 but has a bronze plan available for just $7 more.
Anthem Blue Cross and Blue Shield has a catastrophic plan for $180 and a bronze plan for $210.

That's before considering that single people earning less than $45,460 can qualify for tax subsidies to offset or even pay for most of the cost of a bronze plan.
Catastrophic plans, by contrast, are ineligible for subsidies. It's one of the rules of Obamacare.
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

Quote:
Getting the Credit
To qualify for the credit, you must get insurance through the Marketplace.
During enrollment through the Marketplace, using information you provide about your projected income and family composition for 2014, the Marketplace will estimate the amount of the Premium Tax Credit you will be able to claim for the 2014 tax year that you will file in 2015.
You will then decide whether you want to have all, some or none of your estimated credit paid in advance directly to your insurance company
Quote:
Claiming the Credit on Your Federal Tax Return
For any tax year, if you receive advance credit payments in any amount or if you plan to claim the premium tax credit, you must file a federal income tax return for that year.


M

Last edited by Mari; 11-10-2013 at 02:04 AM.
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Old 11-10-2013, 10:05 AM #24
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Quote:
Originally Posted by Mari View Post
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?
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Old 11-10-2013, 10:53 AM #25
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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.
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Old 11-10-2013, 12:23 PM #26
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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.
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