Affordable Care Act (Obamacare) | Have you signed up?

[futures]

oh man, I’m sorry you have to deal with all that!

i really feel like I lucked out at this place. the doctor there is GREAT. she’s young and nice. (I’ve never heard of the upping the RX, but she’s kept my script the same the last two appts I’ve had) and she’s the one who found all of the tears and holes in my retinas, which later turned worse, I called her in a panic because I was seeing flashes of light, and she stayed an hour after work to check my eyes, then sent me to the ER. I had to get laser surgery on my eyes, because one of my retinas was detaching. so I trust her now and will stay with her.

I still get regular check ups with an ophthalmologist because of the tears/holes in my retinas, which is covered by my insurance... even though I don’t have eye coverage.

Your Dr. seems really great!  What you have is actually really similar sounding to the Lattice Degeneration that I have!  It has to do with retina detachment.  I'm going to look into seeing someone there.  If not for anything just to try them out and see what they say since it's free anyway.

 

Perhaps I could do what you do.  See the Optha for the serious stuff (out of pocket) and the Opto for free checkups and get frames from them at America's Best.

[Snaggle Von Swift]

We have America's Best here!  I've always been kinda skeptical to go to those places that are inside eyeglass stores - I was told that they purposely up your Rx so you have to buy lenses/frames. =\  Is that true?

 

I have gone to America's Best twice, got two complete pair of glasses and the exam for about $120 total. I haven't had any issues, and I would assume the qualifications would be the same as required for an eye doctor anywhere, but I don't know how much of a factor the lattice and fishing mucus syndrome (they really couldn't have come up with a better name for this?!) come into play.

[Snaggle Von Swift]

Also, I am signing up for health care today.

[BuzzersonKillwell]

Our premiums are $1,250 a month. My work covers 70% so I pay $375 a month for health insurance. It went up by around $150 dollars when Obamacare kicked in and the company had to purchase plans through the exchange.

 

I wouldn't say it is a great law by any stretch, but it is that folks who couldn't afford it previously now have options when you factor in the tax credit. 

[lonesomexloveus]

Also, I am signing up for health care today.

 

do it quick before your gallbladder implodes or you get attacked by a pack of rabid street cats!

[lonesomexloveus]

i just want to add that a lot of this thread is focusing on buying insurance through the exchange and cost of insurance, but that's not all that ACA is. possibly an even more important aspect of it, in my eyes, is insurers being unable to deny coverage to people based on pre-existing conditions. also, if you get sick, they aren't allowed to arbitrarily drop your policy. AND it provides free preventitive care, which in the long run will bring down all costs associated with healthcare, as things are caught before they require extensive treatment.

[futures]

i just want to add that a lot of this thread is focusing on buying insurance through the exchange and cost of insurance, but that's not all that ACA is. possibly an even more important aspect of it, in my eyes, is insurers being unable to deny coverage to people based on pre-existing conditions. also, if you get sick, they aren't allowed to arbitrarily drop your policy. AND it provides free preventitive care, which in the long run will bring down all costs associated with healthcare, as things are caught before they require extensive treatment.

YES.

[¯\_(ツ)_/¯]

i just want to add that a lot of this thread is focusing on buying insurance through the exchange and cost of insurance, but that's not all that ACA is. possibly an even more important aspect of it, in my eyes, is insurers being unable to deny coverage to people based on pre-existing conditions. also, if you get sick, they aren't allowed to arbitrarily drop your policy. AND it provides free preventitive care, which in the long run will bring down all costs associated with healthcare, as things are caught before they require extensive treatment.

 

thank you.  the ACA is more than just the insurance marketplace, which, will financially correct itself once enough people sign up.  this system is literally in its 6th month of operation (4th if you want to exclude October/November), be patient.  those of you who signed up and have high deductables... welcome to the rest of society who have been dealing with insane deductables for years from private insurers.  be patient, it'll all correct itself.

[Snaggle Von Swift]

I do wish the plans were broken down into more simpler/easy to understand terms.

 

I am stuck between four plans (1 EPO, 2 EPO HSAs and 1 HMO) that all seem about the same? There is only a $20 per month price difference between the lowest and none of them seem to be covered under my nearest hopistal (which is weird? on the hospitals site it says they take AmeriaHealth, but on these plans according to healthcare.gov they aren't accepted). I haven't had insurance in 4 years and never purchased my own, so it's all new, and pretty confusing.

[¯\_(ツ)_/¯]

I do wish the plans were broken down into more simpler/easy to understand terms.

 

I am stuck between four plans (1 EPO, 2 EPO HSAs and 1 HMO) that all seem about the same? There is only a $20 per month price difference between the lowest and none of them seem to be covered under my nearest hopistal (which is weird? on the hospitals site it says they take AmeriaHealth, but on these plans according to healthcare.gov they aren't accepted). I haven't had insurance in 4 years and never purchased my own, so it's all new, and pretty confusing.

 

dont look at the overall price, look at the difference in deductable, co-pay, in/out network coverage and a few other things on the plans that im forgetting at the moment. 

 

not sure about the coverage at hospitals... but thats a crock of bullshit in itself that were dealing with here in PIttsburgh (and im sure many other regions)

[futures]

I do wish the plans were broken down into more simpler/easy to understand terms.

 

I am stuck between four plans (1 EPO, 2 EPO HSAs and 1 HMO) that all seem about the same? There is only a $20 per month price difference between the lowest and none of them seem to be covered under my nearest hopistal (which is weird? on the hospitals site it says they take AmeriaHealth, but on these plans according to healthcare.gov they aren't accepted). I haven't had insurance in 4 years and never purchased my own, so it's all new, and pretty confusing.

If it's available and in your price range, try Horizon.  I feel they're most widely acceptable in NJ.

[Snaggle Von Swift]

Horizon EPO is on the right, AmeraHealth are left [HMO] and center [EPO HSA]. - How does a co-insurance work, if I get a $10,000 surgery they are only covering 10%, $1,000 and i'm on the hook for the other $9,000? Seems like paying a flat $60 is much nicer.

 

[BuzzersonKillwell]

There was a decent range of premiums in our exchange, but we took the Platinum plan because the max OOP for the year is 2k. Since we will be having a baby this year it seemed like the smartest choice financially. 

[BuzzersonKillwell]

Co-insurance is the amount you pay until you reach your deductible or OOP.

 

So in the example you gave you would pay 10% of 9k if your maximum out of pocket cost was higher than $9,000. If your plan had a maximum OOP at, say, 5k then you would pay 10% of 5k and the outstanding 5k would be paid 100% by your insurer. 

[lonesomexloveus]

Horizon EPO is on the right, AmeraHealth are left [HMO] and center [EPO HSA]. - How does a co-insurance work, if I get a $10,000 surgery they are only covering 10%, $1,000 and i'm on the hook for the other $9,000? Seems like paying a flat $60 is much nicer.

 

 

looks like you pay the 10% and the insurance covers the rest!

 

https://www.healthcare.gov/glossary/co-insurance/

[futures]

Horizon EPO is on the right, AmeraHealth are left [HMO] and center [EPO HSA]. - How does a co-insurance work, if I get a $10,000 surgery they are only covering 10%, $1,000 and i'm on the hook for the other $9,000? Seems like paying a flat $60 is much nicer.

 

I have the Horizon Advantage EPO.  Mine is $50 for a specialist rather than the $60 it's showing there.  It looks like Horizon is probably the best bet for you, too.

[yocaseycasey]

Co-insurance is the amount you pay until you reach your deductible or OOP.

 

So in the example you gave you would pay 10% of 9k if your maximum out of pocket cost was higher than $9,000. If your plan had a maximum OOP at, say, 5k then you would pay 10% of 5k and the outstanding 5k would be paid 100% by your insurer. 

 

What do OOP records have to do with anything?

[BuzzersonKillwell]

I sell them on a site I made to afford my high premiums. SoldOutVinyl.com if you want to check it out. 

[stillused]

I'm really glad this topic was started as I've been researching this for a few days now.  

 

My situation is this: I'm currently unemployed therefore have no income and haven't recorded any income for 2014.  I'm planning on getting a job within the next month as I have a few promising possibilities. I'm in a county in NC that will give me a $243 a month tax credit if I forecast my income to be $15,000 for the rest of the year.  I do need insurance as I have been hospitalized for major depressive disorder so I'm currently on a few medications.  I'm also pretty active with sports so tearing an ACL, etc. has always scared me.  My predicament comes in the form of; should I just wait it out to hopefully get on my future employer's insurance and take the penalty? If I choose to sign up should I use the entire tax credit amount, none of the tax credit, or some of the tax credit and will that hurt me next year when I file my taxes? I can't get Medicaid because NC has not extended their Medicaid program.  Any help would be greatly appreciated.  Thanks

[Snaggle Von Swift]

Last of my [possibly] stupid questions.

 

Gallbladder removal typically run $20k-$30k in NJ

For the specialist visit, I would be required to meet my deductible of $500, and then 10% of the surgery would be $2,000-$3,000.. so all in all I would be on the hook for $2,510-$3,510 -- Now my question - "Out-of pocket maximum $1,500" - does that mean all I am repsonsible for is $1,500 (plus the deductible - assuming) and that's that? Any time I use the insurance the remainder of the year I am not paying anything?

[futures]

Aside from co-pays for office visits/Rx I believe.

[BuzzersonKillwell]

Last of my [possibly] stupid questions.

 

Gallbladder removal typically run $20k-$30k in NJ

For the specialist visit, I would be required to meet my deductible of $500, and then 10% of the surgery would be $2,000-$3,000.. so all in all I would be on the hook for $2,510-$3,510 -- Now my question - "Out-of pocket maximum $1,500" - does that mean all I am repsonsible for is $1,500 (plus the deductible - assuming) and that's that? Any time I use the insurance the remainder of the year I am not paying anything?

 

First off, anytime I've ever called to clarify my insurer has been really helpful, so you can or should just ring them up. Even if you aren't a customer yet! Get it straight from the source. 

 

I'd read this the same as you. Your maximum expenditure for a given year is either $2,000 or $1,500. Depends on whether the deductible counts against the maximum out of pocket. Mine does.

 

 Since 10% of the surgery exceeds your maximum out of pocket cost you won't be on the hook for 10% of the surgery total, just 10% on the amount it takes to hit your max out-of-pocket cost. You shouldn't pay anything for the remainder of the year. Some plans do it by calendar year, others by enrollment period. 

 

EDIT: Yeah, Ashton is right. Most plans have a separate RX out of pocket cost. Could be an additional $1,500. So you'd still be on the hook for those purchases. Including post-surgery medications. Those may or may not be at the 90/10 split. Plans treat it differently, 

[Tardcore]

I work for a large national insurance company and used to be licensed as a broker.  However, I work in IT now and have not been a licensed broker in many years.  

 

Generally speaking, the maximum out of pocket is annual and would include deductible and coinsurance payments made by you (but possibly not copayments). 

 

Some policies may have 4th quarter roll-over in which anything you pay in the last quarter of the year is applied to the next year's max out of pocket.  However, that benefit has been going away as it is not allowed in an HSA compatible plan.

 

These comparison grids are handy but you really should get a detailed summary of benefits and/or speak to a licensed agent before signing up. 

[maneatingcow]

Last of my [possibly] stupid questions.

 

Gallbladder removal typically run $20k-$30k in NJ

For the specialist visit, I would be required to meet my deductible of $500, and then 10% of the surgery would be $2,000-$3,000.. so all in all I would be on the hook for $2,510-$3,510 -- Now my question - "Out-of pocket maximum $1,500" - does that mean all I am repsonsible for is $1,500 (plus the deductible - assuming) and that's that? Any time I use the insurance the remainder of the year I am not paying anything?

 

My company is self insured so I don't know if that creates a different situation.  On our plans though the Out of Pocket Maximum includes deductible.  My deductible is something like $1000 with a $5000 out of pocket maximum.

 

I'm young and have never had to use my insurance but I am borderline diabetic so I'm sure I'll make use of it at some point.

 

 

 

 

More on the "obamacare" topic.  We've had a temp working with us for a few months now and last night he was telling me that he's getting nervous that he doesn't have insurance because Obama is going to put him in jail if he doesn't get it soon.  He heard that people he knows are getting the letters from Obama telling them they need to buy his Obamacare or they face jail time.  I tried explaining to him that isn't how it works, but he was hearing none of it.  He was then telling me about how he thinks that it is unfair that Obama starts an insurance company while he's president and then makes every citizen buy a policy from him.  "Obama is going to make billions of dollars off this"

 

That was the first point in my life where I had to debate how I would go about setting my brain on fire.

[lonesomexloveus]

My company is self insured so I don't know if that creates a different situation.  On our plans though the Out of Pocket Maximum includes deductible.  My deductible is something like $1000 with a $5000 out of pocket maximum.

 

I'm young and have never had to use my insurance but I am borderline diabetic so I'm sure I'll make use of it at some point.

 

 

 

 

More on the "obamacare" topic.  We've had a temp working with us for a few months now and last night he was telling me that he's getting nervous that he doesn't have insurance because Obama is going to put him in jail if he doesn't get it soon.  He heard that people he knows are getting the letters from Obama telling them they need to buy his Obamacare or they face jail time.  I tried explaining to him that isn't how it works, but he was hearing none of it.  He was then telling me about how he thinks that it is unfair that Obama starts an insurance company while he's president and then makes every citizen buy a policy from him.  "Obama is going to make billions of dollars off this"

 

That was the first point in my life where I had to debate how I would go about setting my brain on fire.

 

i'm surprised he didn't then start talking about all the free cell phones that obama is giving out to every freeloading drug addict on welfare sucking on the teat of the government.