<p>Actually, it is. I will be facing an ethical dilemma when my kid gets her own insurance. She will still be a student with negligible earned income but she has a decent sized asset which doesn’t generate much income.</p>
<p>Why is it an ethical dilemma? You are playing by the rules you are given.</p>
<p>Perhaps, it’s an ethical dilemma because now we have working people subsidizing the rich. I don’t intend that to be political at all, just logical. But it’s very hard to understand what is considered political in this thread.</p>
<p>This is not an ACA discussion thread. So anything unrelated to you personally is political. If you love or hate the law, you should find avenues outside of CC to discuss.</p>
<p>I am currently living off savings + investment income. The big unknown is whether we have enough savings + investment income + future income (IRA + Social Security + very small pension + other) to last us for the rest of our lives. My biggest fear is running out of money at some advanced age and being destitute. My joke is my worst case scenario is I live forever. One of the big scary unknowns since I stopped working has been the cost of healthcare. Since moving to NC, the cost and quality of healthcare has been a very pleasant surprise. This year 2013, my wife and I are paying $680/month for a Blue Cross Blue Shield of NC plan. Next year, the equivalent ACA plan will be close to $1600/month. Fortunately, I have the ability to manage my income so we will be eligible for subsidies. Our final cost could be anywhere from $300 to $600 per month which will be less than this year. I didn’t write the law, and I was very happy to pay for what I considered affordable care on my own, but I would be foolish if I did not manage my income to my advantage.</p>
<p>In North Carolina (and other states that did not expand Medicaid), having not enough income or having too much income will leave a person ineligible for subsidies. I will make about $3000 in wages this year from some minimum wage work I have done. If my meager interest and dividend income does not get me to the income threshhold where I am eligible for a healthcare subsidy I will do a partial IRA conversion (for example, maybe convert $20,000 of my traditional IRA to Roth IRA) so that my income is high enough to qualify for subsidies. Likewise, I will be very careful not to sell too much appreciated stock that could push my income over the limit for subsidy eligibility (not likely, or maybe not even possible, but it is definitely something to be aware of).</p>
<p>This is how I will (actually in 2014) manage my income so that my healthcare remains affordable. To do otherwise would be foolish and irresponsible. We downgraded our BCBS plan in 2013 because our monthly premium was going to be over $1000. A $1600 premium that is only going up every year would pose a real financial threat to my family’s well being.</p>
<p>NJRes - Don’t you become eligible for medicare at some point even if you live forever?</p>
<p>Medicare, yes… LOL. Healthcare becomes less of a huge issue after Medicare, ( Medicare doesn’t cover everything) but the “living forever” problem is that in many scenarios I am drawing down assets, not living happily on generated income, so in some worst case scenarios I run out of money at age 85, other scenarios age 120. That is why I want to maximize my social security benefit (subject of a different thread), but you are correct in that my healthcare strategy is basically, how do I make it to age 65 without breaking the bank. 
Currently age 60, but lost my last job at age 55, so I am halfway there!!</p>
<p>Are you looking to work more or increase your income? Wondering how the economy is in NC.</p>
<p>Calmom (dstark, maybe you might know), for Anthem, most of the regions are being offered the Pathway PPO network and then a few very big regions have the tiered EPO networks only. So my region is getting the PPO but LA, where UCLA is located, is in the EPO network. Same is true for UCSF in San Francisco. My question is will the PPO network in my region allow me to go to UCLA which is part of the EPO network in LA or UCSF in SF. Do you guys know?</p>
<p>GP, that’s a good question and probably one that would need to be answered by an Anthem agent. As I noted in another post, I found it somewhat easier to deal with BS in terms of actually getting to talk with a live agent by phone (even though on at least two occasions the phone agents gave me wrong agents. Not to mention the situation years ago when BS decided that my daughter was not eligible for reimbursement for certain medications meant for females because their “records” showed that she was male.)</p>
<p>Honestly, I think that for you its time to get a local, independent insurance agent on board. I’m going to send you PM with a link to an agent in southern California who seems to know a little bit more than the others.</p>
<p>I would think that the PPO would let you use all hospitals in all areas in the Anthem network because of the basic differences in PPO vs. EPO. That is, YOUR plan (PPO) is written to allow you the choice of any doctor, in or out of network, with the understanding that network providers are “preferred” and their services will be reimbursed at a better rate. </p>
<p>An EPO is restricted to in-network providers only, except in emergencies. It’s closer to an HMO, except that the person is not required to designate or work through a primary care physician for purposes of referrals.</p>
<p>Calmom, thanks for the referral. I will look for it in my PM. Although, it doesn’t affect me, I wonder if someone who lives in LA, which has an EPO network, can see a provider in the EPO network in San Francisco? I am thinking this might be relevant for you and dstark. Not sure if you guys are in regions with EPO’s or PPO’s? It could have a bearing on whether dstark is allowed to go to UCSF at the preferred rate.</p>
<p>So far it looks like Anthem has a better selection of doctors than BS in my region, although I guess it is too early to know for sure.</p>
<p>Can a person who lives in an area with only an EPO network see a preferred provider that is in a PPO network in another region?</p>
<p>For those of you waiting for the exchanges to put up complete lists of network providers: if the issue is that the lists haven’t been posted in their final form, you might just check with the providers. If they’ve negotiated to be in the network, they’ll know it and can tell you. Most of them may actually put it up on their own websites. </p>
<p>If the negotiations are still going on, of course, no one will be able to tell you.</p>
<p>Maine, just because someone “asks” for something, doesn’t mean that you have to give what they are asking. I am not giving you advice; I am just telling you that I probably would not fill out a form such as the one the hospital sent you. Years ago I had unexpectedly high bill from my son’s delivery. I think that the bill was over $5000, but I went over the bill line by line and found the hospital billing for all sorts of things we didn’t use. For example, I gave birth in a labor room but they billed for both the labor and delivery room. The best thing that happened to me was that the hospital sent the bill out to collection – the collection agent was wonderful- I gave him an itemized list of all the items on the bill that I disputed and he got them taken off, and the bill was reduced to $3500. Then we made an agreement that I would pay off the bill at $35 per month. I paid that for a number of years, and then at some point I received a big chunk of lump some income from another source and paid the balance. </p>
<p>Again, I do have a lot of experience negotiating payment terms on behalf of clients. If the problem is truly that you have no money – as it certainly was when I was a new mom learning the hard way that motherhood and an independent law practice were not a good mix – then fine, I might truthfully answer a financial form and essentially apply for “financial aid” from the hospital. But if the problem is that I don’t want to pay for different reasons, then I wouldn’t discuss finances. I would say that I dispute the bill and lay out my reasons for the dispute. I might go through their internal “appeal” process, and I would hold out until I was able to talk to someone who had the willingness and authority to negotiate payment terms. Sometimes that is a collection agent – I generally have found medical collections to be more flexible than collections for other sorts of bills, perhaps because it is so hard for them to collect and those claims often end up subrogated in litigation where it may take years before payment is made, and even then often is negotiated down. I’m operating with the simple knowledge that medical bills are negotiable, and that if I refuse to pay anything, the hospital or collection agency would have to sue me – so mentally I factor in the costs of those collection efforts in negotiating. </p>
<p>I am NOT saying that everybody can do this, and that therefore it is no problem at all and no one needs insurance. I am saying that I am very comfortable handling these things, and that I would tend to make providers work very hard to justify charging more than the amount set by insurance as being “usual and customary” in the region. (I also might look up Medicaid and Medicare reimbursement rates for specific procedures – yes, I know that those are notoriously low, but I certainly do not have more money to spend on medical procedures than the government.)</p>
<p>I have excellent credit but there have been times when I have had dings on my credit because of these sorts of disputes. I do know my rights with the credit agencies as well, and I am not afraid of problems there, as I do not rely on borrowing to fund my lifestyle. In other words, getting turned down for a loan might be inconvenient for me, but I can’t envision a situation where it would be devastating.</p>
<p>8 year payment plan?..jeez</p>
<p>
The financial aspects of ACA is handled via the tax system, administered by IRS. It’s not about “ethics” it’s about public policy, which currently means whatever Congress can manage to agree on. (I am not taking a position here – this is just how things work in our country). Congress is heavily influenced by lobbyists - again, not an opinion pro or con, just a fact - lobbyists may work for big corporations, but that is not always the case – they can also represent trade unions or other well-organized constituency groups. </p>
<p>The tax system is full of all sorts of provisions which benefit one group over another, including many things which may favor the wealthy over poor people. (Treatment of capital gains, oil depletion allowance, etc. )</p>
<p>The goal of ACA is to try to get every single person covered, either through private insurance or via public programs like Medicaid and Medicare. That goal is impossible, but in furtherance of that goal it is possible to get a significantly greater number of people covered in the future than were covered at the time of passage of the bill. As a public policy concern, that is beneficial: that is, if lawmakers want everyone insured and could choose between a system that would result in 75% of the people being insured and one that would result in 90% of the people being insured, then it is is rational for them to opt for the 90%. If the 90% system is so controversial that they can’t get it passed, but they can cobble together a system that will insure 85%, that also is a rational approach for legislation. (I’m making up the percentages, but “rational basis” is all that the Supreme Court usually requires to sustain a piece of legislation). </p>
<p>It wasn’t feasible to pass a law requiring that people buy a high cost item that they don’t have the money to pay for, so Congress came up with the idea of tax credits and a system allowing advance payment of those credits to subsidize the purchase of insurance. The chief beneficiary of that system is neither poor people nor rich people, but the insurance companies. But the insurance companies don’t get that benefit for nothing: they are now subject to a law that places limits on the use of premium dollars, and requires them to insure all comers. So if Congress had the goal of preserving the insurance industry, then this is a logical approach to solving the problem of how to finance everybody’s purchase of insurance. </p>
<p>Again, as I’ve posted before, they opted for an income-only based approach because that is something that is easy to implement and monitor within the existing IRS framework. It also allowed them to set up a simple and fairly non-intrusive mechanism for verification. </p>
<p>[I could get my application with Covered California quickly verified simply because the numbers I gave the exchange were a very close match to the numbers on my 2012 tax returns. That is something that literally could be accomplished by a computer check within seconds-- and that saved the state a lot of money, because it took my application outside the queue of pending applications that require more paperwork or handling by a human. (It’s an added benefit to the state and federal government that I’m smart enough to understand that I will have to pay back any excess tax subsidy I get, so I did not opt to actually take the full advance subsidy that I am theoretically allowed.)]</p>
<p>
What’s wrong with an 8-year payment plan? I paid what I could afford at the time, and the collection agency had improved cash flow. The advantage to them of accepting very low payments from consumers is that they probably had very high compliance across the board. The advantage to me at the time was that they didn’t charge me interest.</p>
<p>Families overwhelmed with medical expenses often end up in bankruptcy, and the creditors will generally fare a lot worse in bankruptcy court.</p>
<p>GP, I don’t know the answer to your question about the EPO. I have only PPO’s in my area, but if I lived in SF, I’d go with Blue Shield over Anthem because of the PPO vs. EPO distinction - or if that wasn’t affordable, I’d probably go with Kaiser over the EPO, simply because Kaiser is a known commodity. That is, if I had Kaiser I would know that I could go to any Kaiser facility anywhere in the state, whereas the EPO would come with too many unanswered questions.</p>
<p>I am in Marin and Anthem has the PPO here. With Stanford, UCSF and Marin General covered, I am probably going with Anthem. Anthem has the best pricing here too. I want to sign up before December. </p>
<p>My questions are what is the coverage in NY because that is where one of my kids live? And why the dearth of doctors listed in Marin? And what is going on with Sutter? I called Anthem today because I was on a long car ride. I was hoping Anthem extended working hours. Anthem is closed in Sunday. I was very motivated to talk to Anthem today. If I feel motivated tomorrow, I will call tomorrow. :)</p>