<p>How many medical schools does New York City have (I know of Columbia, NYU, Cornell, Sinai)? There should be an abundance of well known specialists and experts one can go to who wrote the book without ever having to set foot in SK.</p>
<p>There are an abundance of perfectly good specialists pretty much everywhere (as discussed in the previous posts about Kaiser doctors.)</p>
<p>“So the so called “promise” is that a person making $25,500 will qualify for a subsidy for amounts over X. (For what it’s worth, X = 7% of income, or $1800 per year)”</p>
<p>Sounds like there is a sliding scale before it hits the 9.5%?</p>
<p>I dont know where calmom’s post disappeared to but texaspg, that is correct. There is a sliding scale.</p>
<p>Oops, sorry TexasPG – I deleted my post and then you responded to it. (I just realized that the post I was responding to was several hours old and I hadn’t caught up on the discussion in between - I just got back from shopping and did not realize at first how much discussion had taken place since I was last online…).</p>
<p>In answer to your question: YES, there is a sliding scale as to the percentage of income required to pay up to the 400% level, where it is 9.5%. </p>
<p>It’s simple math – the Kaiser Foundation subsidy calculator will report the numbers for any income figure you enter.</p>
<p>re: quality. No (and yes.) Thing is, MSK or DF and others may be more likely to have the cutting edge focus. Some patients need that and the level of the experience and care from nurses, technicians, what the pharmacy stocks, what procedures they are prepared to undertake and how many times they’ve done that, etc. And/or, when a hosp focuses on a set of illnesses, they are more likely to be up on how that patient pool reacts. But, sometimes, all you do is go there for a plan to be devised, then your home specialist docs take over, in the local facility that can handle that. They then work together.</p>
<p>Whether we really need a special facility or a teaching hospital depends. Sometimes depends on the local population. My mother used to insist everything big be treated at UCLA, all that way though traffic. Very surprised by the competence at her local hospital, when it was a heart attack. (Community demographics were lots of retired folks and overstressed executive sorts. Makes sense, eh?) </p>
<p>dstark, thanks- I’ve always liked your financial perspective and silently followed a few threads. You can put in other zips, too- and see costs in say, Podunk vs Beverly Hills.</p>
<p>A community hospital is fine for broken bones. ACL repair, appendectomies, etc. </p>
<p>But I made sure my premie twins were born in a hospital with a level III NICU. Brain tumors are sent to Keck or UCLA. My friend had her kidney transplant at UCLA. When life is really threatened, you need access to a teaching hospital.</p>
<p>^Agree with your post. My brother’s twins were born at the local hosp, Level III NIC. And his insurance didn’t begin to cover the costs. Low max they’d pay out, uncapped OOP. As he put it, “but I liked it (the policy.)” It had covered what it covered, up to that point.</p>
<p>"In answer to your question: YES, there is a sliding scale as to the percentage of income required to pay up to the 400% level, where it is 9.5%. "</p>
<p>I was asking the question about how do we know someone making a specific amount has 9.5% to spare when they have a low income. I did not get an answer. </p>
<p>The sliding scale increase in what people can afford once they cross povertyline would make sense.</p>
<p>It’s not only the hospital but the surgeon. There are some surgeons that I wouldn’t let cut me open in a million years. The hospital is important because the best surgeons may only have admitting privileges to the best hospitals. By limiting the hospitals you can go to, you are also limiting the surgeons you can see.</p>
<p>Re post 5430:
No, you are confused about how it works.</p>
<p>All insurance sold from 2014 forward must comply with ACA, and thus all plans will be identified by metal tier. But that does not mean they have to be sold on the exchange. </p>
<p>To simplify:</p>
<p>ALL plans going forward fit within a metal category.</p>
<p>But only SOME plans are sold on exchanges and are subsidy/tax credit eligible. The others would be sold directly by the insurer, presumably to people who do not qualify for subsidies.</p>
<p>The impact of this is that it will make comparisons of plans sold by different companies somewhat simpler – you won’t have to read a lot of fine print to find out what is really covered. The metal label gives you a quick yardstick of the overall strength of the plan, assuming moderate health costs.</p>
<p>Reply to post 5405:
It’s possible that the could find an off-exchange plan cheaper than what was offered on-exchange, but it is not a good idea for them to go off exchange because they would not be protected in the event of a change of income.</p>
<p>The subsidies can be recalculated at any time if there is a change, and the exchanges are set up to make it easy (in theory) to enter in changes in income. </p>
<p>Keep in mind that the subsidies are keyed to the 2nd lowest cost silver plan on the exchange, so if that plan is priced so low that the low-income person does not need help to pay for it, by definition in most markets there are probably at least two other cheaper plans (the 1st lowest cost Silver and at least one Bronze plan). The under-30’s are also allowed to opt to buy catastrophic if they choose.</p>
<p>Tpg- not all the available plans hit 9.5%. </p>
<p>In my state, a 27 yo earning 26k could get a $90/mo Bronze plan, 0% co-insure after a 5k ded, 6350 max. Includes an $84 credit. And it’s HSA qualified. That’s about 4%. I’m not going to dig deeper to decide if it’s a good plan. But I do agree this is complicated to evaluate.</p>
<p>At 22.9k, net drops to under $60.</p>
<p>Remember, in my state, the plans are preferentially designed to be better than the same-name off-exchange offering from BCBS.</p>
<p>“Agree with your post. My brother’s twins were born at the local hosp, Level III NIC. And his insurance didn’t begin to cover the costs. Low max they’d pay out, uncapped OOP. As he put it, “but I liked it (the policy.)” It had covered what it covered, up to that point.”</p>
<p>But that couldn’t happen anymore. Since ACA there are no max caps, and OOP is capped. </p>
<p>Whether the birth could be at UCLA is another story, but all the costs would be covered after deductible and OOP at a hospital in his network.</p>
<p>
</p>
<p>We don’t – but that is what the government assumes to be the case in determining what it will subsidize. That’s why it is like EFC. If you fill out a FAFSA and enter your income and it comes back and says your EFC is $17,000, does that mean that you really can come up with $17K every year for your kid’s college? No one assumes that it does – but that is the formula the government has set up for determining the level at which they will give your kid a subsidized loan. </p>
<p>Now personally, I would think it is a pretty good deal if I am guaranteed that I can buy insurance for less than 10% of my income. Keep in mind, that’s the amount keyed to the SILVER plan – those direct out-of-pocket costs can always be trimmed by buying a lower-premium Bronze plan instead. (Not really the best option at the lower end of the spectrum due to the cost-sharing-subsidies, but that’s what it is).</p>
<p>Texas PG – FYI, here’s the sliding scale:</p>
<p>Up to 133% FPL – Income percentage 2% </p>
<p>133% up to 150% – 3.0-4.0%</p>
<p>150% up to 200% – 4.0-6.3%</p>
<p>200% up to 250% – 6.3% - 8.05%</p>
<p>250% up to 300% – 8.05%-9.5%</p>
<p>300% up to 400% – 9.5%</p>
<p>This is set by statute so the amounts and percentages are pretty much fixed – see [26</a> USC § 36B - Refundable credit for coverage under a qualified health plan | Title 26 - Internal Revenue Code | U.S. Code | LII / Legal Information Institute](<a href=“http://www.law.cornell.edu/uscode/text/26/36B]26”>26 U.S. Code § 36B - Refundable credit for coverage under a qualified health plan | U.S. Code | US Law | LII / Legal Information Institute)</p>
<p>The statute specifies that “the applicable percentage… shall increase, on a sliding scale in a linear manner, from the initial premium percentage to the final premium percentage specified” for each income tier. </p>
<p>(“Linear manner” means the math should be easy --it’s just a matter of calculating ratios. For example, at 225% of FPL, the number would be 7.175%; 225% is halfway between 200 and 250%, and 7.175% is halfway between 6.3% and 8.05%)</p>
<p>Interesting chart Calmom. </p>
<p>Household Size 100% 133% 138% 150% 200% 300%400% </p>
<p>1 $11,490 $15,282 $15,856 $17,235 $22,980 $34,470 $45,960</p>
<p>So it jumps up to the full percentage between 23k and 34.5k (6.3 to 9.5%).</p>
<p>With the premiums being really low for the young, the poorer young people might feel like they are not getting a discount/subsidy unless they live in an area where the young people’s premiums are also high. </p>
<p>The older people who make the 400% cut probably always qualify for a discount.</p>
<p>Let me add one more level:</p>
<p>400% - 425% – up to 25% of income</p>
<p>[Health</a> insurance now costs $16,000 for average family - NBC News.com](<a href=“http://m.nbcnews.com/health/health-insurance-now-costs-16-000-average-family-6C10960584]Health”>Health insurance now costs $16,000 for average family)</p>
<p><a href=“http://www.ncsl.org/research/health/health-insurance-premiums.aspx[/url]”>Policy Research;
<p>"400% - 425% – up to 25% of income "</p>
<p>Snarky comments aside GP, if you are exceeding 9.5% of your income, you are allowed to go with catastrophic insurance. If you choose to spend 25%, then you must be valuing the insurance at that level.</p>
<p>Frankly, I would not spend 25% income unless I have medical bills reaching that level where the spend equals return.</p>