<p>dstark - no it doesn’t. My prescription coverage is capped at $500 per plan period. I’d probably just keep the plan if the $2000 cap applied. I’ll never see another cap like that.</p>
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<p>I have 4 friends who are doctors. </p>
<p>One moved to teaching and he told me that ACA does not affect him.</p>
<p>Another one is in internal medicine and is part of U of MN hospitals. She told me that ACA does not affect her. She also told me that she probably should have just gotten PA degree. She is an immigrant and did not have any help from parents to pay for medical school. She moonlights by being on call in part due to having student loans.</p>
<p>The other two are specialists and they are telling me that they are affected by ACA. Reimbursement rates have gone down substantially since ACA was passed. </p>
<p>One told me that he is thinking of scaling down his lifestyle (which by no means is lavish) and not work as hard. He feels that it is not worth it for him to sacrifice his family time for low re-reimbursements. He is almost done with paying his medical school loans. </p>
<p>Another one is also affected, but he does not have a choice regarding scaling down (2 young kids, student loans and SAHW who sacrificed her career by constantly moving with him). He is thinking of moving from CA to Texas though. He told me that the wages for his profession are higher in Texas.</p>
<p>Cartera45, but you cant keep that plan because of the inadequate drug coverage. How much is an ACA plan going to cost you?</p>
<p>Bay, the high risk plan in Calif is inadequate. The coverage is too skimpy and the premiums were higher than other plans. </p>
<p>People read my posts and think I am making political arguments because they make political arguments and I disagree with them. This is my political party. The party of whatever works. That is my party. I dont care about the politics so you fellow posters can stop projecting yourselves on me. ;)</p>
<p>The high risk plans in Calif have precondition issues. They have waiting lists. The premiums can be high. There is an annual cap of $75,000 and a lifetime cap of $750,000. </p>
<p>Those caps are low. A friend’s wife had breast cancer and the high risk plan was all she could buy. The coverage at that time was $25,000. </p>
<p>Dont these plans cost the state money?</p>
<p>This is why I dont like the high risk plans.
If you have different information, I would like to see it.</p>
<p>“I was under the impression that all but a handful of states had high risk pool coverage for those with pre-existing conditions. Was your state not one of them, Hanna?”</p>
<p>My state has a high risk pool that was established by the legislature. The costs are:
“State law requires WSHIP premiums to be based on the average of what the largest carriers in the state charge for their individual plans with benefits similar to WSHIP (not on your use of health care services). Premiums cover about one-third of WSHIP’s claims costs. Health insurance carriers in Washington state pay the remaining costs of WSHIP enrollees’ care.”</p>
<p>I assumed that most other states had something similar, for people who were considered high risk.</p>
<p>Lerkin, thanks. I like that info.</p>
<p>Cartera45, </p>
<p>I talked to Blue Cross about drug coverage. The plan I was looking at had a $5,000 medical deductible and an additional $5,000 drug deductible. But… My out of pocket expense could not exceed 6300 or whatever that number is. I am talking in network now. So…if my medical expenses were 5,000 and my drug expenses were an additional 5,000 I would not pay more than 6300. </p>
<p>So, cartera45, there is no out of pocket maximum that includes drug coverage? Your drugs cost 20,000 and you are out 19500?</p>
<p>^^what kind of drugs might those be, dstark? lol</p>
<p>Lol…</p>
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<p>Yes, that is the way I read it. I may call back and talk to someone else though because the woman I just talked to with Carefirst would just read the language to me, tell me what she thought and then ask if I thought that was right. I was kind of hoping to rely on her. I can’t find my booklet so I’m looking online and it says. </p>
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<p>It says this benefit applies to out of pocket max but it also says max is $500.</p>
<p>I have a friend at work who is a contractor. </p>
<p>She had to buy high risk insurance because several years she had a mental breakdown. It was catastrophic 10K deductible policy. I assumed she would be happy with ACA so I asked her last week what plan did she enroll into. </p>
<p>To my surprise she told me that she is very conflicted about her situation. Her plan is cancelled as of January 1st, 2014. She looked at mnsure.com and she was not sure which plan, if any, suits her needs. She was planning to talk to a navigator to help her figure out what was best for her. I told her to also contact MCHA to see if she could still buy high risk policy from them if none of the exchange plans suit her. I don’t know what she decided. I will probably find out after Thanksgiving.</p>
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<p>Cancer drugs. For example, IPI is priced at $120K per dose. At least it was in 2012, maybe now a bit cheaper.</p>
<p>My son’s Remicade for Crohn’s disease is about $24,000/year. He’s been on it for five years and will be until something else is invented or he loses insurance which is less likely now.</p>
<p>Synthetic human growth hormone --$9500/month</p>
<p>“I was under the impression that all but a handful of states had high risk pool coverage for those with pre-existing conditions. Was your state not one of them, Hanna?”</p>
<p>In my state, the number of participants was capped, and they weren’t accepting new enrollees when I explored it. So I don’t even know the details of what was available to those who did enroll. (I’m guessing that it would have been much better than nothing, but not necessarily good enough that I could feel safe leaving my day job voluntarily.)</p>
<p>Wellspring, best wishes to your son. At least the prospect of not being able to get insurance is off the table now. </p>
<p>Crohn’s is such a tough disease to have to deal with. A cousin just went through his 2nd major surgery (first was when he was in college about 10 years ago.) He was doing very well, considering, until this last episode which prompted the surgery and several weeks hospitalization. And he missed the birth of his second child.</p>
<p>I think the high risk insurance dstark referenced was an old plan. The federal govt provided a high risk pool for every state after passage of ACA to be phased out by 2014. The coverage had no caps and was reasonably priced. Interestingly, for the first year or two very few people enrolled, probably because it was hard to qualify for the plan. I think last year or in 2012 the govt closed the pool because it was far more expensive than it had projected. </p>
<p>There is no question these high risk pools are expensive to maintain but I think it would have been a better solution to impose a tax on the populace to provide funding for them, then to have this massive disruption in the insurance market caused by ACA for millions of Americans</p>
<p>Cartera, get rid of your policy. A $500 max for drugs is ridiculous. It is unbelievable for your insurance company to have a $2,000 out of pocket maximum for drug coverage and then limit the benefit to $500. How does that make any sense?</p>
<p>“This is my political party. The party of whatever works.”</p>
<p>I’ll join this party but something tells me we might have difficulty agreeing on what it is that is working. :)</p>
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<p>I believe it was something like 35 or 37 states that had high-risk pools. Most of the state high-risk pools were woefully underfunded. Many were quickly oversubscribed and not open to new enrollments or had long waitlists to get in. Many had low annual or lifetime caps or severe limitations on the kinds of services and procedures they covered. They were a band-aid on a very serious problem. Being by definition confined to high-risk, high cost participants, they couldn’t come close to paying for themselves out of premiums charged to the enrolled participants, and state legislatures didn’t want to be responsible for the difference out of general fund revenues, so they tried to pass the cost on to health insurers through special taxes or “assessments,” usually calculated on a per-policy basis. This met with resistance not only from the health insurers but from their paying customers. As a result, the assessments were set so low that they could never come close to providing adequate coverage to participants in the high-risk pool (who were nonetheless eager to take what little they did get, which was more than they could get from the insurance companies). States are by and large happy to close their high-risk pools which turned out to be a big financial drain that still left everyone unhappy.</p>
<p>Minnesota was one of the few states that fully funded its high-risk pool. It did so with periodic general fund appropriations, plus some big infusions of cash from tobacco settlements. (But then we’ve always had a strong strain of Scandinavian-style social democracy up here). I’ve heard there was one other state that had a well-funded high-risk pool, but I forget which.</p>
<p>bclintock, the federal govt set up high risk pools for every state in 2010. They had no caps and were reasonably priced. See my post.</p>