<p>I believe there is a plan in place to buy just catastrophic insurance on the exchange program</p>
<p>Here’s some questions I was asked today:</p>
<p>If a couple is going to have a baby. She is covered through her employer and he owns a small business which covers him and four other employees. Adding the baby to his plan will greatly increase the premiums for all since a small business pays for an average. We don’t know yet if her employer will add the baby. Let’s assume not.</p>
<p>Can the baby buy health insurance through the exchange? The question asks if they are covered by their employer and the answer is no.</p>
<p>I never had a catastrophic situation…until I did. One incident, emergency surgery, two of them. Medical charges (60k+) exceeded all the premiums I had paid for 15 years. I paid a pittance for the emergency, under $100.</p>
<p>So you pay “what?” for 3 months of coverage?</p>
<p>We got past the part about not understanding- much was clarified here and a chunk of info simply won’t show up til Oct 1. Then we’ll see. My state has staffed up hundreds for phone support. My bcbs reps have been able to explain increasingly more, as we approach 10/1. Over this thread, there have been many pointings to core info.</p>
<p>We’ll see. But neither the availability nor one’s personal feelings about the nature of this new healthcare should prevent one from making wise and sane decisions for themselves and dependents.</p>
<p>Why wouldn’t her plan pay for the child? It doesn’t cover dependents? [deleting the rest.]</p>
<p>Because not every employer offers health insurance to anybody in the family besides the employee. That’s why he buys his own through the company. Hers does not cover even her spouse.</p>
<p>I would expect that the mother’s employer will cover the baby if she pays the family plan premium rate rather than the individual rate the next sign-up time. ( Pregnancy costs should be covered now.) And because both parents do have employee covered insurance, my best guess would be no, they cannot buy a policy for their child through ACA.
The baby is a dependent and cannot purchase insurance, in any case.</p>
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</p>
<p>Is this because she chose an individual policy instead of a family one, or are there no other plans available?
If there is no availabable “family plan” for either spouse from their employers, then my understanding is that they can purchase a family plan to include one of them and the baby, or all of them.</p>
<p>Her employer’s medical insurance will cover the baby if they offer a family plan (and I don’t know of any employer whose medical insurance doesn’t offer a family plan but I suppose there could be some.) </p>
<p>edit: just saw your post that she does not get family coverage. He will have to put the baby on his and yes, the premium will increase or he can go to the exchange and get a family plan. </p>
<p>I also had an unexpected medical emergency (viral meningitis.) I was a perfectly healthy 36 yr. old. Hospitalization and treatment came to about $40K. Fortunately I have excellent coverage and I don’t recall getting billed anything.</p>
<p>If you are a younger person, healthy, making a modest income, and with no assets for the hospital collection agencies to go after, you’re going to pay the small penalty and not get the insurance.</p>
<p>People who gamble by not buying some kind of catastrophic insurance really are betting the bank. It’s just as foolish as driving without insurance, imo.</p>
<p>My biggest concern about ACA at this point is the provider lists. My Dd has insurance now with Anthem/Blue Cross, but I see that the Bronze and Silver Plans are considered HMO plans, which indicates to me that they will have a reduced provider list. This isn’t a surprise I suppose, as HMOs have been in the picture at the low end for a long time. What matters is seeing just how limited one will be. Whether it’s worth paying more will depend a lot on where and how many doctors she’ll have access to.<br>
When will this information be available? There is no mention of it on the California (CoveredCare) website.
And will she have the option of staying on her current private plan? It’s a lot cheaper than either the Bronze or Silver, but the coverage is much less comprehensive.</p>
<p>This may be a really obvious question – but for those who have been following this closely – is there a website you can go to and see what plans are available in your state from which companies at what prices and then see how they are priced for individual vs. family? Interested in NYC mainly. When I do a google search it takes me to the NY state site but I don’t see price listings - just discussions of how affordable this will be - and I have to imagine there will be a huge variance in cost and providers available between say NYC and Syracuse.</p>
<p>TatinG, there are some who may think like that. My kids are building a career and
a credit rating. Skipping out on a $50,000 hospital bill would not help their cause.</p>
<p>Tatin, if you want to risk good care to save a few thousand for a few months, go for it. I just hope no innocent young will have to follow this craziness. </p>
<p>And I do mind the attitude that you can just ditch the charges, leave them to the system (aka all of us) to cover for you.</p>
<p>aj- google healthcare and ACA and whatever. Also Kaiser Family Foundation, Healthcare.gov. Etc. Try exchange and your state name. We went over all this, painstakingly, with much provided by calmom. Full details are not available yet. I hate to say read the thread, but we hashed out so much-- and came through it.</p>
<p>aj725- In California, we do. [Get</a> Covered | Covered California?](<a href=“http://www.coveredca.com/shopandcompare/]Get”>Shop & Compare Health Insurance Plans | Covered California™)</p>
<p>It does have some general comparisons, and you can get a good indication of coverage and cost from the various insurers. (We have four, apparently.) What it doesn’t tell you is where you have to go to get the coverage. There is no Provider List, like you find when you buy private insurance on the web. I hope this will change when the enrollment period begins, or it’s pretty useless.</p>
<p>This took about a second: [Tax</a> Credit and Premium Estimator | New York State of Health](<a href=“http://www.nystateofhealth.ny.gov/PremiumEstimator]Tax”>http://www.nystateofhealth.ny.gov/PremiumEstimator)</p>
<p>Download it, enable editing and go.</p>
<p>“My overall impression on the ACA is this: if this group of well-informed, educated people are having a hard time figuring out the ACA”
-I do not include myself in this group. I do not claim to be well education and well informed at all. I have figured out ACA before it was sign in. It is a temporary set up designed to collapse private insuranse companies so that the health care is rolled into nationalized system. Very much familiar with this one, very much in line with collapsing everything else. The details are not as relevant as the the general idea. People will work it while it is workable. It is completely unsustainable by design.</p>
<p>aj, </p>
<p>go to this link:</p>
<p>[New</a> York Health Benefit Exchange Plans](<a href=“NY State of Health is the #1 Place to Shop Health Insurance”>NY State of Health is the #1 Place to Shop Health Insurance)</p>
<p>a chat box will also pop up so you can ask the customer service person if you have questions.</p>
<p>More info from an insurance company (anonymized by me):</p>
<p>Many may wonder why they can’t just have the same health plan they’re already enjoying. As you know, the Affordable Care Act (ACA) has meant many changes. It’s a good idea to review some of the most significant ones that are driving changes in health plans.</p>
<p>All small group and individual health plans must include the 10 essential health benefits. </p>
<p>Many plans in the past included some, but not all, of these benefits.</p>
<p>Four levels of coverage may be offered. These are often referred to as “metal levels” or “metal tiers” and they specify how costs are shared between health plan enrollee and health plan provider. In our state, there will be three levels of coverage offered in the market: Bronze, Silver, and Gold.</p>
<p>Catastrophic health plans are no longer available to most people. They can only be purchased through our state’s online exchange marketplace—by someone younger than age 30 or someone who qualifies for a financial hardship.</p>
<p>Health insurance cannot be denied for pre-existing conditions. This rule has been in place already for children, and takes effect for adults in 2014.</p>
<p>I’m just saying that people will always make choices that are in their best financial interests (or what they perceive to be their best financial interests at the time). </p>
<p>People without assets dodge auto insurance rules and still drive and the rest of us pay. People use every tax deduction and credit so that 47& pay no federal income tax and still get federal services. </p>
<p>It will be the same with this law too.</p>
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<p>Your first sentence is incorrect, and your strategy will not work. Luckily, they’ve anticipated that some people would think they could hop in and out of the insurance pool in this manner, by creating a short open enrollment period every year. (It will be extended for the first year only.) So let’s say you decide not to get insurance during open enrollment, and a week later, you go to ER with an expensive injury. You will NOT be able to get insurance at that point.</p>
<p>"People without assets dodge auto insurance rules and still drive and the rest of us pay. "
-We drive by choice. We cannot exists without our bodies. Out bodies get sick. Some of it by choice, lots of it not. The comparison between car insurance and health insurance is NOT valid. We are NOT given option of NOT having a physical body, there is no choice. I did not drive for many years, our car (only 1 for both of us) was insured. If I was single, then I would not have a car, I would not have a car insurance either. Driving is a choice.</p>