<p>LF, my point is plenty of the subsidized are going to pay deductibles they can’t afford.</p>
<p>GP, thanks. So you can still see your preferred providers. Sure, you’re paying more than people who don’t need those providers in their network, but that makes sense because those providers are very expensive. I mean, if you bought a Cadillac, you wouldnt be surprised or upset that it cost more than a Chevy, right? And obviously the higher price for that access is worth it to you. So I’m confused about why you’re so upset.</p>
<p>Obviously, my point was you misquoted her, entirely.</p>
<p>LasMa, the reason why I am upset is because many people, unlike me, are stuck in the individual market and have no way of choosing a policy with an adequate network. Now maybe our definition of “adequate” is different but the individual policies in this new Obamacare world have networks that are not sufficient for my requirements. I was able to escape the individual market but I was probably the exception not the rule. I also fear that sometime in the future, group policies will also come under the same restrictions as we have seen with individual policies.</p>
<p>You can call it Picasso healthcare or Cadillac insurance or whatever, but for me it was the type of insurance I have had my entire life. I didn’t feel like I was particularly privileged or any more advantaged than most other people. But I am not surprised there are posters (who are probably ideologically inclined to think a certain way) who think I was somehow gaming the system for the last 25 years at the expense of the poor and the sick.</p>
<p>Dietz, if the LLC=you + your husband, then one way or another you can deduct the full costs of health insurance premium you pay for your coverage. I Googled “llc health insurance deduction”. It gave me a TurboTax article - here: <a href=“Deducting Health Insurance Premiums If You're Self-Employed - TurboTax Tax Tips & Videos”>Deducting Health Insurance Premiums If You're Self-Employed - TurboTax Tax Tips & Videos;
<p>That article says:
</p>
<p>If you get a K1, I’d think you are “partners”-- but either way the money is subtracted out. </p>
<p>So if your premiums go up to $2200 a month, that’s a $26,400 tax write off for you. Are you sure you aren’t eligible for any subsidies after factoring that in as well as other AGI-reducing deductions (401K maybe?).</p>
<p>I’d add that as long as I was Googling, I also checked for doctors in Santa Cruz county and it was pretty easy to find some medical groups that accept one or more of the new plans. I realize that those may not be the doctors you prefer – but my point is that if people buying ACA-compliant plans will have a doctor if they need one. </p>
<p>My own doctor has now notified me that she is not going to accept Covered California plans… so I plan to change doctors. But that isn’t really a situation that is forced on me. I am unlikely to meet my deductible in anycase. I just wrote a check for $335 to my doctor for 3 doctor visits-- one from last June and two this year.(The reason for the delay is that the doctor didn’t get around to billing for the June appointment until now). June was $117, adjusted down after insurance processing from $150 (in-network) – a similar appointment in January was $122 (out of network), also adjusted down from a $150 bill. So basically if I keep my old doctor I’ll pay about $5 more per visit than I would under the old plan. The doctor is not balance billing – that is, the doctor is honoring the insurance company adjustment. The insurance company has applied the 2014 charges to my deductible-- so going out of network doesn’t seem to impact me much as far as meeting my deductible. These charges would increase my potential total maximum out-of-pocket – but that’s a pretty remote possibility given that I haven’t even met an insurance deductible in 26 years – in any case, even if I get very sick, I’m unlikely to run up huge bills with the local GP. I’m sure any serious illness would require a specialist of some sort, and I’d just pick from the current list of in-network doctors. I’ve already found a large medical group that accepts both Blue Shield and Health Net-- so I don’t really see a problem with lack of “choice”.</p>
<p>In fact, when it comes down to it, my biggest barrier is too much choice. With my current doctor it’s easy – she opened up a practice in my town about a dozen years ago, right after completing her residency - and she is the only doctor in town, except for the pediatrician. Given that I’m healthy, it really doesn’t matter; a nurse practitioner could probably handle pretty much any issue I’ve ever had to date. </p>
<p>But if I switch, then I have to go through a very long list of doctors and options from Blue Shield. Should I go with a family practitioner or an internist? If I go with the large medical group I found, the internists are on the 3rd floor but the family practice doctors are on the 4th floor, and either way I have to pick which doctor I want from a web page with photos and little bios of each,and there are at least a dozen doctors accepting new patients to choose from. Of course they all say very nice things about themselves. Some of them even made little videos. I think I’ll go with the internist who says she specializes in women’s health and menopause, as those are about the only two things I can find on the web site that seem to apply to me.</p>
<p>It’s not the internist or general practitioner I am worried about. It is the catastrophic illness which no one is immune from which is the real reason why I buy insurance. Sure, I could probably find some specialist to treat me or go to my local hospital if I have a serious condition, but I and many other people prefer to choose doctors and/or hospitals based on their experience dealing with particular diseases, recommendations of people I trust and treatment modalities which may not be available or properly discharged by local providers (or providers in the Obamacare network) because they have little experience with the particular condition. </p>
<p>Now if you believe you can get the same quality of care from anyone you see regardless of experience, credentials, or particular skills, then you would probably like Obamacare or be perfectly happy with a HMO. I don’t believe this. I think medical care is no different than anything else. There are great physicians, mediocre ones and lousy doctors who I wouldn’t let them touch me with a 10-foot pole. If anyone in my family gets very sick, I will exhaustively research all my options to ensure my family member gets the best care possible. As I do my research to find the best care, I do not want to have worry about having my choices restricted by a limited network.</p>
<p>Now Calmom does not seem to be as concerned about this as I am. Great, I have no problem with that. It’s a free country (at least it use to be); she can do whatever she wants. My problem is when she and other posters, because of their ideology or beliefs, attempt to force their preferences on me. Now I have a problem with them and will do everything in my power to ensure they can’t impede my choices or restrict my freedom to pursue my prerogatives. Apparently, we have two very different visions of the country we want to live in.</p>
<p>Based on what I know, not everyone gets lower deductibles when they get subsidies.</p>
<p>One can play with this on healthsherpa by using an income chart with various poverty levels. A reasonable PPO type silver plan will show you close to full deductible when you use 250% poverty level and almost 0 at 100%.</p>
<p>So a family with an income between 250% and 400% may get subsidies but no reduction in deductibles or max out of pocket.</p>
<p>Unless one family member has some kind of medical event, we never meet our deductibles which are currently at $2500/pp. And, that is always a blessing because it means no one got sick. In fact, the largest sum of our health care (CARE not insurance) goes to providers like chiropractors, massage therapists (who are really PT’s), and acupuncturists. H is currently seeing an out of network concierge Dr who is doing wonders for his weight, ‘numbers’ and overall well being. He says she’s 50% MD, 25% behavioral counselor and 25% listener of the ‘ain’t it awful’ tales. </p>
<p>A few years ago when our Suburban rolled onto its roof after hitting black ice - and no one was seriously hurt…it was off to the cranial sacral therapist. S recently flew over the handle bars during a team bike race at college. After following all the precautions in relation to possible concussion (he was fine)…off to the massage therapist he went. I sent D to a body worker twice every other week during her first two years at college - she was having obvious stress issues and they were manifesting in all sorts of physical/structural ways. Other than the concerige Dr (who offers some very affordable package deals) the typical visit for these therapies runs from $25 at the local acupuncture school to $100 for a 90 minute home visit by an excellent body worker. My office co-pay is $50 and that is only for the first 3 visits…then it’s the negotiated amount until the deductible is hit. So, it’s cheaper to stay healthy with these other modalities. (before anyone says it…no…none of this will prevent cancer or other financially catastrophic illnesses).</p>
<p>All of this is completely, voluntarily and without griping out of pocket. I am certain this behavior has kept us out of the ‘real’ doctors office for many many years. Why does this matter…because frankly, with the increased premiums we will have to cut down on the behaviors which have been a big part of why we have not needed much standard care.</p>
<p>Wish we had been talking decision points like these before, rather than the balls that were lobbed. Dietz, as hard as it is for you to weigh, the less aware guys have to be even more confused. You may get a tax benefit/write down, you may decide a higher deductible works to keep premiums manageable. (And keep an eye on co-insurance rates.) But we don’t know what our various incomes are, family details, exact plan options another person has- and their level of medical certainty. Or what may or may not happen in the next year.</p>
<p>I was comfortably (not perfectly) certain when I picked our plan. Who could know one would then have a suspected heart murmur and the other needed GI tests. Or that I’d need all the testing I do, which will take me up to deductible. But I looked at the deducitbles and coinsurance that would work with what I knew or suspected, at the time. And what I knew or suspected could come out of our income, should something happen. If both girls get jobs with insurance, a lower deductible may look good.</p>
<p>This is all different than quoting some lady (or ten people,) somewhere or telling the crowd they don’t have choices.</p>
<p>My mother has always wanted “the best” doctors- and I can tell you real life doesn’t always work like that. She refused, for years, to use the local hospital and would trek 60 miles through traffic up to UCLA, where, in the end, those folks are as human as the next. Maybe you do want them for some rare and intricate procedure. But when the local hospital saved her life after an odd heart attack, she kept saying how smart they wore, raving about the docs and nurses, everything, wondering why, with all her smarts and medical savvy, she didn’t realize they were also trained, certified, experienced and caring.</p>
<p>When I had emergency surgery, there was no time to vet docs. (Big snowstorm and they called in the closest guy on call that night- turned out to be great.) When my mother had a GI procedure, the best doc in town was away and one of his younger MDs stepped in. She picked the “best” female cardiologist in this area, someone with high commendations and significant research-- and the woman missed signs my mother was in urgent need of cardiac surgery. A different doc spotted it, scheduled her- and completely changed her quality of life.</p>
<p>Anyway, I am off to the med school. </p>
<p>GP, did you see my second question for you which I posted last evening? I’m interested in your response. </p>
<p>“I mean, if you bought a Cadillac, you wouldnt be surprised or upset that it cost more than a Chevy, right?”</p>
<p>Pre-ACA it wasn’t a Cadillac. It was insurance. This is nice summary of Obamacare issues. Of course, I realize they don’t matter a whit to people who seem to think the overall numbers of insured increasing is a win somehow, despite the losers pain. There are many reasons to dislike ACA and since the majority does dislike it for one reason or another this should be obvious. Most of it is not delayed because it’s so wonderful. And, the vast majority is unaffected. Now, if employer plans were scrapped and everyone was in this ACA entanglement that would be interesting.</p>
<p><a href=“Cold Realities Lie Ahead On ObamaCare's Costs”>http://www.forbes.com/sites/gracemarieturner/2014/04/22/cold-realities-lie-ahead-on-obamacares-costs/</a></p>
<p>Well, the good news is I have something completely different to worry about today. The California Tax Board is sending back - in the form of a refund check (!) the funds due (and paid!) for the first quarterly 2014 estimates. This is also happening to both MIL’s. Gotta run and grab the checks from the 90 year olds before they cash 'em and then the State will add a penalty to something which was paid on time. Geez…seems like we just can’t give money away today.</p>
<p>And, I guess the Franchised Tax board is taking a lesson from Health Insurance companies…no live body/voice to be reached…please leave a message and we will get back to you w/i 24 hours…well…unless we don’t and in that case please call again. Heavy Sigh</p>
<p>Sorry to hear about the Franchise Tax Board’s screwups, dietz. If it’s not one thing, it’s another.</p>
<p>Aetna CEO sez:
</p>
<p><a href=“http://www.washingtonpost.com/blogs/wonkblog/wp/2014/04/24/aetna-late-obamacare-changes-account-for-half-of-2015-premium-increases/”>http://www.washingtonpost.com/blogs/wonkblog/wp/2014/04/24/aetna-late-obamacare-changes-account-for-half-of-2015-premium-increases/</a></p>
<p>In some states, Aetna is selling off-exchange only. In other states, it is selling on the federal exchange. Aetna doesn’t seem to be selling in any states that have state exchanges.</p>
<p>actingmt, it was insurance which included providers who were, and are, astronomically expensive. Most of us don’t feel the need for that kind of coverage, and shouldn’t have to pay for the ultra-expensive taste of a few. For those who do have that taste, the coverage is available, at extra cost. That’s free-marketism. I’m not sure why it’s outrageous that those who want a more expensive product should pay more than those who don’t want that product. </p>
<p>Dietz, yikes! My 90-yr-old mom hid In a refund check in her underwear drawer and I didn’t find it for 6 months. 
</p>
<p>What are these coops ACA is supposed to have created to increase competition?</p>
<p>Texas, are you referring to the ACOs, or something different?</p>
<p><a href=“http://www.chrt.org/public-policy/policy-papers/aca-co-op-plans-analysis-of-2014-rates/”>http://www.chrt.org/public-policy/policy-papers/aca-co-op-plans-analysis-of-2014-rates/</a></p>
<p><a href=“http://www.examiner.com/article/co-op-health-insurance-plans-great-hope-of-affordable-care-act”>http://www.examiner.com/article/co-op-health-insurance-plans-great-hope-of-affordable-care-act</a></p>