Under the old system, most people eventually became individually uninsurable after their first significant pre-existing condition, so they could not get any individual coverage at any price (basically needed to be in an employer plan, Medicare, or Medicaid). Too bad if you wanted to retire early or become self-employed…
Think of the extra cost for currently healthy people as a premium to insure insurability.
People on Medicare or disability may not have to worry about copayments or deductables but at that income level have to worry about other costs.
Would you like to live on their income level so that you can qualify for Medicare? Trade them for a disabling condition?
I think you are confusing Medicare and Medicaid. Medicare has a small ( around $135, IIRC) deductible and a copy. It is for people over 65 and disabled people on social security disability. Medicaid is for low income.
@kkmama Of course no one wants to trade their income level.
However, it is a bit weird that someone like @consolation and family needs to avoid any medical treatment because of a “per person $15,000 deductible” while paying $400 a month. If their family had 2-3 family members with any sort of chronic issues, can you imagine how much they’d be paying out each year? I don’t know the Consolation family income, but few can afford to pay out $50k per year in medical expenses.
It just seems strange that a “payer” still wouldn’t really have access.
How is your DD?
I’ve been on and off Medicaid for years. Every time it happens, I have to change doctors. That sucks. It also causes issues- like I just got a $400 medical bill from 2014 because they had me on file as having Medicaid (which my doc doesn’t take) when I was really on private insurance. But it’s the constant jumping back and forth that leads to that.
Anyway, even on Medicaid I had to pay for certain things. Not everything was covered.
Many doors are simply closed to you if you’re on Medicaid rather than private insurance. I’ve never, ever had access to something on Medicaid that I didn’t have while on private insurance.
I don’t think 15k deductibles exist anymore. At least not on the exchange.
It usually pays for those of us who pay for our insurance deductibles to have surgeries scheduled for the beginning of the calendar year…then if anything else comes up the deductible has been met.
There are plenty of people who pay more in homeowners insurance because others have had weather related claims. Insurance can be affected by the coverage of others.
Why even bother buying a SUBSIDIZED cow, if you can get the milk for free?
<<<
It usually pays for those of us who pay for our insurance deductibles to have surgeries scheduled for the beginning of the calendar year…then if anything else comes up the deductible has been met.
<<<
Yes, many strategize for that sort of thing. If we KNOW that we’re going to have a pricey procedure (like H’s upcoming second hip replacement), we’ll get it done at a time that maximizes our insurance.
I've been on and off Medicaid for years. Every time it happens, I have to change doctors. That sucks. It also causes issues- like I just got a $400 medical bill from 2014 because they had me on file as having Medicaid (which my doc doesn't take) when I was really on private insurance. But it's the constant jumping back and forth that leads to that. <<<
[/QUOTE]
Yes, the back and forth (on and off medicaid) would do that. The woman that I know has been constant for decades, so no “on and off.” She’s used the same doctors for a long time, except when one retired…but we all face that situation now and then.
I don't think 15k deductibles exist anymore.
[/QUOTE]
I have no idea. I have never had private insurance. I’ve always had group insurance. @consolation What are you dealing with now? And, what was that? Private insurance?
@mom2collegekids - Why does your housekeeper allow her 30 year old, able bodied son to continue to live in her house?
My son dropped out of college at age 20 and laid around on the livingroom couch for 2 months doing nothing. In July, I gave him the choice of returning to school, getting a job, or moving out by September 1. He went with the job.
If your housekeeper’s son is truly able bodied and employable, then it is not the possibility of free health care at the emergency room that’s de-incentivizing work. It’s the free room and board courtesy of mom that’s the problem.
I think that one thing that was kind of assumed along the way with ACA is that parents would have given unproductive offspring the boot by the time they reach age 26.
<<<
Why does your housekeeper allow her 30 year old, able bodied son to continue to live in her house?
[/QUOTE]
Very good question!!! It’s one that I have gently asked (have to be careful when asking such Q’s). On one hand, he drives her crazy (they fight a lot), and she wants him to move to Texas (his preferred location), but on the other hand, she says that she’d worry that he would “end up on the streets”. She has a good heart, but gets taken advantage of by both sons (another one is moving back home, but he does work). The lazy one is very verbally abusive to her; she’s arrived at my home in tears after one of his nasty verbal onslaughts.
She is under the impression that in this state you have to “evict” someone from your home (after they have lived there) if they won’t leave voluntarily. I’m not sure that is true or not. He doesn’t pay “rent”, he has no lease. She told me that the eviction process takes a few weeks and she worries that during the process he would just make her more miserable as a punishment for the “eviction”.
<<<
If your housekeeper’s son is truly able bodied and employable, then it is not the possibility of free health care at the emergency room that’s de-incentivizing work. It’s the free room and board courtesy of mom that’s the problem.
[/QUOTE]
Oh gosh yes! I didn’t mean to suggest that I thought that he wasn’t working to get occasional free healthcare. He is able-bodied…he doesn’t have many healthcare needs. I was just wondering how people like him are supposed to be covered in an atmosphere that everyone is supposed to be covered.
Yes, his mooching situation is no different than another situation that I knew where the H hadn’t worked in years, just sat on his bed watching television or playing Nintendo. He lived in his own bedroom because he smoked constantly…so much that his bedroom ceiling turned BLACK. In that case as well, the upset working wife enabled it by not demanding more or kicking him out.
One of my younger brothers was just diagnosed with inoperable stage 4 throat cancer. Being a lifelong smoker (age 15) and very heavy drinker makes one more susceptible to squamous cell cancer. He has no insurance; refused to pay for Obama Care. Well, it has bitten him in the butt since he had no money or coverage to see a doctor until he had tumors so large he couldn’t eat. He has been declared indigent and a local hospital is providing care. He now grouses about having to provide financial info so he can get treatment under Medicaid.
Right after he was diagnosed, his boss closed three of the four locations of his business, including the one my brother was managing. He qualifies for SSDi under COmpassionate Allowance and probably SSI, though that paperwork is in the early stages.
I am trying to make sure my 22 yo niece (still in college) and her 19 yo brother (about to start) don’t get hosed by the strict estate recovery provisions under GA law.He lost his job, business, wife and kids die to his drinking, so there is really not much left in terms of assets – with the possible exception of a life insurance policy, which he refuses to confirm or deny. He was supposed to carry coverage after the divorce with the proceeds to go to his kids.
Oh, and he wants to marry his GF later this year. I am playing legal sleuth trying to figure out what the advantages/pitfalls are. My hope is to keep the GF and the kids from getting hosed.
If S2 hits 26 and doesn’t have a job that provides coverage, we will probably pick up a policy for him. We are too risk averse to let him go without.
@countingdown Sorry to hear about your brother. Sounds like a very upsetting, but also very frustrating situation for all of you. You’re a good person to try to make sure that others won’t somehow get screwed by all of this.
That’s how it was before we became protected by law. The insurance companies could do pretty much anything they wanted to, and subscribers had no recourse. For example, our case. We first got our Anthem (back then, Blue Cross) insurance more than 20 years ago. We were younger, we were healthier, it was pretty cheap for pretty good insurance. Then each year we’d get hit with increases that were almost always in the teens, sometimes in the 20s. Every few years, we’d have to step down our coverage a bit in order to keep premiums affordable. Co-pays and deductibles got bigger and bigger and bigger over the years. Premiums went up and up and up. Right before the law kicked it, we had to pay every dollar out of pocket until we reached our huge deductible. We never reached the deductible, though. So technically, we had access to that MRI. Practically speaking, it was a stretch, and we often opted not to get care that we needed.
Why in the world didn’t we switch companies if Anthem was treating us so badly? Pre-existing conditions. Before the law, if we applied somewhere else, we would have been underwritten. By the time Anthem had painted us into a corner, DH had a preexisting condition which would have doubled or tripled his rates, and D had a preexisting condition which made her uninsurable. So Anthem could do anything they wanted to our rates and our coverage, knowing we couldn’t get insurance anywhere else, and there was nothing we could do about it. Under the new law, we can switch carriers every year if we want to, with no underwriting. Also under the law, insurers have to spend 80% of the premiums they take in on member health care. They can’t – as Anthem did one year – spend less than 65% of premium dollars on healthcare and then turn around and build a lavish new headquarters building. Also under the law, insurers can’t kick people out if they dare to get an expensive illness, which they used to do. In other words, they have to deal fairly with us.
You sound like someone who’s never had to worry about financial ruin if someone in your family gets sick. Consider yourself lucky, and understand that millions of us used to lie awake at night wondering if we could afford to take our sick child to the doctor. ACA is not perfect, not by a very long shot. But it has been life-changing for a lot of people.
“People on Medicaid may in fact experience few concerns about seeking care–I don’t know–but I do know that it is very, very difficult for an adult to GET Medicaid.”
This is how it was before ACA. If you were an adult without minor children, it was difficult if not impossible to get medicaid. Single or married, not disabled, not medicaid eligible. Now in the 26 states that have expanded medicaid, single or married adults without children qualify based on income. In all states adults can buy insurance, but if you are low income you won’t qualify for ACA subsidies. The system was designed for all states to expand medicaid but when the Supreme Court said it was up to the states, the ACA wasn’t changed so now there is a big donut hole for all those people - 24 states full of people with no medicaid and no subsidies for those below the poverty line.
The qualifications for medicaid are set by the states, even though the federal government pays 50% of the cost, except that the feds by 90% for those added by ACA expansion. What is covered also varies wildly by state and the reimbursement rates do too. Most states base it on income, not assets so owning a house or car will not exclude you. Income is what matters for SNAP too and most other aid programs like LEAP (heating assistance), free internet or cell phone, bus passes.
Agree with others that just because people don’t pay their hospital bills doesn’t mean they aren’t billed. Other options for people without insurance? Urgent Care, places like Walgreens and CVS with clinics, but they are going to be billed $35-??? for the treatment. Medicare is not all inclusive either. There is a $500 deductible for hospital stays. My parents pay almost $300/mo in Part A and B premiums (each), have a $20 co-pay for the regular doctor and $40 for specialists. They pay a lot for prescriptions and a copay for physical therapy.
Who pays the hospital bill? WE DO. My daughter went to the ER because she passed out (not drinking, not a big deal). The visit with the doctor was about $500, but they took a chest xray and it was $1200 just for the xray. Out of network, my insurance paid the whole thing.
Some areas of the country have had more ethical health insurance - it may be a number of factors that contribute to what insurance is available and at what cost.
There should be some affordable catastrophic insurance policies (I think some of Obama care was to help with that). However many have seen dramatic increases of their health insurance as a ripple effect from Obama Care.
I know a disabled gal (SSD and Medicare/Medicaid) with MS that moved to a different state because she could qualify for more health services, her lowish income would be below various thresholds for additional help, and there was sort of a MS community (I believe NM or Nevada). Read a magazine story that detailed the decisions and the loss of insurance, and then they lost of their home.
I 100% believe that we have had many abuses of the federal benefits and social services system, where people do not have any motivation to work because they want to be taken care of. Unfortunately we as a country do not provide enough incentives for working poor - working poor and all working households should have basic health care services just like disabled people. Public housing in our area is trying to address this (having working families or disabled people in public housing).
Until all employers, instead of hiring hourly workers and paying cash - for example construction pick up work, at least issue pay under misc income if not W-2, you are going to have individuals who have enough walking around cash to be ‘off the grid’. The problem comes in when day workers are homeless, but that isn’t the majority IMHO.
Medical bills are the #1 reason for bankruptcy. Money issues are the #1 reason for divorce.
Unless one has a good employer health care plan with reasonable premiums, health insurance is expensive.
Many people look to the protection of capped medical costs under Medicare - when they reach 65, they have Medicare and an affordable supplement to help with having decent medical coverage. As it is now, health care providers receive more with private insurance than they receive with Medicare payments for services - medical providers agree to be Medicare providers of care. The problem comes in when a doctor’s office practice has to limit the number of Medicare patients they see because the reimbursements are so low that they would not break even/make a profit/stay in business.
Over H and my 36 years of marriage, we have never had a ER visit with us or our children (now 19 and 21). When I was a kid, I had a few times with stitches and a broken leg. Yes there are times when a ER visit is unavoidable. We have fortunately always had employer provided insurance coverage with affordable premiums, capped co-pays and deductibles. However have also not taken higher paid jobs which may have been more of a risk for job loss and insurance loss - so opportunity cost for the peace of mind of the steady income and benefits.
Our local non-profit hospital has had grants to a community free clinic - where people can be seen by volunteer docs and nurses with a few paid staff (many retired but want to give back to community) - I worked for a specialty group that would see some patients and would write off their charges.
Many have made poor decisions while being in lower income households - the alcohol and cigarette consumption are two areas that jump out. However the role models in all the early years do have an effect on the patterns the kids follow.
Not expanding Medicaid was two part - one part was what it was going to do to the State’s budget (taking tax money away from other services), and one part was adding people to Medicaid that are able bodied doesn’t make sense. However the push back is that some of the hospitals and medical providers are having so many non-paying, that getting Medicaid payment versus none will help them.
Well the idea of ACA was to have medicaid fill the gap for everyone on the lower end of the income spectrum. That doesn’t work if you are not in a Medicaid-expansion state – but that’s not what was intended or expected with the original legislation.
Well I will try to ask her more to find out why she uses the word, “free.” If her son gets sent bills that are ignored, that would not be the same. I don’t think she would call it free if bills were being sent to her home.
<<
Well the idea of ACA was to have medicaid fill the gap for everyone on the lower end of the income spectrum.
[/QUOTE]
But, some here have said that adults have a hard time getting on medicaid. (I have no idea.) I can understand why it would be hard.
Not in the Medicaid expansion states – just in the states that turned down the federal money. So my son was in grad school in Washington, shifted to medicaid as soon as ACA came in. It was about 8 months after he graduated before he had a steady permanent job–so he stayed on medicaid… and then as soon as he got hired, he went on his employer’s plan. No issues, purely income based.
If you live in a state where an unemployed 30 year old can’t get Medicaid, that’s a choice made by you state legislature and governor.