It is my understanding that the ACA-initiated marketplaces are merely a means for health insurance plans to be offered to all applicants, with tax subsidies available for those whose incomes qualify them for the financial assistance. The plans themselves can still restrict coverage to within a network. At least this was my daughter’s experience when she signed up (with my help) for a plan in California.
The ACA policies are still just insurance policies. They have networks and co-pays and deductibles and limits on coverage just like any policy did in the past. All insurance policies have to be in compliance with the ACA, but as long as they meet those requirements, the company can do whatever they want.
ACA policies are not suddenly great insurance. Most have fairly high deductibles, like $2000-$5000. They are required to cover certain things by the ACA including many diagnostic tests, yearly physicals, well child care, but once the disease is diagnosed, the treatment requires the payment of that deductible. Sure, you get a ‘free’ mammogram to diagnose breast cancer, but the first treatment will cost you $2000 or more.
One of my previous colleagues described ACA insurance policies in this (twisted) way: Those policies are not meant for us who still have a job. They are for those (the unemployed, those working for close to the minimum wage and illegal immigrants) to whom nobody wants to sell insurance policies. Disclaimer: I am not sure to what extent his saying is true. (Never did he knows that I, together of millions of otherws, may rely on such an insurance.)
The way he said this is somewhat like what my child’s suitemate in college said to him: Our family never wants to shop at Walmart. It is a depressing place to be. I do not want to be around those people. (I’m proud of the reply from DS to him: This is the store my family has been shopping most of the time since my birth. – the truth is that in later years, we have upgraded to the Target, and occasionally even JC Penny.)
Um… well, this working class chick and Mr. R have been THRILLED with our exchange (BCBS) policies. It’s the first time in both of our lives that we’ve been able to afford insurance and we have had them the whole time we were working. If we weren’t working, we’d be on Medicaid.
With that said, we’re happy to be switching over to my school-sponsored health plan which is free to us. It’s a wonderful policy and a great benefit.
@mcat2 your colleague was grossly misinformed about the ACA considering some of the groups you listed can’t even get an exchange plan.
Again, based on a sample of one: my 24-year-old daughter has a plan that she purchased through the marketplace. She is not unemployed, working for close to the minimum wage, or an illegal immigrant. She earns too much to get a subsidy. But her employer does not offer health insurance as a benefit, and I urged her to get a plan because my employer-provided coverage, while still available to her, doesn’t do her much good 2000 miles away.
Illegal immigrants are not even allowed to purchase a plan on the exchange. Your friend is wrong about a lot about ACA. Not unusual since there has been a concerted effort to falsly portray ACA by certain media entities.
The discussion about the ACA reminds me of this. I learned that just because there were more patients relying on Medicaid due to ACA, several clinics in some poor side of a city in that state had to be closing (more patients the clinic sees, the higher the loss due to the low compensation rate funded by the state government), and the patients were told to go 10 miles away to another clinic to see doctors. The clinic may be more crowded now than before.
"The hospital system is the biggest provider of Medicaid in the state. Medicaid enrollment has increased significantly after requirements were expanded several years ago, Petrini said, but while enrollment has grown, funding has dropped dramatically.
According to the federal Medicaid website, as of March 2015, Connecticut has 726,253 people enrolled in the program.
David Dearborn, a spokesman for the state Department of Social Services, said that as of May, there has been a sharp increase from the 592,128 enrolled in 2012. More people than ever before are insured due to enactment of the Affordable Care Act, which expanded the Medicaid program, Dearborn said.
“This means that hospitals and affiliated services are seeing more insured patients and fewer uninsured,” Dearborn said in an email. “As more (state) residents have health coverage overall, the more revenue sources hospitals see and the less uncompensated care they have to provide.”"
Here is how it helps me. I get 12 acupuncture visits on this BCBS plan while it was not covered before ACA. Previously it had to be a standard plan which is more expensive than the basic plan.
I went for a yearly check up without having to pay copay. I don’t recall I could skip copay part for the well check up.
I don’t go to doctors that often so I don’t know if it helps for the out of network or in network.
Has she asked him to leave? I didn’t “evict” my son— I just laid down conditions, as a parent. It was a very calm conversation. My son had the option of staying, but only if he had a job and/or was in school. He opted for the job, and moved out a few months later. (I love my son, he’s a wonderful, respectful person, I was happy to have him stay forever – I just didn’t love the idea of his adopting the lifestyle of a vegetable. But some kids need to be shoved out of the nest before they’ll learn to fly.)
Does the son have separate living quarters, like an in-law unit? Usually the strict rules for tenancy & evictions don’t apply to roommate or shared household situations.
Yes, she has asked him to leave, but he won’t leave. No, her home is too small to have a separate “quarters”. It’s just a small 3bed/2ba home.
she is insisting that she can’t make him leave w/o a formal eviction…which (she says) takes a minimum of 14 days, but sometimes longer???
One huge difference between getting insurance from the “marketplace” (now, under the ACA) and in the marketplace (pre-ACA) is the following: now, insurers can’t reject applicants on the basis of preexisting conditions. When my family needed insurance approximately five years ago (I was below the threshold number of hours for my employer, my husband was fired, our COBRA coverage ended), I worked with an insurance broker, because she knew “how” to apply: do one application, many, many pages long, requiring listing years’ worth of medical treatments and conditions for all family members; and submit it to all potential insurers at the same time, because if we submitted it to one and were rejected, all the others would know that we’d been rejected and would take that into account. My daughter’s application for an ACA plan wasn’t seamless but she didn’t need to provide any personal health information and most of the time required was for comparing plans, not for listing every time she’d been to the doctor in her life.
@mcat2 - your colleague is wrong. ACA is a godsend for the self-employed. We work. We work hard. We often work a lot harder than many people with regular employment, because we’'re not only responsible for whatever we do for a living, but we’ve also got to pay all the costs of doing business, spend time doing things to generate new business or clients, and we tend to do our jobs 24/7. But historically we were at the mercy of the insurance companies, living in fear of getting diagnosed with anything that could be deemed a pre-existing condition and further limit our options for insurance.
Another big segment of ACA buyers are people who are employed in jobs that do not offer health insurance. Perhaps they work for very small organizations – maybe they work in an office or shop with only half a dozen employees – or it could be a single parent juggling part-time work with child-rearing responsibilities, because it’s more cost-effective to work part time than to pay for full time day care for the children.
The unemployed and minimum wage workers don’t earn enough to qualify for ACA-- they get medicaid in the expansion states, perhaps nothing in other states. Illegal immigrants get nothing – they don’t qualify for coverage.
It’s really disturbing when you’re forced to do a formal eviction on your own son. He’s such a smuck.
The sad thing in our country is when illegals( and those like this housekeeper’s son) have access to free health care and most of us pay through the nose for coverage and go without.
Yes, it is.
@calmom simply had to tell her son what the limit was, and he followed it. He respected the “her house, her rules.”
From what I understand, the “list price” of providers’ medical procedures is often highly inflated to be a starting point for negotiations with insurance companies, so that few patients actually pay list price (even self-pay patients may be quietly offered substantial discounts).
Of course, this means that a self-pay patient shopping around finds less price transparency and therefore a poorly functioning market.
Self-employed people, independent contractors and consultants, part time workers not covered by employer medical insurance plans that are limited to full time workers, and early retirees are other classes of people who could have had difficulty (due to pre-existing conditions) finding individual medical insurance in the pre-ACA days.
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Sure, you get a ‘free’ mammogram to diagnose breast cancer, but the first treatment will cost you $2000 or more.
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That’s not necessarily true at all. It depends on the coverage you choose to buy. If you want great benefits, such as low OOP on cancer treatment, you’re going to pay a higher premium. Just like the good old days before ACA. The differences now are that a) you can’t be kicked off of your insurance because you dared to get sick; b) you can’t be charged higher premiums because you dared to get sick; c) the insurer can’t stop paying when your costs reach a certain level. I happen to think those are good things.
I took an MRI just 3 months ago. The lab got reimbursed by about $5000 and I paid 10% which is about $500. The initial price tag was like $9000.
A little complaint here: After the insurance company and I had paid $5500, I was unable to see the doctor. I only had a chance to talk to a nurse on phone call who briefly told me that “it is fine” and asked me back to the lab to have another MRI after half a year. (My wife actually guessed the doctor was on leave – to give birth. That is the reason why no doctor wanted to see me this summer. It is less assuring to hear from a nurse only.)
We were talking about the lower levels through the ACA; almost all have very high deductibles. In order for the insurers to meet all the requirements of the ACA and keep the premiums low, they have to have high deductibles. The policies that excluded certain conditions like pregnancy, smokers, or had a co-pay or deductible for well care and diagnostic tests are not in compliance anymore. My kids used to have a great policy (for us) that was about $75/mo per child. The only policy that comes close now is $400+ per person per month because all policies, even for 6 year olds, have to cover pregnancy, colon tests, mammograms.
My brother is self employed and bought individual coverage for years. He was happy with it, had a couple of surgeries, paid the deductible (I think it was about $800 or so) and the premium was about $300/mo. He tried to schedule a surgery last Jan and found his insurance was ‘discontinued’ without notice because his policy didn’t meet ACA requirements. A new policy with similar coverage would be about $600 per month and have a $5000 deductible. He makes too much to receive subsidies. He hasn’t had the surgery because he can’t afford it. ACA may help some self employed people, but not him.
twoin, the deductibles of the silver plans are on a sliding scale- just like the premiums. My deductible was under 1k (I don’t remember how much exactly).