@calmom, @ucbalumnus, I agree that my previous colleague is clueless about ACA. He is likely the “lucky” one who always has had the private insurance so he does not bother to learn anything about ACA. (And there is a chance that he “looked down on” the “working class”, I guess. He owned several houses in California. This may explain why.)
romani, that might be true in Michigan, but each state approves its own rates and policy coverage (as long as it complies). I know quite a few people in different states that have been shocked by how high they are. My uncle lives in Massachusetts and thinks everyone in the country is very happy with insurance. Try Florida. Try Mississippi. Even before ACA the insurance available for individual policies was not great, and ACA has only made it worse.
Many people who don’t qualify for the subsidies can’t afford the silver or higher plans. The premiums are very high if one isn’t getting $600 per month as a subsidy.
Then the reason he was paying low premiums was because he had substandard coverage. Most people who had substandard coverage didn’t realize it was substandard. They only knew it was cheap. But there were those who found out the hard way that, say, coverage was capped at a very low amount. Or that it only paid $500/day for hospitalization. Or that certain conditions were excluded. Yes, decent insurance is going to cost more. I don’t know why that surprises people.
http://www.mcclatchydc.com/news/health-care/article24760639.html
Romani is correct about sliding scale deductibles and co-pays, for those who receive subsidies on the premiums. That’s true in every state.
She might be right that she can’t make him leave without an eviction order. It sounds like a bullying situation. So it’s long past time for her to get the legal process going. However long it take is however long it takes, but he’ll be there forever unless she starts.
A self-employed person who “makes to much” to qualify for subsidies ought to have no problem at all with a $600/monthly premium.
With all the various income-reducing deductions available to self employed, a single self-employed taxpayer can be bringing in well above the ~$45K cut off for subsidies and still qualify.
I was looking for my daughter who is self employed and the premium is around $200. A few years ago I looked and the premium was like $50-$75.
But why does it mater if the plan is substandard. My kid barely uses her health insurance now, most kids at her age don’t either. There should be one to cover catastrophic and a yearly check up for free. I was looking for one that has HSA too but has not dig in deeper.
“because all policies, even for 6 year olds, have to cover pregnancy, colon tests, mammograms.”
This drives me all kinds of nuts. There are all sorts of conditions that occur only or primarily in childhood that I will never get. So, no, your 8-year-old won’t get colon cancer screening. But this eligible-for-colon-cancer-screening adult won’t need surgery for cleft palate, orthopedic surgery for skateboard injuries, or treatment for childhood leukemia. Nor as a female will I require treatment for prostate cancer. And, at this stage of life pregnancy is in my rearview mirror. Insurers know kids aren’t going to need pregnancy or prostate coverage, and adults aren’t going to need cleft palate repair. It doesn’t matter, because the policies are priced to cover the populations’ medical need, and then adjusted by age brackets so that the young pay less than the old.
And, if your kid is one of the unfortunate kids who does get a childhood cancer, your kid won’t be denied medical insurance for the rest of his/her life, or forced to find a job with a large enough company that pre-existing conditions would not be considered. How much is that worth to you?
That $75-a-month policy looks really great until you find out that the little asthma attack Johnny had now makes Johnny uninsurable with new companies. The “closed block” policies that guaranteed renewability were the insurance companies’ strategy for sticking it to those who actually used insurance – yes, you could keep it, but they kept jacking up the rates so much that everyone with better health left the plan for another plan, and the increases spiraled out of control.
Which, thanks to the ACA, is no longer possible. 
It would be absolutely impossible to stratify different conditions based on certain factors. 12 year olds do get pregnant, as do 60 year olds. Men get breast cancer and some women never get pregnant. Or you have the 17 year old who developed gallbladder disease and had to have her gallbladder out at 21- despite a low-fat diet (hi!).
This is why the rest of the “developed” world lumps all people together. We’ll get there. But in the mean time, no one will ever be denied insurance again because their body dared to develop asthma (also hi!)
I think it makes a lot of sense that no one should be denied insurance if they were previously insured.
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But why does it mater if the plan is substandard. My kid barely uses her health insurance now, most kids at her age don’t either. There should be one to cover catastrophic and a yearly check up for free.
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My otherwise healthy D developed a gastric problem earlier this year. The care she needed wasn’t a checkup and it wasn’t catastrophic. So the office visits, tests, and medications she needed wouldn’t have been covered by the insurance you propose, and she probably wouldn’t have gotten it treated and would still be suffering. She now understands that there is a wide swath of health care in between the annual exam and the emergency room. She also understands why it’s good to have coverage for all those in-between medical issues.
Mom can change the locks - she has allowed him to overstay as a visitor. Since he never contributed to household she can say he was a guest. She also can issue a restraining order against him because she fears him and has legitimate concerns to protect herself.
Mom is probably not going to go to these measures. She is an enabler. At 30 who knows if he would be willing to change his ways when mommy isn’t providing him room/board.
But she can change the health insurance the following year to treat it right.
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The “closed block” policies that guaranteed renewability were the insurance companies’ strategy for sticking it to those who actually used insurance – yes, you could keep it, but they kept jacking up the rates so much that everyone with better health left the plan for another plan, and the increases spiraled out of control.
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This is exactly what happened to us (and another CC poster), and before ACA, we couldn’t get insurance anyplace else due to preexisting conditions. Thankfully, someone sued Anthem – not the first time they’d been sued for this – and won. We were included in the class, so we got to do what Anthem most didn’t want us to do – we got to pick any plan they sold, without underwriting.
Guaranteed issue is one of the most popular parts of ACA. But I wish people understood that guaranteed issue can’t happen without the individual mandate. It drives me crazy too, @arabrab . ACA isn’t an a la carte menu. You can’t pick and choose which pieces to keep and which to toss.
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But she can change the health insurance the following year to treat it right.
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She got it treated this year, and is now all better. Because I was able to persuade her to get real insurance this year even though she believed she wouldn’t need it.
If she hadn’t had comprehensive coverage, then yes, she would have been able to get it next year ( but only thanks to ACA because what is now classified as a preexisting condition can’t be held against her). And she would have been suffering from the condition for the rest of this year, and it might have gotten worse. Like I said, she now understands that expensive medical problems can happen to anyone, even people who think they’ll “never get sick.”
“Then the reason he was paying low premiums was because he had substandard coverage. Most people who had substandard coverage didn’t realize it was substandard. They only knew it was cheap. But there were those who found out the hard way that, say, coverage was capped at a very low amount. Or that it only paid $500/day for hospitalization. Or that certain conditions were excluded. Yes, decent insurance is going to cost more. I don’t know why that surprises people.”
I will disagree with you on this. He’d had the same insurance for a number of years. He’d had several surgeries after an Achilles tear, subsequent infection, about 6 weeks in the hospital and one of those in intensive care. What that policy didn’t cover was pregnancy (he is male), some things like transplants, pre-existing conditions, some preventative care. It’s not that those aren’t good things required by ACA, it’s that they aren’t free, they cost money, and premiums had to be raised. My kids had a great policy for them as children. It was a Blue Cross policy. Didn’t cover pregnancy, only covered 4 doctor visits per year before the deductible had to be paid, covered some dental cleanings, an annual eye exam. It was all we needed and it was affordable, not substandard. The most important part of the policy to me was that we got the negotiated rates if we needed any care (a $20-50 trip to the doctor, not $225) and it had major medical coverage after that deductible if we really needed it. I could afford to pay up to the $5000 stop loss, but couldn’t have afforded a $50k operation. That type of policy is not ACA compliant so no longer available on the individual market.
He’d have to be employed,right? Generally, Medicaid is not available to a healthy, young person just because s/he is lazy, right? So, I never was sure how insurance exchanges were ever going to work for someone like him. Perhaps a certain percentage of non-users/non-Medicaid people was figured in i.e. the ones who just continue to show up in ER’s.
It’s sure not helping our hospital as they claim they are losing money hand over fist, way more than before. I don’t get it but it’s what they base laying off 400 workers on.
@twoinanddone Then in what way was the plan not ACA compliant, as you said above?
BTW if his plan cancelled him without notice, that’s the carrier’s fault. There’s nothing in ACA that required them to do that.
Correction: there’s nothing in the ACA that “allowed” them to cancel without notice.
I had a police cancelled due to ACA. Definitely got notice. It was a big deal at the time. Thousands of other people got notice of their policies being cancelled just around the same time as I got mine.
??? I think the majority of ACA plans have negotiated rates for in-network care, copays for routine care, and only charge a percentage after the deductible until the maximum patient payout is reached, and then pay 100%.
I’ve opted for a cheaper co-insurance rather than copay plan, because I want the added HSA benefit – but I certainly get the benefit of negotiated rates. For lab fees the negotiated rate is a tiny fraction of the ostensible market rate charge shown on the bills.
Well, gee, @twoinanddone good thing those boys of yours never got a girl pregnant. A girl with a similar policy to the one you loved would have been up the creek without a paddle when faced with a pregnancy.