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Is anyone enrolled in the ‘Obamacare’ health insurance market?

Trboatworks

Diamond
Joined
Oct 23, 2010
Location
Maryland- USA
Experiences?
I am looking for a simple high deductible plan to cover any of the big ticket problems which might require hospitalization etc.
I have paid dental and sundry health care out of pocket and wish to continue to do so.

Thanks
 
Experiences?
I am looking for a simple high deductible plan to cover any of the big ticket problems which might require hospitalization etc.
I have paid dental and sundry health care out of pocket and wish to continue to do so.

I looked at it, and have family members who did as well. You can buy individual insurance through a broker or through the marketplace. Your purchase route does not, as far as I know, change any of the available subsidies, etc. There is often better pricing through a broker. I would talk to whoever does your business insurance. They probably have an agent who handles individual health plans, or will be able to point you to someone who does.
 
If you can arrange your personal taxable income to be just over $17,500, there are great deals to be had, like $100 deductible and $5/month premiums here in PA. But not for normal folks AFAICS.
 
If you can arrange your personal taxable income to be just over $17,500, there are great deals to be had, like $100 deductible and $5/month premiums here in PA. But not for normal folks AFAICS.

Socialism at it's finest....:nutter:

UGH.
 
So I called the company which holds the business insurance- they referred me to a broker here in town who seems capable and they are working up quotes.

Odd thing- after filling out my info on the pubic site (Obamacare) my phone exploded with salesmen from all over the country looking to broker the deal- turned me off.

I have been self pay since my 20’s on heath care.
Worked out fine and a bargain so far- I might average $500/year out of pocket for the small things which come up.
I guess I’m tired of the Russian Roulette aspect of it as I close on 60...
 
Socialism at it's finest....:nutter:

UGH.

I live in a country with far more 'socialism' (Canada) and I pay far less than you do for health care. I pay a little through my taxes and then ZERO on top of that. If I get hospitalized I pay nothing. We have single payer health care and it's cheaper per person, and has better outcomes than the US system does....

The issue here is not 'Socialism'. The issue is not enough Socialism. Obamacare is a half-implemented system.
 
I live in a country with far more 'socialism' (Canada) and I pay far less than you do for health care. I pay a little through my taxes and then ZERO on top of that. If I get hospitalized I pay nothing. We have single payer health care and it's cheaper per person, and has better outcomes than the US system does....

The issue here is not 'Socialism'. The issue is not enough Socialism. Obamacare is a half-implemented system.
"Picking winners & losers" mean anything to you ?
 
...Odd thing- after filling out my info on the pubic site (Obamacare) my phone exploded with salesmen from all over the country looking to broker the deal- turned me off.
You're screwed. I made that mistake about 4 years ago. You will never get rid of the insurance spammers on that number.

During the open enrollment period, I get 4-5 robocalls a day on my cell phone. That slows down to 2-3/day for the couple months each side of the renewal period. You can block them, but they use spoofed numbers so it doesn't stop them.

Talk to your broker- but as I understand it, only policies purchased on the exchange are eligible for subsidies. You need the 1095A to do your taxes, and that comes from the exchanges.

My provider has stopped selling on the exchange, but the policy was originally purchased through the exchange and it renews automatically, so I still have it.

You have to be careful- if you let your income get too high you'll get clobbered at tax time...
 
I live in a country with far more 'socialism' (Canada) and I pay far less than you do for health care. I pay a little through my taxes and then ZERO on top of that. If I get hospitalized I pay nothing. We have single payer health care and it's cheaper per person, and has better outcomes than the US system does....


The issue here is not 'Socialism'. The issue is not enough Socialism. Obamacare is a half-implemented system.




Lots of waiting for health care in Canada.

Canadians Are One In A Million -- While Waiting For Medical Treatment

Canada has somewhat less population than the US.

Canada: 37.59 million (2019)

USA: 327.2 million (2018)


Some Canadians come to USA for health care. We aren't perfect but Canadians like to come here.

American Health Care Treats Canadians Who Cannot Wait
 
I don't think it has changed, but when O-care hit, it did away with high-deductible plans. My company plan became illegal and the premium for the closest plan that complied with O-care more than doubled in cost. The company dropped the plan.

When I priced my own plan through the exchange, it would have been over $1400/month because I qualified for no "subsidies." To add insult to injury, that monthly cost would have been paid with after-tax money. Our lowest-paid person at the time was a shop helper. He was able to get a "silver" plan and add on dental coverage for $37/month.

When we were able to get back to providing coverage in the private market, that same employee cost us $900/month. The reason for the difference is very basic - private plans consider the age of the insured. O-care considers only the income of the insured. Most owners will not qualify for any subsidies and will pay through the nose with after-tax funds.

I'm convinced that the entire intent of the law was to destroy the system so that single-payer became the only option.
 
I don't know about you guys, but this doesn't sound so bad to me.

The Fraser Institute researchers also calculated the value of all the waking hours that patients lost because they couldn't fully function. The toll was staggering -- almost $5,600 per patient*

I've been having stomach issues, and after several trips to the Dr, a CT scan and referal to a GI Dr, he wanted me to get an upper GI endoscopy(?) and then, if that couldn't find anything, line up another test of some sort. My health ins, which I pay about $100/week for, had an estimated out of pocket for the endo at just over $5100!! And to add insult to injury, they told me it was basically a 5 minute procedure, with an hour of prep, and some "recovery" time to come out of sedation.

*I did not see, but I think that cost is per year, per citizen on average. Hell, I pay almost that just for the *privilege* of having health ins, then have to pay co-pays and deductibles for everything. :angry:
 
Last time I had to visit a hospital at check out I told the desk I was self pay they told me if I paid the entire bill that day it was just 20% of total.

Odd- I paid cash and got out of there.
 
Last time I had to visit a hospital at check out I told the desk I was self pay they told me if I paid the entire bill that day it was just 20% of total.

Odd- I paid cash and got out of there.

Sounds about right to me. I don't think the Dr's and hospitals want to deal with ins anymore than the rest of us. A year or so back I got sick and was hospitalized for a week? 5 days? Anyways, did not have health ins at the time (just switched jobs). They sent me a letter saying I did not have health ins and the bill was going to be over 60k and I should apply for assistance. The actual bill I got was around 10-15% of that since I did not have coverage.

So riddle me this, if you have health ins, they want to take you (and/or the ins provider) for all your worth - no health ins, and you get a discount, what is wrong with that picture.... :crazy:

Last job (which I knew wasn't going to work out for me) wanted $250/wk for health ins coverage WTF?!! :eek:
 
Lots of waiting for health care in Canada.

Some Canadians come to USA for health care. We aren't perfect but Canadians like to come here.

For better or worse I have a fair bit of experience with the Canadian healthcare system, both personally and through friends and family. My experiences have been overwhelmingly positive. Sometimes people wait for care, but generally speaking those that really need care get it quickly.

Yes some Canadians visit the USA for healthcare. Wealthy Canadians who don't want to wait for whatever length of time they might have to wait here.

However:
  • People in the USA pay more for healthcare than any other country (reference)
  • People in the USA have the WORST healthcare outcomes of any developed country (reference)
  • The USA has the highest rate of death during/after childbirth of any developed nation (reference)
  • The USA has the highest rate of infant death of any developed nation (reference)
  • 66% of all bankruptcies in the USA are because of medical debt (reference)

Let all that sink in for a moment. People in the USA pay FAR more for healthcare than any other nation, while getting the poorest care in many measurable ways.

I can't think of a greater tragedy than a new father going bankrupt while trying to pay the medical bills for his wife who died giving birth to their child... Can you? That's the reality of the american health-care system.
 
One thing to remember is that "Obamacare" is mostly just a set of national standards.
Every individual State can, and does, implement it differently.
So where you live completely determines what "Obamacare" is.

In my state, all that it means is that you might qualify for a reduced premium on the exact same provider you had before.
I still have the same "insurance" I always had- but, since Obamacare, I pay a lot less for it. I still have a pretty big deductible, I still have some copays, I still pay, out of pocket, for most of my healthcare, because I seldom hit the deductible, and, even then, not everything is covered.

My healthcare is with Kaiser, one of the biggest multistate health providers on the West Coast. My billing, my prices, my doctors, whats covered and whats not, are all exactly the same whether I meet the Obamacare income ceiling or not.
Currently, its around $80,000 a year for a couple. So if my wife and I make more than that, my monthly insurance goes from about $200 a month, to about $1200 a month. (Thats just for me, ONE 60 something year old pretty healthy guy- my wife is already on medicare) That has happened once since Obamacare started- I had capital gains from selling a piece of property, and that pushed me up.
But I am not rich- I earn at around the median family income in the USA, and I qualify.

But my state has a pretty simple, organized health system. Makes it really easy to get signed up, and its all done in a few minutes on one website, where you can choose amoung a variety of plans with different coverage, deductibles, and costs.
If your state doesnt have that, its because your locally elected politicians have chosen not to- its easy enough, there are working models in a couple dozen states.

So dont blame Obama- blame the guys in your state capitol.
 
So dont blame Obama- blame the guys in your state capitol.

I'm happy to stand corrected if I'm mistaken, but I think there are basic truths no matter which state you're in that include:

1) O-care is priced based on individual's income. Employer plans are based on the age of the employee.

2) If an employer wishes to have their staff on O-care and reimburse them the cost as a benefit, it must be shown as compensation for the employee and is then subject to payroll tax for the employer and also adds to the employer's payroll (which would increase business insurance costs depending on how your rates are calculated).

3) Health savings accounts, which are funded with pre-tax money, are specifically prohibited from being used to pay premiums.

4) If an individual's employer offers a plan, the individual is not eligible for O-care.

Again, I'll stand corrected if this is not true. Believing it *is* true, the quickest "fix" to the problem would be to change #3 and allow for HSA's to be used for insurance premiums.

That simple change would allow employers to offer the benefit with the same pre-tax funds now spent on the plans they offer (if they offer them) while allowing employees the freedom to choose the plan that best suits their needs at a cost based on their income.

It is the different treatment of employer vs individual that makes the system so offensive. Why can an individual buy a plan for pennies on the dollar of what it costs an employer to insure the same person? For me, the answer to that one question gets to the core of the problem.
 
I live in a country with far more 'socialism' (Canada) and I pay far less than you do for health care. I pay a little through my taxes and then ZERO on top of that. If I get hospitalized I pay nothing. We have single payer health care and it's cheaper per person, and has better outcomes than the US system does....

The issue here is not 'Socialism'. The issue is not enough Socialism. Obamacare is a half-implemented system.


It's more than just a "little" that we pay through taxes. I quickly checked and the average person pays about 10% of their gross income just for health care through taxes. Plus the money the government borrows to make up for the shortfall if they overspend on healthcare which tax payers end up paying interest on. I'd say that 10% rises to about 13-15% once everything is actually factored in.

And yeah, there is too much socialism in this country. Too many people want shit but want others to pay for it.
 
I'm happy to stand corrected if I'm mistaken, but I think there are basic truths no matter which state you're in that include:

1) O-care is priced based on individual's income. Employer plans are based on the age of the employee.

The obamacare policies are also priced based on age (although it's not exact actuarially). The obamacare subsidies are based on income. So the net amount you pay may be (if you make under the cap) based on your income.


2) If an employer wishes to have their staff on O-care and reimburse them the cost as a benefit, it must be shown as compensation for the employee and is then subject to payroll tax for the employer and also adds to the employer's payroll (which would increase business insurance costs depending on how your rates are calculated).

This used to be true, but isn't anymore. From tax year 2017, you can do a Qualified Small Employer Health Reimbursement Arrangement.

Health reimbursement arrangements for small employers
https://www.ecfa.org/PDF/QSEHRA Client Alert.pdf


3) Health savings accounts, which are funded with pre-tax money, are specifically prohibited from being used to pay premiums.

Correct. HSAs can only co-exist with certain types of health insurance, i.e. High Deductible Health Plans

4) If an individual's employer offers a plan, the individual is not eligible for O-care.

You are allowed to buy a marketplace plan. You are not eligible for the subsidies.


Again, I'll stand corrected if this is not true. Believing it *is* true, the quickest "fix" to the problem would be to change #3 and allow for HSA's to be used for insurance premiums.

That simple change would allow employers to offer the benefit with the same pre-tax funds now spent on the plans they offer (if they offer them) while allowing employees the freedom to choose the plan that best suits their needs at a cost based on their income.

QSEHRAs sound a lot like what you're asking for. The only difference from what it sounds like you want is that you can't double-dip and get pre-tax money from your employer and a subsidy from the feds.


It is the different treatment of employer vs individual that makes the system so offensive. Why can an individual buy a plan for pennies on the dollar of what it costs an employer to insure the same person? For me, the answer to that one question gets to the core of the problem.

The individual's plan costs (approximately) the same amount, but they're getting a subsidy to keep the net cost below x% of their income.
 








 
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