Health Insurance Questions

brij2006 · January 2017

I agree with you @AprilZ81
Just this year my H had some issues with his ankles that needed physical therapy 3 days/week for a minimum of 4 weeks straight, or surgery. It was actually cheaper for us to pay for the physical therapy with their cash discount vs going through his insurance. We also paid the specialist without insurance because it was cheaper since we had to meet his $4,000 deductible first before insurance paid anything. So that visit and testing was half the cost if we paid cash vs billing his insurance, them pay nothing, and us have to pay cash for it anyways.

KAdams767 · January 2017

brij2006 said:

jtmh2012 said:

I tried pricing out my wife and I on our separate employer plans. It just wasn't worth it. Her plan was good, but mine was better. And it was only a few dollars different. Didn't think it was worth the hassle of managing two different sets of benefits, providers, etc. Especially knowing that my wife would probably be changing jobs more often that I would be.

Also looked at the fact that as a family we'd have multiple deductibles to meet.

It stinks, but even now we're on 2 separate plans. I'm on my employers plan and H and DD are on his. We did have DD on mine for the first year until my premium for her skyrocketed. Now we have her on my H's higher deductible plan and we cross our fingers she doesn't get sick or hurt.

I seriously don't understand where our health insurance is going. Even on my H's plan, we'd be paying almost $800/month for 4 of us and with a $4,000 individual deductible, $6,250 max OOP for individuals. I believe the family deductible is $9,000 and max OOP is $12,500.

How do people afford this? Even if you can afford the premium, you can't afford the deductible or max OOP if anything were to happen.
My H doesn't make a ton of money, but he doesn't do horribly, and we'll be supporting a family of 4 off of his income. Our month to month isn't pretty by the time we pull out $800 for health insurance for the 4 of us, put into retirement, and taxes. Let alone if I get on his plan and have #2 on it and God forbid something were to happen to baby and I to where we meet that family max OOP. There goes a ton of his takehome pay. Just in 1 calendar year.....and we have zero debts. I don't understand how the typical American family is supposed to cushion a medical event, even WITH insurance. Besides going into thousands of debt with the hospitals.

I mean this without any snark, truly, but the answer is that the US system (as a whole, not just related to insurance) is not designed for families other than well above middle class, to survive on one income.

AprilZ81 said:

short+sassy said:

Xstatic3333 said:

I don't think the typical family can afford it, TBH. HDHPs can be a great tool for people like those of us around here who like to have lots of savings vehicles and have some cushion, but I know a lot of people have gotten pushed onto them recently without time to prepare and it can be completely devastating. I'm lucky to have a MA healthcare plan from the same employer as @LillibetteV so I'm not too worried for myself, yet, but I'm another one who's definitely scared for 2018 in general. My friends with chronic health problems are downright terrified.

Yeessss. Up until this year, my workplace had two plans to choose from. And HDHP and a more typical health plan (lower deductible/copays/etc.). The employee portion for the "typical" health plan was substantially more so, even considering my OOP expenses, I would still choose the HDHP.
This year's deductible on the HDHP plan is almost double what it was last year. This is the first year it would have made sense for me to switch to the "typical" health plan. Except my workplace isn't offering that plan anymore. Now it is only the HDHP plan, which is really no better than a catastrophic plan. Yet, is extraordinarily expensive (if you look at the total cost) for not much.
As for HSA, which I do love, that needs to catch up to what is now happening in the medical insurance industry. There are limits to how much a person/family can have deducted each year. For me and for many, that limit doesn't even cover one year's deductible. And it doesn't even come close to many people's OOP Max.

Yeah, the HDHP are pretty much catastrophic plans. Mine isn't as bad as some ($1,500 deductible, $5,500 OOP Max) but we maxed mine out last year. My employer has us earn funds for our HRA, and that really annoys me. To get funds we are required to do a health survey and get biometric screening ($150) once we do that we can earn additional funds by doing other health related activities. The kicker is that you only have a small number of choices if you don't already smoke, have diabetes or are pregnant. Plus some of the choices are a one time only deal, so if you have already completed it you can't get that credit again. We can earn a max of $500 which is a drop in the bucket.

I really think that health care (care =/= insurance) would be cheaper without the insurance companies. They add a ton of middleman expenses and even more regulations. Let the patients determine care with their doctors. If you cut the middleman out it will lower the cost and most likely improve care.

HDHP are not only catastrophic plans. They include free preventative services the same as other plans, along with similar prescription plans, vision benefits and yes, emergency and catastrophic care. Also, it makes sense that your employer has metrics for contributing to your HRA, those are employer funds and that gripe is on your job, not HDHP plans. I believe most people with an HDHP have an HSA though, which you can contribute to as well along with your employer. I think the HRA is only permitted to be employer funds. I have had an HDHP with an HSA for over 5 years and my employer contribution has never been based on any conditions.

LillibetteV · January 2017

@brij2006 I agree with you 100% that the math in your situation sucks. But I would hope that you would reduce your tithing if it came down to only have $367 to take care of your family - I know my own father went into debt while still tithing a large amount of money and I got so frustrated. Put your own oxygen mask on first before helping others.

jtmh2012 · January 2017

brij2006 said:

I agree with you @AprilZ81
Just this year my H had some issues with his ankles that needed physical therapy 3 days/week for a minimum of 4 weeks straight, or surgery. It was actually cheaper for us to pay for the physical therapy with their cash discount vs going through his insurance. We also paid the specialist without insurance because it was cheaper since we had to meet his $4,000 deductible first before insurance paid anything. So that visit and testing was half the cost if we paid cash vs billing his insurance, them pay nothing, and us have to pay cash for it anyways.

I would double check on this, but I thought you could pay cash and then submit to the insurance on your own after the fact? At least then it would count against your deductible.

I think the ACA does have a lot of good components, but it doesn't make health care affordable. It just forced many people into insurance plans making them covered. So you're not paying high health care prices, but you're paying through the nose in premiums.

We need to fix the actual cost of receiving care. It doesn't cost $6 for an asprin. And it annoys me when my wife gets billed for some test at $500, insurance knocks it down to $40, pays $30, and leaves you with $10. How about I just pay $40 and drop my health coverage?

brij2006 · January 2017

@KAdams767 You are most definitely right. The US system is not set up to live on just 1 income anymore. It's going to be an insanely tight couple of years for us while I stay home. We're very thankful to have all of our debts paid off, but that's the only way it is even remotely a possibility. But our budget isn't pretty.

brij2006 · January 2017

@LillibetteV It honestly would take a lot for us to cut our tithe. I'd lower retirement contributions before cutting the tithe, but that's just where our beliefs stand.

@jtmh2012 I'm right there with you. The itemized $35,000 bill for the delivery of DD was laughable. I got there 45 minutes before she was born, had zero meds, and she was healthy. Yet the billing between the 2 of us to insurance was over $35,000. Insane!
I'm kidding but not really. If H were up for it, I would seriously use the Mennonite midwife that's just outside our town. She costs half my deductible.

julieanne912 · January 2017

I guess I'm in the minority, and maybe because prior to a few years ago, I always had to buy my own health insurance and it was usually a high deductible plan, but I'm really happy with the HDHP plan I have through my employer right now. My deductible is $2,750 with a $5,000 OOP max, and I don't pay the premium, my employer does. And, this is the best plan I've ever had. I also have an HSA, which I never had when I was self insuring. I guess since I've always had pretty high insurance and OOP costs, that a lot of what I'm reading doesn't seem like that big of a deal.... but I suppose if I was coming from a place of really low costs for a long time, it would seem that way.

I also can confirm the ACA saved me a decent amount of money, for birth control costs alone!

short+sassy · January 2017

On the political front, its very distressing to me that it looks like they will be repealing the ACA completely, with nothing else in place. The ACA isn't the answer, but don't throw the baby out with the bathwater. It's completely insane they think throwing 18M people off healthcare, all at the same time, is not going to be a nightmare. For everyone. Even for people who have insurance outside the ACA plans. It will have such far reaching effects.

I've always thought universal healthcare, like pretty much every other developed country has, is the answer. It's not a perfect answer either, but at least people's lives and health aren't in the hands of private industry. I sadly realize, in this country, that is a very UO. Everybody wants good, affordable healthcare. But not if that means their taxes will be raised one iota.

Sorry, off on a bit of a tangent. It's awesome to draw the "long straw" when it comes to health. But some people draw the short straw. Or some people are victims of heinous crimes or accidents. As a society, I strongly believe it is our duty to have a safety net for those people. Because, "There but for the Grace of God, go I."

vlagrl35 · January 2017

Regarding ACA - it isn't all bad. We buy health insurance on our own. The pre existing condition clause needs to stay in the trash. As it is right now for us if by some act of god I get pregnant in the next few months my pregnancy is covered. IF the Rs are stupid enough to take that from us then in 2018 if we had a baby that year would cost us a fortune because it would be pre existing. Personally I am fine if they tweak it for the better. I see them repealing and replacing at the same time.

smerka · January 2017

And that's the problem. We want to force insurance companies to pay for pre-existing conditions, keeping kids on their parents' policies until 26, and no lifetime benefit caps, but no one wants to pay for that. That's the problem with healthcare in general. Everyone wants the best care possible but no one wants to pay for it.

I got the bill for my kids' therapy last week. Each kid sees two therapists for 45 minutes each. The bill (before insurance) is over $600. That's $30,000 per year.

brij2006 · January 2017

vlagrl35 said:

Regarding ACA - it isn't all bad. We buy health insurance on our own. The pre existing condition clause needs to stay in the trash. As it is right now for us if by some act of god I get pregnant in the next few months my pregnancy is covered. IF the Rs are stupid enough to take that from us then in 2018 if we had a baby that year would cost us a fortune because it would be pre existing. Personally I am fine if they tweak it for the better. I see them repealing and replacing at the same time.

This is where my head is at with the pre-existing stuff.
It shouldn't be handled as all or nothing.
So for me being 5 months pregnant, there is no way I should even be able to look at quitting my job and switching to a low deductible/maxOOP plan for the next 4 months to have baby on, then get onto my H's high deductible plan. The insurance company is being forced to take on a risk that they know they'll be paying out thousands in care for within the next 4 months, because the government is saying they have to, and they can't charge more for that increased risk. How are they supposed to not increase premiums when this is the case?
Look at it as a business. Any other type of insurance is charged based on risk. You have a DUI, you pay more for car insurance. You're a higher risk than the 45 year old that has nothing on their record. The likelihood of the company paying out for a claim with the DUI driver is much higher.
Or life insurance. You have stage 4 cancer and are given 3 months to live. Should you be able to take out $3million in life insurance now? If so, should you be charged the same premium as someone who is perfectly healthy and the same age as you?
Insurance companies can take on the risk because they can charge appropriately for the type of risk they're insuring. That's how it works. Now, health insurance most definitely became a monopoly and needed a change. You would be denied for simple things or charged higher premium because you went to the doctor for a Zpac last year. That's not right.
But it seems to be that we went from one extreme to the other and neither extremes are/were working.

vlagrl35 · January 2017

yeah I get why the premium increases for taking on at risk patients but at least COVER it and make it an option for people. Unless you've bought your own insurance you'll never understand the headache people take on when dealing with pre existing conditions. My hernia from pregnancy was pre existing and they wouldn't pay for the surgery so I waited a year and got it fixed when they paid for it. A sinus infection several years ago was diagnosed as chornic sinusitus and they didn't want to pay that and were requesting my medical records in which I told them to F Off. I had to instead call my doctor and request they change the code to a cold instead. WTF its all a game.

vlagrl35 · January 2017

all rants aside the best thing anyone can do when dealing with health insurance is do your research and pick the plan that is the best for your family - other than that you can't worry about things you cannot control. I could be stressing about 2018 health insurance changes but I choose not to. I could stress about having to get pregnant in T minus 3 months for a December baby - but why? Then I would have to stress myself out about getting pregnant on a timeline. And that's why I'm choosing to drown myself in things I can control at this given point in time and focus on living in the present moment

KAdams767 · January 2017

brij2006 said:

vlagrl35 said:

Regarding ACA - it isn't all bad. We buy health insurance on our own. The pre existing condition clause needs to stay in the trash. As it is right now for us if by some act of god I get pregnant in the next few months my pregnancy is covered. IF the Rs are stupid enough to take that from us then in 2018 if we had a baby that year would cost us a fortune because it would be pre existing. Personally I am fine if they tweak it for the better. I see them repealing and replacing at the same time.

This is where my head is at with the pre-existing stuff.
It shouldn't be handled as all or nothing.
So for me being 5 months pregnant, there is no way I should even be able to look at quitting my job and switching to a low deductible/maxOOP plan for the next 4 months to have baby on, then get onto my H's high deductible plan. The insurance company is being forced to take on a risk that they know they'll be paying out thousands in care for within the next 4 months, because the government is saying they have to, and they can't charge more for that increased risk. How are they supposed to not increase premiums when this is the case?
Look at it as a business. Any other type of insurance is charged based on risk. You have a DUI, you pay more for car insurance. You're a higher risk than the 45 year old that has nothing on their record. The likelihood of the company paying out for a claim with the DUI driver is much higher.
Or life insurance. You have stage 4 cancer and are given 3 months to live. Should you be able to take out $3million in life insurance now? If so, should you be charged the same premium as someone who is perfectly healthy and the same age as you?
Insurance companies can take on the risk because they can charge appropriately for the type of risk they're insuring. That's how it works. Now, health insurance most definitely became a monopoly and needed a change. You would be denied for simple things or charged higher premium because you went to the doctor for a Zpac last year. That's not right.
But it seems to be that we went from one extreme to the other and neither extremes are/were working.

Um, no. This is a huge problem. Healthcare shouldn't be run like a for-profit business.

Secondly, calling pregnancy a pre-existing condition has a disparate impact on over 50% of the population. It's discrimination.

short+sassy · January 2017

vlagrl35 said:

yeah I get why the premium increases for taking on at risk patients but at least COVER it and make it an option for people. Unless you've bought your own insurance you'll never understand the headache people take on when dealing with pre existing conditions. My hernia from pregnancy was pre existing and they wouldn't pay for the surgery so I waited a year and got it fixed when they paid for it. A sinus infection several years ago was diagnosed as chornic sinusitus and they didn't want to pay that and were requesting my medical records in which I told them to F Off. I had to instead call my doctor and request they change the code to a cold instead. WTF its all a game.

The last time I was unemployed, which was before the ACA, I called eight different insurance companies. BEGGING for someone...just to sell me a catastrophic plan, with my pre-existing condition totally excluded. Just so, if something crazy happened and I broke my leg or my appendix needed to be removed, I wouldn't face bankruptcy or being in debt for the rest of my life.

EVERY.SINGLE.ONE.SAID.NO. My pre-existing condition barred me from buying any type of medical insurance.

Never mind that, in my entire life, I've only spent one night in a hospital for anything. And that was 23 years ago. Oops! I guess I spent a few days in the hospital when I was first born also, smh.

And you all would be amazed how many people don't initially believe me when I tell them that. During all the ACA debate before it passed, I explained that a lot. Everyone assumed I meant "it was just a really expensive plan" and I'd have to explain 2-3x, "No, no. I couldn't buy any insurance, at any price."

vlagrl35 · January 2017

pregnancy, a hernia, and a freaking sinus infection should not be a pre existing condition - sorry but health insurance is my hot button and those money hungry health insurance CEOs shouldn't make it such and screw the rest of us over. I guess this is one issue I consider myself "left" on and I'm pretty conservative in many areas.

brij2006 · January 2017

KAdams767 said:

brij2006 said:

vlagrl35 said:

Regarding ACA - it isn't all bad. We buy health insurance on our own. The pre existing condition clause needs to stay in the trash. As it is right now for us if by some act of god I get pregnant in the next few months my pregnancy is covered. IF the Rs are stupid enough to take that from us then in 2018 if we had a baby that year would cost us a fortune because it would be pre existing. Personally I am fine if they tweak it for the better. I see them repealing and replacing at the same time.

This is where my head is at with the pre-existing stuff.
It shouldn't be handled as all or nothing.
So for me being 5 months pregnant, there is no way I should even be able to look at quitting my job and switching to a low deductible/maxOOP plan for the next 4 months to have baby on, then get onto my H's high deductible plan. The insurance company is being forced to take on a risk that they know they'll be paying out thousands in care for within the next 4 months, because the government is saying they have to, and they can't charge more for that increased risk. How are they supposed to not increase premiums when this is the case?
Look at it as a business. Any other type of insurance is charged based on risk. You have a DUI, you pay more for car insurance. You're a higher risk than the 45 year old that has nothing on their record. The likelihood of the company paying out for a claim with the DUI driver is much higher.
Or life insurance. You have stage 4 cancer and are given 3 months to live. Should you be able to take out $3million in life insurance now? If so, should you be charged the same premium as someone who is perfectly healthy and the same age as you?
Insurance companies can take on the risk because they can charge appropriately for the type of risk they're insuring. That's how it works. Now, health insurance most definitely became a monopoly and needed a change. You would be denied for simple things or charged higher premium because you went to the doctor for a Zpac last year. That's not right.
But it seems to be that we went from one extreme to the other and neither extremes are/were working.

Um, no. This is a huge problem. Healthcare shouldn't be run like a for-profit business.

Secondly, calling pregnancy a pre-existing condition has a disparate impact on over 50% of the population. It's discrimination.

Not saying it's right, but unfortunately that's what it has turned to.

If we wanted to turn to non-profit, then health sharing programs may be the best direction to go. But many of those have stipulations for smoking, drinking, and don't cover an already established pregnancy. They also don't have an unlimited lifetime maximum. Many max out at $100,000 in health care annually.
There were actually quite a few non-profits who opened up during the start of ACA. In hopes that they would get part of the forced insurance market and be able to offer lower premiums with higher quality service. Majority of those have stopped offering insurance.
I know in Illinois alone, they are down to only 5 companies offering insurance through the marketplace and additional ones outside the marketplace. So 7 companies total. It's actually forced the health insurance industry to become even more monopolized because now people are forced to purchase the insurance or they pay penalties, there aren't many options, and the premiums are increasing astronomically.
Here's what the average increases were in premiums from 2016 to 2017 on the 7 company options in the state of Illinois.
- Lowest-Cost Broze Plan = 44% Increase
- Lowest-Cost Silver Plan = 45% increase
- Second-Lowest cost Silver Plan = 43% increase
- Lowest-cost Gold plan = 55% increase
Craziness!

I seriously have no clue what the answer is to the healthcare issue, but obviously there are more issues than just the insurance side of things or else ACA would have worked and everyone's premiums would have balanced out because you had both the healthy and the unhealthy all insured to even out the risk.

LillibetteV · January 2017

vlagrl35 said:

pregnancy, a hernia, and a freaking sinus infection should not be a pre existing condition - sorry but health insurance is my hot button and those money hungry health insurance CEOs shouldn't make it such and screw the rest of us over. I guess this is one issue I consider myself "left" on and I'm pretty conservative in many areas.

YES! In a country where people go into bankruptcy over medical bills what on earth did those CEOs do to earn more than $10 million each year? I'm not saying they don't deserve to be at the top of the pay scale - I'm saying the wage gap is way too high.

KAdams767 · January 2017

I don't disagree that premiums have increased during the time ACA has been in place. But I think it is a complete red herring. Premiums were increasing steadily prior to ACA enactment, there is no reason to think they would have been stagnant or decreased without ACA. Anyone who thinks the ACA is the reason for increases and things wouldn't have gone up had the status quo been maintained is dreaming.

AprilZ81 · January 2017

KAdams767 said:

I don't disagree that premiums have increased during the time ACA has been in place. But I think it is a complete red herring. Premiums were increasing steadily prior to ACA enactment, there is no reason to think they would have been stagnant or decreased without ACA. Anyone who thinks the ACA is the reason for increases and things wouldn't have gone up had the status quo been maintained is dreaming.

True, but this was pitched as a way to SAVE money on insurance to help out lower and middle class families. That is a complete and utter lie (and they knew it).

When you force a business to provide more services and take on more risk it only makes sense that the rates go up. Businesses are in it to make money (and we can debate whether insurance companies should be for-profit or not at a later date) and they aren't going to accept a lower profit margin and lower return for investors just because the government says they have to provide coverage for everyone and cover XZY procedures.

Insurance companies just muck things up. If you go into your doctor's office and ask how much the visit/procedure/prescription will be they look at you like you have three dozen heads. They don't know and that is largely because they bill insurance companies differently, then there are the negotiated rates and discounts and then your copay/coinsurance... It is crazy. We should be able to go in and know that an office visit is X dollars and this surgery will be Y dollars. They shouldn't get to determine what tests are covered. If my doctor says that I need a test and I agree then that should be the end of it. I shouldn't have to wait for approval to see if it will be covered or not.

I honestly think most of us would be better off paying for our own preventative care and having a catastrophic plan in place for hospital stays and major illnesses. When you add up the premiums, deductibles, copays and how much the average person actually uses their insurance I think it would be a better solution.

Insurance was never meant to cover every little thing like people expect it to now. It was originally a catastrophic plan and I wish it would go back to that.

short+sassy · January 2017

KAdams767 said:

I don't disagree that premiums have increased during the time ACA has been in place. But I think it is a complete red herring. Premiums were increasing steadily prior to ACA enactment, there is no reason to think they would have been stagnant or decreased without ACA. Anyone who thinks the ACA is the reason for increases and things wouldn't have gone up had the status quo been maintained is dreaming.

I'd also like to point out that everyone (general "everyone") assumes if they repeal the ACA or take out some of the clauses, insurance rates are going to drastically drop. Says who?

As we've pointed out, medical insurance companies are a for-profit business. In an oligopoly industry. They'll charge whatever the market will bear. And they've already seen it bear a lot.

Sorry, this is a more broad topic. But a hot button issue that has developed for me over the last 1-2 years is how little our government protects us from oligopolies and monopolies. There is nothing better than the free market. But where it can't or doesn't exist, the government should be keeping a close eye to protect the American people. Maybe I'm wrong, but I feel like they historically used to do that, but now its just rubber stamped. I'm thinking specifically of utility companies (both energy and water), cable companies, and medical insurance. But I'm sure there are lots of other examples.

julieanne912 · January 2017

Removing pre-existing conditions is a very very scary thing for my husband and I. He has an auto-immune disease that has no cure. He is "in remission" but that's only if he stays on his treatments. The cost of his treatments alone exceed my annual salary, and that doesn't count the regular blood work he has to have done, and anything else his doctor deems necessary. If he were somehow to lose his insurance he currently has (most likely through a job loss) and was rejected from a new insurance plan due to his pre-existing condition, well, he could very well die as we wouldn't have that kind of money, especially if he didn't have a job (which if he was unable to get his treatments, he'd very likely be unable to work, at least at the capacity he does now to earn his very good salary), and it would be a slow painful death.

There's also the lifetime max to worry about as well.

I actually was charged a higher premium before the ACA because in 2009, I had a plate and screws put in my arm to fix a fracture, so I was deemed "higher risk". And I can confirm that my premiums had steady increases every year. Some years not as much, other years as much as $50/month.

ETA: we have no problem paying higher premiums if that means we get to keep insurance and can continue to get quality care.

smerka · January 2017

There were way too many moving parts for anyone to accurately predict what was going to happen when the ACA went into effect. No one knew how many healthy people would get insurance because of the mandate to avoid the penalty (which was supposed to offset the cost of having to cover everybody.)

Xstatic3333 · January 2017

The ACA could certainly be improved. I am interested in the idea of plans being sold across state lines that the Republicans have brought up recently. To just pull it and destabilize the market without a replacement plan in effect, though, is pretty unconscionable. It's playing politics with people's lives. There was an article a few weeks ago that showed that many people who oppose Obamacare are actually on the ACA and like it; they didn't realize they were the same thing.
About half the country hated Obama. That's their right, and I get it, but it doesn't mean that taking an immediate blowtorch to his policies is a great idea.

If I ruled the world, I'd like to see single payer, though I don't think it can happen politically in the US in my lifetime. This should not be a for-profit business. I should not have to wonder if my providers' recommendations to me are based on what is best or what pays out better. Until then, though, keeping the removal of preexisting conditions is everything. It's, in my opinion, one of the most important issues our country faces, period. Don't we want people to be able to work and contribute to the best of their abilities? Without that stipulation in MA, my friend with chronic brain cancer would have been stuck in the retail job he had when he was diagnosed, instead of getting his masters, entering the PR field, becoming a homeowner, and contributing to the economy. We all benefit from better health care by the creation of a more robust economy and society and a lower drain on our resources from other social programs. I'm willing to pay for that out of my tax dollars, 100%.

The ACA has not been a total failure, but it has been a total failure in some states. It sounds like Illinois may be one of them. In RI, there are several options of reasonable, affordable plans that we could afford. I can't say we could afford them on one income, because we couldn't afford much in our lives on one income and haven't set things up that way. I don't know what the fix for the problems among states is. It's well above my pay grade, and I'm assuming has to do with regulatory stuff.

AprilZ81 · January 2017

I think some of what needs to happen a new definition of "pre existing condition".

There is a huge difference between someone with an ongoing condition (diabetes, pregnancy, cancer) and someone who broke an arm or had an appendectomy 20 years ago. Health insurance companies tend to look at any little thing and call you high risk to get out of insuring you and that isn't fair.

My mom had a lump in her breast that was just fluid and the doctors said she was all clear. When she went to get private insurance she was given a crazy high rate because she had a "pre-existing condition" which it totally asinine.

julieanne912 · January 2017

AprilZ81 said:

I think some of what needs to happen a new definition of "pre existing condition".

There is a huge difference between someone with an ongoing condition (diabetes, pregnancy, cancer) and someone who broke an arm or had an appendectomy 20 years ago. Health insurance companies tend to look at any little thing and call you high risk to get out of insuring you and that isn't fair.

My mom had a lump in her breast that was just fluid and the doctors said she was all clear. When she went to get private insurance she was given a crazy high rate because she had a "pre-existing condition" which it totally asinine.

Yup that's exactly my problem with my arm. The plate and screws have caused me zero problems, but at the time, they said it made me "higher risk". That's so stupid.

I've also had to go in to have 2 mammograms and 2 ultrasounds, for lumps that were just fluid related because of the time of the month I was at when I was at my doctor for my annual. They weren't even there in the 2nd round of testing. But now that you mention it, I worry that would also put me into a "higher risk" category. Nevermind there is ZERO history of breast cancer anywhere in my family and I'm not even 35 yet.

Xstatic3333 · January 2017

I'm reading that pre-ACA even a prior Caesarean could put you in a higher risk category for health care, whether or not you are planning on more kids. Now I'm trying really hard to stick to reputable news sources with so much craziness flying around these days, and I can't remember where I read that, so don't necessarily quote me on it, but if that is the case, how completely infuriating is that?

short+sassy · January 2017

Xstatic3333 said:

The ACA could certainly be improved. I am interested in the idea of plans being sold across state lines that the Republicans have brought up recently. To just pull it and destabilize the market without a replacement plan in effect, though, is pretty unconscionable. It's playing politics with people's lives. There was an article a few weeks ago that showed that many people who oppose Obamacare are actually on the ACA and like it; they didn't realize they were the same thing.
About half the country hated Obama. That's their right, and I get it, but it doesn't mean that taking an immediate blowtorch to his policies is a great idea.

If I ruled the world, I'd like to see single payer, though I don't think it can happen politically in the US in my lifetime. This should not be a for-profit business. I should not have to wonder if my providers' recommendations to me are based on what is best or what pays out better. Until then, though, keeping the removal of preexisting conditions is everything. It's, in my opinion, one of the most important issues our country faces, period. Don't we want people to be able to work and contribute to the best of their abilities? Without that stipulation in MA, my friend with chronic brain cancer would have been stuck in the retail job he had when he was diagnosed, instead of getting his masters, entering the PR field, becoming a homeowner, and contributing to the economy. We all benefit from better health care by the creation of a more robust economy and society and a lower drain on our resources from other social programs. I'm willing to pay for that out of my tax dollars, 100%.

The ACA has not been a total failure, but it has been a total failure in some states. It sounds like Illinois may be one of them. In RI, there are several options of reasonable, affordable plans that we could afford. I can't say we could afford them on one income, because we couldn't afford much in our lives on one income and haven't set things up that way. I don't know what the fix for the problems among states is. It's well above my pay grade, and I'm assuming has to do with regulatory stuff.

I talked about this in my post a few weeks ago. My job is pretty insecure at the moment, so I'd been scouting out the ACA plans. Absolutely horrific for Louisiana. But it was actually the folks on this board, talking about the ACA plans in their states, that gave me the idea to check out Mississippi plans.

Unbelievable!!!! Their plans were 10x better. They're much better than even the insurance I have right now on my employer's group plan. They're lowest Bronze plan had a $1750 deductible and my subsidized cost was cheaper.

So I had asked you all if I could buy a plan in another state and got the bad news that I can't. Why? WHY? There is just no point to that. To parlay off my (above) post, it is just another example of the government not protecting us from oligopolies. And, in fact, PURPOSELY going out of their way to limit our choices.

Opening up the ACA across state lines would be a huge, obvious stride into making healthcare more affordable for a lot of people. It would certainly be a world of difference for me. After all, isn't the word "affordable" part of the ACA acronym .

To the second bolded, big sigh. I almost wish I hadn't read that. I don't expect the average American to be up on ALL the latest events. I know the slang "Obamacare" is heard more often than the ACA, especially by anti-Obama people. But I still don't understand how anyone could miss that. Especially for people specifically on an ACA plan. Please come out from under your rock and show a modicum of intelligence. Because, if they don't know Obamacare is the same as the ACA, than they're just opposed to something they know nothing about, except it has Obama's name on it.

vlagrl35 · January 2017

Rand Paul just released his version of a replacement ACA plan last night and it included opening state lines. I would be a huge fan of that because of competition between insurance companies.

Xstatic3333 · January 2017

@LillibetteV FYI, in case your H doesn't pass on stuff like this, mine just told me that they're probably going to freeze enrollment in a lot of the lower-deductible state employee plans for next year, including the one we're on (Tufts Navigator). So glad we got on it in time. They're also bumping up the deductibles a little, although still nothing to complain about based on what I've seen here.

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