HarCo2ANewb
Subibro
Do we have any thing coverage pricing related that is viewable at this time or are they taking the it has to go into effect before we know how bad it well really be approach again?
ObamaCare Q&A
- Thread starter jpo183
- Start date
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jpo183
Ultimate Member
Not yet, I have some ball park figures for young guys, but the real numbers are not out yet. The plans are really based on income levels. The lower your income (between 131-400% the federal poverty level) the better the plans get.
Its really backwards, the less you make the lower the premiums cost AND the better the plan you get.
Listen guys, I am NOT for this however if it is here I am going to help people that can get the plans at the best price possible. I think that these subsidies are the undoing of ObamaCare, it is unsustainable and will lead to a single payer socialized health system.
Some guys may like the idea of a single payer ( I do, too many dumb employers hold the keys and choices of health care for too many) The socialized part I do not.
Do not be so sure of yourself that you do not qualify for a subsidy.
Example: Family of 4 can make up to 94k and still get a subsidy, family of 5 110k
That is why I say ObamaCare is unsustainable, it is giving 80% of Americans a subsidy and then once they get used to it, the rug will be pulled out........
jpo183
Ultimate Member
Just got the final MD health plans this afternoon. After going through an 800 page document I am shocked at these plans.
Most plans are $2, 000 + deductibles with little to no up front benefits.
I will do a write up tomorrow. After seeing the deductibles (no rates yet) there is little way for these plans to make sense financially.
The big question will be what happeneds to the pricing of the plans off the exchange.
Remember with deductibles the deductible quotes is 2x the amojnt for any other type of coverage other then individual.
Most plans are $2, 000 + deductibles with little to no up front benefits.
I will do a write up tomorrow. After seeing the deductibles (no rates yet) there is little way for these plans to make sense financially.
The big question will be what happeneds to the pricing of the plans off the exchange.
Remember with deductibles the deductible quotes is 2x the amojnt for any other type of coverage other then individual.
my wife is losing our plan, blue cross blue shield, at her work because of obama care. according to your calander a few pages back we will now be paying 300% more than before with a $6000 per person, $12000 total out of pocket expenses. thats 3 times my house note out of pocket if one of us gets sick.. how in the world does anyone call that affordable? and thats the silver plan. wtf does good insurance cost in this debacle?
jpo183
Ultimate Member
Thats what I will be letting you know once rates are out.
Pray for the congressional standoff to win over the dictator...
Sent from my iPhone using Tapatalk - now Free
jpo183
Ultimate Member
One more thing the out of pocket limits are not what you should focus on but the intial deductible. The out of pocket limit is the MAX you would ever pau with deductibles, co pays and co insurance added up. Think of it as a stop loss.
Jim Sr
R.I.P.
If California's new ObamaCare health-care exchange, 'CoveredCA', is any indication, we're all in for it. 
rac74
Si vis pacem,para bellum
Do you have a link where the Gold,Silver and Bronze plans breakdown what procedures are covered?
jpo183
Ultimate Member
We just got the plans last night. I am working on getting them onto my site. The exchange site is not up yet which is where they should be. The carriers do not even have them up yet.
Will be pulling out the best plans assuming comparable rates to plans out there right now so people can see.
This thread is not meant for obamacare dislike / rants / etc
There are a lot of threads for that already. Please keep this thread to Q &A as this is the job thread.
defygravity
Active Member
Thanks for doing this.
I'm sure you're already beyond busy so to take the time to answer our questions must really be a sacrifice. Thank you!
Sent from my DROID RAZR using Tapatalk 2
I'm sure you're already beyond busy so to take the time to answer our questions must really be a sacrifice. Thank you!
Sent from my DROID RAZR using Tapatalk 2
jpo183
Ultimate Member
OK so as you know there are tiers of plans called metals, bronze, silver, gold, platinum.
There are 4 carriers in MD: Care First, United Health Care (all savers), Kaiser and Ever Green.
Carriers
A summary of the 4 carriers from plans that I have seen (non exchange plans from existing clients)
Carefirst - the most prominent carrier in MD has an extensive provider network. Has always been one of the cheaper health carriers. This carrier is the one we do business with most due to cost and provider network.
United Health Care - Has had awesome individual plans (non group). Great provider network and some of the better dentist take UHC due to better payments.
Kaiser - A very big Montgomery and DC area provider. Kaiser utilizes a "all in one provider" type service where an individual would go to a location and be able to get test, check ups, etc all at one place. Some people like them some dont. If you choose a kaiser plan you want to make sure you have a kaiser center close by, other wise the plan doesn't work as well.
Ever Green - This is a new carrier so not much information is out there. They are a "co-op" and the estimation of cost we have seen are crazy high. Ever Green's plans also require A LOT of pre-authorizations. This would make me cautious.
Plans
I cannot stress enough to check where you fall on the poverty level. The plans change based on the poverty level. Check your status here
This is an over view on plans. I will only high light some major differences between plans if it is significant enough to be mention. (see attachments for plan descriptions)
Each carrier has a "catastrophic plan" which has a deductible of $6350(or 12,700 for any coverage other then individual). This is what I call the "in case you get hit by a bus plan". Pretty much useless for families and is marketed to the young adult. Once the deductible is met everything else is covered.
The bronze level plans are straight high deductibles ranging from 4,000 - 6,350 ( or $8,000 -12,700 for any other type of coverage other then individual)
These plans have NO benefits before the deductible other then you get the contracted price that DRs agree to offer services for any carrier customer.
Once your deductible is met then the covered will pay a 30% co insurance (like a co-payment but a % instead of a flat $ amount)
Notables of Bronze Plans:
- CF has a 6k deductible bronze plan that mimics the catastrophic plan.
- All of CF bronze plans are HSA plans (which means you cant get benefits before the deductible is met)
- Ever Greens plan design state that you pay 40% co insurance BEFORE deductibles. So you get some benefit and it gets credited to your deductible. I do not like how they have their plan laid out and would want to confirm before you take this as gospel, as normally co-insurance doesn't start until AFTER the deductible is met.
- Kaisers has a Bronze non HSA plan that offers PCP visit, specialist, and other practitioner office visits for $50 BEFORE deductible is met. I like these plans as the most common use for Health Care is for the common colds, and your Primary Care Pphysician
- United Health has a non HSA bronze plan which offers $50 PCP visits and $100 specialist visits before the deductible. They also state that the other services are subject to a 20% co insurance. So you get some benefit and it gets credited to your deductible. I do not like how they have their plan laid out and would want to confirm before you take this as gospel, as normally co-insurance doesn't start until AFTER the deductible is met.
All of these are HMOs
CARE FIRST HOWEVER HAS ADDITIONAL BRONZE PLANS
CF has PPO and POS plans in the bronze metal level. A POS is a plan that allows you to use out of network providers but you get the biggest bang for you buck by using in network doctors.
Their POS plan has first dollar coverage for PCP($35 co pay), Urgent care and generic drugs($10). This is a $5500 deductible and then a 20% co insurance for most things afterwards.
Their PPO bronze is a $3500 deductible.
Silver Base Plans is where things get tricky. If you do not qualify for Cost Sharing Reduction (133-250% of the Federal Poverty Level) the Silver plans deductibles range from $1300-$2500 (remember double this for anything other then individual coverage)
Most of the base silver plans are straight high deductible and then a 20% co insurance for CF, 30% for Every Green, 25% for Kaiser, 30% for United Health.
Each carrier has a Silver Plus Plan which have a component where the individual can go to the DR for a co pay. These plans have HIGHER deductibles ranging from $2000-$3500. Co - Pays for PCP visits are reasonable at $20-$35 and Specialist visits ranging from $50-70 (CF makes you pay ded first)
CF has a POS variant of the Silver Plus. The co insurance for the POS providers out of network is 40% They also have a Non HSA variant of the POS plan that is NOT a POS but allows you to have PCP visits before the deductible at $30 co pay. This variant has a deductible of $2000.
Ever Green also has a POS variant of both the Base Silver and Silver Plus plans. The POS variants co insurance for out of network providers is 50%
Ok so this is where things get different, remember how I said you need to know where you fall on the Federal Poverty Level (FPL). If you fall into that range the silver plan deductibles get reduced DRASTICALLY. The new ranges can fall from $0 to $1000 and the benefits start looking like traditional co pay plans. There are too many variants to list here since they drastically change.
There are also gold and platinum plans but without knowing the rates I am not going to bother listing them. The silver base plans and the silver plus plans are where most people will spend the money.
Things to consider
Deductibles are used to lower premiums. If you have a condition where you need to use the DR a lot, then going for a high gold or platinum plan where there is little to no deductible maybe more advisable. The idea of a high deductible is to choose something where you KNOW YOU CAN PAY IT IN FULL if you need to. I tell people that they should take the total deductible and budget that in the cost for the first year. Each year make sure you have that money put away, just in case, and refill as necessary.
If your wife is pregnant or you know you have a procedure coming up. It would be better for you to pay more for a lower deductible (or none at all) since you will max it out in the year of the procedure. For example my wife and I are expecting our third in April. It would make sense for me to pay a little more in premiums this year and essentially "finance out the deliver through health premiums" then get dinged $6k in deductibles.
Strategy and Planning
I want to be clear, I do not like ObamaCare. What I do like is that the individual can plan his future instead of just sign up for an employer plan. Now that you can change plans EVERY year, you can better plan your expenses.
Rates and Carrier News
CF has said they will be phasing out their old current plans and simply offering the same plans on and off the network. This is to get more numbers on their rolls, which will theoretically spread the risk (rule of large numbers)
Rates are going to be going higher, period. The only thing that brings the rates down is the subsidies and the subsidies are out there for A LOT of people and why I believe will kill ObamaCare.
Hope that helps, I typed this up for myself as a cheat sheet.
Attachments are too large and I cant upload them. Sorry guys, once I have them on my site Ill let you know.
There are 4 carriers in MD: Care First, United Health Care (all savers), Kaiser and Ever Green.
Carriers
A summary of the 4 carriers from plans that I have seen (non exchange plans from existing clients)
Carefirst - the most prominent carrier in MD has an extensive provider network. Has always been one of the cheaper health carriers. This carrier is the one we do business with most due to cost and provider network.
United Health Care - Has had awesome individual plans (non group). Great provider network and some of the better dentist take UHC due to better payments.
Kaiser - A very big Montgomery and DC area provider. Kaiser utilizes a "all in one provider" type service where an individual would go to a location and be able to get test, check ups, etc all at one place. Some people like them some dont. If you choose a kaiser plan you want to make sure you have a kaiser center close by, other wise the plan doesn't work as well.
Ever Green - This is a new carrier so not much information is out there. They are a "co-op" and the estimation of cost we have seen are crazy high. Ever Green's plans also require A LOT of pre-authorizations. This would make me cautious.
Plans
I cannot stress enough to check where you fall on the poverty level. The plans change based on the poverty level. Check your status here
This is an over view on plans. I will only high light some major differences between plans if it is significant enough to be mention. (see attachments for plan descriptions)
Each carrier has a "catastrophic plan" which has a deductible of $6350(or 12,700 for any coverage other then individual). This is what I call the "in case you get hit by a bus plan". Pretty much useless for families and is marketed to the young adult. Once the deductible is met everything else is covered.
The bronze level plans are straight high deductibles ranging from 4,000 - 6,350 ( or $8,000 -12,700 for any other type of coverage other then individual)
These plans have NO benefits before the deductible other then you get the contracted price that DRs agree to offer services for any carrier customer.
Once your deductible is met then the covered will pay a 30% co insurance (like a co-payment but a % instead of a flat $ amount)
Notables of Bronze Plans:
- CF has a 6k deductible bronze plan that mimics the catastrophic plan.
- All of CF bronze plans are HSA plans (which means you cant get benefits before the deductible is met)
- Ever Greens plan design state that you pay 40% co insurance BEFORE deductibles. So you get some benefit and it gets credited to your deductible. I do not like how they have their plan laid out and would want to confirm before you take this as gospel, as normally co-insurance doesn't start until AFTER the deductible is met.
- Kaisers has a Bronze non HSA plan that offers PCP visit, specialist, and other practitioner office visits for $50 BEFORE deductible is met. I like these plans as the most common use for Health Care is for the common colds, and your Primary Care Pphysician
- United Health has a non HSA bronze plan which offers $50 PCP visits and $100 specialist visits before the deductible. They also state that the other services are subject to a 20% co insurance. So you get some benefit and it gets credited to your deductible. I do not like how they have their plan laid out and would want to confirm before you take this as gospel, as normally co-insurance doesn't start until AFTER the deductible is met.
All of these are HMOs
CARE FIRST HOWEVER HAS ADDITIONAL BRONZE PLANS
CF has PPO and POS plans in the bronze metal level. A POS is a plan that allows you to use out of network providers but you get the biggest bang for you buck by using in network doctors.
Their POS plan has first dollar coverage for PCP($35 co pay), Urgent care and generic drugs($10). This is a $5500 deductible and then a 20% co insurance for most things afterwards.
Their PPO bronze is a $3500 deductible.
Silver Base Plans is where things get tricky. If you do not qualify for Cost Sharing Reduction (133-250% of the Federal Poverty Level) the Silver plans deductibles range from $1300-$2500 (remember double this for anything other then individual coverage)
Most of the base silver plans are straight high deductible and then a 20% co insurance for CF, 30% for Every Green, 25% for Kaiser, 30% for United Health.
Each carrier has a Silver Plus Plan which have a component where the individual can go to the DR for a co pay. These plans have HIGHER deductibles ranging from $2000-$3500. Co - Pays for PCP visits are reasonable at $20-$35 and Specialist visits ranging from $50-70 (CF makes you pay ded first)
CF has a POS variant of the Silver Plus. The co insurance for the POS providers out of network is 40% They also have a Non HSA variant of the POS plan that is NOT a POS but allows you to have PCP visits before the deductible at $30 co pay. This variant has a deductible of $2000.
Ever Green also has a POS variant of both the Base Silver and Silver Plus plans. The POS variants co insurance for out of network providers is 50%
Ok so this is where things get different, remember how I said you need to know where you fall on the Federal Poverty Level (FPL). If you fall into that range the silver plan deductibles get reduced DRASTICALLY. The new ranges can fall from $0 to $1000 and the benefits start looking like traditional co pay plans. There are too many variants to list here since they drastically change.
There are also gold and platinum plans but without knowing the rates I am not going to bother listing them. The silver base plans and the silver plus plans are where most people will spend the money.
Things to consider
Deductibles are used to lower premiums. If you have a condition where you need to use the DR a lot, then going for a high gold or platinum plan where there is little to no deductible maybe more advisable. The idea of a high deductible is to choose something where you KNOW YOU CAN PAY IT IN FULL if you need to. I tell people that they should take the total deductible and budget that in the cost for the first year. Each year make sure you have that money put away, just in case, and refill as necessary.
If your wife is pregnant or you know you have a procedure coming up. It would be better for you to pay more for a lower deductible (or none at all) since you will max it out in the year of the procedure. For example my wife and I are expecting our third in April. It would make sense for me to pay a little more in premiums this year and essentially "finance out the deliver through health premiums" then get dinged $6k in deductibles.
Strategy and Planning
I want to be clear, I do not like ObamaCare. What I do like is that the individual can plan his future instead of just sign up for an employer plan. Now that you can change plans EVERY year, you can better plan your expenses.
Rates and Carrier News
CF has said they will be phasing out their old current plans and simply offering the same plans on and off the network. This is to get more numbers on their rolls, which will theoretically spread the risk (rule of large numbers)
Rates are going to be going higher, period. The only thing that brings the rates down is the subsidies and the subsidies are out there for A LOT of people and why I believe will kill ObamaCare.
Hope that helps, I typed this up for myself as a cheat sheet.
Attachments are too large and I cant upload them. Sorry guys, once I have them on my site Ill let you know.
So question,
What do they use to determine poverty level?
Gross? Net? Prosposed?
Example, I am a GS-9, 0081 Series FF/Medic. I work a 144hr pay period cycle. This translates to 108 hrs straight and 36 hrs OT. The est. gross (I'm going to make up numbers here) is 85k. The net takehome after getting taxed as much as we do, is $45k. (proportion is about right, just false numbers
) Which do they base the poverty level on?
If it's gross, then I could NEVER afford insurance, as a single male under 35 its 800+% PL, which is $0/0% in subsidies and full on costs for whichever care I want.
If it's net, I'm much lower and could possibly afford some semblance of care.
On top of it, I'm a 30% compensable disabled veteran, with access to the VA. Of course, NOONE has told me exactly what my limits to care at the VA are (I really only see the PCM for Rx refills for my zoloft). So, is my PCP/PCM able to see me for simple colds etc? Or am I better off with the CVS doc-in-a-box clinics for things like antibiotics?
As a health care professional, I can generally diagnose minor crap and treat myself OTC, and I have connections to bounce a DDx off a couple MDs I know for a better idea if I need to seek treatment or not. But it all boils down to cost..
I would be tempted to run the catastrophic plan, but who the hell has near $7k just sitting around all the time in today's society? I live NEARLY paycheck to paycheck at the moment and barely stay afloat.....
What do they use to determine poverty level?
Gross? Net? Prosposed?
Example, I am a GS-9, 0081 Series FF/Medic. I work a 144hr pay period cycle. This translates to 108 hrs straight and 36 hrs OT. The est. gross (I'm going to make up numbers here) is 85k. The net takehome after getting taxed as much as we do, is $45k. (proportion is about right, just false numbers
) Which do they base the poverty level on?If it's gross, then I could NEVER afford insurance, as a single male under 35 its 800+% PL, which is $0/0% in subsidies and full on costs for whichever care I want.
If it's net, I'm much lower and could possibly afford some semblance of care.
On top of it, I'm a 30% compensable disabled veteran, with access to the VA. Of course, NOONE has told me exactly what my limits to care at the VA are (I really only see the PCM for Rx refills for my zoloft). So, is my PCP/PCM able to see me for simple colds etc? Or am I better off with the CVS doc-in-a-box clinics for things like antibiotics?
As a health care professional, I can generally diagnose minor crap and treat myself OTC, and I have connections to bounce a DDx off a couple MDs I know for a better idea if I need to seek treatment or not. But it all boils down to cost..
I would be tempted to run the catastrophic plan, but who the hell has near $7k just sitting around all the time in today's society? I live NEARLY paycheck to paycheck at the moment and barely stay afloat.....
jpo183
Ultimate Member
So question,
What do they use to determine poverty level?
Gross? Net? Prosposed?
Example, I am a GS-9, 0081 Series FF/Medic. I work a 144hr pay period cycle. This translates to 108 hrs straight and 36 hrs OT. The est. gross (I'm going to make up numbers here) is 85k. The net takehome after getting taxed as much as we do, is $45k. (proportion is about right, just false numbers
If it's gross, then I could NEVER afford insurance, as a single male under 35 its 800+% PL, which is $0/0% in subsidies and full on costs for whichever care I want.
If it's net, I'm much lower and could possibly afford some semblance of care.
On top of it, I'm a 30% compensable disabled veteran, with access to the VA. Of course, NOONE has told me exactly what my limits to care at the VA are (I really only see the PCM for Rx refills for my zoloft). So, is my PCP/PCM able to see me for simple colds etc? Or am I better off with the CVS doc-in-a-box clinics for things like antibiotics?
As a health care professional, I can generally diagnose minor crap and treat myself OTC, and I have connections to bounce a DDx off a couple MDs I know for a better idea if I need to seek treatment or not. But it all boils down to cost..
I would be tempted to run the catastrophic plan, but who the hell has near $7k just sitting around all the time in today's society? I live NEARLY paycheck to paycheck at the moment and barely stay afloat.....
You use your gross pay or modified Adjusted Gross Income. Unless you have income coming from multiple sources (like investment, business etc) just use your paycheck gross (or add your spouses as well)
Yea single people are the ones that get screwed through this. If you have dependents that is when the subsidies start "working". You will not qualify for it since 400% of the FPL is like 45k or something.
Dave MP
Retired USA
Any information pertaining to the dental aspect of O/C?
jpo183
Ultimate Member
Yes I did not do any write up on it, give me a few and I will have something.
DarthZed
Ultimate Member
Most of the ACA is made up of cost controls (which kick-in incrementally over the next few years). The argument is that once implemented, the rate of increase will slow dramatically. It is a big convoluted law (it had to be to wind it's way through all the special interests and get enough votes to pass). I've seen studies going both ways on whether it will work (though most of the non-partisan ones, i.e. not funded by the insurance/medical industry, seem to support the claim that it WILL bring down cost growth over time). {shurg} We needed to do something, we have the most expensive healthcare system in the world (twice as expensive per person as the next most expensive system) but we are nowhere near the top in most metrics, and don't even cover our entire population like those other systems.
If Republicans had come up with something, ANYTHING (at least anything that they could numerically support) to oppose Obamacare, it might not have passed. What's hilarious is that a recent poll showed that 46% oppose ObamaCare, but only 37% oppose the Affordable Care Act.
Which kinda proves that most people don't even understand the issue, and are just being whipped up by partisan rhetoric, as usual.
If Republicans had come up with something, ANYTHING (at least anything that they could numerically support) to oppose Obamacare, it might not have passed. What's hilarious is that a recent poll showed that 46% oppose ObamaCare, but only 37% oppose the Affordable Care Act.
Which kinda proves that most people don't even understand the issue, and are just being whipped up by partisan rhetoric, as usual.
wilcam47
Ultimate Member
if people cant afford insurance and are struggling paycheck to paycheck the way it is...I don't see how this Obama care helps
jpo183
Ultimate Member
There are 5 dental carriers offering plans
Alpha Dental, Delta Dental, Dominion, DentaQuest and United Concordia.
The only company I have experience with (these are ancillary plans, normally we pair dental and health with same carrier)
All the plans have $0 -$10 co pays for basic services such as exams, cleanings and x -rays.
The comprehensive services mimic normal coverage through current carriers.
There is not really anything special to mention with the dental plans. They are standard (good) and most include orthodontic coverage.
Alpha Dental, Delta Dental, Dominion, DentaQuest and United Concordia.
The only company I have experience with (these are ancillary plans, normally we pair dental and health with same carrier)
All the plans have $0 -$10 co pays for basic services such as exams, cleanings and x -rays.
The comprehensive services mimic normal coverage through current carriers.
There is not really anything special to mention with the dental plans. They are standard (good) and most include orthodontic coverage.
jpo183
Ultimate Member
Most of the ACA is made up of cost controls (which kick-in incrementally over the next few years). The argument is that once implemented, the rate of increase will slow dramatically. It is a big convoluted law (it had to be to wind it's way through all the special interests and get enough votes to pass). I've seen studies going both ways on whether it will work (though most of the non-partisan ones, i.e. not funded by the insurance/medical industry, seem to support the claim that it WILL bring down cost growth over time). {shurg} We needed to do something, we have the most expensive healthcare system in the world (twice as expensive per person as the next most expensive system) but we are nowhere near the top in most metrics, and don't even cover our entire population like those other systems.
If Republicans had come up with something, ANYTHING (at least anything that they could numerically support) to oppose Obamacare, it might not have passed. What's hilarious is that a recent poll showed that 46% oppose ObamaCare, but only 37% oppose the Affordable Care Act.
Which kinda proves that most people don't even understand the issue, and are just being whipped up by partisan rhetoric, as usual.
The problem is health care is such a special interest and complex subject that it is tough. There are some very common sense things that should have been tried first. I am most opposed to ObamaCare because of the influence of Fed over State Rights. This should have been fought by each State within itself, not at the Fed level.
A couple common sense things would have been:
- Opening up regional competition with inter state commerce and not restrict based on states.
- Tort Reform
The problem with Health Care is that you have a lot of people that do not give a damn about their current unhealthy life styles and those choices are spread throughout the population in the form of risk. That is why insurance always tried to do pre-existing conditions. Its hard to justify taking someone on when you know you're going to lose money. MD has MHIP which is where those that could not get insurance used to go to.
if people cant afford insurance and are struggling paycheck to paycheck the way it is...I don't see how this Obama care helps
Check the link to the Kasier Foundation Subsidy Calculator. It will show you an estimation on cost and subsidy.
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