I hate the Un-affordable Obama Care

[gemini]

Our health insurance base costs have gone up 13% in the last 2 years. Our deductible amount was
increased x2. Computer health records, I have no real problem with properly safe-guarded health info
as long as it's kept in-house. (ie. Baylor/Scott White system).
I do have a problem with the continuing government intrusion into my personal life. Providing the
government with every minute detail of my health? Providing the government with womens personal
health records from their gyno's? Having the government decide ANYTHING related to my health care.
No thanks.
The financial records the government wants from every citizen? Where, when, how, how much, how long,
you've had whatever assets you have? Obamacare giving them the right to directly "raid" your accounts.
No thanks.
Like Phillip964, I want to know how soon I get to stop paying property taxes for Parkland Hospital now that
Obamacare is taking responsibility for those previously uninsured. Obamacare?
No thanks.

[G26ster]

UT SW should accept medicare patients.

They accept Original Medicare, not my Medicare Advantage HMO. There's a big difference between Original Medicare and a Medicare Advantage HMO.

The difference is that Original Medicare is accepted at most hospitals/doctors but you are responsible for the 20% of Part B costs unless you also have a Medicare (Medigap) supplement plan. Under a Medicare Advantage HMO, you;'re not responsible for that 20% BUT you are restricted to doctors and hospitals in that HMO. The two should never be confused.

[The Annoyed Man]

I numbered my thoughts below so that I could put them in some kind of logical order:

1. Regarding cash payment rates, I've seen it go both ways. I've generally paid less because I was a cash customer (office visits, and a procedure here and there), but there have been a few times when I either paid more, or I got no discount at all (which was effectively the same thing). Generally speaking though, the cost of healthcare—even as a cash customer—has kept me from getting some care that I would have gladly purchased if I could have afforded it. More on that in
2. My wife and I finally got signed up for Obamacare, and we're covered as of 4/1/14. I hate it, I really do, and I have railed against this law from day one. I am philosophically opposed to the whole thing, and having insurance through it does not change my opinion of it one bit.
3. In the end, I signed up simply because I'll be hanged if I will pay a fine, still not have insurance, and my fine be used to buy insurance for someone else.
4. Here are the general details of the policy we are getting: It is a Blue Cross/Blue Shield Multi-State PPO, and it is a "silver level" plan. (The plans available through Healthcare.gov fall into Bronze, Silver, Gold, Platinum, and Catastrophic categories; so our "silver" plan is a mid-level plan.) This plan costs $1,278.00/month for the two of us, without taking the subsidy into consideration. The subsidy is where things get tricky. . . .
5. I have been self-employed since late 2007 in an industry where I might do handsomely one month, and then starve for the next three or four. . . .or more. It has been impossible to state with any certainty how much I earn per month, let alone per year, as it can change a lot from month-to-month and year-to-year. As of late, my business has been struggling, and my wife and I had been taking some disbursements from our retirement account to keep things afloat. We can no longer justify doing that, and so I am currently looking for a job. But until I can get a job with a steady paycheck, I cannot answer the question "how much do you make each month" that the healthcare.gov navigators ask you when you phone them.
6. I had to phone the navigators—it took several tries, including one in which I was on hold for 1:15 hrs waiting for a navigator, and they hung up on me before I could even talk to a human being—because the website is NOT set up to handle people who do not have a regular and quantifiable income. The horror stories I endured trying to do it online myself were enough to incite me to riot. In any case, I had to phone the navigators, and it took talking to a couple of different ones before I could talk to one who actually helped me to figure out enrolling. And by the way, once I did get someone to help their system crashed about halfway through the process, and I was instructed to wait two hours and then call back to complete it—which I did.
7. My 2013 taxes aren't filed yet, and all I have to go on is my 2012 Adjusted Gross Income. They are supposed to be able to work with that, but they can't. Get that? Their system cannot handle our 2012 Adjusted Gross Income, which was a modest "low-40K" figure.
8. Instead, she asked me how much I made this month—March 2014. In as much as the month isn't over yet, I couldn't accurately answer the question. So, she asked me how much I had made to date this month. Well, it's not a lot of money. I had the back half of a finished contract come in which paid me, and there was a few hundred other dollars in miscellaneous billing. Then she asked me how much I anticipated making before the end of the month. Well, unless another contract that I have out there waiting for signature comes in, I won't make more than another couple of hundred dollars this month. So.......get this.....she based the amount of my subsidy for the month on an estimated monthly income of about $1,700.00! This means that the amount of my subsidy is SO high that it brings our insurance plan down to $485.00/month from the original $1,278.00. That's a $793.00/month subsidy! Ridiculous.
9. The thing is, because my income fluctuates, I may not qualify for this same level subsidy next month, or the month after that. SO....... I am instructed by healthcare.gov to phone in each month at the end of the month, when I know what my income for that month was, and report the new monthly income amount and have my subsidy adjusted up or down accordingly. I have 30 days to report any changes to my monthly income. The thing is, nobody has told me how rapidly Blue Cross will be updated so that they invoice me for the correct amount each month.
10. God willing and the crick don't rise, I'll land a job here soon enough and I can begin reporting a regular monthly income to the gubmint so that I can count on a certain monthly premium payment. Hopefully, it will be a job that comes with an insurance benefit, and I can stop accepting a subsidy to be insured.
11. Now, before any of you start beating me up, believe me, I DO realize that some of you are paying higher rates than what is fair so that I can get the subsidy which makes this insurance affordable to me. I also realize that some of you will choose to pay the fine rather than enroll, and that your fine will contribute to paying for my insurance, and that isn't fair to you either. I really don't like the situation either, and I think it is unfair to you AND to me. Before Obamacare, I was content to continue being uninsured until such time as I could afford to buy a policy, which I anticipated being if my business could recover, or I came into my inheritance (sadly, probably not that far off from now). The only reason I signed up in the end was that I would be hanged if I would pay the fine AND still have no insurance. My wife had a very affordable plan ($245.00/month from Humana), that worked well for her, and was not encumbered by prenatal care, abortion provision, or any of that other crap that a middle-aged woman does not need. Obamacare eliminates that plan as of 12/31/14. So, unless she signed up for Obamacare, she would be uninsured too in a few months from now.
12. So, I feel very much like I was bullied into doing this, and I would happily take a bat to the head of any democrat politician who voted for this thing, and to the heads of most of the voters who elected those criminals.
13. I am going to state up front that I will keep this policy as long as I can sustain the payments, and then I will change to one of the lower level plans; but until I have to do that, I am going to take advantage of the insurance to take care of some things that I have been putting off because I won't be able to afford them when I have to downgrade my coverage. These are not frivolous items, they involve trying to fix the spine that has given me so much pain over the years, and getting some resolution on a long-term prostate issue which has bedeviled me with various difficulties.
14. I still think it is bad law, but as long as I have to deal with it one way or another, I figure to "get mine" while I can, and then deal with whatever happens when the current iteration of the system collapses because it was so badly conceived from the get go.
15. Personally, I think we are headed for a single-payer system. This is not what I want, but it's where I think we are headed. The current house of cards can't last, particularly when the president who demanded the thing in the first place keeps suspending parts of it, and giving out favors to his largest contributors in the form of exemptions for various of its provisions. The 1:3 ratio in youth:senior premiums mandated by the law impose unsustainability when young people are not signing up for it. There are little known provisions in the law which are going to prove extremely controversial in the next couple of years. One of them guarantees a taxpayer funded bailout of the insurance industry in order to keep the system going as currently configured, and that bailout is going to become a huge political football......one we can lay SQUARELY at the feet of the democrat party, since not one single republican (or libertarian) voted for this mongolian cluster.......you get the idea. After having bailed out the banks, General Motors, Fanny and Freddie, and others to the tune of trillions of $$ over the past 6 or 7 years, taxpayers are NOT going to be in the mood to bail out insurance companies to the tune of another trillion or two $$ (particularly when at least half of them believe the insurance companies to be part of the problem), and any politician who pushes it will lose his/her office. And then there is the provision which allows an individual to opt out of obamacare entirely if they can prove that the rates are unaffordable to them even with the subsidies included. So in the end, the system is primed to fail. When it fails, single payer is the only possible outcome which the majority of voters, after several years of obamacare fatigue, will finally submit to.
16. The only way to avoid single payer is for republicans to recapture the house, senate, AND the whitehouse, and pass some kind of laws which patch the system up and restore some kind of business sense to it. But by then, it is pretty much guaranteed that voters will have come to view taxpayer subsidized healthcare as an entitlement, the same way they view Social Security and Medicare now. So, democrap-care is with us to stay, one way or the other.
17. I believe that has been the democrat party's strategy all along: grind us down and wear us out until we just fold up and give in to their fascist dogma.
18. This is one of the reasons why I hate that party with such a passion. Republicans aren't a whole lot better, but at least they understand the meaning of a dollar; democrats on the other hand stand for the deliberate ruination of free enterprise and all the things which made America great.. . . . .including affordable healthcare—which is the exact opposite of healthcare as an entitlement.
19. Anyway, that is my personal Obamacare experience so far. If I were in a better boat financially, I would have resisted for a lot longer, but I am in a difficult situation because of what democrats did to the small business economy. . . .so I am getting hosed both ways thanks to that bloody abomination of a gang of political thugs. Forum rules prevent me from fully expressing the depth of the contempt I have for democrats.

[mamabearCali]

TAM.....get what you can get fixed while they will still do it. I am guessing it won't be too long till a blood test is considered extraordinary care only to be used in the most severe cases.

[sjfcontrol]

TAM -- regarding the inability to estimate income, I feel 'ya buddy! I am assured by my agent (navigator? What is he, Safari??) that it all comes out in the wash at the end of the year. That on your 2014 tax return (in april of 2015) your tax preparer will calculate the subsidy based on your actual income. If the subsidy is higher than you actually got, you'll get a 'refund' (a refund on a subsidy???), If less than you got, you'll get a bill.

Prepare yourself…

[SewTexas]

There are clinics/doctor office that only accept cash and no insurance whatsoever. Doctor Visit is is just $35 and the only way to know about those clinic is when your PCP kick you out as you do not have insurance. Yep doctor visit and it is just $35. Lab works are also heavily discounted. Legit doctors and regular clinic like any other out there.
Who most visit such clinics? illegal immigrants.

???
I've got plenty of friends who deal in cash with their doctors, negotiating their payments. Mainstream clinics and doctors, the same ones you go to. If you use Samartian Ministries type of Insurance Substitutes, those are considered "not having insurance", because the clinic doesn't have to deal with it, you do. So you pay up front. I know of one lady who was in a horrible car accident, several years ago, they paid cash for her hospital stay, doctor bills, ect. Every bill was cut 30 - 50%. Parkland in Dallas I think. Will every single clinic or doctor reduce their bill? no. That may be when you change doctors, letting them know why, you're saving them time and effort, your account doesn't have to be touched by their insurance dept.

[nightmare]

A high deductible plan may be the best way to go for healthy people. Out of everything out there today, it's the most like the catastrophic insurance of yesteryear. Price shop and pay as you go unless you get hit by a bus. In that case out of pocket is limited to a few months pay.

[rotor]

If there's someone here that is knowledgeable in State health law, I have one for you. I am in a Medicare Advantage HMO. This means I must deal with the PCPs and specialists in my network. I wanted to get a second opinion from a noted specialist at UT Southwestern in Dallas (UT Southwestern does not accept my insurance). I told them I would pay cash. I was informed that Texas state law prohibits them from accepting cash from a patient who has health insurance, even if they do not accept that insurance. Any one ever heard of this?

It is Federal law. A doctor that accepts medicare can not accept such a cash payment from a medicare beneficiary outside of the medicare system for a covered service. Now if the service is not covered by medicare, like some plastic cosmetic surgery, the doctor makes you sign an ABN (I believe that's what it is called) which tells you that the service is not covered by medicare. A second opinion though is a covered service and therefore the doctor if he agrees to see you must accept payment from medicare and since you are an advantage hmo patient and the doctor is outside your network you just won't get seen. You give up a lot when you become an advantage patient. Having insurance does not mean having a card. You must know the network of doctors and hospitals provided. In an hmo the doctor gets paid for not growing corn, as you probably now know.
Options for you, don't tell the consulting doctor you have medicare- I guess you would have to give a false name and ss#. Very hard to do as almost every clinic will require photo id. On the other hand, you can complain like mad, write a letter to the editor, your hmo may make an exemption. Best of luck.

[rotor]

I've never seen what you've experienced. The only time I've seen a doctor's visit be at a reasonable cash rate was for a flight exam where they only accept cash.
Every other procedure - especially dental procedures and emergency visits, the listed rate was far far above what the "negotiated" rate was with my insurance company.
And yes, you can absolutely negotiate down (up front) with smaller offices if you're paying cash, but often the rate for people who can pay for it, especially if they need it now - emergency/urgent care.. Rates are just crazy.

I can't speak for large clinics but in my area of Texas doctors fees are negotiable for cash paying patients. Barter works too. Same for lab fees. Always bargain for rate reductions with your doctor. Ask to see the price list. Ask for a reduction like to Blue Cross rates plus 10%. Most doctors will jump on that. Labs, shop around. Panels are usually cheaper than individual lab tests. The problem is that most non-medical people just don't know how to work the system. I am still working on the dental system though. I could buy my next car for the price of my implant work. I deal with some labs that charge $300 for a test and other labs that do it for $40. We need ombudsman for non-insurance patients. My wife picked up a script today for $24 at United. I checked WalMart and it's a $4 script. I asked her why she picked United vs WM or Sams Club. "I was going shopping for dinner". That's $20 more for dinner.

[G26ster]

If there's someone here that is knowledgeable in State health law, I have one for you. I am in a Medicare Advantage HMO. This means I must deal with the PCPs and specialists in my network. I wanted to get a second opinion from a noted specialist at UT Southwestern in Dallas (UT Southwestern does not accept my insurance). I told them I would pay cash. I was informed that Texas state law prohibits them from accepting cash from a patient who has health insurance, even if they do not accept that insurance. Any one ever heard of this?

It is Federal law. A doctor that accepts medicare can not accept such a cash payment from a medicare beneficiary outside of the medicare system for a covered service. Now if the service is not covered by medicare, like some plastic cosmetic surgery, the doctor makes you sign an ABN (I believe that's what it is called) which tells you that the service is not covered by medicare. A second opinion though is a covered service and therefore the doctor if he agrees to see you must accept payment from medicare and since you are an advantage hmo patient and the doctor is outside your network you just won't get seen. You give up a lot when you become an advantage patient. Having insurance does not mean having a card. You must know the network of doctors and hospitals provided. In an hmo the doctor gets paid for not growing corn, as you probably now know.
Options for you, don't tell the consulting doctor you have medicare- I guess you would have to give a false name and ss#. Very hard to do as almost every clinic will require photo id. On the other hand, you can complain like mad, write a letter to the editor, your hmo may make an exemption. Best of luck.

Thanks Rotor. makes sense. Yes, although my Advantage HMO has been really great since 2008 even with some pretty heavy duty bills and procedures, when it comes to a catastrophic illness, and you want the best possible doctors available in the country, they fall short, as you are restricted in doctor and hospital choice to those in your network. My advice to anyone soon to retire (65 and over) is to avoid a Medicare Advantage Plan, and take advantage of the 6 month "guaranteed right" window after signing up for Medicare Part B, where you cannot be turned down for pre-existing conditions of any kind with a Medigap supplement plan. If you miss this 6 month window, you are basically out of luck for life, with a few rare exceptions, in getting a supplement should you become a victim of a catastrophic illness.

[rotor]

I agree. I have regular medicare and a supplement from USAA. I think that is the best way to go. Advantage plans are not really medicare. They are private insurance and they are a big money maker for insurance companies. The more they limit you the more money they make. Regular medicare will get you into any doctor in the country that takes medicare and more and more are refusing. People don't realize that medicare money is being shifted to obamacare. You worked your whole life and someone who never worked a day is getting the benefit.

[G26ster]

I agree. I have regular medicare and a supplement from USAA. I think that is the best way to go.

I agree of course. I have been a member of USAA for over 47 years, and even they cannot not sell me a supplement plan, with my condition, as it cannot be underwritten. I think the whole "guaranteed right" situation, which requires one to see into the future, is basically wrong. Today, a person under 65, with no insurance at all, can wait for a disastrous condition to befall them, and sign up for insurance after the fact and cannot be denied. With Medicare supplements, the gov't only allows you to do the same within a certain "one time only" period, and if you didn't know about that in advance, you are screwed for life. I think it is unfair and discriminatory for seniors to deny them the same rights as the rest of the country under 65.

[TomsTXCHL]

Thanks Rotor. makes sense. Yes, although my Advantage HMO has been really great since 2008 even with some pretty heavy duty bills and procedures, when it comes to a catastrophic illness, and you want the best possible doctors available in the country, they fall short, as you are restricted in doctor and hospital choice to those in your network. My advice to anyone soon to retire (65 and over) is to avoid a Medicare Advantage Plan, and take advantage of the 6 month "guaranteed right" window after signing up for Medicare Part B, where you cannot be turned down for pre-existing conditions of any kind with a Medigap supplement plan. If you miss this 6 month window, you are basically out of luck for life, with a few rare exceptions, in getting a supplement should you become a victim of a catastrophic illness.

I guess your comment that I bolded above is directed at folks with a nasty preexisting condition? Sorry don't understand you.

I am about to turn 65, am already on SS thus I've been automatically signed-up for Parts A and B, and am being absolutely hounded by insurance agents representing the various Advantage plans. And in surfing the medicare web site itself, I find that I can sign-up for most/any of these plans directly thru the medicare.gov site without apparently dealing with ANY of these "exchange" companies (e.g. extendhealth/oneexchange from Tower Watson).

I don't know WHAT the heck to do, but I've got a couple months still to think and study on it. As healthy as I am (knocks on wood) I still have a GP and a Urologist and a Dermatologist and a Gastroenterologist and <who else> so am thinking still that I want an Advantage plan and co-pays of $15-50 bucks and some minimal prescription help.

[rotor]

Thanks Rotor. makes sense. Yes, although my Advantage HMO has been really great since 2008 even with some pretty heavy duty bills and procedures, when it comes to a catastrophic illness, and you want the best possible doctors available in the country, they fall short, as you are restricted in doctor and hospital choice to those in your network. My advice to anyone soon to retire (65 and over) is to avoid a Medicare Advantage Plan, and take advantage of the 6 month "guaranteed right" window after signing up for Medicare Part B, where you cannot be turned down for pre-existing conditions of any kind with a Medigap supplement plan. If you miss this 6 month window, you are basically out of luck for life, with a few rare exceptions, in getting a supplement should you become a victim of a catastrophic illness.

I guess your comment that I bolded above is directed at folks with a nasty preexisting condition? Sorry don't understand you.

I am about to turn 65, am already on SS thus I've been automatically signed-up for Parts A and B, and am being absolutely hounded by insurance agents representing the various Advantage plans. And in surfing the medicare web site itself, I find that I can sign-up for most/any of these plans directly thru the medicare.gov site without apparently dealing with ANY of these "exchange" companies (e.g. extendhealth/oneexchange from Tower Watson).

I don't know WHAT the heck to do, but I've got a couple months still to think and study on it. As healthy as I am (knocks on wood) I still have a GP and a Urologist and a Dermatologist and a Gastroenterologist and <who else> so am thinking still that I want an Advantage plan and co-pays of $15-50 bucks and some minimal prescription help.

My personal recommendation is to be on regular medicare, get a medicare supplement from a good company ( USAA was for me) and there are various priced and featured supplements so you have to study this, buy a plan D prescription (in my area the choice was Humana (didn't like) or AARP (was good and you don't need to join AARP). There are time limits that you must do this and I believe that if you do this right when you turn 65 you are OK but later on you can't or are penalized. The advantage plans in my opinion are not the way to go.

[TomsTXCHL]

My personal recommendation is to be on regular medicare, get a medicare supplement from a good company ( USAA was for me) and there are various priced and featured supplements so you have to study this, buy a plan D prescription (in my area the choice was Humana (didn't like) or AARP (was good and you don't need to join AARP). There are time limits that you must do this and I believe that if you do this right when you turn 65 you are OK but later on you can't or are penalized. The advantage plans in my opinion are not the way to go.

Thanks I've been trying to understand Medigap (Medicare Supplement) and two things stop me dead-in-this-track:

1. A Plan F covers everything (but prescriptions) but it does not cover routine physicals for example. At least from what I've read. It's only for if/when you get sick (which I very rarely have).

2. A provider that doesn't accept basic Medicare won't accept Medigap. I don't know how many of what kind of Drs don't accept Medicare but this alarms me.

What caught my eye about Medigap is that it "protects your wealth" by paying everything (at least, w/certain Plan Fs) so you don't have to worry about a catastrophic illness draining all your resources. Yeah the prices go up at certain points but frankly these look easy to me.

Maybe paying out-of-pocket for regular checkups is no big deal, I just dunno.