Health Care Thread

Wingz_sl said:

Health Plan Information | HealthCare.gov

As far as your comments about rates. Too bad your logic doesn't equate to other things. Got a cable plan price locked in? Get it canceled and pay more for a new one with all kinds of channels you don't want/need while they tell you the prices was projected to go up anyway.

EDIT ADD: I do understand the difference in medicare and medicaid. I wasn't talking about local, federal. Hopefully 2013 stuff isn't too old for this discussion.

WSJ: Doctors turn away Medicare patients | The Advisory Board Daily Briefing

Doctors turning away from Medicare patients - Atlanta Business Chronicle

If you want to believe it's a good thing, don't let my bad vibes get in your way. Keep the good feelen train going.

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And editing like fanaskin, good times:

You'll note those doctors mentioned are "cash-only" doctors - yes, those are effected - but they're a small subsection of doctors that don't keep a front office and don't file claims for you, you pay in full then you get reimbursed from the insurance company afterwards. Which you can still see with Medicare contrary to how the reporting makes it sound - my wife's nutritionist doesn't accept Medicare - we still go to her as an "out of network" doctor and get 60% back of our visit cost to her from Medicare. (Would get closer to 80% if she complied with Medicare's billing rules, but since she doesn't "accept Medicare" we have to eat the loss)

It's bad reporting because it's easy to take it inaccurately as you have. That's not to say many Medicare patients don't prefer to see someone that factors their coverage into the bill in advance rather than having to upfront the full bill then get reimbursed where many are EFFECTIVELY turned away - but from a literal standpoint that does not occur only effectively because many don't like the idea of footing a full couple hundred dollars that they get back in 4-6 weeks. [Psychiatrists and nutritionists are some of the most common examples that do this]

Additionally it's cute that you said it was a Chicago issue, there's a million articles out there about Medicaid being an issue in Chicago and you come back with an Atlanta and general link.

Also note that part of what they're quoting is that some doctors aren't accepting NEW Medicare patients which is not the same as not accepting Medicare patients. And in fact if you look at how many doctors are accepting new patients at all - 75-85% of doctors are accepting new patients PERIOD depending on the source you use. (Although generally it's reported as the reverse, in other words that 15-25% aren't accepting ANY new patients)

Additionally, don't forget that every insurance plan includes a prescription plan BTW - which the deductible changes often coincide pretty closely to what adding a RX plan onto a similar plan cost in previous years. Not sure about all cases, but I know for the BC/BS I used to administer for my last employer (Excellus BC/BS) we did not include the RX coverage and almost to the dollar the deductible change was in line with what it would've been if we had provided RX coverage as well.

Vaclav_sl said:

And editing like fanaskin, good times:

You'll note those doctors mentioned are "cash-only" doctors - yes, those are effected - but they're a small subsection of doctors that don't keep a front office and don't file claims for you, you pay in full then you get reimbursed from the insurance company afterwards. Which you can still see with Medicare contrary to how the reporting makes it sound - my wife's nutritionist doesn't accept Medicare - we still go to her as an "out of network" doctor and get 60% back of our visit cost to her from Medicare. (Would get closer to 80% if she complied with Medicare's billing rules, but since she doesn't "accept Medicare" we have to eat the loss)

It's bad reporting because it's easy to take it inaccurately as you have. That's not to say many Medicare patients don't prefer to see someone that factors their coverage into the bill in advance rather than having to upfront the full bill then get reimbursed where many are EFFECTIVELY turned away - but from a literal standpoint that does not occur only effectively because many don't like the idea of footing a full couple hundred dollars that they get back in 4-6 weeks. [Psychiatrists and nutritionists are some of the most common examples that do this]

Additionally it's cute that you said it was a Chicago issue, there's a million articles out there about Medicaid being an issue in Chicago and you come back with an Atlanta and general link.

Also note that part of what they're quoting is that some doctors aren't accepting NEW Medicare patients which is not the same as not accepting Medicare patients. And in fact if you look at how many doctors are accepting new patients at all - 75-85% of doctors are accepting new patients PERIOD depending on the source you use. (Although generally it's reported as the reverse, in other words that 15-25% aren't accepting ANY new patients)

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I didn't want to keep posting 2/3 in a row so I just edited my original comment, if you don't like that, it's cool.

I didn't say it's a chicago only issue, I just said it's happening up here. I posted what I did to show it's happening elsewhere not just where I'm at AND to show that I meant it by putting medicare not medicaid (you thought i got them confused where as I wanted to show that I did not.) Though you yourself showed it to be the case as well with medicaid which is saddening to say the least.

As far as the NEW medicare patients...that makes sense that they wouldn't just totally stop accepting existing medicare patients (at least yet) new ones are always coming down the line because old ones leave/die. Eventually you run out by attrition and don't have to deal with the whole mess or at least minimize the damage.

Correct, but why exactly is it that roughly the same amount of doctors are refusing ANY new patients? And why is it not an issue that those same people with a different insurance (major market PRE-ACA) are getting turned away?

You're talking about between 8% LESS Medicare patients getting turned down to as much as 3% more Medicare patients being turned down - the average of reported figures is actually WORSE FOR NORMAL INSURANCE. And the "Medicare is awful in comparison" figure is 3% worse than standard insurance - which I consider pretty negligible personally. It's shitty patients get turned away, but with Medicare falling right in the spread that "Normal Pre-ACA" insurance fell into it doesn't seem like whether it's Medicare or not matters. [Medicaid however certainly does the dropoff for it in Maryland is about 35% and we're a state with pretty good Medicaid funding, I'm sure places like Florida that are trying to gut it it's much worse]

And for your initial quote didn't you say close to a third? Because that is what Medicaid in Chicago is reported at verbatim - and nowhere do I see a third for Medicare anywhere in any microcosm. [Note: I apologize if you were honestly not confused at all - I do project that confusion on many people when I think they're doing it - I personally until I became disabled and thus got Medicare ALWAYS confused the two, so I do tend to project that error on others assuming it's a common mistake (Additionally during that timeframe I was a FOXNews loyalist when I had most of that confusion which FOXNews did not help at all with)]

wormie_sl said:

Yeah i am not sure wtf is the argument is here. A varied number of insurance carriers are not accepted by just as varied number of physicians. Where is the outrage about that? Oh thats right, this isnt about fucking reality, this is about stupid fuck ideology.

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Smaller networks mean less choices for doctors. A system cannot take a whole lot of uninsured, make them insured and expect the level of care to be the same quality as there is now without more doctors to be available. That is just one aspect, ability to pay and what is covered under different plans is another issue. Will people even use their HC insurance or just continue to go to the hospital ER so they don't have to pay the deductible they can't afford. Another interesting aspect is people that signed up at the exchanges, many may stop paying (note that signup numbers don't mean paying customers either) and I don't know of any mechanism that tracks that other than through the insurance provider on the exchange. Who knows if they go..ok did person X signup...yup we got em but they stopped paying in June, ok now what..does the IRS go after em? I believe depending on how it was setup through the excchange that bills are monthly. So that person goes to the hospital/doctor and they have to figure out if they're covered or not and it causes a huge issue. Another point is that the gov't arbitrarily decided what plans should include for basics in healthcare plans, what concerns me and should concern everyone is you are at the whim of what the secretary of health and human services shall determine...is weed covered for pain, maybe one day and now we all have to pay for it.

I am no longer in control over what mainly I can get coverage for, don't need pregnancy care at 65? sucks to be you, you gotta pay for it anyway because girl at 25 needs it, I must suck to be an underwriter.

Note: On ER visits to "dodge the deductible" - might want to check the law on that pal - because if you provide insurance and then try to dodge your portion the INSURANCE COMPANY IS LEGALLY ALLOWED TO COME AFTER YOU AS WELL AS THE HOSPITAL if you've done partial payment (which the insurance company providing their half would mean partial payment has been done). They would have to dodge the entire bill - which if you carry a policy is something they can cross reference with your social (which you're required to give before service if its not a deathly emergency) to force you into paying and filing with the insurance. The "ER trick" only really works if you're uninsured, in other words - it still can work without it, but you're walking on eggshells having to make sure you don't bring an ID and provide a false SSN when asked before they release you, etc which of course gets into fraud territory if you get caught.... Occam's Razor says it's not gonna happen often for insured people that want to game the system...

On cancelling/starting plans - just like forever there's enrollment periods (usually October through December with most) - that's why doctors offices always ask you to verify your insurance is up to date in your first visit in the new year... Starting a policy at another time is not allowed outside of specialized circumstances, and leaving one outside of the enrollment period allows the insurance company to still charge you an early termination fee if you've not been with them the requisite time. (in addition to the ACA costs with the IRS)

Additionally on pregnancy coverage - that's just a fucking meme for retarded people - YOU ALWAYS PAID FOR SERVICES YOU DON'T USE THAT'S THE ENTIRE CONCEPT OF INSURANCE IN A NUTSHELL - when I was 22 getting my first plan of my own I had coverage for living in a fucking nursing home included (as did every policy by law since the mid 80's or so - and before it became a meme because it's "forced" 85% of policies covered pregnancy services, even mens or senior policies) - insurance is not an a la carte industry, if it went a la carte it would fall apart quickly. [Frankly, I think separating dental out is broken personally even - but at least that kind of works...]

I'd rather pay more through increased billing, accounting, and management for a personalized plan with less coverage.

They can't without massive overhead.

I have not read any of this thread but I just wanted to share my experience with obamacare as a liberal who voted for him twice...

It is a steaming pile of shit that is no better than the steaming pile of shit we had prior, except pre-existing conditions.

after 6 months of calling on all of my days off to try and get my account unlocked. yesterday, I finally am able to log in to find that i can not afford a single plan that will help me.
I have an issue which requires medical attention. even with a plan where i pay 300 a month i will still be paying insane deductibles and other out of pocket fees. there is simply no way i will be able to afford everything that i will need. so do i just keep refusing to pay any of the bills and end up with 30k in debt, but keep my netflix and other minor expenditures, or spend every extra dime i have on my heath and just end up 15k in debt?

It does not matter if i pay them anything. it does not matter if i have health insurance. i will always owe money because in my lifetime i will never make enough to cover the cost of the medical care i require.

With subsidies? How much do you make and how much are the plans

Uncognito: If you have such a serious sounding condition you should be able to apply for disability and get Medicare. There's not many medical conditions that are so lengthy as you're talking about there that stand zero chance at Medicare coverage that I can think of.

Additionally if you're in a state that's allowing pay-for-service Medicaid next year, you can likely get a "charitable deduction" if you can prove the debt load that you have I would imagine. (I know there's flexibility in how they report your income for it here at least)

Also as Picasso said, make sure you were looking at it POST SUBSIDY not PRE SUBSIDY - depending on your income you might be getting as much as an 85% subsidy IIRC.

The subsidy also applies to your deductible and total out of pocket, as long as you have a silver level plan. That's something that most people don't seem to get.

Also, if something was fucked up with your account on the shit ACA website, you could have just made a new one.

Kreugen: You got a link on that tidbit? That is honestly the first I've heard of that - I'd love to add it to my list of "Whoa - back up a sec, make sure you know this" packet of ACA stuff.

Ummm quick google I think this one covers it:How the Cost-Sharing Health Insurance Subsidy Works

The tricky part is knowing how to word the search so you don't get mountains of unrelated Obamacare derp articles. Try "cost sharing subsidies"

I have no idea why this aspect of Obamacare is such a secret. Every person I have ever discussed Obamacare with had no idea or outright tells me I'm lying until I show them my fucking insurance card. They think poor people are stuck with $5000 deductibles. The whole thing would be a pretty fucking big waste if that was true, wouldn't it?

There's Silver 70 (regular one), 73, 87, 94 if you're within 250% of the federal poverty level. They lower deductibles and copays quite a bit, especially if you qualify for a Silver 94. It drops your office copay to $3, 0 deductible, and 10% coinsurance.