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Maraya1969

(22,489 posts)
Sat Oct 5, 2013, 08:46 PM Oct 2013

OK someone just posted on FB that for a family of 4 the AHA policy is $540/month with a $2,600

deductible. I said they were wrong right off the bat because I just know that can't be true. But does anyone know what the deductible is for a family of 4? Or for each person if they are paying the full amount?

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OK someone just posted on FB that for a family of 4 the AHA policy is $540/month with a $2,600 (Original Post) Maraya1969 Oct 2013 OP
Depends. Bronze? Silver? Gold? Platinum? What's the family's income? Any disability? Roland99 Oct 2013 #1
It's hard to believe that an average family of 4 is going to rack up more than $2,400 worth of Maraya1969 Oct 2013 #8
** Sigh ** I long to be an average family - or medically boring. Ms. Toad Oct 2013 #11
Me too. We have medical bills in the thousands every year, even with "great" insurance through anneboleyn Oct 2013 #36
You must know a LOT of well-off people... Demo_Chris Oct 2013 #41
Disability is no longer a factor in obtaining insurance under the ACA. n/t Ms. Toad Oct 2013 #9
right, but it can aid re: subsidies Roland99 Oct 2013 #10
As a general rule, it doen't impact subsidies. Ms. Toad Oct 2013 #12
Very true about the variables davidpdx Oct 2013 #13
Someone also just posted on Facebook that President Obama has been seen sodomizing Bigfoot. 11 Bravo Oct 2013 #2
. mzmolly Oct 2013 #31
ok that was good lol nt steve2470 Oct 2013 #44
For a family of 4 making $45000 Demobrat Oct 2013 #3
Avoid Bronze like the plague. truedelphi Oct 2013 #27
IF you have a medical catastrophe it is better than no insurance.... VanillaRhapsody Oct 2013 #34
It will at least get you through the door Demobrat Oct 2013 #43
My experience too VanillaRhapsody Oct 2013 #45
Lot of variables. Parents' ages. Smoking/nonsmoking Pretzel_Warrior Oct 2013 #4
Thank you. That is the problem in a nutshell. truedelphi Oct 2013 #30
50 States, 50 Sets of Plans. NYC_SKP Oct 2013 #5
Costs vary based on the state, the family's ages, the household income, pnwmom Oct 2013 #6
Entirely possible...if they have an asshole governor who didn't accept the Medicaid expansion... Barack_America Oct 2013 #7
Completely meaningless without information on the state they live in, the family's income, and a kestrel91316 Oct 2013 #14
Heres my calculation-fam of four aznativ Oct 2013 #15
So on the Silver Plan if a child racks up $12,600 in medical bills their parents have to pay all of Maraya1969 Oct 2013 #16
And remember, the Out Of Pocket maximum is per CALENDAR YEAR. So if an episode starts near the end o SharonAnn Oct 2013 #24
Out of pocket max is the MOST you would have to pay. In many plans you pay a co-pay for visits which uppityperson Oct 2013 #28
Actually it is not me "saying" it aznativ Oct 2013 #37
based on the calculator I used at my state site(WA), I will pay $550/month in premiums and that is liberal_at_heart Oct 2013 #17
In many plans the deductible frequently does not apply if you stay in-network. Nye Bevan Oct 2013 #18
my husband has been using the same ophthalmologist doctor for 12 yrs. liberal_at_heart Oct 2013 #19
In general you will get royally screwed for going out of network. Nye Bevan Oct 2013 #22
So even if you haven't met the deductible you still only have to pay the co-pay? Then what's a Maraya1969 Oct 2013 #20
It depends upon the plan. Nye Bevan Oct 2013 #21
It depends on income and other factors Blue_In_AK Oct 2013 #23
Given the amount that the OP mentioned the policy cost, a family making $29,000 in your state bluestate10 Oct 2013 #40
If the family gets assistance, a Silver or Gold plan can be purchased for as low as $540, bluestate10 Oct 2013 #25
That is quite erroneous. If the family truedelphi Oct 2013 #38
Medicaid joke: If you've seen one state's medicaid plan you've seen one state's medicaid plan. dkf Oct 2013 #26
^^^^^^^THIS! hedgehog Oct 2013 #29
You are better off if your state expanded medicaid. A lot falls around that. dkf Oct 2013 #32
Individual experience is right - some twenty year olds are perfectly healthy - hedgehog Oct 2013 #33
I've paid $15! Getting efficiency out of such a hodgepodge of a market is going to be difficult. dkf Oct 2013 #35
There are at least 20 or 30 different policies available for each family situation. robinlynne Oct 2013 #39
It's easy to rack up $2600 BlueToTheBone Oct 2013 #42

Roland99

(53,342 posts)
1. Depends. Bronze? Silver? Gold? Platinum? What's the family's income? Any disability?
Sat Oct 5, 2013, 08:48 PM
Oct 2013

Does the employer provide insurance? If so, does it meet minimum value? And, are the premiums affordable?

So many questions.

Maraya1969

(22,489 posts)
8. It's hard to believe that an average family of 4 is going to rack up more than $2,400 worth of
Sat Oct 5, 2013, 09:48 PM
Oct 2013

medical bills in an average years. My car insurance deductible is only $250.

Ms. Toad

(34,082 posts)
11. ** Sigh ** I long to be an average family - or medically boring.
Sat Oct 5, 2013, 09:55 PM
Oct 2013

We hit $3000 in February this year, in January last year for the highest need family member, and $6000 for the family in February this year - and April last year.

Any guesses for this year?

anneboleyn

(5,611 posts)
36. Me too. We have medical bills in the thousands every year, even with "great" insurance through
Sun Oct 6, 2013, 03:48 PM
Oct 2013

my husband's employer. I would love to spend less than 2600 a year!!! -- pretty much every family we know goes over that amount for various reasons. One family has various doctor visits and medications (including one visit to an emergency room when one child fell off a slide), vaccines, allergy issues, dad has a minor but expensive chronic health problem...went well over 2600 in a year. So did we, way over, but I have a major illness. Our parents go well over that amount too. It is a damn good thing, I think, that the amount that was determined is not crazy (similar to many private insurance policies). Healthcare is just incredibly expensive, and I think that people often just have no idea how expensive it is truly -- at least until they have to experience it.

 

Demo_Chris

(6,234 posts)
41. You must know a LOT of well-off people...
Sun Oct 6, 2013, 04:53 PM
Oct 2013

But here's an easy solution to reduce you healthcare expenditures down to, for example, my family's level.

Be poor.

You will find that your healthcare expenses very rapidly approach zero. Other than Ibu and Tylenol (generic of course) and an emergency bottom of Southern Comfort for the pain. I don't know anyone (other than my mom, and she married a multi-millionaire) who has an extra few thousand lying around they can use for healthcare. No one.

Ms. Toad

(34,082 posts)
12. As a general rule, it doen't impact subsidies.
Sat Oct 5, 2013, 10:00 PM
Oct 2013

Unless the disability is severe enough to qualify for SSI or SSD - which is really a different issue than subsidies under the ACA.

davidpdx

(22,000 posts)
13. Very true about the variables
Sat Oct 5, 2013, 10:02 PM
Oct 2013

People have been making such wild accusations about the ACA it's hard to know without more information about the post and the person who said it.

Some people were claiming 2012 was going to be the end of the world, yet it didn't happen.

11 Bravo

(23,926 posts)
2. Someone also just posted on Facebook that President Obama has been seen sodomizing Bigfoot.
Sat Oct 5, 2013, 08:55 PM
Oct 2013

I will require slightly more provenance, but YMMV.

Demobrat

(8,986 posts)
3. For a family of 4 making $45000
Sat Oct 5, 2013, 09:12 PM
Oct 2013

In CA, the deductible on the bronze plan is $6500. The premium is $4, and no I did not leave off any zeros.

truedelphi

(32,324 posts)
27. Avoid Bronze like the plague.
Sun Oct 6, 2013, 03:23 PM
Oct 2013

I repeat, avoid Bronze like the plague.

It is all hat, no cows.

Might as well dig a hole in the back yard and bury the money.

Demobrat

(8,986 posts)
43. It will at least get you through the door
Tue Oct 8, 2013, 02:32 AM
Oct 2013

I found out the hard way when I was briefly (we're talking 90 days here) uninsured that if you don't have insurance the doctor isn't taking new patients. I'll never be without some kind of insurance again for that reason.

 

VanillaRhapsody

(21,115 posts)
45. My experience too
Tue Oct 8, 2013, 12:08 PM
Oct 2013

had breast lump....no doctor would see me because I had no insurance. Had no choice but to use the emergency room to get referred to a surgeon.

 

Pretzel_Warrior

(8,361 posts)
4. Lot of variables. Parents' ages. Smoking/nonsmoking
Sat Oct 5, 2013, 09:17 PM
Oct 2013

Bronze/Silver/Gold.....a dumb over generalized and inaccurate statement.

truedelphi

(32,324 posts)
30. Thank you. That is the problem in a nutshell.
Sun Oct 6, 2013, 03:25 PM
Oct 2013

With the exception of the fact that Bronze plans, anywhere and for anyone, are a terrible idea, there is no way to evaluate how much any family of four is getting with any given amount spent. It is necessary to know if the family lives in a state with or without an exchange, and whether anyone in said family is disabled, etc. And who the inusrer will be, if an employer is helping and all of that.

 

NYC_SKP

(68,644 posts)
5. 50 States, 50 Sets of Plans.
Sat Oct 5, 2013, 09:20 PM
Oct 2013

Step one: Determine which state.

Step two: Go to that state's site and enter in information, size of household age of people covered address, etc.

Step three: Look at the plans available in that state at that income level for people at that age and then compare plans.

Without 1-3 there is no conversation here to be had.

Sorry.

Barack_America

(28,876 posts)
7. Entirely possible...if they have an asshole governor who didn't accept the Medicaid expansion...
Sat Oct 5, 2013, 09:24 PM
Oct 2013

...or if they make enough money such that $540 represents less than 9.5% of their income.

We're a family of 4 and we pay more per month in premiums through our employers coverage -and- have a higher deductible.

 

kestrel91316

(51,666 posts)
14. Completely meaningless without information on the state they live in, the family's income, and a
Sat Oct 5, 2013, 10:18 PM
Oct 2013

couple other criteria that don't fit me so I ignored them lol.

Probably a bald-faced lie. All RWers lie ALL the time.

 

aznativ

(69 posts)
15. Heres my calculation-fam of four
Sun Oct 6, 2013, 01:01 AM
Oct 2013

Went to the Kaiser site for an estimate. Cant get into the ACA one to even register. Will wait for another week or two.

Costs are about same as my premium now, but deductible is quadruple. I will use it too because I have a litany of med issues and go to the DR all the time. I will def spend the $12700 out of pocket easily. I lose my old ins in Jan so now I have to use this plan.

We will see what the real numbers come out to when I can get onto healthcare.gov someday.

Anyway, I am a family of four, wife and I are both 44 y/p (all non-smokers and two kids under 18) in zip code 85208 (AZ). Heres my estimate for Silver plan copy/paste from the website:


Results

The information below is about subsidized exchange coverage. Note that subsidies are only available for people purchasing coverage on their own in the exchange (not through an employer). Depending on your state's eligibility criteria, you or some members of your family may qualify for Medicaid.

Household income in 2014:
318% of poverty level
Unsubsidized annual health insurance premium in 2014:
$6,041
Maximum % of income you have to pay for the non-tobacco premium, if eligible for a subsidy:
9.5%
Amount you pay for the premium:
$6,041 per year
(which equals 8.05% of your household income and covers 100% of the overall premium)
You could receive a government tax credit subsidy of up to:
$0
(which covers 0% of the overall premium)

Bronze Plan

The premium and subsidy amounts above are based on a Silver plan. You have the option to apply the subsidy toward the purchase of other levels of coverage, such as a Gold plan (which would be more comprehensive) or a Bronze plan (which would be less comprehensive).

For example, you could enroll in a Bronze plan for about $5,207 per year (which is 6.94% of your household income, after taking into account $0 in subsidies). For most people, the Bronze plan represents the minimum level of coverage required under health reform. Although you would pay less in premiums by enrolling in a Bronze plan, you will face higher out-of-pocket costs than if you enrolled in a Silver plan.
Out of Pocket Costs

Your out-of-pocket maximum for a Silver plan (not including the premium) can be no more than $12,700. Whether you reach this maximum level will depend on the amount of health care services you use. Currently, about one in four people use no health care services in any given year.

You are guaranteed access to a Silver plan with an actuarial value of 70%. This means that for all enrollees in a typical population, the plan will pay for 70% of expenses in total for covered benefits, with enrollees responsible for the rest. If you choose to enroll in a Bronze plan, the actuarial value will be 60%, meaning your out-of-pocket costs when you use services will likely be higher. Regardless of which level of coverage you choose, deductibles and copayments will vary from plan to plan, and out-of-pocket costs will depend on your health care expenses. Preventive services will be covered with no cost sharing required.
Other Coverage Options

Children and young adults under age 30 are eligible to purchase catastrophic coverage. With a catastrophic plan, you would pay out-of-pocket for most health services until you reach the annual limit on cost sharing ($12,700 in 2014). However, preventive services are covered with no cost sharing required.

Children under the age of 19 may also be eligible for coverage under Medicaid or the Children's Health Insurance Program (CHIP), depending on your state's eligibility requirements.

Maraya1969

(22,489 posts)
16. So on the Silver Plan if a child racks up $12,600 in medical bills their parents have to pay all of
Sun Oct 6, 2013, 01:20 PM
Oct 2013

it in your example? Here is what you said about the silver plan:

"Your out-of-pocket maximum for a Silver plan (not including the premium) can be no more than $12,700. Whether you reach this maximum level will depend on the amount of health care services you use. Currently, about one in four people use no health care services in any given year.

You are guaranteed access to a Silver plan with an actuarial value of 70%. This means that for all enrollees in a typical population, the plan will pay for 70% of expenses in total for covered benefits, with enrollees responsible for the rest. If you choose to enroll in a Bronze plan, the actuarial value will be 60%, meaning your out-of-pocket costs when you use services will likely be higher. Regardless of which level of coverage you choose, deductibles and copayments will vary from plan to plan, and out-of-pocket costs will depend on your health care expenses. Preventive services will be covered with no cost sharing required.
Other Coverage Options

Children and young adults under age 30 are eligible to purchase catastrophic coverage. With a catastrophic plan, you would pay out-of-pocket for most health services until you reach the annual limit on cost sharing ($12,700 in 2014). However, preventive services are covered with no cost sharing required.

Children under the age of 19 may also be eligible for coverage under Medicaid or the Children's Health Insurance Program (CHIP), depending on your state's eligibility requirements. "

SharonAnn

(13,777 posts)
24. And remember, the Out Of Pocket maximum is per CALENDAR YEAR. So if an episode starts near the end o
Sun Oct 6, 2013, 02:23 PM
Oct 2013

of one year and continues into the next year, the total OOP maximum would be double since it resets to 0 on Jan. 1.

uppityperson

(115,677 posts)
28. Out of pocket max is the MOST you would have to pay. In many plans you pay a co-pay for visits which
Sun Oct 6, 2013, 03:25 PM
Oct 2013

if you go to a provider in-network (preferred provider). Rather than paying $150 for a visit, for example, you pay the co-pay, which is applied to the deductible. Rather than paying $100,000 for an emergency room visit, you pay $100 co-pay. In-network. Out of network is where it costs more and what you pay goes towards the deductible.

Not all plans do this, so make sure of what you get.

If somehow you rack up a bunch of money, the MOST you would have to pay is the out of pocket maximum.

And preventative care is free, no matter what the deductible is.

 

aznativ

(69 posts)
37. Actually it is not me "saying" it
Sun Oct 6, 2013, 03:49 PM
Oct 2013

Actually it is not me "saying" it, this is the text I copied from the quote I rec'd from the Kaiser website.

I do believe you are correct- the parents eat all 12700 of the cost if it gets that high.

Like I mentioned in my previous post, I use my health insurance quite a bit. I fully expect to pay out my full deductible every year in addition to the premium.

This will kill me financially in a matter of about 5 yrs as I deplete my retirement savings.

liberal_at_heart

(12,081 posts)
17. based on the calculator I used at my state site(WA), I will pay $550/month in premiums and that is
Sun Oct 6, 2013, 01:32 PM
Oct 2013

with subsidies. I have not put in all of our information yet to find out what our deductible will be. I have to put in birthdates and Social Security numbers of all family members to get more information and I just haven't done that yet. But the income estimation calculator said I would pay $550/month in premiums for a family of 4 with our level of income.

Nye Bevan

(25,406 posts)
18. In many plans the deductible frequently does not apply if you stay in-network.
Sun Oct 6, 2013, 01:36 PM
Oct 2013

In many plans the copay will be something like $20 for a primary care doctor and $45 for a specialist, regardless of whether or not you have met the deductible.

Also bear in mind that preventive care is always free, with no copay, regardless of whether you have met the deductible.

liberal_at_heart

(12,081 posts)
19. my husband has been using the same ophthalmologist doctor for 12 yrs.
Sun Oct 6, 2013, 01:39 PM
Oct 2013

She has performed dozens of surgeries on his eyes. They have formed a trusted doctor/patient relationship. What happens if she is not in network?

Nye Bevan

(25,406 posts)
22. In general you will get royally screwed for going out of network.
Sun Oct 6, 2013, 01:50 PM
Oct 2013

Plans will have a higher deductible, a higher copay, a higher out-of-pocket max, and will often only reimburse the provider the Medicare rate, and the provider is free to bill you for the difference ("balance billing&quot which will not count towards your deductible or out of pocket.

It is critically important to check who is in the network when signing up for a plan.

Maraya1969

(22,489 posts)
20. So even if you haven't met the deductible you still only have to pay the co-pay? Then what's a
Sun Oct 6, 2013, 01:41 PM
Oct 2013

deductible for?

Nye Bevan

(25,406 posts)
21. It depends upon the plan.
Sun Oct 6, 2013, 01:48 PM
Oct 2013

But typically things like a surgeon's fee, diagnostic tests (like CAT scans), lab fees, allergy testing.

Blue_In_AK

(46,436 posts)
23. It depends on income and other factors
Sun Oct 6, 2013, 01:59 PM
Oct 2013

In Alaska, that family, if they make close to $118,000 a year, can pay as much as $1296 a month for their premium or as little as $49 a month if their income is around $29,000. I don't know about deductibles.

http://www.adn.com/2013/10/03/3108341/marketplace-opens-offering-a-glimpse.html

bluestate10

(10,942 posts)
40. Given the amount that the OP mentioned the policy cost, a family making $29,000 in your state
Sun Oct 6, 2013, 04:08 PM
Oct 2013

would likely be able to buy a high Silver or Gold level policy when subsidies are included, so the $49 could go to $540 that the OP mentioned. In my state, a high level Gold policy comes with an individual deductible of $1000 and a family deductible of $2000. Higher Gold policies come with no deductible.

bluestate10

(10,942 posts)
25. If the family gets assistance, a Silver or Gold plan can be purchased for as low as $540,
Sun Oct 6, 2013, 03:11 PM
Oct 2013

those come with low deductibles. In addition, if they live in a Blue state, they may get state assistance, or have many insurers competing for their business.

truedelphi

(32,324 posts)
38. That is quite erroneous. If the family
Sun Oct 6, 2013, 03:59 PM
Oct 2013

Lives in California, which has an exchange, and gets assistance, for example, the family might pay Zip. Nada; nothing.

It really depends on which state you live in, what your circumstances are, your financial resources, if you have applied for food stamps and AFDC and a number of things.

 

dkf

(37,305 posts)
26. Medicaid joke: If you've seen one state's medicaid plan you've seen one state's medicaid plan.
Sun Oct 6, 2013, 03:19 PM
Oct 2013

Same thing for ACA.

hedgehog

(36,286 posts)
29. ^^^^^^^THIS!
Sun Oct 6, 2013, 03:25 PM
Oct 2013

I'm waiting for the state by state comparisons - and suspicious that you're much better off if your state politicians are in support of Obamacare rather than trying to make it crash and burn!

 

dkf

(37,305 posts)
32. You are better off if your state expanded medicaid. A lot falls around that.
Sun Oct 6, 2013, 03:34 PM
Oct 2013

But the plans nitty gritty details are going to be the kicker. If you've picked a reasonably priced plan but the network doctors list is small and they are overwhelmed, it's almost wasted money. You probably have to go out of network and who knows what your potential costs are there?

It's going to be such an individual experience. Not much uniformity.

hedgehog

(36,286 posts)
33. Individual experience is right - some twenty year olds are perfectly healthy -
Sun Oct 6, 2013, 03:38 PM
Oct 2013

but if you have a chronic disease like asthma, you may hit the deductible very quickly! My Advair costs me $40 with insurance; I'd hate to see what it costs without!

 

dkf

(37,305 posts)
35. I've paid $15! Getting efficiency out of such a hodgepodge of a market is going to be difficult.
Sun Oct 6, 2013, 03:48 PM
Oct 2013

Our health care system is ridiculous. RIDICULOUS!!! Just thinking about the variability gives me a headache.

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