General Discussion
Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsOK 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?
Roland99
(53,342 posts)Does the employer provide insurance? If so, does it meet minimum value? And, are the premiums affordable?
So many questions.
Maraya1969
(22,489 posts)medical bills in an average years. My car insurance deductible is only $250.
Ms. Toad
(34,082 posts)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)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)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)Roland99
(53,342 posts)Ms. Toad
(34,082 posts)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)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)I will require slightly more provenance, but YMMV.
steve2470
(37,457 posts)Demobrat
(8,986 posts)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)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.
VanillaRhapsody
(21,115 posts)just saying...
Demobrat
(8,986 posts)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)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)Bronze/Silver/Gold.....a dumb over generalized and inaccurate statement.
truedelphi
(32,324 posts)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)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.
pnwmom
(108,987 posts)and the particular plan.
Barack_America
(28,876 posts)...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)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)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)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)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)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)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)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)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)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)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" 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)deductible for?
Nye Bevan
(25,406 posts)But typically things like a surgeon's fee, diagnostic tests (like CAT scans), lab fees, allergy testing.
Blue_In_AK
(46,436 posts)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)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)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)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)Same thing for ACA.
hedgehog
(36,286 posts)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)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)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)Our health care system is ridiculous. RIDICULOUS!!! Just thinking about the variability gives me a headache.
robinlynne
(15,481 posts)BlueToTheBone
(3,747 posts)My sister dislocated her finger and it cost $900! Dislocated, not broken!