I am trying to find what the copays (coinsurance) for people who pay the Obamacare uninsured "TAX"

[underpants]

will be

Also the Out-of-pocket MAX if there is one.

I have googled to my mind's extent and can't find it.


Anyone? a good source?

[madinmaryland]

1. There is no such thing as a "copay" for someone who is uninsured. That would not

change after 2014.

[TheWraith]

2. Not sure I follow you.

If you pay the penalty, it's because you don't have insurance. So no co-pays, because no insurance.

[underpants]

8. I was wondering if there was still some coverage for the payees

apparently not.

[TheKentuckian]

3. 100% coinsurance on all services.

Which is because the penal...err...tax doesn't get you coverage is a punitive action for noncompliance.

[underpants]

6. thank you. I was wondering if there was some structure for those who don't get in the game

that makes sense. You pay a fine ...er.. tax and then you are on your own.

[SickOfTheOnePct]

9. Not saying you're wrong, but that makes no sense to me

If the idea behind the tax is to force people to contribute to the system so that they can't be free riders, then I would think they would get some benefit for the tax they pay, even something very small.

If all that's going to happen is that they have to pay 100% of the hospital/doctor bill, then they wouldn't be freeriders, and thus the tax would be pointless.

[Schema Thing]

10. They do get some benefit

They get to use the emergency care system as they can now, except then they will be paying a small portion of it.

[SickOfTheOnePct]

12. That makes more sense

Than paying the tax and then having to pay 100% of the bill as well. If that were the case, there would be no free rider issue, and the tax would be moot.

[Igel]

62. No.

If you're uninsured you pay the penalty (a fixed amount or a percentage of your income) and you pay your own way.

There's an income cut-off. Make under $X and you pay progressively less in fees. You at some point start getting a subsidy for insurance.

The assumption made by some is that those who are penalized are those who don't pay for emergency care. That's probably an innumerate assumption.

If you are nailed with the penalty, you probably have money to pay for all but catastrophic care. That would push you into bankruptcy.

If you don't have money to pay for basic care, even through the ER, you're most likely going to contribute $0 in penalty.

The penalty is there to get more people paying. The more who pay, the lower insurance rates (since those who don't want insurance are most likely fairly healthy); the more who pay, the more those who are exempted from the penalty can be subsidized without increasing the deficit.

The penalty is there as a way of motivating people to serve public goals that they otherwise wouldn't, figuring it's better to pay a bit more and get something for their money than pay and get nothing.

[girl gone mad]

42. They will be paying the full portion of their bills..

unless they declare bankruptcy or negotiate some deal with the hospital or collection agency.

Same as now, except with an added tax which was wholly unnecessary.

[sabrina 1]

53. The ER is NOT free! If you go to the ER because you have no insurance,

it is far from a 'free ride'. You are billed after you are treated and many people spend years trying to pay off those bills.

I really don't know where the idea that the ER is free came from.

The only advantage is that the working poor who cannot afford to pay for Health Insurance cannot be turned away BECAUSE of that. But it sure is not a free ride. They will try to get you on Medicaid, but the working poor rarely qualify for Medicaid as the line keeps moving regarding their idea of being eligible.

[marybourg]

22. They will get a benefit if they use

an exchange to purchase insurance, with a tax-supported subsidy, if they qualify for one. That's the carrot. The tax is the stick.

[Tanuki]

4. Do you mean the new federal pre-existimg condition plan?

You can find out about it here:
WWW.pciplan.com
I think some details vary from state to state and there may be multiple plan options.

[underpants]

7. No

The plans that I deal with everyday (mostly pharma related) have a premium a coinsurance and then (hopefully) an OOP Max.

[Tanuki]

13. Ok, I wasn't sure what you meant. Think of it as if an uninsured driver had an auto accident

They would still be cited and fined for failing to have mandated insurance, but that would in no way let them off the hook for any damages incurred in the accident.

[kestrel91316]

30. PCIP is rather pricey. But it EXISTS, so I guess that's an improvement.

[NYC_SKP]

5. Technically there is no "tax". It's either a premium or a penalty.

And I think the details are going to vary by state/income/etc...

[Schema Thing]

11. I don't think the penalties will vary by state, only by income.

[HopeHoops]

14. Zero. They pay for all on their own.

[SickOfTheOnePct]

15. Then what is the point of the tax for not buying insurance?

They're being taxed so that they won't be free riders on the healthcare system, but if they're expected to pay 100% of their bill, then they wouldn't be free riders, so what is the point of the tax?

[banned from Kos]

16. Because the uninsured at ER seldom pay their full bill anyway.

Thus spreading that cost to the insured.

[SickOfTheOnePct]

20. Very true

However, if the tax has been paid and the person shows up at the ER, they should get at least some small benefit from the tax payment.

[HopeHoops]

64. Interesting point! I like that idea.

[girl gone mad]

44. 1/3 of unpaid hospital bills are for the insured...

thus spreading the cost to the uninsured and insured who pay their bills.

Except, wait, no. Medicare and Medicaid pay most of the uncollected bills from the insured and uninsured patients who can't pay. Medicare and Medicaid, already funded from taxes which all working people pay.

Be honest next time.

[HopeHoops]

17. It isn't a tax. It's a deduction if you HAVE insurance.

Face it. We are all taxed right now for the uninsured. If you have insurance, you're cool. If you opt out, then you pay into the system. It's no different than the SS that comes out of your paycheck. Insurance companies make a fortune on our premiums and provide little in return. We pick up the slack when the uninsured hit the emergency room. In most states it is illegal to drive without insurance. The fine is pretty hefty in PA. Yeah, yeah, not everybody drives, but we ALL have bodies that are subject to health problems.

[SickOfTheOnePct]

19. Of coursre it's a tax

If you have the means to buy insurance, and you choose not to, you pay the tax. And the reasoning behind that was keep people from not buying insurance and then expecting to get healthcare when they needed it, i.e., to stop free riders.

But if the people that don't buy the insurance and pay the tax still have to pay 100% of the bill, then they aren't free riders, so what exactly is the point of the tax?

[HopeHoops]

25. Providers have to care for everyone. You don't have to pay the bill!

[kestrel91316]

29. Providers don't have any obligation to provide your day in and day out medical management.

They DO have an obligation to provide emergency care but once you are on your feet you are out the door and on your own again. Fire engine medicine is what you get. Not conducive to a long life, BTW.

[HopeHoops]

31. Agreed, but if you dial 911 you WILL get an ambulance and an emergency room visit.

It's not the best, but it is there, and we all pay for the uninsured. It is usually factored into the base cost of the care, not really an insurance issue, but we still get hit every damn time we use the system.

[girl gone mad]

46. You don't pay for the uninsured.

Medicare and Medicaid pay for most uncompensated care through "charity care" programs.

A third of uncompensated care is provided to people with insurance so it is more than a little bit disingenuous to call the uninsured "free riders" or to blame the uninsured for higher health care costs.

[SickOfTheOnePct]

47. According to President Obama, we all pay for the uninsured

That was the whole impetus behind the mandate.

[girl gone mad]

59. The President's talking point is not accurate.

I understand that this is the way he wanted to sell the corporate bailout mandate, but state governments and the federal government pay for most of the uncompensated care (which is provided to both uninsured and insured patients, by the way).

One estimate put the cost of uncompensated care for 2004 at $41 billion, of which $34.6 billion was funded through a patchwork of government programs. Over half of all government reimbursement for uncompensated care comes from the federal government; most of that is provided through Medicare and Medicaid. These federal funds are a primary source of support for health care providers that serve the uninsured.

http://en.wikipedia.org/wiki/Charity_care

The thing is, our federal government could easily afford to expand these programs and it could also do many things to dramatically bring down the costs of these programs. Shifting the excessive costs (with massive private profits baked in) onto middle class and poor workers was an unconscionable way of addressing the issue, particularly during an economic recession and unemployment crisis. I'm sure it was done to appease health insurers and pharmaceutical companies since Obama had secret closed door meetings with these groups before the bill was crafted.

I"m hopeful that something good will come out of this because now I see so many more people engaged in the debate and asking these types of questions, whereas while the ACA was being debated and written the national dialogue on health care centered around the deluded rantings of unhinged teabaggers. Maybe now that people actually see what this bill does we can have some rational discussions on how to contain costs. Now that many will be mandated to purchase insurance, I hope they will start to demand a maximum wage for insurance company executives and other industry employees who profit from this new tax.

[SickOfTheOnePct]

24. "And provide very little in return"

That hasn't been my experience at all. I've never had a claim denied, nor have I ever had an insurance company deny a pre-approval for something that a doctor said that I or my family needed. I understand that not everyone has had that kind of good experience, but not everyone has had the kind of experience you describe, either.

The only times I've seen insurance issues were with the providers...once with a pharmacy that was charging the insurance company more than they were charging a cash patient for the same med, and just this past week, a doctor that wouldn't sign an immunization form without a well-child visit, even though the shot records were maintained by his office.

[HopeHoops]

26. I had a similar experience with car insurance - three days after I got my license.

I pulled out of a parking spot and hit the fender of the car to my left. I left a note with my contact information. The owner went to a couple of body shops saying he would pay with my insurance and the estimates were in the hundreds. He went to one and said he would pay in cash and they quoted him $35. He went with that one.

[limpyhobbler]

63. denied claims and pre-approvals

Doctors tend to know in what services are ok with the insurance company and won't recommend services that aren't approved. So there are not many explicit denials. Providers kind of run cover for the insurer by only sticking to approved services. The denial is still happening, it's just informal and not written down anywhere. A doc probably doesn't want to buck the insurance company too much. They are too busy to get involved with a lot of extra work.
I could be wrong tho.

[underpants]

21. To make them pay into the system

which they do not now do

[SickOfTheOnePct]

34. If they're paying into the system via the tax (and I agree, they are)

Why do they have to foot 100% of the bill? If they're paying into it via the tax, they should get at least some small benefit from it, and not be stuck with 100% of the bill.

[girl gone mad]

48. Everyone who works pays into the system.

Everybody pays taxes to support Medicare and Medicaid, which cover the payments for uncompensated care so everyone is at least paying something.

People with any type of income or financial resources can expect to be billed for any medical services they receive, including hospital stays and emergency care. The providers and their collection agencies will relentlessly seek payment. The notion that their exists a big group of people getting free care is completely ridiculous. The only people getting any free care to speak of are those below the poverty threshold and they will still be getting free care after the ACA is fully implemented.

[marybourg]

23. Because they mostly don't pay and

the rest of us pay it in higher premiums and hospital bills.

[girl gone mad]

50. Why do you think your premiums or hospital bills would be effected?

How much lower do you expect your premiums and hospital bills to be now that these "freeloaders" are forced to pay into the system?

[marybourg]

61. There are multiple studies on this subject.

Ask Prof Google for help. My off the cuff recollection is that each person, not family, with insurance is paying $1000/year to cover those without who never pay.

[marybourg]

27. Or, more likely, don't pay at all.

[EC]

18. As others have said

no copay if you have no insurance. But I think if you end up in an emergency room without insurance, that is when they will make you sign up for insurance and pay premium or sign a form stating financial responsibility for costs.

[kestrel91316]

28. If you are UNINSURED and have to pay the fine for being UNINSURED, you pay full price for 100% of

your medical care. The fine doesn't buy your way into any plan.

[SickOfTheOnePct]

35. Then we should stop saying that the tax is to avoid the free rider problem

Because if anyone without insurance is going to be stuck paying 100% of the bill, then there is no free rider problem.

[kestrel91316]

60. The problem is, they won't be able to pay the bill in most cases.

They will be hounded into bankruptcy or the hospitals will just write off the bad ER debt like they do now. IIRC the fine just helps the government fund their payments to reimburse hospitals for indigent care.

The fine is an incentive for people to go along with the program. I support it.

[MjolnirTime]

32. You're not really looking for information, are you?

Just throwing a fit.

[Ruby the Liberal]

33. Your copay is 100% and your max is unlimited

up to and including filing medical bankruptcy.

Paying the fine doesn't put you in a different category in the system, it says you aren't even IN the system. The fine goes to offset the higher costs borne by those in the system for people who use (inevitable) services but don't contribute to it.

[SickOfTheOnePct]

36. If the uninsured are stuck paying 100% of the bill

then there are no higher costs being borne by the system for people who use it. And if they're paying the tax, they are contributing, just not via premiums.

[Ruby the Liberal]

38. Not by definition

If they are paying the tax, they are outside of the system.

They are liable for 100% of the bill, but if they don't pay (or file medical bankruptcy), then providers have to eat that loss, which they pass on in higher costs to everyone else, which the insurance companies then pass along in higher premiums.

This is why the mandate, as odious as it is, was necessary. To put as many people into the system as possible to try to stop this snake from eating its own tail.

Now, the fact that providers and insurers are mainly all for-profit doesn't help matters, but it is a first step.

[SickOfTheOnePct]

39. Then there is zero reason for anyone to pay the tax

If you don't buy insurance, and pay the tax, you will owe 100% of your medical bills
If you don't buy insurance and don't pay the tax, you will owe 100% of your medical bills.

Looks like a no-brainer for those that don't want to buy insurance - don't pay the tax.

[Ruby the Liberal]

40. Yes, it is a no brainer.

That is why NO ONE should buy insurance and NO ONE should pay the tax.

The money for healthcare will just come shooting out of flying unicorns just like skittles and rainbows.

Excellent plan.

[SickOfTheOnePct]

43. That isn't what I said at all but of course, you know that

They should be buying insurance, but if they aren't, there is no point in them paying a tax from which they derive zero benefit.

[Ruby the Liberal]

49. It isn't about them.

It is about being a part of society. We are all in this together. Even the selfish ones whether they like it or not.

[Ruby the Liberal]

41. Oh, and I should note

If you file bankruptcy (yes, for medical bills), plan on paying 3-4x the interest rate of someone without those marks on their credit for the next 5-7 years. Noting that in cases, it can cause job loss (in certain industries) or prevent you from being hired until it is discharged.

You will also want to stop into the HR department and do another W9 to adjust your withholding because as long as those taxes are adding up, you will see a reduction in your refund - so you want to be sure that you owe every year as opposed to them refunding you back, because the IRS will take their money first.

[SickOfTheOnePct]

45. Thanks for your concern, but this won't affect me - I have insurance

But everything you mentioned about bankruptcy will happen to the person that doesn't have insurance, whether they pay the tax or not, so why bother?

[Ruby the Liberal]

51. You can't discharge certain things in bankruptcy.

Student loans and taxes are among them. Pay them now, pay them later, or the IRS will settle it out of the estate.

Why people are approaching this as "whats in it for me, and how can I game this to my individual advantage" is to be expected, but very, very sad. You know it is going to happen, and I know it is going to happen. If people would all just pay their share to be a part of the system (as opposed to a burden on it by refusing to participate), then we will ALL pay for that in the long run.

[SickOfTheOnePct]

56. Yes, some people are selfish, and it sucks

But you didn't answer my question, namely, bankruptcy if you pay the tax, bankruptcy if you don't pay the tax. So why pay the tax?

[Ruby the Liberal]

57. Because it is a tax.

It doesn't go away. You can't discharge taxes in a bankruptcy (or student loans). If you don't pay the tax, then it will come out of any refunds, or your estate. The IRS will get their money. If you have no refunds and no estate, that means you just died penniless, and if that is the case, you are likely covered under the 133% Medicaid provision meaning that you are in the system (insured) and don't owe a tax to begin with.

I don't understand what else I need to add to that to answer the question?

[girl gone mad]

55. Most people who file for medical bankruptcy actually have insurance.

So tell it to all of the newly insured "free riders" many of whom will end up with bills they can't afford.

[Ruby the Liberal]

58. Because of exclusions, undocumented "preexisting conditions" and caps

That are all specifically outlined in this bill.

Those "records researchers" who decide that things like a yeast infection in 2001 disqualifies you for breast cancer treatment in 2010 will be out of a job when this kicks in as the vultures can't do that shit any more.

That is where people get stuck. Some "undeclared" meaningless thing from x years ago gets you cancelled (or denied under 'preexisting') the minute you need treatment for some other tangentially related issue.

That, or your kid with leukemia just hit his lifetime max and you are on your own to pay his ongoing cancer treatment with no one else willing to write you a policy.

[girl gone mad]

52. Providers do not eat the loss.

The government picks up the majority of the tab.

The mandate simply shifts some of the costs from the general fund onto working people. It's pretty regressive, actually.

[Ruby the Liberal]

54. It is extremely regressive

and the for-profits do write off losses due to non-payment, modified (lowered) payment and bankruptcy discharge.

I don't know how much the government plows into that, but they do take losses on collections that are less than billings. Including billing the insurance company and settling for a lower repayment than AR billed for.

[Motown_Johnny]

37. That would be a public option. Those paying the tax have no insurance

of any sort.