# Health Care Options in the USA



## Palmettokat (Jul 10, 2017)

Trying to be brief but informative here is not easy for me. But the Affordable Care Act or Obamacare as many still call it is the law of the land we live under for the under age 65 major medical and small group plans up to 50. Right off my belief that will remain the law of the land for of course 2018 but also at least 2019. Any changes will need months from time of passage to time to be effective. But there are some options out there within this law and those plans and outside of those plans you may not know.

To buy a true major medical plan for an individual or a family the only option is an ACA plan but the cost is high IF you are not eligible for a tax subsidy to help pay the premium. Many people or eligible for those subsidy but are missing it for either not understanding what they must do or missing tips to qualify. The subsidy is based upon your household income and size of family and does vary with the income. The only time you can enroll or buy one of these plans is from Nov 1st to Dec 15th or you must have a Qualifying Event. These are firm definitions by the ACA law. Those have only a 60 day window to use and they are: loss of coverage no fault of your own, marriage, birth of a child, released from jail, legal immigration or moving to a different service area. To see a full list here is a link: https://www.healthcare.gov/glossary/qualifying-life-event/

Now the insurance industry hates these and many companies will not pay an agent to help a person obtain coverage outside of Open Enrollment and some never pay an agent so it makes it hard to find an agent I some areas who will. We do a lot of "charity work" here. If you find you need coverage and do not qualify for a Qualifying Life Event or QLE consider moving so you are eligible. Proof of the move is often rental contract or contract of purchase, utilities there such as cell phone, have seen address with bank changed serving to prove this.

The Tax Subsidy amount is very much affected by the number of people in the household and the person or persons income. If you are a legal couple they count the joint income and you must file joint tax return, however if you have a child who if filing their own tax return do not count them nor their income UNLESS it benefits you and you must then file tax return that way. Using Federal Poverty Levels for South Carolina which does vary from state to state below are some idea of incomes used, now SC did not enlarge the Medicaid rules so if a person is below the minimum income there is often no help.

Single person, must have income of at least $12,060 but not over $48,240 per year.

Family of two, must have income of at least $16,240 but not over $64,960 per year.

Family of four, must have income of at least $24,600 but not over $98,680 per year.

It increases as you are seeing there depending on the size of the family. Now the subsidy is not a straight line amount but it takes is larger on an older person than a younger person with the same size family and income for it also takes into consideration the premium price which does increase with age.

So you look at your income and it is say $75,000 and you say honey you and I do not qualify for any tax subsidy help on this. Not so fast! First it is your personal income, not a business income. If your hay income say was $150,000 but your farming or business expenses are $100,000 then you are down to $50,000 income. But lest look past that, if you have self employed income of at least the amount you pay for your (be sure the self employed person is whose name the coverage is in so this works) health insurance it is tax deductible as business expense. So lets say that is a $1,000 per month so another $12,000 of drop in income. Now just say you do this math and you miss the subsidy cut off by $100 dollars and it is a hard number, what can you do? Fund a tax deductible IRA or such qualified retirement plan, it cuts or lowers your taxable income also. This is one option I really like, select a "HIGH DEDUCTIBLE" plan and this is a term that really means something important. The dollar amount of the deductible has nothing to do with the term, you can buy a plan with a deductible that is larger. But the qualified High Deductible Plan qualifies you for a HEALTH SAVINGS ACCOUNT and you are allowed to deposit again income deferred money there that also reduces your taxable income. Below is Bank of America's chart showing the contributions limits.

2017

2018

*Single coverage*

$3,400

$3,450

*Family coverage*

$6,750

$6,850

*Catch-up contribution for those who are age 55 or older*

$1,000

$1,000

The money you deposit into a Health Savings Account or HSA is your money and is not considered income if you use it to pay qualified medical bills. If you are paying a medical provider or for services ordered by one it most likely is a qualified service even if your insurance does not cover it. What does that mean, you put say $5,000 into this account, you lowered your taxable income by $5,000 and you go the dentist but your insurance does not cover that you can still use money from that account and it is not counted as income for you used the account to qualify the money for medical expense. Might not be the wording the IRS uses but my wording. If at the end of the year you have $4,000 of the $5,000 left it is your money and remains in the account. You are still legal to contribute the next year and the next year even if your fund has grown to say $15,000.

I had a self employed person who was able to fund his Health Savings Account and I think max fund his IRA by doing just this with the amount of tax subsidy this make him qualified for. His subsidy amount was about $12,000 for the year.

Go to this web site KFF.org and search for 2018 tax credit calculator. It is very simple to use, just read the input fields given and do select your state to make it the most accurate and while this is not a government site it is very accurate. You are not imputing any info that goes anywhere so just play with the income numbers to see where you are in relationship to the break point on the subsidy. If it says you do not qualify then lower the income till you are and then by small adjustments move up till you loss the subsidy.

My suggestion here, you have your accountant to do this math for you after you have tested it yourself to be sure there is nothing that prevents this working for you. A big miss by those who wrote the ACA rules will hurt some of you on this for if your spouse works for a company who offers a qualified group plan it often prevents the family from being eligible for any subsidy but these still lower your taxable income.

Important notes on tax subsidy on the Market Place: if your income for the year ends up being higher than you used (some degree of fortune telling required) you may have to pay some or all of the subsidy back. Also depending on the amount of subsidy you should consider a "SILVER" plan first for there is something called "Cost Sharing" that can improved those plans coverage but not any other ACA plan.

Now another option is what is called a "FATH BASED" plan. These are not considered Insurance. There are a couple of points here, if they were insurance they could not do what they do due to the ACA but they work a lot like an insurance plan. Some of these have been out there for years. They do vary and there is about five of them. What they do not cover or do cover will vary from plan to plan so this is sort of broad base here. Some will not cover tobacco users period. Some will accept them and maybe keep them covered for a year to allow them time to stop using tobacco. Even if you are a tobacco user these can get you to an open enrollment for an ACA plan if need be. Why would you use one of these plans: you missed open enrollment and do not have a Qualifying Event, you do not want anything to do with Obamacare, you are paying full price for the ACA plans as some of these plans really are about 50% of the ACA plans. You can enroll in these plans any time of the year and they do satisfy the requirement of credible coverage by the ACA rules. I am not aware of any of these that allow you to have a tax deductible HSA plan. There two I know fairly well, Medi-A-Share and Aliera/Unity. These plans operate much like a true insurance policy and some do not. Some require you to have the charge, submit it to them to be then reimbursed maybe over a couple of months. THESE are not for everyone and no other coverage is. If you use tobacco, you drink heavy, you are living with someone but not married or you have serious preexisting conditions they may not be a good choice. They also are limited on their coverage on prescriptions. In those negatives they do a good job at reasonable pricing.

Now some of you will not fit in either of those. However small group plans can be an option. You normally need at least two employees who can be owners or owner and employee and might be owner and spouse but spouse must show up in tax papers as partner or employee. If you are not eligible for a tax subsidy but can do a group plan probably offering you better coverage or better network or both than today's individual plans. You should be able to find help on these plans rather easy for there are more companies in the small group business than individual plans. If you are larger size company and this number will vary with the market but about ten is the lowest size in SC but think takes twenty five employees in North Carolina for what is called a self insured plan which you do not want a "TRUE" self funded plan but you may like what is a limited self funded or a level funded is the name most companies call them. Small group is rather straight forward but if you go with any plan you be sure you ask if I want to terminate this say in six months what happens. That is where the level funded plans can be dangerous. You do not want to go with one of Level Funded if you have ANY doubt you may not keep it for the full term of the contract, you can be liable for any claims that have occurred and not been paid if you do. These can be very good plans but they have moving parts and some of that movement can bite you if you stop the plan early.

This is already long but want to cover those on Medicare quickly.

Depending on the state you are in you may have a guaranteed issue of Medicare Supplements if under 65 and on Medicare. Many states you do not. There is no Federal Law on this for under age 65. However you probably are eligible for a Prescription Drug Plan and or a Medicare Advantage Plan. If you are aging into Medicare at age 65 normally and have part A and B of Medicare you have full guaranteed on all of those plans. Any Medicare Supplement by any company in your state with no health questions asked and some will not even ask on tobacco usage. You have a 6 month window on this beginning the month your Part B begins. You have a 7 month window on a Drug Plan or a Medicare Advantage Plan but time table is different. You have 3 months before your Part B begins, the month it takes effect and 3 months after. My suggestion is make application for what ever you will be doing 6 to 8 weeks before your part B begins. Then all is in place for your effective date. If you work for a company who provides group insurance and has at least 20 employees and plan to keep working and will be keeping the group insurance....you probably should not enroll in Part B just because you are able to. It will most likely provide no benefit on top of the group and you will be paying somewhere at least $130 or more per month for the Part B and your guarantee enrollment period is lost.

I am not a big fan of the Medicare Advantage Plans. But many like them. They do offer some little trinkets of dental, vision and maybe hearing that is not under traditional Medicare and lower premium. However they have a network and if you travel you best look at their rules on out of network. If HMO you for certain best be pleased with the rules and the network. You also have copays and out of pockets on it that in our state can be as high as $6,700 per month. But they do have lower premium and are better than nothing for they do cap you limit of liability and Medicare itself does not with Part B, there is no cap to the 20% you are liable for.

As to Medicare Supplement plans (there are three states this does not apply to, Massachusetts, Minnesota and Wisconsin, they have their own plan designs) I prefer Plan G for the pricing and coverage. Also check on nontobacco rates and household discounts. Household discounts may not be in your state but in some states a company will give you a lower price if your spouse or such has coverage with them or if you live with another adult of a certain age. There is reason for this as a person living with another responsible adult normally lives a healthier life style.

Medicare Supplement plans travel very very very well. Nothin travels any better. You are not in a network, you do not have to get a referral and you have no limit on number of visits and you may wonder why Medicare is in financial trouble. You could get on the road and stop at every hospital and see ER doc and with a Plan F probably have nothing to pay period. Plan G would have to pay the Part B deductible which for 2018 is $183 for the year.

there is lot more that could have been in here but have covered I hope the by far most common areas I see confusion. I do not mind trying to help any one but will tell right now will not be on computer next week, first week of April. In my office we work hard to know these laws and what can be done and who does what. Many agents do not and not finding fault. Health insurance has become a very changing and moving industry and it is not easy. Had BC rep in office today and I asked him to me a couple of simple questions and he said, I do not know. But will ask and get the answer to you. We hit that often.

KT


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## somedevildawg (Jun 20, 2011)

Man what a mess......
I qualify for the RMA coverage.....hope I never need it


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## VA Haymaker (Jul 1, 2014)

Thanks for the info.

When the company I worked for packed up and moved to Alabama (not everything goes to china), no way was I going to move. While the job search was going on, we had to sign up for Obama care. Pain in the arse, crazy deductibles and crazy high premiums and we had a health care bureaucrat (who was great) help us every step of the way. Within a 6 weeks, I had a new job and "normal" insurance again.

IMHO - the present system is unfixable, even so called market driven (and believe me, I'm no socialist leaning dude) are a joke. Can't shop insurance across state lines, in our county, only one insurance provider is available - so much for competition. You really can't shop hospitals or doctor fees in the present environment. After LOOOONG consideration, I'm now for single payer systemof some sort. Don't know what that looks like. Not government doctors, but some kind of Medicare type system - works for my parents, I'd be happy as a clam to have it, I think...

I've read comments/threads on YT from and by Canadians that say their system is good, contrary to what we are told by some.

I'm curious if our Canadian Haytalk members could chime-in on the good, bad and ugly of their health care system.

Bill


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## Palmettokat (Jul 10, 2017)

This afternoon was informed the Short Term policies will soon be able to be sold for up to 360 days rather than the 90 day current limit. These can be good for a person who is not needing care for a current condition. Premium are low for you can not renew the coverage but if you need coverage till open enrollment it works there.

Bill, I am no Canadian expert by no means but I understand their coverage varies from Providence, had a Canadian who worked here and was on group plan here. He said his mother could not visit her sister in I think Arizona for if she was out of her providence or Canada over seven days she was not covered. He also was not aware our coverage had coverage for prescriptions. All that is based upon what experience which has been very limited with Canadian's who worked here.

Some people say the insurance industry is why we do not have single payer in the USA, I do not think so. Medicare is a single payer system and if you listen to medical providers they complain how low reimbursement by Medicare is. It is low and I think it is providers who fear the single payer system. Based upon Medicare there will be gaps in the coverage and there will be a large stable market for supplemental coverage there that the health insurance industry probably will find more profitable than the true major medical market is.

Before you decide on what system you want be careful. The Federal Government has a really large system they totally control. Many problems have been reported over many years in this system. I had a friend who passed due to their gross error and a step father who probably loss his sight due to delay in their treatment. It is the VA. Why we demand a government control system and yet argue the VA is a mess makes no sense to me.


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## woodland (May 23, 2016)

Health care up north is no utopia. There is no coverage for dental, ambulance, or drugs. All of those are retarded what they charge you. Simple annual tooth cleaning was $800 for the wife and I last week and only took an hour.

Anything done in the hospital or doctor office is "no charge " however 40% our provincial budget is consumed by health.

Most people have coverage for things the government doesn't cover through work. Some self employed also buy coverage as well. Others subscribe to the "don't get sick" plan such as us.

Lots of people up here say we have "free" healthcare and it pi$$es me off to no end. Just because you don't pay for something doesn't mean it's free. No system is perfect but it could always be worse than it is.


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## woodland (May 23, 2016)

Ironically I’m writing this while my wife was in the after hours walk in clinic getting diagnosed with an ear infection and now she’s at the pharmacy getting her drugs. I’m sitting in the parking lot with a bull in the trailer we picked up tonight and combined the trip since it’s 45 miles from home. Currently 9:30 pm and going to need some grub soon since lunch was a loooong time ago. Bull doesn’t seem too impressed since he hasn’t settled down yet.


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## Vol (Jul 5, 2009)

Thank you for your frankness woodland. I could tell several months ago you were a good man because you included your family in your discussions. Healthcare has become a expensive issue worldwide. There are no clear cut answers in this country....nor in most places.

Regards, Mike


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## Teslan (Aug 20, 2011)

Palmettokat said:


> This afternoon was informed the Short Term policies will soon be able to be sold for up to 360 days rather than the 90 day current limit. These can be good for a person who is not needing care for a current condition. Premium are low for you can not renew the coverage but if you need coverage till open enrollment it works there.
> 
> Bill, I am no Canadian expert by no means but I understand their coverage varies from Providence, had a Canadian who worked here and was on group plan here. He said his mother could not visit her sister in I think Arizona for if she was out of her providence or Canada over seven days she was not covered. He also was not aware our coverage had coverage for prescriptions. All that is based upon what experience which has been very limited with Canadian's who worked here.
> 
> ...


Thanks for all the info. I still can't my head around the subsidies for ACA. In 2016 we would have qualified for some sort of subsidy. I was under the impression you had to update them throughout the year on your income and there was a possibility of losing the subsidy if your income changed to take you out of qualifying for a subsidy. In addition to my two kids could have qualified for medicaid. But I figured screw it I'm not dealing with all that crap and not changing doctors for medicaid. So we got an Anthem Blue Cross individual plan from them directly. Turns out in 2017 we did rather well. My wife and I own a little real estate brokerage. She sold a lot of properties in 2017. I had a fairly good hay year. So we in no way qualified for a subsidy for our plan in 2018. What annoys me about these plans and subsidies is what if our income tanked. So far my wife has only sold one property this year (more to come in a couple months though). I haven't sold any hay of big quantities this year and won't until June. But we couldn't get a subsidy for the first 6 months even if we desperately needed it based on last years income. Doesn't matter as our health insurance plan isn't a marketplace plan anyways, but still an ACA plan. That's just the part of the subsidies I don't understand and find annoying.

Let me ask you about these short term policies. Now that you mention they can be up to 360 days. So what if half way or 3/4 through the policy a person finds out they have cancer. Typically treatment for cancer can take a few months. It did for me. Took about 6 months total. Do these short term policies cover the cancer treatment after the expiration date of the short term policy or anything after that you are on your own?

I like the idea of those faith based plans. However I do not have faith that the faith based plans will cover the major health problems if they occur. None guarantee it. And after seeing what the bills were for my cancer treatment in 2010-2011 and my sons NICU care for 10 days when he was born that kind of freaks me out if they wouldn't cover anything. Luckily we had good insurance for both those times.

Our premium for our family this year is $1456 a month. Up from $1090 last year. What is it gonna be next year or the next year? It's going to drive us to these faith based plans sooner or later.

I had contacted Anthem Blue cross and blue shield and others about a small group policy through our real estate company for my wife and I, but none responded. Guess maybe the end of this year I'll have to get a health insurance agent to try for us.


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## r82230 (Mar 1, 2016)

As far as medi-gap insurance (Medicare gap) coverage. I'm also a fan of Plan F / Plan FHD. IDK if KT, likes, dislikes or wasn't aware of Plan FHD (Plan F, with a high deductible), just thought I would mention as a possible consideration for those, using (or will use in future) Medi-gap coverage's. The difference in monthly premium might amaze you.

To Teslan's point about a variable income, there doesn't seem to be a break, with ACA. Selling hay (or cash crops), your income can definitely vary month to month (let alone if your off-farm job is in sales, with variable income), let alone year to year. Milk checks come monthly (but do go up and down some, seems more down lately) and most off farm income is some what steady. If you don't count paid volunteer fire fighters. ACA seems to be geared more toward the steady income stream folks.

For my wife and myself, our coverage is costing $1694 a month (considered a family plan, even with just the two of us), it was $1361 a month in 2017 and less than $600 a month BEFORE Obama care. Now this isn't the Gold or Silver plan, nor everything covered plan either. Our plan is the lowest cost (60/40 co-pay), along with a high deductible (HD - $13,300 for 2018). However it is a PPO plan, because I'm not a fan of HMOs, so I pay the price of that choice. Our previous coverage (costing less than $600 a month), was an 80/20 co-pay, HD plan, but the deductible was only $5,000.

If I recall right, we when from 80/20 to 60/40 co-pay, $5,000 deductible to $12,500 and our premium when from less than $600 to almost $1,200 the first year of ACA. We were also in the group that got lied to, "if you have insurance you can keep your coverage".

We are able to keep some money in the bank for the variable cash flow, but I feel for those folks that are not at our stage in life to be able to have such a cushion. With one of my son's (he is single), he doesn't take the subsidy until he files his income taxes. Sometimes he get it sometimes he doesn't, seems his income is not just variable, but keeps bumping into the get/don't get point. He has done this since the first year of ACA, where his insurance agent told him to count on subsidy (against my advice) and he had to pay the subsidy back when he filed his income taxes.

ACA is a poor subject for me. :angry:

Larry


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## Teslan (Aug 20, 2011)

r82230 said:


> As far as medi-gap insurance (Medicare gap) coverage. I'm also a fan of Plan F / Plan FHD. IDK if KT, likes, dislikes or wasn't aware of Plan FHD (Plan F, with a high deductible), just thought I would mention as a possible consideration for those, using (or will use in future) Medi-gap coverage's. The difference in monthly premium might amaze you.
> 
> To Teslan's point about a variable income, there doesn't seem to be a break, with ACA. Selling hay (or cash crops), your income can definitely vary month to month (let alone if your off-farm job is in sales, with variable income), let alone year to year. Milk checks come monthly (but do go up and down some, seems more down lately) and most off farm income is some what steady. If you don't count paid volunteer fire fighters. ACA seems to be geared more toward the steady income stream folks.
> 
> ...


That's what is wrong with the ACA individual policies. I would suspect the primary holder of these types of policies are the self employed type of people whose income is not the same every month. But yet it's the government types whose pay is predictable that wrote these types of programs. Like for this month both my wife and my income is about $750. That puts us in the poorest of poor I guess. But in September we could earn before expenses $100k if I sell a lot of hay and we have a couple of real estate closings. It's not outlandish to think that could happen.


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## endrow (Dec 15, 2011)

My son and I farm together we both Buy are health insurance through ACA his premium is $1600 a month and mine is $2,400 a month . We both have the health care premium deduction coming in that pays about half of our premium. They have a $3,500 deductible maximum out-of-pocket cost 7000 and we have a $6,200 deductible maximum out-of-pocket cost $12400.


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## Palmettokat (Jul 10, 2017)

Will try to answer all these without quoting them.

The High Deductible F is a very good plan and premium can be about half of normal F. Just need to understand the deductible amount.

If you do not apply or enroll into an ACA plan through the Federal Market Place you will jot be eligible for the subsidy regardless of your income. Not sure who said this but I suggest a person who has a wide swing in income to enroll through the Market Place but take no subsidy and if you end up being eligible take it on tax return. The other end is of course to take the subsidy during the year and possibly have to repay it. Do know there is no real enforcement on the repayment, best I understand all they can do is keep your refund but it still sits there until refunds repay it. The other point is, depending on the subsidy level if you qualify for "COST SHARING" that benefit does not have to be paid back and could save you a few thousand if you have medical bills.

On no one getting back to you on group insurance can not explain that. But if you are contracting the insurance company might be the problem. It could be the way you are asking could be the problem or the info you are giving them. You need at least two employed people to be insured but you may not have a company who wants to sell that size group. I am sure you have at least one insurance agent or agency already. Car insurance, home or life. Ask them for referral on health insurance agent. I have three P&C agency that refer to me on Health Insurance.

Woodland, that is sad what you are facing. I understand now why prescription are lower in price in Canada since the insurance does not help pay for it. No idea if it works in Canada but try the web site "goodrx.com" , maybe it will help.

You only can make application now between Nov 1st and Dec 15th for tax subsidy unless you have a "qualifying event". If you have a variable income I strongly suggest you do an application for tax subsidy and then move on through that process to buy on the Market Place. That way if you do qualify you get the subsidy even if at tax filing time but if not it is loss. Last year's income is not what your subsidy is based upon, it is the current year's income. You could have a million dollar income in 2017 and of course no subsidy but those major real estate sales are now closed and all the hay sold with say a $40,000 income in 2018 and probably qualified for several thousand in subsidy. Now they will want explanation as to the major change in income.


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## somedevildawg (Jun 20, 2011)

endrow said:


> My son and I farm together we both Buy are health insurance through ACA his premium is $1600 a month and mine is $2,400 a month . We both have the health care premium deduction coming in that pays about half of our premium. They have a $3,500 deductible maximum out-of-pocket cost 7000 and we have a $6,200 deductible maximum out-of-pocket cost $12400.


Insane isn't it.....I'm lucky, I guess, haven't needed it so I really am lucky....but mine is now lower than last year. But before the Obama debacle that we have now, our family of 5 insurance was 1700 a month with a 5k ded. After O it spiked at 2700 a month with a 14.4k deductable and the coverage went down. It now stands at 1400k a month only because we were able to join a group plan, we could not participate in our employee group plan.


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## woodland (May 23, 2016)

Vol said:


> Thank you for your frankness woodland. I could tell several months ago you were a good man because you included your family in your discussions. Healthcare has become a expensive issue worldwide. There are no clear cut answers in this country....nor in most places.
> 
> Regards, Mike


Thanks Mike. My family and friends mean the world to me and make life worth living. We are blessed up here that the government will patch you up regardless of $$$. The drawback is this gets transferred to taxpayers of which there seems to be fewer all the time even though the population keeps growing. ????


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## somedevildawg (Jun 20, 2011)

woodland said:


> Thanks Mike. My family and friends mean the world to me and make life worth living. We are blessed up here that the government will patch you up regardless of $$$. The drawback is this gets transferred to taxpayers of which there seems to be fewer all the time even though the population keeps growing.


But let me ask you, just curious......at what point, or have you seen a defined point, when the gubmit says, nah....this guy/gal has out lived their usefulness, we ain't gonna spend that amount of money 
Again, just curious.....when do we get put out to pasture  is it retirement age or will they remove that tumor at 82?
The talk here is/was, and the end game being, a single payer system, but it's morphing into a single non-option system with regards to choices of plans, hospitals and physicians.


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## somedevildawg (Jun 20, 2011)

Oh, and the only single payer is the folks that work.....the others are called freeloaders. Maybe we can institute a lottery healthcare system, the lotto funds the healthcare, that way we get some money from the freeloaders....albeit our own


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## Vol (Jul 5, 2009)

woodland said:


> The drawback is this gets transferred to taxpayers of which there seems to be fewer all the time even though the population keeps growing.


Yes, that "disease" seems to have had a "global" outbreak.....with some countries worse than others. It is nationwide here.

Regards, Mike


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## endrow (Dec 15, 2011)

These Network choices have become County specific in Pennsylvania. in our County we used to be able to choose from Aetna or Capital blue or Highmark and we generally had about five insurance companies to chose from. This year all the insurance companies pulled out of our County except for one, it is called Geisinger Health. Geisinger owns a big hospital system an hour north of us. It has been frustrating for many in the area for example my wife and I all the doctors we used are not in their Network we had to get new doctors. In the past if we would have had needed a major procedure we would have went to a hospital in Hershey Pennsylvania 20 minutes away. But now Geisinger the only provider available to us will not allow us to go to that hospital the only way we can get through the doors is by way of the ER. With this system someone said don't worry you can choose, but is it is turning into the opposite we were really surprised that these plans have become county-specific in Pennsylvania seems kind of foolish, but for us when they talk about choice we only had one plan to choose from, and when they sent the insurance card they had our new family doctors name on there someone we never heard of, so we called the number and they said yes this is where you should go to the doctor now and the doctor's name on the the front of your insurance card is not really your doctor, our network will use an interim program where the family doctor we go to you actually be seen by an interim student who is overseeing by a doctor. And we can't choose the hospital we went to go to and we can't choose the surgeon


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## somedevildawg (Jun 20, 2011)

endrow said:


> These Network choices have become County specific in Pennsylvania. in our County we used to be able to choose from Aetna or Capital blue or Highmark and we generally had about five insurance companies to chose from. This year all the insurance companies pulled out of our County except for one, it is called Geisinger Health. Geisinger owns a big hospital system an hour north of us. It has been frustrating for many in the area for example my wife and I all the doctors we used are not in their Network we had to get new doctors. In the past if we would have had needed a major procedure we would have went to a hospital in Hershey Pennsylvania 20 minutes away. But now Geisinger the only provider available to us will not allow us to go to that hospital the only way we can get through the doors is by way of the ER. With this system someone said don't worry you can choose, but is it is turning into the opposite we were really surprised that these plans have become county-specific in Pennsylvania seems kind of foolish, but for us when they talk about choice we only had one plan to choose from, and when they sent the insurance card they had our new family doctors name on there someone we never heard of, so we called the number and they said yes this is where you should go to the doctor now and the doctor's name on the the front of your insurance card is not really your doctor, our network will use an interim program where the family doctor we go to you actually be seen by an interim student who is overseeing by a doctor. And we can't choose the hospital we went to go to and we can't choose the surgeon


Incredible, absolutely incredible......what a mess, elections do have long consequences as we are seeing everyday


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## Teslan (Aug 20, 2011)

I'm just waiting for the biggest health system in my area to begin to offer "insurance" themselves. I wouldn't be opposed to it. They have every specialty imagined. Hospitals everywhere. Clinics every where. If Kaiser can do it so could they just on a smaller scale.


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## somedevildawg (Jun 20, 2011)

Teslan said:


> I'm just waiting for the biggest health system in my area to begin to offer "insurance" themselves. I wouldn't be opposed to it. They have every specialty imagined. Hospitals everywhere. Clinics every where. If Kaiser can do it so could they just on a smaller scale.


But what if your healthcare provider was one of the worst in the nation, you my friend are left with no choice.....
There is getting to be less and less competition and that is NEVER a good thing for the consumer of said goods....


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## r82230 (Mar 1, 2016)

somedevildawg said:


> But let me ask you, just curious......at what point, or have you seen a defined point, when the gubmit says, nah....this guy/gal has out lived their usefulness, we ain't gonna spend that amount of money
> Again, just curious.....when do we get put out to pasture  is it retirement age or will they remove that tumor at 82?
> The talk here is/was, and the end game being, a single payer system, but it's morphing into a single non-option system with regards to choices of plans, hospitals and physicians.


I don't know about today, but a few years ago there were more MRI machines in Detroit area than the whole country of Canada. I live close enough that if a Canadian could afford it they would come to the USA to get MRI and even open heart surgery. A good friend's wife worked at hospital that did a lot of open heart surgeries, she said that generally the reason the Canadian's came here for the surgery (and paid out of pocket), was the waiting list for open heart surgery might be 6-12 months. The people that I know that have had open heart surgery, seem to have the surgery within days of being diagnosed. Survival of the fittest perhaps??? Or just plain lucky to live until your scheduled surgery time.

Waiting 6-12 months, might reduce the cost of some patient's care for certain. Especially, if the heart blockage was what is called 'the widow maker' in MY area.

Hopefully, this has changed for our Canadian friends today.

Larry


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## Palmettokat (Jul 10, 2017)

ACA rules have really harmed the health care in the US. The cost for those mandates only come from one place, the user/tax payer. You have seen providers joining forces and hospitals buying doctor offices are in effort to survive. We have got to get lawsuits under control and the fear of them which causes the cost of medical device to be many times more since the term "medical" is tied to it. Think of Edwards who was lawyer turned democrat president candidate that won many lawsuits to be proven years later basically the suits were scams, if memory is correct. Of course there are some legit suits and will always be as long as MAN is involved for all make mistakes.

Something that has been lost in all this ACA mess is there were in every state a state designed and run high risk health pool which was guaranteed issue and coverage and yes high premium at least in my state of SC. However compared to today's ACA plans many long for those plans as they were lower deductibles and premiums. But, the big miss was the Federal Government also had a plan that was very very reasonable priced and with very reasonable deductible and such. All those plans required a person to first apply in the free market and to be declined or have an exclusion placed on their coverage to be eligible for those plans. In SC the state plan was partly funded by the insurance companies based upon the size of the company.

As to a provider being able to build their own product, I have no idea how reasonable or possible that is for would they have to meet the ACA rules or would they be exempt? Your larger companies have options in their coverage when they self insure for that is not considered insurance but employer benefits, different laws. Tthere are some ACA rules that apply but not near the same as on an insurance company.

Within some in the insurance industry the fact Short Term Policies will be able to be written again up to almost a full year will speed up the collapse of ACA individual plans, I agree. With the penalty for not having ACA coverage is now zero (law is still there but fine dropped to zero in tax bill in December, remember Supreme Court said it was a tax?) healthy people who get no or little subsidy will be buying those and with the option to move into an ACA plan once a year during open enrollment if need be it is almost a no brainier. Just look at the short term plan in it's coverage as they do vary. If there is a family of say four and one has even a serous sickness or injury they could be insured with an ACA plan and the rest of the family on a short term plan.

I find it hard to believe any plan does not allow you to select the surgeon or doc you want. Of course within those that are in their network.

Lets move away from health care here a moment, college tuition has jumped much faster than makes any sense think all but those who make their income there will agree. At same time many are saying the education is steady getting worse and look at some of the courses now being offered, how to grocery shopping and such added as new course in a school in Florida was on the news this week. What changed? How much of the tuition is funded now with the lotteries and rules changes by the Federal Government schools can charge more and provide less. Why would health care be any different and it is following the same path I think.

Woodland, it had to be twenty years ago an insurance group I was member of sent a group to look at the Canadian system and reported back to us basically we as agents have nothing to fear if the US follows the design there. They related it much to the US Federal Medicare System said people have to buy supplement plans to the Canadian plans. Are such plans offered there or was that not correct?

No idea in Canada but in the US a few years back insurance companies were getting concerned with the rising cost of medicines, it is growing percentage of health care every year. Maybe this is the reason medicines cost less in Canada.

On Medicare Supplements, some of this varies along state lines but do price shop them. if you are buying one if you are looking at any plan as long as you are comparing a Plan F either the regular one or High Deductible or Plan G (my preference) or any plan the coverage is the same regardless the company selling it. Here AARP, Blue Cross, Humana, Colonial Penn are not on the lower price end of the market.

I do disagree with President Trump on one point he says will lower cost, selling across state lines, unless networks go away. Why would a provider agree to a low price with an insurance company who may have 1% of the population of their area? It is not worth the time to learn their system for even filing a claim. Now if there were some how nationwide pricing on services much like Medicare uses and there are some level funded plans that are paying off of Medicare rates at three or five time those rates to any provider that would solve the network issue and to me be a big improvement to the system. A person on Medicare does not worry about balance billing the provider has already agreed to accept the Medicare pricing if they accept Medicare.

We have some hard decision before us as a people. Some have been pointed out by some of you and they are not easy. Today's local news was about a young man on life support totally since shot two year ago with no brain activity. Reason on the news family wants to know when the trial for the person who shot him will be. I wonder how much it has cost to keep his body going when the brain is dead. No way am I saying the support is wrong or right. Just saying it is very costly and is it right, I do not know. I do not remember the percentages now but in something like the last two years of a person life the majority of the cost of medical care for their life time i spent. We have to come to the realization as per of Ecclesiastes Chapter 3 reads, "a time to be born, and a time to die:" Those times only God knows but both are real times in a life. God here is telling us to be ready for death and we also have to realize there are limits to medicine. I have seen care wasted and value of that same level of care in my own family. Those are not easy decisions. Three years ago my brother's wife told him, "Bill I am ready to die, let me." For her it was easy, she had been in and out of hospital for about eight months. No cancer, no heart, no scary disease, her body digestion system was slowly no longer adsorbing necessary nutrition. She was seventy one, she was a Christian and her children raised and grands were at least in their teens. There was a good bit spent to treat her for her hospital stays and I think it was the diligent thing to do but when it was clear it was in man's hands a losing battle she realize and admitted where her life was. She was blessed with the time to have those she loved over a period of a couple of days to talk with each one as she shared her heart with us. It really was very special. I had a sister who had many thousands spent on her cancer treatment in 2014. It was not just very expensive dollar wise but suffering wise it was terrible. About the last two if not three months of her life she was in great pain with morphine drip steady that mostly had her out. Same brother was very close to her due to age difference in the children and he would say as we left her bedside that is worst than death. These are discussions that must be held in own homes and families and in our ruling bodies also.Very much I believe God gives life and only he has right to take it. Yet I also understand this life does have an end date to it. Ready or not.


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## swmnhay (Jun 13, 2008)

Teslan said:


> I'm just waiting for the biggest health system in my area to begin to offer "insurance" themselves. I wouldn't be opposed to it. They have every specialty imagined. Hospitals everywhere. Clinics every where. If Kaiser can do it so could they just on a smaller scale.


I think Sanford has.Based out of Sioux falls SD


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## Aaroncboo (Sep 21, 2014)

Health care is such a racket...


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## Palmettokat (Jul 10, 2017)

Aaroncboo said:


> Health care is such a racket...


It is a mess.

It can be fixed but it will take MATURE people who care to do it. To me they need to bring in a qualified group of the following to bring their suggestions to improve health care from their perspective: doctors, hospitals, insurance companies, maybe some medical provider other than traditional medical doctors such as mental health and chiropractor. I know some solutions can be simple such as all insurance companies must use the same claim process by the providers. Would save learned the process for different companies.

Many if they knew have forgotten there was such a commission of providers that were given this responsibility to do just this for the ACA bill and were not even heard. They brought back many recommendations that wold save millions and were not even allowed to be heard. They went to the media to tell their story and they told over and over what their recommendations were and how they were ignored by those who were writing the bill even though they were commission I think by the Democrats.

News tonight is Wal Mart is in early talks to buy Humana. Humana is a company that is ripe to buy so I understand as Aetna wanted to and the Feds blocked it on anti trust. It was announce about first of the year Caremark who owns CVS was looking to buy Aetna, have not heard much on that since. UHC rep told in meeting following the Caremark and Aetna story broke that is more likely to happen than the government allow a large health insurance company to buy another due to how few there are now.

It would be interesting to know what either of those companies plans would be if they do buy the insurance company. Wal Green is in major battle against CVS for market share and is in tight position as CVS is owned by Caremark which owns the largest Prescription drug plan company, Silver Script. If they buy Aetna then that gives Caremark and CVS more power to control or influence the retail drug market.


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## somedevildawg (Jun 20, 2011)

And the mess will get thicker.....


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## luke strawwalker (Jul 31, 2014)

I don't understand a thing you just said... might as well be the Chinese tax code to me...

We'd have our stupid "employee benefits meetings" at the school, the insurance people would start yakking and my eyes would glaze over... I'd take the packet home, toss it to Betty, and tell her "do whatever you want with it".

First day of school we'd get back from the bus routes and the insurance guy would be sitting in the breakroom with his laptop out; we had to "select a plan and sign up". I just tossed him the paperwork my wife gave me and say "here". He'd start asking questions and I'm like, "H3ll I dunno I can't understand any of this gobbledygook... Here I'll call her you talk to her".

I've NEVER been able to understand any of that garbage and never will. Bout like taxes... I'll either pay it or if I can't I won't. Probably will end up under a bridge but oh well, nothing I can do about it...

Later! OL J R


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## r82230 (Mar 1, 2016)

Palmettokat said:


> The High Deductible F is a very good plan and premium can be about half of normal F. Just need to understand the deductible amount.


The Plan F high deductible (HDF) in MY area is less than 20% (15% for a 65 year old, Plan F), than a Plan F or a Plan G.

Here are the *monthly* standard rates for a in my area:


For a 65 year old Plan F - $271 Plan HDF - $40 Plan G - $205
For a 70 year old Plan F - $338 Plan HDF - $52 Plan G - $260

The annual deductible is $2,240 for 2018 (HDF).

The annual premium difference between Plan F and Plan HDF is $2,772 for the 65 year old & $3,432 for the 70 year old.

So I think of it as who do I want to pay the POSSIBLE deductible. If I pay it, my total costs are $532 less for a 65 year old or $1,192 less for a 70 year old, per year.

A 65 year old total premiums Plan F, $271 x 12 = $3,252 compared to HDF $40 x 12 = $480 + $2,240 = $2,720 ($3,252 - $2,720 = $532), if I get sick/ill and have to pay full deductible for a 65 year old. Savings greater for a 70 year old naturally.

This is for MY area, your area could be much different.

Larry


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## Vol (Jul 5, 2009)

I am amazed how much higher some states are on insurance. I thought it was terrible here, but not as bad as some.

A standard Plan F is $110.00 per month for a 65 year old individual. Not sure what the HDF is....as I did not know there was even such a thing. F here covers everything that A and B does not cover.

Regards, Mike


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## r82230 (Mar 1, 2016)

Vol said:


> I am amazed how much higher some states are on insurance. I thought it was terrible here, but not as bad as some.
> 
> A standard Plan F is $110.00 per month for a 65 year old individual. Not sure what the HDF is....as I did not know there was even such a thing. F here covers everything that A and B does not cover.
> 
> Regards, Mike


I believe everyone's Plan F covers Medicare Part A and Part B deductibles, required by Government. My thought is it was to make all insurers coverage the same in the market place (so you can compare more 'apples to apples' coverage) verses the Wild West.

I'll send a PM, with some info.

Larry


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## Vol (Jul 5, 2009)

r82230 said:


> I believe everyone's Plan F covers Medicare Part A and Part B deductibles, required by Government. My thought is it was to make all insurers coverage the same in the market place (so you can compare more 'apples to apples' coverage) verses the Wild West.
> 
> I'll send a PM, with some info.
> 
> Larry


This will explain what Plan F covers from my insuror.

Regards, Mike

https://www.fbhealthplans.com/medicare-supplement/plan-f


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## Palmettokat (Jul 10, 2017)

On Medicare Supplements or Medigap plan same two different names used. The Federal Government "standardized" the coverage sometime about mid 80's I think. In those plan which ever plan letter you are looking at if a "B" or "F" or "G" or high Deductible "F" the coverage is the same regardless of the company. The industry has a saying..."a plan F is a plan F".

On prices in NY there can be a variety or reasons for their prices compared to TN. I think TN is like SC most if not all insurance companies use "current age" rates meaning as we get older the rates increase and NY may use "issue age" which means you keep the age you were when your coverage began. They also could use same rate for all ages. Regardless the method used they all have rate increases due to increased medical care price increases, increased use of coverage and the cuts made to Medicare itself with the raising of deductible and other ways those plans are locking into often having to pay more as bigger part is being paid by them.

I think covered this up front some but you need to really price review lets say every three years at least. I get amazed the difference between companies yet so many people buy a name, who spends millions to keep their name out there. Of course we do that with all products.

On High Deductible Plan F, I do think it a good option for many but it is a personal decision.With over $2,000 deductible, look at your health. Same thought process with going with a Medicare Advantage. If your have health issues that require treatments often buying a Plan G makes better financial sense. Again no plan is best for everybody.


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## Palmettokat (Jul 10, 2017)

Today had email sharing Senator Susan Collins recent comments on the ACA law. Short was if not fixed and she does not expect any legislation this year, some parts of the country may be without insurance (impression I got was next year).


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## endrow (Dec 15, 2011)

Palmettokat said:


> Today had email sharing Senator Susan Collins recent comments on the ACA law. Short was if not fixed and she does not expect any legislation this year, some parts of the country may be without insurance (impression I got was next year).


 I believe that would make perfect sense. For the year 2016 when we shopped 4 ACA insurance on the marketplace open enrollment, the amount of plans and companies that offered insurance that my wife and I were eligible for were that many it took about an hour to review them in 2017 we had about seven choices total. In 2018 we had one choice and that was one company one plan and that is the way it was for everyone in our County. If that one company pulls out next year and no one comes in no more Obamacare for this county is what we're told.


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## Palmettokat (Jul 10, 2017)

endrow said:


> I believe that would make perfect sense. For the year 2016 when we shopped 4 ACA insurance on the marketplace open enrollment, the amount of plans and companies that offered insurance that my wife and I were eligible for were that many it took about an hour to review them in 2017 we had about seven choices total. In 2018 we had one choice and that was one company one plan and that is the way it was for everyone in our County. If that one company pulls out next year and no one comes in no more Obamacare for this county is what we're told.


 Not sure have this 100% correct but if memory is correct less than half the counties in the US have more than one insurance company.Think it was Oklahoma who was down to the wire to have all their counties covered.


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## JOR Farm (Aug 27, 2019)

My plan when I was young was similar to "the outlaw Jesse James " when I was a teen I realized it didn't work out for him and I probably better get to work.


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