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  1. #1
    Senior Member dstrong's Avatar
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    Affordable Care Act...

    Posting here because I don't want this to be a political thread...as if that that can be avoided...but...

    My 27 y.o. daughter works for a large retailer and has had a "medical discount" plan that really doesn't provide much in the way of benefit. She got a letter this week saying that since the plan doesn't satisfy the ACA that it will be discontinued at the end of the year. She is now faced with obtaining insurance through the exchange.

    So I'm curious about anyone that's had experience getting signed up. She's lives in Texas also, so I think that may limit her choices...but maybe not. I'm also convinced she'll be able to receive subsidies since her annual income is so low. She has several pre-existing conditions, primarily mental health related, and takes meds to even things out...it would be great if those were covered cuz they ain't cheap.

    Any CONSTRUCTIVE advice out there? Please let's try to avoid a move to P&R.

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    Photon-Ninja tjax's Avatar
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    I have read the Obamacare law all the way through because it really impacts my family. I can tell you that if the program is discontinued, the company has until January 1st to find a traditional means of health insurance for your daughter (as long as she is full time). Our exchange in CO works, but the pricing is TERRIBLE. $350 premium a month gives you health insurance and a $12,000 deductible. Either way you are rolling the dice, but I hope she is a full time employee so she can have a couple options to choose from during the open enrollment from November 1st to January 1st.
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  3. #3
    Senior Member dstrong's Avatar
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    Unfortunately, she's a part timer...about 30 hours/week. Is your $350 premium/month for the family? $12,000 deductible would ruin a lot of folks financially these days if needed.

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    derailleurs are overrated bigbenaugust's Avatar
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    Quote Originally Posted by dstrong View Post
    Unfortunately, she's a part timer...about 30 hours/week. Is your $350 premium/month for the family? $12,000 deductible would ruin a lot of folks financially these days if needed.
    See, and all of the retail shops are bumping all of their full-timers down to 30 hours to avoid it.
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    Senior Member Michigander's Avatar
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    I am also 27. What it looks like I am going to get is twice the price for twice the deductible.

    The only constructive advice would seem to be that many will obviously be working under the table to make sure they can have their IRS known wages below the threshold of getting federally subsidized health care. This however will not be for everyone. Many of us are simply screwed.

    I do not think it's possible to so much as talk about the specifics of the financial harm this law will cause to young people without it being implicitly political.
    Last edited by Michigander; 10-30-13 at 12:32 PM.
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    thats why i hate kangeroos

  7. #7
    Cool Beans MangoPumpkin's Avatar
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    Not trying to be rude but does your daughter have any disabilities? I work for the DPW, not in Texas though, but I can try to get more info for her. We are dealing with ACA because they can apply through us if they don't qualify.
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    Can'tre Member 3alarmer's Avatar
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    Quote Originally Posted by dstrong View Post
    Posting here because I don't want this to be a political thread...as if that that can be avoided...but...

    My 27 y.o. daughter works for a large retailer and has had a "medical discount" plan that really doesn't provide much in the way of benefit. She got a letter this week saying that since the plan doesn't satisfy the ACA that it will be discontinued at the end of the year. She is now faced with obtaining insurance through the exchange.

    So I'm curious about anyone that's had experience getting signed up. She's lives in Texas also, so I think that may limit her choices...but maybe not. I'm also convinced she'll be able to receive subsidies since her annual income is so low. She has several pre-existing conditions, primarily mental health related, and takes meds to even things out...it would be great if those were covered cuz they ain't cheap.

    Any CONSTRUCTIVE advice out there? Please let's try to avoid a move to P&R.
    ....I think you have described what i perceive to be the realities quite well.

    It appears that the online sites for places like Texas will not be operating smoothly for
    some time now, and that creates some anxieties, but it sounds like your daughter is
    one of those who should benefit overall once things are running and working.

    The shoppping for a new plan thing is going to be problematic, even then, because it
    is unlikely she will know what her subsidy levels will be prior to having to chose a plan.

    I live in California, things are going a little more smoothly here, and I can't claim to know
    much about what will or will not happen in the great state of Texas.(I like the place, mostly.)
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  9. #9
    Senior Member tizeye's Avatar
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    First of all, a "medical discount" plan is not insurance, but a pre-negotiated price for specific services.

    I keep hearing these astronomical deductions for ACA and something isn't adding up. I have a feeling opponents are finding the absolute worst example and suddenly touting it in their talking point. I know there is a lot of garbage discussions out there, typical was a 70 y/o talking about how ACA was causing his monthly premium to go up 300% and huge deduction, when a 70 y/o is on Medicare and not even eligible for ACA. But he is a loud mouth poster spouting garbage that people interpret as fact.

    While I haven't officially logged onto the ACA web site as I am in no hurry, I have been doing secondary research, specifically trying to get greater detail on the various "metal" plans beyond the marketing summary. I am in no hurry because I am covered by my wife's employer's plan, plus the VA (disabled veteran) as backup. However, things are tense at work and she is looking at other employers to escape the environment.

    One thing I was specifically researching was the deductible in the various plans. There is no set deductible established by ACA, rather part of the insurance company's pricing formulae. One link in my research jumped me out to a place like e-insurance.com and reviewing private plans, premiums less that $150/mo and deductibles s low as $250 on up with most around the $5000 mark with a few up in the $10000+ range. Of course there was the note that the premium quotes was the lowest possible and may be rated higher based on medical history. (They can't turn you down for pre-existing, but they can charge you an arm and a leg.)

    What she may want to do is see what is available on the private market. That at least gives her a baseline to compare ACA. Given that she is low income, she may be eligible for the subsidy, making ACA plan preferable.
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    Your daughter will benefit from "obamacare"-
    Working folks with pre existing conditions who don't make much money-and have crummy to no health insurance thru their employer
    will be pleasantly surprised.
    She will pay more for obomacare insurance -but it will be actual insurance -yes it could pay some of her pharmacy bill-maybe 2/3 or so-depends on which policy she buys.

    Young healthy folks-who wouldn't have bought health insurance-and moderately affluent folks will be hit hardest-
    They will pay for the poorer folks and folks with pre existing conditions. It is a tax of a sort.

    Insurance companies can "rate you" based on pre-existing condition-BUT you won't actually be paying all that premium-GOV assistance- will pay much of that rating.
    Last edited by phoebeisis; 10-30-13 at 05:44 PM.

  11. #11
    Senior Member koolerb's Avatar
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    Everything I've heard from people that have been able to get signed up has been positive regarding rates. The trick seems to be navigating all the way through the process on the web site. Some sail right through, while others are stopped in their tracks.

  12. #12
    Bicycle Repair Man !!! Sixty Fiver's Avatar
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    Lets just say I ran the numbers as if my wife and I were living in Oregon with our daughters... the ACA is not affordable.

  13. #13
    Senior Member dstrong's Avatar
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    Quote Originally Posted by windhchaser View Post
    thats why i hate kangeroos
    I hear ya...those pouches freak me out.

    Quote Originally Posted by MangoPumpkin View Post
    Not trying to be rude but does your daughter have any disabilities? I work for the DPW, not in Texas though, but I can try to get more info for her. We are dealing with ACA because they can apply through us if they don't qualify.
    Her mental issues would probably qualify her for disability but we've never gone down that path.

    Quote Originally Posted by tizeye View Post
    What she may want to do is see what is available on the private market. That at least gives her a baseline to compare ACA. Given that she is low income, she may be eligible for the subsidy, making ACA plan preferable.
    Since the private market won't provide subsidies, I suspect ACA will be preferable.

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  14. #14
    A tiny member bikeguyinvenice's Avatar
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    Quote Originally Posted by Sixty Fiver View Post
    Lets just say I ran the numbers as if my wife and I were living in Oregon with our daughters... the ACA is not affordable.
    I shopped on healthcare.gov last week. It's not affordable. To get something similar to my current health care plan I'd have to spend about $400 per month vss $120 per month for my employer provided plan. I think a lot of people will pay the penalty tax vs buying healthcare.
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    Crispy Member ahsposo's Avatar
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    Quote Originally Posted by bikeguyinvenice View Post
    I shopped on healthcare.gov last week. It's not affordable. To get something similar to my current health care plan I'd have to spend about $400 per month vss $120 per month for my employer provided plan. I think a lot of people will pay the penalty tax vs buying healthcare.
    Most employer provided plans provide a subsidy that they get a tax break on and the employee picks up some, but not all of the cost.

    I was forced out of a job years ago and had to provide my own insurance. I went from paying maybe $120 a month to over $1600 a month. A rude awakening.
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  16. #16
    Bicycle Repair Man !!! Sixty Fiver's Avatar
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    Quote Originally Posted by ahsposo View Post
    Most employer provided plans provide a subsidy that they get a tax break on and the employee picks up some, but not all of the cost.

    I was forced out of a job years ago and had to provide my own insurance. I went from paying maybe $120 a month to over $1600 a month. A rude awakening.
    That too is wacked.

    My wife experienced the same thing when she was laid off in the US. As a two time cancer survivor there was no such thing as affordable insurance for her but she did not have to worry about this for too long as she has emigrated to Canada where health care is affordable. We have no premiums here and she was subscribed to our Provincial Health Care Plan in a few minutes.

    We pay for prescriptions, dental, and optical... but the basics are covered 100%.

  17. #17
    Crispy Member ahsposo's Avatar
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    I haven't talked to a Canadian yet that is unhappy with their healthcare.

    The worst comment I heard is that there was something of a 'brain drain' after the law was implemented as greedy doctors left for the greener pastures of the US.
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  18. #18
    Senior Member GP's Avatar
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    For a comparable plan under the ACA, it will cost $639 per month less than what I'm paying now. It's the same insurance company and the same doctor.
    Last edited by GP; 10-30-13 at 05:40 PM.

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    I can remember the family having to change doctors when medicare came to BC as our doctor left for the "greener pastures" of the US. A few years later Dad saw him in the emergency and the doc said he came back because he couldn't stand having to turn patients away because they couldn't afford his bill.
    P.S. Sixty-fiver, Don't tell the fine folks on here what your medical coverage costs you, I don't think they could handle the sudden influx of Americans into Alberta.

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    Maybe God forbids anyone in Texas getting their own affordable health care, especially the working poor which is a major aspect of the ACA.

    Texas has the highest uninsured rate in the country, the highest children rate, a governor who would rather tell his poor citizens they’re out of luck rather than accepting federally funded Medicaid extension programs (to qualify for existing Medicaid in Texas a family of three has to earn less than $5,000 a year). Most importantly is the Texas refusal to set up a state exchange that acts as a active purchaser exchange which is what my state of California did.

    As an active purchaser exchange the state was able to choose only those insurers offering competitive rates and broad enough services. That caused insurers to lower rates to be included in the program. Rates are actually lower than those predicted. California has Bronze, Silver, Gold and Platinum plans. The Silver has a $2000 deductible (no deductible with Gold and Platinum), $19 prescription and $45 co-pay and costs a 21 year old between $40 and $216 and a 40 year old up to $276 depending on income. A family making less that $92,000 and a single person making less than $45,000 will get subsidies according to how much less. A 20 something year old making less than $18,000 can get a Bronze plan for no out of pocket money for the plan.

    Personally I work for a smaller company that pays full health insurance costs with no deductible through Kaiser, dental and gives profit sharing to all employees. We have had no lay offs, moves to part time work or anything else related to health care costs.

    Quote Originally Posted by tizeye View Post
    (They can't turn you down for pre-existing, but they can charge you an arm and a leg.)
    Where did you get that? Under the ACA insurers cannot charge different rates for health insurance because of health status. They can have different rates based on age but that increase, over the standard rate, is also capped.
    Last edited by clemsongirl; 10-30-13 at 10:03 PM.

  21. #21
    Senior Member tizeye's Avatar
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    Quote Originally Posted by bikeguyinvenice View Post
    I shopped on healthcare.gov last week. It's not affordable. To get something similar to my current health care plan I'd have to spend about $400 per month vss $120 per month for my employer provided plan. I think a lot of people will pay the penalty tax vs buying healthcare.
    When I see statements like this, it typically is not comparing apples to apples - even if the insurance plans were identical. The reason is because employers subsidize their employees health premium, gaining a tax break - which we all pay for - while calling it a personnel benefit. While doing a hypothetical review, as HR what the current COBRA payment is "if you left the company". That is basically 100% of the employer's cost for the insurance plus a small (1% or so) administrative fee for COBRA. Watch you $120/mo suddenly shoot up to $400 or more.
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  22. #22
    genec genec's Avatar
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    Quote Originally Posted by GP View Post
    For a comparable plan under the ACA, it will cost $639 per month less than what I'm paying now. It's the same insurance company and the same doctor.
    Now wait a minute... don't go touting successes here. Com'on there has to be some horror story behind your post... did you contact the death panels directly?

  23. #23
    Crispy Member ahsposo's Avatar
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    Quote Originally Posted by tizeye View Post
    When I see statements like this, it typically is not comparing apples to apples - even if the insurance plans were identical. The reason is because employers subsidize their employees health premium, gaining a tax break - which we all pay for - while calling it a personnel benefit. While doing a hypothetical review, as HR what the current COBRA payment is "if you left the company". That is basically 100% of the employer's cost for the insurance plus a small (1% or so) administrative fee for COBRA. Watch you $120/mo suddenly shoot up to $400 or more.
    This is what happened to me. I found a great little plan for my boy and myself through Blue Cross/BS at about $500 a month, very comparable to my plan with my previous employer provided plan - which was a great benefit of that job. My wife had a pre-existing condition so I had to COBRA her for $1100 a month. Then instead of following my entrepreneurial dream I had to become a wage slave to get her into a group policy before she would, at the time, become uninsurable for her pre-existing condition.
    Quote Originally Posted by toddles View Post
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  24. #24
    Super Moderator no1mad's Avatar
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    Quote Originally Posted by Sixty Fiver View Post
    That too is wacked.

    My wife experienced the same thing when she was laid off in the US. As a two time cancer survivor there was no such thing as affordable insurance for her but she did not have to worry about this for too long as she has emigrated to Canada where health care is affordable. We have no premiums here and she was subscribed to our Provincial Health Care Plan in a few minutes.

    We pay for prescriptions, dental, and optical... but the basics are covered 100%.
    Sounds like the OP's daughter needs to find a mate in Canada
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  25. #25
    Senior Member Michigander's Avatar
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    Quote Originally Posted by tizeye View Post
    When I see statements like this, it typically is not comparing apples to apples - even if the insurance plans were identical. The reason is because employers subsidize their employees health premium, gaining a tax break - which we all pay for - while calling it a personnel benefit. While doing a hypothetical review, as HR what the current COBRA payment is "if you left the company". That is basically 100% of the employer's cost for the insurance plus a small (1% or so) administrative fee for COBRA. Watch you $120/mo suddenly shoot up to $400 or more.
    Where I am at now, what is available is a group rate that the company doesn't really add much of anything to, where I am essentially asked to pay more than what it would cost to insure myself so that I can help cover older folks who badly abuse their bodies in every typical legal way, and a small few people who need health care through no fault of their own. This is a similar situation, but now at the federal level under the weight of federal law.

    It's a shame George Carlin is no longer with us. He'd have had so much fun with this debacle.
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