Recommend
16 
 Thumb up
 Hide
26 Posts
1 , 2  Next »   | 

BoardGameGeek» Forums » Everything Else » Religion, Sex, and Politics

Subject: my experience with obamacare rss

Your Tags: Add tags
Popular Tags: [View All]
Shawn Fox
United States
Richardson
Texas
flag msg tools
Question everything
Avatar
mbmbmbmbmb
So I'm leaving my job at a large corporation to become an independant contractor. This requires me to buy my own health coverage so I logged in to healthcare.gov (since Texas opted out of building a state specific site) to see what was available. I have a pre existing condition that can be treated quite effectivly with modern drugs (psoriatic arthritis, I take Enbrel which is very expensive). Hard to find exact info, but the cost of Enbrel is somewhere around $1500 to $2500 per month. So prior to the ACA I'd be on the hook for that cost as no free market insurance company is going to cover that cost, so through my own bad luck with genetics I'd be 100% on the hook to pay for it.

So anyway, I had a look on healthcare.gov at the various plans and did some analysis on which one worked best for me. I wanted to stick with a very well known provider and a PPO instead of an HMO as the HMOs I looked at were very restrictive and did not include any of the doctors that I normally use.

So the best plans at each level had the costs shown below, the 'max cost' number is just the premium plus the maximum out of pocket cost for the plan. So in the absolute worst case that is the maximum that I'd spend per year for that health insurance policy no matter how sick I was.

Bronze: $242/month (6000 max out of pocket) - max cost = $8904
Silver: $334/month (6000 max out of pocket) - max cost = $10008
Gold: $405/month (3250 max out of pocket) - max cost = $8110

The bronze plan was basically designed as a catastrophic plan. The only thing it paid for before the $6000 deductible was reached was preventative care. Any prescription drug coverage, specialists, hospital/emergency room visits, etc came 100% out of pocket until the $6000 deductible was met. Since Enbel is quite expensive that means I'd always end up paying the full $8904 every year. Ouch, that is a lot more than I expected coverage to cost.

The silver plan changed things up to a standard copay of $30 doctor / $50 specialist visits and $150 per prescription for specialty medications (90 day supply, and it does cover Enbrel). I generally go to the doctor twice per year and my rheumatologist 3 or 4 times per year, so my minimum yearly cost under this plan is 334*12 + 30*2 + 50*4 + 150*4 = $4868. This one looks much better than the bronze for me. Of course I might get really sick, have an accident, or whatever, but even then my max cost is $10008 which is only $1100 more than the bronze plan.

The gold plan was basically identical to the silver plan. There were some minor differences in the cost for emergency room visits and a few other things here and there. The main difference is the lower max out of pocket the gold plan has (3250 for gold vs 6000 for silver) Clearly if you are sick and require a lot of medical care the gold plan is the way to go due to it having the lowest max out of pocket cost of $8110. For my known costs the gold is a bit more expensive: 405*12 + 30*2 + 50*4 + 150*4 = $5720 vs $4868 for the silver. As long as I don't have a serious accident/illness the silver plan costs me around $850 less per year with the potential to cost $1900 more than the gold plan if something bad happens.

At 40 years old I think (hope) it is very unlikely that I'll have a serious illness more than once every 2 years so the silver plan is the way I'm going. Anyway, I thought it was an interesting exercise and was worth a post here on RSP. I should also note that the silver/gold plans cover 100% of hospital costs (after a $250 per incident deductible) whereas the bronze plan covers nothing outside of preventative care until you hit the $6000 deductible. How other insurance providers structure their bronze/gold/silver plans may be different of course, but based on looking at the bronze/silver/gold plans in Texas that is the way they seem to be structured.

Also just as an FYI, I haven't paid anything yet. They are supposed to send me a bill for coverage starting March 1, hopefully it will work correctly. As for the healthcare.gov site itself, it worked well enough. My only complaint is that you can't really compare the plans via the site, you have to go to the health insurance companies's site and either get a PDF or read a web page and try to figure out what the plan actually covers. A bit of a pain in the ass to be honest, but after reading through 4 of 5 of them they started to make sense.
29 
 Thumb up
0.50
 tip
 Hide
  • [+] Dice rolls
Shawn Fox
United States
Richardson
Texas
flag msg tools
Question everything
Avatar
mbmbmbmbmb
I also had a second thing to say about this as well but didn't want to include it in the first post. The post above is mostly just facts, this has a bit more opinion in it.

I know I am not the type of customer than the healthcare insurance companies want. When I sign up I am costing them something like $20000 per year more than I pay them. For every person like me, there has to be 5 to 10 healthy people sign up for the insurance company to break even. I didn't ask for psoriatic arthritis, I just got it. That is often the way of things, sometimes we just have bad luck, but other people have good luck.

That idea is the basic underpinnings of how health insurance works, that most people who pay for it will never need it. This isn't true once you get past a certain age of course, but that is why we have a government insurance program for the elderly. For those under 65, however, many people will never get seriously ill and will end up having to pay a great deal of money over their lifetime for insurance that they never used. The fact is those people are the real winners in the entire situation. Sure they may be out a lot of money, but they have something money (usually) can't buy, their good health. I'd be very happy to be paying for insurance and not having to use it. You won't find anyone on my side of the equasion who would disagree with that statement.
23 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
James Webb Space Telescope in 2018!
United States
Utah
flag msg tools
Avatar
mb
I'd be interested to hear about your experiences in the future, too, as you use ACA
1 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
Welcome Rolling Stones
Latvia
Bullshit
flag msg tools
Avatar
mbmbmbmbmb

What about the Death Panels? Did they come by your home yet?
8 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
Moshe Callen
Israel
Jerusalem
flag msg tools
designer
ἄνδρα μοι ἔννεπε, μοῦσα, πολύτροπον, ὃς μάλα πολλὰ/ πλάγχθη, ἐπεὶ Τροίης ἱερὸν πτολίεθρον ἔπερσεν./...
badge
μῆνιν ἄειδε θεὰ Πηληϊάδεω Ἀχιλῆος/ οὐλομένην, ἣ μυρί᾽ Ἀχαιοῖς ἄλγε᾽ ἔθηκε,/...
Avatar
mbmbmbmbmb
49xjohn wrote:

What about the Death Panels? Did they come by your home yet?
Tuesday.
 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
Shawn Fox
United States
Richardson
Texas
flag msg tools
Question everything
Avatar
mbmbmbmbmb
tesuji wrote:
I'd be interested to hear about your experiences in the future, too, as you use ACA

The ACA is just a set of rules, the insurance is all provided by private companies, no different than the insurance companies that normally provide insurance to corporations. The provider I went with was BlueCross BlueShield, but I also could have chosen Cigna, Aetna, or Molina. I'd never heard of Molina so I didn't even bother looking at their plan.

In past jobs I've had insurance from all of these providers except for Molina. The PPO plan I chose from BlueCross is basically identical to the plan I currently have.

I live in a fairly affluent suburb of Dallas, so I have a lot of choices. I doubt anyone that lives in a large city will have any problems finding a good plan for them via the heathcare.gov site (or the state ran site if the state built their own exchange). People who live in rural areas may find their plans to be a lot more expensive, but that is because it is much more expensive to provide health care out in the middle of nowhere. Hard for the hospitals and doctors to be efficient without the volume that comes with a large city. Large cities also force competition between hospitals. There are 5 large hospitals and hundreds of doctors within 15 minutes of my house, so that allows the insurance companies to negotiate a good rate.
1 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
United States
St. Louis
Missouri
flag msg tools
Avatar
mbmbmbmbmb
Does Enbrel really cost that much, or is that simply the price the drug companies and insurance companies have come to agree upon in the rigged game known as health insurance?

I'm glad you've found coverage and a plan that works. I'd be interested to know what costs would really look like if we had real HEALTH CARE reform, and not just insurance.

Some food for thought.
1 
 Thumb up
1.00
 tip
 Hide
  • [+] Dice rolls
Shawn Fox
United States
Richardson
Texas
flag msg tools
Question everything
Avatar
mbmbmbmbmb
COMPNOR wrote:
Does Enbrel really cost that much, or is that simply the price the drug companies and insurance companies have come to agree upon in the rigged game known as health insurance?

I'm glad you've found coverage and a plan that works. I'd be interested to know what costs would really look like if we had real HEALTH CARE reform, and not just insurance.

Some food for thought.

Enbrel is created by using Chinese hamster ovary cells. It isn't like a typical small molecule drug that gets far cheaper to make as you scale up. It is very difficult to make, it is a long process involving the deaths of thousands of Chinese hamsters.

Here is a story about how it is made and why it costs so much. And you thought I was joking. Well, I was joking about about killing thousands of Chinese hamsters, but it is actually grown in vats using cells from Chinese hamster ovaries. Creating these biologic drugs is a very difficult, and thus very expensive, process.

http://seattletimes.com/html/health/2008120449_drugs18m.html

6 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
J
United States
Lexington
Kentucky
flag msg tools
Avatar
mbmbmbmbmb
COMPNOR wrote:
Does Enbrel really cost that much
Yes. I also have psoriatic arthritis, but take another biologic called Humira. It's about $2500 per month. That's for two shots a month.
3 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
Mindy G
United States
Portland
Oregon
flag msg tools
By Meow Command!
badge
Mold the chaos into something beautiful
Avatar
mbmbmbmbmb
sfox wrote:
The PPO plan I chose from BlueCross is basically identical to the plan I currently have.

For comparison, do you know yet what your COBRA rate through your employer would be?
 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
Shawn Fox
United States
Richardson
Texas
flag msg tools
Question everything
Avatar
mbmbmbmbmb
oriecat wrote:
sfox wrote:
The PPO plan I chose from BlueCross is basically identical to the plan I currently have.

For comparison, do you know yet what your COBRA rate through your employer would be?

I'll see if I can find out, but my current employer self insures so probably has a better rate than is typical. I was actually planning to go without insurance for one week but if I can get COBRA for 1 week I suppose that would make sense to go that route.

The $4008 cost of premiums for the plan I chose through ACA seems quite good compared to the numbers floating around the internet. Most sources say that the typical cost paid by corporations is somewhere between $5000 to $6000 per year for an individual.
 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
Trace
Australia
Perth
Western Australia
flag msg tools
Avatar
mbmbmbmbmb


Just curious I looked up the price of the drug Enbrel here in Australia.

It is listed on the PBS (a list of 600 drugs that are subsidised by the Govt.) and this takes it from being $25 000 in 2003 to a maximum of $32.90 per prescription.

mmmmmmmmmm





5 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
Isaac Citrom
Canada
Montreal
Quebec
flag msg tools
badge
MENTE, MANU ET INSTRUMENTUM
Avatar
mbmbmbmbmb

I looked up Enbrel under the Quebec drug insurance plan. Wow! It's $173 per small-dose pill (25 mg). It's on a special list of drugs wherein the wholesale markup is limited to $33.

The Quebec drug insurance plan is far younger than our "Medicare". Prior to it, one paid fully for all prescriptions. Drugs were never part of Medicare.

Now, we also have the Quebec drug insurance program which is mandatory. It includes monthly premiums, monthly deductibles, co-pay, is capped, and is income indexed.

The result is that some people will pay $0 total for anything and everything. The worst case scenario is a maximum out-of-pocket annual expense of $992.

The system was put into place exactly because of drugs like Enbrel, costing thousands of dollars per month for treatment, during the height of AIDS.

The net result is that the casual prescription receiver will still end up paying for his drugs (plus his premium), once the monthly premium, deductible and copay are factored in. But, those spending a lot per month on drugs, such as the elderly, or catastrophic amounts, are covered such that they'll never pay more than $83/month.

As I said, some people pay $0, depending on annual income, your premium and other charges may scale down as far as $0.


The only thing that pissed me off about the whole story is that while the elderly, who were paying taxes and paying into multiple social security plans all their lives, could pay so much for drugs as to be living on cat food, that was OK. As soon as HIV/AIDS became a hot button issue, only then did drug insurance become necessary.
.
2 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
Germany
flag msg tools
Avatar
mbmbmbmbmb
In Germany you pay about $400 to $800 per month as an independent contractor for the non-profit social health insurance, depending on your income.

The only additional costs for you would be:
$7 for each prescribed medication
$14 for each day in hospital (but you only have to pay for the first 28 days)
some more sophisticated dental stuff
1 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
Paul DeStefano
United States
Long Island
New York
flag msg tools
designer
@TaintedDragonInn
badge
www.TaintedDragonInn.com
Avatar
mbmbmbmbmb
sfox wrote:
it is very unlikely that I'll have a serious illness more than once every 2 years

Don't limit yourself to illness.

Injury accounts for 99% of my medical bills.

OK, maybe I'm a bit of a special case, but realize accidents and such are what need to be covered as well.
3 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
Scott Russell
United States
Clarkston
Michigan
flag msg tools
badge
Avatar
mbmbmbmbmb
I have no problem with paying into insurance voluntarily and hoping to not need it.

Making it mandatory is what irritates me.
 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
Sweden
Stockholm
flag msg tools
designer
Avatar
mb
Hegel wrote:
In Germany you pay about $400 to $800 per month as an independent contractor for the non-profit social health insurance, depending on your income.
As an independent contractor, I pay somewhere between $0 to $0 per month.
2 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
United States
St. Louis
Missouri
flag msg tools
Avatar
mbmbmbmbmb
sfox wrote:
COMPNOR wrote:
Does Enbrel really cost that much, or is that simply the price the drug companies and insurance companies have come to agree upon in the rigged game known as health insurance?

I'm glad you've found coverage and a plan that works. I'd be interested to know what costs would really look like if we had real HEALTH CARE reform, and not just insurance.

Some food for thought.

Enbrel is created by using Chinese hamster ovary cells. It isn't like a typical small molecule drug that gets far cheaper to make as you scale up. It is very difficult to make, it is a long process involving the deaths of thousands of Chinese hamsters.

Here is a story about how it is made and why it costs so much. And you thought I was joking. Well, I was joking about about killing thousands of Chinese hamsters, but it is actually grown in vats using cells from Chinese hamster ovaries. Creating these biologic drugs is a very difficult, and thus very expensive, process.

http://seattletimes.com/html/health/2008120449_drugs18m.html


Interesting read, thanks. I'm still skeptical about the actual price though. But if it gets you covered, good for you.
1 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
nothing but static
New Zealand
Unspecified
flag msg tools
mbmbmbmbmb
We have a drug buying company that purchases all subsidized drugs. If it can do a deal with the drug manufacturers then it will subsidize the drug otherwise you have to pay full amount. It has a fixed budget so buying one drug will usually mean another will not be purchased. Expensive drug that have a low number of users would probably not be covered.

 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
Shawn Fox
United States
Richardson
Texas
flag msg tools
Question everything
Avatar
mbmbmbmbmb
oriecat wrote:
sfox wrote:
The PPO plan I chose from BlueCross is basically identical to the plan I currently have.

For comparison, do you know yet what your COBRA rate through your employer would be?

I just got a packet in the mail, COBRA would cost me $451/month vs the $334/month I am now paying though ACA. The COBRA plan went to a max deductible of $6350, so in the worst case I'd pay $11762 if I continued my health coverage with my former employer.

My employer is paying significantly more than the comparable health insurance plans that are available for individuals through the ACA website, despite the fact that I'd think there would be professionals negotiating the rate and my former employer has several hundred thousand employees. I'd think they could get a better deal than that. I think the issue is that my former employer has a large number of retired workers with pensions that supply health insurance, so maybe they are rolling the cost of the pensions into their current employee's health insurance cost.

Also just a general comment, I've made my first payment and have received my insurance cards (both medical and dental). The only messy part of the system is that I haven't been able to set up autopay, maybe I'm just too dumb to figure out their web site though. I found a form that I could print out and mail/fax in but there has got to be a better way. Probably I can just set up my checking account to automatically send a check each month.
 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
Mac Mcleod
United States
houston
Texas
flag msg tools
Avatar
mbmbmbmbmb
I remember in the web site that you can't use ACA until your COBRA eligibility has expired. The worst downside is that you won't get the subsidy so insurance thru ACA may still be substantially cheaper than cobra (mine was similar $371 unsubsidized ACA BCBS vs $531 cobra).

If you are getting a subsidy, they may take it back next year at tax time (i.e. big tax bill).


I paid a year of premiums in advance (in case I forget, was in the hospital, or on a vacation when a premium came due).
 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
UA Darth
United States
Boca Raton
FL
flag msg tools
Avatar
mbmbmbmbmb
tesuji wrote:
I'd be interested to hear about your experiences in the future, too, as you use ACA

As pointed out, this statement makes no sense. Everyone will be "using" the ACA, as it is simply regulation.
 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
Shawn Fox
United States
Richardson
Texas
flag msg tools
Question everything
Avatar
mbmbmbmbmb
maxo-texas wrote:
I remember in the web site that you can't use ACA until your COBRA eligibility has expired. The worst downside is that you won't get the subsidy so insurance thru ACA may still be substantially cheaper than cobra (mine was similar $371 unsubsidized ACA BCBS vs $531 cobra).

If you are getting a subsidy, they may take it back next year at tax time (i.e. big tax bill).


I paid a year of premiums in advance (in case I forget, was in the hospital, or on a vacation when a premium came due).

That doesn't seem to be the case as far as not being able to use ACA if you have COBRA: https://www.healthcare.gov/what-if-i-currently-have-cobra-co...

I think what it is saying is that if you can buy insurance through COBRA then you can only switch to ACA insurance during the open enrollment period, normally November 15 through January 15th each year. I'm not sure of that interpretation though, but it is very clear that during the open enrollment period you can just switch to ACA insurance if you want.

My assumption would be that you should be able to drop COBRA at any time, otherwise many people wouldn't be able to pay for their insurance if they were fired instead of making a voluntary career change.
 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
James Stein
msg tools
mb
oriecat wrote:
For comparison, do you know yet what your COBRA rate through your employer would be?

 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
Mac Mcleod
United States
houston
Texas
flag msg tools
Avatar
mbmbmbmbmb
sfox wrote:
maxo-texas wrote:
I remember in the web site that you can't use ACA until your COBRA eligibility has expired. The worst downside is that you won't get the subsidy so insurance thru ACA may still be substantially cheaper than cobra (mine was similar $371 unsubsidized ACA BCBS vs $531 cobra).

If you are getting a subsidy, they may take it back next year at tax time (i.e. big tax bill).


I paid a year of premiums in advance (in case I forget, was in the hospital, or on a vacation when a premium came due).

That doesn't seem to be the case as far as not being able to use ACA if you have COBRA: https://www.healthcare.gov/what-if-i-currently-have-cobra-co...

I think what it is saying is that if you can buy insurance through COBRA then you can only switch to ACA insurance during the open enrollment period, normally November 15 through January 15th each year. I'm not sure of that interpretation though, but it is very clear that during the open enrollment period you can just switch to ACA insurance if you want.

My assumption would be that you should be able to drop COBRA at any time, otherwise many people wouldn't be able to pay for their insurance if they were fired instead of making a voluntary career change.

http://go.pomcogroup.com/blog/bid/190104/COBRA-Coverage-and-...
Quote:
For example, if an individual chooses to elect COBRA coverage, they would be able to drop that coverage and switch to a Marketplace plan only during open enrollment, and, while not entirely clear, they may not be eligible for a premium tax credit to help pay for that coverage either, until the COBRA coverage period is exhausted.

Looks like if you start cobra, you not not be eligible for the subsidy until you exhaust cobra. I ran into similar text on healthcare.gov.

You are probably fine since you never were on cobra to begin with.
 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
1 , 2  Next »   |