ACA OBAMA CARE

[DRC458]

Yes, BCBS has several different options and I'm sure the others do as well. We've opted for the highest option they offered and, although it may cost quite a bit more, we have certainly been pleased with the coverage. For instance, the latest total I heard on the wife's back surgery this year was over $76K and we haven't paid a dime ... yet ... knock on wood. Everything so far has been covered, between Medicare and BCBS, 100%.


.

 

[JD8]

Well I can say this much... I know some folks who have this insurance, aka the BCBS on the exchange, end up not getting much if anything in coverage. I don't know all the ins and outs, but...

It brings to mind a family I saw last year a number of times. Now this was a man, his wife and their young adult son. When we schedule people, we verify they have current insurance coverage for every visit, or they have to pay cash. These folks, I saw the man maybe... 3 or 4 times. Wife I saw at least that many and several times spent a LONG time with her - like going on an hour or more. Counseling for various stuff, etc. Son I think I saw 2 times, maybe 3.

Keep in mind, all these were verified insurance current and up to date before and at the time of visits. Wife I had come in to see our counselor multiple times, too.

Then they all dropped off the map. Haven't seen them in nearly a year.

A few months ago, I get notice from our business office manager and I realize why they're gone - they owe nearly $2,000 in bills to us (actually more like $2500, now that I think about it) among the three. Insurance (again, BCBS) never paid us a single penny for any of their care. Not one. So we had to try to collect from them, of course, they skipped and bailed. I know husband worked in Tulsa as a welder, that much came out. Son, I think worked locally part-time, maybe for WalMart or something. Wife didn't work.

But this was a working family, obviously lower end of the income scale from my interactions with them, living in an apartment, subsidized or not, I don't know. But they DID have BCBS, I am assuming it was "exchange coverage" aka "Obamaca/ACA". And BCBS never paid us a dime for all the care we provided. Patients never paid a copay, either, I'll add. Usually people just walk out the door instead of stopping on the way out to pay, or they give a reason they can't pay their copay today, etc. I think with our new system, they're asking them to pay the copay up front.

So that's an experience I have with this kind of stuff. My staff and I provided good, quality care, went above and beyond, I tried significantly to help these folks, all three, and we got stiffed for nothing.

And this is part of why I'm in the position I am (meaning struggling financially right now). People think it's a racket when their doc 'bills' $150 for a visit - you don't see what we actually COLLECT on that bill, and a lot of the time we collect NOTHING. Usually my collections run... oh, maybe around 50-60% of what we 'bill'? Some months a good bit less.

<edit> Oh, and when we turn people over to collection, we lose 50% of whatever they manage to collect, as well.

There is only one way for an individual to buy healthcare, and that's on the exchange. What people are really calling "Obamacare" is really a subsidy and has nothing to do with the coverage, except for the fact that all plans have to meet certain requirements of the ACA.

Could be a catastrophic/high deductible or HSA qualified plan. They are cheaper, but the deductible is HIGH. Hell, lots of deductibles start at 3500 for individuals last I checked. Individual family plans would be VERY expensive for a deductible lower than that.

Glad you are make them pay the copay up front, most doc offices do that from what I've seen.

 

[Slim Deal]

Everything so far has been covered, between Medicare and BCBS, and Plan F 100%.
.

Medicare and Plan F is why everything is paid for. Medicare is highly regulated and insurance companies choose plans they offer and which add ons to Medicare they want to sell. BCBS's Plan F is exactly like United Health's Plan F and Bob's Hometown INS Plan F. Plan F is Plan F. The only difference between insurance companies is what the premium is.

My Plan F started at $95 per month, it's now $199 but that's how the cookie crumbles. Two heart surgeries, lots of DR visits etc and 100% of everything is covered and no deductibles.

 

[JD8]

Medicare and Plan F is why everything is paid for. Medicare is highly regulated and insurance companies choose plans they offer and which add ons to Medicare they want to sell. BCBS's Plan F is exactly like United Health's Plan F and Bob's Hometown INS Plan F. Plan F is Plan F. The only difference between insurance companies is what the premium is.

My Plan F started at $95 per month, it's now $199 but that's how the cookie crumbles. Two heart surgeries, lots of DR visits etc and 100% of everything is covered and no deductibles.

Just a heads up..... Plan F is going bye bye. If you have a Plan F, expect it to get a whole lot more expensive as you should be grandfathered in, but that insurance pool will shrink.

 

[COZICAN]

Thank you all for your responses. Unfortunately my wife does not qualify for medicare due to assets. We never expected this crap at 59/58 but it's what we've got to deal with. I'm trying to "retire" and looking at all options for health insurance. I know a gun board isn't the best place to ask but I knew there would be experienced users of ACA insurance and am just looking at and for all opinions. I will likely pay for COBRA benefits for 18 months (if she lasts that long) but only because I'm too afraid to not have my group policy. Answers are not easily found regarding insurance coverage.

Coz

 

[rswink]

There is only one way for an individual to buy healthcare, and that's on the exchange. What people are really calling "Obamacare" is really a subsidy and has nothing to do with the coverage, except for the fact that all plans have to meet certain requirements of the ACA.

Could be a catastrophic/high deductible or HSA qualified plan. They are cheaper, but the deductible is HIGH. Hell, lots of deductibles start at 3500 for individuals last I checked. Individual family plans would be VERY expensive for a deductible lower than that.

Glad you are make them pay the copay up front, most doc offices do that from what I've seen.

No, you can call them and get your own price. You do not have to use the exchange.

Sent from my Pixel 4 using Tapatalk

 

[tRidiot]

Just a heads up..... Plan F is going bye bye. If you have a Plan F, expect it to get a whole lot more expensive as you should be grandfathered in, but that insurance pool will shrink.

Wow, I wasn't aware of that. A lot of people going to have an awakening. Is this being replaced somehow?

I think we all better pay attention to Medicare supplements if we're over 40, because I predict when Medicare for all comes along (and I think it will), private insurance is going to be all about the supplements.

 

[DRC458]

Medicare and Plan F is why everything is paid for. Medicare is highly regulated and insurance companies choose plans they offer and which add ons to Medicare they want to sell. BCBS's Plan F is exactly like United Health's Plan F and Bob's Hometown INS Plan F. Plan F is Plan F. The only difference between insurance companies is what the premium is.

My Plan F started at $95 per month, it's now $199 but that's how the cookie crumbles. Two heart surgeries, lots of DR visits etc and 100% of everything is covered and no deductibles.

Just a heads up..... Plan F is going bye bye. If you have a Plan F, expect it to get a whole lot more expensive as you should be grandfathered in, but that insurance pool will shrink.

You are correct. I should have pointed that out. Thank you. I am anxious to see what happens with our Plan F. I hope we can still afford it next year!


.

 

[JD8]

No, you can call them and get your own price. You do not have to use the exchange.

Sent from my Pixel 4 using Tapatalk

In which there is no difference in price. In Oklahoma you're not going to get it any cheaper and you won't be able to compare anything easily.

 

[JD8]

Wow, I wasn't aware of that. A lot of people going to have an awakening. Is this being replaced somehow?

I think we all better pay attention to Medicare supplements if we're over 40, because I predict when Medicare for all comes along (and I think it will), private insurance is going to be all about the supplements.

Plan G will take over. Basically it's the exact same minus the carrier paying the Part B dedcutible.