[quote=TemekuT]My heart goes out to both of you – BG and CardiffBaseball. I have the same situation with my beloved baby sis, who has always been vigilant about diet, weight, exercise. She was diagnosed with stage IV cancer 2 years ago at age 47 and is fighting with all she’s got. Thankfully, when she was struggling financially in the prior 2 years, she did not cancel her PPO and now has many care choices and can be selective about her treatments. I believe my sis will benefit from Obamacare and I am fine with helping her and others similarly stricken.
On the other hand, I will now have to contribute to relatives, acquaintances, and strangers’ future medical costs due to their laziness, lack of discipline and bad choices. I have some relatives that take cholesterol meds and blood pressure meds, but indulge almost daily in bacon, egg, and donut breakfasts. I get to watch as the metabolic syndrome they obviously have transforms into diabetes. They regularly circle around parking lots to get the spot closest to the restaurant door, where they consume pizza or fried chicken, followed by sugary and fatty desserts. They have packed on the pounds around their middles, and it’s not attractive being 50 lbs overweight.
Now my sis, that’s just genetic bad luck, but I do resent paying for others’ preventable conditions.
BG – I also have an individual AETNA PPO and received the letter, and am confused about what to do. I take great care of myself, with a very healthy diet and lots of exercise. I am slim, and have no conditions at 55+. It’s not always fun to haul myself out of bed early like I did this morning, walk a few miles, and then breakfast on oatmeal, but I do it because I want to be a healthy oldster.[/quote]
TemekuT, it appears we’re both in the same boat. I have spoken to a third broker in SD last week and he told me that, even though Covered CA’s website and charts do not indicate that tax credits are available for anything but the “Silver Plan” (2nd from the bottom plan), he was certain they would be available to help pay for the Gold or Platinum Plan. I have a few unanswered questions about ALL of the plans on the exchange, mainly regarding access and choice. I understand the differences in the co-pays and all of the plans offered by Covered CA have low deductibles. But I’m wondering if access and provider choice are the same on all of them. If it is, then the Silver Plan would be the way to go because it is, by far, the cheapest. But if access and choice are better or much better on the Gold or Platinum plan, then those plans merit looking into.
I’m waiting to see which of the exchange’s plans will be administered by CA carrier Anthem Blue Cross. That will undoubtedly be the plan with the most choice.
I don’t care as much about the cost of copays but want preventative care (incl periodic “expensive” tests) covered at least 75%.
The “Bronze Plan” appears to be geared towards 20-somethings (who generally have little need for any services outside of basic preventative care).
I’m also in the 55-60 age group and, at first blush, it appears the top three plans on the exchange will have monthly premiums between $557 and $866 month (abt 50%-250% higher than my current mo premiums). Even though I currently have a higher deductible ($5K) and coinsurance requirement ($3K), I have the ultimate in nationwide access, the ultimate in provider choice and 100% of my preventative care is covered (incl “expensive” tests and scans). In addition, my copays for office visits are less than those on the “Silver Plan.” (My particular plan configuration is “grandfathered” and thus hasn’t been offered to new enrollees since before the PPACA became law in March of 2010.)
I’m so sorry to hear about your sister, TemekuT. My sister never drank or smoked but was a road/sky warrior 8-12 business days per month for many, many years so had to learn to regularly sleep on planes, live in hotels and dine in restaurants alone or with colleagues for nearly every meal. When she returned home, she spent her precious time watching her kids sporting events and readying her suitcase for the next trip instead of going to the gym. She even traveled extensively while expecting and a few weeks after the births of her children. Luckily, she had competent caregivers and a supportive spouse, who took care of her until the end. In hindsight, I feel her lifestyle took a toll on her health in that it possibly contributed to a late diagnoses. She wasn’t obese but became a little overweight in her forties. I believe her cancer was inherited but will not know for certain for at least another year when I will be able to return to the east coast and pay for genetic testing. I’m worried about my kids as well and, even if it skips me, I’m worried about my nieces and nephews.
If a “single-payor system” is the direction this country ends up taking, I don’t have a problem either with subsidizing the health premiums of unlucky people like our sisters. But I’m with you in that I don’t want to subsidize the premiums of people who are eating, smoking, drinking and drugging themselves into early graves.
Due to the sheer volume of currently uninsured people in CA who will qualify for tax credits to obtain health coverage on one of Covered CA’s plans, I just feel their need will be great. Throughout 2014 and 2015, (if this group continues to consistently pay the monthly balance of their premiums after their tax credits), they will become established with primary care providers and specialists. In doing so, they will be taking up a LOT of appointment time (meaning a 45 min appt instead of 5-15 mins) because many of them haven’t seen a health provider in decades and will undoubtedly encounter many surprises. I just feel these provider groups will be swamped and not know how far apart to space appointments and possibly have to stay open evenings and Saturdays to accommodate all the new insureds, along with their regular longtime patients. Going to the doctor will be like going to traffic court. These problems will severely lessen the quality and quantity of care for everyone, IMHO, if the provider list for all of the exchange’s plans are the same.
If the above happens, not only do I see a lot of (very established) providers retiring or relocating, I see a lot of boomers leaving large CA urban areas and flocking to the “nicer” rural areas (ex: Lake Tahoe, Mammoth Lakes, Mendocino, Solvang … even the Rockies) where there aren’t so many people (the previously uninsured and newly-minted US citizens) vying for appointments with the same provider groups. I’ll be right behind them.
