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bearishgurl.
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September 15, 2013 at 12:07 PM #765504September 15, 2013 at 2:47 PM #765509
scaredyclassic
Participantif you see all of life in society as combat, struggle and conflict, with winners, and losers, havign universal health care just seems like a pussy way out, like, everyone wins and gets to get health care.
wouldn’t it be more american, more capitalist, to let people fight it out in the marketplace, and the winners in the top 20% say of income can get really amazing care, and the middle people can get a little bit of care, and the bottom gets nothing, not one lousy thingnot even a bandaid…because they lose. they lost.
isn’t that at least a reasonable position to take?
how are we going to motivate people to win if we keep losers alive? people will just loll about and eat govt cheese and get govt bypasses….
September 15, 2013 at 11:17 PM #765512
svelteParticipant[quote=6packscaredy]if you see all of life in society as combat, struggle and conflict, with winners, and losers, havign universal health care just seems like a pussy way out, like, everyone wins and gets to get health care.
wouldn’t it be more american, more capitalist, to let people fight it out in the marketplace, and the winners in the top 20% say of income can get really amazing care, and the middle people can get a little bit of care, and the bottom gets nothing, not one lousy thingnot even a bandaid…because they lose. they lost.
isn’t that at least a reasonable position to take?
how are we going to motivate people to win if we keep losers alive? people will just loll about and eat govt cheese and get govt bypasses….[/quote]
Wow.
I don’t even know where to begin on that position.
Being poor is not equivalent to being a loser. I know a lot of caring people who contribute a LOT to our society who don’t make much money. And many of them have historically went without healthcare. One example: day care workers.
My wife and I started out with nothing and spent many years sans insurance because quite frankly it was either insurance or eating. And I know what we chose. We were fortunate and made it through to the years where we want for nothing.
Having as many members of the public healthy as possible brings the entire country up: financially, physically, and morally.
If that isn’t self-evident I’m not sure what to say.
September 16, 2013 at 6:41 AM #765513UCGal
ParticipantI’ve had Kaiser for years. It’s a closed network for routine visits. But it absolutely covers you when you are out of network. As someone who’s traveled with kids who don’t pick opportune times to get sick I learned the system… You call them and they tell you what clinic or urgent care to go to… And it’s covered in full. ER out of network is also covered.
Like any hmo your care is as good as your primary care physician. If you don’t like your primary it’s easy to switch. Our pediatrician is totally awesome.[quote=bearishgurl][quote=no_such_reality][quote=citydweller]I’ve just been looking at the Covered California sight and it appears I don’t qualify for any tax credits (I’m single with good income). However, it looks like I can sign up for the Kaiser Bronze 60 HSA HMO for $392 per month ($4,500 deductible and maximum out of pocket for one person is $6,350). I currently have an individual plan thru Anthem/Blue Cross which costs $720 per month ($2,950 deductible and max out of pocket is $11,810).
It has been years since I’ve even reached my current deductible, so the cheaper plan seems like a good idea.
I have a couple questions, Does anyone have experience with Kaiser and would you recommend it? Also, does “maximum out of pocket” really mean what it says? In other words, once I’ve spent $6,350 in medical bills in one year, is EVERY other bill paid by the insurance?[/quote]
Any reason you’re not looking the Anthem/Blue Cross EPO or HSA/EPO that is cheaper than the Kaiser one? Kaiser has 7 million members in California. Basically, 1 in 5 Californians is covered by Kaiser. Your service level will be largely dependent on your ability deal with the system. There’s horror stories, but horror stories are common place across any group that is that large.
As for OOPM, yes and no. The kicker is they’ll cover the bills that are medically necessary. So no optional treatments once you hit the limit, but if you get hit by a bus, you’re covered.[/quote]
nsr, there is a good reason why the plans you are suggesting (above) are “cheaper.” My research on them indicated that they have virtually zero out-of-network coverage. I’m not sure how that applies to emergency coverage but as a road traveler, I’m concerned that these carriers wouldn’t cover my bills at all, even if I was moved from an EMT to a regional hospital from a rural area where I sustained a medical incident or injury.
If one spends 46+ weeks per year in a large metropolitan area because they are a “worker bee” (ex: SD County) and takes “staycations,” drives to nearby cities in populous counties or only flies to other large metropolitan areas within the CONUS, these plans can work for them.
But they don’t work for campers, hikers, off-roaders, skiers, road travelers and/or those with friends/relatives residing in rural areas of the country for whom they regularly visit.[/quote]
September 16, 2013 at 7:40 AM #765514Participant[quote=svelte][quote=6packscaredy]if you see all of life in society as combat, struggle and conflict, with winners, and losers, havign universal health care just seems like a pussy way out, like, everyone wins and gets to get health care.
wouldn’t it be more american, more capitalist, to let people fight it out in the marketplace, and the winners in the top 20% say of income can get really amazing care, and the middle people can get a little bit of care, and the bottom gets nothing, not one lousy thingnot even a bandaid…because they lose. they lost.
isn’t that at least a reasonable position to take?
how are we going to motivate people to win if we keep losers alive? people will just loll about and eat govt cheese and get govt bypasses….[/quote]
Wow.
I don’t even know where to begin on that position.
Being poor is not equivalent to being a loser. I know a lot of caring people who contribute a LOT to our society who don’t make much money. And many of them have historically went without healthcare. One example: day care workers.
My wife and I started out with nothing and spent many years sans insurance because quite frankly it was either insurance or eating. And I know what we chose. We were fortunate and made it through to the years where we want for nothing.
Having as many members of the public healthy as possible brings the entire country up: financially, physically, and morally.
If that isn’t self-evident I’m not sure what to say.[/quote]
doesnt our society measure success only bye money?
September 16, 2013 at 8:09 AM #765515bearishgurl
Participant[quote=bearishgurl][quote=no_such_reality][quote=citydweller]I’ve just been looking at the Covered California sight and it appears I don’t qualify for any tax credits (I’m single with good income). However, it looks like I can sign up for the Kaiser Bronze 60 HSA HMO for $392 per month ($4,500 deductible and maximum out of pocket for one person is $6,350). I currently have an individual plan thru Anthem/Blue Cross which costs $720 per month ($2,950 deductible and max out of pocket is $11,810).
It has been years since I’ve even reached my current deductible, so the cheaper plan seems like a good idea.
I have a couple questions, Does anyone have experience with Kaiser and would you recommend it? Also, does “maximum out of pocket” really mean what it says? In other words, once I’ve spent $6,350 in medical bills in one year, is EVERY other bill paid by the insurance?[/quote]Any reason you’re not looking the Anthem/Blue Cross EPO or HSA/EPO that is cheaper than the Kaiser one? Kaiser has 7 million members in California. Basically, 1 in 5 Californians is covered by Kaiser. Your service level will be largely dependent on your ability deal with the system. There’s horror stories, but horror stories are common place across any group that is that large.
As for OOPM, yes and no. The kicker is they’ll cover the bills that are medically necessary. So no optional treatments once you hit the limit, but if you get hit by a bus, you’re covered.[/quote]nsr, there is a good reason why the plans you are suggesting (above) are “cheaper.” My research on them indicated that they have virtually zero out-of-network coverage. I’m not sure how that applies to emergency coverage but as a road traveler, I’m concerned that these carriers wouldn’t cover my bills at all, even if I was moved from an EMT to a regional hospital from a rural area where I sustained a medical incident or injury.
If one spends 46+ weeks per year in a large metropolitan area because they are a “worker bee” (ex: SD County) and takes “staycations,” drives to nearby cities in populous counties or only flies to other large metropolitan areas within the CONUS, these plans can work for them.
But they don’t work for campers, hikers, off-roaders, skiers, road travelers and/or those with friends/relatives residing in rural areas of the country for whom they regularly visit.[/quote]
Both of the bolded plans suggested by nsr are EPO’s and thus do not have out-of-network coverage.
http://www.ehow.com/facts_5003224_what-epo-health-plan.html
All EPOs and the Kaiser HMOs are inferior to citydweller’s current Anthem/Blue Cross PPO.
I agree that a Kaiser HMO can contract out a patient within their service areas to a specialist provider which they do not have locally available. I’ve seen this happen a few times with co-workers on their plans. I also agree with UCGal in that Kaiser HMOs cover emergencies while the planholder is traveling within the US (not sure out of country). As far as Kaiser’s 60% HSA plan mentioned here by citydweller which will be featured as a “Bronze Plan” on CA’s exchange, it is anyone’s guess if this particular plan will cover out-of-network providers. This particular plan seems as if it may have been “watered down” specifically for CoveredCA and not one of Kaiser’s typical HMO plan offerings.
In spite of citydweller’s $700+ mo current premium, I really think he (or she) should think twice before leaving his current plan to purchase one on CoveredCA, especially since he states that his existing policy has been “grandfathered” and that he won’t be eligible to receive tax credits in 2014.
There are no longer any more PPO plans available which have quite the level of coverage and features of a “grandfathered” plan. Break out your magnifying glass, folks, as the devil is in the details :=0 They have ALL been “dumbed down” in various (insidious) ways to be marketed on the state’s exchanges, since the carriers can no longer discriminate as to who gets covered. That’s the major reason why Aetna, Cigna and United Healthcare have decided to dump their indiv policyholders located in CA on the state’s exchange, IMO.
citydweller was obviously medically underwritten at one time (upon application).
September 16, 2013 at 8:27 AM #765516ParticipantIn my case, I don’t want to have an EMT, ski-patrol member, search-and-rescue member or person I’m with have to sit on hold with a toll-free number to first find out “where I’m supposed to go” if I’m injured or fall ill (that is, IF he/she can actually GET cell phone service, lol). I want the 2-5 doctors available within a 50-mile radius of where I am to be able to treat me, even if that is in a helicopter or on-site and they rushed from home to do so. And I want the emergency providers to know that their agency will be reimbursed by my carrier, so I get the best care. I want them to take me where THEY think (in their best judgment) that I should go and take me to the most convenient place for THEM to get me to (for stabilization). After I get to the (likely small regional) hospital, I don’t want my providers there to be told that I’m not eligible to be flown to a particular trauma center or to be treated in xyz hospital by xyz provider who will fly in to perform surgery on me.
Blah, blah … you get the drift.
In a nutshell, I want CHOICE. And for that, I will settle for a higher deductible if I have to in order to afford the premium.
You pay for exactly what you get in this life.
September 16, 2013 at 9:02 AM #765517Participant[quote=6packscaredy]doesnt our society measure success only bye money?[/quote]
Unfortunately, in our society, money (or level of/possibility of reimbursement) DOES talk when receiving healthcare, especially emergency healthcare.
Don’t kid yourselves if you think some of these “seemingly cheap” plans on the state’s exchanges are going to get you the care that you may have been used to in the past (provided by an employer?). I’ve carefully perused the info available on three states’ exchanges and can safely say that several of their plan offerings are but half-a-step up from Medi-Cal/Medicaid. For instance, the planholder on the cheapest plans will be seeing the same (limited) set of providers in a particular locale as a Medicaid recipient but those providers’ reimbursements might end up being slightly higher than Medicaid.
I’m not sure if this will be enough to get you to the head of a (possibly lo-o-o-ong) line :=0
Choose wisely, folks … or leave well-enough alone.
My .02.
September 16, 2013 at 9:29 AM #765518no_such_reality
ParticipantThere is one PPO available, Blue Shield in the San Diego region.
It covers 50% for out of network providers.
The Anthem EPO, also covers 50% for any out of network providers for emergency purposes.
In LA, the Anthem EPO has 8839 doctors in network. HealthNet, a much smaller competitor has 2316.
In San Diego, HealthNet isn’t a viable option, IMHO, they only have 216 primary care doctors in network.
September 16, 2013 at 9:36 AM #765519FlyerInHi
GuestBG, cares what your situation is? You say that money talks but, in the same breathe, you seem to want a Cadillac plan that covers everything you could want.
We already know that money always talks. That’s not the point of the policy discussion.
People in Europe and Canada who are rich could always pay out of pocket for the very best care. Same here, with or without obamacare.
One problem with our health system is that in many cases, we provide too much care for the level of payment, so some people get too much and millions go without.
September 16, 2013 at 9:45 AM #765520spdrun
ParticipantThe problem is also that uninsured people (or people who are denied coverage on a procedure) are charged vastly inflated out-of-pocket fees. In all other industries (car repair, home repair), you can often get a discount if you don’t go through insurance. Not so with the healthcare system in 2013.
September 16, 2013 at 10:10 AM #765521Participant[quote=FlyerInHi]BG, cares what your situation is? You say that money talks but, in the same breathe, you seem to want a Cadillac plan that covers everything you could want.
We already know that money always talks. That’s not the point of the policy discussion.
People in Europe and Canada who are rich could always pay out of pocket for the very best care. Same here, with or without obamacare.
One problem with our health system is that in many cases, we provide too much care for the level of payment, so some people get too much and millions go without.[/quote]
Flyer, LOTS of people regularly travel. I’m simply using myself for an example, because I am frequently in outlying or rural areas. A “Cadillac Plan” would be an “indemnity plan” which has very low deductibles, very low co-pays, provide low-cost brand-name drugs and possibly also provide a nurse by your side when flying you to MD Anderson/Johns Hopkins at whim. That is NOT the plan I am seeking, nor can I afford such a policy. I will sign up for a PPO with the biggest network I can find that is present in the places I visit. I don’t agree with your (emphasized) statement, above. Perhaps you are referring to some emergency rooms currently providing “charity” care to non-paying patients (which will supposedly cease come 2014, assuming everyone signs up for a plan). But people who have HMO or PPO plans never have had and can’t now have “everything (they) could want.”
The only ones who likely can have “everything they could want” are “Cadillac” (indemnity) policyholders and those paying all cash for care.
The rest of us poor slobs now have to “work the system” to the best of our ability with the “mass-produced” plans offered by our employers or on the exchanges.
It was actually scaredy who, in essence, brought up the “money talks” issue. He is right. Money (cash/reimbursement level) will still talk to healthcare providers in 2014 and beyond. The issue will just be presented a little differently. The NAME of your carrier and the TYPE of your plan will speak for you. As before, your insurance card will your calling card in the game of medical services procurement.
I don’t see “level of care” being exactly equal among exchange planholders. Medi-Cal/Medicaid recipients will have their own plan administrators who may also administer one or more of the lowest-cost “Bronze” or “Enhanced Silver” plans.
In other words, the poor and indigent will receive care, Medi-Cal will be expanded to include more of the poor and working poor but I don’t see these groups receiving the same level of care (or choice) as those purchasing Gold or Platinum Plans.
September 16, 2013 at 10:15 AM #765522Participant[quote=no_such_reality]There is one PPO available, Blue Shield in the San Diego region.
It covers 50% for out of network providers.
The Anthem EPO, also covers 50% for any out of network providers for emergency purposes…[/quote]
These were the two carriers which I recently posted that I am going to look into as soon as more details are revealed about these plans.
We do not yet know whether these plans will be offered as a Silver, Gold or Platinum Plan (or 2 or 3 of them).
September 16, 2013 at 10:32 AM #765523SK in CV
Participant[quote=bearishgurl] Perhaps you are referring to some emergency rooms currently providing “charity” care to non-paying patients (which will supposedly cease come 2014, assuming everyone signs up for a plan). [/quote]
That’s not exactly true. There are, as of a few days ago, still 26 states that have not agreed to expand Medicaid coverage, with no current cost to those states. Three of those are leaning towards expansion. The majority of the rest have declined expansion, with seven states leaning towards not expanding Medicaid. Those currently uninsured, that would qualify under Medicaid expansion will not be eligible for credits under the state run exchanges. They are likely to remain uninsured, and will remain a burden to non-profit hospitals in those states.
September 16, 2013 at 10:55 AM #765524citydweller
ParticipantI’m looking at the benefits page of my current policy (Anthem/Blue Cross), it shows a deductible of $2,950 and then “Participating and Non-participating provider Copayment/Coinsurance Maximum” of $8,850. I take this to mean my annual max out of pocket is $11,800. My monthly premium is $752 (and yes, I’m a boomer, mid-50’s)
I’m again looking at the Bronze plans, the Anthem EPO is only $388 per month, which means I would save $4,368 per year just in premium costs and still be able to stay within the Anthem network.
The deductible for this bronze plan is $5,000, which is ok with me if I’m saving over $4,000 in premium payments per year, and would still have to hit my deductible of $2,950 (on my current plan) even after paying $9,024 annual premium.
Also, the bronze plan has an annual max out of pocket of $6,350. Am I missing something, or does it make sense to switch to this lower cost plan?
I really appreciate everyone’s comments. I very seldom have medical bills and so have very little knowledge of how this all works, but I would like the security of knowing I have good coverage if I need it.
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