[UCGal]

I’m pretty sure Kaiser Permanente will bill you, and hound you if you don’t pay at time of service.

It’s part of the negotiated rate for group insurance. My sister and I both have Kaiser. She has a $10 copay, mine is $20. Because they premiums and copays were negotiated by different employers.

I guess you could not pay it – but they could come after you for it. Perhaps your doctor decided the cost to bill is more than the copay… but if enough people do it – they’ll come after you.

Just curious – do you pay your deductible if you’re in a car accident and get your car repaired? Or is that optional also? Do you pay the full ask when you get a haircut – or do you pay a lesser amount and hope they don’t mind too much?

[UCGal]

[quote=6packscaredy]

Booze, crankiness lack of exercise, repressed sexuality, cigarettes better explain squabbles.[/quote]

Actually narcissism explains it best. Look at all the posturing for/against the fake fillibuster and the names being tossed out like “surrender caucus”.

It’s all ego and no substance.

(And I chose a GOP issue – but it could just as well been a DEM issue – both sides are more about the ego than the people.)

[UCGal]

But CV is still pretty hot – friends listed their house on a Friday and had two offers by Tuesday. 5 days on the market before it went into escrow.

[UCGal]

It’s all a hallucination.
And I can’t figure out why I’m giggling at everything….

hmmmm

[UCGal]

BG –
Once again you assume that because it doesn’t fit your personal wishes/lifestyle/demographic – it’s invalid.

Yes – you’re a baby boomer looking towards retirement. Yes – you do a lot of work downtown. Yes – you’ve only got one child left at home – soon to fly the nest. So for you – southbay is a good fit for your needs. That doesn’t make it the ideal spot for others, with different needs.

Not everyone buying houses is a baby boomer nearing retirement. In fact, I would assume that many home buyers are folks with minor age children, or planning on having children in the future. Most baby boomers have already purchased their primary home… although some might be looking for retirement homes to downsize to.

BG – you need to remember there are job centers outside of downtown. Sorrento Valley/sorrento mesa is a huge employment center. Probably more folks working there than downtown. (Based on traffic I’m pretty certain this is true.) Carlsbad has quite a few businesses/industries. The I-15 corridor from Scripps Ranch up through Rancho Bernardo has a number of large employers. Folks who work in these areas would not be well served by having a commute to the southbay.

True – the legal stuff is downtown because of the courthouse and jails – and that’s the field you’re in. But there are other industries in San Diego county – so living close to downtown might not do anything for your commute if you work in Carlsbad.

Please try to remember that not all home buyers have the same needs/wants that you do. I get frustrated by the way you attack folks who have different views.

[UCGal]

We used sears to replace our 45 year old nat-gas furnace. No complaints. Our issue was finding a unit that fit in the same spot. Sears had a unit, and was decently priced.

[UCGal]

Neanderthals had similar sized skulls/brain cavities – so they might have been smarter. They were tool users and had fire – so they were on par with homo sapian-sapian.

According to 23&me – modern humans of european descent have between 1 and 4 % dna from neanderthals – with the average person of european descent having 2.7%. I’m above average by a smidge… < insert grunt here > … perhaps I should pluck my eyebrows thinner to hide this. LOL

My husband likes to tease me that I’m more neanderthal than him. I always threaten to bop him over the head with a club.

[UCGal]

Thanks for linking that article ER – that’s the story I heard on the news yesterday.

I’ve been telling friends about your decision to pay off mello roos. Most look at me like it’s crazy because who could ever afford that… but I hit them with politics and math and have convinced one friend to consider it.

[UCGal]

KPBS had a radio story this morning – following up on the articles ER posted.

Apparently PUSD was confused (nice term) when asked about the misused mello-roos funds. Different officials had different (conflicting) stories/explanations.

In a related story on the website – there’s been so much bru-ha-ha over the overpayment of mello roos by folks in Del Sur, they have posted a website to verify your mello roos amounts.

http://www.kpbs.org/news/2013/sep/17/poway-district-responds-inewsource-probe-mello-roo/

[UCGal]

We did it. For me – my family risk of cancer made me want to know. My husbands family leans torwards heart disease and stroke… As well as some family history of dementia. If we had the increased risks we wanted to know to address bucket list things sooner than later. For the most part we got good news… No increased risks.

For the biggies, you have to go through several locks to make sure you really wanted to know. Parkinson’s, Alzheimer’s, colon cancer, breast cancer.

As far as the family and genetic stuff… My husband has connected with several 3rd cousins in the old country…. (He chose to respond to the anonomyzed inquiries… And was able to trace back the common ancestor.). That’s been cool and we’ll probably meet them when we next go across the pond. Less luck on my side.

It was worth the $99 to us.

[UCGal]

I’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]

[UCGal]

Yep. I’ve been looking at the same things – weighing it all.
My husband is a few years older than me – so he’ll be going on Medicare sooner. That’s a relatively known price. (Limits on increases tied to CPI.)

But for me and my minor sons – I’ve got to figure out the most frugal way to get coverage – or I have to work a lot more years – JUST for health insurance. I know the cobra costs for my current insurance – and they are similar (slightly better coverage – same cost) to what I can get from insurer privately… and the silver plan of the exchange is in the same ballpark.

I hadn’t looked at a 5 year plan (push 5 years of income into one year – so you qualify for 4 years of lower income/subsidies.) But I’d looked at pushing all deductible expenses into one year (prepay prop taxes, etc), and income into the other. (Sell stocks with gains, etc). So it bounces 1 year with subsidies, 1 year without… I like your idea better – except the interest rate issue.

[UCGal]

[quote=bearishgurl]
Everyone has a choice on which side of the “balance sheet” they want to be on, here. You read UCGal’s post where she stated that posters on earlyretirement.org are trying to figure out how to become eligible for tax credits by retiring earlier than planned or manipulating the types of retirement accts they are contributing to. They can also take a demotion NOW, work less hours or take LWOP or FML for part or all of the balance of 2013 in order to be eligible for tax credits in 2015. There are more than nine ways to skin a cat.

The “rules” have changed now so if you’re completely a W-2 worker who wants to insure yourself or a family member though a state exchange, you have to figure out a way to “work the system” if you want to be eligible for a tax credit or a higher tax credit. For many high earners, it isn’t worth it to do this, especially if all their family members are currently covered through employer(s) and they are happy with that coverage.

If you are a high earner and like it that way but need to get yourself or a family member health coverage through a state exchange, then suck it up and pay the premium they ask for whatever level of coverage you desire.

None of us really know how the nuts and bolts of the HCRA are going to play out until a year or two passes.[/quote]

Ummmm. I don’t think I said that.
Folks on E-R.org are discussing that they are now FREE to retire without worrying about pre-existing conditions.

They are discussing how it can pay off if you can manage your retirement budget to be under the ACA subsidy levels… But not from a still working perspective, but from a retired (early) perspective. And that crowd how ALWAYS focused on the spending side of retiring early. (Need a smaller nest egg if you live on the cheap.)

One of the tools previously used – pre ACA – was doing ROTH conversions – up to the top of your current tax bracket… for a tax payoff in the future. That has been discussed as being weighed against losing the subsidy if you convert too much and end up outside the subsidy.

Retirement contributions (for those still working) DO count as income (not tax defered from an ACA tax subsidy point of view… just as it’s not tax deferred from a SS contribition point of view.). Hence the MAGI vs AGI.

BUT – they are not talking about retiring earlier than planned. This group is heavily focused on saving/investing so that they can retire early… So there’s no lack of planning… the goal of most is to become financially independent and retire early. But many held back because of healthcare concerns. They had the money – but were worrying about not being able to get affordable insurance. Staying in jobs they They are talking about having the FREEDOM to retire because pre-existing conditions are off the table, and health care is possibly more affordable than they expected (with subsidies.)

No one is talking about taking a demotion.

[UCGal]

Back to the OP.
In reading about this elsewhere I see the following:

The IBM changes have NOTHING to do with the Affordable Care Act. They are moving MEDICARE age employees, from an IBM subsidized medigap policy, to giving a subsidy for the retired, age 65+ employee to get insurance through a Medicare Exchange program.

http://www.reuters.com/article/2013/09/07/us-ibm-healthcare-idUSBRE98602Z20130907

IBM is still subsidizing the retired medicare eligible employees – just letting them chose their own plan (and take on the risk of premium increase.)

According to the wall street journal – Time Warner is the same situation – they announced the change for medicare eligible retirees.

http://online.wsj.com/article/SB10001424127887324549004579063170451763800.html

In some ways this may benefit the retiree – they can apply the employer subsidy to any plan offered on the exchange – vs a one size fits all choice.

[UCGal]

[quote=bearishgurl]

flu, you, all of people stand to be on the “winning side” of this HCRA equation if you retire early. Had the HCRA never become law, you might have been required to pay $2000+ month just for yourself for coverage (for a crappy HMO) :=0

Go check out coveredca.com and quit complaining.[/quote]
Actually – FLU will likely not qualify for subsidies based on his income. Subsidies (tax credits) only apply to those with income < 4 times poverty level. And it's MAGI, not AGI income. (MAGI income = your AGI income PLUS your 401k/IRA contributions.) That said - I suspect FLU will benefit because of the ban on pre-existing conditions. He's relatively young - and premiums are based on age. His medical issues will not jack his rates up or allow insurers to not insure him. This will give FLU the opportunity to do consulting, entrepreneurial ventures, etc - and not be tied to an employer for healthcare. As far as retirees - Any non-government retiree that was firmly counting on retiree healthcare hasn't paid attention for the past decade. It's gone away along with pensions. And it was NEVER protected under PBGC, the way pensions were. I know a lot of folks on the early-retirement.org board who are waiting till October to verify the exchange rates - then turning in their notices at work... Access to insurance for the early retiree has been the big crap shoot preventing people who would otherwise retire from doing so. Lots of discussion over on that board about 4x poverty rate thing (and the cliff on the other side if you don't manage it right.) How that effects the roth conversion plans (don't convert to roth because it might kick you above that threshold.)

[Author]

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