penguinbar

Every state is different. On the New York exchange the price for the silver Blue Cross plan for my husband and me is about $900. We don't qualify for any subsidies. It's also an HMO. I pay less getting Blue Cross privately and I have a PPO.
All exchange plans effective on January 2014 in New York will see an average premium prices for a mid-tier “silver” plan fall in the range of $359 per month to $691 per month in New York City.

scrubbedexpat099

I doubt if that is an average of the policy premiums written, more likely the age groups.

penguinbar

It's an average of the premiums. The minimum monthly for a Silver Plan in New York City is over $300.That is for an adult in their twenties. The state is broken up into 62 county's . Each county has their own minimum. Granted this is without subsidies but you have to make less than $45,000 as a Single and $62,000 as a couple for any type of subsidy. In New York City these aren't decent salary's .
There also was a big article recently about how many cancer centers will not take plans that are part of Obamacare

Michael

But they were likely the same cancer centers that wouldn't take people without insurance and if you developed cancer and had purchased insurance on the open market, your insurance was likely either canceled or your deductible, co-pay, and out of pocket expenses were so high that the cancer centers wouldn't take you due to the fear of default. At least with ACA, there are probably some cancer centers that will take ACA plans. Also it is not surprising that many cancer centers won't take patients with ACA since they often charge significantly more for a treatment plan than hospitals that treat cancer patients so they usually only want patients with Cadillac plans and/or people that that have plenty of money to pay for out of pocket expenses.

Many cancer centers also did not accept employer based insurance prior to ACA unless the policy was above a certain standard. So unless you worked for a large company with very good health insurance benefits, you may not have your pick of cancer centers.

In my opinion, many cancer centers are rackets since they usually charge significantly more in one way or another but produce similar results as hospitals. I'm always suspect when cancer centers advertise as if they had the only cancer treatment program in the world that can cure cancer patients. It's similar to drug companies that slightly change a generic drug and produce a brand name drug, spend millions to advertise the drug, charge 20x more than the generic drug, and the results produced are often not any better than the generic drug.

Cancer centers are often big profit making machines.

scrubbedexpat099

MEDICAL ASSISTANCE ESTATE RECOVERY PROGRAM


WHAT IS ESTATE RECOVERY?

Estate Recovery is a federally mandated program to help pay for medical costs for the increasing
number of people in need of care. The Colorado Department of Health Care Policy and
Financing recovers medical care costs from the estates of certain former recipients.

WHO WILL BE AFFECTED BY ESTATE RECOVERY?

The Department may recover the costs of medical assistance from the estates of institutionalized
clients OR persons age 55 and older who receive medical assistance in any living situation.

DOES ESTATE RECOVERY AFFECT A RECIPIENT’S ELIGIBLITY OR BENEFITS?

No. This program does not affect eligibility or exempt property that can be held by a living
recipient for eligibility determination.

WHAT COSTS WILL BE RECOVERED BY THE ESTATE RECOVERY PROGRAM?

ALL payments made by Medicaid will be recovered in the Estate Recovery process. Payments
include, but are not limited to: payments made to providers on behalf of the client, capitation fees
paid on behalf of the client, cost sharing for Medicare and private insurance coverage (e.g.
premiums, coinsurance, deductibles, etc.), etc.

WILL ANY ESTATES BE EXEMPT FROM RECOVERY?

The Department will not recover medical assistance costs from the sale of a deceased recipient’s
home if:

1) The deceased recipient is survived by a spouse, child under age 21, or blind or disabled
dependent residing in the home.
OR

2) There is a brother or sister who lived in the home for at least one year before the recipient
went into a nursing facility, and who has lived there continuously since the date of the
nursing facility entry.
OR

3) There is a son or daughter who lived in the home for at least two years before the
recipient entered a nursing facility, whose care allowed the recipient to delay nursing
facility placement, and who has lived in the home continuously since the date of the
nursing facility entry.
OW WILL ESTATE RECOVERY BE ACCOMPLISHED?

The Department will file a claim against the estate of a deceased medical assistance recipient.
The estate will include all of the property (personal and real) that is left when the recipient
passes. The personal representative handling the estate will use money from the sale of the
property in the estate to pay the Department for the costs of medical care provided to the
recipient.

DOES THE PROGRAM REQUIRE A RECIPIENT TO SELL A HOME?

No. The program does not require a medical assistance recipient to sell a home. However, the
Department may place a lien on the property while the recipient is alive. A lien secures property
so that medical costs can be recovered by the Department when the property is sold.

A lien on property does not change the ownership of the property. It only represents a debt that
must be satisfied when the property is sold. Liens will be used when ALL of the following
conditions are met:

1) The recipient lives in a nursing facility.
2) The recipient owns a home or other real property.
3) The Department determines that the recipient is not likely to return to the property.
This determination is made by the Department’s peer review organization.
4) The nursing facility resident does not have a spouse, child under age 21, or blind or
disable dependent living in the home.
5) The recipient does not have a brother or a sister who is part owner of the home and
who has lived in the home continuously since at least one year prior to the recipient
entering the nursing facility.

If a nursing facility resident is discharged and returns home to live, the Department will dissolve
any lien it has on the recipient’s home or other property within thirty (30) days.

CAN A RECIPIENT’S HEIRS KEEP THE PROPERTY FROM THE ESTATE AND PAY
THE DEPARTMENT THE AMOUNT THEY INTEND TO RECOVER?

Yes. If the heirs wish to receive the property that is in the estate they may do so as long as they
agree to pay the amount the Department would have otherwise recovered. If the heirs are not
able to pay the full amount of the claim at the time the estate is settled, the Department may
arrange a payment plan.

ARE THERE EXEMPTIONS IF ESTATE RECOVERY WOULD CAUSE A
HARDSHIP?

Yes. The Department will not recover from an estate if doing so would cause a hardship for the
heirs. The heirs may submit a request to waive or compromise the recovery of medical assistance
costs from the estate on the basis of hardship. Determination of hardship is at the discretion of
the Department.

scrubbedexpat099

OK

In Colorado as you might expect those buying are disproportionately older, higher premiums, higher subsidies.

There is actually a major variance in premiums between the urban areas and the boonies, the boonies are a lot more expensive, often those out there have much lower incomes.

I have read articles that some of the more prestigious Hospitals will not take it, makes sense, it is like the NHS and Dentists.

Giantaxe

Site rules???

scrubbedexpat099

Never read them, it was from a Co Gov flyer.

penguinbar

I have insurance that is not Obamcare. My insurance was not cancelled, my premiums did not go up very much and it is not from a large company. My mother is being treated at Sloan Kettering. She also is not on Obamacare and has been treated there before. Her plan has not changed either.I know other people who have been treated there with different types of insurance as well. Sloan Kettering is an amazing place. She was treated for cancer about 10 years ago at a regular hospital and the difference is like night and day. Many of these centers also have clinical trials that are not done anywhere else. Unless you've been through it yourself( I am also a former cancer patient) and have something to compare it to you have no idea.

Michael

Is your insurance employer based? If it is, that explains why your premiums, your deductible, co-pay, and maximum out of pocket expenses didn't significantly increase after you had cancer.

With a maximum out of pocket expense of $6,500 with ACA, insurance companies have to make choices to try to keep premiums low to attract people to the Bronze plans. There is nothing that says they can't provide more expensive services such as cancer centers for the gold or platinum plans or non ACA plans that meets minimum ACA requirements but the more high priced treatment that is added, the cost of premiums will likely rise and possibly make those plans uncompetitive with plans from other insurance companies.

Although I have never had cancer, the plan offered to me prior to ACA was very expensive, very high deductible, had unlimited out of pocket expenses, no prescription drugs, and 30% co-pay for in network treatment all because I had a pre-existing condition called fatigue. If I developed cancer or spent a significant amount of time in the hospital with that plan, it would have likely bankrupted me.

If ACA plans had been available at that time, there is no doubt in my mind that I would have taken an ACA plan over the plan that was offered to me.

We'd all like to have unlimited choice but even prior to ACA, few did. People on HMO plans have to get referrals and many cancer centers were out of network for PPO plans.

The US has the best medical treatment in the world but only if you can afford it.

penguinbar

My insurance is not employer based. In the restaurant business you usually are not offered insurance. My deductible is $5000. Covered 100% after that. $788 a month for my husband and me . $30 for pcp and $50 for specialists. It's a PPO as well so I don't need a referral. $100 for ambulance. $200 for emergency room. I have a discount prescription and dental plan included. I usually get my prescriptions from Costco because they are really reasonable.It's Blue Cross Blue Shield .I also had a pre existing condition ( not my cancer) that I was up front about . As I said every state is different. If we went on Aetna which is what my husbands company is offering it would cost us over $1200 a month, They have no couples plan only a family plan. So if it was two of us or six of us that would be the rate Which is pretty bad for a multi billion dollar company.

whatsnext

Wow...this really seems crazy....makes me really appreciate how it's run in Europe and Australia, even though no one system is perfect, at least on either end of the Atlantic or Pacific, you get basic insurance at affordable rates based on your income, and no deductibles. In many parts of Europe, it is a rather high percentage of your income, though (ex. Germany is a standard 15.5% of your income, while this is shared 50/50 between employer and employee, maxed at a certain income), while Australia is a low 2-3% and if you don't earn you are still insured for free.

Michael

Mine was 13 years ago at age 57 with a $10,000 deductible with Blue Cross/Blue Shield at $600 per month. My Cobra insurance was 3 months from ending when I applied and one week before it was to expire, I received a letter in the mail saying I was denied but they could offer me a high risk pool policy (they had to offer some sort of policy since I was previously covered). Because they took so long to make a decision, it was basically take it or leave it since they weren't going to offer me anything else and if I were to leave it, I didn't know if I would have time to shop for another policy (which could possibly even be worse) and get approved before a 62 day break in coverage and if I couldn't, insurance companies wouldn't be required to offer me any insurance at all.

They had my complete health history from my doctor for over thirty years with nothing on my records except during the previous 18 months, I had 5 doctor visits trying to solve the fatigue problem. Therefore the reason I could assume for the denial was the visits for fatigue.

I suspect today, the same policy would likely cost double that amount. I calculated my break even point (including cost of premiums) and I would need over $40,000 per year of medical bills to break even.

Checking Covered California ACA for a Bronze PPO Plan with Anthem Blue Cross, the cost for someone 57 is $485 per month with a $5,000 deductible and $6,350 maximum out of pocket expenses for a maximum annual cost of $12,170 including premiums. So it would have been a no brainer if Blue Cross would have offered me that policy 13 years ago.

Yours seems to be one of the few success stories under the old regulations. You had cancer and a pre-existing condition and Blue Cross/Blue Shield didn't jack your deductible, co-pay, maximum out of pocket expenses, and premiums through the roof.

When I got the denial letter with the high risk pool offer, I was in a tizzy not knowing what to do since there was no maximum out of pocket expense. Should I go with the high risk policy and possibly go bankrupt if I had a major illness or not go with the high risk policy and possibly go bankrupt if I had a major illness?

For days, I soured the internet looking for other options without success until I hit on the VA web site and discovered that I might be eligible for VA health care. When I called and asked how much were the premiums, they said nothing and my cost will be $12 per doctors visit, $50 for specialists and ER, free lab work, $8 for drugs (generic or brand), and 100% coverage for hospitalization after $1,000 deductible. Maybe VA health care is not perfect but it sure seemed a 100x better than what Blue Cross/Blue Shield offered.

Since I always previously had employer provided health insurance with outstanding coverage and no premium cost to me, I was shocked at what Blue Cross/Blue shield would offer. It was a wakeup call that the health care system in the US stinks for many people.

penguinbar

That's terrible what happened to you but I think part of the problem with Obamacare is that it can really vary not only state to state but county to county. You could be the same age and have the same conditions as I have but if you love in California and I live in New York we would be offered totally different plans. I still hate to pay nearly $800 a month. My husband hopes to change jobs partially because the next step up would be his bosses position which won't happen anytime too soon and the other is that his insurance options with his company. I think everyone has to do what's right for them. I also have a feeling that like everything else the Obamacare premiums will continue to increase as well.
I remember before 9/11 I worked for a restaurant that offered a great insurance plan The owner owned three restaurants so we were under a group plan. I was paying $128 for a great low deductible Blue Cross plan. A few months after 9/11 when the renewal came up it went to $266 because New York was a dangerous place to live. I couldn't believe that it more than doubled.I wish they could just come up with a happy medium.

scrubbedexpat099

I tried to find an article online I read in yesterdays Denver Post. DP is a Obama friendly source.

It was examining the actual costs people were finding for their plans, particularly with regards to drug costs. seems many drugs have been shall we say re allocated.

One of the things they mentioned was the co pays, the amount you pay once you have maxed out your deductibles etc. So that $12,170 is not a max cost.

ACA premium comparison with a Mobile or TV package, $1,000 a month, who pays that.