Has anyone successfully navigated ObamaCare?

Discussion in 'The Watercooler' started by peg2, Nov 29, 2013.

  1. peg2

    peg2 Member

    My 28 year old is trying to navigate the ObamaCare website and I am trying to help. Has anyone gotten a clear answer on this?
    It looked like he is eligible for a Bronze Package as he isn't really sick much, but the deductible is $6300.00??? My understanding is that must be met first before insurance will kick in and that is with a $192.00 monthly premium. Who can afford that? He might as well pay to go to the doctor on his own, he would never have that much in doctor bills.
    If anyone has applied and gotten some direct answers your reply would be appreciated.
  2. AnnieO

    AnnieO Shooting from the Hip

    I got in, and set up an account but never even got that far... It hung up on me for days and I gave up after about 15 tries.

    The deductibles are crazy. And copays do not count towards deductibles... But some things are still covered... It's confusing.
  3. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    You will get much farther calling rather than using the website. They are very helpful on the phone and you can both choose what you want and also sign up this way. The number is 1/800-318-2596. Unfortunately, insurance isn't what it used to be. When I first got married, my husband had a great policy from work. He barely had to pay any premiums and the insurance almost covered everything. I was in a psychiatric hospital for ten weeks and the insurance covered almost all of it. Now you aren't allowed to be in a psychiatric hospital for ten weeks. The insurance companies throw you out after a week or so, even if you are still sick. It was the same for other various illnesses.

    Times change and insurance companies got too big and charge too much and cover too little. Obamacare isn't about changing the policies. It's about getting everyone at least insured. A policy with a huge deductible will be cheaper on the premiums, but will basically be a catastrophic only coverage policy. If your son ended up in the hospital, probably about 80% of it would be covered. But for regular visits, it has low coverage and mostly would have to be paid out of pocket. But at least hospitalization will be covered. My daughter is 29 and in the same boat only she is pregnant. Her SO could cover her, but it would cost them about $600 month and they can't really afford it. They would like to get married, but it all depends on what kind of insurance she can get while being single as opposed to his work insurance which is so expensive and still has a huge deductible. Sad that marriage is even being based on insurance costs.

    This is what insurance companies have come to. Good luck to your son.
  4. Signorina

    Signorina Guest

    I realize that 6300 is a lot if money- but if he is hospitalized, has an accident (god forbid) etc., it's really nothing in comparison to being on the hook for the whole bill.

    Also- my understanding is that the bronze deductible is about $3200 and it's the out of pocket max that is the $6300- but it varies by state so I could be wrong.

    I also believe that preventative care is covered at 100% so at least well visits will be paid.

    He may qualify for subsidies to cover his premium price.

  5. witzend

    witzend Well-Known Member

    Those are hospital deductibles. Ours through husband's work are huge and a 2 day visit to the hospital last summer cost me $4,300 out of $11,000. Which I will pay off over time. Your 28 y/o doesn't have to go for the Bronze plan. FWIW, our premiums are $762 a month.

    Yes, I navigated it. Use Explorer rather than Firefox. It works better with Explorer (as do many other sites). MWM is right about getting through on the phone, as well.
  6. DammitJanet

    DammitJanet Well-Known Member Staff Member

    Witz...you are going to have to pay that much even with you being on disability? Are they doing away with Part B? I havent paid much attention to it because I assumed it wouldnt effect me and Tony cant afford it anyway so he isnt even trying. Billy is keeping his insurance through work.
  7. Signorina

    Signorina Guest

    Also - MWM - as far as Julie & her SO's premium. Remember that the deduction from her SO's pay should be pre-tax, which may lessen the blow a little bit. I believe the exchange premiums are not tax deductible unless they exceed 7% of your income (as part of the overall medical expense deduction) - so that may be a consideration too. Since they will also have to insure the baby once he/she arrives - his plan may be their best option. He should talk to his HR person or the company's insurance agent and work out the details. For our company, the premium for an employee to add 1 dependent is $500ish, and the premium to add 1 or more dependents is less than $700, so it isn't like it doubles for 2 versus 1. There is also some caveat about determining whether the employee plan is affordable, and if the gov't considers it affordable, then the person or the dependent won't qualify for the low cost government plan premiums. Now if Julie is not his wife; it won't matter but it will effect the baby regardless. Again, I am basing it on the information I received from our agent - as employers we are trying to navigate these waters and it isn't easy. We just had to send out a letter to our employees detailing that our health insurance is "affordable" which meant that they won't qualify for the low premium government plans. Even our agent is confused - but I just thought I would put it out there - for Julie to look into...
  8. DammitJanet

    DammitJanet Well-Known Member Staff Member

    There is another option for Julie but I dont know her income. Medicaid has a program called Medicaid for Pregnant Women. The income limits are very high. One of my coworker's wives met the income limit even when I know he was making what I did.

    If she can get MPW, then the baby is covered under Medicaid for the first year. That is just automatic.
  9. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Julie is working part time right now so her income is low. But last year it was higher, although only about $20,000 or so. She is worried that because she lives with Geoff, they will include both incomes. Illinois, I've heard, has pretty good help, unlike Wisconsin. They are looking at all options.
  10. ctmom05

    ctmom05 Member

    The Affordable Health Care Act web site is tough to navigate, whether you are using the national one, or your state has it's own. There are all sorts of hurdles to jump.

    I got thru the process by applying over the phone, after trying the online process. At this point, all that is left to happen is for me to get a bill for the first month's premium. I am eligible for a tax credit, which defrays my out of pocket cost for the premium.

    However I won't feel successful until I actually I get that bill reflecting the tax credit and all the ducks are in a row
  11. Kathy813

    Kathy813 Well-Known Member Staff Member

    My difficult child called this morning and was able to enroll. She got a silver plan for $81.00 a month. It has good coverage and low copays. She put the service rep on speaker (with her permission) and so I got to hear the options, too. The next step up was $160 a month which she can't afford. She also went ahead and enrolled in a dental plan that was separate from the health care plan for $10.99 a month. I believe her deductible was $1000 but that was separate from her doctor visits with copays of $20. Also, preventative care has no copays and is separate from the deductible.

    That $6300 number you hear about is the out of pocket maximum. That is not the same as a deductible. I don't believe all plans have the same out of pocket maximum, either. It depends on the level of plan that you pick. The silver plan can be no more than $2250 (see below). From what I have seen, only the catastrophic plans have the $6300 out of pocket before they will pay anything. Your son does not want one of those!

    Here is an excellent site for you to go to. It pretty much hit the cost of her health care premiums on the nose for my daughter:http://kff.org/interactive/subsidy-calculator/

    Here is some information from the site:

    I believe my difficult child will also qualify for help with the copays based on what I read on the website so I plan to follow up on that, too. I am so relieved that she will finally have health insurance.

    difficult child did the first part of the application on the website with no problems but when it was when she came to going into the marketplace that she got stuck but it gave her a number to call. She had about a five minute wait and then the woman we talked to was very nice and helpful. It took about a total of 30 minutes after she got on the phone. I would say that the whole process start to finish was 45 minutes.

    There is a lot of misinformation being spread about the Affordable Care Act. Please don't be misled by those who want it to fail. Read up on it (the site above has awesome information) and talk to the representatives of the marketplace.

    Last edited: Dec 1, 2013
  12. LittleDudesMom

    LittleDudesMom Well-Known Member Staff Member

    *I went on the site to sign up pretty much right at the beginning. It was frustrating since it "locked up" or was really slow but I did successfully sign up and qualified for a tax credit. I have chosen my plan and all I have to do Monday is sign up online or call. I kinda dropped the ball for the last month and was also registering bonehead and his wife (for renumeration!). I found the site to actually, even though slow, very clear to the untrained eye - I worked in the insurance industry for years so know all the terminology and also handle the benefits at work for eons - almost too clear since there were so many steps. I also found the person on the phone when I called very helpful and knowledgable. The site is working much faster now!

    *Remember that the biggest reason for bankruptcy in this country is medical bills. The largest out of pocket max under the new healthcare plan is 9K. While that is a lot of money, it's not something than cannot be negotiated and worked out over a payment plan. My surgery last summer, including all the docs, emergency room, hospital stay, tests, etc., was $63k. Now that would have broke me!
  13. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Thanks, Sig. They are currently checking everything out. She lives in Illinois which is more Obamacare-friendly than we are. Still, like most people, they don't understand it all yet and want to get the best that they can for both Julie and the baby. I appreciate all the input I can get from anyone who understands!!

    To Janet: I don't think disability coverage changes at all. At least, here in very Obamacare-unfriendly Wisconsin, it has not. I get Medicare and Medicaid on disability. My husband and Jumper will have to go through the exchanges, but Sonic and I remain covered...it should be the same for you.
  14. Nancy

    Nancy Well-Known Member Staff Member

    I have been on the healthcare.gov wesbite many times in the past month and have had no problems, although I did the first month it went online. I know a fair amount about the ACA since we have always had an individual policy and we are buying through the exchange. In our area there are about 45 plans for a 28 year sold, some with very low deductibles and around $240 a month. Is he eligilbe for a subsidy? Of he makes below $45,960 he will get a subsidy to help with the monthly premium. Of course the less he makes the bigger the subsidy.

    It is true many people are surprised by the high deductibles of some plans. It's important to remember that health insurance was never intended to pay for doctor bills. It was intended to be there for serious illnesses or accidents. But many people under group plans were use to paying low premiums, have low deductibles and low co-pays. My sister use to complain because she had to pay $15 to go to the doctor, while we were paying the entire dr bill out of pocket because we had an individual policy. Our premium is currently $1350 a month for two of us and our deductible is $10,000 per person. Our insurance has never covered any of our medical bills. Individual policy holders have subsidized group plans in the past, helping to keep their rates low while charging very high rates to those not in group plans. We found a plan on the exchange for $950 a month with a $6,000 deductible, we will save quite a bit.

    Many of the plans include 2-3 dr visits at no cost a year. Some have very low co-pays. They all cover preventative services now. If he is healthy and makes enough to get a subsidy his premium will be low and yes he may have to pay for a doctor bill but insurance was not designed to do that anyway. If he has a serious illness or accident he will not have to pay more than $6350. There are more things that are covered under all plans now but they will not apply to him, for example well baby visits, vaccinations, birth control, pap tests, colonoscopies.

    Our difficult child will probably make below the poverty level this year. She will either be eligible for medicaid or get a subsidy that will pay almost all of the premium. Yes she will still have to pay for a dr visit if she gets sick and we will probably have to pay that for her, but at least we know she is covered for anything serious.

    Your son should check all plans that are available to him to find the one that will best suit him. If you have any question that I can answer I'll be happy to try.

    We were very disappointed that the small business part of the exchange isn't working yet. My husband is trying to get his employees covered under the exchange. From the rates he has been able to see they can save quite a lot. He pays 100% of his employees premiums. He can go through a broker to buy the insurance but it's so much better to be able to see allt he plans in front of you.

    by the way MWM, my difficult child is living with her boyfriend and they do not combine their income. They will each get their own policy.
  15. Nancy

    Nancy Well-Known Member Staff Member

    Kathy where did you get that info on the silver out of pocket being $2250? Everythign I read said the max out of pocket for all plans was $6350.
  16. Signorina

    Signorina Guest

    MWM- just an FYI- I live in WI but work in IL - so the info was based on IL, from what I've learned so far. We have a few people who decline our insurance because they don't want to/can't pay a portion of their premium (about $180 a month). Because they are eligible for our plan and the fed government considers it affordable - they aren't eligible for the exchange subsidies AND the exchange is more expensive. It's been an eye opener and we are looking into every option for our people. (Two of these employees have court ordered child support garnishments - and can't afford to lose more of their pay, the others are usually young and prefer to take their chances)

    Like nancy, I am hoping the small business exchanges will help eventually.

    For now, the only difference btwn WI & IL is that WI is using the federal exchange and IL has built their own. The rates & coverage - from what I have seen- are not really different.
  17. Nancy

    Nancy Well-Known Member Staff Member

    Sig, in Ohio the rates through the exchange are very similar to the rates you can get privately through the insurance companies themselves. I don't know if that is the same for you, but you may want to go online and get rates through insurnace companies, not through the exchange and see if that would help your employees.

    Also you can still buy the small business policies in the exchange but you have to go through a broker or agent. My husband is now paying for a group plan but the rates are awful. He filled out the application through SHOP but just found out they are not going to be up and running until next year but he can call them or a broker and get the same rates. You may want to call whomever your company uses for insurance issues and ask them.

    Another thought, are any of those employees eligible for a subsidy?
  18. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    To Nancy: Thanks. They do own a house together though. Does that change things? She is very worried about it and does not want to get into any trouble.
  19. Nancy

    Nancy Well-Known Member Staff Member

    MWM I do not think that matters but I would call the exchange and ask. You can call and just ask the general question, you don't have to give any private info out. They are not married correct? Do they call themselves married?
  20. Signorina

    Signorina Guest

    Nancy- we are working with a broker- we've offered health insurance for about 23 years but we fall into that 20 -30 ppl plan and the rates kill us. The employees who decline are not eligible for the subsidy because we offer an affordable plan (as determined by the govt.) We are hoping to see a rate reduction with our renewal 2/1 but it's unlikely. We're toying with a cafeteria style plan or we may give raises, pay the penalty and terminate our plan all together. We also will be passing the smoking penalty along to our employees who smoke which we are allowed to do under the ACA. We're doing our best but there are still so many unknowns.