The Obamacare Experience; what is it all for?

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  1. wilderness profile image97
    wildernessposted 4 years ago

    I finally got signed up for Obamacare, a most eye opening experience.  2 days to sign up, then the blasted web site "pay here" button doesn't work.  It takes two days to verify and must be done by the 15th.  The vendor is only a mile from my home, but can't look it up for two days to tell me the idiot web site worked.

    But the biggest question is "why"?  The plan is 100% paid for by government, but with a $12,700 deductible; before I could come with that much (in just a year's time) I'd be bankrupt, so what good is it?  I can pay just as much of my bills with insurance as without it, and anything over that massive deductible (deductible, not out of pocket!) will bankrupt me anyway.

    Then there's the cost; $12,700 deductible, plus $9000 per year for insurance costs.  Somebody (govt or me) has to put out $21,700 before the insurance will pay one thin dime.  Now, with national costs at 3 trillion, that's only $17,000 average per couple (all this is for my wife and I), including such things as pregnancy, birth, birth control and any other expenditures we cannot incur. 

    And thats $5000 to pay the paper shuffler handling my paperwork and profit.  Profit on a $9.000 sale! 

    What kind of idiot came up with this garbage?

    1. janesix profile image60
      janesixposted 4 years agoin reply to this

      Our entire system is corrupt. Unsustainable. This is just one of the cards on the house that's going to fall.

      1. gmwilliams profile image83
        gmwilliamsposted 4 years agoin reply to this

        Let's hope it falls soon.  Obama is a DISASTER of a president.  He is a bungler and does not know what he is doing.  Let me correct, he intends to bankrupt and socialize America.  He DOES NOT care about Americans!

    2. Genna East profile image89
      Genna Eastposted 4 years agoin reply to this

      Hi wilderness...

      Did you purchase the "catastrophic" health plan?  They have lower or free premiums but very high deductibles.

      1. wilderness profile image97
        wildernessposted 4 years agoin reply to this

        No, not a catastrophic plan (thought it certainly WILL be if it ever gets used!).  I don't think you can get those with the subsidy anyway, can you?

    3. Quilligrapher profile image84
      Quilligrapherposted 4 years agoin reply to this

      Hi Wilderness,

      I am sorry to hear that your experiences buying healthcare insurance have caused stress. The advantages and disadvantages of the ACA are not the same in every state. In New York, the average premium for individual coverage is half of what it was before the ACA. {1}

      I was upset to read about your difficulties so I took a look at the plans available in Boise. There are 38 different plans available in your area and a few offer terms and conditions much more favorable than the plan you bought. Of course, you had good reasons for your selection and I do not presume to know the details surrounding your healthcare insurance needs.
      The HealthSave Silver 3500 premium for two adults each around 50 years of age is under $7800. The deductibles and max-out-of-pocket are $3500 (ind) /$7000 (fam). There are NO charges for primary doctors, specialists, generic drugs, and ER visits for the person who exceeds the $3500 deductible. {2}

      The SmartAlliance Value Silver 3600 plan runs about $8,500 a year for the same enrollees. After meeting the $3600/$7200 individual or family deductible there are NO charges for primary doctors, specialists, generic drugs, and ER visits. {3}

      Naturally, you chose the plan you found to be the best suited for your needs. Never the less, there are other plans available at a lower cost.

      You also wrote, “Then there's the cost; $12,700 deductible, plus $9000 per year for insurance costs. Somebody (govt or me) has to put out $21,700 before the insurance will pay one thin dime.  Now, with national costs at 3 trillion, that's only $17,000 average per couple (all this is for my wife and I), including such things as pregnancy, birth, birth control and any other expenditures we cannot incur. 
      And thats $5000 to pay the paper shuffler handling my paperwork and profit.  Profit on a $9.000 sale!”

      Here again, your plan does not cover expenses before the deductible has been met. There are a number of other plans available with reasonable co-pays that begin paying benefits with the first office visit.

      In addition, your $5000 calculation for the insurance company’s overhead and profit is a totally false assumption. You can not assume that the national average applies to your gender, age, and specific location. You might want to check with your insurance company or state insurance commissioner to determine the real average annual costs per family holding the same $9000 policy that you hold. It might be different than the national average.

      Finally, my friend, the best part of any insurance policy is never having to use it. I certainly hope, Wilderness, this is how it works out for you.
      {1} … -new-york/
      {2} … Silver.PDF
      {3} … 4294967626

      1. wilderness profile image97
        wildernessposted 4 years agoin reply to this

        You are looking at a different program than I am, then.

        The healthsaver silver 2000 plan costs 996/month (11952/yr) for two people my age.  It has a family deductible of $4,000, out of pocket of $10,000 (half that for individuals.  The absolute minimum cost for the year, then, without any care at all is $12,000; way beyond my means.

        The Smart Alliance Value Siver 3600 costs $1097 per month ($13164/yr) with deductible and OOP of $7200 per year (half that for individual).  IF the family deductible is met, total cost to me for the year is $20,364; again far beyond my means.

        The cheapest silver plan runs $938/month, $11256 per year, for us.  Ded. and OOP are $8,000 and $12,700

        The cheapest plan is the one I bought, listed above.

        With the govt. subsidy I could have purchased the Silver Connect plan, at $5800 and $10,400 ded and OOP (they do not match the information on the site because I qualified for a second deduction, reducing deductible and OOP).

        Curious, I ran a bunch of cost scenarios; my total cost for different care costs.  No one making the deductible, one person making it, both making it, one person making OOP, both making OOP, large sums for one or both, and several more under the OOP figures.

        In only 2 cases was there a savings with the more expensive plan, and it was less than $300 both times.  In all other cases my cost was less with the cheaper plan even though I could not use the entire subsidy to purchase it.  Want to guess where the extra money paid for the expensive plan ends up?  Bottom line here is that the one I purchased, with extreme deductibles and OOP, is almost certainly to be the cheapest over the year and if it DOES end up higher (rare, but could happen), it won't be by much.  Not enough to worry about.

        I ran into that same thing years ago when an employer offered us 3 choices of plans, with varying deductibles.  The highest deductible, with the lowest monthly cost, was cheaper irregardless of what medical bills were incurred.  Few people took it because it could give rise to large care bills, but if monthly premiums were simply set aside and saved those bills could be covered with money left over.  The same thing is seen here; as the deductibles and OOP fall, premiums are being set high enough to raise profits considerably.  You buy the best, you pay extra for it.

        I understand I am making a false assumption on the profit, but don't really know how to do differently.  I would need a breakdown, by age and sex, of the average health care cost over the country; I've never seen such a breakdown that actually gave average cost figures.

    4. gmwilliams profile image83
      gmwilliamsposted 4 years agoin reply to this

      Obama"care" SUCKS and SUCKS big time.

  2. Mighty Mom profile image84
    Mighty Momposted 4 years ago

    I would point out that some services under Obamacare are not subject to the deductible... but that's small consolation, I know, wilderness.
    You asked for Obamacare experience.
    Here's mine.

    My Obamcare signup experience has been a total NIGHTMARE.
    Out of the gate I knew the picking a health plan online would be too hard. Trying to figure out if we are eligible for subsidy -- way above my pay grade.
    I knew enough not to try this at home. I called upon a broker to navigate for us. We started the process in mid-November.
    And my husband and I ended up both being uninsured for the month of January anyway! The process was so insane even a trained broker couldn't get our application processed in time for Jan 1 coverage.
    Part of the problem is that we submitted individual applications then had to cancel them and reapply as a household.
    I consider this a huge "glitch" in the system.
    I have my own business. My husband has his own business.
    We have different last names. We do file taxes together.
    We have always had different health plans. I had been on mine since moving to CA in 1992 and had established longstanding relationships with my doctors. I did not want to change providers. I just wanted lower premiums!
    Well, the Obamacare system cannot deal with a household (defined as married filing taxes jointly) being on separate health plans.
    One of us was going to have to defect. Or else get no reduction in premiums from what we have been paying!
    For the sake of $1,000 less a month in premium payments, I made the sacrifice. But am still very unhappy about it.
    Also not real happy to have an insurance card with my husband's name only and not mine! WTF?
    My son always had his own insurance card with his own member number. This just seems WRONG to me!

    In the month of January -- AFTER we had paid our first month's premium and Blue Shield had definitely accepted the money -- we were still getting conflicting letters from CoveredCA and BlueShield.

    Thank God we could pound on the broker every time we got a new (wrong) piece of communication. Poor thing. She certainly earned whatever commission they gave her.

    On Feb 4 -- as soon as we could get appts when the insurance finally kicked in -- my husband and I both had doctors appts.
    I met my new Primary Care Physician, who will not be in that role much longer. Ugh. Bitter much? Not me:-).
    He FINALLY got in to see the neurosurgeon his neurologist had referred him to in December. Oh yes. While we were fighting to get into the CoveredCA system we were also living
    in a frightening vacuum, not knowing if my husband would need to have brain surgery or not!!
    (what a relief -- he does not).

    Oh, final note. We got another letter from  CoveredCA just the other day. It welcomed us into the CoveredCA system but said "We show that you have yet to pick a health care provider."
    I don't know whether to laugh or cry.

    As much as I still believe all Americans should have health insurance and believe the concept of Obamacare is going in the right direction, I am beyond dismayed at the first year rollout.
    The very worst of two horrible bureaucracies: government and insurance.
    And this is California's exchange! I can only imagine what it must be like trying to do this through


    1. wilderness profile image97
      wildernessposted 4 years agoin reply to this

      Even worse than mine, sounds like.  I had semi-picked a plan, with Blue Cross, and they had an office set up in town to help people sign up.  I visited, and got some advice, then went back home to think about it and sign up later.

      But could not verify the sign up had been successful: Blue Cross would not know for 48 hours.  They thought 24, but turned out to be 48.  I finally got hold of them to verify this afternoon, with it being imperative that it all worked out by the 15th and me leaving in the morning to be gone all weekend. 

      But it is done.  I'm just glad that this really crappy plan isn't costing me anything; that would have been the final straw to have to PAY for something I cannot make use of.


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