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Author Topic: Obamacare explained for musicians  (Read 14118 times)
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growlerbox
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« Reply #60 on: Dec 19, 2016, 10:30PM »

This kind of nonsense is why I blocked Chit Chat. It has nothing to do with trombones. It shouldn't be part of "The Business of Music."

Seconded.  It's become an opportunity for the denizens of the "No PP" group to get their "PP" rocks off.
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« Reply #61 on: Dec 20, 2016, 12:48AM »

For starters, if your job "offers" health care, but charges you $500/person or more for the privilege, you're being screwed, and that is not the fault of the ACA. Take that up with your employer.

Before the ACA, the lowest plan I could find was a $275/mo plan with a 7500 deductible.

I'm a professional musician and a teacher. A $7500 might as well be $75,000. $275 a month would've compromised my standard of living in a way that people who've never had to worry about money will never understand. Unlike most of my peers who had a day job, my jobs generally don't offer much in the way of benefits (kids who want to be musicians, think about that next time you're on the internet stealing music.)

Since the ACA, I can get a really cheap plan for about $75 - has a high deductible (6500) but at $75 I can at least afford to pay it and not sacrifice my standard of living too much. I recently found one with a $500 deductible that's just a little more per month, and I might need it because there may be some surgery for me on the horizon.

I don't get workman's comp. I don't get benefits. I'm very likely going to need a procedure this year. With this plan, that procedure won't bankrupt me and put me in the poor house, and if things turn out bad at least my family won't be left with a ton of medical bills.

If I lose this, I could very likely be facing serious financial issues along with medical issues that without resolution could be debilitating or fatal (and are already affecting my career.) Without the ACA, people like me are screwed.

This definitely belongs in the Healthy trombonist. It is topical and relevant If you dislike the politics of the bill, discuss that in PP  - or just shut the hell up.
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« Reply #62 on: Dec 20, 2016, 12:03PM »

Employer based health care made perfect sense as you were trying to attract employees with better benefits than the company down the street. Worked great until Obamacare kicked in.

Actually, the percentage of people with employee-based health care was dropping long before that due to the decline of unions. Health coverage peaked in the 1980s, as a matter of fact. That was the problem that Romneycare and Obamacare were trying to solve.

As you say, it made some sense to have a 'market-based' incentive for offering health care to attract employees when the employees were in a better bargaining position. When it turned into a buyers' market for labor and a sellers' market for jobs, the incentive to offer the insurance withered away. That's simple market economics, and it didn't happen recently.
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« Reply #63 on: Dec 20, 2016, 12:11PM »

One of the more bizarre aspects of how things have worked out is that you can be too poor to qualify for subsidies.  In that case, Medicaid (provided it's available in your state) or full price are the only choices.  At least for now.

Medicaid isn't bad. I have a couple of friends who qualify for it and it's zero out of pocket. My premiums are through the roof and I still have to substantially pay for my care out of pocket.
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« Reply #64 on: Dec 20, 2016, 12:23PM »

That does make sense. 

You lost your plan, because it didn't cover everything that was required. 

Your new plan cost more, because it covered more things. 

For you it is lose lose, because you were happy with what you were getting, even though it didn't meet the new standards.  For a larger group it was a win. 
It covered everything that was required for my wife and I.

Now, it covers nothing MORE (no extra coverage, as you seem to think), and it actually covers LESS.

T.
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« Reply #65 on: Dec 20, 2016, 01:50PM »

Medicaid isn't bad. I have a couple of friends who qualify for it and it's zero out of pocket. My premiums are through the roof and I still have to substantially pay for my care out of pocket.
Medicaid is terrible for providers.  That's why the provider list is so short.  Not just low reimbursements. Mountains of paperwork. Payments are delayed. Payments can be denied even after the procedure is approved and completed.
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« Reply #66 on: Dec 20, 2016, 01:53PM »

It covered everything that was required for my wife and I.

Now, it covers nothing MORE (no extra coverage, as you seem to think), and it actually covers LESS.

T.

I think the fair analysis is that it covers things you don't necessarily want, like mental health, addiction, and reproductive services. The big benefit for anyone who has assets is that there's no longer a lifetime cap, which is a huge benefit. Some of those affordable plans of yore could have been brought into compliance with the new laws but they didn't want to offer low rates without the lifetime cap. It looked like better insurance than it was, until you got really sick.

My suggestion is that if you have significant income, you're better off with less day-to-day coverage without a lifetime cap, because it's better asset protection. At one time, most medical bankruptcies were sustained by people who had medical insurance.
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« Reply #67 on: Dec 20, 2016, 01:54PM »

Medicaid is terrible for providers.  That's why the provider list is so short.  Not just low reimbursements. Mountains of paperwork. Payments are delayed. Payments can be denied even after the procedure is approved and completed.

I'm guessing most of the people hoping to qualify for Medicaid aren't providers. It's been a great deal for the people I know who are on it. Literally a lifesaver in at least one case.
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« Reply #68 on: Dec 20, 2016, 02:25PM »

I'm guessing most of the people hoping to qualify for Medicaid aren't providers. It's been a great deal for the people I know who are on it. Literally a lifesaver in at least one case.

Funny. 
People/patients have a hard time finding providers to treat them because not many providers want to participate.   
I thought that was obvious in my post.
Almost half of the 62 providers in my area are pediatricians.
Bottom line.  It's not a solution. It works for some patients and new docs just out of residency. But if a doc only saw medicaid patients he/she would be practicing out of a shack with minimum wage employees and nothing more than a stethoscope and a few tongue blades.
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« Reply #69 on: Jan 24, 2017, 01:28PM »

What I suspected all along... the insurance companies that "pulled out" of Obamacare were lying about why they did it.

It wasn't for business reasons, it wasn't because they were losing gobs of money on Obamacare policies. It was to make Obamacare look "unsustainable" and get revenge on the Administration...


U.S. judge finds that Aetna deceived the public about its reasons for quitting Obamacare


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Aetna claimed this summer that it was pulling out of all but four of the 15 states where it was providing Obamacare individual insurance because of a business decision — it was simply losing too much money on the Obamacare exchanges.

Now a federal judge has ruled that that was a rank falsehood. In fact, says Judge John D. Bates, Aetna made its decision at least partially in response to a federal antitrust lawsuit blocking its proposed $37-billion merger with Humana. Aetna threatened federal officials with the pullout before the lawsuit was filed, and followed through on its threat once it was filed. Bates made the observations in the course of a ruling he issued Monday blocking the merger.


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...Aetna pulled out of some states and counties that were actually profitable to make a point in its lawsuit defense — and then misled the public about its motivations. [Judge] Bates’ analysis relies in part on a “smoking gun” letter to the Justice Department in which Chief Executive Mark Bertolini explicitly ties Aetna’s participation in Obamacare to the DOJ’s actions on the merger, which we reported in August.



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Robert Holmén

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« Reply #70 on: Jan 24, 2017, 01:59PM »

You know what the replacement is:

Get sick -> no money -> die

The Republicans want to replace ObamaCare with what we had before Obamacare.
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Bruce Guttman
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« Reply #71 on: Jan 24, 2017, 02:36PM »

The Aetna suit is much more complicated than your quotes would indicate. Insurance companies actually don't typically make money off of claims. Most take losses in the billions on claims each year, part of which is underwritten. The rest is offset by investment activity. So they may bring in X amount of dollars in gross revenue from claims which then immediately invest. After pooling the money, they can get a return of a few % off of it, which is where the money comes from to pay the claims from.  The problem is that its obviously hard to predict that ROR since more risk means more losses but lower risk means a lower overall number.  So even though the company may have made a profit, that doesn't mean it wasn't a business reason to pull out as it was a good investment year. Smaller amounts of revenue would mean less money to invest which would in turn mean a projection that indicated that in the future the claims couldn't have been met in that state. Obviously the judge disagreed - but it isn't particularly surprising that a merger with another company would have perhaps allowed them to pool more money to get a sufficiently high rate of return with which to pay claims.  I'm not sure with what grounds the author can label that as a 'rank falsehood' when a merger has a huge influence on whether or not an insurance company is solvent.
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« Reply #72 on: Jan 24, 2017, 08:34PM »

I've always had the impression that insurance companies more or less break even on the core business and make their profit on the free use of the money.

For years, I've had an amazing rate on liability insurance. When other companies came in, they'd look at it and not even try to bid. The reason was that the company that insured me was young and hungry and wanted the business, and because revenues on capital were good. So they were willing to treat my restaurant/bar more like a traditional dinnerhouse to get access to the capital. Once they grew a little bit, and after the relatively safe places to park money stopped paying so well, their incentive went away and I'm back at market rates. In other words, they had to try to make money from the actual premiums.

Cheap money is good for some parts of the economy and bad for others, obviously. I suspect that something similar is happening in health insurance, along with all the other problems. Premiums are raised to overcome shortfalls from investment revenues. As interest rates rise (and they will, unless someone screws up the economy) that could help health insurance rates, at least in theory.
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« Reply #73 on: Nov 05, 2017, 03:23PM »

Some explanations for what you will need to do differently this year during open enrollment...

Under Trump, Obamacare Shopping Is Even More Confusing. We’re Here To Help.
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Robert Holmén

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« Reply #74 on: Dec 14, 2017, 10:51PM »

Reminder, Dec 15 is last day for "Open Enrollment" at HealthCare.gov

As a returning enrollee I was able to do all the steps in about an hour.

New wrinkle this year. The "eligibility statement" I got mid way through the process said I could only sign up for "silver" plans, no "gold" no "bronze." It wasn't a big deal since I wanted silver level anyway but I'm not sure what that was about.

As always, don't automatically renew your current plan, shop the various plans that are available to you.


Obamacare Subsidies: Are You Eligible?
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Are you one of the 10.4 million Americans who are missing out on Obamacare subsidies? Kaiser Health reported that 60 percent of those who deserved subsidies didn't get them. Why? They simply didn't sign up for insurance on the health insurance exchanges.

Most people think the Affordable Care Act was designed to help the poor. In fact, more than half (56 percent) of the subsidies will go to middle-income families.
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Robert Holmén

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