Obamacare

J-Bug

I would like to start a topic where everyone can contribute to how Obamacare has affected them. I don't want to argue about it, just factual descriptions of its effects. The reason that I thought of this was a story I just watched on the news about a woman with invasive ductal carcinoma. http://fxn.ws/1dJBsTo  

doxie

This is very unfortunate for her at such a difficult time.  With or without the Affordable Care Act, this type of insurance problem happens more times than you may realize.  It is not unusual for an employer to drop an insurance company or vice versa and an employee is mid treatment.  Where I work, we have very little notice about such changes.  I may not remember correctly, but some states require that the new insurer allow the care to continue for several weeks (6?) even if it is out of network.  

Yes, this was initiated by President Obama, but I think it is important to remember that the Congress helped write and pass this law.  If there is a desire to "blame" someone for this, it does not fall entirely on the President.  Also remember that many women with BC now will be insured.  Yes, there are those unfortunately impacted, but others will avoid being bankrupted because of the law.  

My daughter's insurance was canceled but her insurer had a plan she could automatically roll over into.  She chose to upgrade her policy.  With the upgrade she figured she would have saved $2,200 in medical costs if she had had the same plan last year.  She went from a $5,000 deductible with at limit of $7,500 in charges to a $1,000 deductible and at $1,500 limit at a lower cost per month.  

Kicks

To my thoughts - that's more political than is appropriate here.  I will say that THANKFULLY so far Hubby and I, as both Veterans, are still able to get our VA care.  BUT - who knows about 'tomorrow'.

ziggypop

I don't know that this topic is a good idea for this board. I find myself wishing to make an 'argument' for my own position regarding the ACA (we all like to express our opinions), and I'm just afraid that it could sow seeds of dissent unnecessarily. 

georgie1112

I also do not think this is a good topic for this board. Just my 2 cents.

Kicks

This thread has been moved to the 'Insurance' section.  Please lets do the best we can to support each other and NOT be drawn down into squables over politics. 

itsjustme10

None of my doctors accept the HMO plans offered.  Only HMO plans are offered in my state.  In my state, in 2014 no matter what company you go to, you can only purchase an HMO.   I can have no follow up care at my chosen hospital because it is not participating.  My oncologist is not participating.  My breast surgeon is not participating.  My plastic surgeon is not participating.  And depending on who you get on the phone, my PCP may or may not be participating. Because I can only purchase these limited HMO plans, whether on or off the exchange in my state, I am looking to sell my home of 25 years and move to a nearby state which offers PPO's and indemnity plans.  

My choices are sub-par care with strange doctors or hours long trips to my doctors after I move.

i empathize so much with that lady in the article because but for the fact that my surgery was 2 years ago, and I am only being followed now, that would be me. 

J-Bug

Doxie: there is no desire to blame anyone here. I am sincerely wanting to see how this is impacting those with illnesses who see a number of specialists. 

I have two special needs children who see several specialists and recently lost my husband's insurance. Fortunately, after doing contract work for two years, I just got a new position in 2013 with excellent healthcare. However, with the extent of treatment that I went through, I am concerned about what I would do if my health took a turn for the worse. I did have to go through a bankruptcy with around $200,000 in medical debt while having a very good insurance plan through my husband. I have NO retirement, a hugely reduced income from losing my husband, suddenly a single mom and just getting my career under my feet again at 42. I am very concerned about how healthcare is going. I would only like to hear the real stories of how the new laws are affecting our group. I have heard that a lot of specialists will not be participating and was wondering if that was true.

Thank you itsjustme for sharing your story. If you can only buy an HMO plan in your state, why wouldn't the docs participate? Who are they getting business from? It sounds like there were problems with your care before the ACA? 

farmerlucy

Since we are self-employed we purchased our health insurance through a professional group. BCBS did not renew the group's plan, but did offer individual plans. We're actually paying less now than we were, although it is still about $1200 a month. All my docs accept it. We're glad about the change, but bracing for the premiums to go back up.

blanviper

I am self employed as well and have been for over 20 years. For the bulk of that time, we relied on having my husband's job to give us insurance. But every time he changed jobs or his place of employment changed plans, we had to deal with the issue of getting new docs. Obamacare did not cause that issue - it's been the way things are for years. You were tied to whatever plan your employer offers, and only its providers, unless you bought your own insurance or paid for your own doc OOP. We've also had doctors opt out of being providers in certain plans. Pre- BC, I used to pay full fee for my old GYN just to keep her since I had her for 15 years, until hubby lost his job and we had to switch to a plan that did not allow out of network coverage at all. That plan was a group plan HMO set up specifically for sole proprietors. My husband is now self-employed too. We are the people who are meant to benefit from the ACA. My old plan probably would have been great if I never had cancer or got seriously ill in any way, but turned out to be truly awful in a lot of ways: Small network, refusal to pay docs in a timely manner (over a year- seriously!), no reconstructive PS in network and loads of hassle to get approval for one, no prescription plan, etc. Then they cancelled my product and raised rates by $400/mo.

I found a plan on the NY Healthcare Exchange that was $30 cheaper/mo full price, had a prescription plan, all my docs are on it, pays for chiropractors and acupuncture, reimburses for gym membership and has been extremely easy to deal with so far. At the moment, we get a subsidy so it's about $300 cheaper. If we make any more money, we won't get the subsidy but full price is still cheaper with a lot more value added benefits. I can't imagine being forced to keep my old plan forever or pay ridiculous rates to switch to new one like back in the days before the ACA, just because I had a pre-existing condition. Health care would have bankrupted us. The system was broken and is no way 'fixed' yet, but contrary to Fox News, a lot of people have been helped by the ACA. Just my 2 cents...

ibcmets

My premiums went up a bit with United Healthcare, as well as my out of pocket expenses & deductible; but I am still in a  much better position than most since my out of pocket is much less than $6000 a year and my deductible is now $1500 instead of the $500 I used to pay.   Considering everything, I'm still better off.

Terri

itsjustme10

JBug...that's for individual plans.  People who are on employer plans still have PPO's and Indemnity plans as choices  Plus, HMO's that are purchased as part of a large group, still have much more extensive networks.

I had no problems with my care before the ACA caused my plan to be cancelled.  Everything was paid for, minus my copays, including my plastic surgeon.   It was an HMO, but the network was much larger.  it all has to to with reimbursement rates.  I've spoken with almost all of my doctors - as of December, none had signed up to accept the ACA plans because none of the reimbursement rates were available, and they weren't going to lock themselves into a situation where they are losing money.  Memorial Sloan Kettering actually called to tell me that they were not accepting any of the plans, and then later called back to say the hospital was considering 2 of the more obscure ones, but I don't see the oncologist listed as in network - and my pcp definitely isn't..

The number of people in the individual market is greatly dwarfed by the number of people on employer plans, so this is not hurting the doctors' income.  Next year, when small businesses are taken out of the free market and put onto exchange based plans, that story may change.  There's no way to know that right now.

it's the first year, and there are growing pains, I understand that.  I just hate that I'm spending hours and hours on hold trying to get BCBS to allow me to use my own PCP, who on their website is listed as in-network, and to remove some random doctor they assigned me to, without my knowledge or consent.  It's been about a week since I discovered this, and I am not happy with the carrier.  Thank goodness I can change plans until 3/31, since it's still the open enrollment period - I think I will do that after February 1st.

I'm sure it will get better.  I just hate, hate, hate the thought of such a limited network HMO, with no safety valve, no out of network coverage  I'm willing to pay for a ppo, in order to have that peace of mind.  I don't have that option here in 2014.  And that bothers me.  Not everyone was uninsured in the past.  Not everyone is looking to save every last cent to get the cheapest plan possible.  They're not taking that into account, and i'm really frustrated by this whole experience.

kerri72

Hi everyone, I'm in NY (Westchester County) and freaking out because Empire cancelled my old plan, and none of the plans being offered through the state exchange will cover my oncologist (or any of my other docs). I've looked into individual plans bought directly from Empire, but they've changed the networks so there's no such thing as a PPO plan anymore. Even as someone who's just undergoing surveillance now, this is terrifying. I can't imagine how stressful it is for people in active treatment.

J-Bug

kerri72, I am sorry to hear what you are going through. I hope that you find a solution. 

kerri72

Thanks, J-Bug. I ended up buying an individual policy with Oxford because all my doctors are in-network. I had to buy outside the state health insurance exchange, so I'm paying $1,900/month for myself and my husband, and we won't be able to get tax credits (even though we're income eligible). I assume the kinks will get worked out of the Obamacare plans eventually, but it's pretty scary in the meantime.

itsjustme10

After 6 weeks of calling, emailing, yelling and crying, as of today i finally got my correct PCP put on my Empire BCBS plan!! Unfortunately, that's tempered by the fact that I found out that the closest hoepital that accepts ACA plans is about 15 miles away, so I hope I never need to go to the ER, but at least 1 doctor is on one of those plans.  

Kerry- I just read where WCMC wasn't taking any ACA plans, either.  You guys are in as bad a shape as we are...it's probably all of downstate where the lack of coverage is super bad.  I wasn't eligible for the Oxford plans, because I'm not working, so I was stuck with what I can find.

I am so grateful I'm in the check-up stage after treatment, and my heart goes out to anyone who was in the middle of treatment.

SyrMom

Bosumblues .... I know nothing about how the system is working now, however, how about calling your attorney and having an emergency court date to have the ex pay all or part of your Cobra?  Or have your alimony increased to help cover the costs?  That way you will be covered until you get another job.  You should be eligible for 18 mo of Cobra, I believe.

pupmom

Bosum, are you eligible for Medicaid and/or the tax refund. Seems like $23,000 would make you eligible for all the help out there.

J-Bug

BosumBlues: I hope that you were able to find some resolution with your healthcare. It is terrifying what an illness can do to your finances and entire life.