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New Insurance -- Get Ready

jazzy1's picture
Posts: 1385
Joined: Mar 2010

I'm on another message board for cancer and a woman who's a health insurance advocate posted what she has learned about this forthcoming insurance craze.  No matter whom I speak with, no one truly knows how this will all pan out, plus betting our gov't doesn't quite know.  Now doesn't that make any US citizen feel comforted, especially when dealing with cancer?  Below is a copy of her posting.

NOTE:  At the bottom you'll see a website listed for calculating what you could pay.  It's very interesting.  

Hoping to start some discussion on what others are hearing out there or thinking



As a consumer health insurance advocate, I have been getting loads of questions about the details of the new insurance policies that will go into effect January, 2014. Very little info has been released to the general public. In fact, insurance companies have not yet released info on how much they will charge. However, don't dispair. There is information out there. It is not complete - nor the final word. But it is a start.
My goal in advocating is to try to translate all this info into Plain English so that you will then be empowered to advocate for yourself and others.
My motto: No Technically Correct But Totally Useless Information!
This is what you usually get. The info comes out in Insurance Insider Speak - not easily understood by insurance outsiders. Advocacy can't take place in that type of environment.
*ACA Basics - 101
*Sign Up - Begins in October
*Effective date of insurance coverage: Jan/2014

*Companies with 50+ (equivalent) full time employees must provide insurance. Full time is 30 hours per week - 120 per month.
*Fines against companies not complying with the law = $2,000 - $3,000 (not counting the first 30 employees)
*MediCaid - will be expanded to cover everyone within a certain income level. That means that Medicaid will now cover single individuals under 65 years of age. There will be no disability requirement. This new program will cover healthy individuals. This is new!
*New Medicaid income level for an individual:
I have seen two different figures on this - $14,500 - $15,000.
*Anyone above this income level who is uninsured must sign up for the new insurance or pay a fine.

I know what you are thinking. How can I afford to buy insurance?
Well, there are many, many different levels of subsidies that you might receive to help you pay the premium. And, you may be eligible for help in paying the out of pocket charges.

How will you sign up?
You will call an "exchange" run by the government. They will explain the four standardized plans being offered. They will also tell you how much money you will be eligible for in subsidies. At that point, you will sign up through the government exchange.

The Insurance Plans:
*4 basic plans will be offered - from a lower coverage plan to a high end plan. The subsidy is based on the selection of a middle level plan - The Silver Plans.
*The Plans: Bronze - pays 60% - Silver - 70% - Gold - 80% and the high end plan - 90%.
*This doesn't mean that the plan pays 60% for every item. It is a complex overall calculation. The plan could pay more in many area.

Bottom Line: How much will you have to pay for the Silver Plan?

Examples: The calculations depend on the number of people in the household and age. 
*One person - income $16,000 Age - 60. 
*The insurance co. will charge $635 a month
*The government will give you a subsidy of $594 per month
*The government will lower your out of pocket maximums (normally $6,400) to $2,250.

*Single Individual: Age 60 Income - $30,000
*Insurance company charges - $635 a month
*The government will provide a subsidy of $426
*The government will not provide help with the out of pocket-$6,400.
*You pay - $209 a month

*Family of 4 - oldest person is 60 years old 
*Income level is - $50,000
*The insurance company will charge $1,723 for the entire family
*The government will provide a subsidy of $1,443
*The family will pay $280 for coverage for 4 people.

Some level of subsidy help will apply to a family of 4 up to $90,000+ per year.

How can I find out how much I will have to pay?

*Go to an ACA calculator.
*I have used several calculators. The best ACA calculator will be found at: Covered California Calculator
*Even if you don't live in California, you can use this calculator to get some idea of how much you will receive in subsidies/how much you will have to pay. It may not be accurate for your state - but it is a start.
*You will find the actual insurance company charge and the real amount that you will have to pay - after deducting the subsidies.

One proviso: Insurance companies have said that we should be ready for sticker shock. That means that these calculator prices are not correct because we don't know the real prices. But that won't matter for folks getting subsidies. You Will Not Be Asked To Pay More Than the Amount Listed Under: You Pay.

The problem is that the government will have to pay those higher premiums to the insurance companies. 

Will these prices be inflated? We don't know at this point. But we do have the power to make our voices heard - once we understand the issues.


debrajo's picture
Posts: 1095
Joined: Sep 2011

Everyone is confused!  I was told by the administer at step-dads nursing home that SO FAR there are 13,000 new regulations!  I can't keep up with the Voodoo they do now! Debra

jazzy1's picture
Posts: 1385
Joined: Mar 2010

I read an article last week in WSJ noting how Medicare was changing some policy for types of scans to pay.  They weren't sure exactly the amounts or if they'd continue to pay, so decided to REFUSE PAYMENT for now.  So...anyone having this type of procedure done would be refused payout from Medicare.  What the heck are these idiots thinking????  I get so rattle every time our government gets their hands in our pockets.....I'm a crazed woman

I know breathe in deep and let 'er rip.....lol!



Alexandra's picture
Posts: 1311
Joined: Jul 2012

Due to the current financial situation caused by the slowdown in the economy, Congress has decided to implement a scheme to put workers of 50 years of age and above on early retirement.

This scheme will be known as RAPE (Retire Aged People Early).

Persons selected to be RAPED can apply to Congress to be considered for the SHAFT program (Special Help After Forced Termination).

Persons who have been RAPED and SHAFTED will be reviewed under the SCREW program (Scheme Covering Retired-Early Workers).

A person may be RAPED once, SHAFTED twice and SCREWED as many times as Congress deems appropriate.

Persons who have been RAPED could get AIDS (Additional Income for Dependants & Spouse) or HERPES (Half Earnings for Retired Personnel Early Severance).

Obviously persons who have AIDS or HERPES will not be SHAFTED or SCREWED any further by Congress.

Persons who are not RAPED and are staying on will receive as much S.H.I.T. (Special High Intensity Training) as possible. Congress has always prided themselves on the amount of S.H.I.T. they give our citizens.

Should you feel that you do not receive enough S.H.I.T., please bring this to the attention of your Congressman, who has been trained to give you all the S.H.I.T. you can handle.

The Committee for Economic Value of Individual Lives (E.V.I.L.)

PS - - Due to recent budget cuts and the rising cost of electricity, gas and oil, as well as current market conditions, the Light at the End of the Tunnel has been turned off.

ConnieSW's picture
Posts: 1193
Joined: Jun 2012

You are really flying high.  Thanks for the laugh.

debrajo's picture
Posts: 1095
Joined: Sep 2011

I printed this out for my husband to take to work!  He loves it and it so validates what he has been saying(DO NO EVEN GET HIM STARTED ON ILLEGAL ALIENS!!!)  Well put and so very true.  Thanks for the great laugh...first one I've had in days!  debra

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