Questions about Health Insurace...

[USArmyParatrooper]

I'm making this thread because the only experience I have is employer coverage (of which I never used) and the coverage I get in the military.

I did go to the emergency room once when I did not have coverage. It was just prior to me shipping off to the army and I had quit my job to make preparations to ship off. I had started a vigorous exercise program and soon I began feeling my heart periodically skip a beat. This when on for three days before I got worried enough to visit the emergency room. Here is a summary of my experience with the visit.

- They asked me repeatedly if I was doing drugs, even though I told them "no" the first, second and third time.
- They had me pee in a cup. I don't know if they were checking for medical issues or if they did their own drug test.
- They hooked me up to an EKG machine.
- They then told me, "They're PACs, you're fine" and sent me home.... with a bill for $1500

I do know that things like surgery and treating caner are extremely expensive - to the tune of hundreds of thousands of dollars, sometimes over a million. I looked some things up online and a search of "Average cost of treating cancer" revealed cancer drugs costing tens of thousands of dollars!

So I saw the threads criticizing President Obama for signing the health care bill because of the high cost of the insurance pools for people with preexisting conditions. Right off the bat I think it's infinitely better than having no coverage at all, but I don't know how these costs fair against the general market.

https://www.pcip.gov/StatePlans.html

MONTHLY PREMIUM BY AGE:
00-34: $232
35-44: $387
45-54: $495
55+ : $688

1st Question: How do these premiums compare to the general market? What is the average for people in this age groups who have a clean medical history? How about for people considered "high risk"?

Next we have this.

In addition to your monthly premium, you will pay other costs. Covered in-network services are subject to a $2,500 annual deductible (except for preventive services) before the plan starts to pay benefits. Once you’ve met the deductible, you will pay a $25 copayment for doctor visits, $4 to $30 for most drugs at a retail pharmacy for the first two prescriptions and 50% of the cost of the prescriptions after that. If you use mail order, you will pay $10 for generic drugs or $75 for brand drugs on the plan formulary for a 90 day supply. You will pay 20% of the cost of any other covered benefits received from a network provider. Your out-of-pocket costs cannot be more than $5,950 per year. However, your out-of-pocket costs may be higher if you go outside the plan’s network.

2nd Question Same as above, how does the above compare for normal and "high risk" recipients?

3rd Question The out-of-pocket cap of $5,950 per year, do most health insurance policies have an annual cap - and if so what's the average?

Next, this FAQ is on the this page here:

https://www.pcip.gov/FAQ.html#q8

What do I do if I can’t afford these premiums?
If you have limited income and resources, you may be eligible for the Medicaid program in your state. If you are seeking insurance coverage for your child, go to www.insurekidsnow.gov to learn more about children’s health insurance in your state.

4th Question How would Medicaid work in conjunction with the high risk pools, and who qualifies? My mother has been on Medicaid for years and she's in her 50s.

Last Question I do know that the HCR bill has provisions to provide government subsidies to help lower the insurance costs for low income people. Would this also apply to those who are in high risk pools?

[Warpy]

1. Medicaid in my state kicks in only if you're destitute,

meaning less than $1500 in assets, total. So forget getting it if you're "rich" enough to have a jalopy and a few other possessions. The high risk insurance pool is limited to specific conditions and very difficult to get into. Insurance "reform" means that companies have to write policies for high risk people starting three years from now, but they it didn't have any provision to force them to cover those conditions. There is also a formula combining deductibles, premiums, and out of pocket copays that makes such insurance too expensive to use even if you do get sick.

I am left covering my expenses out of pocket, hoping I don't get any devastating illness for a few more years until Medicare kicks in.

Insurance has remained something accessible only for the healthy. Once you get sick, forget it.

[TBF]

2. Insurance is for the well-off, and those who are healthy -

it is a much different ball game if you have children, or if you happen to get a health condition as you age (and many do of course). The idea is that we all pay premiums to spread the risk, and that might actually work if we all had one big pool to pay into - but only if it is done on a sliding scale according to percentage of income or something like that.

We are a family of 4 and I am the only one with any conditions (allergy & arthritis). I do believe Obama's work on pre-existing conditions may help me, but only as long as we can afford to pay premiums. Currently we pay about $1,000/month (we have good coverage, can pick our doctors, etc...).

It's not that I don't agree with what Obama did, I think it was a start. It seems to me that it would make the most sense to have a program like Canada's however, to hopefully spread the risk out more, and be able to cover more people. I'd love to see actual well-care covered, so folks don't end up waiting for care until things are much worse (and cost much more).

[USArmyParatrooper]

3. Well apparently with the high risk pools that's not neccarily true.

Respectfully I was I asking how the premiums for those pools compare to the boarder market.

[TBF]

4. Ok, well I'm happy to give it another kick for visibility -

maybe someone who has looked at this very closely can give you the specific answers you're seeking. Good luck!

:kick:

[BzaDem]

5. "but only if it is done on a sliding scale according to percentage of income or something like that"

In 2014, anyone making under 400% of the poverty level on the individual market will be paying premiums on a sliding scale according to percentage of income. 9.5% of income at 400% of the poverty level, ~2.5% of income at 133%, and a sliding linear scale in between.

[BzaDem]

6. Here are some answers

The high risk pool is heavily subsidized by the government. So you do pay premiums, but they are MUCH lower than they would be on the open market for those with conditions.

In 2014, the risk pool will end. It is just temporary, to get us to 2014. In 2014, exchanges will be set up that can NOT deny based upon pre-existing conditions, so the pools will no longer be necessary. The government subsidies start in 2014 with the exchanges (after the high risk pool is phased out).