Quick question: Are there out-of-pocket limits in the bill?

[Hello_Kitty]

I've tried reading the bill online but I can't find it and can't read government gobbledygook anyway. Since the typical plan people will buy on the exchange covers 70% of medical expenses, what is the income percentage limit on out-of-pockets?

[NJmaverick]

1. Here

<<They also have agreed to create health insurance exchanges designed to make it easier for small businesses, the self-employed and the unemployed to pool resources and purchase less expensive coverage. Both the House plan and the Senate bill would eventually limit total out-of-pocket expenses and prevent insurance companies from denying coverage for pre-existing conditions.>>

http://www.cnn.com/2009/POLITICS/12/24/health.care/index.html

[Hello_Kitty]

2. Wht is meant by "eventually limit"? Are there limits in the bill or not? eom

[NJmaverick]

3. ?

The House bill would cap annual out-of-pocket medical expenses at $5,000 per individual and $10,000 per family starting in 2013. New plans offered through new employers, as well as policies sold through the proposed health insurance exchange, a marketplace where consumers can compare plans and prices, would be subject to limits.

Most employers today offer policies with limits on out-of-pocket expenses. Under Senate proposals, existing employer plans would be exempt from the limits, but the House would require employer plans to have caps in place by 2019.

The Senate legislation would tie the annual out-of-pocket limits to those that exist under current law for health savings accounts, which will be $5,950 and $11,900 in 2010 but should increase by the time new rules would go into effect in 2013 under the proposed legislation.

Out-of-pocket expenses are expected to include co-payments for medical services and prescription drugs, deductibles and co-insurance, though premium payments wouldn't count toward the out-of-pocket maximum.

Once a consumer reached the limit, his or her plan would pay 100 percent of further expenses.

http://www.miamiherald.com/news/politics/story/1305143.html?storylink=mirelated

[Hello_Kitty]

5. That's from Oct. 28th. If you don't know what's in the bill now, say so. eom

[NJmaverick]

6. I am not wasting any more of my time dealing with someone

with you utter lack of gratitude.

Oh and unrecc for a rotten attitude

[Hello_Kitty]

12. You got your precious bill signed.

How about some graciousness?

[NJmaverick]

18. This bill doesn't help me, but it does help millions of other Americans

and that's what is important to me.

[Schema Thing]

4. The word "limit" indicates there are "limits" in the bill.

eventually ;)


:shrug:

[mcablue]

8. What's the limit? $20,000? $1000? nt

[Orangepeel]

7. $5,950 for individuals and $11,900 for families, if more than 400% FPL

300 - 400% FPL is 2/3 of that
200 - 300% FPL is 1/2 of that
100 - 200% FPL is 1/3 of that

that's how I read it, anyway.

Making Coverage Affordable: New, refundable tax credits will be available for Americans with incomes between 100 and 400 percent of the federal poverty line (FPL) (about $88,000 for a family of four). The credit is calculated on a sliding scale beginning at two percent of income for those at 100 percent FPL and phasing out at 9.8 percent of income at 300-400 percent FPL. If an employer offer of coverage exceeds 9.8 percent of a worker‟s family income, or the employer pays less than 60 percent of the premium, the worker may enroll in the Exchange and receive credits. Out of pocket maximums ($5,950 for individuals and $11,900 for families) are reduced to one third for those with income between 100-200 percent FPL, one half for those with incomes between 200-300 percent FPL, and two thirds for those with income between 300-400 percent FPL. Credits are available for eligible citizens and legally-residing aliens. A new credit will assist small businesses with fewer than 25 workers for up to 50 percent of the total premium cost.

http://dpc.senate.gov/healthreformbill/healthbill05.pdf

[Garam_Masala]

9. $11.900 on top of insurance premiums will be severe hardship

for most middle class families. A typical family plan costs
$600-800 per month so you are looking at $20,000 out of pocket
not counting transportation, meals etc at the hospital.

[DJ13]

11. but..... think of all the profit for the insurance companies!

[Orangepeel]

15. true. but it's probably better than it is now, which is often 20% of whatever the total costs are

I'd like it to be less. People with a catastrophic illness shouldn't also be burdened with paying 22% of their income for health care costs. The only upside is that it is better than paying 100% of their income.

[frazzled]

16. Read that again, I think

It's saying the maximum a family would ever have to pay (for the family) is $11,900--and that only if they are above 400% of the Federal Poverty Level. The FPL for a family of 4 today is $22,050--so only families earning over $88,200 would have to incur that full $11,900 liability. Remember, you probably won't incur that much cost unless there are some very big illnesses or hospitalization. But you could.

The family who earns only the $22,050 will be eligible for Medicaid, I presume. The family earning 200% of FPL (or $44,100) would be getting subsidies to help them pay for the insurance, and then their total out-of-pocket potential liability would be capped at half the $11,900, or at $5,950.

[quiller4]

21. You are misreading what an out of pocket max. is.

This comes into play only if you meet your deductible and then have sufficient expenses that you share reaches that level. In my present policy I have a $3500 deductible which I met in July. Since then my plan paid 80% on most medical expenses leaving me to pay the remaining 20%. My out-of-pocket max is $15,000 and would come into play only if my medical expenses were so high that my 20% share exceeded $15,000. Would that be difficult for me or for most middle income earners? Sure. But it wouldn't force a family into medical bankrupcy. Instead they'd be locked into a monthly payment plan with a hospital. I've been paying St. Clare Hospital $300/mo since July.

Now many private plans have no annual caps which is how even with insurance middle income folks are forced into medical bankrupcy.

[depakid]

23. Actually, experts expect there to be little change in the rate of medical bankruptcies

Bills pending before the House and the Senate would set different limits, but virtually everyone agrees on a key principle: "You shouldn't go bankrupt" because of your medical costs, said Elizabeth Carpenter, a policy analyst at the New America Foundation, a center-left research center.

According to a study in the August issue of the American Journal of Medicine, increasing numbers of people are going bankrupt because of illness and medical costs. Health-related debts caused 62.1 percent of all bankruptcies in 2007, up from 46 percent six years earlier.

Dr. Steffie Woolhandler, the study's senior author, expects about the same percentage of this year's anticipated 1.4 million to 1.5 million bankruptcies to be caused at least in part by medical expenses.

The increases are caused largely by "health coverage that is getting skimpier and skimpier," said Woolhandler, a professor of medicine at Harvard Medical School.

She was skeptical that the legislation would cause the bankruptcy numbers to drop.

"Yes, the limits would be an improvement," she said, but "if you have diabetes or some other chronic condition, every year you'd still be subject to the cap over and over again."

http://www.allbusiness.com/government/government-bodies-offices-legislative/13336128-1.html

[Oregone]

10. So...dumb question...does that include premiums?

If more needs to be spent by copay policy or uncovered procedure, is the insurer required to pay it, no questions asked, no appeal, nothing, nada, zip?

IOW, once someone spends that, is the insurer forced, by threat of being arrested or dismattled, to cover anything else that would come out of a persons pockets, no matter what?

[Hello_Kitty]

13. Not from what I understand. Those figures are out-of-pockets. eom

[Oregone]

14. Ouchy. So, how do they enforce it?

Just curious what is in the bill to require all insurers to, no questions ask, no matter what, with no denial or red-tape, cover out of pocket costs above that. Is jail time written in the bill for execs? How abot arrests? Penalties even?

[DJ13]

17. .......

[JoeyT]

19. That's kind of how I read it too.

Though I don't think it's a terribly good thing.
FPL for a single person is 10800 a year. So if you make that your healthcare expenses are going to cap out at more than 10% of your yearly income. Plus whatever subsidies don't cover.

I don't think "refundable tax credit" is the same as "don't have to pay", either.
If you're anywhere close to the FPL, you're probably not going to be able to afford treatment in the first place, even if the government is going to give it back to you later.

[SpartanDem]

20. So that works out to

300-400%= $3,966
200-300%= $2,975
200-100%= $1,983

[TheKentuckian]

22. As I suspected people will have a tough time seeking actual treatment

but folks will be able to pat themselves on the back for providing coverage and be excused from giving a shit about the poor and struggling because they refuse to lift themselves up by the provided and subsidized bootstrap, the lazy bastards and welfare queens.