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Old 01-10-2013, 10:57   #136
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

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Then again, I do not think overseas ever would have taken US insurance, unless it is a specific travel plan.
I would have thought that US insurance is exactly like most other countries with private heath insurance schemes, you are covered for short term foreign visits , usually on a pay and reclaim basis. is this not so?

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Old 01-10-2013, 11:00   #137
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

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Originally Posted by goboatingnow View Post
I would have thought that US insurance is exactly like most other countries with private heath insurance schemes, you are covered for short term foreign visits , usually on a pay and reclaim basis. is this not so?

dave
That is my understanding. You would pay cash for overseas care, and the file a claim with your insurance company (if they cover you overseas). Nothing in Obamacare would change that that I can see.
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Old 01-10-2013, 11:05   #138
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

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Funny isnt it, the US system generally has good pricing ,( lumber plumbing cars etc ) but medicine seems miles out of whack.
Yep becasue someone ELSE is paying...
Not getting political here, so no slaging of ACA OK.

But lots of things are paid for by insurance, When I crash my car, insurance pays out and I get it fixed. Its a bit more expensive then "the bloke round the corner fixing it" , but not that much so.

I dont think its anything to do with public or private spending, WHy does a MRI of teh head cost $1200 in the US and ( equivalent) $150 in some where else. The equipment is the same or better, the MRI personnel is trained to a similar standard, as is the radiographer.

I wonder is it the existence of a huge private insurance market thats causing the problem. there simply no market pressure on a supplier to reduce costs.

IN European countries , because the government is essentially a huge "patient" with massive economic clout. It simply "tells" health providers, "Aspirin will cost x" MRIs will cost "y", thats what you charge or else ( private or public) . Hence it acts to keep prices under control.

I dont know, but something seems odd. No person should have to think so much about medical insurance like US people do, Mine gets as much thought as my car insurance.


Sounds like the US should ban private health insurance and you all just pay direct, soon see prices tumble then ( and poorer doctors too) .

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Old 01-10-2013, 11:10   #139
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

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...Standard of care was generally very good, even better than stateside in many cases.... Phil
I am curious to know what you are basing that on?
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Old 01-10-2013, 11:10   #140
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

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So, let's take a real example right off the Rhode Island ACA website today:

58 year old couple. Income $40,000

Monthly cost of cheapest plan - $2.86 - yes, a month for both of us.

The plan:

$5000 deductible (each), $6300 out of pocket maximum. Very broad coverage including prescriptions once you clear the deductible.

What a great plan! It's like paying out of pocket for health care but once you hit the max you have 100% coverage. If I'm very healthy, our cost is $2.86 a month. If one of us get's really sick, the maximum monthly cost is 1/12 of the $6300 maximum or $525 a month - but only in a year where we get really sick. The $40,000 income allows $2500/month after tax cruising spending. What's not to like?

To not go over the $40,000 income, I'd put some savings in municipal bonds that aren't taxable income and stocks like Berkshire Hathaway that don't pay dividends.

Am I missing something?

If all of that is correct, then you must be missing the part where someone else is subsidizing your care, because $35 a year seems like an obscenely low rate, even for catastrophic coverage.
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Old 01-10-2013, 11:12   #141
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

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correct me if Im wrong , do you mean you have to find 6K in cash first if you have a claim. How many real 40Kers, have that

dave
Dave,

I'm just trying to find the best arrangement for me to cruise under ACA. I have the $6300 to cover the max out of pocket. Because I can afford it, ACA is a great deal.

But to your questions, I think most people making $40,000 could probably come up with $6300 if they got really sick - especially if they are only paying $2.86/month for health insurance.

It's a lot better than coming up with a $100,000 or whatever an uninsured person might face today. And if I got a long term health problem I'd only pay the $6300 the first year and then switch to a lower deductible plan at the next open enrollment.

ACA would be fairer if it counted assets instead of just income but that's a fairness problem all through the US tax system (e.g. assets aren't taxed). I'd be in favor of fixing that even though it probably hurts me personally.

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Old 01-10-2013, 11:13   #142
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

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If all of that is correct, then you must be missing the part where someone else is subsidizing your care, because $35 a year seems like an obscenely low rate, even for catastrophic coverage.
em, presumably the taxpayer/gov is, cause of the low income levels, though again where you get the deductible if you are really in 40K?
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Old 01-10-2013, 11:14   #143
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

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Dave,

I'm just trying to find the best arrangement for me to cruise under ACA. I have the $6300 to cover the max out of pocket. Because I can afford it, ACA is a great deal.

But to your questions, I think most people making $40,000 could probably come up with $6300 if they got really sick - especially if they are only paying $2.86/month for health insurance.

It's a lot better than coming up with a $100,000 or whatever an uninsured person might face today. And if I got a long term health problem I'd only pay the $6300 the first year and then switch to a lower deductible plan at the next open enrollment.

ACA would be fairer if it counted assets instead of just income but that's a fairness problem all through the US tax system (e.g. assets aren't taxed). I'd be in favor of fixing that even though it probably hurts me personally.

Carl
Seriously someone on 40K, can find 6K , you dont really believe that , my experience of low paid people is every penny is counted, ie they live hand to mouth


Yes we all agree on asset versus income tax. I wasnt getting at you , youre just using the system as its designed
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Old 01-10-2013, 11:14   #144
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

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Originally Posted by goboatingnow View Post
Not getting political here, so no slaging of ACA OK.

But lots of things are paid for by insurance, When I crash my car, insurance pays out and I get it fixed. Its a bit more expensive then "the bloke round the corner fixing it" , but not that much so.

I dont think its anything to do with public or private spending, WHy does a MRI of teh head cost $1200 in the US and ( equivalent) $150 in some where else. The equipment is the same or better, the MRI personnel is trained to a similar standard, as is the radiographer.

I wonder is it the existence of a huge private insurance market thats causing the problem. there simply no market pressure on a supplier to reduce costs.

IN European countries , because the government is essentially a huge "patient" with massive economic clout. It simply "tells" health providers, "Aspirin will cost x" MRIs will cost "y", thats what you charge or else ( private or public) . Hence it acts to keep prices under control.

I dont know, but something seems odd. No person should have to think so much about medical insurance like US people do, Mine gets as much thought as my car insurance.


Sounds like the US should ban private health insurance and you all just pay direct, soon see prices tumble then ( and poorer doctors too) .

dave
You make some good points, but it's not just insurance. It's the fact that nobody is controlling costs. Consumers don't even know the costs, so they can't make educated decisions about their care.

Either you need government controls or market transparency to keep costs down, and this is a system with neither of those.

Meanwhile, the providers determine among themselves what the cost of care is.

Medicare/Medicaid set some rates, and insurance seems to follow those rates, but they are really out of date and out of sync with real costs. So health care remains a major profit center for all involved, without many checks and balances.

So Americans pay double what other countries pay for care, some people don't have care, and everyone remains oblivious to what care actually should cost or how much they're getting.

The elderly use a ridiculous amount of care, simply because nobody is acting as a gatekeeper to ration out a fixed resource, so it seems unlimited.
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Old 01-10-2013, 11:18   #145
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

I'm sitting here listening to Obama's 1:00 speech on how easy getting insurance is beginning today. While he's speaking, I went to his healthcare.gov site as he instructed, and tried to enroll in an insurance plan... answered all the questions and was informed that "enrollment is closed." He's still talking....
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Old 01-10-2013, 11:22   #146
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

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The elderly use a ridiculous amount of care, simply because nobody is acting as a gatekeeper to ration out a fixed resource, so it seems unlimited.
well thats cause they're closer to dying I think , duh. its no more then a car with 100K miles needs more repair parts, then one with 10K miles.

I think when you create a market based healthcare system and then try to shoe-horn in controls cause you want the elderly , or the poor to have basic cover, you end up with a confused system .

I really think either full market system ( pay and recover) or single payer works.

Personally , I think healthcare should be like secondary education , employ the people and deliver the service from taxes. ( but thats just me and ive gotten slightly political , slap)

I do sympathise with US cruisers, this seems like an expensive nightmare.

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Old 01-10-2013, 11:22   #147
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

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I'm sitting here listening to Obama's 1:00 speech on how easy getting getting insurance is beginning today. While he's speaking, I went to his healthcare.gov site as he instructed, and tried to enroll in an insurance plan... answered all the questions and was informed that "enrollment is closed." He's still talking....

Sheesh try getting an MMSI from the FCC site........

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Old 01-10-2013, 11:24   #148
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

Yes, I have been trying all day to create an account just to see what the plan options are. The website was not built to handle the traffic. However, it is not just the US gov site with the problem, all of the independent state sites are also overloaded, so they also were not built for the traffic.

I understand why enrollment should start at a specific date, but I don't understand why basic information on the plans and prices couldn't have been available 1-2 years ago (this law is 3 years old). Right now, every US citizen has been completely in the dark as to what will even be offered until today, and everyone is trying to find out and are frustrated.

Besides, have you EVER been to a government website that worked?

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Old 01-10-2013, 11:26   #149
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

Without getting all foamy at the mouth it’s hard not to think of politics when discussing the ACA because:

1. It was conceived by politicians.

2. The politicians were from one party only.

3. The politicians from the one party exempted a whole bunch of their voting base from the program.

4. The politicians exempted themselves and government workers from the program.

A reasonable person then logically asks that if the program is such a great thing, why 3 and 4 above particularly when the plans stated efficiency and cost depends on lots of people participating?

After mulling the inconsistency of that, the speculation begins and ………………………?
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Old 01-10-2013, 11:28   #150
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Re: ACA/Obamacare for American Cruisers Abroad MERGED THREADS

to answer goboating now, it is my understanding the the ACA deductible does not apply to prescriptions and dr visits, just pay the co-pay. Also, your co-pays apply to the annual deductible under ACA. That is a nice change, especially for patients with many prescriptions. My company-provided group health insurance agent told us that all group plans have to apply co-pays to annual deductible under the new ACA rules. My wife's co-pays average $1,200/month, so now we will reach the deductible sooner.
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