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Old 03-11-2013, 16:22   #61
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Re: Affordable Care Act - catastrophic plans cancelled

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Originally Posted by colemj View Post
And even if you could, that type of illness is still expensive in other countries, relative to many people's bank accounts. This is why we have catastrophic asset insurance (I no longer refer to it as medical insurance).

Mark
Mark,

With your current catastrophic asset insurance (you no longer refer to it as medical insurance). Will you be considering one of the Affordable Care Act medical Policies?

At your current $4000 usd medical expense and as a cruiser your income would be low enough to make an Affordable Care Act medical Policy available for much less than $4000.

I have been struggling with this medical coverage for a few years now as we would like to be out cruising as yourselves, but have not been able to make the medical number work in the past.

I plugged our numbers into the Affordable Care Act calculator for our home state and with a low yearly income it looks like it would cost us just under $2000 per year.
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Old 03-11-2013, 16:23   #62
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Re: Affordable Care Act - catastrophic plans cancelled

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Originally Posted by Stugots View Post
Sorry if this has already been asked, but have you shopped around at all? $1200 is many times higher than any bronze plan I've heard quoted... it doesn't sound right. I went on and looked at costs for bronze plans in California and they were in the $200-300 range. If you're cruising I would imagine your income level is also low enough to get subsidies on top of that.
I was wondering the same? How many people are you insuring? 59 yrs old, single, my $10k deductible was ~$140/mo under ACA $5k deductible will be $230/mo.
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Old 03-11-2013, 16:49   #63
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Re: Affordable Care Act - catastrophic plans cancelled

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Originally Posted by Cotemar View Post
Mark,

With your current catastrophic asset insurance (you no longer refer to it as medical insurance). Will you be considering one of the Affordable Care Act medical Policies?

At your current $4000 usd medical expense and as a cruiser your income would be low enough to make an Affordable Care Act medical Policy available for much less than $4000.

I have been struggling with this medical coverage for a few years now as we would like to be out cruising as yourselves, but have not been able to make the medical number work in the past.

I plugged our numbers into the Affordable Care Act calculator for our home state and with a low yearly income it looks like it would cost us just under $2000 per year.
Well, of course. Certainly. I woke up before dawn on the day it went live all excited to see what was available and if we can get good health insurance.

As of 20 minutes ago, I still can't get past the log-in. All it does is tell me that I cannot have two or more of the same answers to the security questions. Yes, I am smart enough to type three distinct and different answers - the website is the problem.

From the Kaiser Foundation calculator, we can get very good REAL medical insurance for less than we pay now for asset insurance. The cost of the lowest plan that most closely approaches our current asset insurance plan is basically free.

Our only unanswered concern is what this coverage will look like in practice. Since we are not allowed to actually see the plan details until I can figure out how to convince the website that I am providing different security question answers, I don't know if these healthcare plans are like HMO's, where we will have to go to specific doctors and hospitals in our local "home address" area.

If so, then this whole thing is useless to us.

If you (Cotemar crew) have pre-existing health conditions that require a lot of care or medical access, then it is probably prudent to wait until all of the healthcare issue ducks are all lined up before shoving off. If, however, you are generally healthy and can scrounge up the occasional C-note or two, then you don't have anything to fear about medical care and expenses once you leave the US.

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Old 03-11-2013, 16:50   #64
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Re: Affordable Care Act - catastrophic plans cancelled

what i am reading not just here but everywhere i have found mention of the aca, is that folks are confusing health care delivery with health care insurance.
the aca is a market for INSURANCE, not health care delivery. it has nothing to do with delivery of health care..
i also see folks who believe with all their hearts that social security is a handout. they also think veterans affairs is a handout.
anyone who has paid fica knows social security is a tax that pays for old folks and disabled citizens to prevent destitution.
every year every worker earning a paycheck pays into social security via fica. i have paid in over 500,000 usd. how much did all of you pay into that fund. i will have regained under 130,000 usd total of these paid into fund taxes by the time i am dead. same is with all of us receiving these benefits we PAID for.
as for veterans affairs benefits-- military doesnt pay enough to go out and do that which the kids in military are sent out to do. the benefits are hard earned, not to mention inadequate in many regions. the meds prescribed to vets are antiquated items which have been replaced in market by more effective medications, which vets are disallowed. the primary physician is a resident at some nearby university hospital, not a seasoned physician with experience in the exotic conditions many suffer, which is inadequate, at best.
i have worked in va hospitals and with vets under many situations out of hospital. yes i hear their complaints about the program. yes i helped train the mds in va..lol...as an rn i did this.
this aca is merely a market for insurance policies required by governmental agency to be used under penalty of fine. unemployed are not exempt from this mandatory purchase requirement.
one more question for you mandatory insurance freeks out there.....do you truly believe you will receive better health care delivery from mds in usa after this insurance `program is put into effect, or do you think the good mds who will no longer be able to afford their own malpractice insurance leave practice as did many with onset of hmos...or do you think they will take it in the chops and be your doctor pro bono, essentially......
remember, the govt already has removed the physicians ability to practice medicine as he sees fit, or to the best of his ability. that was with advent of hmos and regulation concerning the essential pricing of delivery of health care, named diagnosis related groups, the mandatory method of diagnosing patients, thanks to legislation made not by anyone in health care delivery,specifically , lawyers. many superb physicians left practice because of this. my uncle was one of the extreme dermatologists who sold practice and left because he was no longer allowed to practice his medicine as he saw fit--he was one of 7 dermatologists in usa at the time who was certified to perform reconstruction surgery during cancer surgery of face--he performed reconstructions as deconstruction occurred. i personally know many specialists who left practice due to the intrusion into health care delivery by legislators and legislation.
we will see just how affordable aca actually is when it proves itself--whichever way that happens to be. i think folks will find it way more pricey than anticipated not only insofar as insurance pricing is concerned, but health care delivery will also be affected by the further departure from practice by the better physicians,leaving practice to the inexperienced new from fellowship mds.
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Old 03-11-2013, 17:04   #65
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Re: Affordable Care Act - catastrophic plans cancelled

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Originally Posted by colemj View Post
If you (Cotemar crew) have pre-existing health conditions that require a lot of care or medical access, then it is probably prudent to wait until all of the healthcare issue ducks are all lined up before shoving off. If, however, you are generally healthy and can scrounge up the occasional C-note or two, then you don't have anything to fear about medical care and expenses once you leave the US.

Mark
We have enough cruising kitty set aside to throw the dock lines off.
We are both healthy with no pre-existing conditions, so all is good on the heath side.

The first mate finally agreed to give up the house and live on a boat full time, although she wants it to be a FP Helia 44, but that is a different story.

The first mate also wanted to make sure we had good medical insurance which until this ACA came up has left us in park.

This ACA may finally allow us to throw off those dock lines for a long cruising sabbatical.
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Old 03-11-2013, 17:07   #66
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Re: Affordable Care Act - catastrophic plans cancelled

For those that had saying their costs are lower with the ACA, are you only looking at a policy for the US?

My understanding was that the ACA exchanges wouldn't really cover you outside the USA.

But is would still seem that one could get a lower cost policy if outside the US than the exchanges.
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Old 03-11-2013, 17:33   #67
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Re: Affordable Care Act - catastrophic plans cancelled

Quote:
Originally Posted by zeehag View Post
what i am reading not just here but everywhere i have found mention of the aca, is that folks are confusing health care delivery with health care insurance.
the aca is a market for INSURANCE, not health care delivery. it has nothing to do with delivery of health care..
i also see folks who believe with all their hearts that social security is a handout. they also think veterans affairs is a handout.
anyone who has paid fica knows social security is a tax that pays for old folks and disabled citizens to prevent destitution.
every year every worker earning a paycheck pays into social security via fica. i have paid in over 500,000 usd. how much did all of you pay into that fund. i will have regained under 130,000 usd total of these paid into fund taxes by the time i am dead. same is with all of us receiving these benefits we PAID for.
as for veterans affairs benefits-- military doesnt pay enough to go out and do that which the kids in military are sent out to do. the benefits are hard earned, not to mention inadequate in many regions. the meds prescribed to vets are antiquated items which have been replaced in market by more effective medications, which vets are disallowed. the primary physician is a resident at some nearby university hospital, not a seasoned physician with experience in the exotic conditions many suffer, which is inadequate, at best.
i have worked in va hospitals and with vets under many situations out of hospital. yes i hear their complaints about the program. yes i helped train the mds in va..lol...as an rn i did this.
this aca is merely a market for insurance policies required by governmental agency to be used under penalty of fine. unemployed are not exempt from this mandatory purchase requirement.
one more question for you mandatory insurance freeks out there.....do you truly believe you will receive better health care delivery from mds in usa after this insurance `program is put into effect, or do you think the good mds who will no longer be able to afford their own malpractice insurance leave practice as did many with onset of hmos...or do you think they will take it in the chops and be your doctor pro bono, essentially......
remember, the govt already has removed the physicians ability to practice medicine as he sees fit, or to the best of his ability. that was with advent of hmos and regulation concerning the essential pricing of delivery of health care, named diagnosis related groups, the mandatory method of diagnosing patients, thanks to legislation made not by anyone in health care delivery,specifically , lawyers. many superb physicians left practice because of this. my uncle was one of the extreme dermatologists who sold practice and left because he was no longer allowed to practice his medicine as he saw fit--he was one of 7 dermatologists in usa at the time who was certified to perform reconstruction surgery during cancer surgery of face--he performed reconstructions as deconstruction occurred. i personally know many specialists who left practice due to the intrusion into health care delivery by legislators and legislation.
we will see just how affordable aca actually is when it proves itself--whichever way that happens to be. i think folks will find it way more pricey than anticipated not only insofar as insurance pricing is concerned, but health care delivery will also be affected by the further departure from practice by the better physicians,leaving practice to the inexperienced new from fellowship mds.
Zeehag,

First a fact check: You have been working for 72 years pulling down a minimum salary of $113,000 (SS contributions are capped at this amount)?

I ask this, because this is the salary amount and number of years at that salary necessary to have paid a cumulative $500,000 in Social Security. I don't know you, so it is possible that you have worked that long at that salary level.

I agree, that like you, I will never get back the amount of money I put into the SS system. Also like you, I am happy that some of my taxes went to helping people who needed it. My parents are two of those people. They worked hard and did their best by me, but they never earned enough to save for a 100% basic living retirement. I am also happy to have paid for road systems and other country infrastructure that I will never use (it is a very large country, and I won't be using all of it).

I am less happy that my taxes have supported obscenely rich agricultural industries and have been used to kill people in other countries. However, I understand that general taxation is a part of a social democracy and that the actual political aspects are handled through the democratic voting process.

In other words, similar to one of the points I think you were attempting to make, it is disingenuous to pick and choose in a tax-supported democracy what is a "fair" use of tax money and what is "unfair" based on political, social, cultural or religious beliefs. I agree that it is disingenuous to refer to someone receiving more relative tax help as "getting handouts", while ignoring that their 75 cent jumbo Snicker's Bar contains $3 worth of subsidized sugar. Or ignoring that Lockheed-Martin and many other companies would be out of business if the US worker tax-based collapsed. Or not seeing the benefit of fixing highway bridges in Oregon when you live in Tennessee.

The ACA is the Affordable Care Act. It's description and purpose is to make access to healthcare affordable. I don't think anyone is confusing that with quality of healthcare.

Certainly, almost the entire rest of the world outside the US has quality medical care programs based on controlled and reasonable costs, and none of these suffer greatly (regardless of all the scare stories told in the US).

After that, I can't make heads nor tails of your posting - it kind of goes off the rails for me.

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Old 03-11-2013, 17:45   #68
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Re: Affordable Care Act - catastrophic plans cancelled

So it's all about finding a PRN(take as needed) loophole that fits ones particular needs.

I thought this thread was supposed to be about appropriate health insurance strategies for cruisers, etc.with the new ACA rules, regs,etc., not about being for. or against the ACA.

And I really think your post should be edited, or removed for the considerable political rant it contains.

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Originally Posted by Mark Johnson View Post
In in my view, the ACA is the best thing for "Americans" cruising, since GPS...

We have cruised for many years and been to over 20 countries. We never carried health insurance when out of the country, as it was totally out of our meager budget. This was, however, with over $10,000 in the bank at all times, to "self insure". We also found that you could get IN country, or OUT of the country coverage, but no policies that covered both... (Like 6 mos in, and 6 mos out). Dual policies would be steep indeed!

In the third world OR Europe, the cost for minor stuff is at a fraction of US prices, so we could pay out of pocket for these small injuries.

Before the ACA, however, IF we were diagnosed that we needed a $150,000 operation, we the uninsured, were just going to have to die!

Now we are older, and prefer to be insured, HOWEVER... IF we were going out cruising for 3 years again, we can now just pay the penalty, go uninsured as we used to, and as before... pay out of pocket (from wherever we are), for the small stuff.

This is with the comforting knowledge that IF one of us got that big expensive illness, we could fly back home, and get good insurance without being put in a waiting cycle of 3 years, because of our "pre existing condition". With our INSTANT coverage, we could then get the majority of our hospital bills paid.

Sure, The ACA web site is pretty flawed at present, but they will no doubt tweak it and the ACA, to get the bugs out. It took over a year to get the bugs out of Romnycare and its web site... We need to give the ACA 5 years or so, before making a judgement...

The "ultimate solution" to our health care costs dilemma, imo, is to go for total "single payer" socialized medicine, like almost all of the developed world has, and then the prices go way down. These savings FAR exceed the amount that taxes would go up. Remember, we pay the least taxes now in the developed world... I would gladly pay 10% more in income taxes, for the benefit of a lifetime of free health care.

With a single payer system... If they ALSO change the legal structure to "looser pays", like in GB, there are suddenly only a fraction as many law suits across the board. This cuts doctor's expenses DRASTICALLY!

THEN:
With "non profit" hospitals & clinics, (albeit without all private rooms and marble floors), and without the overcharging "for profit" drug companies and their lobbyist, without the incredible expenses uncured in our complex billing, without insurance companies taking their cut, without all of the lawyers & malpractice expenses, and with flat fees for a procedure rather than complex itemizing... the cost of health care would be a fraction of what it is.

We Americans could learn a lot from other country's ways of offering high quality healthcare to their citizens! I spent a lot of time discussing these issues with my non-American friends. They were all incredulous that a prominent county such as ours, is so backwards when it comes to our antiquated healthcare/insurance intensive/litigation intensive ways.

Since most Americans are so opposed to this form of socialized health care, in spite of its advantages, it will probably never happen. Short of the switch to a single payer system, the ACA is at least a step in the right direction.
Time will tell.

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Old 03-11-2013, 18:16   #69
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Re: Affordable Care Act - catastrophic plans cancelled

Our experience in the Easter Caribbean reinforces that the US health care system is flawed, but superior to a lot of the world. In Trinidad, the cost of dental work, doctor visits, etc, are very good. The medical offices are about on a the same level as the US was about 25 years ago as far as equipment and sanitary conditions. The public hospital was a bit tough. The middle class in Trinidad carry insurance so they can go to the private hospital where they get better care. My wife fell in the boat, in Bequia. We went to the clinic there and immediately left and went back to the boat. The next day we sailed to St. Vincent and the hospital there. They had only a few thermometers available, and took her temp by putting the thermometer under her armpit as they had no way to sanitize it. We paid double the price for xrays, $20us instead of the $10 locals pay, which I really don't mind. As we were leaving, there was a truck unloading a full truck load of crutches, but no themometers. We sailed back and forth from Bequia to St. Vincent a few times for follow up treatment. We were fortunate there wasn't a serious injury. We had a friend who was hospitalized in Grenada. He had to supply his own food, which, obviously, he couldn't due. A nurse, for a fee, brought him meals from her home. Wasn't a lot of money. Our decision for the 9-10 years the boat was in the Caribbean was to carry a policy that would cover emergency treatment out of network. We did dental in Trinidad, but when the wife needed surgery, it was in the US.
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Old 03-11-2013, 19:29   #70
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Or just call the Dr and tell them you are a Cash payer...I did it last week when I broke my foot. At first they were booked up, told them I was paying cash and I walked right in past the 8 people sitting in the waiting room and walked out with an X-ray and cast-boot for less than the deductable anyway. no drama...no forms...no govenment handouts or programs needed.
When I go to my doctor, there's a queue , irrespective of whether I'm paying cash , people on government support , 100% subsidised etc. they all get seen in order. That's how it should be. Health should never be determined by money in a civilised country.

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Old 03-11-2013, 19:45   #71
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Re: Affordable Care Act - catastrophic plans cancelled

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People keep talking about self-insuring and only getting insurance if something big happens. If one decides not to get insurance unless something catastrophic happens that would cost a lot of money, how does one go about then obtaining insurance? I know they now cannot deny pre-existing conditions, but do you just show up at a hospital and demand an instant insurance form and write a premium check?

Even if the problem isn't acute and you could wait a short period of time before needing the healthcare, will you be able to get insurance in a week or two after they process the paperwork or whatever?

Mark
There is an open enrollment period during which you are able to sign up for new, or change existing insurance. This year the open enrollment runs until March. This is because it was expected that there will be glitches.

Next year and all the following years, open enrollment will be basically October and November.

If you don't sign up during this time you will not be able to sign up until the following October. This doesn't count if you lose a job, get divorced, or have some other precipitating event that causes you to lose existing insurance.

Signing up in Oct/Nov is for insurance that starts in January.
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Old 03-11-2013, 19:58   #72
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Re: Affordable Care Act - catastrophic plans cancelled

Ever heard the story of the pigs and the corn?
Maybe it belongs in the "joke thread".
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Old 03-11-2013, 20:00   #73
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Re: Affordable Care Act - catastrophic plans cancelled

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Surely , there will be clauses to prevent that type of moral hazard. In my case this side of the pond there is a 13 week before the first claim. There is no pre conditions ( as its community rated ) but there is a delay.

I suspect the small print will attempt to mitigate that issue

Dave
If you miss the signup window there could be a ten month delay before you can file your first claim...
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Old 03-11-2013, 21:10   #74
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Re: Affordable Care Act - catastrophic plans cancelled

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Health should never be determined by money in a civilised country.
And people shouldn't cut people off on the freeway or anchor too close in an anchorage. Show me a Country where people with the ability to pay don't trump those that don't and I'll show you a fantasy land. The ACA just put up the velvet ropes to keep the masses happy and those with money in the front of the line....as most Utopian Government programs always do, all good intentions aside...realiy is a hard place to live at times.

I got my "Plan Cancelation notice" due to the ACA so yes....I'm pissed off that some Government idiot decided for me, a guy with a Vasectomy and Wife with no Ovaries, needs to pay for maternity insurance. My insurance will double (thank you Obama)...so I'm paying the fine and taking a vacation to Mexico for our yearly health tests and procedures.
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Old 03-11-2013, 21:14   #75
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And people shouldn't cut people off on the freeway or anchor too close in an anchorage. Show me a Country where people with the ability to pay don't trump those that don't and I'll show you a fantasy land. The ACA just put up the velvet ropes to keep the masses happy and those with money in the front of the line....as most Utopian Government programs always do, all good intentions aside...realiy is a hard place to live at times.
France and Canada come close in my experience. Some countries make a reasonable stab at it. Some countries get all confused, mix up political ideology with healthcare , others just let you die in a free market

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