Affordable Care Act - catastrophic plans cancelled

[letsgetsailing3]

Originally Posted by Paul L

Its still a social service supplied by the government, whether you pay into it over lifetime via fees, taxes or work. VA health care is government supplied health care.

Social Security benefits are based on money that a person has paid during their lifetime. VA medical benefits are earned by providing military service. Yes, those things are different than the Affordable Care Act, and one might legitimately accept their earned benefits from these programs and STILL legitimately disagree that the government should be more involved in health care provisioning. Much in the same way that you might agree with a government service that you perceive gives you benefits, while disagreeing about another government service that you don't perceive as giving you benefits.

But perhaps we should save this debate for a political thread (as it is pure politics), and get back to the topic of U.S. cruisers searching for new health care options.

[jongleur]

HBWT:

What line on the IRS 1040 form
is the "less than 30,000" to be
eligible for the exchange?

[CatInHand]

Originally Posted by jongleur

HBWT:

What line on the IRS 1040 form
is the "less than 30,000" to be
eligible for the exchange?

It's your AGI with a few differences:

How to Calculate Eligibility for Health Insurance Subsidies - Businessweek

[Stu Jackson]

Originally Posted by SV THIRD DAY

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.

Going back to page 2. The operation I needed to have (broken femur, not a simple boot cast) cost over $12,000. NOT pocket change. Wouldn't work for me.

Obamacare "Victim" in Florida Happy She Can Get Real Coverage | New Republic

[Southern Star]

Canadians do not go to the US for 'heart surgery' unless: an emergency while in the USA dicatated it; or, money was no object and as they already owned property and resided there on at least a part-time basis, it was therefore convenient; or, if there was some very rare condition treatable at this point by only a select few doctors worldwide, none of whom were in Canada (and in which case, our own health insurance might give coverage). I have had heart surgery in Canada, as did my father and many others that I have known. No one I know has had heart surgery in the United States.

Surely, however, this thread is not about scare tactics, or attacks on health insurance coverage in Canada or France or countries other than the USA - it is about the effects of the 'Affordable Care Act' on insurance coverage and costs for American cruisers (the only ones to whom the Act applies).

To a non-resident of the USA, I read this thread with interest. It would seem to me that the impact will be case specific - individual income, risk factors, home State, insurance provider, type of coverage and existing policies, if any, will all impact on whether a person is a winner or loser (or perceived winner or loser) under the Act. It is nice to know that at least some cruisers (particularly those with limited incomes) seem to believe that they may be better off than before. In a country as large and diverse as the USA, I cannot imagine any law that would meet with the approval of (or indeed be perceived to benefit) everyone. I suspect that only time and experience will tell the whole story.

Nevertheless, in the interim it is clearly productive to hear specifics from those who are able to provide the same in terms of costs and coverage for themselves. The information concerning relative costs from state to state is surely also helpful to members of this forum for, as has been pointed out, it is typically easier for persons who cruise internationally for much of the year to change their 'home' state.

In any event, thanks to the moderators for keeping this thread away from political vitriol and largely centered on the topic at hand.

Brad

[CatInHand]

Originally Posted by Southern Star

Canadians do not go to the US for 'heart surgery' unless: an emergency while in the USA dicatated it; or, money was no object and as they already owned property and resided there on at least a part-time basis, it was therefore convenient; or, if there was some very rare condition treatable at this point by only a select few doctors worldwide, none of whom were in Canada (and in which case, our own health insurance might give coverage). I have had heart surgery in Canada, as did my father and many others that I have known. No one I know has had heart surgery in the United States.


Brad

Especially since WHO ranks Canadian healthcare above the US.

http://en.wikipedia.org/wiki/World_H...health_systems

In fact, many countries rank above the US which suggests that you should consider your destination and the quality of the available care before considering the need for catastrophic, US based insurance.

[Mark Johnson]

In in my view, the ACA is a breath of fresh air for American cruisers...

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! For couples like us that cruise on about $15,000 per year, health insurance from the US can be a deal breaker.

In the third world OR Europe, the health care cost for minor stuff is at a fraction of US prices, so we could pay out of pocket for these small injuries. This was for health care that is EVERY bit as good as ours, or better!

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! We now consider that too much of a risk to take.

Now that we are older, we prefer to be insured, HOWEVER... IF we were going out cruising for 3 or 4 years again, we now have the option of just paying the yearly penalty, going uninsured as we used to, and as before... pay out of pocket (from wherever we are), for the small stuff. As seniors... Without the ACA, we would be afraid to go uninsured again, as we might be uninsurable when we return, due to our numerous pre existing conditions. If we were only out of the country for part of the year of course, it makes more sense to stay insured, even though it would cost over 1/3rd of our yearly budget!

With the ACA, the "going cruising uninsured option" is now at least possible for some of us, with the comforting knowledge that IF one of us got that big expensive illness down island, we could fly back home, and get good insurance without being refused or put in a waiting cycle of 3 years. With our "almost" INSTANT coverage guaranteed, we could hopefully 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. I think we need to give the act at least 5 years or so, before making a judgement as to its sucess...

THE MUCH BIGGER CHANGE:
Imo... The "ultimate solution" to our skyrocketing health care costs dilemma, would be to go for total "single payer" socialized medicine, like most of the developed world has, and then the prices would go way down. These savings would very likely FAR exceed the amount that taxes would go up. Remember, we pay among the least taxes in the developed world, so it might not hurt so bad... I would gladly pay 10% more in income taxes, for the benefit of a lifetime of free health care.

Along 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 hospital's, doctor's, and thereby OUR expenses, DRASTICALLY!

THEN:
With "non profit" hospitals & clinics, (albeit without all private rooms and marble floors), and without the "for profit" drug companies, without the incredible expenses uncured in our complex billing system, 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 in the US would be a small fraction of what it is now.

We Americans could learn a lot from other country's ways of offering high quality healthcare to their citizens! When out cruising, we had European friends who did pay a small yearly fee into their country's healthcare system, but when they needed it, they docked the boat and flew home for a major operation, at no extra charge. Without having to budget for health emergencies, the peace of mind that they could cruise with was enviable indeed.

The ACA in my view, is at least a step in the right direction.
Let us all hope so...

Mark

[goboatingnow]

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!

well to my knowledge and certainly in European countries , if you are hospitalised you will be treated unto and including whatever is needed to make you well and this will be provided FOC at the point of delivery, and is not dependant on your nationality.

I don't think anyone is going to leave you "die"

Elective treatments are another matter entirely

Dave

[John A]

I thought that I had an offshore health plan from the US, each year the premium increased to around #4500 a year.

While in northern Panama I had to have some spot welding done to the inside of my blatter. Six days in the hospital with total cost of $395usd, I never submitted a claim.

Two years later I had a spot of cancer removed from inside my blatter, while in Trinidad. three days in a private room with a total charge of %5600. My insurance paid $1300 so I cancelled it. Each year I returned for an exam for around $1000, a two pass cat scan was $300

Three weeks of office visits to fix my foot in Bequia was free.

My sister in Washington State enrolled me in Medicare while I was still cruising and it works in the USVI and PR.

Most long term cruisers have neither medical insurance or boat insurance.

[Dockhead]

Originally Posted by goboatingnow

well to my knowledge and certainly in European countries , if you are hospitalised you will be treated unto and including whatever is needed to make you well and this will be provided FOC at the point of delivery, and is not dependant on your nationality.

I don't think anyone is going to leave you "die"

Elective treatments are another matter entirely

Dave

Only if it doesn't involve an overnight hospital stay. At that point, if you don't have one of those magic Euro health cards (how I would like to have one of those), you have to cough up.

Cost is still a fraction of what it would cost in the US.

[sailorboy1]

Originally Posted by Mark Johnson

With the ACA, the "going cruising uninsured option" is now at least possible for some of us, with the comforting knowledge that IF one of us got that big expensive illness down island, we could fly back home, and get good insurance without being refused or put in a waiting cycle of 3 years. With our "almost" INSTANT coverage guaranteed, we could hopefully get the majority of our hospital bills paid.

I don't think this is true, but it doesn't seem anyone really knows the answer which is the point of the thread to me. I think you would have already had signed up for the insurance during the yearly enrollment (unless you had a qualifying event but still have signed up prior) in order to have coverage.

I don't think the system works as: 1 -get sick, 2 - sign up, 3 -get covered for #1. It so no one would ever sign up and would wait till they got sick first.

[SV THIRD DAY]

Originally Posted by goboatingnow

I don't think anyone is going to leave you "die"

You are right Dave
With many members of my family working in the evil medical industial complex, no hospital in the USA was allowed to just let you die if you came in seeking care. So much of the arguments these days are talking points and myths spread by both sides of the argument that it's hard to be against the ACA without being acused of wanting people to die. From a winning the argument POV it's a smart move to demonize the oposition, but is doesn't seem to me, looking at Washington DC these days, that the demoization game is working out too well.

This is what worries me folks:
Talk to the average Joe American about us cruisers and boat dwellers and we are viewed as the "evil 1%-ers". Of course we know it is not true, but when the "us vs them" cards are played it won't end well for people with enough income to live "The Dream" on a boat. Before long we will be in the crosshairs right next to the evil drug company exec that would rather buy his gold watch than let you kid have a live saving cancer treatment or the Investment Banker that got the bailout.

[colemj]

Originally Posted by Mark Johnson

THEN:
without the "for profit" drug companies... the cost of health care in the US would be a small fraction of what it is now.

Not to nitpick, but was there really a time when drug companies were non-profit entities? If so, that is a new one for me.

Perhaps you meant there was a time when it did not cost so much to bring drugs to market because of fewer regulations, etc?

Mark

[colemj]

Originally Posted by John A

Most long term cruisers have neither medical insurance or boat insurance.

Can you support this with evidence? It fits almost none of the people we have ever met cruising. A minority are without boat insurance, but all non-US citizens have medical coverage, as do any US citizens older than 65. For those US citizens younger than 65, the intersection of no insurance of either ilk is pretty much limited to the very young cruisers.

And there are few of those.

Mark

[SV THIRD DAY]

Originally Posted by sailorboy1

It so no one would ever sign up and would wait till they got sick first.

BINGO....the exact decision all those "fine payers" are making.