ACA/Obamacare for American Cruisers Abroad MERGED THREADS

[HBWT]

I hope I can help with some of the questions and misinformation.

No co-pays do not count towards a annual deductible. They do count as the max out of pocket but that is entirely different from a deductible.

Your current plan will change nationwide. All plans unless exempt (you would know by now if it was) will be changed Jan 1 2014. Many previous benefits will be dropped and I am sure out of country pay and claim is one of them. Unless specifically designed for out if country use (Kaiser and Blue Cross have options) I would not assume your plan will stay the same. Group or employer sponsored plans will be changing at renewal in 2014 to cover expanded essential benefits. Catastrophic plans do not count as a silver level plan and not available for tax credits. Whoever had a friend that would pay 36 per month for a catastrophic plan is uninformed of this fact.

The exempt companies and unions that everyone foams at the mouth about are entirely different. These are "self funded" plans and the entity pays total cost out of pocket. Microsoft and the SWU are great examples of this exemption. Oh yes, back massages at work and no out of pocket cost, we should all be so lucky.

In order to receive subsidies (tax credits) you must purchase a silver level plan or better. For example the cheapest silver plan in my state for a 30 year old is 274 per month and for a 60 year old is 619 per month. If you qualify for tax credits and cost sharing you will have deductions based on annual GROSS household income. Single 43,000 or less, married 58,000 or less, family of 3 72,000 or less and family of 4 92,000 or less. If one family member is eligible for a employer group plan the entire family is ineligible for tax credits. If my wife is offered a plan through her employer, I can't receive tax credits through the exchange.

Plans are offered inside and outside the exchange. You will find a greater selection and price option outside of the federal and state exchange. Your local (stateside) broker would probably be the best help in finding the right plan for you. All states allow brokers to work inside and outside the exchange.

Disclosure: I am not a health insurance broker.

Remember these are tax credits and not subsidies. This allows the state and federal government to recapture if overpayment ( calculated monthly). This is a huge problem for cruisers as annual income levels are always in flux based on needs. For example if last year you only made 32,000 you receive a tax credit for that amount. If you need to replace some items onboard and take 36,000 for the year your tax credit is SIGNIFICANTLY reduced based on FPL (Federal Poverty Level) and recapture will be in effect when you file your taxes for the accessed monthly rate . Sorry to burst anyone's healthcare bubble.

Lastly in regards to health insurance companies and making "tons of money" insurers are required to spend 80% of all premiums payed on actual patient care. If that value is not spent, you will receive a refund in the mail at the end of the year. If you want to be mad at the rising cost of healthcare, blame all those elderly individuals who created the baby boomer generation. Blame hospitals for not publishing rates and allowing consumers to shop, blame the added tax you pay on your health insurance premium 7% in 2012 and goes to 13% in 2015.

Hope this helps.

[Boatguy30]

If you spend savings on boat repairs that is not income.

I appreciate your post, but I think very few of cruise solely on "returns" on investments. Most of us withdraw a certain amount from a nest egg and that is not taxable income.

I myself will need to slightly over report self employments income to qualify for the exchange as FL is not doing Medicaid until after the next election (I'd guess)

So if you go to a independent broker/ he gets his cut AND you can still get the subsidy? I actually thought you needed to buy from the exchange to get the subsidy.

See, learn something every day.

[HBWT]

I agree that some retirees have a set nest egg, but the majority of retirees under 65 that need health insurance and do not collect early social security live off of their investments. 90% of which are 401k, 403b, IRA, all calculated into a 99r and taxable as income. Most draw variable amounts based on needs. I would bet my bottom dollar if more so for those of us out cruising.

Yes your local broker gets a cut, about 3% of your premiums total but has no effect on your premium rate. The broker can sign you up in the exchange if you qualify for tax credits.

[goboatingnow]

reading the ACA with a European perspective, its seems a really good deal

I mean banning pre-existings, great , and subsidising the poor , is great ( and teh subsidies seem very generous).

community rating, thats good too,

The Mandate thing is unusual , but I suspect everyone is going to take some plan , so in reality its of very little consequence.

The "exchanges" idea seems complex, why not let the insurance companies run that subject to controls.

I mean all in all , complex, but not bad. lots of bureaucracy , but wouldnt be the US without lots of that ,, right.

its would seem to suggest a family of 4 could get cover for 200-500 a month ( upper end is a little steep) . not too bad, then add back the tax credits which seem to extend a long way up the salary scale. not bad at all.

whats happens above the 400% cutoff, ??

I suspect over time , with tweaks it will get sorted. Cant see it being repealed once most people sign up.

Historic day


Dave

[jkindredpdx]

Originally Posted by colemj

. . . 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. . .


Mark

I've been too lazy (head in the sand) to look into the details. Thanks to some info in this thread I decided I better learn more. Oregon's had their CoverOregon.com site up for some time with information and the Director has been on the radio radio for months. I know part of the wait was to allow providers time to qualify.

This morning I started with the HealthCare.gov site chose my state and got a plan comparison within minutes. Of course, each state is different. Options for my age and income will start at $230/mo with $5000 ded and $6350 OOP max. I used Ehealthinsurance.com before to shop and the Exchange looks a lot like it, just more information and the lowest price plan offered now meets the imposed minimum for my age and income.

Originally Posted by colemj

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

IMHO, the IRS website is very good (painful as the answers might be), NOAA is great, and our State Unemployment site was good when I needed to use that.

[goboatingnow]

This morning I started with the HealthCare.gov site chose my state and got a plan comparison within minutes. Of course, each state is different. Options for my age and income will start at $230/mo with $5000 ded and $6350 OOP max. I used Ehealthinsurance.com before to shop and the Exchange looks a lot like it, just more information and the lowest price plan offered now meets the imposed minimum for my age and income.

Just by way of comparison, what age and are you single etc, no preexistings etc

$5000 seems a lot of deductible from this side of the pond, is that capped or annual or what. does that cover ordinary practitioners ( ie GP visits, are they limited etc ) /prescriptions etc

Whats the cost if you lower the deductibles ( like say to 500-1000 dollars or none) .

Does the ACA have co-pay systems or are they now gone.

And do you qualify for the federal subsidy.???

Aside from the deductibles , its seems like some , this side of the pond

interesting. complex but interesting

dave

[belizesailor]

Originally Posted by Boatguy30

Ok, so this isn't political.

....

Now there are plenty of issues with all health systems, but when you look at the total amount of money the US spends on healtcare there is more than enough money being spent to give every American the VERY best care.

the problem for any approach is breaking the medical industrial complex we've built up. No doubt half those big yachts they can't build fast enough belong to implant CEOs, insurance CEOs, pharma, etc, etc

Again, there's no reason why we shouldn't have the best care and we already spend the money. but it's hard as hell to come up with a system when only 1/2 of the people are willing to try to fix the problem. and the other 1/2 spend literally billions to fight it.

Non-politically agreed.

The fundametal problem in the USA is that the insurance and financial side of the system is broken. The ideal, but not practical, solution would be to trash it and totally redesign and rebuild, but thats not going to happen. From having worked in the industry, and skimmed through the actual ACA, it looks like a reasonable compromise first step to me. Hopefully that will prove true.

What people forget, or dont know, is that it is really just a frame work with a lot of details to be worked out as it is implemented. Unfortunately, our broken political system is going to make fleshing out the details a monumental challenge.

[belizesailor]

Originally Posted by goboatingnow

Jeepers a nurse paying for medical, wow , all the RNs I know , just whistle and medicine appears , and they haven't half a good avatar as yours !!!! I don't think any doctor or nurse needs any form of insurance , I mean there,re inside the system

Yes they do, there are proffesional courtesy discounts, but major medical in the USA is still going to cost big bucks. Have a friend whose nurse practicioner wife was diagnosed with cancer while not covered...cleaned them out financially and she still died...tragic...should not happen in a country with such vast resources.

[belizesailor]

Originally Posted by goboatingnow

No unicorns please on CF. there's enough myth as it is.

Dave

No myths or unicorns, the referenced calculator does exactly that.

[belizesailor]

Originally Posted by Ocean Girl

Third day, my boat sank ( brain tumors ), I'm pretty darn grateful for the pre existing clause.
God bless

Wow, good luck for, and to you. Had a freind just a couple of years ago diagnosed with a large brain tumor. No coverage, hit him hard financially, but he was in strong fianancial condition and it was a survivable hit, he lived thru it too.

Hope the ACA works well for you and your outcome is good.

If your up for it, keep us posted on how it works out.

[belizesailor]

Originally Posted by goboatingnow

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

...

Depends on your overhead, its not what you make but what you spend. When I was a young engineer only making $40K, I had plenty of cash because my overhead was almost zero. I now have friends making 10x that who would have trouble putting their hands on $6K because they have huge overhead.

Also, borrowing 6K, or owing that to the medical service providers, is certainly far from an insurmountable burden on $40K.

[Aussiesuede]

Originally Posted by goboatingnow

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.



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

While I'm no big fan of insurance companies, the 'pricing' isn't nearly as much their fault as it is the hospitals. Insurance companies EARN more money if you, the insured, uses the cheapest service as opposed to the most expensive service.

Example: Let's say your insurance premium is $100/month. You fall off your bike and bang your head. An ambulance get's called via 911. The folks at 911 call the ambulance service that's been awarded the standard service call for that area. But there are 3 ambulance providers in the area.

Company #1 charges $125 for delivery to the county hospital.
Company #2 charges $400 for delivery to a hospital it's contracted with & $1200 for delivery to one it's not contracted with.
Company #3 charges $800 for delivery to a hospital it's contracted with & $1500 for delivery to one it's not contracted with. And $2000 to the county hospital

The insurance company has no say in which of those 3 companies get's to provide the service, but are responsible for paying the wildly divergent fees.

Next you are delivered to a hospital.

Hospital A has a flat rate agreement with your Insurance company of $400 for an ER visit and bone reset. When at the hospital, the doc suggest an MRI to be on the safe side. THAT hospital charges $1200 for an MRI.

Hospital B has a floating scale agreement with your Insurance company of $500-$800 for an ER visit and bone reset. When at the hospital, the doc suggest an MRI to be on the safe side. THAT hospital charges $800 for an MRI.

Hospital C has no agreement with your and charges a UCR of $4000 for an ER visit and bone reset. THAT hospital has no MRI and refers to a private MRI facility which charges $250 for an MRI.


Obviously the insurance company would most prefer you were delivered to Hospital A by Ambulance company #1 and then goto the private medical facility for your MRI because that's the lowest cash outlay for them. But it's not their say. And the Supreme Court had been hearing a case about whether or not it's legal for YOUR insurance company to INFORM you of lower cost options when they have other contractual agreements with the hospital where you're receiving care.

The BIGGEST culprit here are HOSPITALS which are acting as profit centers and competing for the highest number of insured patients in need of the highest billable care.

[jkindredpdx]

Originally Posted by goboatingnow

Just by way of comparison, what age and are you single etc, no preexistings etc

$5000 seems a lot of deductible from this side of the pond, is that capped or annual or what. does that cover ordinary practitioners ( ie GP visits, are they limited etc ) /prescriptions etc

Whats the cost if you lower the deductibles ( like say to 500-1000 dollars or none) .

Does the ACA have co-pay systems or are they now gone.

And do you qualify for the federal subsidy.???

Aside from the deductibles , its seems like some , this side of the pond

interesting. complex but interesting

dave

My parameters: 59yrs in 2014, Single, non tobacco, no pre-existings. The $230/mo I quoted was the least expensive for which I was eligible. $5,000 is the highest deductible I'm allowed. $6350 is maximum OOP/Out Of Pocket (most I'd have to pay). After that it's covered 100%. Some plans provide free or co-pay preventative care below the deductible is reached. Don't know about prescriptions. That is what I gleaned from the FAQs posted on the site for Oregon. I assume each state has differences.

$500-$1000 ded is priced about $350-$600/mo. I didn't see an option for an HSA, but I would deposit into one if I can, you can then use those dollars to cover the payments, co-pay, and not covered procedures if any tax free. I don't qualify for subsidy but I understand there is a sliding Tax break.

[RainDog]

Originally Posted by jkindredpdx

Some plans provide free or co-pay preventative care below the deductible is reached. Don't know about prescriptions.

Under ACA all plans have to provide free preventative care with no co-pay. They also have to cover prescriptions and they count towards the deductible and out-of-pocket max.

[Pete7]

Originally Posted by Aussiesuede

The BIGGEST culprit here are HOSPITALS which are acting as profit centers and competing for the highest number of insured patients in need of the highest billable care.

Suddenly the UK's National Health Service including the ambulance service funded centrally by Government looks like a model of simplicity. Whether it is affordable in the future decades is a different question, but health care regardless of problem is free at the point of treatment including all follow up appointments. Visits to your doctor also free, with minor charge $10 for prescription drugs. The true cost being incorporated in general taxation.

Oh and it works when you are visiting other foreign exotic European counties as well which is kind of neat when you go sailing.

Pete