General Discussion
Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsI thought the ACA covered preexisting conditions ....
Gold Plan...Gold Plan co-pays in my area for "Specialty Medications" run from 25% to 50%.
Ever check the cost of MS drugs?
Oh, wait, I can always go direct to the drug company and plea for charity:
http://www.copaxone.com/shared-solutions/copaxone-co-pay
FSogol
(45,485 posts)Junkdrawer
(27,993 posts)with a non-ACA policy.
pnwmom
(108,978 posts)Also, the ACA policy has a 2014 maximum out-of-pocket of $6350 for drugs this year. In 2015, your ACA policy will have a maximum out of pocket covering both medical and prescriptions for the same amount -- $6350.
Glitterati
(3,182 posts)Seriously, you really have to deal with FACTS, please.
joeglow3
(6,228 posts)Edit to add that everywhere I looked listed your number as the FAMILY deductible (meaning for everyone in total) and not for each individual in the family.
questionseverything
(9,654 posts)I started looking after reading this thread...this one is based on 55 grand income/////////////////
You could receive a government tax credit subsidy of up to:$7,689 per year
(which covers 71% of the overall premium) Amount you pay for the premium:$3,076 per year
(which equals 5.86% of your household income and covers 29% of the overall premium)
OTHER LEVELS OF COVERAGE
The premium and subsidy amounts above are based on a Silver plan. You have the option to apply the subsidy toward the purchase of other levels of coverage, such as a Gold plan (which would be more comprehensive) or a Bronze plan (which would be less comprehensive).
For example, you could enroll in a Bronze plan for about $694 per year (which is 1.32% of your household income, after taking into account $7,689 in subsidies). For most people, the Bronze plan represents the minimum level of coverage required under health reform. Although you would pay less in premiums by enrolling in a Bronze plan, you will face higher out-of-pocket costs than if you enrolled in a Silver plan.
OUT OF POCKET COSTS
Your out-of-pocket maximum for a Silver plan (not including the premium) can be no more than $4,500. Whether you reach this maximum level will depend on the amount of health care services you use. Currently, about one in four people use no health care services in any given year.////////////////////////////////////
I am not sure 4500 is any more affordable than the 6350 but it does seem there is a difference in what out of pocket can be
noamnety
(20,234 posts)you may as well get charged 100%. It's not happening either way.
I suspect the OP's point is that for most people the treatment is available "in theory" for MS - but in reality, not so much. It's really not covered.
Walk away
(9,494 posts)He just didn't bother to check and see that deductibles and OOPs include perscription drugs.
MADem
(135,425 posts)You've gone and ruined the "faux outrage" in two succinct sentences!
Well done!
How much more of this shit will be flung before they just give it up?
VanillaRhapsody
(21,115 posts)wonder if Obamacares covers Faux Outrage? Is there a pill for that?
pnwmom
(108,978 posts)the same maximum out of pocket will cover both medical and drug costs -- and could be reduced by tax credits for eligible incomes.
noamnety
(20,234 posts)Not just the $6350 as an emergency fund, but that much extra in their salary each year?
VanillaRhapsody
(21,115 posts)might be better....
MADem
(135,425 posts)Let's just go back to the "old" system, where people relied on emergency rooms and ducking the bill collector....
So much better, doncha know....
for the irony-impaired.
noamnety
(20,234 posts)A rent subsidy that covers 50% of the cost of living in a mansion isn't useful for someone who doesn't have the other half of a mansion's mortgage.
I'm not all opposed to the ACA. I had a thread on the greatest page a while back saying how it benefited my family personally.
But I'm not into the disneyfication of things, where every bill, every politician is either 100 percent sainted or satan. I can recognize that it helped us, but for some people it still doesn't get them access to the healthcare they need.
It helped me, but someone else in my family is getting married because they finally got a job that comes with health care, and their long time partner needs access to it. I am happy for them getting married, but sad that access to health care (not to "insurance" - but to the actual health care) is still a reason that people have to hang onto a job, or a reason to feel pressured into marriage.
And I understand that for some people, just getting married or getting that job isn't a path to health care, and the new system in effect still is the old system, as far as it affects them personally.
MADem
(135,425 posts)That's what the Big Fake Out is, here. It's not about Disneyfication, it's the whole "Perfect is the enemy of the good....because...OBAMA!" line. I'm not accusing you of this, mind you. It's just that I see it here constantly. It's repeated over and over and over again. It is TIRESOME. And with ACA, you DON'T have to keep your job to be insured, and you DON'T have to get married, either--it's liberating.
Under the old system, health insurance or no, in that lousy job and married to that jerk, if you hit that lifetime cap with super-expensive drugs, you're screwed. Forever. So, if you can't afford that allegorical mansion with the ACA, you couldn't afford it under the old "find your own damn insurance" system either. One way or another, you were HOMELESS.
I have a poverty stricken relative who had a brain stem stroke. MONTHS in hospital and rehab, and everything was covered, save meds, which at the generic rate were inexpensive.
I have a working relative with cancer who doesn't have to sell the house to afford the chemo and the surgery. I think that's good news. Silly me!
People who have chronic illnesses, everything from MS to cancer to AIDS, can't be turned away now. You don't think that's a big deal? A sea change?
The profit taking by the insurance companies is also capped. That may not be a solution, but it is one helluva start.
I think people who are looking for the negative, the bad, the "Waaah, it sucks" of the ACA are carrying the GOP water BIG TIME. Particularly this year, during the mid-terms. I can't help but wonder what in hell they're thinking. Do they REALLY want a wing-nut Senate to go with the wing-nut House?
The ACA is the greatest thing going, to this point. It's a place on the road to better things. It is one of the most important pieces of social legislation to happen in the last forty years. I agree with Skinner wholeheartedly in that regard.
There will come a time, and it will be on a fairly short curve, that people who crapped on this legislation (because it didn't line up all the people working in the insurance industry and shoot them*--or didn't solve the very separate "drug price" issue--which some people VERY wrongly think are "free" with the NHS, and in Canada, but they are not... or some other reasons) will realize they are on the wrong side of history, and they will DENY that they ever opposed it in the first place. I anticipate a whole heaping load of the "But....but.....****I**** was always in favor of it" chorus in a year or three, from people who were most decidedly NOT in favor of it--or if they (secretly) were, they liked to play the "opposite game" and thought everyone knew what the hell they were on about.
*Huge for the irony-impaired.
Ms. Toad
(34,072 posts)This statement is, unfortunately, not true:
"Anyone who is "that poor" can get subsidized. And there are max out-of-pocket costs."
It was intended to be true - as the law was written. Unfortunately that provision was gutted by the Supreme Court for the poorest of poor in the red states which decided not to expand Medicaid. In those states, the poorest of the poor cannot obtain insurance except by purchasing it at full (unsubsidized) price - which may equal or exceed their salary. If they cannot afford the premiums, their out of pocket expenses will be uncapped.
Myrina
(12,296 posts)Because ACA! Best thing since sliced bread. EVAH! And isn't POTUS just dreamy??
Even though most of us can't afford the deductible or co-pay.
VanillaRhapsody
(21,115 posts)best thing for Women's rights since Roe V Wade....that is for sure! Or did you like paying twice as much as men Myrina?
Glitterati
(3,182 posts)Then, hey....well, as the right wingers would say.....you're screwed, too bad, so sad.
VanillaRhapsody
(21,115 posts)you don't get off that easy...
What is the max out of pocket..
This might impress all your rightwinger friends....but it won't fly on DU....
Glitterati
(3,182 posts)However, you might want to ask the OP for those specifics.
Of course, I do think he'd be a fool to share such personal information with you, but you might be able to convince him.
VanillaRhapsody
(21,115 posts)but you know that....
You want to sling shit but wail when asked to provide specifics....shit gets slung back.
Glitterati
(3,182 posts)I have no intention of sharing MY personal information with someone like you with a reputation of making up facts out of whole cloth!
Too bad, so sad.
VanillaRhapsody
(21,115 posts)and I am no genius...
"making up facts" hahahahahahahahahah I provided links to support me....
You want to be able to just say whatever you want....then you accuse me of making up facts out of whole cloth...hahahahahahaha
Glitterati
(3,182 posts)And, links to myths are easy to find.
VanillaRhapsody
(21,115 posts)myths like the ACA "rate review"? those myths (I linked to healthcare.gov)....like subsidies for the poor....that myth? Like the gold plans are not subsidized...that myth?
You got nothing....
Here...for your further "research"
https://www.healthcare.gov/
Glitterati
(3,182 posts)Got the FACTS and insurance. It's a good damned thing I didn't depend on DU for those facts, though.
VanillaRhapsody
(21,115 posts)I HAVE it too...FYI...and I know more about it than you obviously.
Glitterati
(3,182 posts)You really make my day. A barrel of laughs a day.
VanillaRhapsody
(21,115 posts)being full of hate is not good for your health.
Glitterati
(3,182 posts)Most especially who and what I do or do not "hate."
That is your single most obvious problem - your refusal to do your research.
VanillaRhapsody
(21,115 posts)I know that much...
I have done my research....you would be so surprised to know how I researched in fact....
I HAVE the affordable care act....and I have gone without insurance....its a GODSEND!
Glitterati
(3,182 posts)anything you say.
Thanks for being such a prime example of all that is wrong with Obama cheerleaders and their assumptions about their fellow travelers.
It is you, and your cohorts, who attack without doing your research who give the right wingers all the ammunition they need to defame ACA.
RandoLoodie
(133 posts)aquart
(69,014 posts)VanillaRhapsody
(21,115 posts)or just hates President Obama...
Walk away
(9,494 posts)anything between $6350 and $0. Of course that would be in a Silver plan. For some reason the OP is only looking at Gold.
Glitterati
(3,182 posts)on a silver plan.
VanillaRhapsody
(21,115 posts)you seem to always miss that part...
Glitterati
(3,182 posts)My income is $17,000 per year.
IF it were capped at 9.5% of income, my deductible would be less than $1,700 per year.
Oooops.
VanillaRhapsody
(21,115 posts)then you must live in a state that didn't expand Medicaid....my regrets...
Glitterati
(3,182 posts)there ya go.....leaving out those pesky things called FACTS again!
Damn, you just can't win, can you?
VanillaRhapsody
(21,115 posts)that would be your state not the Affordable Care Act....
VanillaRhapsody
(21,115 posts)VanillaRhapsody
(21,115 posts)but your "research" at "msn money" and not on Healthcare.gov tells you so!
Walk away
(9,494 posts)And he can keep his old policy this year and wait until the medical and prescription OOPL is combined. He seems to want a gold plan even though there is a 50% co pay but on Silver plans it's only 40%.
There are counselors at the exchange that can help figure out the best plan for your needs.
One of my meds comes to $400 a month. Because it is the brand name drug my insurance company paid half and I had a $100 per month coupon from the drug company. That left $100 per month for me for just one drug. I called the insurance company, explained my situation and they now cover another $96 per month. Now I pay $4 a month and they even called my pharmacy to reimburse the month of January.
People really have to try a little harder to resolve their issues instead of just reacting negatively and giving up.
Glitterati
(3,182 posts)I believe that's WHY the OP came to DU.....to try a little harder to understand and get answers.
Besides, I don't believe he has inferred that he has "given up" at all.
Oh, and the subsidy you are getting from the insurance company, did that entail filling out some paperwork or did they just give you that $96 per month without any hoop jumping?
Walk away
(9,494 posts)but I usually expect to find a problem or two with health insurance coverage. It is pretty standard if you need the rules to change. It has always been that way and it is that way with Medicare as well.
I don't consider it "hoop jumping" to do some research and make a request to get what I want once and a while.
The OP chose coverage that had no subsidies and the highest % OOP for specialty drugs. Why? I cannot imagine. Things like insurance, mortgages and other contracts do require some reading and preparation before you enter into them. The information is readily available at www.healthcare.gov
Glitterati
(3,182 posts)but, I do think that we need to be patient with folks who really aren't use to dealing with the bureaucracy of insurance companies.
For some, like my daughter, it's not something they have ever dealt with before and they don't understand the process.
Accusatory questions just make folks defensive and don't open the door to changing hearts and minds about ACA.
Walk away
(9,494 posts)They must have done backflips avoiding looking at the Silver level plans that would clearly be better for him. The web site is very clear about what is offered. If you have a question about something you should just ask it and not make dramatic accusations that aren't quite factual.
Glitterati
(3,182 posts)were nothing more than political showmanship?
For what purpose? To what end?
Just to give a showcase to Obama cheerleaders so they could attack him and his family? Yeah, I bet that's exactly how he wanted to spend his day.
Walk away
(9,494 posts)This is about the Affordable Care Act which, apparently, you should be grateful for instead of spreading your scare tactics around the internet. Telling people at this critical time that, if they sign up, they may see their premiums triple is not only untrue....it is harmful to all of us who need the Exchange and possibly deadly to folks who believe you and don't sign up because of you.
I have not mentioned the President in this thread. You are the one using his name as an insult to anyone who doesn't like it when you make up facts.
VanillaRhapsody
(21,115 posts)no agenda there at all....
accusing OTHERS of not doing research....when you got your information from "MSN Money"
Glitterati
(3,182 posts)of Obama cheerleaders making outrageous claims, posting lies, defaming fellow Democrats because they DARE to question their hero!!!!!!!!
Your true colors make me ashamed to share the Democratic party with you.
VanillaRhapsody
(21,115 posts)rate review...is written into the Affordable Care Act...Is that a lie? (Rates to triple next year according to YOU and MSN Money)
Have I defamed or lied about what you said?
Nope....
Glitterati
(3,182 posts)Still all fired up and no one to argue with.
I'm off to work. Later.
VanillaRhapsody
(21,115 posts)I am having a boat load of fun punishing you for your false accusations regarding the ACA...that you got from MSN Money!!!!
VanillaRhapsody
(21,115 posts)they come here with a "narrative" and an agenda....
I didn't jump any hoops....took 15 minutes to get mine....
Glitterati
(3,182 posts)That's what your behavior is.....shameful. It makes me ashamed to share the same political party with the likes of you.
VanillaRhapsody
(21,115 posts)hardly.
Shameful to LIE about the single biggest achievement in women's rights since Roe V. Wade....Yeah I am not ashamed to support that....why don't you!
Ikonoklast
(23,973 posts)Vanilla Rhapsody is a Democrat.
VanillaRhapsody
(21,115 posts)Silver Plans are what are comparable to most private employer provided plans are....
Walk away
(9,494 posts)VanillaRhapsody
(21,115 posts)they really think that the Obama supporters on DU are as ill informed as they are!
Glitterati
(3,182 posts)It sure as hell covers my pre-existing condition, AND the medication required to treat it.
Junkdrawer
(27,993 posts)not sure why that matters, but I'm in Georgia.
I was uninsured for 30+ years prior to ACA. Even the carve out for pre-existing conditions was too expensive for me to take advantage of, priced at a third of my monthly income.
But, since February, I've had a Humana HMO through ACA and it covers everything concerning my Graves Disease and congestive heart failure.
pnwmom
(108,978 posts)Glitterati
(3,182 posts)Even moreso is the relief knowing my daughter is insured for the first time in her 18 years.
Can ACA be improved, expounded on? Of course it can, but OMG only those with a chronic illness, facing millions of dollars in uninsured medical bills can understand the daily stress this adds to ones life.
I understand the OPs pain and concern. For years, we went through this appeal to the drug companies for relief for my husband's very expensive medications before he died. And, let me tell you, the process is as demeaning as signing up for welfare, AND as soul crushing. It's a process that has to be repeated every six months, too.
It's not simple, nor is it acceptable that anyone has to endure such humiliation just to get life saving medication. Add to that, the fact that if you don't get your "application" for relief in fast enough, the drug company may have reached its "quota" for charity and deny you any relief.
When your life, or that of a loved one, is based solely on the charity of some Big Pharma's quota, the stress is unimaginable.
pnwmom
(108,978 posts)which we should maybe try to remember when we're fighting about e-cigs!
Glitterati
(3,182 posts)because we have to deal with FACTS and not supposition.
The FACTS in this situation mean the process for relief from expensive, life saving, medication is not a simple, nor easy, experience.
No one should diminish the humiliation, pain and anger involved in such a situation when the parties involved are already paying federally mandated MONEY for the coverage they are being denied.
blue neen
(12,321 posts)I have non-ACA insurance. They have a medication formulary, and there are many drugs that have higher co-pays than others.
Junkdrawer
(27,993 posts)$80/month is the maximum co-pay on my current plan.
notadmblnd
(23,720 posts)So I really don't understand your complaint?
Junkdrawer
(27,993 posts)Surely, you're not saying....
"The best way to take care of everyone else is to take better care of yourself"...
That's what those in the OTHER party believe.
notadmblnd
(23,720 posts)current insurance. However, you hadn't specified how you were insured. For example, I have insurance through my deceased husbands Union's survivor benefits. It it very good insurance. I am happy with it. I do not need to sign up for insurance through the ACA. People' whose employers that provide insurance is another group who do not need to sign up for the ACA.
That is all I was saying- if you already have insurance you dont have to sign up for the ACA.
So, how you got- that I'm one of "those" from the "other" party out of what I posted is a mystery to me.
Junkdrawer
(27,993 posts)as long as I had acceptable insurance...for now.
hunter
(38,313 posts)We ran it to the end and then we were uninsurable.
My wife eventually got accepted to our state's "High Risk" program, and I went without insurance.
We now have mediocre insurance through my wife's work, but not before our savings were depleted and our credit rating destroyed.
I do feel more secure with the ACA even though we're not using it now. Even within the limitations of the ACA, it's better than the grinder we went through.
I would rather have a Single Payer system. My wife and I wouldn't have had any troubles beyond the health issues if we'd been Canadian.
WinkyDink
(51,311 posts)thing.
Junkdrawer
(27,993 posts)The cost for a one-month prescription is $4,600.
Schema Thing
(10,283 posts)Thanks.
Junkdrawer
(27,993 posts)the rest is private - except I live in Pgh. PA.
Schema Thing
(10,283 posts)Is "private"? I don't understand.
Junkdrawer
(27,993 posts)If you don't believe my characterizations of the Pgh, PA plans....
https://www.healthcare.gov/marketplace/b/#welcome/
pnwmom
(108,978 posts)Ms. Toad
(34,072 posts)I had a $6000 merged deductible/out of pocket cap for the past 3 years. March was the farthest we got into the year before reaching our max, then zero medical expenses for the remainder of the year.
mcar
(42,331 posts)Search "Obama POS used car salesman" and you will get all the answers.
Junkdrawer
(27,993 posts)But sometimes the pain..well, you know.
VanillaRhapsody
(21,115 posts)since this person will also now get free mammograms, colonoscopies, immunizations etc free with no co--ays and not paying twice as much for being a woman and no Lifetime Max....etc etc etc
But it sooo sucks right?
Glitterati
(3,182 posts)Free mamograms, colonoscsopies, immunizations mean NOTHING to a person who will die of MS without their medication!!!!!!
This is a FEDERALLY MANDADTED program one has to PAY FOR. Sure, the subsidies make it more affordable, for now.
But ACA does NOT help someone who is not able to afford their life saving medication because this very law allowed Big Pharma to exclude it from coverage.
VanillaRhapsody
(21,115 posts)What part of drug "formularies" do YOU not understand?
Glitterati
(3,182 posts)You, on the other hand, try to change the subject when you're losing the debate.
And, you should note, I wasn't the one who brought up FREE anything. That was you.
VanillaRhapsody
(21,115 posts)subisidies make it more affordable "for now"
YOU expect failure!
(Like I am surprised)
Even medicare doesn't cover ALL drugs....
Glitterati
(3,182 posts)that said ACA insurers plan to triple the cost of insurance next year?
After all, you seem to miss most of the FACTS since you're so busy defending your hero.
VanillaRhapsody
(21,115 posts)I also know that was IF Obamacare didn't reach the mark for new enrollees....
HELLO ....they are already almost there...
there is a couple facts for YOU.
Glitterati
(3,182 posts)The Affordable Care Act is designed to place health care within reach of all Americans, but the law may end up making insurance more costly for healthy people.
A review of proposed health care plans across eight states shows premiums for those in good health may double or even triple under Obamacare, while costs for people with chronic conditions will likely decrease, The Wall Street Journal reports.
http://money.msn.com/now/post--healthy-obamacare-may-triple-your-premium
Cause, you know, I have a chronic condition, so this won't likely affect ME.
However, if they triple my daughter's premium from $38.75 per month to $116.25 per month, she won't be able to afford it. The FINE will be cheaper and will be her fallback position.
VanillaRhapsody
(21,115 posts)I know that for a fact....they cannot JUST go up as they HAVE been capped at 20% overhead....
Where is your daughter getting an ACA approved policy for 38.75 a month that is not through the exchange....because on the exchange that is NOT going to happen...
Insurance companies had no limits on raising your premiums. The rate review provision protects you against unjustified rate hikes. So far the program has curbed the rising cost of employer based premiums and reduced premiums for many Americans due to the new State-based health insurance marketplaces.
Besides it is capped at 10% of your income
Faux premature outrage!!!!
Glitterati
(3,182 posts)You're starting to make up whole conversations out of your imagination.
VanillaRhapsody
(21,115 posts)rate review.....they cannot JUST triple her rates...
see here
http://obamacarefacts.com/health-care-reform-timeline.php
Glitterati
(3,182 posts)You really should read the ENTIRE thread before you go off on folks.
You might even be able to figure out who your mutual ACA supporters are.
VanillaRhapsody
(21,115 posts)I posted the relevant text even....sheesh
by the way the Affordable Care Act is the single BIGGEST achievement in Women's rights since Roe V Wade...
Why WOULDN'T I support that?
Glitterati
(3,182 posts)Again, trying to change the conversation with baseless accusations.
Do you REALLY think this does ACA any favors? Berating people like the OP who ask questions? Seriously!
VanillaRhapsody
(21,115 posts)your daughters exceedingly low health insurance rate or not? Did I not just debunk that bullshit with the fact that there is a "rate review board" that would put a check on that?
Sheesh....you cannot multitask?
Glitterati
(3,182 posts)I do my own research and understand ACA very clearly.
You debunked nothing. You offer nothing more than blind support of Obama, propped up with outrage, temper tantrums and debunked myths.
VanillaRhapsody
(21,115 posts)where is your proof that it will triple next year?
The Affordable Care Act is already working: Intense price competition among health plans in the marketplaces for individuals has lowered premiums below projected levels. As a result of these lower premiums, the federal government will save about $190 billion over the next 10 years, according to our estimates. These savings will boost the health laws amount of deficit reduction by 174 percent and represent about 40 percent of the health care savings proposed by the National Commission on Fiscal Responsibility and Reformcommonly known as the Simpson-Bowles commissionin 2010.
Moreover, we estimate that lower premiums will lower the number of uninsured even further, by an additional 700,000 people, even as the number of individuals who receive tax credits will decline because insurance is more affordable.
In short, the Affordable Care Act is working even better than expected, producing more coverage for much less money. http://www.americanprogress.org/issues/healthcare/report/2013/10/23/77537/the-affordable-care-acts-lower-than-projected-premiums-will-save-190-billion/
Premium expense is capped at 9.5% of income, and out of pocket expense excluding premium expense ranges from $6,350 for a single individual up to $12,700 for a family of four. You are welcome to play around with the calculator to fit your situation. - See more at: http://www.financialsamurai.com/subsidy-amounts-by-income-limits-for-the-affordable-care-act-obamacare/#sthash.pLfB4QhC.dpuf
doing your "research" indeed....
VanillaRhapsody
(21,115 posts)ONLY frequent DU to bash Democrats and any achievements they make.....
Glitterati
(3,182 posts)by your rush to defend.
VanillaRhapsody
(21,115 posts)twice elected by majority vote President. YOU claimed that you believed "MSN Money" telling YOU that your daughter's (who judging by her current rate is obviously already subsidized by the ACA) rates would "triple" next year.......
THAT kind of premature faux outrage is the person that is "confused"
Glitterati
(3,182 posts)Made so by your refusal to do any research and attempt to understand your own allies.
VanillaRhapsody
(21,115 posts)$61 a month Affordable Healthcare....
Sad is being full of shit...
Ms. Toad
(34,072 posts)It was a problem which existed before the ACA and which the ACA did not FIX - but the ACA did not create the problem.
Junkdrawer
(27,993 posts)for the past 18 years. (Currently $80/month). The ACA plans available in my area expect me to pay $600 to $1200/month until I reach some maximum. This will effect not only MS patients, but cancer patients, transplant patients, etc, etc.
Looks to me like a hole in the ACA that the insurance companies are jumping all over themselves to exploit.
Ms. Toad
(34,072 posts)Other insurance companies have charged differently. My last plan required me to pay 100% until I hit the deductible, and then it was covered 100%. We had one $3008 prescription bill in January 2012, which covered my daughter's entire deductible/out of pocket for the year. The plan before that one required me to pay 25% (uncapped); my current one (not an exchange plan) requires me to pay 35%, but is capped at $150 per month.
Again - this is a pre-existing problem with insurance coverage, not one caused by the ACA. A few years ago (around the time the ACA was being drafted), insurance companies started adding a specialty drug category which included most or all drugs generally used to treat MS, IBD (my daughter's condition), HIV, and some cancer treatment (those are the ones I remember from reviewing the list at the time - and being outraged that the specialty drug list appeared to be targeting particular costly illnesses). My daughter's drugs which used to be brand name formulary were suddenly at least 3 times more expensive, because that is how most insurance companies started to treat them (including my three most recent plans). It had NOTHING to do with the ACA - and a lot more to do with classes of drugs which were more costly than insurance companies were used to dealing with (typically - but not entirely - biologics).
The ACA did not fix the pre-existing problem of specialty drug classification (and we still need to fix it), but the ACA did not create it.
Junkdrawer
(27,993 posts)I've NEVER see an employer-provided plan with those sort of $1K/month co-pays.
But in the end, you're right. We'll adapt to the "New Normal". Just don't mention the ACA during campaign stops here until we adjust.
VanillaRhapsody
(21,115 posts)Junkdrawer
(27,993 posts)In our circle.... Then there's those who still listen to AM shock jocks and get their politics from billboards. Fortunately, that's something you see as you drive out of Pittsburgh.
In general, low expectations for the ACA were met. You see, there are only two insurance giants who have been beating us pillar-to post and realistic hope here died with the Public Option. Your milage may vary, depending on location.
VanillaRhapsody
(21,115 posts)whoopdie doo...
It is the biggest achievement for Women's rights since Roe V Wade....but you want it DESTROYED....because THAT will get us Single Payer...
LMAO!
Junkdrawer
(27,993 posts)1.) I don't (nor could EVER) dictate to said circle.
2.) We weren't born yesterday (maybe the day before...). Health insurance and the waltz of the two elephants have ALWAYS been big topics of discussion. Sicko got a standing ovation when I went. As I said, when the Public Option died, given our circumstances, what we see on the "exchange" is predictable and predicted.
3.) Sooner or later the rubber will meet the road. Many, many people will have to deal with huge co-pays that come at an impossible time. Would you rather they have realistic or unrealistic expectations? "biggest achievement for Women's rights since Roe V Wade" You think that's how it will be seen in some distant future? Really?
VanillaRhapsody
(21,115 posts)things....I am glad those with better sense prevailed.
There will not be HUGE copays...you are wrong....it has "rate reviews" built in....
Yeah I DO KNOW it is the biggest achievement in women's rights...and here is my proof
http://obamacarefacts.com/obamacare-womens-health-services.php
and they won't be charged twice as much as men like they were before ACA:
More than 20 million women will get expanded coverage of preventive servicesprenatal care, mammograms, pap smears, breast-feeding supplies, testing for sexually transmitted diseases, well woman checkups, immunizations, birth control and more.
http://www.thenation.com/article/168833/obamacares-women
Currently in the United States, nearly one in five women ages 18 to 64 are uninsured, according to the Office on Women's Health. Meanwhile, those who are insured consistently pay higher health insurance premiums than men, according to the National Women's Law Center -- and often without the coverage they need. What's more, women are twice as likely as men to be insured through a spouse's plan, meaning they risk losing coverage if their spouses lose their job, they get divorced, or their husbands die.
"It's apparent that something has been seriously amiss with women's healthcare in America," says Vista Health Solutions editor Michael Cahill, "The Affordable Care Act has the potential to reshape the landscape of women's healthcare starting in 2014."http://www.huffingtonpost.com/ellen-sarver-dolgen/the-affordable-care-act-a_1_b_4275609.html
Junkdrawer
(27,993 posts)Thought so.
VanillaRhapsody
(21,115 posts)or do you want to go back to what we had before one in 5 going without...
1. Obamacare guarantees coverage of preventive services with no cost sharing. Preventive care promotes health and saves money. Yet many preventive care services are out of womens reach due to high co-pays, deductibles, and co-insurance. More than 50 percent of women have delayed seeking medical care due to cost, and one-third of women report forgoing basic necessities to pay for health care. But under the health reform law, insurers are now required to cover recommended preventive services such as mammograms, Pap smears, and well-baby care without cost sharing. More than 45 million women have already taken advantage of these services. And starting this August more services, including contraception, gestational diabetes screening, and breastfeeding supports, will be added to the list of preventive care that must be covered at no additional cost.
2. Maternity care will be required in new insurance plans. Coverage for maternity carehealth care that only women needis routinely excluded in the individual insurance market. Only 12 percent of plans sold in the individual market even offer maternity coverage, which is frequently inadequate because of waiting periods or deductibles that can be as high as the cost of the birth itself. But once Obamacare is fully implemented in 2014, about 8.7 million women will have guaranteed access to maternity care in all new individual and small group plans.
3. Women will no longer be denied insurance coverage for gender-related reasons. In todays insurance market, it is common for insurers to refuse to cover women because of gender-based pre-existing conditions, such as having had a Cesarean section or being the victim of domestic violence or sexual assault. Thankfully, this practice will be outlawed under Obamacare in 2014. In the meantime, adults with pre-existing conditions who have been uninsured for at least six months can purchase affordable coverage through temporary Pre-existing Condition Insurance Plans.
4. Women will no longer be charged more for their insurance coverage just for being women. Under a practice known as gender rating, insurers currently charge women higher premiums than men for identical health benefits. As a result, women now pay $1 billion more than men each year for the same health plans in the individual market. As of 2014, however, under the Affordable Care Act, gender rating will become illegal in all new individual and small group plans.
5. Women have more control over their health care. Already, women no longer need a referral to see their obstetrician-gynecologist thanks to Obamacare. And they get to choose their primary care physician and their childs pediatrician from their plans list of participating providers.
6. Women will gain better access to affordable health insurance. Starting in 2014 women and their families, as well as small businesses, will receive tax credits on an income-based sliding scale to help purchase insurance coverage. This will help individuals who earn up to $43,000 per year and up to $92,200 for families of four. Also in 2014 up to 10.3 million women will gain insurance coverage when Medicaid expands its income eligibility to include people with incomes below 138 percent of the federal poverty levelless than $15,000 for individuals and about $31,809 for a family of four in 2011. The health law also eliminates Medicaids categorical requirements, so that low-income women who meet the income requirements can be enrolled even if they have no children and are not pregnant.
7. Insurance companies can no longer place limits on the amount of money theyll spend on covered medical expenses. Women are more likely than men to suffer from a chronic condition, and an unforeseen medical emergency or a chronic illness can cause an insured person to rapidly reach a coverage cap in their insurance plan, leaving enrollees to fend for themselves, sometimes with thousands of dollars in unpaid medical bills. But under Obamacare lifetime coverage caps have been eliminated and annual limits are being phased out. Approximately 39.5 million women have already benefited from the ban on lifetime caps.
8. Women and their families benefit from critical consumer protections in Obamacare. Because women use health care services at higher rates on behalf of themselves and their families, ensuring just insurance practices is of critical importance. The Affordable Care Act has already eliminated the practice of rescission, when an insurance policy ends the moment a beneficiary gets sick. The health law also requires insurers to spend at least 80 percent of premiums on actually providing health care, as opposed to administrative costs, or pay enrollees a rebate. Policyholders and employers will receive approximately $1.3 billion in premium rebates this year alone.
9. Women in marginalized communities are seeing reforms that respond to their needs. Women of color, lesbian and bisexual women, and transgender people are disproportionately uninsured and subject to higher rates of health disparities. Obamacare is making critical strides in providing vulnerable women with quality health care through increased access to insurance coverage, increased funding for community health centers, promoting health literacy and cultural competency, prohibiting discrimination in the health insurance market, and improving data collection. For instance, already an estimated 5.5 million African Americans, 6.1 million Latinos, 2.7 million Asians, and 0.3 million Native Americans, many of them women, have received preventive service coverage with no cost sharing under the health reform law.
10. Mothers have peace of mind, knowing that their children have health insurance. Obamacare prohibits insurers from denying coverage to children under age 19 because of pre-existing conditions. And adult children can now stay on a parents plan up to age 26, an especially helpful provision in this tough economy, where finding a job with benefits is challenging. Young women in particular report delaying needed health care because of high costs. To date, 2.5 million young adults have gained coverage under the Affordable Care Act.
Obamacare is a lifeline for women and their families. Women cannot afford to go back to a world where they pay more for less health care coverage, are denied preventive and essential health care services, and are treated like pre-existing conditions. A ruling that strikes down this important law would not only undo decades of precedent, it would have a devastating effect on the health and well-being of millions of women. Women have gained too much from Obamacare to lose it now.
http://thinkprogress.org/health/2012/05/24/488844/top-10-obamacare-benefits-at-stake-for-women/#
Being a woman is NO LONGER a pre-existing Condition....Thank YOU President Obama...
and THAT is why it is the biggest achievement in the women's movement since Roe...
frazzled
(18,402 posts)The Specialty Tier of drugsunique, very high cost prescriptionscarry a much higher copay or coinsurance than generic, formulary-preferred, or even formulary non-preferred drugs.
https://www.medicare.gov/Pubs/pdf/11136.pdf
And NO, you don't need to go to the drug company for charity. There are expedited review processes to get the drugs covered or covered at a lower rate if your doctor makes an appeal.
pnwmom
(108,978 posts)and UK national health, all of which have formularies and don't cover every drug in a category.
I'm curious, though -- are you saying no MS drugs are covered except with high copays, or that your specific MS drug isn't covered?
Junkdrawer
(27,993 posts)in the past, we've had co-pays ranging from $50 to $160 / month.
As a responsible adult caring for a family, I check formularies before I change/choose insurance plans.
25% to 50% floored me. For folks with MS, it's like "oh, and women will no longer receive college assistance" thrown onto an education bill.
pnwmom
(108,978 posts)Also, I vaguely remember there being an out of pocket limit on prescriptions, too, but it might not be in effect till next year. Do you know about that?
Junkdrawer
(27,993 posts)pnwmom
(108,978 posts)are exorbitant, so they reduce them only for people who ask for it.
But as it is, this year there is a maximum prescription out of pocket of $6350 for an individual, and next year the same maximum will apply to your COMBINED medical and drug costs.
Junkdrawer
(27,993 posts)the doctor asks, so they're trying to stay on the good side of doctors and patients by preventing tear-soaked letters. Haven't applied YET, but I'm beyond the income limit for ACA assistance. And, as I said, as long as I hold by present plan, $80/month doesn't break me.
But even at $6350 for an individual, you can see how my yearly medical costs would/will jump unless this is fixed.
pnwmom
(108,978 posts)will be $6350 -- including both drugs and medical.
What sort of annual out of pocket does your non ACA policy have? And doesn't it have lifetime limits? We've always had good large group insurance, but I've always been aware that one serious accident, or one baby in long term NICU, could wipe out the lifetime limits.
Junkdrawer
(27,993 posts)my wife is in pretty good health except for MS and arthritis. Currently, we run ~ $2000/year in co-pays.
Both majors in the area have "separate" medication plans, so $2,000/year would become $12,000 plus for a year.
My current plan is a Cobra-conversion plan, so I hope it lasts for at least this year....
But I imagine these huge specialty medication co-pays have to hit many like a ton of bricks. Imagine expecting to hear $80 and having the pharmacist say "$1,200 please" - and then having to find the funds to meet said "yearly maximum".
I won't be the only yowls.
pnwmom
(108,978 posts)That's why I never felt secure even with gold-plated insurance -- there were still those lifetime limits. We knew someone who had an accident and was paralyzed from the neck down. His insurance ran out in a year.
enlightenment
(8,830 posts)an increase of $250 and $500 respectively.
http://www.zanebenefits.com/blog/aca-cost-sharing-rules-for-2015
VanillaRhapsody
(21,115 posts)your friend needs to to speak to someone...
Junkdrawer
(27,993 posts)VanillaRhapsody
(21,115 posts)Ms. Toad
(34,072 posts)The problem existed long before the ACA. Without diminishing that it IS a problem, stop trashing the ACA for (1) not fixing every problem that pre-existed it and (2) mischaracterizing pre-existing problems as problems caused by the bill.
gollygee
(22,336 posts)For instance, well child visits are supposed to be covered 100% with no co-pay, but my insurance company wants me to pay a co-pay for my daughter's hearing test, which is a part of a well child visit at her age.
Ms. Toad
(34,072 posts)Hearing screening is supposed to be covered for newborns. https://www.healthcare.gov/what-are-my-preventive-care-benefits/#part=3
If your daughter is eligible, and talking for them doesn't work (9 times out of 10 it does, as long as you are accurate about the law), then file an appeal.
pnwmom
(108,978 posts)pnwmom
(108,978 posts)with better drug coverage for you. Maybe you should call the other ones in your area now.
You might also be able to get assistance here:
http://mymsaa.org/about-ms/sources/
Copaxone
Program name: Shared Solutions
Phone: (800) 887-8100
Website: www.copaxone.com
Shared Solutions will assist patients in the following ways:
Individuals with no insurance are referred to Assist RX. The Shared Solutions case manager will conference-call with the patient and the Assist RX organization. The information about eligibility is not public. An individual's cost would be zero for one year. He or she will then need to reapply. If not eligible at this time, there is no further assistance.
If a person is on Medicare, the Medicare Team, working with a specialty pharmacy (ACS) will pay through the coverage gap. This program is ongoing.
For people with private insurance, the Co-Pay Solutions program will assist. Co-pay amounts based on a sliding scale. This program is ongoing.
*The offer is not valid for patients covered in whole or in part by Medicaid, Medicare, TRICARE, or any other federal or state government pharmaceutical assistance plan or program (regardless of whether a specific prescription is covered), or by private health benefit programs that reimburse for the entire cost of prescription drugs.
Walk away
(9,494 posts)So there is a limit on any drug costs.
Why do people have to post anything that comes into their heads about the ACA? Is it some kind of mental disease? There is coverage for that now!
pnwmom
(108,978 posts)out-of-pocket limit for prescriptions IF they are administered under a separate plan.
http://www.horizonblue.com/about-us/health-care-reform/how-reform-affects-you/members/obama-administration-delays-aca-limit-out-pocket-costs
Recent news reports have brought attention to a postponement of the Affordable Care Acts (ACA) single, overall limit on out-of-pocket health care costs until 2015. Under the ACA, the limit on out-of-pocket costs could not be more than $6,350 for an individual and $12,700 for a family for non-grandfathered group health plans. This limit would include costs for doctors services, hospital care and prescription drugs, for example.
SNIP
If a plan or any health insurance includes an out-of-pocket maximum on coverage that does not consist solely of major medical coverage (for example, if a separate out-of-pocket maximum applies to prescription drug coverage), then the out-of-pocket maximum cannot exceed the dollar amounts required by the ACA.
Walk away
(9,494 posts)the OOP on my Silver plan currently includes prescription drugs and diabetic supplies.
pnwmom
(108,978 posts)But many companies had different administrators for their medical plans and their drug plans, so for those companies Obama gave them another year to coordinate the benefits.
Walk away
(9,494 posts)companies insuring their employees?
Ms. Toad
(34,072 posts)Marketplace plans have a merged cap - it is just those of us getting insurance through work who are being dinged for another year.
Walk away
(9,494 posts)He says he purchased a Gold plan from the exchange. If that is so then his plan should cover medical and prescription and the OOPL cannot be more than $6350 combined.
Ms. Toad
(34,072 posts)I believe he is talking about a per person family.
Motown_Johnny
(22,308 posts)Just because that plan doesn't work well for you doesn't mean that all others won't either.
If Silver plans don't work for you then maybe calculate the cost of the drugs under your gold plan and see if a Platinum plan would reduce those costs more than the increase in premiums.
NCTraveler
(30,481 posts)That has nothing to do with affordable or health care. Nothing at all. The ACA was largely about getting people to sign up for health insurance. The benefits in the bill are with many of the excellent new regulations. The fundamental structure is still there. That structure lends itself more to insurance than care.
I don't see where you have shown that your preexisting condition has been denied. You just can't afford your preexisting condition.
Junkdrawer
(27,993 posts)from my wife's MS friends on her Facebook page. As I said upthread...
Wait for it....
sinkingfeeling
(51,457 posts)There are formularies and 'specialty drugs' lists involved with every insurance plan that covers drugs at all.
That gold plan is covering MS as a preexisting condition and somewhere between 50% and 75% of the cost of the MS drugs it chooses to carry that are on their list. They might also choose to pay 0% of a different MS drug not on their list.
JoePhilly
(27,787 posts)Junkdrawer
(27,993 posts)if the shit finds the fan.
National MS Society is very pro-research and thus tends to be friendly with the drug companies.
JoePhilly
(27,787 posts)to help he and his doc go back to his insurance company and appeal multiple times prior to the ACA passing.
Junkdrawer
(27,993 posts)help for MS patients within a system controlled by the major insurers and drug companies.
As they're not very political (except to argue for more funding for research), that's probably a good stance for the National MS Society.
But that doesn't have to be (nor should it be) my stance.
JoePhilly
(27,787 posts)nadinbrzezinski
(154,021 posts)If this is to work. You and will and many others.
I see the usual folks already showed up. Though consider pleading with the pharma company.
Ms. Toad
(34,072 posts)having different pricing for different medications.
Do you somehow think that a person diagnosed after obtaining health insurance under the ACA gets the drugs for a different price?
What you are noticing has NOTHING to do with either the ACA or pre-existing conditions.
I have a daughter on specialty meds, off and on. That has been the case since long before the ACA was a twinkle in Obama's eye. Now, at least, she is eligible for insurance (to cover both the pre-existing conditions and everything else), and there is an annual cap on what she has to spend for health care.
It doesn't mean we can't do better - but stop bashing the ACA for not immediately fixing all problems, and stop mischaracterizing what it does do. Insurance under the ACA DOES cover pre-existing conditions, both by making it possible to get insurance at all - and by covering a condition like MS in the exact same way whether your diagnosis was before insurance (pre-existing) or after you bought a new policy.
Junkdrawer
(27,993 posts)if I haven't responded, it's because the only answer I can think of is:
Woosh...
Ms. Toad
(34,072 posts)is a correction to the fact that you implying pre-existing conditions are not really covered under the ACA, and that specialty drug classification
I am not saying there aren't problems - my daughter will hit the maximum out of pocket every single year, with billed expenses in the range of $60,000 plus a year. What I am saying is that her medical expenses were not caused by the ACA and, in fact, her condition is significantly better off than it was before the ACA passed.
So stop blaming pre-existing problems on the ACA merely because the ACA did not fix each and every pre-existing problem.
Doctor_J
(36,392 posts)to beat Big Insurance. That's sort of the whole idea behind Heritage Care. While it's true that you may be able to make your insurer pay, it will take work. Upthread one of the Fan Club said that "It's expensive so they'll only offer discounts to people who call and ask".
America - where vital medicine is sold just like a used car.
Junkdrawer
(27,993 posts)Brevity...soul...wit
VanillaRhapsody
(21,115 posts)area51
(11,909 posts)CFLDem
(2,083 posts)but I recommend talking with your doctor about Avonex. They've been very generous offering my family at no cost to $10/mo.
Junkdrawer
(27,993 posts)CFLDem
(2,083 posts)Well there's always immigrating to Canada.