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View Diary: ACA, Understanding the details: Actuarial values of the plans' tiers & why you can ignore them (154 comments)

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  •  Not in every plan. (4+ / 0-)
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    marina, splashoil, worldlotus, Cory Bantic

    I'm going to tackle OON, but I need to do more research on that topict as it varies somewhat according to state law. And of course from plan to plan.

    Many years ago when I was choosing a plan for us I coind a new payment category to go along with OON (out of network), OOP (out of pocket): it was OOL (or out of luck).

    Some plans are heavy on the OOL part.  Hopefully some of the changes in the ACA will diminish that category.


    •  Another thing people forget to account for (1+ / 0-)
      Recommended by:

      is that if you're really hurt, you can expect a lot of non-covered expenses - things like travel, extra help around the house or yard, more eating out, help getting to doc appointments, heck in a city even parking can blow your budget in a hurry at $10-$20 per appointment.

      Fry, don't be a hero! It's not covered by our health plan!

      by elfling on Mon Oct 07, 2013 at 04:37:24 PM PDT

      [ Parent ]

      •  What plan ever covered this stuff? (1+ / 0-)
        Recommended by:

        I have never in my life heard of an insurance plan even at the best of big platinum spending employers that covered this stuff.

        It is really unreasonable to mention things like this in connection with the FIRST attempt to get nationwide coverage of MOST important medical expenses for everyone.

        Sure people may have to pay for these things but people have always had to pay for these things.

        Please forgive me if I seem argumentative, but what exactly was the point of your post?

        •  The sane ones. (2+ / 0-)
          Recommended by:
          splashoil, Cory Bantic

          In other words, the Euro models of UHC/single-payer.

          They're the models we should be striving toward as a goal, instead of pretending that PPACA is the end, especially as industry-sided as it is in its current form.

          Yes, it will help people, but no, it's not the first attempt to insure people nor should it be the final word on doing so. Now's the time to discuss the Fix It part of Pass It, Then Fix It.

          •  Don't think anybody is claiming PPACA as "the end" (0+ / 0-)

            Other than the teahadists, who see it as the end of the world as they know it.

            Every sane person knows that it will need "tweaking" -- and the sane and smart ones know that it is the pathway to some more rational system in the future, be it Canadian style, French style, British style, German style or whatever.

          •  Are you a troll, WR? (0+ / 0-)

            I can't think of a US insurer who covered this stuff on a normal policy, so why would we expect a first-try compromise bill in the US to cover it.

            We can't even get a budget passed or the debt ceilng raised, but you complain against what we do have and you think we have to fix this in this climate with this Congress?

            That's close to troll behavior. NO one said the ACA is the end. It has barely even started yet.

        •  American plans don't cover it (1+ / 0-)
          Recommended by:

          But my point is that they are real expenses that most of us don't account for when considering a high deductible plan.

          We're thinking... $5,000 deductible. I have that in savings. I can cover it if something bad happens.

          We're not thinking... I'm hurt in December and I need $5,000 worth of care and prescriptions that has to be paid at time of service... and then I'll have those same expenses again in January.

          We're not thinking: I was so badly hurt/sick that I could not work in December, and lost a month's pay.

          We're not thinking: I cannot drive myself to my appointments, so my spouse has to take time off or I have to take a taxi.

          We're not thinking: I cannot cook or mow the lawn, so I spent the month having food delivered and paid someone to take care of the yard.

          We're not thinking: I'm going to need to see that specialist in the city who is 4 hours away and I'm going to need a driver and a hotel and two days off for every appointment.

          So that $5,000 easily becomes $15,000 in emergency expenses, and that's assuming it only lasts a month or two and your job will take you back.

          With a $1,000 deductible it might have been "only" $6,000 out of pocket.

          We're not used to making those calculations when we think about what we can afford.

          Fry, don't be a hero! It's not covered by our health plan!

          by elfling on Tue Oct 08, 2013 at 08:24:54 AM PDT

          [ Parent ]

          •  Yes, life is like that. (0+ / 0-)

            Your car can break down, too. My washing machine and my icemaker just crapped out.

            None of that, nor your examples, have ever been in the realm of health insurance in the US.

            None of that is something that is a negative about the ACA. It's so much better than where we were.

            •  Oh, definitely (0+ / 0-)

              my point is directed towards people who thought they were protecting themselves with lower cost, very high deductible plans that are no longer available. In practice, they leave you with much more financial exposure than most people would realize.

              Fry, don't be a hero! It's not covered by our health plan!

              by elfling on Wed Oct 09, 2013 at 06:56:28 AM PDT

              [ Parent ]

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