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View Diary: ACA: Understanding the details: Deducing the deductible; something you DO need to think about (65 comments)

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  •  EPOs and also many HMOs (4+ / 0-)

    Are such a PITA>  I am very disappointed that I only have HMOs - and prettyt restricted ones at that - to choose from in my area.

    My own HD individual policy has somewhat better benefits than those on the Exchange, and costs less than the best approximation I can get on the Exchange, and is a PPO with good OON coverage. But I've already received notice that the company has been sold, with no news on whether the new company will continue offering my policy.

    I'm likely to wind up with an Exchange policy for the months 2014 before I turn 65 and can slide on over to Traditional Medicare.  

    Provider networks are a huge deal that people have to pay attention to in choosing a plan. More so than many people realize, I think.

    Araguato

    •  Ah, Medicare! (2+ / 0-)
      Recommended by:
      sewaneepat, Araguato

      There's a constant refrain running through my head these days ... "Just 3-1/2 more years, Pat. Just hang in with paying premiums for 3-1/2 more years. Medicare isn't that far away. Just hang in there."

      "Long term: first the rich get mean, then the poor get mean, and the rest is history." My brother Rob.

      by Pat K California on Wed Oct 09, 2013 at 03:35:49 AM PDT

      [ Parent ]

      •  I had the same refrain running my in my head (1+ / 0-)
        Recommended by:
        Pat K California

        for Mr. A. who is both slightly older and has had some major health issues.

        He turned 65 in March last year.

        I was more than a little surprised to discover that our "health insurance" costs for him on Medicare did not go down very much compared to our private plan beforehand.

        Say what?

        Under Part A (hospitalization), you still have costs and deductibles. Under Part B (medical costs including doctors' services) you have to pay an income-deterined monthly premium and still have costs (20% co-insurance) and deductibles. Under Part D (drug plan) you have to pay a monthly premium, co-pays and may fall into the infamous donut hole where suddenly your drug prices go to full-ish retail before you emerge and get really cheap drugs on the other side.

        Because any people want to insulate themselves from exposure to the deductibles and the 20% you need to co-insure under many Part B benefits they add a commercial supplemental policy to take up the slack, so another monthly bill.

        Some people opt for a Medicare Advantage Plan which rolls all this into one plan - but then you're stuck right back into the world of non-governmental health insurance, complete with all its dubious features, including in- and out- of network issues, etc.  Plus the the MA plans costs the Medicare system more for for each participant ine an MA plan than for those who are on Traditional Medicare. They are attractive to many seniors, though, because they often come with everything covered at NO monthly cost.  They make up their money from using prescribed networks and other well-worn health insurance techniques, and of course, from the Treasury.

        It was the network provider issues, more than anything, that made my husband choose Traditional Medicare coverage as his specialized docs weren't local.  We're in NY and one doc was in Boston another at the Mayo clinic.

        When people here long for "Medicare for All" I know they are usually younger and haven't grappled with it yet. It's not without its challenges, because medical care is not cheap, no matter who is paying.

        Araguato

        •  Say WHAT??? (0+ / 0-)

          You know, Araguato, deep down I know what you say is true. I know that Medicare will not be free.

          But, it will make SOME difference. Heh ... you see how I operate? Give me a small ray of hope and I'm off to the races! 3-1/2 more years, 3-1/2 more years ....

          "Long term: first the rich get mean, then the poor get mean, and the rest is history." My brother Rob.

          by Pat K California on Wed Oct 09, 2013 at 11:31:19 AM PDT

          [ Parent ]

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