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View Diary: Woman in debunked Obamacare horror story finally speaks ... to Fox News (232 comments)

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  •  Wrong---you don't have to fulfill Out Of Pocket.. (5+ / 0-)

    ..yearly max before the insurance kicks in...this is the BIG LIE the Rethugs want you to believe! You are comparing health insurance to car insurance where there is a deductible for every accident/event.  That is NOT how health insurance works.  OCare requires routine office visits, tests and prescriptions to be available for a simple copay. And each of the co-pays gets credited against the Out of Pocket annual maximum. Stop perpetuating the LIE! Even before OCare, under a decent plan, you could get plenty of healthcare without ever reaching your yearly Out of Pocket. Under OCare, it is even better as it is mandatory.  Again--YOU DO NOT HAVE TO FULFILL THE ANNUAL OUT OF POCKET MAXIMUM BEFORE HEALTH CARE BENEFITS AND PAYMENTS TO PROVIDERS BEGIN.

    •  I didn't say that (1+ / 0-)
      Recommended by:
      GrandmaTess

      You should look again at what I wrote, in my discussion of  high deductible plans. I never said you had to pay the out of pocket maximum before health care payments to providers begin - I said you had to pay your deductible first.    Wellness visits are a nice perk and all, but I generally want to see a doctor when I'm sick, not when I'm well - and since the insurance company is pricing that "free" cost into the premium, it's still the health insurance customer paying.

      Health insurance companies would also say that while you're paying the deductible, you still get the benefit of using the rate the insurance company negotiated with the provider, as opposed to the rate the provider charges an uninsured patient.  How providers/insurance companies get away with charging an insured man $10 and an uninsured man $100 for the exact same service, I really don't know, but that's the system we have.

      •  re copays (4+ / 0-)

        I just replied to your comment yesterday before I saw this one....it may be dependant on the policy chosen, but I DID NOT have to pay my$3000 deductible first to get my copays.
        I've seen similar comments to yours many times and its not necessarily true

      •  Do notice, though, that she has said nothing (2+ / 0-)
        Recommended by:
        eatapeach, kfunk937

        anywhere about there being a DEDUCTIBLE with her new insurance...nor, apparently, is there one...just an 80/20 copay.  

        Which means that she is paying 20% of her incurred charges only up to the maximum of $6,350 a year.  Which means she's ultimately paying no more than $2 this year than last year under her old insurance.

        Ah!  But she did say she had "low out-of-pocket expenses" on her old plan...in addition to her premiums  And this is important to remember.  

        Why?  Because her insurance premiums last were twice as expensive as her new plan...plus she had those additional out-of-pocket expenses.  

        So, instead of her costs being $2 a year more this year(a whole 17 cents a month), they will actually be LOWER this year by whatever her last year's out-of-pocket expenses were less that $2 :-)  This will give her more money to pay off the $6,350 sooner...and leave her some left over.  

        She needs to understand that it is simply NOT necessary to come up with the entire 20% of any given charge at once.  She can set up payment plans.  People do it all the time.  

        She also needs to understand the meaning of the word "cap".  Understand that once she gets, in total, to $6,350, her insurance company will pay 100%.  

        Considering the type and cost of chemo medication she is taking...even if it isn't the one she used to be on (there are 18 more options)...she's actually already met that cap and won't get any more new bills for the rest of the year.  So I hope that she gets interviewed again a month from now and asked about that.  Asked about how much she's having to pay in new charges each month.  By then, she'll know the answer is $0.  Ah, but will she tell us?

        •  That is all true (0+ / 0-)

          Which is why I tried to steer away from this person's policy in particular and discuss high-deductible plans in general.  I don't know this woman's policy.  She's apparently married to a Republican operative, and it's very likely she's arguing in bad-faith.  I do wish the media would do more fact-checking on "Obama ruined my great health care!" and I know that most of these stories don't add up.  

          Having said all that, I stand by my concerns regarding high deductible plans - having one myself through my employer, I'm familiar with their advantages and disadvantages, but it may come as a big shock to many customers first getting this type of plan.   I think we should be prepared to accept that on its own terms, instead of looking at it through a partisan prism.

      •  Wong again---the deductible is the same as the... (2+ / 0-)
        Recommended by:
        salliezoo, eatapeach

        ..."out of pocket"...and "co-pays" are indeed "out of pocket" which go towards the annual Out of Pocket cap.  This is what you said "What you're brushing off as "make some adjustments" means that she may be paying thousands of dollars during the first month of coverage (until she hits a deductible), whereas before she may have paid just a single small co-pay"...and you are wrong...and this wrongness is confusing people and scaring them....just what the Repugs want.  Again, you do NOT have to fully satisfy "deductibles" before you get benefits under Ocare.  

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