I need to debunk this bullshit

[LaydeeBug]

Here it is:
Okay, so - Mr. and Mrs. Jones find out that their 'Obamacare' premiums are $357.00 (after qualified subsidies) a month for their family of which is sustainable. However they have an annual family deductible of $12,000.00. Hmmm...maybe we should call it 'Obama-Doesn't-Care'. The whole thing is a fraudulent bust and if you do not comply the IRS comes after you.


Please help if you can.

[VanillaRhapsody]

1. Is this for JUST Mr and Mrs Jones...or also their 2 children?

If so...do you know how quickly you would eat up $12,000 with just minor medical incident or two among 4 people?

but let me add...I am skeptical of these figures...

[Fumesucker]

4. It's obvious the purpose of high deductibles is to keep people out of the doctor's office

For all but the most dire necessity.

For probably half of American families now twelve thousand or twelve million, they ain't got it.

[Warpy]

15. That's the effect it will have

meaning poor folks will do what they do now, put off seeing a doctor until that $400 problem has escalated in severity and cost into the million dollar range.

This is major medical insurance, not health insurance. It will keep some people out of bankruptcy but make no mistake, it will not allow them to get treatment when they get sick.

This is how you know it was designed by the far right lunatics who never realize you can spend a few dollars at the outset of an illness or you can spend millions for multiple complications and a long hospitalization.

We didn't get health insurance because of men like Baucus and Liebermen.

[NYC_SKP]

2. They don't have to pay the deductible every year.

I wonder if the Jones couple know what a deductible is, and I wonder if they considered other plans under ACA.

$357 is 1/4 of my current cost for just myself.

[Ms. Toad]

10. Depending on their medical needs, they may.

We do - and would at $12,000.

So, while it is not guaranteed that medical costs will meet or exceed $12,000 - it is certainly possible.

But I agree - if that deductible is a concern for them they need to consider other plans. But before considering other plans, they should see whether they are eligible for cost sharing on the deductible end. (If their premium is subsidized (and for a couple, at $357 it may well be), the cost sharing will likely be, as well)

[NYC_SKP]

13. I pity the folks who have to make these decisions without really knowing actual costs.

It's not that easy to anticipate what procedures in coming years will cost.

But I'm really happy for the ACA and that, so far, we aren't doing the stupid ass Health Savings Accounts.

Thanks for the wisdom!

[Ms. Toad]

18. The HSAs have their place

Although they have tightened them up, there are some things which are helpful for my daughter's care which are not covered by insurance. That helps cut the cost a little, since we can pay for them with pre-tax money. I'll have one and will contribute the max this year.

[NYC_SKP]

19. For what have been available to me...

And this may be different for you, plans offered once per year required setting aside a predetermined amount each month toward a total annual sum.

At the end of that year, with proper evidence to offset that sum, we would receive that pay tax-free.

If we failed to provide evidence, they keep the money.

Is that how an HSA works?

And if so, why not just make medical expenses deductible???

[Ms. Toad]

23. It varies.

Some work that way. I had an HRA at my previous workplace (a slightly different beast - a reimbursement rather than a savings account) - we had to submit copies of the EOBs for medical care, or the receipts for prescriptions in order to be reimbursed, but we got reimbursed on a 1 month delay. I'm just starting a job with an HSA - my understanding is I'll have a debit card which I can use to charge eligible expenditures, but I'll know more the first week in November when I go through the benefits orientation.

Personally, I think all medical expenses should be deductible. It is annoying to have to capture the documentation, submit it, wait for reimbursement, verify that I was actually reimbursed, and so on...

But since medical expenses aren't deductible (except above a certain % of your income), it at least provides a way to use pre-tax money to pay for some of it a little more cheaply. Even though we've had exhorbitant medical expenses, there is only one year when I had out of pocket expenses which came close enough to require me to go through all the paperwork to see if I hit the 8.5% (without checking - I think that's the floor).

[NYC_SKP]

24. We must both remember when credit card interest was deductible.

So I'm fine that they ended that, but to require us to go through cumbersome paperwork to shelter medical expenses just seems brainless and, actually, mean.

[Ms. Toad]

26. Oh yea.

And I agree.

But for now I'm just grateful for any pennies it will save me this year - since I just started a job with a 50+% pay cut (ouch!)

[JaneyVee]

3. $12,000? Are they both 55 year old smokers making $86k a year?

[Ms. Toad]

5. Mr. and Mrs. Jones should look at other plans.

If the $357 is unsubsidized, they are probably looking at the bronze plan - the silver plan would likely have a lower deductible (or there would likely be more than one option to chose from).

If the $357 is subsidized for a couple, the cost sharing would also be subsidized and the annual family deductible will be considerably lower than $12000.

[VanillaRhapsody]

9. Thank you Ms. Toad...I laughed so hard reading the title...

one of those clean the monitor moments! And thanks for choosing the name Ms Toad...as I never foresaw myself thanking a Ms Toad before which also made me chuckle!

[Sedona]

6. We need to know more about your bullshitter

but I'm willing to bet the $12K is maximum out of pocket, not a deductible.

[TexasBushwhacker]

11. I was thinking the same thing n/t

[Ms. Toad]

14. I actually have seen silver plans with a $12,000 deductible.

But my initial reaction was the same as yours.

In that case, there were other silver plans with much lower deductibles, with premiums that were somewhat higher, but not nearly enough higher to make it worth the added deductible.

[arcane1]

12. Please, enlighten us.

If we have been had, then the only moral thing to do is demonstrate it to us, to show us.

[arcane1]

8. Sounds like some kinds of made-up chain letter

The author should first source their claims and provide evidence of them. Anyone can type a few sentences.

[DevonRex]

16. That depends on whether that's an actual policy or

The maximum out of pocket expenses allowable based on their family size, income, etc. If all they've done is go to the estimate site, they have just gotten a ballpark figure and the maximum OOP allowable NOT an actual plan with specific deductibles listed.

Maximum OOP includes copays for doctors, prescriptions, x-rays, MRIs, surgeries, coinsurance and deductibles. Everything but premiums. Anyone with a family member who has a chronic and/or serious illness or disease can easily hit that mark per year. Especially when medical supplies made added in. Or home health care and physical therapy.

[Lex]

20. So they shop for a better plan. ACA beats no insurance at at all.

[jazzimov]

21. What is the co-pay for office visits and

preventative care? That would keep them from spending that $12k.

[politicat]

22. On the bronze plans in my area,

None of the office visits have a copay, but are co-insured (usually 30%) after the deductible. I read that as the client is responsible for 30% after the deductible.

If I'm reading it correctly (and may not be, since I've been on an employer provided HMO my entire life and co insurance isn't something we deal with)
Family of four pays the monthly, but has to pay retail for office visits that ARE NOT for immunization, screenings or preventative care. (Which, when added to viruses, are the majority of office visits.) They also have to pay retail for the urgent care/ER visit for a soccer injury or a home repair mishap until they reach the deductible. (Which would be 100 office visits, but only about two broken bones or one pregnancy.) after that, they pay 30% until next year.

I can see how it looks sketchy for someone who is mostly healthy and manages self-care effectively. Most years, we wouldn't come close to hitting the deductible, despite 3-4 visits each per year. But we don't have any major issues -- both my partner and I have some minor midlife issues we're managing with diet, exercise and watchful waiting. It's actually not the money that keeps me from the surgical option on my knee and back -- it's the surgery itself, and the recovery, and the rehab, which all have time and pain costs. For now, my blown left ACL and the slightly herniated disc in my lower back get achy if I push them too hard but they aren't bad enough to warrant 6 hospital days, 6 months of rehab and restrictions. (I have standards of comparison -- I had the right knee repaired and an intervention for a cervical disc that I injured in college so I know what the commitment will be.)

I can see how someone in my situation but who has been entirely self-pay until now would be skeptical -- it looks like a high payment for a likely small or no return in the near future. (Since we humans don't have a great grasp of long-range prediction or planning.)

I wanted a single payer NHS, but this covers catastrophic. Which is better than you're on your own.

[mstinamotorcity2]

25. Medicare for ALL!!!!!!!

Medicare for ALL. Medicare for ALL. Medicare for ALL. Debunked as good as I can.

[fifthoffive]

27. Question

Doesn't the ACA make preventive care (annual checkup, screenings, vaccinations, etc) covered with no co-pay? I read or heard that somewhere.

We are lucky and are healthy in our late 50s, so we rarely have any costs beyond what we pay towards our employer-provided plan (which is substantial). However, if we had a major medical emergency, I'd rather have a $12,000 deductible than no insurance at all.

Most hospitals will work with patients to make things more affordable for them - reduced markup and payment plans. They'd rather that than not get paid at all. If it's a planned procedure, you should work this out in advance. I assume doctors would do so as well, but as with all things, your mileage may vary.