Are You Ready for Obama Care?

[SeaBreeze]

I'm paying a lot now for my husband and I to have acceptable health insurance from Kaiser. I'll be interested to see if Kaiser is going to offer some plans we can use at a more reasonable cost. We rarely see the doctor at all, but we always have health care coverage for serious surgeries we may need in the future, or unexpected car accident, or other emergency medical needs. I always had good Kaiser coverage through my union job, for little to no cost to me...well worth the union dues to get that. I did continue it through Cobra for as long as allowed, then we had to re-apply and review some plans to continue coverage. Here's some info with the basics of the Affordable Care Act...

Call it The Patient Protection and Affordable Care Act (PPACA), the Affordable Care Act (ACA) or Obama Care (ObamaCare) the open enrollment phase begins next week on October 1, 2013.

The enrollment process begins at what is called the Health Insurance Exchange or Health Insurance Market Place (the Market Place). This is the federal insurance information site where individuals, families, and business owners can learn about coverages, compare options, levels and prices on available health care plans. The Market Place will send you to a state run site if your state has one.

Some important things to remember are:

•Medicare, Medicaid and the Children's Health Insurance Program participants are covered and do not need to use the Marketplace.

• It is fraud for someone to sell Medicare, Medicaid and the Children's Health Insurance Program participants a Marketplace insurance plan.

• The Marketplace is for use if you do not have coverage now or if you have it but want to look at other options.

• Marketplace coverage starts as soon as January 1, 2014.


Four things women should know:

•You will not be charged more for health insurance just because you are a woman.

•You cannot be denied coverage or charged more due to pre-existing conditions, like cancer or being pregnant.

•You can choose from any primary care provider, OB-GYN, or pediatrician in your health plan’s network without a referral.

•You will get free preventive care like mammograms, well-woman visits, contraception, and more.


When you visit the site this is how the Marketplace works:

1.You will create an account - First provide some basic information. Then choose a user name, password, and security questions for added protection.

2.Apply - Starting October 1, 2013 you will enter information about you and your family, including your income, household size, and more. Here is the governments checklist to help you gather the information you will need.

3.Pick a plan - Next you will see all the plans and programs you are eligible for and compare them side-by-side. You will also find out if you can get lower costs on monthly premiums and out-of-pocket costs.

4.Enroll - Choose a plan that meets your needs and enroll.


Published September 24, 2013
http://www.silverplanet.com/health/...e/are-you-ready-obama-care/58956#.Ukev6qnnaos

 

[Anne]

I'm not even ready for Obama..........

But that's another story. Thanks for the info and link, Seabreeze. Hubby had me look something up, but that was just for Missouri; we've been wondering just what's in that bill, and this will help. Confusing, even so, but at least we have some idea what to expect. Good to know that about pre-existing conditions, as I wondered about that, too.

Although it looks now like they might delay it for a year, so we'll see what happens there.

 

[rkunsaw]

The company ( Whirlpool) I worked for for 43 years quit offering medicare supplement insurance last year. Noe they send us each a check every month to help cover the cost and we can choose which plan we want. I like it this was but I'm afraid obummercare is going to change everything or at least make it too expensive.
We've gotta take control of the senate away from the democrats in 2014 or we'll all go broke.

 

[SeaBreeze]

Well, I'm hoping that prices for health care come down a bit, one thing I can say is that we're all taken to the cleaners when we need medical care, the costs for everything is outrageous, especially hospital stays, etc. From what I hear for example, they can charge $6 for a band aid if you need one, although they buy them in bulk and it's just pennies for them...lots of greed out there it appears...not fair to the average American who's worked hard all their lives to be responsible and self-sufficient. Some folks spend their life savings going through a medical emergency, that's just not right.

 

[TICA]

We probably have the highest taxes in Canada, but we don't pay for medicare. If someone needs to go to the hospital or a doctor, $$ doesn't influence the decision. You show up, show your card and get taken care of. I have extended medical which I do pay for - about $20 per month and that covers 90% of any drugs I might need. So....although we all bitch about high taxes, I'm comforted to know that no one has to choose between medical attention and money.

I've heard about the Obamacare debate and admit that I don't know the details, but I was under the impression that he was trying to accomplish something similar to what we have? Obviously from reading these posts, I'm wrong so the only choice is for you all to move here.

 

[That Guy]

Something is just plain wrong about all this. I'm still not over the shock of a government ordering me to buy something under penalty of law and the whole process is just confusing.

 

[Katybug]

We've been screwed to the wall on health care in the country for decades. Good example was given, a hospital band aid costing $6 and on and on and on, to the point of absurdity. You can stay on a beach in Hawaii for less money than the cost per night of a small hospital room. I'm not nearly as up on changing the program as I need to be, but I truly believe all Americans are entitled to health care. I was also under the impression of accomplishing something similar to what Canadians have. And for all the moaning and groaning from the left and the right, they say it is being postponed for a year.

 

[TICA]

Something is just plain wrong about all this. I'm still not over the shock of a government ordering me to buy something under penalty of law and the whole process is just confusing.

I agree! From what I understand, the point is to make sure that everyone in the US has health care. So, the choice is to make it mandatory so that individuals buy it or raise taxes and have the government provide the coverage. I can certainly see why people are upset and I'm sure I've seen discussions on how employers seem to be taking the brunt. Health care insurance companies are making a fortune off of this and god forbid the rich have to pay taxes to ensure their less fortunate citizens can go to the hospital.

I guess because medical coverage has never been an issue for me, I'm having a hard time understanding the debate. On one hand, no one wants the gov't telling them what to do, but on the other, everyone also wants medical coverage. Canada provides health care - period. In my province, the taxes pay for it and everyone has equal coverage. When I lived in BC, the taxes were a bit lower, but we had to pay an extra premium for the Provincial health care. Each province has a different way of doing it, but yes, it is mandatory and if you can't pay, then it is subsidized for you.

I should really bow out of this conversation, as I don't know enough about your system but I have a strong belief that everyone should have access to a hospital without having to sell their soul to do that. OK - I'm backing out slowly.....................

 

[Jackie22]

As I understand it the new healthcare plan does not affect anyone that is currently on Medicare or if you like your existing health plan you can keep it.

Below are some links explaining different aspects of the plan....


Marketplace open enrollment is a 6 month period, from October 1 to March 31.

Health Insurance Marketplace: You can create your Marketplace Account beginning on Oct. 1.

https://www.healthcare.gov/

https://www.healthcare.gov/quick-answers/#step-1

https://www.healthcare.gov/creating-an-account-and-logging-in/

Kaiser Foundation Subsidy Calculator. There is important information for you at this link, and you can get an estimate of the insurance subsidy you may be eligible for here:

http://kff.org/interactive/subsidy-calculator/

There are four types of plans:

• Bronze: Your plan pays 60%. You pay 40%.
• Silver: Your plan pays 70%. You pay 30%.
• Gold: Your plan pays 80%. You pay 20%
• Platinum: Your plan pays 90%. You pay 10%.

How to find the Health Insurance Plan that is right for you:

https://www.healthcare.gov/blog/how-to-find-the-health-insurance-plan-that-s-right-for-you/?utm_medium=email&utm_source=govdelivery&utm_campaign=hcgov_25dayslearn&utm_content=09_06_13

Prices will be available for Marketplace Insurance Plans on Oct. 1:

https://www.healthcare.gov/how-much-will-marketplace-insurance-cost/

10 Essential Benefits you receive from the Affordable Care Act – What is covered under Marketplace Insurance Plans:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management, and
10. Pediatric services, including oral and vision care

http://www.healthinsurance.org/learn/health-reforms-10-essential-benefits/

The ACA and Women:

http://www.hhs.gov/healthcare/facts/factsheets/2012/03/women03202012a.html

Premium Tax Credit

https://www.healthcare.gov/glossary/premium-tax-credit/

Qualifications For Lower Premiums:

https://www.healthcare.gov/will-i-qualify-to-save-on-monthly-premiums/

Some FAQ

http://kff.org/health-reform/faq/health-reform-frequently-asked-questions/

Medicaid Eligibility

http://www.medicaid.gov/AffordableCareAct/Provisions/Eligibility.html

Who is required to obtain insurance under the ACA:
http://www.irs.gov/uac/Questions-and-Answers-on-the-Individual-Shared-Responsibility-Provision

The main ACA IRS homepage is:
http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions-Home

What is the Affordable Care Act?

The Patient Protection and Affordable Care Act (PPACA), commonly called Obamacare or the Affordable Care Act (ACA), is a United States federal statute signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act, it represents the most significant regulatory overhaul of the country's healthcare system since the passage of Medicare and Medicaid in 1965.
The ACA aims to increase the quality and affordability of health insurance, lower the uninsured rate by expanding public and private insurance coverage, and reduce the costs of health care for individuals and the government. It provides a number of mechanisms—including mandates, subsidies, and insurance exchanges—to increase coverage and affordability. The law also requires insurance companies to cover all applicants within new minimum standards and offer the same rates regardless of pre-existing conditions or sex. Additional reforms aim to reduce costs and improve healthcare outcomes by shifting the system towards quality over quantity through increased competition, regulation, and incentives to streamline the delivery of health care. The Congressional Budget Office projected that the ACA will lower both future deficits and Medicare spending.
http://en.wikipedia.org/wiki/Affordable_Care_Act

Full Text of the Affordable Care Act (this is a pdf file):

http://www.gpo.gov/fdsys/pkg/BILLS-111hr3590enr/pdf/BILLS-111hr3590enr.pdf

 

[Katybug]

Thanks for the good info and excellent reference links.

 

[Warrigal]

I should really bow out of this conversation, as I don't know enough about your system but I have a strong belief that everyone should have access to a hospital without having to sell their soul to do that. OK - I'm backing out slowly.....................

Here! Here! Like you, Tica, I have maintained my own private cover but underneath that is the government system, paid for by an income tax levy of 1.5% to which the lowest income levels are exempt. No-one has to mortgage the family dog to get medical treatment in this country. It is a great blessing for everyone, especially children who need treatment.

 

[SeaBreeze]

We probably have the highest taxes in Canada, but we don't pay for medicare. If someone needs to go to the hospital or a doctor, $$ doesn't influence the decision. You show up, show your card and get taken care of. So....although we all bitch about high taxes, I'm comforted to know that no one has to choose between medical attention and money.

I heard a man from Canada calling in on a radio show last night, he was also very happy with the heath care system there, he said that all the stories of waiting months for treatment or an operation are all myths.

Something is just plain wrong about all this. I'm still not over the shock of a government ordering me to buy something under penalty of law and the whole process is just confusing.

I don't like the government telling me anything to do really, but I look at it realistically. I've never been without health care coverage, and I think it's everyone's responsibility to take care of themselves and their families. When people don't have their own coverage, what happens when they end up in the hospital, who pays for that? ALL of us. Good thing about the Affordable Care Act, is that the cost will be much lower for those who couldn't afford it before, so to me, that's a good thing.

Here! Here! Like you, Tica, I have maintained my own private cover but underneath that is the government system, paid for by an income tax levy of 1.5% to which the lowest income levels are exempt. No-one has to mortgage the family dog to get medical treatment in this country. It is a great blessing for everyone, especially children who need treatment.

I'm not completely against universal health care either. Everybody's covered, and the medical providers are kept in check with costs.

 

[SeaBreeze]

As I understand it the new healthcare plan does not affect anyone that is currently on Medicare or if you like your existing health plan you can keep it.

Thanks for the info and links Jackie. Kaiser sent me a letter saying that my health plan will be discontinued on January 1st. They said in order not to have a lapse in coverage, I had to sign up for a new plan with them or someone else by Dec. 15th. They're supposed to send an open enrollment packet to me in September, well, they're running out of time...sure I'll have to hound them for it. But, I didn't want to keep my plan as is, if there's something less expensive available out there.

 

[SifuPhil]

It's times like these that I truly appreciate being a monk. See, having paid health insurance is against our religion, so I can just sit back and watch y'all runnin' around like headless chickens, trying to figure out dozens of different legal papers and begging someone to cover you.

They want to throw me in jail? Fine! I'll get free healthcare. There's no downside! Three hots and a cot, learn a trade, free education AND free healthcare - it doesn't get much better than that.

 

[JustBonee]

As I understand it the new healthcare plan does not affect anyone that is currently on Medicare .....

I believe that is true. .. but the whole thing is so confusing.

 

[Jillaroo]

Phil wrote

They want to throw me in jail? Fine! I'll get free healthcare. There's no downside! Three hots and a cot, learn a trade, free education AND free healthcare - it doesn't get much better than that.

Hey move over Phil i might join ya, that sounds damn good to me, hope the beds are comfy.

 

[That Guy]

Re: The informative post by Jackie22.

The LAST thing I wanna do is have to read through all that confusing stuff. I appreciate the great references but . . .

 

[JustBonee]

Happy Obamacare Day!

 

[atwhatcost]

If Obamacare is good enough for us, why isn't it good enough for D.C. politicians, the largest companies in our country, and unions? Why have they all been "personally exempted" for another year, by special creation of law by Obama himself? (Who, for the record, isn't supposed to create law.) Why won't he and the Democrats talk to Republicans about this to resolve the closing of federal services? Why has he refused to talk or arbitrate with Republicans ever? Neither side ever enjoyed compromising, but both did anyway, until one man went with, "Last I checked, I won. Be quiet."

It's a chess game, and we're the pawns. Three hots and a cot? Dream on. Try $95 a month or 1% of your income--whichever is the higher price. No one is going to prison over this. They're being "fined." The Supreme Court said it was legal? Guess again. They said it's not a fine, it's a tax. Then, and only then, did the Democrats use the word "tax."

People on Medicare are fine now? That's good to hear, because we weren't fine before. Last read, my "Medicare and You" book told me I had to pay $100 a night plus 20% of cost for the first 10 days in a hospital. I don't know about you, but I only make a little over $900 a month on Disability, so $100 + 20% is already outside my budget. I've resolved that "little" problem. I'll die before I go to a hospital over night. That resolves the issue of "preventative care." No use finding out if I have heart disease or cancer, because I can't afford to be treated if I have it. Oh, and I already spend $173.50 a month on supplement insurance, because I can't afford the other cost to that really helpful deduction called "Medicare."

We've been "helped" by the government before with something called "Part D." Whereas I used to spend $50 a month to afford my meds, once that was enacted, my insurance rose to $100 a month to cover the same thing, except then there was a doughnut hole that wasn't there before.

Rumor has it the doughnut hole is disappearing now. So is my $100 a month supplemental insurance. It was $125, when Obamacare became law. Now it's $173.50, and only half of what I used to get. No telling how much the cost is growing (and benefits are decreasing) now that all parts of the law are in effect--at least for those of us who don't work as federal legislators, aren't union members, and don't work for the largest companies in the country.

Every time the federal government "helps" me, I lose more and more money. I could use less help.

Add to that, the whole purpose of this act was to help those who couldn't afford health insurance. The 2%ers, who genuinely couldn't afford it, not the 20%ers who were young and healthy, so chanced no insurance. The 2%ers were helped? How? Now they're charged $95 a month, because they still can't afford insurance?

Pay no attention to the man behind the curtain. It's all smoke and mirrors anyway. But feel free to blame the Republicans for shutting down the government. After all, how dare they ask the obvious? "If it's okay to exempt Congress and the President, the largest companies and unions for one more year, why is it not okay to exempt everyone else too, just for one more year?" Too much to ask? How about that!

No, this is different than Canada. This has nothing to do with taking care of people who couldn't afford insurance or good insurance. This was capturing a rook with a pawn. The pawn was sacrificed. The average American citizen was the pawn. The Republicans were the rook. (Guess who the king and queen are. lol) Americans just don't get that yet.

I've been getting that since Part D. The more Baby Boomers retire or become disabled, the more Americans catch on to the game.

 

[Jambi]

We've gotta take control of the senate away from the democrats in 2014 or we'll all go broke.

How do we get it away from the RINO's?

If Obamacare is good enough for us, why isn't it good enough for D.C. politicians, the largest companies in our country, and unions?

DING DING DING!!!!!!!

 

[Jambi]

We probably have the highest taxes in Canada, but we don't pay for medicare. If someone needs to go to the hospital or a doctor, $$ doesn't influence the decision. You show up, show your card and get taken care of.

Tell that to my friend the former elevator repairman who went to the hospital after being hit by a car on his motorcycle. They gave him pain pills and told him to leave, no x-ray or diagnostics.

Three days later when he couldn't walk at all, they did the x-ray. Fractured pelvis. Due to the nerve damage incurred over the delay, he can no longer climb multiple flights of stairs.

Now that's great healthcare.

 

[SifuPhil]

It's a chess game, and we're the pawns. Three hots and a cot? Dream on. Try $95 a month or 1% of your income--whichever is the higher price. No one is going to prison over this. They're being "fined." The Supreme Court said it was legal? Guess again. They said it's not a fine, it's a tax. Then, and only then, did the Democrats use the word "tax."

While I appreciate their enthusiastic and creative use of the term "tax", I still defy them to get blood from a stone. I don't have it to pay, and what happens when you can't pay your taxes? There's no more debtor's prison, right?

Wrong. It's alive and well, when the government wants it to be. So I'll go, happily.

 

[That Guy]

 

[Jackie22]

ASK FACTCHECK

[h=1]Congress Exempt from Health Bill?[/h][h=4][/h]

• Q: Does the health care bill specifically exempt members of Congress and their staffs from its provisions?

A: No. This twisted claim is based on misrepresentations of the House and Senate bills, neither of which exempts lawmakers.


We’ve received many questions about claims that House and Senate members would be exempt from the health care legislation taking shape in Congress. But neither the House nor the Senate bill exempts Congress from its provisions.
Members of Congress are subject to the legislation’s mandate to have insurance, and the plans available to them must meet the same minimum benefit standards that other insurance plans will have to meet. "All plans would have to follow those requirements by 2019," Aaron Albright, press secretary for the House Committee on Education and Labor, told FactCheck.org. "People actually believe we wrote in the bill that Congress exempts itself from these requirements. That falsehood has been going around since the very beginning."
How did the notion of an "exemption" get started? So far as we can find, the first to make the "exempt" claim was columnist John Fund, who used the word in a June Wall Street Journal opinion piece to describe a draft of the Senate Health, Education, Labor and Pensions Committee bill. Fund wrote that the proposal "would specifically exempt Members of Congress from many of [the Obama plan's] provisions." But that was a misrepresentation.
Rather than listing "many" exemptions, Fund pointed only to page 114. That section stated that individuals who buy their own insurance and small firms (size to be determined) would be eligible to participate in state-based exchanges, which would offer a range of health insurance plans for purchase. Those who already get insurance through Medicare, Medicaid, the military’s Tricare insurance program, or the Federal Employees Health Benefits Program wouldn’t be eligible. All federal employees, including members of Congress, fall under the FEHBP. Those who have coverage from a large employer wouldn’t be eligible, either, unless their coverage didn’t meet minimum benefits criteria or was deemed to be unaffordable.
The exchanges are designed for those who can’t get adequate or affordable coverage. By Fund’s logic, most Americans would be "exempt" from the privilege of buying insurance through the exchanges — not just members of Congress. Fund further claimed that everyone except Congress "would be shunted into health insurance plans under the straightjacket of whatever the government decides is a ‘basic’ plan." But that was also a misrepresentation. The "basic" plan’s minimum benefit standards would have been just that — a minimum. The draft actually called for three tiers of plans to be offered through the exchanges, two of them with more benefits than the "basic" plan.
Even the speculation that Congress’s FEHBP plans would be better than those offered through the exchanges is outdated. The bill passed by the Senate actually requires members of Congress and their staffs to get coverage through the exchanges.
The Senate bill now says:

H.R. 3590: D) MEMBERS OF CONGRESS IN THE EXCHANGE.— (i) REQUIREMENT.—Notwithstanding any other provision of law, after the effective date of this subtitle, the only health plans that the Federal Government may make available to Members of Congress and congressional staff with respect to their service as a Member of Congress or congressional staff shall be health plans that are— (I) created under this Act (or an amendment made by this Act); or (II) offered through an Exchange established under this Act (or an amendment made by this Act).
​

The provision comes from an amendment by Republican Sen. Chuck Grassley of Iowa.


more here......http://www.factcheck.org/2010/01/congress-exempt-from-health-bill

I'd also add that anyone claiming President Obama and Democrats do not talk or negotiate with Republicans hasn't been paying attention.

 

[Jambi]

ASK FACTCHECK

Congress Exempt from Health Bill?

• Q: Does the health care bill specifically exempt members of Congress and their staffs from its provisions?

A: No. This twisted claim is based on misrepresentations of the House and Senate bills, neither of which exempts lawmakers.

A Project of the Annenberg Public Policy Center

Well, certainly no bias with that organization.

John Bresnahan, a senior congressional reporter at Politico, nabbed a choice Capitol Hill scoop today on the politics of the government shutdown. The backdrop for the story was the attempt of House Speaker John Boehner to round up support for a bill eliminating alleged special health-care treatment for congressional members and staffers.
As Bresnahan noted, Boehner issued an appeal on the House floor: “Why don’t we make sure that every American is treated just like we are?” The proposal was to cut off the subsidies that congressional personnel would be entitled to receive as they enroll in Obamacare’s insurance exchanges.
And yet! Boehner, in private discussions over recent months, has been working with Democratic leaders to preserve those very subsidies, Politico reports. It’s a great Washington moment: Boehner was for the subsidies before he was against them. That revelation comes from documents that were shared with Politico by, well, you be the judge:

Boehner and his aides worked for months with Senate Majority Leader Harry Reid (D-Nev.), House Minority Whip Steny Hoyer (D-Md.), and others, to save these very same, long-standing subsidies, according to documents and e-mails provided to POLITICO. Senate Minority Leader Mitch McConnell (R-Ky.) was also aware of these discussions, the documents show.

​

http://www.washingtonpost.com/blogs...de-on-congressional-exemption-from-obamacare/