Posted on 12/27/2013 12:27:31 PM PST by SeekAndFind
Oh, not up front — although the bronze plan premiums do cost more than many paid before ObamaCare’s mandates went into effect. No, McClatchy and Kaiser Health News worry about the big hike in overall cost that will hit consumers who choose the so-called “affordable” low-tier plans in the ObamaCare exchanges. They may not cover what people think — or anything at all, until those consumers pay thousands of dollars out of pocket first (via Gabriel Malor):
If you buy one of the less expensive insurance plans sold through the new health law’s marketplaces, you may be in for a surprise: Some plans won’t pay for doctor visits before you meet your annual deductible, which could be thousands of dollars.
“This could be the next shoe to drop, as people don’t realize that if they’re buying a bronze plan, they may have to pay $5,000 out of pocket before it contributes a penny,” said Carl McDonald, senior analyst with Citi Investment Research, speaking at a conference last month in Washington.
Comprehensive plans with deductibles usually cover wellness checks from the start (especially in group plans) — or at least they did until ObamaCare made the entire risk pool a lot more costly. In order to trim costs, especially with millions of new policyholders expected to flood the risk pools, insurers have shielded themselves against the larger risk. Unfortunately, that will have a dampening effect on what Democrats said would be the biggest benefit of ObamaCare — heightened access to routine care:
Experts are worrying that some new enrollees will be discouraged from seeing doctors if they have to pay the full charge, rather than simply a copayment. In Miami, for example, 40 percent of bronze plans require consumers to pay the full deductible before coverage kicks in, according to an analysis by online broker eHealthinsurance.com, a private online marketplace, for Kaiser Health News. The average deductible among the examined bronze plans in Miami is $5,735.
Patients in those plans who haven’t yet met their annual deductibles would have to pay the full cost of the visits, unless they were for preventive services mandated by the law. A typical office visit can run $65 to $85, while more complex visits may cost more.
Put it this way: If the average deductible is $5,735 and a doctor visit is $85, it would take sixty-eight doctor visits before the insurance kicked in — more than one visit per week. And it would start all over again every year.
In one sense, Karl is right:
.@gabrielmalor @EdMorrissey BTW, that's not necessarily bad policy. But it's not what people were led to believe ACA would be like.
— Just Karl (@justkarl) December 27, 2013
A proper reform of the health-insurance sector would eliminate (or at least greatly reduce) the footprint of third-party payers in most routine care, as well as transform health insurance into what it should be — a protection against catastrophe, not a club for medical care. That would introduce price transparency to the consumer, relieve most providers of a ridiculous amount of overhead, and reduce premiums to a realistic level for catastrophic coverage.
This, however, is the worst of both worlds. The law forces people to pay higher premiums for largely unnecessary comprehensive coverage — especially the middle class — and then forces them to pay for the routine care out of pocket anyway. Health-savings accounts that might have shielded consumers from the pain are now being discouraged, which means this comes out of their checking accounts, right along with the higher premiums.
The result? People will pay more for less coverage, and then spend thousands of dollars before seeing the first dollar in benefits, except for certain preventive tests that HHS deemed mandatory. This will discourage people from getting normal wellness care and quick intervention on illnesses, forcing them to wait until they’re very sick to see a doctor. And even that might be not so bad, considering how often people fill waiting rooms for cold and flu symptoms that could easily be handled with over-the-counter treatment, but it’s not what the Obama administration and Democrats promised. And it’s certainly not “affordable care.”
This is just one reason why the unfolding of ObamaCare in 2014 will be the biggest longterm political issue. It will drain American bank accounts every day, all year long, and each unexpected cost will rub a little more salt in the wound of betrayal. Just wait until the employer mandates take effect, and businesses kick employees out of group-plan coverage and into the ObamaCare exchanges … right before the midterms.
They’re government “Hammers”.
What’d people think they would cost?
It’s cost plus....
The plans cost so much and you are still paying for your doctor visits so.......there is no money left to save.
Obamacare combines the worst of very expensive private health insurance with none of the universal coverage of single payer health care.
That’s a toxic combo.
The Bronze Plan is so laughable, Medicaid looks much better. Only suckers pay inflated premiums for skimpy coverage.
Well I was gonna post from coveredca.com where it says for me and hubby $18,400 out of pocket not counting premiums of $1200 per mnth....but the site is not working! lol
Lots of people are unaware of it. It’s not widely publicized, probably because of the inevitable question:
“Who is paying the rest of the costs if they exceed the Out of Pocket limit?”
In Ontario’s OHIP, you’re covered if you’re native to the province or 90 days after you move there.
You never pay a premium. All your doctor office visits and medically necessary services are covered.
If you believe access to health care is a human right, Obamacare is a cruel political joke. Single payer would have been much better.
Obamacare doesn’t even pretend to guarantee universal health coverage, despite the law’s official name.
Don’t the premiums come out of your pocket? :-)
True exammple: Couple in their late 50s. If they get the 2013 rates with a $5,000 deductible their monthly premium is $550. If they get the Obamacare rates after January 1st, the earliest they can start the policy is January 15 and the rate jumps to $1516 per month. Thank a Democrat! Affordable Care Act my rear-end!
Good point in the rest of your post.
A sizable part of the uninsured were uninsured by choice. When they needed care, they paid for it in cash, made use of the community clinic system, or took advantage of the federal mandate for ER's to provide free care. It's kind of revealing of the Democrat mentality that they think "helping" this population consists of forcing them to buy something they don't want. If there was ever an example of "we're your betters and we'll decide what you need", that's it.
not according to them.
When I was in the Kaiser HMO, they had a $1400 out of pocket cost limit. When your cost limit was reached, customer service would give you an exemption for the balance of the year.
Obamacare is worse - you pay until the out of pocket cost limit is reached. So much for “affordable” health care coverage. I don’t face that problem.
But its a looming one for millions of Americans.
This should not be a surprise to anyone.
The very name of the law gave away its intent: “The AFFORDABLE Care Act”.
Everyone knows that it is SOP for congress and presidents to use antonyms when naming and/or describing new violations of the constitution... ...I mean, federal legislation.
Just like any other insurance policy in the world, the total risk pool is. Others who have paid premiums, and in the case of Obamacare, possibly risk corridor bailouts ultimately paid partly by the taxpayer.
Seems the only “out” is to pay the “penalty”.
Because, with single payer, government would never ever play politics with healthcare access and treatments.
Just like the IRS didn’t target political enemies of the current regime.
Just like the EPA didn’t target political enemies of the current regime.
Just like OSHA didn’t target political enemies of the current regime.
Yeah. I trust government with my access to chemo, surgery and other lifesaving treatments. I’m sure they’ll come right on board with those after I’ve been so outspoken against the current regime.
You too in fact. I’m sure they’d pay right up for that chemo. Even if you’re sixty ONE years old.
Yup. I believe in skittle pooping unicorns too.
If you’re 250% of the official federal poverty level, you are advised to sign up for a silver plan - then you get federal subsidies to lower your health care cost.
The cheapest option doesn’t always give you the best health insurance plan. Caveat emptor!
Not sure what you’re saying.
This is what happens with any plan:
1. You pay the full cost of any covered medical charge until the personal or family deductible is reached, except for deductible-exempt charges that might have coinsurance or a copay. For example, some of the plans with a $25 flat copay for an office visit right from the beginning, or free procedures.
2. Once the deductible is reached, you pay the coinsurance part — 30% etc., until the Max OOP is reached.
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