Health insurance deductibles - ouch

[disneysteve]

ACA is only "affordable" for those that are receiving a subsidy, like retired doctors.

Any individual earning under $87,480 or family earning under $180,000 qualifies for a subsidy this year, at least here in NJ. I'm not sure if those numbers vary by state. That encompasses the vast majority of the population, not just "retired doctors".

[FrostedMoose]

Any individual earning under $87,480 or family earning under $180,000 qualifies for a subsidy this year, at least here in NJ. I'm not sure if those numbers vary by state. That encompasses the vast majority of the population, not just "retired doctors".

Exactly. Folks making 2.5 times family income are being "subsidized". And all the other tax payers are paying for those subsidies. In this country, we have too many people riding the cart, and not enough pulling it. That's we are in debt to the tune of $266,000 per taxpayer, and $103,000 per U.S. citizen. Surely folks posting on a forum such as "saving advice" can get a grasp of this.

[FrostedMoose]

Before the ACA began, there were 50 million Americans who were uninsured. As of 2022, that number had dropped to a record low of 26 million. So right there it has benefited 24 million, and that number is from 2 years ago. ACA enrollment has been steadily climbing so it's probably more now.

And then there are the millions of people who fall into the other categories I mentioned. So yeah, I'll stand by the "tens of millions" comment.

A huge chunk of those 24 million - about 15 million of them - were previously insured by Medicaid. They weren't uninsured. And I could make the case that Medicaid is a significantly better plan. Lower copays and much better provider acceptance. About 70 percent of providers accept Medicaid, versus about 30 percent for ACA. When less than a third of the physician community accepts a health plan, it isn't much of a health plan. Wait a minute, you're a doctor, why am I explaining this?

[disneysteve]

Exactly. Folks making 2.5 times family income are being "subsidized". .

Exactly. That means around 85% of the population qualifies. Ideally we'll get to the point where it's 100%, like in EVERY OTHER DEVELOPED COUNTRY IN THE WORLD.

[disneysteve]

A huge chunk of those 24 million - about 15 million of them - were previously insured by Medicaid.

That is simply not true. Before the ACA there were nearly 50 million uninsured meaning they had no health insurance at all. If they had Medicaid, they certainly didn't count as uninsured. The ACA did expand Medicaid so more people have it now than before, but that doesn't change how many were completely without insurance previously.

[disneysteve]

When less than a third of the physician community accepts a health plan, it isn't much of a health plan.

Our ACA coverage is with Aetna which has one of the largest provider networks around. We actually had a very similar plan through my employer previously so we have the very same network that we had then. We didn't have to change anything with our providers or facilities when we switched to the ACA coverage. There's no acceptance issues at all.

[FrostedMoose]

Exactly. That means around 85% of the population qualifies. Ideally we'll get to the point where it's 100%, like in EVERY OTHER DEVELOPED COUNTRY IN THE WORLD.

I see where you're going.

[FrostedMoose]

Our ACA coverage is with Aetna which has one of the largest provider networks around. We actually had a very similar plan through my employer previously so we have the very same network that we had then. We didn't have to change anything with our providers or facilities when we switched to the ACA coverage. There's no acceptance issues at all.

What city are you in, I'll have to check that out.

[disneysteve]

What city are you in, I'll have to check that out.

I'm in southern NJ just outside of Philly. Aetna Whole Health is a great plan. We've got a $4,700 deductible which isn't terrible. $50/$75 copays.

[FrostedMoose]

I'm in southern NJ just outside of Philly. Aetna Whole Health is a great plan. We've got a $4,700 deductible which isn't terrible. $50/$75 copays.

If you've got good provider participation in Philly, that must mean it's woefully bad other places, since only about 30 percent of providers accept ACA.

[disneysteve]

If you've got good provider participation in Philly, that must mean it's woefully bad other places, since only about 30 percent of providers accept ACA.

I'm referring to the network in New Jersey. I have no idea about Philly. Around here, every major healthcare group accepts Aetna as far as I know. We haven't run across any that don't yet.

[FrostedMoose]

I'm referring to the network in New Jersey. I have no idea about Philly. Around here, every major healthcare group accepts Aetna as far as I know. We haven't run across any that don't yet.

Understood, but the Aetna provider network for group health plans isn't the same as the ACA network. The ACA network will undoubtedly be a small subset of that group, as it is where I live with Blue Cross ACA.

Blue Cross is one of the few large players in the ACA space. 90 percent of providers accept Blue Cross, but only 30 percent of providers accept ACA.

It could be that you haven't needed specialist care, or pathology/radiology/ER/anesthesia. Hopefully you won't - your eyes will be opened.

[ua_guy]

Understood, but the Aetna provider network for group health plans isn't the same as the ACA network. The ACA network will undoubtedly be a small subset of that group, as it is where I live with Blue Cross ACA.

Blue Cross is one of the few large players in the ACA space. 90 percent of providers accept Blue Cross, but only 30 percent of providers accept ACA.

It could be that you haven't needed specialist care, or pathology/radiology/ER/anesthesia. Hopefully you won't - your eyes will be opened.

Have you been personally denied coverage? By whom? For what service?

I've worked with some of the biggest healthcare systems in the country, and they definitely accept ACA plans. These are orgs that provide some of the best care across all specialties throughout their hospital and clinic networks.

ACA covers plenty of employed people who do not receive health insurance benefits through working. 1099 contractors, for example, they have to buy coverage for themselves, and it's always been expensive to do so. The ACA provides a marketplace for competitive plan comparison and shopping for these folks too.

Something isn't adding up here with your assertions, FrostedMoose. You've quoted a lot of incorrect and/or outdated statistics and say everyone else is pushing a narrative. I don't think so.

[FrostedMoose]

Have you been personally denied coverage? By whom? For what service?

I've worked with some of the biggest healthcare systems in the country, and they definitely accept ACA plans. These are orgs that provide some of the best care across all specialties throughout their hospital and clinic networks.

ACA covers plenty of employed people who do not receive health insurance benefits through working. 1099 contractors, for example, they have to buy coverage for themselves, and it's always been expensive to do so. The ACA provides a marketplace for competitive plan comparison and shopping for these folks too.

Something isn't adding up here with your assertions, FrostedMoose. You've quoted a lot of incorrect and/or outdated statistics and say everyone else is pushing a narrative. I don't think so.

YES. I live in a city of over 400,000. My granddaugher was pregnant and there was no OB/GYN in ACA in the entire city. The nearest one was in a small town of less than 15,000 about 60 miles away. He was a foreign medical graduate. Had she not miscarried, she would have had to deliver there.

Only about 30 percent of physicians accept ACA. Facilities/health systems don't provide healthcare; doctors do. If Johns Hopkins accepts ACA, but their referring doctors do not, then it that doesn't do me much good.

I buy ACA, so I have a pretty good idea how much it costs and what it covers - if you can find a provider.

Tell you what, post your city or zip and let's see how many ACA providers there are in your community. Pretty easy to find out.

[disneysteve]

Understood, but the Aetna provider network for group health plans isn't the same as the ACA network. The ACA network will undoubtedly be a small subset of that group, as it is where I live with Blue Cross ACA.

It could be that you haven't needed specialist care, or pathology/radiology/ER/anesthesia. Hopefully you won't - your eyes will be opened.

Through my employer, I had Aetna Whole Health. Through the ACA, I have Aetna Whole Health. It's the same provider and facility network. The ACA network isnt any different than the group health plan network. Maybe it is in your town but you need to understand that that isn't universally the case.

My wife sees a spine surgeon, an ENT surgeon, an infectious disease specialist, an orthopedist, and her PCP. She's had x-rays and CT scans as well as lab work. I see my PCP, had labs and an ultrasound a couple of weeks ago, and have a urology appointment coming up. All of these providers and facilities are in network with Aetna. So far, we haven't found any difference in coverage since switching to the ACA plan.