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Affordable Care Act - USA

Sonja..everyone should look unless they are on Medicare or in a large group..more than 50 employees which means they can't use the marketplace but there are other avenues for larger groups. My suggestion is to check with HR and also go online. Remember not every state is doing this through the govt system and are setting up their own systems. But pre existing is no longer considered so your BIL should look to see what is available. Usually group insurance will include more benefits than an individual policy.

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Jozilla.. so much inaccurate information out there. I am curious to see what happens to COBRA. So much is wait and see.

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I have a question. Of course I haven't been able to check things out very well, but I did get in and saw that they are wanting to know what our estimated 2014 income will be. Being a farmer, our income can vary by a lot. I asked our accountant how in the world can we estimate it and she said we can't. So what is a person suppose to do? I think I might just stick with my current insurance. It did go up. I am 59 and will cost me $648 with a $5000 deductible.
 
Debbie..I think your accountant can take an average if your income has varied. I would at least try.

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Thank you Knitter4444 for the great information you have provided on this topic.


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Time is running out and I'm in a mess. I've always had insurance all my life and now when I need it the most I can't get it. I work for a small company that took away our benefits two years ago. I was always under my husband's plan. I was to be the back up plan if my husband was unable to work. He has serious health problems and then he did lose his job two years ago. So we went on COBRA until it was exhausted. Luckily the VA has taken him in to provide care for him. I was refused by every insurance I applied to. So I was able to get on our state's high risk plan. That will end at the end of the year. So I have contacted Bc/Bs for a quote and they have not returned my calls. I have applied online to another insurance and they sent me a quote. So I applied for their insurance 11/17 and have not heard back from them. I've called and they just say it is being processed and will notify me. I started my application on the Healthcare.gov but my income is right at the cut off for any subsidy and there is not much of a choice for me there. I just don't see any benefit to go thru "obamcare" for me. Are the insurance companies playing a game with me? Do you think they see that I was in a high risk group so by avoiding me and just not answering they in effect are denying me? I have even made an appt with a broker for Mon and he was to call before he comes and he hasn't as of yet. I might be forced to go thru the website for a lesser insurance because I'm running out of time. Any suggestions?
Martha
 
Martha, these are difficult times right now not only for people like you needing insurance, but also for the insurance companies that are trying to work with whatever the new system is going to be. I'm sure they are as much in a state of confusion as you are and I don't think anyone is trying to avoid talking to you. These are businesses and they want your participation in whatever plans they have to offer.

I think your best course of action in more of just what you're doing. Don't give up! Investiage everything out there. Be pushy. If you don't hear back when you'd like to, call them. There will be something that will work out for you. But because of the insurance turmoil right now, you make have to work a little harder to find it.
 
Martha..would you like me to contact you so that I can try to help. I don't sell anything but I know about the health industry.



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fyi I did get accepted by the insurance I applied with online. I just received my cards today. The broker that sent the quotes to me I was able to contact over the weekend via email. She was responding as late as 10PM on Sat night and later again on Sun. So the brokers are very busy handling all these new people like me. Bc/Bs never got back to me. And the other broker I set up an appt with never called back. Just letting you know my one experience out of so many out there but I HAVE insurance now! Yah!
Martha
 
I also got my cards with an agent. I felt good to be among the insured but now I'm learning that MOST doctors (I have BS) are not accepting Covered California. I'm sad when I call for an appointment and hear, "we aren't accepted Covered California."
I just learned last month I need a TKR, a revision of a PKR that is intact but the lateral side is worn. I was certain the pain was tendonitis. My GP (cash pay) said it was bone to bone. Both knees are making lots of noise! I backpack alot so it's understandable that my parts are worn out. I see the local OS (cash pay) Friday to get his opinion.
Looking into a TKR, I've learned BS isn't accepted by any of the local OS. Hospital charge is 20% of the cost as is surgery (if it's accepted). The deductible is $6350 here. It would be costly if approved.
So, I'm going to India again for my surgery. I had my PKR there as I was uninsured and it would've cost $30K here. I paid $5200, including hospital and was treated well. I had to buy an plane ticket. U.S. docs marveled at the beautiful job the surgeon did. There was a program on 60 Minutes I saw about 10 years that gave me the idea.
I'll find out Friday if I need a BTKR. I've already contacted India and will go within the next month or two. I wish I could stay home (it's a long flight) but it's cheaper for me to go abroad. I know things will go well. I want to get it done so I can backpack again, maybe by next summer. And just go for a walk for longer than 1/2 hour.
Good luck to everybody with the new ACA insurance. It isn't going to cover what I need without lots of co-pay. I won't spend months awaiting authorization and risk being rejected. (I don't think there's that problem with Kaiser.)
I really hope everyone can get their surgery approved. Maybe if I stuck it out I could eventually find a good OS and hospital that would work. But I've decided not to wait. It's best for me financially and medically. I trust the OSs there and I won't be disappointed.
I've read all these posts and have gained confidence and courage and learned lots for post op. I know I'll be okay.

Medicare with be a wonderful thing for older ladies like me (gents too.) But, I won't wait 3 years. Sorry, I really rambled. Good luck to all of us!
 
I had a Revision TKR with insurance under the ACA, have not got all the bills yet. Some of my EOB's are being paid in full so I must have met the deductable. The significant savings on my monthly premiums will cover the out of pocket costs. Right now I am covered by a small insurance company, they are merging with United Health Care later this year, I think everything will change then. Only have 1.5 year until I am elgilble for Medicare, whew.

Just curious @ATPlus , where did you go in India for your surgery?
I hear the post op nursing is top notch, one on one in India.

Be sure to start a thread in the pre op forum, then the post op forum after your surgeries, we would like to hear about your experiences.
Looking forward to hearing your story.
 
Your EOB's should show if you have met your deductible and your max out of pocket. Do keep track and dont pay any bills if you get them til you are very sure that you owe them. I recently got a $2000 plus bill for spinal epidurals. Sedation and facilty was paid but they coded it incorrectly. I had to send them the correct codes. Wasnt concerned about my bill but what about those that get a bill and just pay it. Contact me if you need help.

Merry
 
I saw an OS. The x-ray tech mentioned knees were not the OS's specialty.
Doc said my left knee with PKR should be revised. My right knee was "grinding" and intercondylar spiking is noted in the tibia. Also loose body in lateral aspect of femur. Meaning? Not explained. it will need a TKR. He could give me injections for right knee.

He would accept my case (doesn't accept ACA insurance). It was his opinion that I wait 3 years until Medicare and that insurance would not cover surgery until I couldn't walk. He would start me on NSAIDs and a brace. Because I am very active, he felt that I would wear out TKRs , another reason to wait. I replied I would have it done again rather than remain inactive.
Anyway, we discussed cost, etc. He was impressed with my PKR, done in India and I mentioned cost in India verses costs here. He said, "Go to India."

Are others put off until they can't walk?
I'll have to check how to send a PM.
 
@ATPlus ,
I have ACA insurance and just had a revision with the surgeon of my choice. The OS you saw is out of date, and apparently does not do many TKRs, find someone who does lots. Many people on the forum are in their 40's and doing great, who knows how long their knees will last, some will last 30 yrs or more.
I suggest you take a look at your providor list for a OS who specializes in TKR, and make an appt.
During the next open enrollment this fall, find a reputable insurance agent who will be sure your plan has a good selection of specialists. You may have to pay more per month to find the coverage you need, in the long run you will be ahead. Don't wait, you can have your active life back now!
@Josephine can better address your concerns about waiting until you cannot walk.
@Knitter4444 , is in CA and can better explain ACA there.
 
You also need to be sure to check your OOP (max out of pocket). Most people just look at the premiums and copays trying to keep expenses down. I also think most drs practices dont understand about the ACE. If their contract , that they may have signed 20 yrs ago includes all.. For example Blue Shield plans than they have to accept a covered CA plan. (CA does not have Blue Cross/Blue Shield. They are separate plans and each one covers professional and facility fees)

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