Jacksonville Jaguars Fan Forums

Full Version: Obamacare is a mess
You're currently viewing a stripped down version of our content. View the full version with proper formatting.
Pages: 1 2 3 4 5 6 7 8
Quote:It sounds to me like you have Fixed-Benefit Medical Indemnity Insurance.  

 

<p style="color:rgb(51,51,51);font-family:Georgia, 'Times New Roman', Times, serif;font-size:16px;">Fixed benefit health insurance, or indemnity insurance, is not ObamaCare compliant and is not the same as major medical plans sold on the marketplace. Fixed benefit plans are sold by private companies and pay a specific amount each time you see a doctor or go to a hospital. The ACA is trying to take these plans off the market as they do not meet the standards of minimum essential coverage.

<p style="color:rgb(51,51,51);font-family:Georgia, 'Times New Roman', Times, serif;font-size:16px;">Fixed benefit plans were popular in the past due to their cheap overhead, however a fixed benefit plan is a big gamble as it could leave you with major medical costs out of pocket in a worse case scenario. Still many are choosing fixed benefit plans to supplement their current plans or are holding on-top their plans due to grandfathered status obtained before the law went into place.
 

 

This might be what it is as they did term it supplemental, but they're saying that for $250 I'm covered for virtually any situation. The tougher part is actually getting any coverage details from these guys. But the $300 plan apparently isn't doing my any favors either even in a worst case scenario. Apparently you can get the $50 plan alone and it would be MEC, but they're telling me it pretty much only covers doctors visits and meds. 

Quote:But why should I have to pay the extra $50 for the $300 plan when it gives me no additional coverage? That's $600 per year, and there's a slight chance the combined fine won't even be that much, although it could be over $1200. We have issues so we can't go without, and as I also said the best plan to go our own route would have us now paying $750 per month because I no long qualify for subsidies. It sounds like I have to do the $250 plan and hope the fine isn't too steep.
 

I could be wrong but my understanding is that by law the fine can only be taken out of the refund from the IRS. If you end up owing them every year then there may be a fine but it can't be collected. It's not added on to what you owe.

Because what you have isn't a health insurance plan.  

<b>Fixed benefit indemnity plans.</b> These plans will reimburse you a set sum, generally low, for medical services, after which you’re on your own, most likely with a load of medical debt if you experience a major health problem. The $450-a-month plan Tenenbaum was sold was a typical one: it pays $100 apiece for up to five doctor visits a year, $50 a year for screening tests, and $1,000 a day for up to 30 days in the hospital. A typical hospital stay runs about $1,850 a day, and these plans cover little if any of the associated costs, such as tests, medications, and surgery. Unlike mini-meds, which though stingy function like real insurance policies and charge very low premiums, indemnity plans can cost as much as major medical insurance.

http://www.consumerreports.org/cro/magaz.../index.htm


Let me be clear here.  I'm not defending Obamacare here.  I just want to make sure that you are able to actually be covered, and not just think you're covered.  Apparently there's been problems with this with many people.  


“Don’t buy fixed benefit plans,” says Karen Pollitz, a senior fellow at the Kaiser Family Foundation and an expert on individual insurance. “You’ll still be uninsured but out a bunch of money.”

Quote:I could be wrong but my understanding is that by law the fine can only be taken out of the refund from the IRS. If you end up owing them every year then there may be a fine but it can't be collected. It's not added on to what you owe.
 

The penalty gets added whether you owe taxes or are getting a refund.
Quote:The penalty gets added whether you owe taxes or are getting a refund.
 

http://www.dailyfinance.com/2015/06/25/c...e-penalty/
I just confirmed that it is an Limited

 

Quote:http://www.dailyfinance.com/2015/06/25/c...e-penalty/
 

 

This is interesting advice...


 

<p style="margin-left:40px;">For those who categorically oppose Obamacare and its individual mandate provisions, the better course of action is to apply for an open-ended hardship exemption based on the "any other hardship" provisions of the statute. Even if none of the listed exemptions applies to your situation, the ability to make your case could get you out of penalties entirely -- and never have to worry about whether the IRS might be able to enforce a penalty later.

Quote:Because what you have isn't a health insurance plan.  

<b>Fixed benefit indemnity plans.</b> These plans will reimburse you a set sum, generally low, for medical services, after which you’re on your own, most likely with a load of medical debt if you experience a major health problem. The $450-a-month plan Tenenbaum was sold was a typical one: it pays $100 apiece for up to five doctor visits a year, $50 a year for screening tests, and $1,000 a day for up to 30 days in the hospital. A typical hospital stay runs about $1,850 a day, and these plans cover little if any of the associated costs, such as tests, medications, and surgery. Unlike mini-meds, which though stingy function like real insurance policies and charge very low premiums, indemnity plans can cost as much as major medical insurance.

http://www.consumerreports.org/cro/magaz.../index.htm


Let me be clear here.  I'm not defending Obamacare here.  I just want to make sure that you are able to actually be covered, and not just think you're covered.  Apparently there's been problems with this with many people.  


“Don’t buy fixed benefit plans,” says Karen Pollitz, a senior fellow at the Kaiser Family Foundation and an expert on individual insurance. “You’ll still be uninsured but out a bunch of money.”
 

 

I confirmed it is such a plan, and there's no deductible to boot. But yeah they only cover so much. It sounds like enough for most situations, but I could be bankrupt with a huge surgery.


 

I asked what makes the other coverage compliant. Basically for the MEC insurance it's $50 but it only covers the 63 Obamacare requirement minimums. The differences are very small. For instance, the plan I'm on covers diagnostic tests 100 percent up to $75 per day where the MEC requirement covers such tests 100 percent with no minimums. Obamacare MEC also covers "screenings" which this plan does not, but I'm not sure how important or expensive that is. And the Obamacare MEC plan covers immunizations that we typically don't get anyways. Otherwise it's not offering anything more. There is no MEC requirement for coverage beyond the limited amounts they offer.


 

For the extra $50 I'm just not sure it's worth it. That's $600 per year, and there's no telling if the fine would even be that much, plus I'm likely in a situation of owing money anyways meaning the fine would just forward until the day comes I actually am do a refund, and by then Obamacare might be abolished with former fines waived.

Quote:But why should I have to pay the extra $50 for the $300 plan when it gives me no additional coverage? That's $600 per year, and there's a slight chance the combined fine won't even be that much, although it could be over $1200. We have issues so we can't go without, and as I also said the best plan to go our own route would have us now paying $750 per month because I no long qualify for subsidies. It sounds like I have to do the $250 plan and hope the fine isn't too steep.
Go up to $300. The penalty is 2% of your household income, which would be $1,004.00, an additional $83.67 per month. You can always open a complaint against your insurer later, but the penalty is much higher than the premium hike.

Quote:http://www.dailyfinance.com/2015/06/25/c...e-penalty/
 

EDIT:  This article is wrong.  I've certainly had people who owe taxes in addition to penalty.  I don't know where the author of this article is getting his information.  It's not true in practice.  I've had people who owe the health care penalty in addition to taxes. Whether or not they got a refund is irrelevant.

 

In this situation he is certainly getting a refund unless there is another source of income.  So it doesn't matter anyway.

Quote:Oh I see. I guess in my experience I've had many people own the IRS in addition to penalty, but that was because they received a subsidy, made too much money, the had to pay it all back.
Yeah, I just changed my subsidy level today because my income isn't going to be what I thought it was, and this is the second to last day I can do it before being screwed at the end of the year.
Quote:Go up to $300. The penalty is 2% of your household income, which would be $1,004.00, an additional $83.67 per month. You can always open a complaint against your insurer later, but the penalty is much higher than the premium hike.
 

I'm going to agree with this.

Quote:Yeah, I just changed my subsidy level today because my income isn't going to be what I thought it was, and this is the second to last day I can do it before being screwed at the end of the year.
 

i edited my post.  I think this article is wrong.  You can owe both penalty and taxes in the same year.

 

Yes, just be careful and continue to update the marketplace if you expect an increase in income.  You dont want to be in a situation where you have to pay money back.  I had several people have this happen.
Quote:I just confirmed that it is an Limited

 

 

 

This is interesting advice...


 

<p style="margin-left:40px;">For those who categorically oppose Obamacare and its individual mandate provisions, the better course of action is to apply for an open-ended hardship exemption based on the "any other hardship" provisions of the statute. Even if none of the listed exemptions applies to your situation, the ability to make your case could get you out of penalties entirely -- and never have to worry about whether the IRS might be able to enforce a penalty later.
 

You would have to apply for such a hardship and get approved, at which point you get a certificate to use on your 1040.  You can try.  Are you by chance a member of an indian tribe? haha

 

Be leery of the advice in that article and in the comments.
I think the rule the author is confused about has to do with interest.  The IRS will not charge interest on unpaid health care penalty unlike other amounts owed.

When I worked for the independent garage with no worker provided insurance a company of 10 people we looked at the ACA exchanges. The prices are ridiculous big reason why I made the move to a bigger chain garage that can help with insurance.
Obamacare rears it's ugly head again.

 

The problem with insurance is that it's been so misleading as it relates to health care.  Insurance is supposed to cover an unexpected or catastrophic event, not provide basic service.  Think of it this way.  Your car insurance covers damages related to an accident (unexpected and possibly catastrophic).  It doesn't cover an oil change, tune up, tire rotation, etc..  Your homeowner's insurance covers a major event such as a fire or maybe wind damage.  It does not cover electrical or plumbing repairs, lawn maintenance, etc..

 

Health insurance is there to cover a health related issue that is unexpected such as injury or unexpected illness.  It should NOT cover a routine office visit for a physical or something like that.  That's what a health savings account is for.

Quote:Obamacare rears it's ugly head again.


The problem with insurance is that it's been so misleading as it relates to health care. Insurance is supposed to cover an unexpected or catastrophic event, not provide basic service. Think of it this way. Your car insurance covers damages related to an accident (unexpected and possibly catastrophic). It doesn't cover an oil change, tune up, tire rotation, etc.. Your homeowner's insurance covers a major event such as a fire or maybe wind damage. It does not cover electrical or plumbing repairs, lawn maintenance, etc..


Health insurance is there to cover a health related issue that is unexpected such as injury or unexpected illness. It should NOT cover a routine office visit for a physical or something like that. That's what a <a class="bbc_url" href='https://en.wikipedia.org/wiki/Health_savings_account'>health savings account</a> is for.


The problem with that is routine medicine and visits have outpaced what the average person can pay. When a doctor visit without insurance is north of $100 and the tylenol is north of $50 people need insurance to help with the cost. We didn't have any insurance for years and we just never went to the doctor it was ridiculous if you could even find someone accepting seld paying patients they wanted $100+ before even walking in the door.


I don't know what the fix is and obviously obamacare only made it worse but what we had before was just as bad.
Quote:The problem with that is routine medicine and visits have outpaced what the average person can pay. When a doctor visit without insurance is north of $100 and the tylenol is north of $50 people need insurance to help with the cost. We didn't have any insurance for years and we just never went to the doctor it was ridiculous if you could even find someone accepting seld paying patients they wanted $100+ before even walking in the door.


I don't know what the fix is and obviously obamacare only made it worse but what we had before was just as bad.
 

I somewhat agree with you regarding how the cost has gone up, but let's be clear about it.  I went in for a physical a couple of years ago and paid cash.  It cost me roughly $60, and that was for a complete physical.  Now getting blood work done at a lab cost a bit more, but it wasn't an outrageous amount.

 

The basic way that it works as an example for a physical... if you have "insurance" you pay your $10 co-pay or whatever, then the doctor's office bills the insurance company $125.  People will immediately blame the doctors for "milking the insurance company", but that's not the case.  The doctor's office staff has to get paid for their time dealing with the insurance company.  The insurance company has to pay their staff, and so on...  Both the doctor's office and the insurance company have to make their money as well so something that costs $60 more than doubles if "insurance" is involved.  That's why if you have "insurance" a pill might cost $50.  If you pay cash that pill might cost $10 or less.

 

Here is another way to look at it.  You're a mechanic.  Say 1 hour of your shop time is $60.  A customer comes in for a routine tune-up, and it takes you an hour or less, you bill the customer for 1 hour of shop time.  The customer pays you in cash and you can immediately deposit that money into your bank account.  However, say the customer has "insurance" or a "maintenance plan".  In order for you to fill out the paperwork, contact the "insurance" company and wait a couple of days to get your money, well that costs you time and so that's why you bill the "insurance" company more money.
Quote:Health insurance is there to cover a health related issue that is unexpected such as injury or unexpected illness.  It should NOT cover a routine office visit for a physical or something like that.  That's what a health savings account is for.
Yes, yes it should. If I'm going to pay for health insurance, that health insurance is going to cover a portion of my routine expenses. I am not paying $400/month for a private "catastrophic coverage" plan then $100+ out of pocket every time I have a flu.

I went for an eye appointment.  Basically they did nothing for me except say I dont need glasses.  Ok.  I asked how much I owed before I left, they said nothing.  Then later on I get billed $75.  I can see they already billed my insurance about $125.  I'm refusing to pay it.  I haven't paid it in over a year.  I'll be damned if they get paid $200 for doing nothing.

 

What are they going to do?  Take me to court over 100$?

Pages: 1 2 3 4 5 6 7 8