Huge rate increase for Obamacare--I think I'm screwed

[awakenedsoul]

I've bought my own health insurance for the past 20 years, since I was self employed. Until Obamacare, I had a catastrophic policy with Blue Shield. Once we switched to Covered CA I got the Silver Plan with Health Net. Although I have been perfectly healthy my whole life, I did use the insurance twice: once for my bike accident last Fall, and again for my recent bilateral hip replacement.

I really studied the plans, and it has worked for me financially. With Health Net, I paid $108. a month, because I qualified for a subsidy. My out of pocket expense for an ambulance trip, MRI, and a few hours in the emergency room was only $1,000. I stopped them when they wanted to do more xrays. I explained that I didn't know how much Health Net would cover. You don't have to do everything they say. The doctor agreed with me (quietly, and in private,) and he released me.

For my hip replacements, I chose a surgeon who doesn't bill through insurance. He is very famous, and is booked for months is advance. I changed my insurance over from Health Net to Blue Shield. (You have to have a life change to be able to switch. I had a change in income.) Blue Shield covered the hospital and rest of the visit. My bills totalled about $21,000. $13,000 of that was for the surgeon. He charges $6,500 per hip. I will receive a reimbursement check from Blue Shield for between $1,000.-$13,000. In October, I will go back to a less expensive plan. When I see my surgeon a year from my surgery date, I will pay him cash. It will still be cheaper. He told me that they don't do much at that visit, so it shouldn't cost much. It will still be less than staying with the PPO that I got in August. The PPO is $439. a month. I only had to pay that for part of the year.

While in the hospital, I refused the sleeping pills, Benadryl, and other medications that I didn't need. I bought used crutches at the Salvation Army. I used my mom's walker. I told them I would buy a cane, but I didn't need one. I didn't need the crutches, either. I also didn't need a refill of the prescriptions. I only used about half. I switched over to Motrin.

There's a lot you can do with planning and research. Hip replacements are very expensive. I feel like the system worked very well for me. It was worth it to me to pay cash for Dr. Matta. His testimonials all say the same thing.

[freshstart]

There's a lot you can do with planning and research. Hip replacements are very expensive. I feel like the system worked very well for me. It was worth it to me to pay cash for Dr. Matta. His testimonials all say the same thing.

I get this, but you can only do it if you have a qualifying event, correct? And this works well when you can plan ahead. Now that I learned the hard way that you cannot always plan for everything or you make a mistake in your planning for the unexpected (I never thought private LT Disability insurance was worth the big price tag, I was very wrong), I do not feel so comfortable in my ability to choose the right plan in NYS's Marketplace. Especially since I have memory and confusion issues. So I should just make an appt with a Marketplace helper person, but I suspect these are not highly paid and trained people since NY managed to produce them so quickly. I feel like an old person who cannot begin to figure out Medicare A, B, D and I totally do not remember anything about MCR C or if there is one and their secondary insurance. I totally get now why they just hand anything medical related in a huge pile to their kids or me. That was always fun, but I punted to the SWs. It does not need to be so hard, money and politics, that's who I blame.

I would gladly accept the Universal Healthcare that other nations are doing. I am ok with waiting and letting the acute go first, I am fine with good solid care that may not have the latest and greatest PET scanner and older, reliable cost effective meds. But how we could ever get our country to remotely resemble these others, I do not know. I do not think it will happen in my lifetime. For example, I had a 24 hr EEG, this is really old technology, for some reason only done at the expensive trauma center, probably because it's so old and should be very cheap, no one else bothers with it. I got a bill for 4k and my insurance would pay $600, I was in-network at a non-prefered provider. Well, that God I reached the OOP max and that one should only cost $500. But charging 4k for it in the first place is obscene. How do we change that, because the people profiting from that 4k are not going to compromise easily. And they will use every scare tactic to stop major change. People will be scared of even more change and they will listen and vote for those saying it must stay the same, even though it is in their best interest for the change to occur. Like the Death Tax crap, I had patients so upset about that when the only thing they had in their estate was a house worth maybe 60k in what had become a horrible neighborhood.

ok, now I really am confused IRL so I better shut up!

[Williamsmith]

Awakened soul,

It is great that at this point in time for your personal experience and planning, you got the treatment you deserved for the spending you could afford. But I would challenge you to think about the system as more than an anecdotal experience. Yes, I may be standing at x location and the weather may be fine, even a little sunshine but just a few miles away at y location there might be some nasty weather occurring. In fact, there is. And that weather is coming towards x location but right now standing there I'm very satisfied but in danger.

The facts about the current condition and the future are easily found. Healthcare spending is concentrated on a very small proportion of the populace. Easily 20% of the spending was on only 1% of the population. Half of the total spending was done by only 5% of the population. Baby boomers are soon to be the elderly. Who are he high spenders? The elderly. Who are going to be the target for cutting expenditures? The elderly.

Our stagnant economy is not going to contribute to solving the problem. It is only going to worsen as more and more workers pull out of the workplace and the healthcare system. 15 % of the population spends nothing on healthcare. Why should they remain in the system if they have other challenges like food, clothing, heat, housing and transportation? Talk about income distribution. So that's one place the middleclass and poor are being sucked dry of their futures.

As as it is now, if you qualify for government subsidy it might make it tolerable and feasible for you. But there are those especially on the east and west coast who have higher costs of living it is not feasible.

the healthcare system is nothing but organized crime. That's the truth.

[bekkilyn]

the healthcare system is nothing but organized crime. That's the truth.

Probably the best description I've heard in a while!