Blue Cross in New York has a plan for a 42 year old with a $1000 deductible, $30 office visit copay and a full Rx card for $482 a month in Albany.
Preventative care identifies medical issues, many times before they reach the stage of expensive treatments. Last year when I was 60 I did not have a physical and colonoscopy because it was not covered, this year I will. That's worth $1500 of my premiums right there.
It's $520 in NYC, and is rated 2 stars - one of the lower rated plans. I had called around - doctors in NY don't take that one. They want Oscar. Oscar no deductible plan is $562/mo.
Yeah Oscar is a new tech startup insurance company. They don't give you much information about how their plan actually works on the inside though with claims payment. I can't figure out if they are a PPO, EPO or a network discount plan. Doctors not taking BCBS is not because of Obamacare though, that would be because of doctors and BCBS having a disagreement over pay rates. I ran a search using a Manhattan zip code though for BCBS and got thousands of results. So maybe the doctors you want don't take BCBS, but there are definitely plenty in NY that do. It's not surprising really. Doctors want to maximize their revenues just like all business owners. In NYC they have access to very wealthy people. If they take insurance plans that pay them a negotiated discounted rate, they lose money. That's profit maximization though, it has nothing to do with Obamacare.
You haven't given me your age or anything, but Oscar has a Gold plan for $470 with a $1300 deductible with a couple of free office copays and stuff. The reason some of these plans are putting more towards the deductible and raising them is because there is an out of pocket limit on your dollars now. Before ACA there were no dollar limits on you except for deductible expenses like surgeries and stuff. You could pay office copays and Rx copays forever. Now all of that applies to a cap (no higher than $6350.) That cap is pretty low honestly.
Again, this isn't true. When you go to the doctor, you pay a flat co-pay that's far less than their regular rate. If you get x-rays, you will pay a much lower insurance rate. On and on and on. Your costs of regular care with insurance are far lower than without, even before you meet your deductible. Not true. High-deductible plans have always existed and they still do. So do low-deductible plans. You can still get one if you want. Quit saying this unless you're willing to provide specifics. What was your old plan? Who was it with? Was it an individual plan or group plan? What did it cover? What did it exclude? What is the new plan you're looking at? What is the name of it, and who is it through? What tier is it? This is just ridiculous at this point - you're comparing apples to cars and then making all sorts of nonsensical claims based on it. No, they aren't. They account for all that stuff - this is for comparable plans. And you're doing a terrible job based on what you're posting. You don't seem to understand the basics of what insurance does or how a deductible works. You've posted multiple things that are flat out false. Why on earth would I trust your research when you keep saying things that are absolutely wrong? I don't know it because I live in NY. I know it because I understand what insurance is and how the studies work - something you apparently really do not.
So a few years ago, you could get a no-deductible plan for $450 and now you can get one for $562 three years later? So your complaint actually has nothing to do with any of what you were saying, but instead that insurance has gone up about 7% annually for the same coverage in your mind?
True - most plans have co-pays of some sort, but yeah, that's not necessarily the case. It would be helpful if he'd share details of the plans he had and is looking at instead of making vague claims.
Let's be clear. There are definitely plans without copays. Major seems to have not known that which is understandable as most people don't buy them. Edit: But even the plans without a copay have to cover preventive care (as described in ACA) at 100%, no cost to the member. However, Sweet Lou can afford a plan with a copay as I've shown them in this thread. If he has a plan with a high deductible and no copays then it is by choice.
Preventative care is such a crap term. Lipitor prevents heart disease. Blood pressure meds prevent, these all cost. I know you didn't invent it, and are just using the term as it is explicitly defined, but it is a huge misnomer.
No, it's just a misunderstanding of what words mean. Preventive means it is something done before the onset of a condition. Lipitor and any other med like it is something prescribed when something has been diagnosed and could lead to something worse. Sure, they are preventing the heart disease, but they are treating the high blood pressure, liver enzymes, on and on and on. Prior to diagnosis=preventive No one has ever been given high blood pressure medication because they were perfectly healthy.
Lipitor TREATS high cholesterol by blocking a cholesterol producing enzyme. While an effect of lower cholesterol is lower risk of heart problems and is a reason to strive for lower cholesterol; it is not the end game for Lipitor...it is there purely to help lower cholesterol.
There is no such thing as Individual PPO Plans. You can only get them as part of a group plan via work. Like I said, I think where Obamacare creates a problem is in that the pre-existing condition shifts costs from those with pre-existing conditions to those who don't. It's good if you are already sick, but if you are healthy, it means you lose something. In my case, it means higher premiums or a deductible. What annoys me is that all this promise of LOWER premiums. What they don't tell you is that yeah, it comes with a catch - higher deductibles. If you want to continue with no deductible insurance, you actually end up paying HIGHER premiums than before. I'm not saying Obamacare is a failure, I am just pissed that my choices really aren't all that better than before. I guess that's to be expected. Obamacare really was about helping those in lower income brackets. But really this year I am having to choose whether I want to contribute to my IRA or pay for Obamacare. If I don't put $7k into health care, I get hit with a 1% penalty in taxes. But if I put that money into an IRA, it basically cancels that penalty out and then some. So really I am still more incentivized this year to put money into an IRA instead. Which is what I am leaning towards doing.
That isn't true at all. Yes, this is correct. Yes, this is correct. Edit: You should look for an insurance agent in NY to help you instead of doing the research yourself.
You prevent it from becoming a problem. High blood pressure and low HDL is only a problem because it leads to problems. You are really stretching this. If a colonoscopy is a preventative treatment so is lipitor. A colonoscopy removes polyps that could lead to cancer. Polyps are not a problem unless they lead to cancer. Same thing.
High blood pressure is a medical condition. It is not the normal, ideal state of blood pressure, therefore treating it is not preventive, it is, well, treatment. If a colonoscopy discovers polyps it is not preventive and it will not be paid at 100%. A colonscopy is only covered as preventive if there are no polyps, otherwise it is billed and paid as a diagnostic procedure.
There isn't an Individual PPO. Not on the exchange, not from the insurance companies. I called Aetna, BXBS, and quite a few others. They do not offer PPO plans as Individual plans. You can tell me this is false all you want, but in NY, it is not. I looked for one extensively.
I don't have anything to add to this discussion but I have to ask. Sweet Lou you wouldn't be trying to revive your NewYorker persona to troll us? From my admittedly limited knowledge of healthcare plans it doesn't seem like everything you are saying is accurate.
No. According to the plan and what they say this is simply false. The way it works is you have a co-pay and deductible and then co-insurance. So If you show up to the doctors office and need an x-ray - that x-ray costs lets say $500. If you have a $1,500 deductible. You pay $500 out of pocket. Doesn't matter if you don't have insurance. Once you have met your deductible. Then you pay the co-pay and the insurance coverage kicks in. They are more expensive than before. Think about it, if you cover pre-existing conditions - who is absorbing the cost for that? It can't magically be done - someone has to pay for it. My only plan was Harvard Pilgram. But it was an employer plan that had 18 months of cobra coverage. So it was a very good plan. It was not an individual plan. But I did look into individual plans prior to cobra coverage. They were not great. So many I am looking at. But as I have said, I am looking at about $550 for deductible free coverage, and $450 for coverage with a deductible of about 1,500. Problem with a deductible is that right now it's already hitting May. So any deductible I take resets in just 8 months. No I am basing it on the reality of experiences. No they do not. Ok, you are sounding like JTR now.
