The Cost of Affordable Healthcare:Domino Principal
 

I was forced this year to get insurance through the Marketplace. My own out of pocket insurance was being phased out and due to pre-existing conditions nobody would touch me for a reasonable amount of money.

So I used my insurance for the first time last month. All of my refills on my medicines had expired and they are meds that I need to stay healthy. Retiring and becoming a full time homesteader forced me to change physicians. My new health care provider is a Nurse Practitioner and I really like him.

My old physician charged us 75$ for an office visit. He gave us a professional discount as we were health care providers in a previous career life and neither of us had insurance that would cover office visits. I expected my first visit to be a little higher with the new medical practice given it was an initial visit and more complex. I reasonably thought to myself may 125$.

Imagine my surprise when I got my statement today and the initial cost of my first visit was 202.00 dollars. That is for a basic sit down, getting to know you and your chronic health problems sort of visit. No labs, no preventative health care. Just talk.

I hadn't reached my deductible yet on my policy and they gave me a $94.93 write off on my charges leaving me with a total of 107.00 to pay out of pocket.

Now first off, that's okay. I'm willing to pay that out of pocket for good health care. But look at the regular cost of service! 202.00 dollars (if they pay in installments. You'll understand this better in a minute) and think of the people who are going to that practice, possibly Amish if the need arises, or people who just haven't insurance to fall back on and are paying the annual penalty in their Taxes.

For every 94.93 that office is writing off on me, some poor soul with no insurance is paying the full amount of 202 dollars for an initial visit to make up for the loss that practice is taking in seeing me.

And we wonder about the rising costs of health care in America!

The office is offering a 50% discount to people who pay cash at the time of service but if you have insurance to use that pretty much goes out the window. Although if I had used that option, I would have only paid 101$. So they are making 6$ more on me than they would have if I had paid cash at the time of service. Oh man, 6$ that really is going to be a big money maker in a medical practice where insurance rates and licensing fees, not to mention operating expenses are skyrocketing. And many people do not have 101 dollars in ready cash to hand over to anyone these days. So those folks are paying the full price of 202 dollars in monthly payments.

Anybody else ran into this with their Marketplace policy? Have you noticed a rise in the charges for an office visit/services from your family doctor since the start of Obamacare?

For me, it's a safety net. I lead a pretty energetic life style for a lady in her 60s and as I like to say, it's not a matter of if I break a bone but when. But I only see this having, as I expected, a HUGE negative effect on health care in America.

All I can say is: Hang on til medicare.
DH lost his ins due to the "If you like your ins you can keep it. Period." He'll be medicare age in 1 1/2 yrs, hoping for no lithotripsy charges in the meantime. He passed a small stone just the other day. Nearly a weekly occurance.

Man, I feel for him. As bad as childbirth, I have been told.

That is what happened to my personal policy also. I could keep it if I liked it but then I was told it was obsolete and due to be phased out.

Medicare is 3.5 years away for me and 1.5 years off for DH.

What is so alarming is whether or not price tags on medical care are going to rise, or maybe even double because of Obamacare.

If they do, you will see more people filing for assistance.

Where are we as a nation going to get all this money?

I live in PAand the large medical center has a healtph plan that is working for me very well. I have a $300 deductible..but they "give me $1500 in a hospital checking account that I write the checks to pay for that first $1500. Since i hadn't used it for a couple of years and this year I needed too badly I was able to pay my $3000 from my hospital piggy bank money so no out of pocket for me this time.For prescription I use our county hospital from the same medical center and am able to get heart medication x'3 for 90 days for reasonable rates with no added policy. For a 90 day supply of one it cost me $12 yes..twelve dollars and the other 2 are less. This has worked well for me and what happens is the SS medicare payment takes care of the monthly cost.so I don't pay any real out of pocket preminum payments either . It has worked well for me so far. It doesn't cover eyes, dental or hearing exams but usually can afford twice a year dental checkups and every 2 years for glasses and lenses. Will cover the eye exam though.

OPPS!!!!!..Mean a $3000..3 thousand...deductible..Need to prove read better...

The people who've been pushing for socialized medicine for decades have finally gotten the foot in the door. They don't give a rat's rear if it puts people in hardship as long as they've got their "control" through the ability to dictate the most vital part of our lives. From here it just gets worse, until people are clamoring for relief. That's when they "give" us the relief of what they term "single payer" (national healthcare), just like Great Britain.

Next year, when my wife retires, we'll sign up for Medicare. I can hardly wait.

Isn't Medicare "Socialized Medicine"?

Yeppers, and I highly doubt it would pass the big 0's "test" without buying supplemental insurance to go with it.

Of course.

Honestly, I don't know how else to do healthcare for the elderly except the kind of coverage Medicare offers.

The problem is that most elderly people are on limited fixed incomes and are unable to supplement their incomes because they are unable to work. At the same time, their healthcare is more expensive than it's ever been before in their lives. The idea is that when people reach retirement age their health insurance was already paid for during working years. Additional funds come from people who die younger and didn't need to use it. Think of it as insurance against growing very old.

In theory, Medicare could be done by private insurance instead of the government, but it would then have built-in profit drag on the program. I don't know if the results would be a good as what we have today.

You don't believe in supplemental insurance?

I pay cash out of pocket at the local walk in. Last year it was 100 per appointment, this year I went in for something minor and saw the price had gone up to 150.

of course I believe in supplemental insurance. I believe in it enough to purchase it. My point was that medicare by itself would most likely not qualify as being adequate by Ocares standards when it comes to "if you like your plan you can keep it". At best its very expensive and offers very little by way of coverage without purchasing supplemental coverage to fill in all the gaps.

Oddly enough that profit drag you speak of is usually far less than most government waste. How much profit drag would it take to equal a billion dollars or so of aircraft being sold to scrap dealers for what figured out to about 6 cents a pound? ($30,000) I saw that one on the news just last night.... I cant think of ANY private company that would throw that much money out the window. Our government does it on a regular basis.

You know, Nevada, there are times I agree with you and times I disagree but this time I agree with you 100%.

I remember during my nightmare ordeal/personal purgatory dealing with the Marketplace seeing a note somewhere that said "please notify us if and when you qualify for Medicare".

I dread the day I have to do that. IMHO they are going to push everyone into that mandatory purchase also. I think insurance is a great safety net. I just question the definition of 'affordable' and what 'affordable' is doing to medical practices and private pay individuals.

I have always thought of Medicare as the ultimate Ponzi Scheme. They are just sitting around hoping we all die young instead of old and broke.

It all reminds me of the old joke that goes, how dare they say this is a dictatorship. Just because we demand that everyone learn to play a musical instrument or face death? We are not dictators, we are music lovers!

No matter how you stir it up and serve it, or label it, it still smacks of socialized medicine and yes, a dictatorship presidency.

Yes, and next year it will probably be 175 or higher. The docs have to make up the loss somewhere and it's gonna be through you, the private, cash on the line patient.

It makes me want to curse and cry at the same time.

Health insurance isn't really a safety net any longer. Insurance used to be limited to care for major illness or injury, but routine care has become unaffordable. The idea of insuring routine care is to spread the cost of routine care over monthly payments.

The thing is that most of us will only see our doctors once or twice each year. If the doctor visit, lab work, and immunizations are going to hit us with a bill of several hundred dollars, then spreading that cost over monthly payments is going to help a lot of people.

I think Medicare needs to be audited. You figure most people pay into it for 40 years before they collect a penny in benefits. 4.5% of their gross pay, up to $113k per year, just recently it was raised. Then, they pay over $100 monthly premium when they start using it. Look at the obituaries on any given day. A lot of people die in their 50s and early 60s, they paid in but didn't collect much if any benefits. So cutting $700billion out of Medicare to help pay for O-care is stealing, IMHO.

From my post: "Next year, when my wife retires, we'll sign up for Medicare. I can hardly wait."

I was being facetious.

I think you'll find Medicare to be pretty good insurance. The conservative complaint isn't that it's bad coverage, the complaint is that it's so good that we can't afford it.

Boy you are so far out of this world if your thinking is that about the right. WOW just wow.

OK, straighten me out then.

Personal responsibility!

Okay, this is one of those times that I'll just have to disagree with....on both parts of your statement.

From a provider POV medicare is a POS when it comes to reimbursement to providers, but then most insurances are, forcing the doctors to take a write off that equals about 70% of their profit margin. And Why? Why to have the ability to see the patients that have the insurances to start with.

Second, as a conservative desperately clinging to my Bible and my guns, I don't have any recollection of anyone saying that Medicare is so good we can't afford it. But I do remember a lot being said about money being funneled from Medicare to fund Obamacare. And whose idea was that?

Who is saying that?

From an insured point of view, Medicare is standard 80/20 indemnity insurance, with affordable supplemental insurance available.

https://www.google.com/#q=medicare+unfunded+liabilities

Of what THEY consider to be usual and customary charges based on regional average...supposedly. Trust me when I say I know what I am talking about with this. It was my job for 7 years. And Affordable? By whose standards are you saying that? What is affordable for a retired government employee isn't the same for a retired non union factory worker or a retired restaurant employee.


I don't have time to read every link but the one I did scan from WSJ claimed that rising medical costs would be slowed. Nope. Not seeing it. Not when an office visit costs 202 dollars and another posters visit to an urgent care walk in clinic went up 50$. Had we stayed in business, we were looking at sharp increases in our fees in order to cover the hit we were going to be taking from Obamacare and the rising cost of licensing and insurance coverage.

Unless you've been a medical professional, working in the trenches of trying to run a medical practice, you only know what the media and Google is letting you know.

Don't believe everything you read on the internet. Try talking to some Doctors and Office Managers some time who are dealing with insurance companies on daily basis. I guarantee it will be an eye opener for you.

I don't draw my medical experience or opinions from Google.

Why do I bother answering this?
Do you not read anything on HT, do you just post?
Do you ever look at paycheck stubs?
Do you even know Medicare is paid into all your working life w/o any benefit at all til age 65? Then another $100/mo is taken from you.
Do you think ins. is socialized medicine? People pay into it every month whether used or not.
Save this post for when you are tempted to post that ? again. And again. And again.
Yes, medicare IS a form of soc. med but we pay for it.

Post of the century award.

NV, I'll tell ya agian, you've got ONE leftie site saying the 1/2 trillion TAKEN from medicare was NOT really taken & we've provided you w/several TRUE sites tellin ya that it WAS taken. but carry on w/lies, we all know.
Love ya anyway.

You do know that you described socialized medicine.

Socialized medicine is paid for by the people to be used by the people, it just leaves out the insurance companies.

If it's so good, why do you want a supplemental policy? Maybe because the base coverage isn't really as good as you say?

I need a script refilled, too, and the doctor won't do it unless I come in. That's fair enough -- I don't work for free and I don't expect anyone else to, either.

But here's what I did: Obamacare allows one free 'well-woman' visit per year for a physical or checkup. You don't have to meet your deductible first in order to have the cost of the visit paid for by insurance. If you Google 'ACA preventative care,' you'll find a list of screenings and other services that are supposed to be included in this free visit.

I figured I'd keep this option in my back pocket, like a 'Get Out Of Jail Free' card in Monopoly, until I needed to see the doctor, and then I'd invoke it.

I printed off a list of the screenings and highlighted the ones I want to discuss with the doc. But while I'm there, I'll also ask about getting my scripts refilled. ;)

I can't say whether this tactic will work -- my appointment isn't until Monday! -- but I figured it was worth a shot.

GO FOR IT, GIRL! Let us know if your 'get out of jail free' card works for you.

I talked the preventative care options over with my NP and he said that they are now advising labs every three years and if you have had a pap done within 4 years of your 65 birthday and it was negative, you didn't have to have anymore unless you started having symptoms that warranted it. Well, darn, I had everything done last fall so no freebie for me.

I try to avoid doctor's offices as much as possible and told the new provider that. I'd bow to coming in every 6 months but unless I was deathly sick or hurt, don't count on seeing me.

For years I have paid for my own office visits and really thought I would be paying less with my Anthem coverage. Surprise. I'm paying more. That was the whole jest of this topic.

Are you paying more or less for you health care coverage under Obamacare?

It was passed down to providers last year that we were going to be getting reimbursed less by Medicare this year. I don't remember just how much less but whatever we didn't get paid means either the patient will pick up the copay if their supplemental insurance doesn't or the physician will be forced to do a write off of the charges.

That's bad news for the Medicare enrollees and for the providers.

Some retired people can't afford 20% with straight Medicare. We have alternatives to that here. We have Medicare Advantage HMOs that have modest enough copays that supplemental insurance isn't necessary. That's what I'll be getting next summer when I go on Medicare.

I'll say it again. Medicare is cutting what they are paying to health care providers. Who is that going to affect? The group who is going to be paying more for their health care is the percentage of people who do not have insurance. That's the whole point I'm trying to make here. Physicians and health care providers are having to raise their fees in order to off set the hit they are taking from the Affordable Health Care Act.

It doesn't matter what type of supplemental insurance you have, Medicare Advantage, HMO...dealt with it. BCBS dealt with it, Humana Medicare? Dealt with it. They are all on board to pay the health care providers less leading to higher fee prices being passed down to the private pay, non insured patient.

Raise prices enough and you force people to sign up for insurance to avoid paying the higher out of pocket prices. It's the same thing they are doing to gun owners. They can't take the guns away but they can control the amount of ammo you can buy by buying up the public surplus ammo sitting on the gun shops shelves. Tried to buy .22's lately? Can hardly do it.

In a lot of ways the party is just about over for medical providers. They've finally killed the goose that lays the golden egg through overpricing. They've priced themselves into a new era. They'll either become more efficient and do things for less, or go work for someone else.

An industry can only raise prices to a certain point before consumers revolt. We've reached that point in medicine. The ACA is telling providers that we're not going to pay six figures for heart attacks and cancer any longer.

They only have themselves to blame for this.

A better question.... If its so good why isnt it offered "free choice" instead of being forced upon everyone?

Oddly enough it isnt the consumers that revolted.... once again its the government forcing the citizens to play in their game. They got away with it with SS, They got away with it with Medicare, now they are taking over everyones freedom to choose for themselves with the ACA. I am quite sure the government knows best how to make our choices for us... I dont know of any citizen who would go into 17 trillion dollars worth of debt with no possible way to pay it off. That kind of wisdom seems to be reserved for the government. :hair