250 a month payment and a copay of 7500 and yes it was going to be a way to find low cost health care ? Originally Posted by rexdutchman
.. a "copay" of $7,500 ...So in 2015 for last plan year (2016) as the ACA plans made their first big attempt to keep from collapsing, they kept premiums about the same and some reduced them. (Texas I'm talking about)
That sounds more like an annual deductible. If so here's my point:
"Self-insured":
Premiums $250 a month = $3,000 annually
Annual deductible = $7,500
Total annual cost = $10,7500
....... Originally Posted by LexusLover
But what they then did,...was RAISE the deductible AND the OOP cap. Of course bronze plans were higher and gold lower....but in any case, the trend was for the deductible to equal the cap.
So likely her deductible or "copay" is 7500 AND her cap is 7500. Funny misleading part is that she may have a benefit for something that pays at 80% (her copay 20%). But benefit doesn't kick in until she reaches her deductible...which happens to be her cap.
So for an 80/20 procedure, she either pays ALL of it...or NONE of it depending if she is under or over the deductible/cap.
What that means is that, basically, one has NO COVERAGE until the deductible is met and then basically 100% because the OOP limit was met at the same time.
"coverage" meaning something is actually "covered" under the plan
To me,...IMO this is basically catastrophic insurance. No coverage for little stuff (pay out of pocket 100%)....then bankruptcy protection against the big stuff...obviously only for one year at a time. So it would be better to get cancer or have your heart attack in January instead of December.
Now, for me,....a rich guy....this would be FINE AND DANDY.
IF,....the fucking cost of entry wasn't so expensive. In other words, I'd happily just pay my doc for a visit or even the plan fee for a stress ekg once a year. Then rely on insurance for a heart attack, cancer, or other detrimental financial hit.
The feds could probably work that out for me,....If my premium didn't need to cover the cost of four poor families.
I'll continue on.....
I have my 2016 spreadsheet on another computer. So later I might try to make a postable table of the numbers for 2015/16/17 for all's FYI.
But here is a brief summary of a few of THE FEW plans offered to me this year. Now,...remember,....I'm RICH and in that 2% the dems always attack for money. So the numbers have to be high enough for the feds to provide health care for 4 or 5 families out of what I pay.
Plan Monthly Annual DedFam Prem+DedFam OOP Fam Prem + OOP Fam
Bronze 1 920 11,052 10,000 21,052 14,300 25,352
Silver 1 1,120 13,445 3,000 16,445 14,300 27,745
Bronze 2 1,218 14,620 14,300 28,920 14,300 28,920
Silver 2 1,704 20,450 7,000 27,450 14,300 34,750
Note that IIRC the max OOP of 14,300 for the family total seemed to be across both plan brands. Me thincks that number came from the FEDS.
Scenario 1: everyone in my family NEVER gets healthcare. Min cost for me for the year = 11,052 Bronze / 20,450 BCBS silver
Scenario 2: enough of us in the family get enough healthcare to get us to the family cap, the max cost for me is 25,352 Bronze and 34,750 BCBS Silver
Now for both scenarios, don't forget the expenses that weren't covered...like say eye glasses, contact lenses, dental work including 3k wisdom teeth extraction and so on.
Finally, I haven't run the numbers for last year. But in the years past, if you add up what I paid in premium and subtract the benefit i received from the plan, there was a helluva lot of money left over for the four poor families I'm paying for through the back door.
Also note that the Silver 2 plan from BCBS Tx went up 70% from 2016...with REDUCED coverage.
It is unfucking believable.
