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To clarify 2 points: - The annual out-of-pocket maximum for any Exchange plan can be no higher than $5,950 for individuals and $11,900 for families (2010 dolla

by daguar 13y ago

To clarify 2 points: - The annual out-of-pocket maximum for any Exchange plan can be no higher than $5,950 for individuals and $11,900 for families (2010 dollars, so will be higher now). [1] - The out-of-pocket maximums are lower for people with incomes less than 400% of the federal poverty level, specifically: -– 100-200% FPL: one-third of the HSA limits ($1,983/individual and $3,967/family); -– 200-300% FPL: one-half of the HSA limits ($2,975/individual and $5,950/family); -– 300-400% FPL: two-thirds of the HSA limits ($3,987/individual and $7,973/family). [2] - All preventive services are covered at no cost, and are not subject to the deductible. [3] [1] http://kaiserfamilyfoundation.files.wordpress.com/2011/04/8061-021.pdf http://kaiserfamilyfoundation.files.wordpress.com/2011/04/80... (page 5, search "out-of-pocket") [2] Ibid. [2] Ibid, page 10 ("Coverage of preventive services" section) EDIT 12:31 PM PT: Added note on income-indexed annual maximums.

drakaal 13y ago
How many poor people are going to use the preventive services? What do you think a Physical and an annual check up prevents? You have generations of thinking that the Doctor was where you went when you are about to die, and suddenly expect them to get check ups. The response is "but they might find something" and that would cost money.
- daguar 13y ago
  I can't address your speculative claims on how lower-income folks think about health care, but to give a concrete example of a positive preventive outcome: - A 55 year-old woman making $30,000 a year purchases insurance through the Exchange. She pays: -- $2,512 for the year's premiums ($209 per month) - She receives a preventive breast exam (no cost) that is positive for breast cancer. - She receives comprehensive treatment costing $60,000. - Because she is at 261% of the federal poverty level, she stops paying out of pocket at the maximum of $2,975. - Her total costs paid for the year are $5,487. ($2,975 in cost-sharing [2] + $2,512 in premiums) [1] http://kff.org/interactive/subsidy-calculator/#state=ca&zip=94606&income-type=dollars&income=30%2C000&employer-coverage=0&people=1&adult-count=1&adults%5B0%5D%5Bage%5D=55&adults%5B0%5D%5Btobacco%5D=0&child-count=0&child-tobacco=0 http://kff.org/interactive/subsidy-calculator/#state=ca&zip=... [2] Note: the out-of-pocket will be somewhat higher because of the OOP maximum is in 2010 dollars.
  - drakaal 13y ago
    She was probably already getting her breast exam free if she was earning less than $50k a year. http://www.komencanaz.org/understanding-breast-cancer/about-breast-cancer/ http://www.komencanaz.org/understanding-breast-cancer/about-... She would have gotten the treatment anyway. Filed bankruptcy and as a renter lost nothing, except her next car costs 5% more because her interest rate is higher.
    - Klinky 13y ago
      Charities often have strict income limits regarding those who they will serve. Some of the charities your link mentions state they can only serve a limited number of patients. Many of the programs are in a single county. You may end up having to call around to many programs to only find out you don't qualify for any of them. If you have insurance through your employer, it may have a huge deductible and even if it does cover a mammogram it may not cover treatment. These factors all discourage people from getting preventative medicine done. Bankruptcy should never be regarded as a valid solution for medical care costs. What if her state has rules that don't allow her to keep her car(or certain other items) when filing for bankruptcy? What if she had already filed for bankruptcy the year before?
  - jrs235 13y ago
    That assumes the costs all fall with in the fiscal calendar year... Or is there a rolling year?
- nknighthb 13y ago
  I grew up pretty poor. We used preventative services regularly. I've actually gotten worse about that at the same time my income has grown dramatically.

by daguar 13y ago

drakaal 13y ago

How many poor people are going to use the preventive services? What do you think a Physical and an annual check up prevents? You have generations of thinking that the Doctor was where you went when you are about to die, and suddenly expect them to get check ups. The response is "but they might find something" and that would cost money.

daguar 13y ago
I can't address your speculative claims on how lower-income folks think about health care, but to give a concrete example of a positive preventive outcome: - A 55 year-old woman making $30,000 a year purchases insurance through the Exchange. She pays: -- $2,512 for the year's premiums ($209 per month) - She receives a preventive breast exam (no cost) that is positive for breast cancer. - She receives comprehensive treatment costing $60,000. - Because she is at 261% of the federal poverty level, she stops paying out of pocket at the maximum of $2,975. - Her total costs paid for the year are $5,487. ($2,975 in cost-sharing [2] + $2,512 in premiums) [1] http://kff.org/interactive/subsidy-calculator/#state=ca&zip=94606&income-type=dollars&income=30%2C000&employer-coverage=0&people=1&adult-count=1&adults%5B0%5D%5Bage%5D=55&adults%5B0%5D%5Btobacco%5D=0&child-count=0&child-tobacco=0 http://kff.org/interactive/subsidy-calculator/#state=ca&zip=... [2] Note: the out-of-pocket will be somewhat higher because of the OOP maximum is in 2010 dollars.
- drakaal 13y ago
  She was probably already getting her breast exam free if she was earning less than $50k a year. http://www.komencanaz.org/understanding-breast-cancer/about-breast-cancer/ http://www.komencanaz.org/understanding-breast-cancer/about-... She would have gotten the treatment anyway. Filed bankruptcy and as a renter lost nothing, except her next car costs 5% more because her interest rate is higher.
  - Klinky 13y ago
    Charities often have strict income limits regarding those who they will serve. Some of the charities your link mentions state they can only serve a limited number of patients. Many of the programs are in a single county. You may end up having to call around to many programs to only find out you don't qualify for any of them. If you have insurance through your employer, it may have a huge deductible and even if it does cover a mammogram it may not cover treatment. These factors all discourage people from getting preventative medicine done. Bankruptcy should never be regarded as a valid solution for medical care costs. What if her state has rules that don't allow her to keep her car(or certain other items) when filing for bankruptcy? What if she had already filed for bankruptcy the year before?
- jrs235 13y ago
  That assumes the costs all fall with in the fiscal calendar year... Or is there a rolling year?
nknighthb 13y ago
I grew up pretty poor. We used preventative services regularly. I've actually gotten worse about that at the same time my income has grown dramatically.