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MDC
Member

361 Posts

Posted - Nov 03 2013 :  10:34:08 PM  Show Profile  Reply with Quote
Thank you so much Rita. I will keep you informed.

No Mam I do not quaulify for any medicaide or other help. Other than small investment income, most will be be from SSDI and I will hold off my 401K as long as possible till I can get Medicare.

Thank you for your concern. I did consulting work for the government for nearly 20 years and I can and will play their games if necessary and help all those I can.

If I have to I will pay out of pocket for awhile buying on the private market while this mess gets settled, but this is not an option for most. If I get through this maze, I have found my calling, the application is not hard to do and to help those that need help would be very satisfying.

God Bless,
Mike

Knowledge is knowing a tomato is a fruit.
Wisdom is knowing not to put it in a fruit salad.
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MDC
Member

361 Posts

Posted - Nov 21 2013 :  10:16:03 AM  Show Profile  Reply with Quote
Well still waiting. Thinking about buying a policy on open market in case not approved in time for January coverage. Trying to find out if that will affect my eligibility for coverage.

Mike

Knowledge is knowing a tomato is a fruit.
Wisdom is knowing not to put it in a fruit salad.
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Dave-OH
Administrator

USA
4002 Posts

Posted - Nov 21 2013 :  1:28:42 PM  Show Profile  Reply with Quote
Look at valuepenguin, that site will help you choose. You can not buy there, but can do research.

Dave, Forum Administrator
COPD Support, Inc. http://www.copd-support.com/
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MDC
Member

361 Posts

Posted - Nov 24 2013 :  09:00:45 AM  Show Profile  Reply with Quote
Well after half a dozen phone calls, healthcare.gov told me that it was ok I just would not be reimbursed when approved for ACA subsidies. But they insisted that I wait till last minuter to purchase as they think dec 15 deadline will be met.

Well to be safe I called my agent and she said her non subsidized policies only took about 15 minutes with usually automatic jan 1st coverage, but to be safe buy by Dec 15 to be positive.

I think a 500-700 premium is good insurance against a 25-50K hospital bill.

We have sites in Arkansas where you can see the policies and calculators on them for subsidies and coverage.

Knowledge is knowing a tomato is a fruit.
Wisdom is knowing not to put it in a fruit salad.

Edited by - MDC on Nov 24 2013 09:02:01 AM
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Dave-OH
Administrator

USA
4002 Posts

Posted - Nov 24 2013 :  12:13:37 PM  Show Profile  Reply with Quote
The extended the December deadline 1 week.

Dave, Forum Administrator
COPD Support, Inc. http://www.copd-support.com/
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MDC
Member

361 Posts

Posted - Nov 28 2013 :  12:15:48 AM  Show Profile  Reply with Quote
Well finally got signed up today. A $500 deductible and $2,250 stop loss. $25 copays for Dr $60 for specialist till I reach stop loss.Drug copays are 25 generic 35 preferred 90 nonpreferred. They apply against stop loss. All for less than 100 a month.

Mike

Knowledge is knowing a tomato is a fruit.
Wisdom is knowing not to put it in a fruit salad.
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Diann-NY
Member

USA
58 Posts

Posted - Nov 29 2013 :  3:20:13 PM  Show Profile  Reply with Quote
MIke, that is great. My stop loss is $5000 with similar dr copays. Rx is $15,$30,and a percentage. There are 5 tiers but I forgot some of them. This is costing me $235 per month so you are getting a good deal. But like you, I am just thrilled to have the insurance so I can get my LVRS. Penny really has the cheapest set of plans, but she has done lots of research to get it. Wish I could be like her, but I am a scaredy cat.

Diann
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Rita1
Senior Member

543 Posts

Posted - Dec 01 2013 :  5:09:07 PM  Show Profile  Reply with Quote
Mike and Diann, I am so happy for you. I can't imagine the stress of living with a chronic disease and not having insurance. Now, you can concentrate on getting as healthy as you can.

Rita
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MDC
Member

361 Posts

Posted - Dec 01 2013 :  9:51:02 PM  Show Profile  Reply with Quote
Thank you so much Rita!!

I have been in a flareup for 2 weeks now fighting going to ER. But after several hospital stays last year I had all the meds on hand to take and went on 02 just like hospital 24/7 for a few days and seem to be stabilizing. Just taking antibiotics Dr gave me and steriods orally. Only difference is I take my meds orally instead of IV so takes a while longer.

But you are so true the stress of having this w/o insurance is terrifying.

Thanks,
Mike

Knowledge is knowing a tomato is a fruit.
Wisdom is knowing not to put it in a fruit salad.
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Rita1
Senior Member

543 Posts

Posted - Dec 02 2013 :  4:40:51 PM  Show Profile  Reply with Quote
Hang in there Mike. In less than a month you will have a whole medical team available. What a relief. Meanwhile you apparently have a plan which is working.

Take care,
Rita
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MDC
Member

361 Posts

Posted - Dec 23 2013 :  4:53:28 PM  Show Profile  Reply with Quote
quote:
Originally posted by MDC

Well finally got signed up today. A $500 deductible and $2,250 stop loss. $25 copays for Dr $60 for specialist till I reach stop loss.Drug copays are 25 generic 35 preferred 90 nonpreferred. They apply against stop loss. All for less than 100 a month.

Mike



Well got my policy from ABCBS the other day and deductible went to 1,250.00 instead of $2,250.00. Also get hearing aides and eye exam. No glasses but all helps. They keep calling me saying they need more info and I call back and no one nows why I am being called. Got policy, was billed, paid bill, got cancelled check, have card. Also it appears med co-pays might be included in stop loss, I hope so but not holding breath. Daliresp is all I get here anyway.

Obamacare has been an experience!But I am fortunate in my case.
Mike,

Knowledge is knowing a tomato is a fruit.
Wisdom is knowing not to put it in a fruit salad.
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Cindi-TX
Member

USA
53 Posts

Posted - Jan 21 2014 :  3:41:58 PM  Show Profile  Reply with Quote
Anyone else in Texas on BCBS ? I got the bronze plan, very happy to get it, but I got my Rx for Symbicort filled and it was $261.62 for 1. I have tried calling BCBS but the predicted hour wait turned into more and still no answer, if these are typical prices I'm still better off getting my drugs in Canada. The kid at the Walgreens counter also told me that I have no pharmacy coverage till I meet my deductible, and that my deductible is $12,000, which I'm on an individual plan, not family plan, so I'm confused and hoping that this a mistake that they will fix.
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Dave-OH
Administrator

USA
4002 Posts

Posted - Jan 21 2014 :  4:50:43 PM  Show Profile  Reply with Quote
That is the issue with a bronze plan. A gold plan would be better. You need to read your benefits.

Dave, Forum Administrator
COPD Support, Inc. http://www.copd-support.com/
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rosytomato
Contributing Member

USA
1342 Posts

Posted - Jan 22 2014 :  10:22:39 AM  Show Profile  Reply with Quote
I'm sorry Cindi-TX, they shouldn't be offering plans like this. I hope you will be able to change it.
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PennyPA
Contributing Member

USA
5826 Posts

Posted - Jan 22 2014 :  12:20:11 PM  Show Profile  Reply with Quote
Unfortunately, many people didn't look into their obamacare plans deeply enough (not meaning you, Cindi) and look at the monthly cost and the subsidy and figure "wow, isn't this great?" What I don't understand is if people couldn't afford to buy insurance before, how in the world are they expecting to pay the deductible? Cindi, your deductible is so high, you might as well not have insurance at all! Granted, it's worthwhile if you have some catastrophic illness or accident but it sure doesn't sound very good for the average person...even the average copd person. I agree with Rosy; a plan such as this shouldn't even be offered.

****************************************************************
Do Not Regret Growing Older. It is a Privilege Denied to Many

You canít change the past but you can ruin the present worrying about the future.

The Bad News: Time flies as you get older.
The Good News: Youíre still the pilot.

Penny's Lung Volume Reduction Surgery

And Our Travel Blog After LVRS




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Cindi-TX
Member

USA
53 Posts

Posted - Jan 22 2014 :  12:39:38 PM  Show Profile  Reply with Quote
My quote and all correspondence online says $6,000 deductible, which may sound high, but I have had $25,000 hospital bills in the past, that my old catastrophic plan barely touched, plus they paid 0 for tests, exrays, etc., my life since cancer 13 years ago and losing insurance then. The ACA process was a nightmare, you couldn't get through by phone or online and we all did the best we could, I still have faith that eventually it will work. I'm used to getting my meds in Canada anyway and didn't expect much. My husband is on Medicare part D and his drugs would be cheaper there, but in order to have supplemental insurance he has to have part D. Regarding the $12,000 deductible, unless there was some really fine print somewhere, it should be $6,000, but I can't get through online or by phone to find out, so Im not going to scream yet, but maybe later lol.
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Rita1
Senior Member

543 Posts

Posted - Jan 22 2014 :  6:12:21 PM  Show Profile  Reply with Quote
Cindy, BCBS is having some problems in Illinois as well. Some people have been double billed for their premiums due to the last minute change which allowed them to keep their old policies. BC apologized and said the long waits on the phone are due to the unexpected number of callers who they thought were finished when they signed up for new policies and the length of the calls because so many callers never had insurance before and need definitions for words like "co-pay" and "deductible." Hang in there and hopefully this will work for you. Some people, many who qualified for Medicaid and then Medicare, haven't had to try to work with private insurers and are unaware of what a nightmare that can be and how much easier it is most of the time to work with the government. Many also have never been denied insurance due to a pre-existing condition and have no idea how desperate one gets for insurance, any insurance. For example, like you, I had cancer (18 years ago, knock on wood) and took a job I hated in order to be covered and delayed starting my own practice.

Scream all you want! I hope you get through soon and it all gets straightened out.

Rita
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Cindi-TX
Member

USA
53 Posts

Posted - Jan 22 2014 :  6:24:09 PM  Show Profile  Reply with Quote
Thanks for the info Rita, all the calls for Texas are actually directed to Illinois, so I'm sure they are swamped and I will just bide my time and scream into a pillow lol. The teenager at the Walgreens counter was not exactly a rocket scientist either because I did have a co pay on another script I filled later, so I'm pretty sure I don't have to pay $12,000 first to get Rx benefits.
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rosytomato
Contributing Member

USA
1342 Posts

Posted - Jan 22 2014 :  6:46:02 PM  Show Profile  Reply with Quote
So then why were you charged full price for your Symbicort if you were only charged a co-pay on another script. Something doesn't sound right here.
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Rita1
Senior Member

543 Posts

Posted - Jan 22 2014 :  10:12:03 PM  Show Profile  Reply with Quote
Rosy, I'm not Cindy but I think the kid behind the pharmacy counter didn't know what the heck he was doing or what he was looking at. I don't think prescription drug coverage ever has a deductible - just copays, but I may be wrong. I've refilled 3 prescriptions this month with no deductible, only my usual co-pays. When Cindy filled a different prescription, (with a different clerk I assume) she didn't have a problem, only a co-pay.

I had a horrible problem last summer with a clerk at a Walgreens who refused to honor a free 10 pills manufacturer coupon. I even called the drug manufacturer and had her talk to them on my phone but she still refused and I finally paid my co-pay for 30 pills but didn't get my extra 10 despite assurances from the manufacturer that Walgreens would be reimbursed. I know it's not a big deal because I have great rx insurance but it was the principle of it. I was totally frustrated and sent off a nasty email to Walgreens telling them I should have taken the prescription and my coupon back from the clerk and gone across the street to CVS. Their email contact form asked for which store it was and I filled it in. The store manager called, apologized, told me the clerk should have contacted him (he didn't start until later in the day) and he had the 10 tablets delivered to me. He told me that Walgreens had had problems with reimbursements from that manufacturer but he would give it another try.

My point is that Cindy's experience could have to do with the clerk or Walgreens and not with her insurance. We'll know more when she finally gets through to BCBS.

Rita
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MDC
Member

361 Posts

Posted - Jan 30 2014 :  5:42:29 PM  Show Profile  Reply with Quote
I got the best Silver Plan. I love it it has the prescription coverage and is really better than the Cadillac Plan I had at work. Once I reach stop loss ($1,200) even meds are free. Just $50 copay for Specialist, $25 for PCDr. They approved me for daliresp and I have almost met deductible in January. Then I pay 10% untill $1,200 total. After that they pay 100%. Copays count toward $1,200 max also.

MIke

Knowledge is knowing a tomato is a fruit.
Wisdom is knowing not to put it in a fruit salad.

Edited by - MDC on Jan 30 2014 5:43:00 PM
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fatpuppy
Member

170 Posts

Posted - Jan 30 2014 :  8:32:55 PM  Show Profile  Reply with Quote
and on a lighter note...

Man Getting Screwed By Companyís $180,000 Health Deductible
http://www.theonion.com/articles/man-getting-screwed-by-companys-180000-health-dedu,35096/

ďAs democracy is perfected, the office of president represents, more and more closely, the inner soul of the people. On some great and glorious day the plain folks of the land will reach their heartís desire at last and the White House will be adorned by a downright moron.Ē H.L.Mencken 1920
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Rita1
Senior Member

543 Posts

Posted - Jan 30 2014 :  8:57:48 PM  Show Profile  Reply with Quote
Thanks for letting us know, Mike. It sounds like an excellent plan and I'm sure you are relieved to know what your health care will cost you this year. The health care law was passed to help people who, like you, didn't have insurance.

Rita
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rosytomato
Contributing Member

USA
1342 Posts

Posted - Feb 13 2014 :  10:37:26 AM  Show Profile  Reply with Quote
The ACA (Obamacare) is certainly affecting medicare. My friend was just told that her PCP of 20 years is not longer accepting medicare. This is not the first time I've heard of this happening and I think we will see more and more doctors dropping their medicare patients.




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Dave-OH
Administrator

USA
4002 Posts

Posted - Feb 13 2014 :  12:23:47 PM  Show Profile  Reply with Quote
Medicare is affecting Medicare. I have an Advantage plan and choose it for the doctors in the plan.

Dave, Forum Administrator
COPD Support, Inc. http://www.copd-support.com/
Your source for peer support and COPD Info

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PennyPA
Contributing Member

USA
5826 Posts

Posted - Feb 13 2014 :  12:39:16 PM  Show Profile  Reply with Quote
But the government won't be paying as much to the Advantage plans so the cost of what they don't pay will be forwarded to you in the form of an increase in what you pay.

I think doctors who are no longer accepting medicare has been around since obama first started talking about his great plan. However, I believe those doctors who chose to no longer accept medicare patients WERE keeping the ones they already had. Thankfully, in all our travels, and all the different doctors we've seen, we've never run into one that didn't accept medicare and the only negative thing I've seen on my statements is that some payments weren't paid or were reduced by the sequester.

****************************************************************
Do Not Regret Growing Older. It is a Privilege Denied to Many

You canít change the past but you can ruin the present worrying about the future.

The Bad News: Time flies as you get older.
The Good News: Youíre still the pilot.

Penny's Lung Volume Reduction Surgery

And Our Travel Blog After LVRS




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jmrommes
Contributing Member

1730 Posts

Posted - Feb 13 2014 :  12:46:32 PM  Show Profile  Reply with Quote
Docs who don't accept Medicaid and Medicare patients have been around for a lot longer than Obama and certainly than the ACA. Ten years ago, I was doing a consulting job in CA, in a community sort of in the middle of the state and there was no doc in the entire town who would accept either. The organization had to take their Medicaid recipients (all people with disabilities) 150 miles one way to a doc who would accept Medicaid. I don't know what people with Medicare did; the staff told me that their parents had all moved to other communities where there were docs who would treat Medicare patients. They had to go almost 300 miles to a dentist who would accept Medicaid. This has been around for a LONG time, and in my opinion has very little to do with the ACA.

Jean

Exercise not only lets me live, it enables me to have a life.
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Rita1
Senior Member

543 Posts

Posted - Feb 13 2014 :  3:49:33 PM  Show Profile  Reply with Quote
Many years ago, I had an HMO. Since all my doctors (and I had few back then) were with the same medical practice, Northwestern Medical Faculty Foundation, "NMFF", I never had an issue of wanting to go outside the HMO and the premiums were really small with no co-pays. Then, NMFF sent me a letter saying they would no longer accept my HMO and I had the choice of switching to a different medical practice or changing my insurance with them to a PPO. I didn't want to go elsewhere so I switched to the PPO. My premiums were more than double and I had a co-pay but nothing else changed.

My point is that medical practices make decisions based on different factors, in most case financial, and it has little to do with the ACA or any other federal law. Since the law was passed in 2010, some people have searched for anything they could find that is, or may be, a negative(and there are some) and never have seen any positives (and there are some. I don't know if the law will prove to have more negatives than positives but what I do know is that it has been good for several people on this forum and I haven't read any reports from anyone here being hurt in any way by its passage - only someone that told them of a problem that they trace to the ACA.

As for me, as far as I know, the ACA hasn't affected me one bit. I still am with NMFF (and have loads of doctors) and I have benefited greatly from Medicare and only wish the whole country could be on a single payer government run program.

Rita

Edited by - Rita1 on Feb 13 2014 3:51:44 PM
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Dave-OH
Administrator

USA
4002 Posts

Posted - Feb 13 2014 :  5:14:16 PM  Show Profile  Reply with Quote
I had been with Anthem for a number of years. When they dropped the academic medical center and my doctors I lived with the higher co-pay as I had a PPO. Then they decided my hospital co=pay would not be a day charge but 30% and that was it. Switched to Humana as they had my doctors and hospitals in the plan.

Dave, Forum Administrator
COPD Support, Inc. http://www.copd-support.com/
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rosytomato
Contributing Member

USA
1342 Posts

Posted - Feb 16 2014 :  09:15:38 AM  Show Profile  Reply with Quote
Dave, are you saying that Obamacare had nothing to do with Anthem dropping your doctors and medical center?
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Dave-OH
Administrator

USA
4002 Posts

Posted - Feb 16 2014 :  09:56:43 AM  Show Profile  Reply with Quote
Yes, they did it 2 years ago before the ACA was in effect. They have been fighting on and off for as long as I can remember over their contracts. Since I have a PPO, it did not matter until they changed how they charged for the hospital.

Dave, Forum Administrator
COPD Support, Inc. http://www.copd-support.com/
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PennyPA
Contributing Member

USA
5826 Posts

Posted - Feb 16 2014 :  11:57:11 AM  Show Profile  Reply with Quote
Actually, Dave, obamacare officially started in 2010; it's only now, in 2014, that some people will see the benefit from it.

****************************************************************
Do Not Regret Growing Older. It is a Privilege Denied to Many

You canít change the past but you can ruin the present worrying about the future.

The Bad News: Time flies as you get older.
The Good News: Youíre still the pilot.

Penny's Lung Volume Reduction Surgery

And Our Travel Blog After LVRS




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Dave-OH
Administrator

USA
4002 Posts

Posted - Feb 16 2014 :  1:08:30 PM  Show Profile  Reply with Quote
Yes, but Anthem has been fighting with UC Health for years. Long before the ACA was passed. My doctors have been in and out of network many times, and the ACA has nothing to do with it. Long and complex battle over money. I switch and hopefully Humana will stay in network with UC.

Dave, Forum Administrator
COPD Support, Inc. http://www.copd-support.com/
Your source for peer support and COPD Info

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greyfox612
Member

USA
37 Posts

Posted - Feb 26 2014 :  11:20:24 AM  Show Profile  Reply with Quote
I am losing my company insurance April 1st. Only because I'm the only one still carrying insurance. The other 4 guys either have it through their wives or just stopped having health insurance altogether. Anyways we have to have at least 2 people to still be considered a group. So they are dropping my coverage.

Anyways, I'm getting insurance through the ACA market place. Without it, I wouldn't be able to afford insurance with my pre-existing conditions. It's actually going to cost me a little less per month but the deductible will be a little higher. Co-pays for doctor visits are a bit less, as are co-pays for RXs. So what I save a month I can put to the higher deductible I guess.
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MDC
Member

361 Posts

Posted - Mar 01 2014 :  12:37:47 PM  Show Profile  Reply with Quote
Humana is a dirty word here. Many Hospitals dropped them as medicare supplements and Advantage Plans. BCBS and AARP seem to be most used. My wife has had no changes, hers is United Health endorsed by AARP.

Knowledge is knowing a tomato is a fruit.
Wisdom is knowing not to put it in a fruit salad.
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Dave-OH
Administrator

USA
4002 Posts

Posted - Mar 01 2014 :  1:16:49 PM  Show Profile  Reply with Quote
For me they have all my providers, and Anthem did not - they have been fighting for years. It is a matter of who is best in what market.

Dave, Forum Administrator
COPD Support, Inc. http://www.copd-support.com/
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rosytomato
Contributing Member

USA
1342 Posts

Posted - Mar 01 2014 :  4:09:18 PM  Show Profile  Reply with Quote
I'm sorry, but I just think this ACA/Obamacare is causing so many problems. I'm happy to hear that some of you have been able to find some type of insurance when you had none, but on the whole, this health plan is not good, and in many cases it is certainly not affordable.

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Rita1
Senior Member

543 Posts

Posted - Mar 01 2014 :  5:10:41 PM  Show Profile  Reply with Quote
Rosy, you have made negative comments wrt the ACA before. It is a law, not a health plan. Unlike Medicare, medical insurance continues to be provided by the private sector which is why some of the same problems with various insurers exist just as they did before ACA.

You say it is "causing so many problems." What are they? All I see is that some of my fellow copders who were unable to obtain insurance before have been able to obtain "affordable" insurance now through the ACA. See, e.g., posts from Mike and Diane on this forum. The law was intended to help people obtain insurance and it seems to be working.

So please tell me the problems and why it is "not good." Because I have good insurance with or without ACA, I haven't followed the reasons so many people like you find it so problematic and I really would appreciate some evidence contrary to the positive comments made here.

Rita
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BJoTX
Rookie

15 Posts

Posted - Mar 01 2014 :  5:52:50 PM  Show Profile  Reply with Quote
"I don't think prescription drug coverage ever has a deductible - just copays, but I may be wrong.[/quote]"

Our prescription insurance, Scripts, formerly Medco, has an annual deductible, per family member.

Things are to be used, not loved. People are to be loved, not used.
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Rita1
Senior Member

543 Posts

Posted - Mar 01 2014 :  6:00:42 PM  Show Profile  Reply with Quote
I stand corrected.

Rita
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