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Dave-OH
Administrator

USA
4002 Posts

Posted - Jun 11 2014 :  3:45:21 PM  Show Profile  Reply with Quote
I have never had an issue with lab work, but I have an Advantage plan. And my wife has not had issues with her annual exams.

As for test strips, that was done via part B and they now want it as part of Part D if I remember. The issue is the over promotion by mail order companies of products like that. I know that my fathers plan paid for his strips.

Dave, Forum Administrator
COPD Support, Inc. http://www.copd-support.com/
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Rita1
Senior Member

543 Posts

Posted - Jun 11 2014 :  4:13:13 PM  Show Profile  Reply with Quote
Penny, I'm sorry Bob is having problems with his coverage. I am not. I have no cysts, or overies but Medicare covers my annual exam. I wonder why yours was not covered. Sorry about your cysts.

I think we agree that money should be available for Bob's medical needs. Where it comes from is a political decision and we can't discuss it here which is a good rule.
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greyfox612
Member

USA
37 Posts

Posted - Jun 11 2014 :  5:10:17 PM  Show Profile  Reply with Quote
I agree with Greg. When you don't have any insurance, the ACA is a great thing. I know there are still lots of bugs to be worked out. I'm sure Social Security was the same back when it was started. But w/o the ACA, and with my medical problems, I'd have no insurance at all. I lost my insurance 4/1 of this year, only because I was the only one in our shop still carrying it, and we needed 2 people to be considered a group. So I went on the ACA site and got comparable coverage. My deductible went from $1000 to $1500 but my premium dropped right around $100/ month so that more than covers the deductible increase. And as for premium increases, my health insurance has went up in the 30-40% range every year for the past several years. Mine is a gold plan. I'm 64 yo (tomorrow in fact) and my premium in $597/mo. This is Highmark BCBS. It's called a Gold - Shared Cost Blue PPO.

So for those who want to criticize it, go for it. But for me it's a life saver.
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Rita1
Senior Member

543 Posts

Posted - Jun 15 2014 :  4:49:08 PM  Show Profile  Reply with Quote
I read in the Chicago Tribune earlier this week that United Healthcare, which chose not to participate in the ACA marketplace in Illinois for this year, has decided to participate next year. Along with some smaller insurers, the addition of United to Blue Cross will add 540 more choices of available insurance plans in Illinois. Hopefully, the website will be able to handle it and people will be able to compare the options and choose one without too much trouble. The article went on to say that premiums will go up but not by very much due to competition.

I hope your states also will have many insurers competing for the business of those who need to use the ACA for insurance.

Rita
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PennyPA
Contributing Member

USA
5826 Posts

Posted - Jun 15 2014 :  8:33:30 PM  Show Profile  Reply with Quote
They probably see how much money they'll be getting and want to jump on the bandwagon.

****************************************************************
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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Rita1
Senior Member

543 Posts

Posted - Jun 15 2014 :  8:45:03 PM  Show Profile  Reply with Quote
Penny, what absolutely floors me is how much money the ceo's of United Healthcare, Humana and other health insurers make. The profit health insurance companies is pulling in boggles the mind. Google "how much do ceo's of health insurance companies make". But, make sure you are sitting down!

Rita
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PennyPA
Contributing Member

USA
5826 Posts

Posted - Jun 16 2014 :  12:57:35 AM  Show Profile  Reply with Quote
Don't have to do that, Rita. I've already read about it and it IS outrageous!! So we're paying for their vacations in Aruba or Europe...and they really don't earn half of 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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Rita1
Senior Member

543 Posts

Posted - Jun 16 2014 :  11:30:45 AM  Show Profile  Reply with Quote
Penny imo no one deserves half or 1/10th of the millions they pull in every year. I know you don't agree with a single payer/government run health care system but those millions could be going for healthcare. As far as I know, no Medicare employee, no matter how far up the ladder is being paid millions in yearly pay.

Rita
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fatpuppy
Member

170 Posts

Posted - Jun 18 2014 :  5:19:01 PM  Show Profile  Reply with Quote
We have many different opinions about what the ACA can and should be but I think this is a part of it we can all support

Obamacare Will Help You Quit SmokingóOr Charge You for Your Habit

http://time.com/money/2889340/obamacare-will-help-you-put-down-the-cancer-sticks-or-charge-you-for-your-habit/

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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rosytomato
Contributing Member

USA
1342 Posts

Posted - Jun 18 2014 :  5:41:49 PM  Show Profile  Reply with Quote
... "it also allows insurers to charge smokers up to 50% higher premiums." I don't support that at all.

Yes to the quit smoking help if it's available.
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fatpuppy
Member

170 Posts

Posted - Jun 18 2014 :  7:43:23 PM  Show Profile  Reply with Quote
quote:
Originally posted by rosytomato

... "it also allows insurers to charge smokers up to 50% higher premiums." I don't support that at all.



Many companies, large and small, have been adding an extra charge to the employee contribution for the past few years. I work for an international company with 60,000 employees. They banned all use of tobacco products (smoking and smokeless) on their campuses worldwide and charge their US employees an additional $25/month ($300/year) to the insurance for smokers.

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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Helen-CO
Member

243 Posts

Posted - Jun 19 2014 :  09:34:01 AM  Show Profile  Reply with Quote
I'm in favor of anything that motivates smokers to quit. I feel guilty that my COPD has cost my insurance and now Medicare big bucks.
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sslei
Member

75 Posts

Posted - Jun 19 2014 :  10:08:32 AM  Show Profile  Reply with Quote
First they came for those who drank soda's , I did not drink soda's so what did I care, then they came for those who planted vegetables , I did not do that either, then they came for salt, I don't like much salt to heck with those that do, and they came again, and again, Why do you suppose they don't just pass a law saying smoking is illegal?
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sslei
Member

75 Posts

Posted - Jun 19 2014 :  10:20:26 AM  Show Profile  Reply with Quote
sorry for duplicate post.
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PennyPA
Contributing Member

USA
5826 Posts

Posted - Jun 19 2014 :  12:14:07 PM  Show Profile  Reply with Quote
And how successful do you think that would be? Look at prohibition for an example. You'd also be putting many more people out of work.

****************************************************************
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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Rita1
Senior Member

543 Posts

Posted - Jun 19 2014 :  2:21:33 PM  Show Profile  Reply with Quote
It is common in the insurance industry to charge higher premiums for risky insureds. For example, in automobile insurance, anyone who is "accident prone" or has many moving violation tickets (red light, speeding, etc.) pays a higher premium so that safe drivers pay less. It's only fair that those who present a bigger risk for the insurer's money should pay more so I don't see anything wrong with charging people who choose to risk their health by smoking and who, most likely, will cost insurers more money should have to pay higher premiums.

I assume that someone who builds a house on a cliff is going to incur high property insurance premiums.

As for "them" coming to take away our rights, once again, there is confusion here between a private business, in this case, insurance companies, and our government. A law in NY restricting the size of sodas (which IMO presents an infringement on our rights) is very different from a private business setting prices. That business sets the price for its product, in this case, health insurance, not the government.

Tobacco is big business from which some people make a lot of money, including investors (stock holders). The tobacco industry has a lot of powerful lobbyists. (I wouldn't be surprised if Eric Cantor, who is from VA, becomes a lobbyist for the tobacco industry when he leaves Congress). Also, the tobacco industry (growers, manufacturers, sellers, etc.) contributes an enormous amount of money to politicians' campaign funds. I'm sure our elected officials pay no attention to who contributes to them when making their decisions, e.g., wrt making tobacco illegal. (And, if you believe that, I understand there's a bridge for sale in Brooklyn.)

Rita (in Chicago where there are no corrupt politicians.)
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Dave-OH
Administrator

USA
4002 Posts

Posted - Jun 19 2014 :  11:40:10 PM  Show Profile  Reply with Quote
Actually insurance companies set their prices under the rules and guidance of the state. For health insurance, the new rules prevent individual underwriting. So insurance companies price their health insurance based on the cost of care, plus administrative costs and profits based on the entire pool. By law they must pay 80% of their premiums as claims.

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

Chat room http://chat.copd-support.com
Mobile chat room for pads and phone Chat room http://chat.copd-support.com/m

My Site: http://lungresources.com
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Rita1
Senior Member

543 Posts

Posted - Jun 20 2014 :  4:44:13 PM  Show Profile  Reply with Quote
Dave, are you saying that the various state insurance regulatory agencies have ruled that insurers must charge higher premiums for their insured smokers?

Rita
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Dave-OH
Administrator

USA
4002 Posts

Posted - Jun 20 2014 :  5:08:51 PM  Show Profile  Reply with Quote
No, I am saying that the states set the rules. For the ACA, I do not believe they can charge higher rates, but for private companies they can.

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

Chat room http://chat.copd-support.com
Mobile chat room for pads and phone Chat room http://chat.copd-support.com/m

My Site: http://lungresources.com
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Frekkies mom
Rookie

USA
2 Posts

Posted - Jul 01 2014 :  02:51:47 AM  Show Profile  Reply with Quote
All of this makes me long for real single payer health insurance or not for profit health insurance. What is wrong with All American health insurance, clinics, and hospitals is that they are for profit. They should take a look at the Netherlands, Germany Sweden France where it's working and not nearly so expensive.
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PennyPA
Contributing Member

USA
5826 Posts

Posted - Jul 01 2014 :  11:14:27 AM  Show Profile  Reply with Quote
Is it REALLY working over there? How long do they have to wait for an elective procedure (knee surgery, LVRS, other non-life threatening procedures)? How long do they have to wait to see a specialist? Why do they come to the U.S. to have serious surgery performed? Why do many of their students come to the U.S. to learn medicine...and then stay here? I guess if we didn't have to support so many illegal aliens and non-working people and give money to other countries, etc. etc. etc., we might be able to afford a single payer system.

****************************************************************
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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Sam-Tx
Senior Member

597 Posts

Posted - Jul 01 2014 :  12:53:00 PM  Show Profile  Reply with Quote
Be careful, Penny. You are starting to express good sense and intelligent logic - and you know that's not politically correct!
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Dave-OH
Administrator

USA
4002 Posts

Posted - Jul 01 2014 :  5:08:06 PM  Show Profile  Reply with Quote
My uncle in Montreal was astonished that my wife could get a CT scan within 1 hour of the doctors request. And I have had the same experience at the Cincinnati VA - next available spot for the new high speed scanner.

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

Chat room http://chat.copd-support.com
Mobile chat room for pads and phone Chat room http://chat.copd-support.com/m

My Site: http://lungresources.com
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Rita1
Senior Member

543 Posts

Posted - Jul 01 2014 :  10:04:20 PM  Show Profile  Reply with Quote
I don't think we need to worry about a single payer health insurance program in our country during our lifetimes. Maybe our grandchildren, when they're in charge, will argue less and get more done.

What's strange about all the negative comments wrt countries that have such a plan, is that just about every copder in addition to patients with other serious medical conditions who live in countries that have single payer health insurance (like Medicare, but for everyone) are quite happy with their health insurance and wouldn't dream of having anything like what we have. They laugh at us. IMO, the people who actually live with a single payer health insurance plan are the ones entitled to like it or dislike it. Not us based on what we read or heard or what someone's uncle's nephew's cousin's sister in law's neighbor who lives in Australia said. I want to hear it from the Australian neighbor and so far have only heard satisfaction from him/her.

Rita
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Dave-OH
Administrator

USA
4002 Posts

Posted - Jul 02 2014 :  12:05:44 AM  Show Profile  Reply with Quote
The problem in Quebec is they do not train enough doctors to meet the need. The government controls the medical education and the insurance.

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

Chat room http://chat.copd-support.com
Mobile chat room for pads and phone Chat room http://chat.copd-support.com/m

My Site: http://lungresources.com
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Greg-TX
Member

209 Posts

Posted - Jul 02 2014 :  12:54:30 AM  Show Profile  Reply with Quote
I've had numerous customers from Canada over the years who have lived and worked in both countries and like Rita, not one would trade their health care system for ours. I was very surprised always hearing the horror stories about their gov't run health care.

Greg-TX
"Alcohol"- because no great story ever started with someone eating a salad!
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Rita1
Senior Member

543 Posts

Posted - Jul 02 2014 :  09:01:46 AM  Show Profile  Reply with Quote
I'll bet you hear those horror stories about Canada's system from Americans. We are quick to talk about how they train or don't train their docs or long waits or other problems we see over there from here. But the actual patients over there are not complaining. And that's what matters.
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jmrommes
Contributing Member

1730 Posts

Posted - Jul 02 2014 :  09:10:58 AM  Show Profile  Reply with Quote
Just to add some perspective to this discussion, the US health care system has been consistently rated last or near-last by a number of ranking systems, including the World Health Organization (they rated us 37th out of about 50), Commonwealth (rated us 11th of 11), and a number of others. We spend more per capita on health care than any other country and we have very poor outcomes. As a whole, our population's health is rated poor among developed countries. We're not rated well in terms of efficiency or effectiveness and access to health care is always dead last when compared to other developed nations.

Those of us with money fare well in the US in terms of health care. Some of us get the best care money can buy. If you don't have money, and with the middle class imitating the incredible shrinking man, that means many of us don't have money, our access to health care is extremely limited. We have health care rationing now: it's driven by economics and it affects the poor (whose ranks are growing by leaps and bounds).

I've always been lucky. I've either had a job that provided good health care for me and my family or I've been able to afford the premiums so we were always covered. Under Medicare, with a supplement and Part D, I have access to just about anything I need and the cost isn't out of reach. Nevertheless, like many of you, I do order some of my meds from ADC because the cost of meds is ridiculously high here. If you recall, the cost of meds was part of the discussion leading up to the ACA, and the pharmaceutical lobby prevailed (and what does that say about our legislators?).

This is getting perilously close to being political, so I'm going to quit now. I think my point is that while some of us do really well in the US in terms of health care, we do it on the backs of others.

Jean


Exercise not only lets me live, it enables me to have a life.
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Greg-TX
Member

209 Posts

Posted - Jul 02 2014 :  3:15:53 PM  Show Profile  Reply with Quote
Jean, I think you hit the nail on the head. I've been in both positions of health care insurance. Unfortunately, when I was younger and I had all the coverage I needed but didn't need it. Then when I could only afford catastrophic coverage, I wasn't able to afford the meds and screening I needed and subsequently I'm sure, going without proper care, exacerbated my COPD.

It's amazing that all the people who have great health insurance are the ones complaining about the affordable health care act. I'd like to see them with the shoe on the other foot. I've depleted all of my savings to what I could afford for health care and subsequently just didn't get treated. It was a life send finding out about ADC through this forum. I went for years without taking the medication I needed.

Greg-TX
"Alcohol"- because no great story ever started with someone eating a salad!
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Cindi-TX
Member

USA
53 Posts

Posted - Jul 02 2014 :  6:58:01 PM  Show Profile  Reply with Quote
Me too, Greg. I paid and paid, when I had cancer I had coverage, then lost it on my job and couldn't get anything but catastrophic coverage. My medical expenses have cost us most of our savings in the last 15 years and they didn't all pertain to my COPD, but we were pretty depleted when that cropped up. It seems most people I know think there is some alternative to ACA, my brother in law said "That's where family comes in, you don't need that'' I replied "So next time I'm in the hospital I can count on you for a loan or donation of about $27,000.00 (my average hospital bill)? Silence of course. Yes, Canadian medicine is cost regulated, that is why that even with insurance now, I can still get my medicine there for less.
My daughter in law's entire maternal family is from Canada and they have no complaints about medical care.
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Dave-OH
Administrator

USA
4002 Posts

Posted - Jul 02 2014 :  9:02:51 PM  Show Profile  Reply with Quote
Health insurance used to cost us a small fortune. $18,000 a year for a good plan for the two of us. If we were not on Medicare Advantage, it would be less than half that now, and given our income then, we would have gotten subsidized. We dealt with thins like age and annual increases that doubled our costs in about 6 years.

When they thought I needed a transplant, I used the VA, as for me it was free. A transplant over the lifetime is hundreds of thousands of dollars, and I did not want to deal with Anthem. Now if I do need one in the future, the VA will pay for the meds afterwards, and that is a ton of the cost.

I think the ACA is good. I think it offers affordable health insurance to all. I do not think it is perfect, but much better than in the past.

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

Chat room http://chat.copd-support.com
Mobile chat room for pads and phone Chat room http://chat.copd-support.com/m

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MDC
Member

361 Posts

Posted - Jul 14 2014 :  07:56:07 AM  Show Profile  Reply with Quote
Interesting/ACA and Medicare effects on COPD

Mike



http://health-tools.health.msn.com/living-life-to-the-fullest-with-copd/what-the-affordable-care-act-means-to-copd-patients

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 - Jul 24 2014 :  3:10:21 PM  Show Profile  Reply with Quote
Under the ACA, insurers who didn't spend at least 80% of the premiums they collected on medical services or quality improvement measures must issue rebates based on a medical-loss ratio. According to today's Chicago Tribune, "108,000 Illinoisans who bought insurance policies in 2013 will receive rebates averaging $77.25..." by August 1. Among the state's largest insurers, only Unitedhealthcare must issue rebates for 2013. Blue Cross, Aetna and Humana exceeded the 80% requirement.

This is the 3d year of the rebates which are aimed at making health insurance less expensive by capping insurer profits. More than 6.8 million Americans will receive refunds this year.

Rita
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Sam-Tx
Senior Member

597 Posts

Posted - Jul 24 2014 :  7:31:08 PM  Show Profile  Reply with Quote
So????
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Rita1
Senior Member

543 Posts

Posted - Jul 24 2014 :  8:31:15 PM  Show Profile  Reply with Quote
So - the topic is the ACA and I thought some people may not know they may soon be getting a rebate in the mail. I live in Illinois but I'm sure you can find the info for your state online. That is, of course, if you have private insurance. Medicare, as we all surely know by now, is a government run program and thus is not spending less than 80% of the premiums collected on patient care.

Rita
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greyfox612
Member

USA
37 Posts

Posted - Jul 30 2014 :  11:13:48 AM  Show Profile  Reply with Quote
I hope this isn't off topic but here is a good website form RXs. My wife has no RX coverage and we've used it a few times, and saved a good bit. Walmart always comes up the cheapest on her stuff and they take the coupons this site gives you.

http://www.goodrx.com/
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Lector
Rookie

USA
17 Posts

Posted - Aug 28 2014 :  1:16:36 PM  Show Profile  Reply with Quote
quote:
Originally posted by Dave-OH

We can discuss the insurance aspects of it without the political overtones. It is an insurance exchange, similar to the one on Medicare.gov. It helps you select and enroll in health insurance. There are technical issues they are trying to resolve. As a former software developer I can tell you that the web makes everything harder than on a PC network.

If people have questions about who, what, when or why, that is fine. If there are complaints about the process, that is fine. But the politics of it violates our legal obligations as a 503(c)(3). I will make this a sticky.



If it were called by it's real name the AHCA instead of A derogatory name I believe the conversation would be beneficial
to all involved.

If you can't be positive, at least be neutral.
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MDC
Member

361 Posts

Posted - Sep 03 2014 :  08:36:53 AM  Show Profile  Reply with Quote
Arkansas BCBS has proposed to lower ACA rates by 2% next year. I love mine. I just dread the Advantage Plan as Ar has no medi gap policies for ssdi recipients

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 - Sep 03 2014 :  09:31:47 AM  Show Profile  Reply with Quote
SSDI has not Medicare supplements that I know of anywhere.

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

Chat room http://chat.copd-support.com
Mobile chat room for pads and phone Chat room http://chat.copd-support.com/m

My Site: http://lungresources.com
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MDC
Member

361 Posts

Posted - Sep 03 2014 :  10:54:55 AM  Show Profile  Reply with Quote
My wife got one thru United Healthcare when she became medicare eligible thru AARP. However they no longer sell medi gap policies in Arkansas to disabled under 65. We are one of those states that if you are not 65 no company has to offer any medicare plans, gap or advantage. ABCBS does offer an advantage plan.

My wifes plan is a great one, never been out a cent besides high premium, $275 per month w/o drug. She has had years her bills exceeded $400,000.00.

Mike

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

Edited by - MDC on Sep 03 2014 10:59:38 AM
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