Obamacare, (ACA), stress test

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beavergod1

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I am writing this in response to other people’s inquiries on health insurance. If this can help one person, it is worth my time and effort to share.
My wife recently underwent a heart valve replacement and at the same time had another undiscovered, severely leaking valve on the other side of her heart repaired.
This was covered entirely under Obamacare, (ACA), insurance. This is first hand experience, not second or third hand, or hearsay, but real time ongoing experience. My wife is now in heart rehabilitation therapy for 3 months.
My wife had her operation on July 12. She is currently in heart rehab for 3 months. Her total bill so far has topped $600,000. She has a Bronze plan with BCBS, (Blue Cross Blue Shield), with a total deductible and out of pocket yearly maximum of $8700 p/yr.
All of her treatment, including her $600 p/mo temporary cocktail of drugs are covered 100% until the end of the year.
She pays $86 p/mo for her premium on a household income of $40,000 p/yr, (MAGI), household income. Excuse me for thinking $86 p/mo is a trivial amount, but for life saving care, to us it is a bargain. Yes, it is basically a high deductible plan, but it saved my wife’s life.
I have read on these threads of people having disappointing results from their ACA plans. I think this is due to their choosing a low priced, narrow network plan, with limited care options. She could have chosen a plan for under $10 p/mo or $0, but instead chose a plan with a company with the largest network of doctors and medical facilities nationwide for $86 p/mo. It appears to have paid off.
Again, this is our ongoing experience right now and it is working. I have been on Medicare from the beginning of this year and it is a dream, with the G plan supplemental. My wife won’t qualify for 3 more years.
Thank God, Obama, and John Mccain for ACA. For the price of a good used car I got my wife’s life back for 20+ years. If this info helps just one person make an informed choice, then it was worth the time to write it up…
 

beavergod1

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I am writing this in response to other people’s inquiries on health insurance. If this can help one person, it is worth my time and effort to share.
My wife recently underwent a heart valve replacement and at the same time had another undiscovered, severely leaking valve on the other side of her heart repaired.
This was covered entirely under Obamacare, (ACA), insurance. This is first hand experience, not second or third hand, or hearsay, but real time ongoing experience. My wife is now in heart rehabilitation therapy for 3 months.
My wife had her operation on July 12. She is currently in heart rehab for 3 months. Her total bill so far has topped $600,000. She has a Bronze plan with BCBS, (Blue Cross Blue Shield), with a total deductible and out of pocket yearly maximum of $8700 p/yr.
All of her treatment, including her $600 p/mo temporary cocktail of drugs are covered 100% until the end of the year.
She pays $86 p/mo for her premium on a household income of $40,000 p/yr, (MAGI), household income. Excuse me for thinking $86 p/mo is a trivial amount, but for life saving care, to us it is a bargain. Yes, it is basically a high deductible plan, but it saved my wife’s life.
I have read on these threads of people having disappointing results from their ACA plans. I think this is due to their choosing a low priced, narrow network plan, with limited care options. She could have chosen a plan for under $10 p/mo or $0, but instead chose a plan with a company with the largest network of doctors and medical facilities nationwide for $86 p/mo. It appears to have paid off.
Again, this is our ongoing experience right now and it is working. I have been on Medicare from the beginning of this year and it is a dream, with the G plan supplemental. My wife won’t qualify for 3 more years.
Thank God, Obama, and John Mccain for ACA. For the price of a good used car I got my wife’s life back for 20+ years. If this info helps just one person make an informed choice, then it was worth the time to write it up…
I would also like to thank John Roberts of the Supreme Court...
 

bullfrog

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Good health, preventative medicine and being able to access care when needed for everyone is the one most important things this country unlike other developed countries has failed to consider and is causing us to fall behind other countries in every way. Many are forced into the nomadic lifestyle due to medical and medicine bills forcing them to learn to live cheaply, many without a vehicle. Progress has been made but until everyone is educated and offered the opportunity to stay healthy without going bankrupt I won’t be thanking anyone. Glad your wife is well and the “system” worked for you. My wife on the other hand who has BCBS after verifying her hospital was in network and her costs would be paid as we had already met her $6,000 deductible recieved a notice 3 days after being released we would owe $33,000. She also had to have rehabilitation which they had said they would pay for for thirty days but couldn’t verify until after the surgery. The hospital furnished a cab and suggested she go to a motel when BCBS refused to pay for rehabilitation the doctors stated was required not once but twice. From my point of view there are still a few things need to be worked out.
 

beavergod1

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Good health, preventative medicine and being able to access care when needed for everyone is the one most important things this country unlike other developed countries has failed to consider and is causing us to fall behind other countries in every way. Many are forced into the nomadic lifestyle due to medical and medicine bills forcing them to learn to live cheaply, many without a vehicle. Progress has been made but until everyone is educated and offered the opportunity to stay healthy without going bankrupt I won’t be thanking anyone. Glad your wife is well and the “system” worked for you. My wife on the other hand who has BCBS after verifying her hospital was in network and her costs would be paid as we had already met her $6,000 deductible recieved a notice 3 days after being released we would owe $33,000. She also had to have rehabilitation which they had said they would pay for for thirty days but couldn’t verify until after the surgery. The hospital furnished a cab and suggested she go to a motel when BCBS refused to pay for rehabilitation the doctors stated was required not once but twice. From my point of view there are still a few things need to be worked out.
An HMO is a time consuming pita. I had to be on top of all the referrals, preauthorization's, and coverages. Yes it was time consuming. Any doctor other than her PCP had to have a referral. Any inpatient treatments had to have preauthorization's. I even checked to make sure the outpatient treatments didn't need preauthorization's. I checked back and forth between BCBS, doctors, and treatment facilities. To say I was paranoid about the coverage and unexpected charges is an understatement. I did all I could to cross my t's and dot my i's. Checked, rechecked, and rechecked again. I trusted nobody. I agree it shouldn't be this hard, but it worked out fine for us. Also something BCBS pointed out to me on the EOB, (explanation of benefits), was I was not responsible for unauthorized charges or non referrals. That is the responsibility of the doctor or facility proving the treatment once they have your insurance information. They also pointed out under Texas insurance regulations, this was true.
 

bullfrog

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^^^Thank you for your post. Hope the best for your wife’s recovery! In my wife’s case she couldn’t walk and living in a RV where a wheel chair doesn’t fit becomes a problem. We waited luckily only 6 weeks as we got a cancellation for surgery and had been assured all was covered which turned out not to be true, insurance companies are there to make money and apparently in my case take my money without much service in return in my opinion period. I have been informed the average cost of a hospital room she was in is $11,000 a day, insane considering no treatment was done during that time other than pain medication. Sorry if I am ranting and I’m sure it will get worked out one way or another. There are many causes of and issues that complicate nomadic life in our country. I sincerely hope everyone someday will be cared for when illness (mental or physical) or disability occurs and that good health, eating habits and simple living survival methods become a part of public education. A lot of problems could be solved like universal health care, a national drivers license, vehicle insurance, voter registration and the list goes on. Organizations like Homes On Wheels help but they need much more support to be effective.
 
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beavergod1

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Just one example and I credit my wife for catching this one. The hospital wanted to know if she wanted them to supply her with her glaucoma eye drop medicine and administrate it to her. My wife refused and I asked her why. She said they would vastly overcharge for it and charge for putting the drops in. I confronted the nurse and he confirmed she was right. So I brought her medicine from home and put the drops in myself. I also found out that BCBS would not cover the cost of the drops or administration of them because they were not needed for her heart procedure. My wife probably saved me thousands by speaking up. We make a good team. I can't wait until she is on Medicare and we can put this HMO horseshit behind us. That said, I'm very thankful for it.
 

bullfrog

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^^^My wife turns 65 in December and can’t wait to get on Medicare A and B with a supplement. Funny how everybody is against socialism but can’t wait to get on Medicare! Lol!!! Since I’m a veteran I’ve had available medical treatment all across the country and since it is administered by the government pretty much socialized medicine. Wonder how many people realize the situation. Many things need to be nationalized that just don’t work between state lines and several middle men making a profit.
 

mattvei

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If you haven't had the experience yet, be aware! I am on "old school" Medicare with a G supplement. Having been in and out of hospitals and skilled nursing facilities the thing that shocked me was the first time I went in they took all my prescription medications, threw them out, and reissued them from their own pharmacy; they claim that so they can control quality but it's just another money making scheme.So like the eye drop fellow above said. don't admit to any prescription drugs; bring them in yourself; hide them; administer them yourself and save a bunch of money
 

Morgana

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the first time I went in they took all my prescription medications, threw them out, and reissued them from their own pharmacy;
Wow that seems shady. Was this recent? Have you considered reporting it to Medicare? (Well, I guess asking Medicare if it's legal or if you can refuse.) Some outrageous things hospitals do are legal, but not all of them.
You shouldn't have to sneak around to avoid a thing like that.
I wonder if they would do the same to a younger person.
 

WVWildflower

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I am writing this in response to other people’s inquiries on health insurance. If this can help one person, it is worth my time and effort to share.
My wife recently underwent a heart valve replacement and at the same time had another undiscovered, severely leaking valve on the other side of her heart repaired.
This was covered entirely under Obamacare, (ACA), insurance. This is first hand experience, not second or third hand, or hearsay, but real time ongoing experience. My wife is now in heart rehabilitation therapy for 3 months.
My wife had her operation on July 12. She is currently in heart rehab for 3 months. Her total bill so far has topped $600,000. She has a Bronze plan with BCBS, (Blue Cross Blue Shield), with a total deductible and out of pocket yearly maximum of $8700 p/yr.
All of her treatment, including her $600 p/mo temporary cocktail of drugs are covered 100% until the end of the year.
She pays $86 p/mo for her premium on a household income of $40,000 p/yr, (MAGI), household income. Excuse me for thinking $86 p/mo is a trivial amount, but for life saving care, to us it is a bargain. Yes, it is basically a high deductible plan, but it saved my wife’s life.
I have read on these threads of people having disappointing results from their ACA plans. I think this is due to their choosing a low priced, narrow network plan, with limited care options. She could have chosen a plan for under $10 p/mo or $0, but instead chose a plan with a company with the largest network of doctors and medical facilities nationwide for $86 p/mo. It appears to have paid off.
Again, this is our ongoing experience right now and it is working. I have been on Medicare from the beginning of this year and it is a dream, with the G plan supplemental. My wife won’t qualify for 3 more years.
Thank God, Obama, and John Mccain for ACA. For the price of a good used car I got my wife’s life back for 20+ years. If this info helps just one person make an informed choice, then it was worth the time to write it up…
It's great to hear your wife was able to get the care she needed, with cost at a minimum and not bankrupting you.

What Medicare G plan do you have? I need to sign my mom and step-dad up for Medicare/social security and I'm so confused about the supplementals.
 

ChiTown2SD

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Just one example and I credit my wife for catching this one. The hospital wanted to know if she wanted them to supply her with her glaucoma eye drop medicine and administrate it to her. My wife refused and I asked her why. She said they would vastly overcharge for it and charge for putting the drops in. I confronted the nurse and he confirmed she was right. So I brought her medicine from home and put the drops in myself. I also found out that BCBS would not cover the cost of the drops or administration of them because they were not needed for her heart procedure. My wife probably saved me thousands by speaking up. We make a good team. I can't wait until she is on Medicare and we can put this HMO horseshit behind us. That said, I'm very thankful for it.
Let’s be clear every time BCBS denies a service or treatment they are increasing profits. People’s quality of life and sometimes people’s survival are in conflict with insurance companies. This is why we need a government option to compete with these insurance companies. At the very least every medical insurance company that wants to do business on the exchange should be run as a nonprofit organization. Many insurance companies were nonprofit but that is a thing of the past. We have a long way to go but ACA was a good thing for a lot of people. Medicare for all would be a bigger jump in the right direction.
 

Morgana

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I'm so confused about the supplementals.
Try googling SHINE + Medicare + the name of your state. It's a volunteer-based organization that helps people figure out Medicare. I'm not sure if it exists in every state but it exists in several for sure. I got their help in Florica and they were great.

SHINE = Serving Health Insurance Needs of Elders.
 

Carla618

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Try googling SHINE + Medicare + the name of your state. It's a volunteer-based organization that helps people figure out Medicare. I'm not sure if it exists in every state but it exists in several for sure. I got their help in Florica and they were great.

SHINE = Serving Health Insurance Needs of Elders.
Just saw SHIP, a similar program, in an article at PBS about Medicare Part B. It stands for State Health Insurance Assistance Program.

For years I received links in my FB news feed warning about Medicare Part B (why you should not use it). I didn't read them, because I wasn't old enough. So I'm trying to find out what the warnings were about. They were from sources I trust. Anyway, here is SHIP:


And the PBS article where I found SHIP: https://www.pbs.org/newshour/economy/didnt-want-medicare-part-b-social-security-enroll
 

beavergod1

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It's great to hear your wife was able to get the care she needed, with cost at a minimum and not bankrupting you.

What Medicare G plan do you have? I need to sign my mom and step-dad up for Medicare/social security and I'm so confused about the supplementals.

This link should answer all your questions. I chose Mutual of Omaha. I believe it is the 2nd largest player next to United Health. It has excellent customer service, quick claim settlement, and offers $50,000 lifetime overseas coverage for travel. They also give you a 10% discount for a participating spouse.
 

beavergod1

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Let’s be clear every time BCBS denies a service or treatment they are increasing profits. People’s quality of life and sometimes people’s survival are in conflict with insurance companies. This is why we need a government option to compete with these insurance companies. At the very least every medical insurance company that wants to do business on the exchange should be run as a nonprofit organization. Many insurance companies were nonprofit but that is a thing of the past. We have a long way to go but ACA was a good thing for a lot of people. Medicare for all would be a bigger jump in the right direction.
Agree 100%. You are preaching to the choir. ACA is better than what we had before, which was nothing. It enabled me to retire at 56 and my wife would be slowly dying right now if not for the ACA. (or I'd be working at Walmart for the health insurance).
Under ACA the insurance companies by law have to return to their policy holders any extra profit over 20% of costs. I just received a check from BCBS for $410 this year and over $1200 last year.
 

WVWildflower

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This link should answer all your questions. I chose Mutual of Omaha. I believe it is the 2nd largest player next to United Health. It has excellent customer service, quick claim settlement, and offers $50,000 lifetime overseas coverage for travel. They also give you a 10% discount for a participating spouse.
Thank you!
 

beavergod1

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Thank you!
I pay $110 p/mo for my G plan,(Mutual of Omaha) and $7 p/mo for my D,(drug), plan with Aetna Silverscripts. I only use 1 drug for thyroid control so this plan may change as I get older and sicker. I don't smoke or toak.
I may go with a high deductible plan in the future once I get all my initial health crap out of the way, that I've been putting off until Medicare. I rarely see a doctor. Once a year for physical...
 

WVWildflower

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What is a G plan? There's parts A, B, C and D. A is for hospitals, B for doctors, and D for prescription. I haven't heard of G. Then there are "supplemental" plans, whatever those are, and then Medicare Advantage which is A, B, C, and D?

My mom will have insurance from her state job when she retires as a secondary. She has to sign up for Medicare as the primary. Will she need these other things then (part C and D)? Ugh...I'm so confused.

They aren't in great health and I can't mess this up. Thank you all for sharing your wisdom and experience.
 

bullfrog

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I was in a similar situation I believe when I turned 65 as my state paid my health insurance and paid for a Medicare Advantage plan when I started Medicare. Problem is Advantage plans only pay 80% where as Supplemental plans pay almost all. Once I figured that out the 6 month period when companies must accept you for Supplemental insurance without regard to your health had passed. As I had high blood pressure I couldn’t get accepted for coverage after the 6 months grace period and have been stuck with a Medicare Advantage plan. To this day I have been luckily healthy and having VA benefits to keep costs down at least this is my understanding. My wife is turning 65 and is also employed by the government which will pay for what little cost or no cost Advantage plans but thanks to the recommendation of a SHIP counselor is choosing to go with a Supplemental Plan within the grace period but you must first sign up for Medicare and get you card with your id number to apply within the six month period as I understand it. Again I’m a dummy that probably did it wrong so don’t take any advice from me. Go to a SHIP counselor as they are nonprofits and have nothing to gain from the advice they give. There are plenty of sales people that won’t charge you for their services as they get paid by the insurance companies, avoid them like the plague they are. Plan G is one of the few remaining Supplemental insurance options I believe.
 
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beavergod1

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What is a G plan? There's parts A, B, C and D. A is for hospitals, B for doctors, and D for prescription. I haven't heard of G. Then there are "supplemental" plans, whatever those are, and then Medicare Advantage which is A, B, C, and D?

My mom will have insurance from her state job when she retires as a secondary. She has to sign up for Medicare as the primary. Will she need these other things then (part C and D)? Ugh...I'm so confused.

They aren't in great health and I can't mess this up. Thank you all for sharing your wisdom and experience.
Medicare Part A is hospital, Part B is doctor, Part C is Advantage(HMO), Part D is drugs, and Part E is Extraterrestrial. You have to ask for Part E because they take you to another planet in an alien spacecraft to be cared for, but it's one way only. Plans A,B,D,G,K,L,M, and N are supplemental plans to cover the 20% that Medicare doesn't cover. You can see those plans at the bottom third page of the link I sent you...
 
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