Health Insurance OOP Costs - Americans Can't Handle This!

[AllenChicago]

Friday, March 13, 2015

The most recent study of Obamacare ACA-compliant plan related costs to consumers, indicates that Americans are now getting hammered exceptionally hard by Out-of-Pocket costs related to their health insurance.

Excerpt:
"Only three in five households have enough liquid assets to meet a deductible of either $1,200 per individual or $2,400 per family, according to the Kaiser Family Foundation study. Only about half of U.S. households had enough such assets to cover higher deductibles of $2,500 per individual or $5,500 per family.

The situation only gets worse for households when considering their exposure to total out-of-pocket costs. Just 48 percent of households have enough liquid assets to cover what were considered to be the mid-range of such out-of-pocket health cost limits: $3,000 per individual and $6,000 per family, according to the Kaiser study.

Just 37 percent can meet the higher range of such costs, or $6,000 per individual and $12,000 per family, the study found."

Source: Even with insurance, Americans have trouble paying medical bills

Note: The above numbers don't take into account the potential for thousands of dollars OOP for medications.
ac

 

[Yagents]

medications go towards the OOP............by law, in all ACA plans

 

[YouGotMyMoney]

medications go towards the OOP............by law, in all ACA plans

Which isn't true with Medicare lol go figure

 

[AllenChicago]

medications go towards the OOP............by law, in all ACA plans

Here is wording from our BCBS-IL Silver Plan Summary of Benefits.
"Prescription drugs do not apply to the deductible."
Link to SOB: http://www.bcbsil.com/PDF/sbc/36096IL0790004-01.pdf

Since the Deductible is met before the Out-of-Pocket, how can prescription costs avoid being applied against one, but not the other?
ac

 

[DS4]

Since the Deductible is met before the Out-of-Pocket, how can prescription costs avoid being applied against one, but not the other?
ac

Like Yagents said, Rx goes to OOP.
Allen, the summary will not have the answer you are looking for. You need to review the COC for your answer.

 

[YouGotMyMoney]

Because they are covered at a copayment and not subject to a deductible like an office visit would be.

 

[AllenChicago]

Like Yagents said, Rx goes to OOP.
Allen, the summary will not have the answer you are looking for. You need to review the COC for your answer.

Thanks for that screen image of your COC, DS4. If that's from BCBS, yours is worded more clearly than ours. It's called a Outline of Coverage (OOC) by BCBSIL.
-ac

 

[redeemed]

I have no clue where they came up with that $1,200 per person or $2,400 per family nonsense, in my area, silver plans have 3-6k ded per person, and double that per family.

Now if the average American family can't swing a $2,400 deductible, that is poor financial management for most of them, if there income is so low that even the $2,400 is a problem, they are likely eligible for cost sharing assistance. I helped a lot of low income families get on plans for with $500 deductibles this year. The middle class ones though are completely SOL with $13,200 ded/moop.

 

[AllenChicago]

I have no clue where they came up with that $1,200 per person or $2,400 per family nonsense, in my area, silver plans have 3-6k ded per person, and double that per family.

You know you're in trouble when even the Kaiser Family Foundation doesn't understand that the Out-of-Pocket is what their studies should focus on.

I just ran a quote for a single non-subsidy person on HealthSherpa. The lowest Silver Deductible is $1,500, but the out-of-pocket is $6,450. It's a 70/30 plan from our state's Co-op. The lowest OOP among the 47 Silver plans available is $6,000!

The crazy thing that I never understood (and gave up trying to) is that Silver plans are supposed to cover 70% of medical bills. Bronze = 60%, Gold=80%, etc.. If you have $100,000 in cancer treatments they do far better than those percentages. But if you have a $5,000 injury...

 

[DS4]

Max OOP in California for SCR,

$5200 Silver 73 ($1600 ded)
$2250 Silver 87 ($500 ded)
$2250 Silver 94 ($0 ded)