Bella_mezzo|1381188880|3533899 said:My brother is in the military and I have to say, I would have been a lot happier if the exchange plans were TriCare...I truly believe that socialized medicine is a far superior alternative and think that the Affordable Care Act should have provided a federal single payer system. The current plan is like the worst of both worlds...
Have you looked through the coverage?
I am pregnant and due in Feb, thankfully I think that my job is going to continue to offer insurance that covers l&d with a $500 deductible and reasonable copay.
My husband currently does not have insurance b/c we can't afford the premiums for him and we are considering paying the "penalty" for 2014 as there is no way for us to afford the monthly premium for him until the fall when he hopefully will resume working (he is currently in school full-time).
Just in case my job dramatically changes their plan/coverage/premiums, I checked the exchange and ...Here is the maternity coverage on the exchange (I live in NYC).
Bronze: $6000 family deductible, $12,700 family out of pocket max, 50% coinsurance AFTER deductible for in-patient hospital delivery AND 50% coinsurance (after deductible) for delivering physician. Premiums for this are about $14,500/year for a family of 4 with no subsidies and children covered under ChildHealth Plus.
Silver: $4,000 family deductible, $11,000 family out of pocket max, $1,500 per admission AFTER deductible AND $100 copay for delivering physician (after deductible). Premiums for this are about $16,500/year for a family of 4 with no subsidies and children covered under ChildHealh Plus.
Gold: $1,200 family deductible, $8,000 family out of pocket max, $1,000 per admission AFTER deductible AND $100 copay for delivering physician (after deductible). Premiums for this are about $18,000/year for a family of 4 with no subsidies and children covered under ChildHealh Plus.
Platinum: $0 family deductible, $4,000 family out of pocket max, $500 per admission (no deductible involved) AND $100 copay for delivering physician (no deductible involved). Premiums for this are about $20,000/year for a family of 4 with no subsidies and children covered under ChildHealh Plus.
AND, HERE IS THE KICKER...ALL OF THESE PLANS STILL REQUIRE "PARTICIPATING PROVIDERS" SO YOU HAVE TO DEAL WITH THE HASSLE OF MAKING SURE THAT ANY PROVIDER YOU SEE (FROM THE DR TO THE ANESTHESIOLOGIST TO THE PATHOLOGIST TO THE LAB, ETC. IS A "PARTICIPATING PROVIDER" or you'll need to pay in full for the services.
Billed amounts for standard vaginal deliveries with no complications in NYC are about $30,000 and insurance companies usually pay about $10,000. If insurance coverage continues to work the way it currently does...in the Bronze plan, you would pay the $6,000 deductible AND 50% of $30,000...SO A TOTAL OF $21,000...then the insurance company would pay whatever it pays of the remainder, based on my recent insurance bills that would be about $1500 b/c on all my bills from the past few years, insurance companies have paid about 10% of the charged amount.
Whoop-dee-doo...I'll get a "free" breast pump too. In my mind that is one h*ll of an expensive breast pump!
And that is why, if you are planning a family, you don't buy the Bronze plan! We live in Mass which already has RomneyCare, and when we both went self-employed, we could choose our plan. Our premiums are $1,100 per month for us both but all prenatal and postnatal visits are free and a vaginal birth costs 1k to the insured (not sure about billed amounts but it's top-notch hosp, Mass General in Boston) including anaesthesia, radiology, delivery, lab tests, and hospital for mother and baby. And free breast pump too.
Other plans didn't cover diabetic care. You've just gotta read all the small print when buying and relate it to your own healthcare situation.
ETA: Considering we pay over 13k per year for us two, that Gold plan sounds OK. $18k per year for FOUR people? Not so bad. Very low deductible and that $1,200 is per family, not per person. I've heard much worse, considering that private health insurance in the US means fast and accessible tests and results. I had a breast lump; in the same day at MGH Breast Center, despite being only 36. That would never have happened on the NHS. I had reason to believe that my husband has brittle bones; I won't bore you with the symptoms. He goes to see his PCP and he gets a DEXA scan two days later. The NHS is liable to tell you it's very unlikely at his age (45) and tell you to come back for a scan at 65.
If you are truly in trouble on the NHS, you will get your leg saved or your heart replaced and it won't cost you a penny. But tests and results can be very problematic, and so can be getting taken seriously. At 25 I went to my GP and told her I thought I had a particular fertility-threatening disease. She just laughed, told me there's no way I would have it, and refused to examine me or test me. Fortunately for me, I went to a different NHS facility where they did take me seriously, and I did have that disease.
I'm just trying to say that you do, in many healthcare scenarios, get what you pay for. In the UK you get excellent urgent care and no one is bankrupted or loses their house; but you don't get the in-depth GP appointments (NHS target is 10 mins per patient I believe unless you book a double appointment) and you don't get the easy access to tests and speedy results that you get here, no siree. So, there is a benefit to paying those premiums, over the universal healthcare model.
But then, you have to pay the premiums, which you don't in the UK! It's kind of a pick-your-poison scenario.