Choosing to self pay

[somarco]

higher cost is really more so an under 65 ACA

Are you saying folks with Obmacare, including those with heavily subsidized plans, have difficulting paying their medical bills?

Isn't that also true for some of the folks with $0 MA plans?

 

[sman]

Are you saying folks with Obmacare, including those with heavily subsidized plans, have difficulting paying their medical bills?

Isn't that also true for some of the folks with $0 MA plans?

Back when PDP plans were more reasonable, I would have the occasional client who would choose a plan without a deductible because they didn't feel they could come up with $400-$500 in January for their medications. Keep in mind, by going this route they were spending more over the course of a year had they gone with a plan that had a deductible. Sometimes it was a few hundred dollars more over the course of a year.

 

[somarco]

@sman, I had clients that did the same thing. As I recall, SilverScript had a $0 deductible plan for $26/month. That was a no-brainer for many folks including those with high insulin copays.

 

[C Ins Solutions]

Are you saying folks with Obmacare, including those with heavily subsidized plans, have difficulting paying their medical bills?

Isn't that also true for some of the folks with $0 MA plans?

I am saying when I put my average client's Med Adv summary of benefits next to my average client's ACA under 65 summary of benefits, the clients cost sharing across every single benefit is significantly higher. Doctor copays, ER, imaging, deductibles, max OOP.

Majority of my clients, including myself, are on higher deductible/OOP Bronze plans because the Silver/Gold/Platinum options (that look more like Med Adv plans) simply do not compute in regards to premium increase vs cost reduced at time of service i.e. pay $5k more in premiums to lower your exposure $2,500.

As an example, ER on my plan is charged to a $6,500 deductible and $9,450 max OOP. A Med Adv plan has a $90 ER copay majority of the time.

Yes, there are a handful of clients that are heavily subsidized and also qualify for CSR however that is probably 10% of my book as I work with higher income self employed/1099 clients.

My main point is comparing Med Adv to under 65 ACA is oranges to tangerines. Different cost at time of service completely. With that said, 99 of 100 of my clients take Med Supp. The network contract disputes in my south FL market are leaving Med Adv clients out to dry mid year with no recourse. Not ideal.

 

[somarco]

when I put my average client's Med Adv summary of benefits next to my average client's ACA under 65 summary of benefits, the clients cost sharing across every single benefit is significantly higher.

Why are you ignoring my comment? I neither said, nor implied, anything that compares one type of health care financing vs the other.

TWICE I have stated many people have trouble paying a $300 medical bill and have stated, that to them as least, the bill might as well been $3,000 and that is not affordable (to them) either.

Reading comprehension is a challenge for many.

 

[C Ins Solutions]

Why are you ignoring my comment? I neither said, nor implied, anything that compares one type of health care financing vs the other.

TWICE I have stated many people have trouble paying a $300 medical bill and have stated, that to them as least, the bill might as well been $3,000 and that is not affordable (to them) either.

Reading comprehension is a challenge for many.

No issue with my ability to comprehend but thank you for CAPITALIZING and bolding. Not arguing any of your points. I am simply stating that there is a much higher cost at time of service that policyholders experience on under 65 ACA compared to Med Adv.

Boy, everyone is so sensitive nowadays. I'll make certain to tread lighter around you as it appears your feelings are easily hurt. Or at 38,000+ comments on this forum, maybe you are just another keyboard warrior.