[tophcfa]

Originally Posted by OrangeBlossomBaby

The insurance plan I'm on now (FloridaBlue BlueSelect Silver 1443) retails at just under $2000 per month. Of course no one actually pays that much, but that's the MSRP.

So wrong, many people pay the full MSRP. The reason the MSRP is so ridiculously high is because the people paying it are subsidizing those who are paying only a fraction of the cost.

[dewilson58]

Originally Posted by tophcfa

You are both correct and totally wrong at the same time. You don’t have to buy your insurance through the marketplace if you don’t qualify for free or subsidized
Health insurance. That being said, the premiums for everyone not getting insurance through an employer are all dictated by the “affordable care act marketplace”, regardless of where you purchase the insurance. So where you actually purchase the insurance is simply a matter of semantics. The pricing for those who pay the full price for insurance got jammed down everyone’s throat to help pay for free and subsidized insurance.

[tuccillo]

That is not true. FB offers numerous plans. Some are obamacare compliant and some are not. The obamacare compliant plans are the same price whether you buy them through the marketplace or not. Buying them via the marketplace may allow for a subside, which can be applied each month or you can opt for no subside each month and receive the total subside when you do your taxes the next year. Plenty of people pay the full price because they don't qualify for a subside. You can probably guess how I know this.

Originally Posted by OrangeBlossomBaby

The insurance plan I'm on now (FloridaBlue BlueSelect Silver 1443) retails at just under $2000 per month. Of course no one actually pays that much, but that's the MSRP for it. I'm charged $436/month for that plan.

[Hifred]

Hi - My husband and I are both under 65. The Villages health care latched on to us - We have United Health Care PPO. It must have been the type of insurance you have. No doctor in Florida has turned us down. Our monthly charge for our insurance is $1350 a month. But it is a lousy policy - we pay $100 deductible when seeing a specialist and then 20% of the remaining balance. We pay a lot in addition to our policy cost. Our experience with TV Healthcare and seeing a primary care doctor has been exceptionally poor. Whenever we need to make an appointment with the doctor we have to see a nurse practitioner. We have been misdiagnosed on several occasions, sent for unnecessary tests per doctors at Shands when we ended up there because of poor care at The Villages Health Care. Moving here from Chicago the health care protocols followed here seem 3rd world. My husband had his blood work done at The Villages Health Care and the nurse put the tubes of blood in her pocket without any label. Typical protocol is to read the name and birthdate on the label and confirm identifying information with the patient before taking blood. The results of the blood work was inconsistent with our past results so we ended up getting our blood work redone at Shands and the results didn't reflect what we got from TV. The doctor at Shands jokingly said are you sure they didn't mix up the tubes and we thought - hmmm no we are not sure that didn't happen. In short - don't feel bad you didn't get a doctor to treat you at The Villages Health Care. Although the people are very nice there you will find better health care outside The Villages. I would look at a University Health Care System like UF Health Shands, University of South Florida, or Orlando. UF Health has physicians in Ocala, Summerfield, Gainesville. University of South Florida has doctors with offices as close as Wesley Chapel. What I do is I keep a doctor close by if I get a cold or flu and for specialty care I drive to see specialists connected to University Hospitals that use research based treatments. However, I went to The Villages for what I was told was a cold and was really sick. I was told to expect to have a cough for a month. I ended up at Shands because I was in horrible pain and couldn't keep my head up. Turns out I needed antibiotics which the physician's assistant at TV would not give me. I had an ear ache and went to TV. I was prescribed an antibiotic drop with steroids in it. The pain intensified and I ended up at an ENT in Orlando who told me you should never put a steroid in your ear if there is an infection because the steroid takes down swelling and with pus in the ear from the infection there is no room for the swelling to go down so it can damage the drum of the ear. I was told to stop the drops immediately and was treated with an oral antibiotic. I have a long list of things I could write about mistakes at The Villages. The physician's assistants there have less education than vets yet they diagnose and more times than not with my husband and I they have made mistakes. I have had good health care outside of The Villages. I suffered a finger fracture where the ligament separated and got really good treatment by a hand specialist at Shands. Yes the drive was long to get there and back but my finger works perfectly now.. I had a series of removeable casts that were remade at different angle degrees every two weeks and was given daily exercises that were changed every two weeks to do in warm water so that the finger would heal properly. At some point when I get older and can't drive outside TV for good health care I will probably end up moving out and going to an area with better health care.

[Rainger99]

Some of these posts are very disturbing. Who is in charge of TV Health? Has he ever addressed these issues? It would be great to have a meeting with the top medical people so that these issues can be addressed.

[PoolBrews]

Originally Posted by rustyp

Obamacare eligibility is based upon next year's projected income. Thus looking for insurance for 2023 you project your income for 2023. The risk is if you go over your projection you will owe a penalty. The benefit is based upon "earned income". You should read the definition of earned income in the Obamacare rules. There are ways to limit your next year's income. For example if you are planning on drawing from a retirement account next year consider drawing it out this year. Compare Obamacare benefit to what extra tax will be this year Vs next year which you are going to pay on it anyways but perhaps in a different tax bracket.

It's not a penalty, you just have to return the difference. i.e. if you claim a certain income and it says you get $1,700/month in credits, and then at the end of the year your income was higher so the credit should have been $1,600/month, you have to pay the $1,200 ($100 x 12) back when filling out taxes.

[OrangeBlossomBaby]

Originally Posted by Rainger99

Some of these posts are very disturbing. Who is in charge of TV Health? Has he ever addressed these issues? It would be great to have a meeting with the top medical people so that these issues can be addressed.

There's no singular person in charge of The Villages Health. There's really only one issue: most of the current roster of primary care physicians there are not accepting new patients. That means their schedule is already full with existing patients and they simply can't accommodate more.

Many patients refuse to see a Physicians' Assistant for simple things like a gynecological exam and pap smear, or a sprained finger check or mandatory 5-minute visit to get a renewed prescription of certain medications, which puts more of a burden on the physicians, and devalues the PA's work (which at the Villages Health is actually pretty good). So the physicians are in short supply with an increased demand. The facilities exist. They just can't get enough doctors to work in them to meet that increased demand.

[tuccillo]

Villages Health has a CEO, he is in charge.

Originally Posted by OrangeBlossomBaby

There's no singular person in charge of The Villages Health. There's really only one issue: most of the current roster of primary care physicians there are not accepting new patients. That means their schedule is already full with existing patients and they simply can't accommodate more.

Many patients refuse to see a Physicians' Assistant for simple things like a gynecological exam and pap smear, or a sprained finger check or mandatory 5-minute visit to get a renewed prescription of certain medications, which puts more of a burden on the physicians, and devalues the PA's work (which at the Villages Health is actually pretty good). So the physicians are in short supply with an increased demand. The facilities exist. They just can't get enough doctors to work in them to meet that increased demand.

[golfing eagles]

Originally Posted by OrangeBlossomBaby

There's no singular person in charge of The Villages Health. There's really only one issue: most of the current roster of primary care physicians there are not accepting new patients. That means their schedule is already full with existing patients and they simply can't accommodate more.

Many patients refuse to see a Physicians' Assistant for simple things like a gynecological exam and pap smear, or a sprained finger check or mandatory 5-minute visit to get a renewed prescription of certain medications, which puts more of a burden on the physicians, and devalues the PA's work (which at the Villages Health is actually pretty good). So the physicians are in short supply with an increased demand. The facilities exist. They just can't get enough doctors to work in them to meet that increased demand.

Exactly!!!

[Nucky]

Many of the last posts are slipping off into the care people receive. That ain't da subject here. Coverage for young's is.

Everybody here has stories about the shortcoming of medical care around these parts. I wonder if anybody has success stories? Once I got past the ER in The Villages Hospital I got what I think was great care. All except for the severe infection I got from rusty instruments in the Operating Room. Just kidding. I don't know where I got it in the hospital but I went in there uninfected. The only reason I didn't lawyer up is it may have dragged my primary doctor into the situation somehow and I wouldn't do that to him or her for all the money the people have on the other side of Route 44.

Back to more people who I really respect who have Bronze instead of Silver, Gold, or Platinum. Let's go for more info, please. I gotta make a decision by December 15th.

[Nucky]

Originally Posted by golfing eagles

Exactly!!!

Gotcha Doc!!! Here is the Head of The Hospital. I sent a registered letter to him and I have saved his name. Gimme a minute. Here it is Director of Customer Relations Vinnie Boombatz!

[tophcfa]

Originally Posted by Nucky

Many of the last posts are slipping off into the care people receive. That ain't da subject here. Coverage for young's is.

Everybody here has stories about the shortcoming of medical care around these parts. I wonder if anybody has success stories? Once I got past the ER in The Villages Hospital I got what I think was great care. All except for the severe infection I got from rusty instruments in the Operating Room. Just kidding. I don't know where I got it in the hospital but I went in there uninfected. The only reason I didn't lawyer up is it may have dragged my primary doctor into the situation somehow and I wouldn't do that to him or her for all the money the people have on the other side of Route 44.

Back to more people who I really respect who have Bronze instead of Silver, Gold, or Platinum. Let's go for more info, please. I gotta make a decision by December 15th.

Hey Nucky, our insurance is in Mass, not Florida. That being said, I believe all the metallic tires of health insurance are the same regardless of state. Being the rather quantitative/analytical person that I am, I put together a very detailed spreadsheet with all the details of each metallic tier and ran through several hypothetical insurance need scenarios. My analysis showed, hands down, that the Bronze tier was the best option (cheapest) under the widest range of scenarios.

At the end of the year, if one has a series of unfortunate health events, the insured always ends up paying almost exactly the same amount regardless of the tier. With the Platinum, you pay up front in the form of premiums but pay way less over time as you utilize health care. With the Bronze, you pay way less up front in the form of premiums but must pay a lot more over time as you utilize health care. If one is very sick and anticipates needing lots of health care, it’s best to go with the highest premium Platinum tier, as most bills are covered so the insured won’t have the hassle of having to pay for everything a-La-cart. On the other end of the spectrum, the Bronze tier has the lowest premiums, but the insured has to deal with the hassle of paying for just about everything a-la-cart until they reach the annual max out of pocket.

The biggest difference between the Platinum and the Bronze is that if the insured is fortunate enough to have a very healthy year, and needs only basic health care, they will save lots of money in the lower premium Bronze tier.

The gold and silver tiers fall somewhere in between the two, with the gold being closer to the platinum tier, and the silver being closer to the bronze tier.

In summary, the Bronze tier always has the potential to be the cheapest tier if the insured has a healthy year, but also has the potential to be the most work for the insured if they wind up requiring extensive health care. The Platinum tier is typically the most expensive tier unless the insured has a very unhealthy year (then the cost of all plans winds up almost exactly the same), but the insured has the benefit of less ongoing work as the coverage is more extensive.

The biggest advantages of the Bronze tier is that you pay the lowest premiums and if your health care needs are minimal it’s absolutely the cheapest plan. That huge advantage is offset by the fact that if your health care needs become extensive, the pay as you go becomes lots more work for the same cost. That disadvantage is what makes the pricing of the bronze tiers premiums so cheap, as the hassle of paying as you go discourages the insured from seeking health care unless it’s absolutely necessary.

Kind of long winded, but hope that helps.

[Nucky]

Originally Posted by tophcfa

Hey Nucky, our insurance is in Mass, not Florida. That being said, I believe all the metallic tires of health insurance are the same regardless of state. Being the rather quantitative/analytical person that I am, I put together a very detailed spreadsheet with all the details of each metallic tier and ran through several hypothetical insurance need scenarios. My analysis showed, hands down, that the Bronze tier was the best option (cheapest) under the widest range of scenarios.

At the end of the year, if one has a series of unfortunate health events, the insured always ends up paying almost exactly the same amount regardless of the tier. With the Platinum, you pay up front in the form of premiums but pay way less over time as you utilize health care. With the Bronze, you pay way less up front in the form of premiums but must pay a lot more over time as you utilize health care. If one is very sick and anticipates needing lots of health care, it’s best to go with the highest premium Platinum tier, as most bills are covered so the insured won’t have the hassle of having to pay for everything a-La-cart. On the other end of the spectrum, the Bronze tier has the lowest premiums, but the insured has to deal with the hassle of paying for just about everything a-la-cart until they reach the annual max out of pocket.

The biggest difference between the Platinum and the Bronze is that if the insured is fortunate enough to have a very healthy year, and needs only basic health care, they will save lots of money in the lower premium Bronze tier.

The gold and silver tiers fall somewhere in between the two, with the gold being closer to the platinum tier, and the silver being closer to the bronze tier.

In summary, the Bronze tier always has the potential to be the cheapest tier if the insured has a healthy year, but also has the potential to be the most work for the insured if they wind up requiring extensive health care. The Platinum tier is typically the most expensive tier unless the insured has a very unhealthy year (then the cost of all plans winds up almost exactly the same), but the insured has the benefit of less ongoing work as the coverage is more extensive.

The biggest advantages of the Bronze tier is that you pay the lowest premiums and if your health care needs are minimal it’s absolutely the cheapest plan. That huge advantage is offset by the fact that if your health care needs become extensive, the pay as you go becomes lots more work for the same cost. That disadvantage is what makes the pricing of the bronze tiers premiums so cheap, as the hassle of paying as you go discourages the insured from seeking health care unless it’s absolutely necessary.

Kind of long winded, but hope that helps.

I absolutely concur. Big premiums and the the coverage sucks anyway. What’s up with that? I’ve been doing the same thing. Bronze is the new Gold for Mrs. Nucky. God Bless that woman. Not going to finish the application until I get some sleep. Haven’t been to sleep yet.

Thanks for the helping hand hand to all!!!!

[Plinker]

Originally Posted by PoolBrews

It's not a penalty, you just have to return the difference. i.e. if you claim a certain income and it says you get $1,700/month in credits, and then at the end of the year your income was higher so the credit should have been $1,600/month, you have to pay the $1,200 ($100 x 12) back when filling out taxes.

How about zero deductible, zero or very minimal monthly payments and a $5400 out of pocket maximum for pre-Medicare retirees with multi-million dollar net worths.
Easily accomplished:

Access Denied

[OrangeBlossomBaby]

Originally Posted by tophcfa

The biggest advantages of the Bronze tier is that you pay the lowest premiums and if your health care needs are minimal it’s absolutely the cheapest plan. That huge advantage is offset by the fact that if your health care needs become extensive, the pay as you go becomes lots more work for the same cost. That disadvantage is what makes the pricing of the bronze tiers premiums so cheap, as the hassle of paying as you go discourages the insured from seeking health care unless it’s absolutely necessary.

Kind of long winded, but hope that helps.

The tiers have changed a LOT since the ACA was first passed. Also medical needs of subscribers change from one year to the next, especially as we get older. As of January 1, my new plan will be BlueSelect Bronze 2139.

I'm expecting to need hip replacement surgery next year. The customary cost, for operation, facility fee, doctors and anasthetics, pain meds, follow up visits, scans and xrays and whatever the heck else they do, will be somewhere around $25,000.

Under my CURRENT plan - BlueSelect Silver 1443A, I pay $436/month just to be on the plan. It has a 7000 per person deductible and a 8500 per person out of pocket expense. Having the procedure at the hospital instead of a surgical center is only covered to something like 40%, leaving me with having to pay 60% of the balance. Certain other parts of the surgery aren't covered at all, though I'll get some kind of schedule of fees discount. It's pretty complex, lots of things that are and aren't covered, covered only partly, with a bunch of exclusions.

The tl;dr is I'll likely be on the hook for around $15,000 total for the surgery, assuming I have no other medical issues all year, and including my premium.

For the NEW plan, it's a $9100 out of pocket max, 0 deductible. That basically means I pay for all my expenses as I go, and once it hits $9100 total payout, everything else is covered at 100 or with a reasonable additional copay (like $50 for a doctor's visit for a sprained ankle or whatever else).

This new plan will cost me $146/month, for myself and beloved spouse.

The tl;dr of the new plan is I'll be on the hook for around $10,000 total for the surgery, assuming I have no other medical issues all year, and including my premium.