That's not how it works. No one has to buy through the marketplace. Anyone can walk into a Florida Blue office, or call Cigna or United Health, and sign up for whatever insurance package they offer to the public. Individual plans are, and have always been incredibly expensive no matter where you are.

But now, if you DO go through the marketplace, you are guaranteed certain minimum of care: all vaccines are covered. All yearly checkups and yearly bloodwork is covered. Routine mammograms, pap smears, prostate exams, all covered. You can go bare-bones, and the law requires these plans, no matter how expensive or cheap, to cover these things 100% with no co-pay.

Private insurance is not obligated to cover those things, free or otherwise. If you don't qualify for ACA subsidies, then don't buy from the marketplace. The marketplace exists for the purpose of providing health care to people who qualify for subsidies and guarantee a minimum of health care to everyone who signs up for it.

It was never fully in effect. A huge and significant chunk of it was completely gutted and eliminated before it ever got to the President's desk. That's why it is the mess that it is now.

It would've been an amazing legislation. Now, it is helpful to those who qualify - but it's not nearly as good as it could have or should have been, and does cost people who don't qualify, more than it would have.

Medicare in some ways is a curse. Many of the drugs from Big Pharma, that you see on ads on TV for as low as $30, or $10, or $0 INTENTIONAL BLOCK MEDICARE PATIENTS.
The public doesn't learn this from anyone or the MSM. The MSM is too busy pocketing all the $$$ from Big Pharma ads. The truth is suppressed again.

Wow! With those prices, it looks like she isn’t going to retire any time soon! Social security wouldn’t even cover her medical costs.

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.

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.

:bigbow:

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.

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.

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.

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.

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.

Villages Health has a CEO, he is in charge.

Exactly!!!

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.

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! :$:

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!!!!

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

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.

Of course, because the multi-million-dollar income earners need to welch off the system, costing the middle-class more since they /can't/ change their income, since they're still working and rely on that paycheck for living.

Excellent example of why the insurance companies are valuing their plans at $2000/month or more.

I hear ya, I have essentially the same insurance except I pay a crap load more in monthly premiums without the tax credit subsidies. I got really sick in 2021 from an infectious disease from a tick bite and had to spend 8 days in critical care in a Gainesville Hospital before they finally figured out was was wrong with me and how to treat it (basically the same treatment used for Malaria). They ran just about every imaginable test on me trying to diagnose what was making me so sick. The billable expenses from that episode ran close to a quarter million dollars, but I only had to pay the max out of pocket, which was close to 10 grand. Now I need a second knee replacement (too many years of pounding ice moguls in Vermont), but I’m going to suck it up a little longer until I turn 65 because it will be way cheaper once I am on Medicare.

Best of luck with the hip.

Thanks! Same to you with the knee. I almost got the hip done this year, but it turned out the excruciating pain I experienced was probably just a mild bone infection caused by the cortisone shot they gave me to relieve the hip pain (go figure). THAT pain resolved itself, the cortisone shot worked perfectly otherwise. And now, it's just starting to wear off.

It's my third and final cortisone shot, I'm not allowed to get more than 3 lifetime. Once the pain progresses back to where it was before I got the last shot, it's time to replace the thing.
So - probably next year. If not, then I will have saved a fortune in premiums without needing expensive care, so it'll be a win-win.

Wow, as a Canadian those insurance costs are astronomical!!

I had same issue in 2021. ONLY carrier in Sumter County was Florida Blue and was able to get a PPO plan. Happy with the plan and cost around 10k.

Not a problem for me, but I had only one choice last year in Sumter County. No insuance company wants to insure 64 year olds.

Agree 100%. Last year I had capital gains which pushed my premum up $800 a month since I did not anticipate high capital gains in 2021 and instead of getting an IRS check, I sent them a check.

There is a difference between income and net worth. "multi-million-dollar income earners" aren't "welching" off the system but they are paying a crap-load of taxes. Retired and under 65 with high net worth and low reported income can get a subside. Complain to the people who wrote the obamacare law such that the means testing is on reported income and not net worth. Just like with every other aspect of the tax law, people will adopt tax reduction strategies.

Exactly. Which is why I refused to get a subsidy even though I have essentially zero income. While the law has a few good points, it is also deeply flawed and was more political than medical in nature. Back in 2009 I was on one of the committees that was developing part of "Obamacare". I quickly resigned when I found out there were 70 people on this committee and only 2 physicians, most were politicians and bureaucrats, and it was obvious the outcome was already pre-determined.

The scenario outlined above is highly unlikely. If one is truly a high net worth individual than the income on their investments will almost certainly put them well above the income cap to receive Obamacare income tax credit subsidies. For a high net worth individual to keep their income low enough to qualify for subsidies, they would basically have to stuff their savings under a mattress. Who in their right mind would forego many thousands of dollars of investment income to save a few thousand dollars in health care premiums? I suppose there are some examples of idiots that stashed their savings in crypto to avoid reporting income, but how did that work out for them?

I agree that the number of people who can do this is limited. If most of your money is in IRAs then it is entirely possible you can do this. You could be living off of non-qualified money that doesn't generate a tax event or much of a tax event. Did you read the link posted previously? It was about financial advisors and clients who are doing this. I know savvy people who have done this.

Or doesn't get involved. I used one of our urgent care facilities on a Sunday recently for sudden dizzyness and balance problems. I walked in waited 15 minutes and was taken into a room and was asked by the nurse what my problem was. Took my pulse and BP, checked my response to several simple head and eye movements. Nurse went and discussed with doctor and returned with script for Meclizine (which you can buy off the shelf). Total time less than 1/2 hour, never saw doctor. Advice was vertigo and go to see my doctor if it did not get better in a day or so.

Urgent care bill to Medicare was $2800, and Dr was $1300, Total was $4100+. Medicare authorized a total of $300 (Less than 8% of charge).

What happens to a person with no insurance? How is this type of billing tolerated? I know Medicare has payment codes for provider services, but such a difference leads to total mistrust of all involved.

Perhaps someone on this forum can help explain.

Yup.

Dehydration caused fainting in the town square. Needed IV fluids, nothing else. Mandatory ambulance ride: $670. Two sets of chest x-rays because patient was stressed out (I mean who would NOT be stressed out after being transported to the ER?), 1.5 hours laying on a gurney watching TV with no visitors allowed, full CBCs, to get 2 bags of fluids that only took 1/2 hour to administer. Patient didn't know they could just refuse more service and walk out, the spouse was not permitted in to explain that to him.

Finally after 1.5 hours the spouse was able to flag down a medical employee to explain the situation, and was allowed in. Patient was angry, had wanted to go home an hour before, didn't want ANY of the tests he was told he HAD to take...

Nurse made nasty comments...

and the bill for THAT lovely service was $2000.

Oh that $600+ ambulance ride was one BLOCK away from the ER.

Insurance covered only part of the cost because UFHealth's free-standing emergency center was considered "out of network" and therefore not covered, so the payment to ambulance and UFHealth ended up being around $1800 total.

If you fall within the income limits, you not only qualify for a subsidy amount that will lower your monthly premium but you also get lower copays and a lower out of pocket max. Now, if you significantly underestimate your income (maybe you sold stock or a rental property for a $50k capital gain), you will have to pay part of the subsidy back that reduced your premium. This is a fairly straightforward process. However, what about the copays? Maybe you initially had zero copays with the estimated low income and now with the actual higher income, you should have been paying $20 copays all year. These would have been paid directly to the doctors' office or hospital, etc. How are these recaptured or clawed back?

It should be based on what you will make this year. Last year after having covid I was unable to work. After losing my job I signed up for Obama Insurance. I estimated my income for this year at $18k. I ended up making $20k no problem. The year before I made $120k for the year.

At the end of the year it always is based on the actual income for the year (income as defined by Obamacare). Everything is trued up when you file your federal tax return and any discrepancies between projected and actual income will result in an adjustment to tax credits, unless you go over the cap, then all credits received will have to be returned.