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

Discussion in 'Health Insurance and Ancillary Benefits' started by AllenChicago, Mar 13, 2015.

  1. AllenChicago
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    AllenChicago Well-Known Member

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    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
     
  2. Yagents
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    Yagents Well-Known Member

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    medications go towards the OOP............by law, in all ACA plans
     
  3. YouGotMyMoney
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    YouGotMyMoney Well-Known Member

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    Which isn't true with Medicare lol go figure
     
  4. AllenChicago
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    AllenChicago Well-Known Member

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    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
     
  5. DS4
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    DS4 Well-Known Member

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    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.
     

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    Last edited: Mar 14, 2015
  6. YouGotMyMoney
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    YouGotMyMoney Well-Known Member

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    Because they are covered at a copayment and not subject to a deductible like an office visit would be.
     
  7. AllenChicago
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    AllenChicago Well-Known Member

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    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
     
  8. redeemed
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    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.
     
  9. AllenChicago
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    AllenChicago Well-Known Member

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    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...
     
  10. DS4
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    DS4 Well-Known Member

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    Max OOP in California for SCR,

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

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