Two Other GIGANTIC "Screw You" Parts Of Obamacare

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Two Other GIGANTIC "Screw You" Parts Of Obamacare

Postby Indaswamp » Sun Oct 27, 2013 11:21 pm

Two Other GIGANTIC "Screw You" Parts Of Obamacare


Two additional things that I haven't seen discussed often (if at all) or which are given only flippant service -- but which could easily bankrupt you.

Actuarial Value. This is a complicated way of saying "what percentage of total health care expense" is the policy expected to cover? For a bronze plan (the least-expensive, but still expensive policy) the answer is 60%.

You may have heard the "actuarial value" but you probably didn't understand what it meant. Let's put some numbers on this. Assuming you will pay $300 a month for your "bronze" plan under Obamacare, or $3,600 a year.

The policy can of course, at most, pay $3,600 per year, per person who has it on average or the company will go out of business because it will lose money. Eventually all firms that lose money continually go bankrupt. Therefore, on average it must pay out less than this much per person, assuming zero overhead (which is of course impossible.)

This means that on average you are expected to fork up about another $2,400 in cash for your medical care on top of the $3,600 in premiums, or $6,000 annually.

Don't have $6,000 in disposable income?

Tough crap.

Now note that these are averages, and further disregard inefficiencies. In other words, the total you are expected to spend will be somewhat less, because the inefficiency goes not to provide care but to run the insurance company. Nonetheless this illustrates the problem -- you think it's $3,600 a year but it's really $6,000 you're signing up for!

The worst part of it is that while there will be some people who will "win" (and spend less or even zero beyond the premium as they use no services) there will be just as many people who get raped for much more. That's how averages are -- they're statistical things and apply only over large groups of people, not to individuals. But on average, and quite-likely, you are not going to spend $3,600 -- it's going to be much closer to $6,000 instead when all is said and done.

Worse is another problem that I am just starting to get reports on -- and which has not been cleanly disclosed. With most conventional insruance there is a fair bit of "out of network" coverage. Most people think of this as a big deal when they want to see a doctor that is not "in network" because they like him or because there is some specialty need.

I am getting multiple reports that many of these Obamacare policies have zero out-of-network coverage and this is not clearly disclosed up front until you sign up for the policy itself. Indeed, I've seen exactly no clean disclosure on this point before you create an account if you're "just shopping."

Now add to this that previously insurance was sold on a state-wide basis. Under Obamacare it is sold on a county-by-county basis.

Why is this a big deal?

Because if there is no out-of-network coverage at all what happens when you are traveling out of your immediate home area and either get sick or have an accident of some sort (other than in a car, where your auto insurance likely provides injury coverage)?

You're screwed -- you will pay 100% with no limits as your insurance is worthless if there is no out-of-network coverage!

I wonder why there's been no widespread public discussion and clear disclosure on these two points.......

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