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ObamaCare Questions
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Posted on 12/06/2013 12:16:02 PM PST by airedale

I have some question about the Affordable Care Act, ObamaCare:

1. What does the drug formulary cover and are there drug tiers ( from really cheap to expensive brand name. I switched to Medicare when I turned 65 and stayed with Kaiser. The only real difference I can tell is with the drug formulary. Medicare’s is much smaller and more restricted. If they aren’t on the formulary you have to pay full price. I didn’t have any mediations that were not on the new formulary, but I don’t have diseases like cancer, Parkinson’s or AIDS for example. I don’t know what the Medicaid formulary looks like or the ObamaCare formularies’ look like. Are they substantially more restrictive than what had been provided in the past? If they are people who need those drugs are in for a big surprise.

2. Since most of the plans have large deductibles (Bronze plan in California has a $5,000 per person deductible before the co-pays kick in) what rates do the doctors and hospitals get to charge. Anything they want? A set government price list? Do they charge the price they have contracted with the insurance company to be reimbursed when the deductibles are met? With the limited supply of high quality doctors and hospitals taking Medicaid and reports of the similar conditions for ObamaCare it is open to price gouging.

3. Does Medicaid have a deductible like the Bronze and Silver Plans? If not if your income goes over the threshold of Medicare eligibility while you may still get a subsidy so the price is very low the deductibles will be a major hit to your disposable income. It’s a real incentive to keep your income below that threshold. This is punishing success. This is in addition to the penalty when your income goes above the subsidy thresholds. It’s almost like the authors and the supporters of this bill want to keep people in poverty.

4. What can a doctor/hospital do if a person refuses to pay the amounts they owe for the deductibles? Can they refuse to treat them? Drop them as a patient? Or does the law require and their contracts force them to continue to treat them? In the past the doctor could sue them and refuse to continue to provide services. If they can’t refuse or drop them aren’t they being forced into involuntary servitude?

5. The President has allowed Congress staff and others to receive subsidies which are specifically excluded by the act. The problem they are having in fighting this is no one apparently has standing. These subsidies are paid with taxpayers dollars so aren’t all taxpayers being harmed by this illegal act? Don’t all the taxpayers as a group have standing even though as a taxpayer our share of this illegal subsidy is very small. Doesn’t this same argument apply to any other waiver or illegal change in the law such as the reinsurance fee waiver for Unions? I know federal class action suits are more difficult to file now, but if this gives valid standing a single individual/company should be enough.


TOPICS: Your Opinion/Questions
KEYWORDS: affordablecareact; obamacare

1 posted on 12/06/2013 12:16:02 PM PST by airedale
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To: airedale

If you identify yourself to the feds as a sexual degenerate, they will take good care of you.


2 posted on 12/06/2013 12:18:53 PM PST by Safrguns (PM me if you like to play Minecraft!)
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To: airedale

I was just dumped into Medicaid and the formulary is exactly the same as it was previously (cancelled paid plan with same insurance company). I checked the formulary first thing.

There is no drug copay in my state and there are no deductibles. We were disappointed to not be able to purchase a silver exchange plan we had picked out but that’s the way it goes. I would respond to your other questions but busy with a new pet.


3 posted on 12/06/2013 12:26:01 PM PST by steve86 (Some things aren't really true but you wouldn't be half surprised if they were.)
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To: airedale

First and foremost, could you please stop mixing Medicare and Medicade? They are two different beasts. If you are on Medicare, then none of this nonsense affects you. You can still buy part B coverage, and supplemental insurance which is outside of the PelosiCare/ObamaCare system. *as far as I can tell, I’m sure someone will correct me.


4 posted on 12/06/2013 12:29:10 PM PST by kingu (Everything starts with slashing the size and scope of the federal government.)
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To: steve86

I had a Cadillac plan before and the formulary is 2/3 to 1/2 the size under Medicare and a number of drugs were shifted into different tiers that determine their costs. For me it was a wash.

One other question if you have ObamaCare and travel outside your plans area how does coverage work? With the lower tier plans who the heck knows. If I’m out of area I can get reimbursed for emergency care, but I travel outside their area it can get expensive for non emergency depending on how they feel about reimbursing me.


5 posted on 12/06/2013 12:39:39 PM PST by airedale
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To: airedale

You have to pay the deductible before a doctor or hospital will treat you. So if your deductible is $5K per person, for a family of 5, insurance doesn’t kick in until you have paid your $25,000.00 deductible. But there are some things that the co-pay is waived for, check your policy. I know my son can get two check ups per year with a doctor, and girls can get loads of freebies from birth control to maternity. For the rest of us NOTHING!!!!!!!!!!!!!

and this was on facebook today...
OBAMACARE A comment posted on the Affordable Care Act/Obamacare FB page:

“I actually made it through this morning at 8:00 AM. I have a preexisting condition (Type 1 Diabetes) and my income base was 45K-55K annually. I chose tier 2 “Silver Plan” and my monthly premiums came out to $597.00 with $13,988 yearly deductible!!! There is NO POSSIBLE way that I can afford this so I “opt-out” and chose to continue along with no insurance.

I received an email tonight at 5:00 P.M. Informing me that my fine would be $4,037 and could be attached to my yearly income tax return.

Then you make it to the “REPERCUSSIONS PORTION” for “non-payment” of yearly fine.

First, your drivers license will be suspended until paid, and if you go 24 consecutive months with “Non-Payment” and you happen to be a home owner, you will have a federal tax lien placed on your home. You can agree to give your bank information so that they can easy “Automatically withdraw” your “penalties” weekly, bi-weekly or monthly! This by no means is “Free” or even “Affordable.”

Kinda sheds a lot of light on all of the arming and beefing up of arms for all of the domestic departments INCLUDING the IRS now doesn’t it? There’s a war coming folks....


6 posted on 12/06/2013 12:41:23 PM PST by buffyt (Abortion is murder. It is not a choice, it is a CHILD of GOD.)
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To: airedale

Our one and only local hospital has signs up that read “We do not accept Medicaid, if you are Medicaid patient, please make other payment arrangements before we see you” Scary! Most doctors here do not accept Medicare OR Medicaid. So buyer beware!


7 posted on 12/06/2013 12:42:55 PM PST by buffyt (Abortion is murder. It is not a choice, it is a CHILD of GOD.)
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To: Safrguns

We figure we can go in for a sex change op and while there we can get our knees and hips replaced, etc LOL


8 posted on 12/06/2013 12:43:54 PM PST by buffyt (Abortion is murder. It is not a choice, it is a CHILD of GOD.)
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To: Safrguns

Reread the history of Nazi Germany for any and all answers.


9 posted on 12/06/2013 12:45:36 PM PST by ExTexasRedhead
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To: buffyt

When in doubt, you can always sign in to a Hospice Center for an Obama/Pelosi/Reid pill.


10 posted on 12/06/2013 12:46:27 PM PST by ExTexasRedhead
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To: kingu

I know that. I wasn’t mixing them. I understand Medicare and used it as an example of how things changed when I went from private insurance to Medicare. I don’t know about Medicare’s formulary and how it differs from either normal private insurance and even Medicare. Which is why I was asking. This program is adding a ton of people to Medicare and a number of them had insurance in the private market that’s being canceled due to the legal requirements of ObamaCare. If you qualify for Medicare you can’t buy the ObamaCare plans if you go through the exchange. You have to be placed in Medicare. Those people are the ones who potentially will be getting a surprise.

We already know that the doctors and hospitals are severely limited and the best ones have opted out. It’s extremely hard to get a Medicaid doctor and like the doctor problems I suspect but don’t know that the formulary is restricted to eliminate expensive drugs. If you have a chronic condition which requires expensive drugs being forced into Medicaid can really limit your options. There have been news reports in the past about newer or expensive cancer treatments not being covered by Medicaid.

I do have outside insurance through a Senior Advantage Program, but with my carrier the formulary is the Medicare formulary as most Senior Advantage Programs do. I suppose some do cover additional drugs. Senior Advantage federal dollars were also cut by ObamaCare so some companies are cutting doctors and next year who knows what’s going to happen to that market as the lower rates kick in. FWIW at least here in California any senior who isn’t on an Advantage program is nuts unless their tax situation is really unusual.


11 posted on 12/06/2013 12:52:03 PM PST by airedale
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To: ExTexasRedhead

Yes Obama said the eldery should just take a pain pill. They actually do that in Canada, and people end up ADDICTED to pain pills for months before they have their sugery, then they have to go through withdrawl from pain pills. That won’t work on me. I am hypersensitive to pain pills and after 2 or 3 days they stop working. And no, I don’t take more. I stop taking them then. I rarely take them, only when I have had a terrible injury.


12 posted on 12/06/2013 12:52:10 PM PST by buffyt (Abortion is murder. It is not a choice, it is a CHILD of GOD.)
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To: ExTexasRedhead

But I wonder about those signs at our local hospital that read We Do Not Accept Medicaid. That is what Obamacare IS


13 posted on 12/06/2013 12:52:53 PM PST by buffyt (Abortion is murder. It is not a choice, it is a CHILD of GOD.)
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To: ExTexasRedhead

>>> Reread the history of Nazi Germany for any and all answers.

Hah!... which version?

2. Where do I find the old reliable version?


14 posted on 12/06/2013 12:53:14 PM PST by Safrguns (PM me if you like to play Minecraft!)
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To: buffyt

Your drivers license can be suspended? I assume you are in a state exchange not the feds. Can the feds do that (suspend state issued license rather than a federal issued license) or only a state? Is this a rule just in your state or in all states covered by state exchanges?


15 posted on 12/06/2013 12:54:43 PM PST by airedale
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To: buffyt

If your income qualifies you for Medicaid you have no option if you go through the exchange. If you don’t go through the exchange you don’t get subsidies.


16 posted on 12/06/2013 12:55:59 PM PST by airedale (f)
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To: buffyt

The FB post/email is not accurate & is circulating around and scaring people (my mom got it via email). About all they can do (for now) is take any tax refund you are due .... no driver’s license suspension.

Here’s a link for you:
http://www.rushlimbaugh.com/daily/2013/10/28/politico_rush_is_right_on_obamacare_tax

You might want to post it in response to the FB inaccurate post.


17 posted on 12/06/2013 1:08:30 PM PST by MissMagnolia (You see, truth always resides wherever brave men still have ammunition. I pick truth. (John Ransom))
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To: buffyt
We do not accept Medicaid, if you are Medicaid patient, please make other payment arrangements before we see you”

I sure would like to see a photo of that sign. It is illegal according to federal law. The hospital would be in violation if they accepted any other sort of payment arrangement from a Medicaid patient.

All the hospitals (4) in my area accept Medicaid patients as do the hospital-affiliated primary care clinics (where I go -- I don't have to change providers). I realize this is not the situation in all other locations.

18 posted on 12/06/2013 1:12:52 PM PST by steve86 (Some things aren't really true but you wouldn't be half surprised if they were.)
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To: airedale
If you qualify for Medicare you can’t buy the ObamaCare plans if you go through the exchange. You have to be placed in Medicare.

You are confusing Medicare and Medicaid right there.

19 posted on 12/06/2013 1:14:47 PM PST by steve86 (Some things aren't really true but you wouldn't be half surprised if they were.)
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To: buffyt

It isn’t really a $25,000 family deductible before the insurance company pays for anything other then the “freebees” It’s $5,000 per person subject to a max of about $13.5K out of pocket per person. If one person in the family goes over the $5,000 then the plan starts to pay for them. The other members are still working on their deductible. If your family gets in an auto accident and is hospitalized and each of their bills exceed $5,000 then you’re in to the co-pays until you exceed the per person max. The families that buy these lower cost plans are in for a nasty shock. That’s also why their billed costs are an issue before the deductible is satisfied. The amount changed by a hospital/doctor for services is a lot higher for those who don’t have insurance with it’s negotiated payment schedule. One doctor on TV was talking about his reimbursement rate for services on Medicaid and said the rate for a mammogram was something like $20. If the other reimbursement rates are similar (probably are because of the number of doctors and hospitals that reject Medicaid patients) you know that’s not what they bill for the same service for those who are paying cash or don’t have insurance. Now ObamaCare isn’t Medicaid but it does have it’s own reimbursement rate and with the programs stated goal of bending the cost curve down you know it’s going to be low and probably similar to Medicaid. Even Medicare has to have an annual Doc Fix to increase the payments to the doctors and hospitals to keep them from dumping seniors. But the reimbursement rates are not the same thing as what they doctor or hospital will charge you under ObamaCare until your deductible is satisfied. BTW if you are under ObamaCare and think you have been over charged by a hospital or doctor who do you get to appeal to? The law has cut the courts out of a lot of the areas covered by this law (courts only have authority to adjudicate cases in areas where Congress has given them authority. In this law the courts review was eliminated in lots of areas including the panel that sets up what services are covered and how they are reimbursed. That’s Sarah Palin’s Death Panel).

WIW the Silver Plan has a $2,500 deductible. The Gold and Platinum plans have no deductible but are more expensive.https://www.coveredca.com/coverage-basics/PDFs/standard-benfits-for-individuals.pdf Other states deductibles and programs are different.


20 posted on 12/06/2013 1:19:00 PM PST by airedale (f)
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To: steve86

If you read the sentence that’s obviously a typo, but I can see why you got confused.


21 posted on 12/06/2013 1:21:01 PM PST by airedale (f)
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To: buffyt

Hoax. That’s been around since October 1.


22 posted on 12/06/2013 1:31:35 PM PST by catnipman (Cat Nipman: Vote Republican in 2012 and only be called racist one more time!)
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