This is topic So Who Signed Up For Obamacare? in forum General Support at LymeNet Flash.


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Posted by Carmen (Member # 42391) on :
 
I didn't sign up for Obamacare. I just figured I'd pay the fine of $100. I dont have several hundred dollars to spend on a health insurance that will not cover chronic lyme nor provide for me the treatments that I believe are in my best interest.

Since we live on 1500 a month perhaps I would be elibible for medicaid, dont know. But medicaid wont provide for me what I want or need either and I resent being forced into being a ward of the state.

If you did sign up whats it costing you and will your doctor accept it for your lyme treatment? and will the insurance pay for your lyme treatment?
 
Posted by lax mom (Member # 38743) on :
 
My husband and son will have Obamacare effective 1/1. We were going to have to pay over $1000/mo in COBRA and now we will only pay $299 for insurance, not medicaid. That's a relief to our budget. I am grateful for whatever coverage it provides.
 
Posted by Lymetoo (Member # 743) on :
 
I doubt anyone will get treatment for lyme on Obamacare. They don't get it now, so why would it change?
 
Posted by lax mom (Member # 38743) on :
 
quote:
Originally posted by Lymetoo:
I doubt anyone will get treatment for lyme on Obamacare. They don't get it now, so why would it change?

Yep I agree.
 
Posted by MADDOG (Member # 18) on :
 
It totally failed me.I have Medicare so i have to pay 20 percent myself. That means on a $20,000 buck shoulder repair i would have to pay $4000.

WHO HAS $4000 bucks laying around????????

I allso have medicaid but it has a huge spend down each month. The base income for medicare in ohio is $595 a month make more than that and you have to pay medicaid what ever you get a month over that.

Obama care said that the state medicaid would be
%133 of poverty levil not half of poverty levil.

It is unless you have medicare,then YOU WERE LEFT OUT.make more in a month than $ 595 pay it to medicaid.

I am trying to get the medicaid spend down for people with Medicare raised to %133 of poverty levil.
MADDOG
 
Posted by Carmen (Member # 42391) on :
 
MADDOG,

am I understanding right with medicaid,,, if you make over $595 in income a month what ever is over that goes to medicaid? even if you have no medical bills?

How can people live?

as for the shoulder repair you might as well take a vaction to Costa Rica or Columbia and have it done. Get some ocean time in and still save money. Columbia is the least expensive. They have very good doctors there!

[ 12-28-2013, 01:01 AM: Message edited by: Carmen ]
 
Posted by Anthropologista (Member # 35483) on :
 
Don't forget about the tax credit when you buy insurance under Obamacare. If you have a low income, this credit can be substantial. The fine buys you nothing.

It's annoying to have to wait for a tax refund, but it means that Obamacare may not cost you as much as you think.

Many people do get at least some insurance coverage for Lyme treatment, and may get it more cheaply under Obamacare. I know many insurance companies deny coverage for Lyme. Those companies have blood on their hands. But it's a more complex picture than one of blanket denial.

Our insurance (Tufts POS) reimburses most of the tests & medications (oral, but still some expensive ones) that my husband's LLMD orders. And a proportion of the fee for an office visit.

Plus, people with Lyme can still get other illnesses and injuries--car accidents, falls, appendicitis, cancer. It's important to have coverage for those.

Americans die at younger ages than people in almost all other high-income countries. Infant mortality in the US is twice as high as in several European countries. That's partly because millions of people had no access to health insurance.
 
Posted by Anthropologista (Member # 35483) on :
 
Maddog--didn't see your post until I posted mine. Angry to read that you're in this position because Medicaid and Medicare haven't been properly reformed.
 
Posted by droid1226 (Member # 34930) on :
 
I'm self employed and will now have to go uninsured. My monthly premium went from 179.00 to 410.00 through UnitedHealthCare.

Absolutely crushing to me.
 
Posted by lax mom (Member # 38743) on :
 
Maddog: you may be better off getting a Medicare Advantage plan. I have a PPO. My surgeries only required a copay. Usually in the $150 range for the facility and nothing for the Dr. Then apply for Special help for Rx's.

I have had Medicare for 4 yrs due to disability and am very happy. For the past couple of years, I have had Medicare Advantage only.

Carmen: that's not how Medicaid works.
 
Posted by lax mom (Member # 38743) on :
 
droid: is your only option United?
 
Posted by lax mom (Member # 38743) on :
 
Anthropologista: I think the problem with Maddog's situation is a political situation specific to Ohio (states that turned down additional Medicaid funds for other reasons-obviously political). The losers are the Ohio residents.
 
Posted by randibear (Member # 11290) on :
 
I go on medicare in april when I turn 65 but im keeping my bc/bs low cost plan. We have tricare but I dont trust this administration not to cancel my insurance.

My husband never goes to a doctor so hes ok but I.go often and have had several surgeries.

I feel sorry for those people who got their plans cancelled. My docs are not taking new patients.
 
Posted by lpkayak (Member # 5230) on :
 
New Hampshire is like Ohio I guess it does not have Medicaidand I don't really understand this but a good friend does not make enough money to go on Obamacare she would be eligible for Medicaid but since New Hampshire doesn't have it she still has nothing

I've paid my dues teaching in a very difficult district. but it was worth it I guess even though the kids did me in at the end I do have very good insurance it didn't pay for IV but as long as I paid up front for most things I got almost all of it back 80 percent usually
 
Posted by Carmen (Member # 42391) on :
 
quote:
Originally posted by lax mom:
Carmen: that's not how Medicaid works.

Just trying to make sense out of what maddog said. How does it work?
 
Posted by lax mom (Member # 38743) on :
 
Carmen: Maddog is talking about a Medicaid "spenddown" where you take in all of your medical bills and apply after the fact, they look at your income and say you are responsible for x% and the state with pay x%.

The only situation where I know they would take all of your money except for a small bit is in the case of Medicaid and nursing homes.

Regular Medicaid pays the medical expenses and prescription costs. You just have to use the Drs who accept it.
 
Posted by Lymetoo (Member # 743) on :
 
quote:
Originally posted by Anthropologista:

Many people do get at least some insurance coverage for Lyme treatment, and may get it more cheaply under Obamacare.

-
Proof of that?? How do you know they will pay for Lyme treatment? The IDSA is still in control.

[ 09-09-2015, 07:28 PM: Message edited by: Lymetoo ]
 
Posted by Carmen (Member # 42391) on :
 
Here's a calculator to help you figure out what your premiums might be if you enrolled.
It require no personal information.

http://kff.org/interactive/subsidy-calculator/
 
Posted by soccermama (Member # 35101) on :
 
I feel very blessed. While my husband's company had to get rid of the cadillac plans due to Obamacare, they had already made all the changes by the time my husband was hired.

As a result, we are not seeing any changes or increases. As a matter of fact, they are contributing $100 more to our HSA this year.
 
Posted by MADDOG (Member # 18) on :
 
Hi Carmin
No ,only if i need the Medicaid for that month
I cant make more than $595. I can spend that amount on medical stuf or just write them a check for the spendown.

They do not get that unless i need it.

Ohio did take the Obama care Medicaid .

Obama Care forgot the disabled and Retired,that make less than %133 of poverty levil.

MADDOG
 
Posted by Carmen (Member # 42391) on :
 
MADDOG, Im so sorry, its terrible. I dont know how you manage.
 
Posted by steve1906 (Member # 16206) on :
 
This is from Maine.Gov

Pre-Existing Condition Insurance Plan
The Pre-Existing Condition Insurance Plan is a federal program to help individuals who have been uninsured for at least the past six months and who have been previously diagnosed with a serious medical condition enroll in the DirigoChoice Program.

As part of the Affordable Care Act, the Federal Government will pay for the claims of Individuals who meet these criteria if the claims exceed a certain amount. This allows DHA to cover more people.

The medical conditions that qualify enrollees for the Pre-Existing Condition Insurance Plan are:

ALS
Angina pectoris
Arthritis
Asthma/Chronic Lung Conditions
Cancer
Celiac Disease
Cerebral Palsy
Chronic Kidney Disease
Chronic Obstructive Pulmonary Disease (COPD)
Chronic Seizure Disorders
Cirrhosis of the Liver
Congestive Heart Failure
Coronary Artery Disease
Coronary Occlusion
Crohn's Disease
Cystic Fibrosis
Dementia and Alzheimer's Disease
Depression
Diabetes
Eating Disorders
Fibromyalgia
Friedreich's Ataxia
Hepatitis
HIV/AIDS
Heart Disease Requiring Open Heart Surgery
Hemophilia
Hodgkin's Disease
Huntington's Chorea
Hypertension
Juvenile Diabetes
Leukemia
Lupus
Lyme Disease
Meningitis/Encephalitis
Motor or Sensory Disorders
Multiple Sclerosis
Muscular Dystrophy
Myasthenia Gravis
Myotonia
Parkinson's Disease
Polycystic Kidney Disease
Psychotic Disorders
Quadriplegia/Paraplegia
Scleroderma
Stroke
Syringomyelia
Thrombosis
Wilson's Disease


http://www.dirigohealth.maine.gov/Pages/pre_exist.html

For more information about the Pre-Existing Condition Insurance Plan and the Affordable Care Act, please see HealthCare.gov

ALSO read this from Hearthcare.gov

https://www.healthcare.gov/what-if-i-have-a-pre-existing-health-condition/
 
Posted by Lymetoo (Member # 743) on :
 
Steve.. that does NOT mean they will pay for Lyme TREATMENT.
 
Posted by steve1906 (Member # 16206) on :
 
Lymetoo, I know,,,I just wanted to post whats out there...
 
Posted by randibear (Member # 11290) on :
 
A doctor has to recognize you as having lyme and if your doctor is not accepted by ilads and cdc then dimes to donuts they wont accept a lyme diagnosis. Remember theres no lyme in texas!!!!
 
Posted by Lymetoo (Member # 743) on :
 
Thanks, Steve. Just pointing that out. I don't want anyone to get false hope up.

You are also right, randi. (except it should say "if not accepted by the IDSA and CDC")
 
Posted by Anthropologista (Member # 35483) on :
 
Tutu, my husband has used 3 LLMDs in 3 different states (one outside NE) and has got about 80% of his Lyme treatment for each one reimbursed by our insurance. Sometimes he has to appeal. But so far--touch wood--it's been granted on appeal.

When we made contact with these doctors, we asked about insurance reimbursement. They all said that it varied from plan to plan, but that most of their patients get at least some. I spoke to the office of another LL practitioner in a 4th state we didn't end up using. Was told the same thing.

Here's a quote from the website of another LLMD in the same part of the country. Same thing again:

"Most of our patients who have health insurance plans with out-of-network benefits and who have reached their deductible are partially reimbursed by their health plans."

But I'd guess from your and Randibear's responses that coverage varies a lot from state to state.
 
Posted by Anthropologista (Member # 35483) on :
 
Droid, is the $410 per month before or after the tax credit? My stepdaughter is paying $400 per month. But by doing that she gets a tax credit of over $2,000 for the year. That makes it somewhere in the low $200s per month.

I know that not everyone can afford to wait until tax time for the refund, though.
 
Posted by map1131 (Member # 2022) on :
 
Yes, people need money week to week to pay the bills. What are people suppose to do? Tell the electric company, as soon as I get my tax refund I will pay my bill?

Washington DC, our representatives, our lawmakers need to get real. Get real about real life for folks out in the field.

We're not allowed to make posts political on lymenet, but I'm worried for our fellow Americans.

I feel each and everyone of you who are in dire situations. I'm blessed with good insurance thru my husbands employer and Medicare as secondary.

I'm not using a LLMD these last several years. What I do have to do it pay out of pocket for the type care I need for my illness. I pay for my body work/physical therapy, aka body massage.

Nothing luxury about my therapy but in state of KY they don't pay for alternative type tx unless you have cancer. Cancer patients, thank goodness are being given body work, which makes a world of difference in their healing from toxic matter.

I spend out of pocket for supps, herbs, vit more per month than my Big Pharma drugs. Josh I wish I could can BP.

Many lyme ill patients due to money issues can't afford to buy those supps, herbs etc that can be so important to our lyme ill bodies.

Many can't afford out of pocket anything!!! For this it so saddens me.

Pam
 
Posted by Tincup (Member # 5829) on :
 
It might help to see the post in Medical Section about "Codes".

Here is the link...

http://flash.lymenet.org/scripts/ultimatebb.cgi/topic/1/127375?
 
Posted by lax mom (Member # 38743) on :
 
map: I agree wholeheartedly. My family is beyond broke for that very reason. Sucks but we only have one life and I'm not giving up without a fight.

[ 12-29-2013, 03:01 PM: Message edited by: lax mom ]
 
Posted by Anthropologista (Member # 35483) on :
 
I agree too Pam--absolutely no argument with anything you say. We're blessed with good insurance too. But earlier my husband, getting sicker and sicker, had to pay more and more for less coverage, until finally they dumped him. I'm sad and angry about everything you describe.

A tax credit is inadequate as a means of making insurance more accessible. But it does exist, it may make a difference, and I wanted to make sure that people know about it.
 
Posted by lax mom (Member # 38743) on :
 
You can also get an advance premium tax credit much like the advance earned income tax credit. This will lower the premium amount each month immediately without waiting until the end of the year.

https://www.healthcare.gov/glossary/premium-tax-credit/
 
Posted by Rob_h (Member # 38104) on :
 
I just looked up the APTC, and it appears its offered at the time of the purchase of 2014 ins. via an Obamacare state or federal marketplace. So for instance for my daughter, she selected a $400 a month plan, per her income received paid to the ins company $200 of advanced tax credit, and makes $200 monthly prem. payments. I think its rare that many people will opt to pay the $400 and get a $2,000 tax refundable tax credit a year plus later.
 
Posted by Lymetoo (Member # 743) on :
 
quote:
Originally posted by Rob_h:
I think its rare that many people will opt to pay the $400 and get a $2,000 tax refundable tax credit a year plus later.

-
That's what the government was banking on.

I got a lot of my LLMD costs reimbursed many years ago. But that's because I have a good plan which covers out of network (to some extent) doctors.

I don't know what will happen when the ACA begins to affect my group plan. I think they get an extra year before they/we are affected.
 
Posted by droid1226 (Member # 34930) on :
 
Anthrop,

No, I've had over 90k in bills out of pocket. Only the initial few visits were reimbursed and then considered "unnecessary and convenient to my dr". So nothing has been covered after 30 days. I've also appealed every bill multiple times and prob spent months on the phone.

This is with a + IGM and IGM. So many people may get Lyme treatment covered but not me or anyone really I know with Lyme, with the exception of a few people I've seen on this board.

My income allows me 0.00 tax credit, but they've assured me it can't go above 6,350.00 annually, for a lesser plan than I had. Which is what I'm going to end up paying almost.

Now I can switch over to Kaiser, they will give me basically an emergency plan for around 180.00.

Since I've been sick, my only sanity is my business and trying to grow it. Im not going to do this, but it seems I could live a lot better by tossing in the towel, going on medicaid, welfare, and sign up for ACA.

I would actually do that(for survival purposes only) but that wouldn't allow me to treat myself for Lyme and cos.

I know ACA has done some good, just don't assume your situation is the way it is for everyone. It's not. It's not fair either, but neither is life so I'll shut up now.
 
Posted by lax mom (Member # 38743) on :
 
I'm so sorry droid. Even freaking Medicare pays for this crap (well, oral abx, labs and tests...I have no experience with IV abx) and your private insurance is putting you through hell. I am sorry.

[group hug]
 
Posted by Anthropologista (Member # 35483) on :
 
Droid--not what I assumed. I'm sorry it sounded like that. Your insurance experience is horrendous, and all too common.

You must be amazing. Growing a business when you have Lyme & co is herculean.

I hate health insurance companies. I hate that the ACA is a huge windfall for them. But some people will be helped from Obamacare + the tax credit. My concern is that they might think it's not even worth looking into.

People who are eligible for the Tax Credit can get it paid monthly. They can reduce their monthly insurance payments without having to wait a year (thanks for the info, Lax).

I don't know how many people get insurance coverage for Lyme & co. Far too few. All I know is that, if what the 5 LL practitioners said about their patients' insurance reimbursement is true, it could be worth exploring if you're in this part of the country.
 
Posted by map1131 (Member # 2022) on :
 
All young healthy adults that ACA was banking on those signing up for this....are not doing it. I spoke with each of my nieces and nephews over the holidays. Esp those I know didn't have health insurance.

They can't afford another bill. Their roof, electric, car and car insurance(?)food, student loans, etc take up their whole income.

They consider health insurance a luxury. These are hard working young folks in 20-30 range.

Myself I lead 2 lyme ill patients to sign up pronto. One of them was the last day of so called sign up. Both are no doubt Medicaid illegible.

That was not the plan for ACA to be successful was for more ill folks than well folks. I'm so happy that those that had no insurance can at least have coverage now.

I'm hoping one of them is going to be able to find at least one LLMD within their driving distance that takes insurance. At least Igenex will take Medicare for blood testing, which is wonderful.

I will look at the tax credit monthly and read up on reducing insurance payments. Thanks for sharing that info.

But I realized having emailed with these 2 ladies that the message had NOT gotten through to all those that are in such need.

So we need to keep this thread going for those that can get info needed so they too can get ACA insurance. It might not cover "Lyme" doctors but it will help them with other doctors and rx to get them functioning. That's my prayer.

Tincup needs to post her codes thread post within this thread to give everyone a way to go around the "lyme" merry-go-round.

Whoops just went up and seen TC did post it in this thread. Thanks TC.

Pam
 
Posted by Dekrator48 (Member # 18239) on :
 
This has been a nightmare.

I was cancelled this year and my husband is cancelled next year.

We buy our insurance privately. I do not want to go without insurance.

My premium is going up (it was $432/mo), my deductible is going from $250 to $1500, and the amount that I will be left responsible for is also higher. My benefits now include things I should not need to pay for, such as pediatric dental and maternity....ugh. The other plans I had to choose from had deductibles up to $6500 and premiums as high as $650/mo for just me.

My husband currently has an affordable private plan. He is cancelled as of the end of 2014. As of now, when he signs up later in 2014, his rate will MORE THAN DOUBLE...and who knows how much rates might go up again before then.

I did not buy a plan through the govt site for several reasons: we do not qualify for any tax credits, the site was a horrible fiasco (I tried many times to use it), and I do not want the govt having any more info about me than they already do.

Even the govt's estimator site was a fiasco. It asked if I was under 50 or 50 and over, then it gave me a quote based on either a 27 year old (if the answer as "Under 50", or the premium for a 50 year old (if answer was "50 or over").

The difference between the estimated quote and the actual premium that would be charged if a policy was purchased, could differ by HUNDREDS of dollars.

I fear that the real blow of Obamacare will come in a year or so, after insurance companies adjust their rates based on their payouts.

If not enough healthy people sign up, it could send rates up way higher than they just went up.

It does not work to provide free care for millions of people...someone has to pay for it.

Any young, healthy people who could have bought a policy before Obamacare (when rates were cheaper)and chose not to buy, are likely not going to buy one now, when the rates are higher. This will significantly impact rates in a year or so.

Some of the new plans in my area are now excluding large portions of Doctors/hospitals nearby. This is not good.

I believe there will be many negative consequences of Obamacare in the future.
 
Posted by lax mom (Member # 38743) on :
 
Is anyone happy with it? Am I the only one?
 
Posted by randibear (Member # 11290) on :
 
My two nieces and nephews said no way.
 
Posted by gmb (Member # 23562) on :
 
One of the pharmacy assistants taking my Rx refills the other day said she is not signing up and will pay the penalty rather than monthly premiums.

gmb
 
Posted by lax mom (Member # 38743) on :
 
It seems like the only way we are ever gonna get Lyme covered by insurance cos and Social Security, etc is to have a Lyme lobby.
 
Posted by randibear (Member # 11290) on :
 
Or get enough politicians to get it....
 
Posted by lax mom (Member # 38743) on :
 
quote:
Originally posted by randibear:
Or get enough politicians to get it....

Yep.
 
Posted by sickofthepain (Member # 39579) on :
 
Ironically this afternoon I got a letter from my llmd and said he will no longer be participating in any insurance. I pay cash anyway when I go, if

I have it and then go so that doesn't affect me but I fear he will be taking retirement soon because of this. I will be *)^&*%&^%^%8 when I

get more money to go back to the dr because there is no one around here. He will be an opt out physician because of medicare's legal term.No

longer taking blue cross/blue shield because of how intrusive it is becoming.I don't blame him but I just hope that he rides out the storm. What a mess.
 
Posted by randibear (Member # 11290) on :
 
Mine doesnt take any insurance either and its 150 per office visit every month or so. Sometimes ive cancelled when I didnt have it.

And several times bc/bs questioned the scripts.
 
Posted by droid1226 (Member # 34930) on :
 
Anthro. Definitely not Herculean but thank u, it sounds good. I work in web development and just had to go off on my own when I couldn't physically make it to work. Now the only difference is I lay there sick and work, haha.

I get there's good intentions but it's nudging more and more healthy people to choose not to work.
 
Posted by sickofthepain (Member # 39579) on :
 
Might be in the market for looking for another country to move to. Any suggestions?
 
Posted by Anthropologista (Member # 35483) on :
 
Anywhere with a single payer health system.
 
Posted by kam (Member # 3410) on :
 
I tried to scan through this post to see woh actually did sign up adn the results.

I know our health care system is broke. I did not realize this until I came down sick myself in 2001.

I also know getting an insurance plan will not help wtih lyme and company.

But, our health care system still needs a lot of work.

I, too, considered moving to antoehr country at one time to get the help I needed. But, then I learned that those in other coutnries are also not getting the help they need with lyme disease.

I was disappointed in the review on the news for 2013 and the subject lines.

re: health care....all that was talked about was the snafu of the programing for the computer site.

No reports on how or what the US is doing to improve our health care system.
 
Posted by Carmen (Member # 42391) on :
 
Kam, in my opinion they will do little overall to improve healthcare until they fully integrate alternative medicine and the alternative paradigm of disease.

I am outraged that they want to force me to pay for a medical paradigm that I believe causes mayhem and death, and will not pay for what I believe heals. They are attempting to strip away my constitutional rights to life liberty and the pursuit of happiness by stealing what little money I have and economically disenfranchising me from medicine that works and heals and cures.
 
Posted by Carmen (Member # 42391) on :
 
Sickofthepain, if I were seeking another country and I had money I'd go to Germany. If I had little money I'd go to India. Both have excellent health care available.

Germany does integrate alternative and conventional medicine. I've read the lyme protocol for Germany. They have a solid game plan if you want to use drugs.. if you dont want to use drugs they are also masters at oxidative therapies and herbals.

In India there are master Homeopaths as well as conventional doctors who are very smart. Acutally some of the most brilliant doctors I have worked with were from India in the conventional realm. Medicine and medical care there is very inexpensive.
 
Posted by jkmom (Member # 14004) on :
 
I have UHC and my plan does pay for Lyme. I do have to pay out of pocket but then I get reimbursed at the out of network rate (70%). All of my abx have been covered just like other meds. I have not tried IV so it is possible that is where there would be a problem.

I don't see why it would be impossible to get similar coverage on the exchange.

My LLMD puts the code for Lyme, babesia, and bartonella on the insurance form. I have been treating for 6 years, one way or another, all covered, subject to the copay.

[ 01-01-2014, 09:20 PM: Message edited by: jkmom ]
 
Posted by sickofthepain (Member # 39579) on :
 
[Smile]
 
Posted by BuffyFan (Member # 34679) on :
 
quick question, are tax credits the same as subsidies?
 
Posted by SouthPaw (Member # 35229) on :
 
lpkayak - NH does have Medicaid, they just chose not to participate in Medicaid "expansion" necessary for a state exchange. I had to put my kids on Medicaid last year, I lost my job shortly after I got my PICC and couldn't afford to put my kids on COBRA.

Medicaid "expansion" was rejected by 34 states because the fed gov will only fund that expansion for a certain number of years (I think three?) then dumps all the costs on the individual states, creating a huge financial burden (and god knows there's enough of that going around).

Not saying it's right or wrong, just clarifying NH's Medicaid situation.

Hope you're feeling better, you had some rough times last year.
 
Posted by SouthPaw (Member # 35229) on :
 
Sadly there's just no way I could afford insurance under ACA.

For a family of four the cheapest Bronze plan offered in NH costs $760/month in premiums with $11,500 deductible, copays, 20% coinsurance, and $250/$500 fees for ER visits/hospital admission. That's roughly $22,000/year and I don't qualify for subsidies. The "no more than 9.5% of income" rule is a lie.

Fortunately I was rehired when my PICC came out. The sum total of my premiums and employer contribution (we each pay 50% of premium), and deductible ($3,000) is still cheaper than that Bronze plan (approx $15,000 total).

Even the rates I was given for full coverage of my family under COBRA were cheaper, approx the same $15,000 listed above.

To make matters worse:
1) There is only one exchange provider in NH - Anthem BC/BS

2) Anthem announced it is dropping 10 of NH's 23 hospitals from coverage for exchange customers. One of our counties won't have any available hospitals at all.

3) No out of state specialty hospitals will be allowed for exchange patients. This is important because NH hospitals rely heavily on Boston's specialty hospitals......so ACA patients won't be going to Children's Hospital, Dana Farber, Shriners, etc....

4) Another aspect of ACA that went into effect two years ago was a limitation on the amount of pre-tax $$ that could be contributed to an FSA (down to $2,500), and elimination of the ability to use FSA for OTC meds.

This bill was written with good intentions but was poorly designed and implemented.

I hope some folks can benefit from it, I just haven't met anybody yet who has.
 
Posted by SouthPaw (Member # 35229) on :
 
Jkmom - I'm on UHC as well.

My LLMD doesn't take insurance so her visits are paid in cash, but UHC has never balked at paying for any of my meds or blood tests (get blood drawn every 6 weeks for the last two years). You might hit a snag if you need IV meds (i.e. PICC line), they'll most likely only pay for 28 days which is typical for insurance companies and IV meds for Lyme.

I think Lyme patients might run into trouble on the exchange for two reasons:
1) Payments to physicians will be much lower (similar to Medicaid/Medicare payments). The pool of physicians willing to take on these patients, who are willing to take insurance for Lyme, will be smaller, which will just add to the difficulty of finding a qualified LLMD who actually takes insurance.

2) Rx coverage isn't necessarily the same. Many of the exchange plans have restrictions on "authorized" meds, meaning if they determine a cheaper abx will do the job that's all they'll pay for. This is dangerous for us because LLMDs often need to try different combos of meds to find out what works best for each Lyme patient.
 
Posted by lax mom (Member # 38743) on :
 
Well my husband's first experience yesterday with insurance coverage from the exchange was a good one.

Copay for the same Dr he always had=$15.

Prescriptions for allergies, high blood pressure, Nystatin, and others covered with $100 deductible and reasonable copay.

I'm very happy with it. Plus we aren't paying $1040 Cobra. Before they raised it the cost was $740. That's devastating for middle class paycheck to paycheck folks which Obamacare clearly helps.

I see nothing but good in that.
 
Posted by lax mom (Member # 38743) on :
 
PS I truly dislike this thread. Just my 2¢
 
Posted by randibear (Member # 11290) on :
 
Hey at least its civil andpeople are not calling each other names.

Besides its good for us to know how it works.
 
Posted by lax mom (Member # 38743) on :
 
Yeah randibear you're right. I got the last Aca thread closed down. I don't wantthat to happen. I just needed to express my dislike of the topic.

I like all of you I just don't want you all to start hating me because I am on the other side of the fence with my family's experience on this topic.

I know there are people who truly hate the ACA to the core, but it has been a blessing to my family.
 
Posted by droid1226 (Member # 34930) on :
 
One thing is obvious, people hate it or love it depending on whether it helped them or not.

I really don't like it naturally cause it's costing me more money. But I'm sure it has helped a lot of people.

I think we let it all play out til the end of 2014 and make a better decision then.

As much as I dislike it, I played with the site and it's not nearly as bad as I've heard.
 
Posted by SouthPaw (Member # 35229) on :
 
lax mom - I hope you don't think I was bashing ACA. I was In dire straights for health insurance last year so researched all my options. The numbers I gave for NH were actual quotes from healthcare.gov using my login.

I'm happy you were able to benefit from ACA. My intention wasn't to make any type of political or partisan statement, I was just sharing information.
 
Posted by lax mom (Member # 38743) on :
 
No Southpaw, I don't think any one is bashing. I just wish the feelings were less love it or hate it like droid said and more middle of the road... but that's the nature of political policy.
 
Posted by map1131 (Member # 2022) on :
 
Lax, please don't take offense to the thread. As you can see it has been a blessing for many and a curse for many.

As long as we all treat each other with respect and just tell our story about what is known there is no reason to close it down.

The truth is the truth is the truth. I'm so glad for you and your family and you know that. I also feel for those that had their insurance canceled.

I see the writing on the wall. The company my husband works for is union. Indy union contract last year was changed and the company/union only pay for the employee only. Right now Humana is my primary and Medicare is secondary.

So when this happens in KY, which it will. I will be Medicare Primary and of course will need to have a supplemental policy with it.

Or however these new plans work. My mother has tried to explain to me how her and dad's BCBS policy works with Medicare. I just don't understand what she is trying to explain it to me.

But I better get an understanding of it all before the next union contract which is early 2015.

So please don't take down a very informative thread for all of us that are in different situations.

Pam
 
Posted by lpkayak (Member # 5230) on :
 
you guys understand New Hampshire doesn't have Medicaid and that makes a big difference right I don't understand it but I know makes a big difference and its a real problem here at least a problem for people I know that I thought it would help it didn't occur to me someone could not make enough money to get on but im very lucky to have good insurance

There must be other states like nh-i wonder what kind of problems they are having

I do know people who can't afford good cars and now I have to go over an hour to a doctor for a hospital that's really hard here with the long winters
 
Posted by map1131 (Member # 2022) on :
 
If my insurance co told me I had to find another PCP.....I would absolutely fall apart at the seams.

My PCP has been with me and my nightmare since day 10. I can't even fantom looking for another.

lp, here comes the big winter monster. Our system starts tomorrow. Oh my, all weather systems come thru my body.

I better start praying now. Spend the day in a detox bath all day.

Pam
 
Posted by Tincup (Member # 5829) on :
 
Randibear said.. "Hey at least its civil and people are not calling each other names."

[lol]

Had to laugh out loud at that comment! HA! Thanks for the laugh!

If it helps, I was able to help 3 people get coverage that had none and they are very happy. Cost them so very little too. And it was done in the early days when supposedly the site wasn't working!

I put in my own info more recently just to see the costs, and I'd pay about $20.00- $30.00 a month for the second best plan in their program. (Can't now remember the exact amount.) Plus I'd get meds and little co-pay for them. Low deductible too.

For the direst in straights, many with long term chronic illness who had no help at all, I am so far pleased with what I've seen and experienced.

For those having troubles, please do see the codes I've listed. If they want it called ABL (Anything But Lyme) we can certainly cooperate with their way of doing it to get treatment.
 
Posted by map1131 (Member # 2022) on :
 
I too lead 2 lyme woman to kynet.gov, which our state was one of a dozen or more that took it on at the state level. On the last week(?), supposed week of signing up.

Both were lower income and will qualify with Medicaid or very low cost Medicare/insurance company coverage.

I was totally shocked when one asked me about pre-existing condition and not being qualified? I explained hey this is a huge part of ACA, pre-existing is no longer a reason for insurance company to use.

Explained that now you will be able to get care you need. Not that a LLMD is going to be covered, because I'm not sure of which LLMD is still taking Medicare/Medicaid?

Gave her all the doctors in surrounding states not to far away. But for those that are ill, getting a PCP is the first step if they don't have one today.

Immediate care and emergency rooms should become for the ones that have an ear ache=immediate care.
For someone that just broke their leg on Saturday morning, you might need an emergency room.

A primary care doctor will become familiar with you. You can build trust and relationship, if you are lucky to find doc that you like and seems to be willing to help with your symptoms.

No, the odds of finding a PCP that is lyme literate isn't great, but you never know. You might get real lucky.

If you are having a symptom that is preventing your from functioning like some minor feelings of depression, they can take history and they very well could prescribe for you some mind anti-depressant that will make your world not so bad.

They can do thyroid tests. Remember lyme does attack many thyroids. So if your test results show low thyroid or even hyperthyroid they can do medication.

In the ideal world with this illness...you have a LLMD that you see every 3-4 mths accordingly and you have a PCP that sees you for any tests, blood work not related to lyme & co(unless they are lyme aware).

Your general healthcare needs with PCP and sometimes they even agree to do some tests that your LLMD says you need to have done. Ideally? That's the good combo. Which does happen.

Especially when you make history with one doc and not jumping all over here and there.

Like Tincup said, that list of codes is great. If your primary wants to dx you with fatigue and call it chronic fatigue. So be it. Don't fight their system, just use them to help you with non-specific lyme & company issues.

Some healthcare is better than no healthcare anyday. Some of our healthcare like supplements, vitamins, herbs, etc aren't covered by insurance. but some patients have severe Vit B12 defeicient and need high dosages of this, a doc can write you a script.

EX: Maybe get it filled at the pharmacy. If not that then use the cost of B12 as a tax deduction/write off. Doc rxed, so it's a tax deduction.

Pam
 
Posted by lax mom (Member # 38743) on :
 
quote:
Originally posted by map1131:
I'm so glad for you and your family and you know that. Pam

I know that Pam [Smile] Thank you. That's why you founded a support group...because you're so...well...supportive and caring [group hug]

Anyway, to reiterate, I never wanted this thread closed...I just wanted to express my dislike of the topic, that's all [Wink]
 
Posted by randibear (Member # 11290) on :
 
Hey I got an idea....lol...

Lets call each other names....its more fun....

I'm hardheaded, stubborn, opinionated, and of course, modest..
 
Posted by lax mom (Member # 38743) on :
 
Hey randibear! I'M stubborn!

Why don't you go lie on a beach like a clam in the polluted ocean after an oil spill who had a lobster bite its shell and got an infection and needed healthcare but didn't have it cause they forgot to sign up for Obamacare...

...or something like that...oh forget it...I'm not good at those one liners like you!!!! [Big Grin]
 
Posted by lax mom (Member # 38743) on :
 
randibear: I was referring to your post about a dead clam on a polluted beach [Wink]
 
Posted by randibear (Member # 11290) on :
 
Well shoot....

Im off to jus sit and read today. Its football on sunday. Luckily I made roast and chili last week so im good there.
 
Posted by lax mom (Member # 38743) on :
 
Yeah, it's way too cold to be outside tonight. I'm in the SE and even here it's gonna be frigidly cold. Supposed to be a windchill of -23 tomorrow night...and that's not even up north!!!
 
Posted by SouthPaw (Member # 35229) on :
 
lpkayak - NH does have Medicaid. My kids were on it last year.

http://www.dhhs.nh.gov/ombp/medicaid/

I wonder if you're confusing it with NH's decision not to participate in Medicaid expansion, which would have been necessary to set up a state level exchange.
 
Posted by kam (Member # 3410) on :
 
I had Blue Cross/Blue Shield when I was working and came down sick.

It took me 18 months to finally get a dx.

I was not able to afford Cobra.

Blue Cross/Blue Shield seemed to have their doctor's working out of a very small tool box.

I don't know if I had run into a lyme literate doctor while I still had insurance if it would have helped or not.

I do know that I was ony reimbursed $20 for the Igenex Test.

I was hoping to see more posts on people who had actually needed the ACA and how things went for them when they signed up.

I know many in the small town I lived in were small business owners and were not able to afford insurance for their families back in 2001 when I first started learning a bit more about health care due to my health going south big time.

Since I no longer live in that town, I don't know if they were helped or not by ACA.

I also knew others who were not able to get insurance due to a pr existing condition

A concern I had when my health went south. At that time, I thought it was tempary and I would be back to work.

Typing with eyes closed , laing in bed.

There is buzz here at the apartment complex I live in for senior citizens and the disabled about changes in insurance.

There was a meeting a while back on the subject and another on Thursday by someone else.

Best I can figure thees people are in business to help peole decide what insurance plans to get and what things they can get help with.

I have sent emails to both businesses.

They did help me to know that I should be covered with prescription needs at a time when I thought I wasn't covered and had paid out of pocket.

The pharmacy re imbursed me thankfully...pharmacy was also going thru new ownership with new help so things got a bit confusing for a while then pharmacy closed down.

I am still confused about it all. If health was doing well enough I would go to the meeting but health is not doing well enough.

I am concerned about coming up with the funds needed that medicare doesn't pay for and would like a second insruance.

But, since the people I contacted have not replied to my emails I assume it is because I don't have the insomce to pay out of pocket for a second insurance.

OK need to stop. This is making my brain worse.
 
Posted by kam (Member # 3410) on :
 
Another thing I learned when I moved from CA to AZ is that I was getting 40 hours a week with caregiver service whiel living in CA.

When I moved to AZ, I was given 4 hours a month caregiver service.

I thought they would be the same in both states. Wrong.

Income went down to $500 a month to when I moved across state lines.

I don't recall what it was in CA.

I know this topic is supposed to be on ACA but it has opened the window to health coverage in general.
 
Posted by kam (Member # 3410) on :
 
There is a post on another web site from a lady who wants to move from the San Diego area in CA as she is not getting the caregiver help needed.

She doesn't have lyme disease. I think she has a form of CP.

Another condition that varies a lot

She wanted to know which states were more helpful and provide more caregiver services.
 
Posted by lpkayak (Member # 5230) on :
 
Not nh

I m pretty sure the aca will help with basic health care but not lyme. Around here the new tx for a tickbite is one doxy one time. And if you dont have. A bullseye you have to fight for that

If you break an arm youre all set. And probably a minimal ckup once a year. They will probably happily give you statins and steroids and psyc meds.

There is value in getting the basics...but really. If we have to fight so hard for tx it will not become the norm soon

Again...there is value-if your gall bladder goes or your thyroid tests low youll probably get tx. Not armour-synthroid...

Kam i think you are smart to research what states give more basic help...but moving to an area where there is an llmd is risky. It would cost a lot of time an energy and you could not count on the llmd staying in business unless it is one that is really expensive cash only. Also the tx they prescribe are not covered

I do think you should look for a better place for general care...but lyme care is a wild card

I have no first hand experience with any of this but have seen things happen-both good and bad to ppl i know

[ 01-09-2014, 09:36 AM: Message edited by: lpkayak ]
 
Posted by nefferdun (Member # 20157) on :
 
Stir things up randibear!

I got medicare a couple of years ago. It hasn't covered any lyme treatment yet except the tests the infectious disease doctor did, which were pretty useless.

What it DOES cover though is a therapist! I mean the mental emotional kind. This can drive you nuts and when you add in the trauma of life itself, it helps to have someone else on your side.

SO maybe if you all get Obamacare and go to therapists, it will be so expensive they will see that just paying our doctors bills is a cheaper alternative.
 
Posted by Lymetoo (Member # 743) on :
 
quote:
Originally posted by nefferdun:


SO maybe if you all get Obamacare and go to therapists, it will be so expensive they will see that just paying our doctors bills is a cheaper alternative.

-
Good point!
 


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