Ask Lemmy

You may have heard about "Obamacare" or the "Affordable Care Act". This did a lot of things which helped some but also did not do much.

For example, insurance premiums can cost hundreds of dollars per month, but if you get subsidies you can reduce that cost down to, potentially, zero. Unfortunately these subsidies are in the form of tax credits, which means if you don't work you do not get any subsidies.

Additionally, if you happen to live in a red state, then your state probably didn't expand Medicaid. Medicaid is the government insurance for poor people. If your state didn't expand it, then your state only gives Medicaid to families and disabled people (basically). So if you don't have kids, you don't qualify for it.

For me, this means that when I stopped working and got insurance through the ACA, I had to pay $500 per month in health insurance premiums (dental and vision are separate insurance plans and not typically covered in standard health insurance). Did I mention this was while I wasn't working?

With that $500 per month, I still had a $900 deductible (so I had to pay $900 before the insurance company would pay anything). After that $900, my insurance company paid different rates depending on the service (often called coinsurance). A common percentage is 80/20, which means insurance will pay 80% and you will pay 20%. So hospital bills tend to be thousands of dollars. BUT insurance plans also have what's called an "out of pocket max" which means your insurance will cover services at 100%. So any medical things you do after that magic number are basically free for you (you still have to pay the premium).

Ok, but you might have also heard that elderly folks have their own government insurance - called Medicare. Medicare is also available for disabled people like me.

Medicare is confusing AF. It has multiple parts to it - I will only talk about what's called "traditional Medicare", which basically means everything is between you and the government (There's other Medicare plans through private insurance companies, and those plans are similar to what I described above).

So with traditional Medicare there's Part A (hospital), Part B (basically outpatient services), and Part D (prescriptions). Part A is free for most people, part B currently costs about $75 per month, and part D varies but is much like the private insurance above. If you only have part A, then only hospital visits will be covered. If you only have A and B, then none of your medications will be covered! It sucks.

So remember how I said about the deductibles and coinsurance? So Medicare has their deductibles and coinsurance separate for each part! For my part A, if I go to the hospital, it comes out to about $1300 per DAY, but only for short hospital stays. Oh and that's only for room and board. Longer hospital stays have different rates. Also, if you stay in the hospital too long, it starts going against your lifetime hospital days. That's right, if you use up all your lifetime hospital days, then Medicare will just...not cover your hospitalization anymore. Ever. For the rest of your life!

And don't forget you still have to pay extra for any imaging, medications, and doctor visits you had while in the hospital because the daily rate is basically for the bed.

Part B is a straight 80/20 coinsurance. But part B also doesn't have an out of pocket maximum. So if you have a lot of outpatient procedures, then you will end up paying out the nose for it. Currently I basically just end up paying around $30 for each doctor's appointment (not including lab work or any procedures).

Part D depends on what plan you get. Mine was basically 80/20, which means I was going to have to pay outrageous amounts for medications! I'm on like 25 medications and it was going to be hundreds of dollars each month just for the prescriptions. Luckily, we have programs like GoodRx! Which is basically a coupon but for medications. Unfortunately, you can't use insurance if you use GoodRx. Also, the pharmacy won't usually automatically compare the prices to see which method would come out cheaper for the patient. Oh, also, each pharmacy has a different price for the same medication! I'm not even talking a few dollars. Some medications can be hundreds of dollars different in pricing depending on which pharmacy you go to! And it's not consistent either. So basically if you're on Medicare you get to go on GoodRx every month for each prescription and see where you can get it the cheapest at and then either ask your doc to send it there or try to get it transferred. Imagine doing that with 25 prescriptions every single month!

Luckily for me, I qualify for what's called "Extra Help." This program pays for my Part B premium ($75) as well as part of my part D premium (it was about $100 but with the help it's down to $75). They also bring all my prescription costs to $1.55 per medication per month. Unless it's a brand name medication.... 😬

If you're following, when I had private insurance I was paying $500 per month in premiums alone, plus about $50-100 per month in doctor's visits, plus about $50-100 per month in prescriptions until I met my out of pocket maximum. Then just the premium.

Nowadays, I have Medicare + Extra Help. So I pay $75 per month for my prescription premiums, plus currently about $200/month in doctor's visits, plus about $50/month in prescriptions. So it comes out cheaper currently but if I have to go to the hospital again....well, I'm fucked.

By the way, most insurance plans do not have out of network coverage...so if you go somewhere that doesn't have a contract with your insurance company then you will probably have to foot the bill. And a lot of the charity programs that hospitals and doctors have won't let you apply if you have insurance soooooooooooo....

A few years ago, I went to a treatment center for a few months. My total bill was almost $200,000. My personal portion was supposed to be around $15,000. Did I mention I wasn't working? Right. Luckily the treatment center enjoys the tax benefits they get when they write off people's bills, because they wrote mine off. I still had to file for bankruptcy though, because that wasn't my only medical bill.

PS insurance is often provided by your job here so if you lose your job you, at maximum, have until the end of the month with your insurance :) so don't quit your job at the end of the month ;) there is a thing called COBRA which is supposed to bridge the gap between jobs, but it's usually something ridiculously expensive like $700 per month for a single person's premium (yeah, you have to pay more premiums if you want your spouse and/or kids to be covered).