If you have "no place to go," come here!

Do the Math

connecticut man1's picture

Susie Madrak at C&L suggests you do the math:

The bill provides financial assistance on a sliding scale. Premiums range from 1.5 percent of income to 12% for those at 400% of the Federal Poverty Level. The plan provides additional assistance for households up to 400% of the FPL by limiting cost-sharing to 3% of plan costs at the lowest tier, to 30% of plan costs at 350-400% of the FPL.

For instance: If your income is under 133-150% of the poverty level, your premiums will be limited to a range of 1.5 to 3%. That means you'll pay 3% of plan costs, with an annual out-of-pocket cap of $500 for individuals and $1000 for families.

And so on:

150-200% - 3-5.5% - 7% - $1000/$2000

200-250% - 5.5-8% - 15% - $2000/$4000

250-300% - 8-10% - 22% - $4000/$8000

300-350% - 10-11% - 28% - $4500/$9000

350-400% - 11-12% - 30% - $5000/$10,000

The Federal Poverty Level is:

Persons in family

1 $10,830

2 14,570

3 18,310

4 22,050

5 25,790

6 29,530

7 33,270

8 37,010

For families with more than 8 persons, add $3,740 for each additional person.

So although I've been on unemployment for the past year, I would be expected to pay approximately $4000 a year. Huh? Your individual mileage may vary, but those figures aren't very reassuring to me.

Do the math, and let me know if you think this is affordable.

Go ahead and figure it out for yourselves. Is this making healthcare more affordable for you?

No votes yet


DCblogger's picture
Submitted by DCblogger on

so good to see you back at the Mighty Corrente Building with your outstanding posts.

connecticut man1's picture
Submitted by connecticut man1 on

I just don't post when you all have it covered already. Right now is crunch time; we don't have time to waste; and I really don't like what I see in the bills so far. If they don't make the public option a lot better than this I can't see supporting the charade.

I am still waiting for PNHP and other sources to weigh in on HR 3962 before I make a final judgment on where I stand.

Submitted by hipparchia on

that what i've been thinking too. also that for once i'm happy to have an ultra-republican congresscritter.

Submitted by hipparchia on

i would volunteer to come to dc and help with that filibuster.

Submitted by lambert on

I'm seeing a lot of talking points at OL, but I'm not seeing any detail or data or cites.

Only to be expected, of course.

Submitted by hipparchia on

correnteans are ahead of the curve in math.

a family of 4 at 150% fpl would pay $1571/year [$131/mo] for everything -- no copays, no deductibles, no out-of-pocket, no out-of-network to worry about. if you lost your income entirely you'd pay $0 until you got back on your feet and earning money again, and no matter what, you could always take your child [or yourself] to the doctor if they got sick.

also, the final bill keeps what looks to be a possible loophole on that "cap" on out of pocket spending:

(4) COST-SHARING.—The term ‘‘cost-sharing’’ includes deductibles, coinsurance, copayments, and similar charges, but does not include premiums, balance billing amounts for non-network providers, or spending for non-covered services.

connecticut man1's picture
Submitted by connecticut man1 on

That just sounds like they are trying to force providers into the exchanges (because, theoretically, that would force them to cover more things, end rescission, etc.) by withholding "cost sharing" from those that don't join in AND they won't pay for stuff like plastic surgery 'n other stuff.

That seems like a relatively smart definition if I am reading that right. Would have to see it used in context in the bill.

Submitted by hipparchia on

NOT in medicare for all.

insurance companies control their spending in part by contracting with doctors, hospitals, etc -- we'll promise you __ hundred [or thousand or million] customers if you'll only charge us $xx for a dr visit [or hospital stay or ...]. kind of a volume discount thing.

all the drs and hospitals that sign that contract for that year are 'in network' for you if you buy that insurance plan that year. if you need a certain kind of specialist and the insurance company wasn't able to contract with any specialists of that kind, you have to go 'out of network' to see a specialist. the insurance company may agree to pay the specialist what they expect they would have paid any other such specialist if they'd gotten a contract with one, but the specialist is then free to bill you for whatever extra it takes to make up his fee [that's what "balance billing" is].

this difference can be huge, and it won't count toward your capped out-of-pocket expenses.

the theory is that you won't need to see a doctor out of network [there's stuff in the bill about the hhs sec making sure provider 'networks' are 'adequate'] and therefore if you go out of network it's only because you're greedy [or your dr is greedy and knows you won't defect to an in-network dr]. anybody who would do that deserves to pay more! right?

in practice, of course, networks do not always have specialists [and it's usually specialists] of every conceivable kind that might be needed in every locality. what also happens irl is that insurance companies don't always contract with the same set of drs every year, or in other cases, employers don't always contract with the same insurance companies every year. you could conceivably start your cancer treatment, say, with one dr, and halfway through have to switch drs [or decide to stick with your same dr for the duration of treatment and pay the difference].

Submitted by lambert on

it's an another artificial complexity introduced to allow the insurance companies to hide higher fees.

Submitted by hipparchia on

from the insurance company [and the taxpayer] to you, and insurance companies have been doing this for, like, ever.

but look on the bright side, this way neither the insurance company nor the taxpayer [if you are getting a subsidy] has to pay for various health care services you might need.