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Wow, Pre-Existing Claims

Tuesday, November 22, 2016 12:08
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With 2017′s Open Enrollment in full swing, lots of folks are calling in for quotes and explanations, hoping to get their coverage in place for January 1. By now most of us know that, for better or worse (but mostly worse) ObamaPlans cover pre-existing conditions. This means that if one has, say, asthma, the new plan will cover it right away.

Some people, though, are less clear on the subject.

For example, 29 year old Megan Tice-Royea, is a grocery store manager in Newport, Vermont. Last year, she she decided she couldn’t afford health insurance, despite making what appears to be enough to qualify for a healthy subsidy (or just buying a Cat Plan).

Which was a fine, rational decision, until it wasn’t:

In September, she was admitted to the hospital with a gallbladder infection. The surgery left her $32,000 in debt.”


Now let’s rewind the tape a bit, and take a look at “what might have been:”

Megan’s 29, makes $14 an hour, and we’ll assume that she doesn’t smoke. Had she taken (literally – I timed it) 3 minutes, she could have visited her state’s Exchange, where she would have learned that she qualified for a $347 per month subsidy, and then purchased a Bronze level plan for less than $60 a month (that’s about $2 a day).

[ed: all rates and plans based on 2017 Exchange info, YMMV]

Her maximum out-of-pocket (including deductible) would have been $7,150 plus the $720 in premiums, meaning that the $32,000 claim would have cost her less than eight grand (about 25% of the actual bill).

Expensive 3 minutes.

[Hat Tip: FoIB Dr Dino]

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