Healthcare.gov for US citizens

[Ironhold]

60% of my monthly pay is going to a trash fire of a "Bronze" policy so bad that I had to shell out $2200 for a mere kidney stone. 

This policy is being eliminated, and my only alternatives had *higher* premiums and *higher* deductibles for less care. 

Yeah - the "Affordable" Care Act is bankrupting me. 

[anatess2]

On 11/11/2017 at 6:22 PM, JohnsonJones said:

Where did she go where there is not socialized medicine and they actually pay even half as well as the US. 

Several doctors from the US are in the Philippines.  My brother was supposed to do his residency in Georgia, but he flew back home instead.  Back in the late 60's, early 70's the US was hiring immigrant doctors left and right.  I have several uncles that moved to the US because of it.  The past couple decades, Filipino doctors were avoiding the US or if they really wanted to stay in the US, they abandoned their physician career and became nurse practitioners.

[JohnsonJones]

3 hours ago, anatess2 said:

Several doctors from the US are in the Philippines.  My brother was supposed to do his residency in Georgia, but he flew back home instead.  Back in the late 60's, early 70's the US was hiring immigrant doctors left and right.  I have several uncles that moved to the US because of it.  The past couple decades, Filipino doctors were avoiding the US or if they really wanted to stay in the US, they abandoned their physician career and became nurse practitioners.

Interesting...so I did a little research on this.

According to here the average salary of a Physician or Doctor in the Philippines is around  591,795 PHP, which I think means Philippine pesos.

The Median is 479, 323 pesos.

Sounded great at first, but then I went to see what the exchange rate for a Philippine Peso to the dollar was.  It was .02 which isn't a whole lot.

I used the google monetary converter to figure out the amounts they currently translate into USD.

Did a conversion, you make a little less than 9,000 USD per year with the median and 11,552.18 USD per year at the average.

It said they can make up to 1,189,905 Pesos which I ran through the calculator as well to get 23,227.64

I got the information from here...

Doctor Payscale in the Philippines

I think I might be missing something, because even teachers in poorly paying areas make more in the US than Doctors in the Phillipines from that research.  I'm not an expert, need you to fill in the blanks for me on this one.

From what I understand, those who practice medicine in the Philippines don't do it to get rich, but to help others.  Nevertheless, I must be missing something in regards to pay if they are going to get half as much in the Philippines as the US...but my research skills are lacking on this one to find this answer. 

Help would be good on this for me.

 

Edited November 13, 2017 by JohnsonJones

[Grunt]

56 minutes ago, JohnsonJones said:

Interesting...so I did a little research on this.

According to here the average salary of a Physician or Doctor in the Philippines is around  591,795 PHP, which I think means Philippine pesos.

The Median is 479, 323 pesos.

Sounded great at first, but then I went to see what the exchange rate for a Philippine Peso to the dollar was.  It was .02 which isn't a whole lot.

I used the google monetary converter to figure out the amounts they currently translate into USD.

Did a conversion, you make a little less than 9,000 USD per year with the median and 11,552.18 USD per year at the average.

It said they can make up to 1,189,905 Pesos which I ran through the calculator as well to get 23,227.64

I got the information from here...

Doctor Payscale in the Philippines

I think I might be missing something, because even teachers in poorly paying areas make more in the US than Doctors in the Phillipines from that research.  I'm not an expert, need you to fill in the blanks for me on this one.

From what I understand, those who practice medicine in the Philippines don't do it to get rich, but to help others.  Nevertheless, I must be missing something in regards to pay if they are going to get half as much in the Philippines as the US...but my research skills are lacking on this one to find this answer. 

Help would be good on this for me.

 

You’re comparing Philippine wages to the US economy.  To be accurate, you would have to compare the salary to Philippine teachers, who seem to average just over 220,000 PHP annually, or less than half what a dr makes.  

[JohnsonJones]

7 minutes ago, Grunt said:

You’re comparing Philippine wages to the US economy.  To be accurate, you would have to compare the salary to Philippine teachers, who seem to average just over 220,000 PHP annually, or less than half what a dr makes.  

I'm taking the slant that a US doctor would leave practice in the US to practice medicine in another nation.  As far as I know it, most other nations do not pay half as well as what a doctor in the US could make doing the same thing, and those that do in many instances are under the same ideas of the US (uniform healthcare for the poor) or Socialized medicine (Like the Netherlands or Sweden or Germany).

However, I am open that there are nations that may be out there that US doctors would go to that pay as well, and based upon an earlier comment made in this thread, I'm trying to find the research that show that a US doctor that goes to the Philippines can do as well there, or at least half as well monetarily as they do in the US. 

I did not find it on my initial foray into it (and it indicated that this was an incorrect assumption on my part), but basing it upon what was indicated, I'm trying to find it.  I haven't been able to yet, but I am trusting that there may be information regarding that out there.

PS: On the otherhand, if the costs and prices are any indication from what I've seen, the Philippines could actually be a place I could retire to...finally.  I wasn't the wisest investor in my youth, and hence I still have to keep up the job I have now, lest I end up in the poor house in the US.  However, it may be that I could live somewhat comfortably in the Philippines, which is an interesting thing I'm tossing up in my head right now.  It may be very nice to actually finally retire.

Edited November 13, 2017 by JohnsonJones

[Sunday21]

@JohnsonJones. The Philippines has 3 temples! Either constructed or planned.

[Fether]

On 11/11/2017 at 5:48 PM, Ironhold said:

60% of my monthly pay is going to a trash fire of a "Bronze" policy so bad that I had to shell out $2200 for a mere kidney stone. 

This policy is being eliminated, and my only alternatives had *higher* premiums and *higher* deductibles for less care. 

Yeah - the "Affordable" Care Act is bankrupting me. 

My wife had to get 2 tests done and I had one. In a Weird exchange of events we would be paying $2100 for the tests WITH insurance and $1600 WITHOUT. I ended up not getting my test done and just paid for my wife’s.

[anatess2]

3 hours ago, JohnsonJones said:

I'm taking the slant that a US doctor would leave practice in the US to practice medicine in another nation.  As far as I know it, most other nations do not pay half as well as what a doctor in the US could make doing the same thing, and those that do in many instances are under the same ideas of the US (uniform healthcare for the poor) or Socialized medicine (Like the Netherlands or Sweden or Germany).

However, I am open that there are nations that may be out there that US doctors would go to that pay as well, and based upon an earlier comment made in this thread, I'm trying to find the research that show that a US doctor that goes to the Philippines can do as well there, or at least half as well monetarily as they do in the US. 

I did not find it on my initial foray into it (and it indicated that this was an incorrect assumption on my part), but basing it upon what was indicated, I'm trying to find it.  I haven't been able to yet, but I am trusting that there may be information regarding that out there.

PS: On the otherhand, if the costs and prices are any indication from what I've seen, the Philippines could actually be a place I could retire to...finally.  I wasn't the wisest investor in my youth, and hence I still have to keep up the job I have now, lest I end up in the poor house in the US.  However, it may be that I could live somewhat comfortably in the Philippines, which is an interesting thing I'm tossing up in my head right now.  It may be very nice to actually finally retire.

This is silly.

A programmer in California makes twice that of a programmer in Florida.  I live in Florida because... programmer's wages goes a lot farther in Florida than in California.  Surely you understand that concept?  The differences is taxes alone almost offsets the difference in pay.

My brother, who is a neurologist, makes half my Florida programmer's pay, maybe even less comparing dollar to dollar.  His wife is a pediatrician making less than he does.  He has a 7 bedroom/5 bathroom house, 4 maids, a driver, and a private security guard manning his house's gate.  He paid off his house a few years ago.  A neurologist in Florida would need the first $100K of his pay to go to malpractice insurance.  No such thing in the Philippines.  

There's a lot of retired US Military people living in the Philippines too.  Several of them are my brother's patients who got tired of waiting for the VA.  

In any case, you can't compare economies across 2 very diverse countries dollar for dollar.  A Big Mac in the Philippines costs more than a professional haircut.  If you want to live in the Philippines and not run out of money in a week, you need to learn to live the Filipino way.  For example, if you think A/C is a necessity instead of a luxury, you can't live in the Philippines.

Edited November 13, 2017 by anatess2

[NeedleinA]

23 minutes ago, Fether said:

 $2100 for the tests WITH insurance and $1600 WITHOUT

This is what I've always seen play out, both before the ACA and after it.
Hospitals and Doctors are in business, more often than not they are going to charge as much as they think they can get out of whomever is actually footing the bill.
In my observations, a person paying directly outside of insurance will usually be charged less, since a person paying out of pocket is more likely to monitor/care about their money than a person who simply says, "Just bill my insurance".

[Guest]

For my family:

Premiums through work:  $900/mo.

Obamacare penalty: $175/mo.

Bonus from work for NOT accepting health insurance through work: $1200/yr.

Medical expenses that would have been covered by insurance:  $200/yr.

Do the math:  I'm almost $10,000/yr better off by NOT getting insurance.

What if something catastrophic happens?  If it weren't for Obamacare, this may have been a good argument in certain rare instances.  But thanks to Obamacare, this simply isn't a good argument anymore.

[NeuroTypical]

On 11/11/2017 at 3:47 PM, a mustard seed said:

So, what now? We'll get a penalty in taxes this year if we don't have health insurance? I didn't have any for most of 2015 and didn't have any for any of 2016...or 2017.

If you had no insurance in 2016, and didn't have any of the exclusions or exemptions, you should have paid a penalty when you did your taxes in 2017. As much as $695 per uninsured person.

And if it's the same situation for 2017, you might have a higher penalty.

https://www.healthcare.gov/fees/fee-for-not-being-covered/

[NeuroTypical]

On 11/11/2017 at 4:22 PM, JohnsonJones said:

I've heard doctors grumble about the ACA, but the only ones that I know actually decided to stop practice in the US were those who were actually around retirement anyways, or close enough to be able to retire and stop their practice. 

Any idea where the pediatric surgeon went?  Or what happened to Her? 

Well, now you know of a young doctor (I'm guessing 30's or early 40's) who did it. 

I have no clue where she went.  Her office staff didn't either, and they seemed rather flustered that I kept asking.  The office person finally told me "we can't tell you where she went because we don't know ourselves."

[NeedleinA]

48 minutes ago, Carborendum said:

What if something catastrophic happens?

Curious Carb, what is your plan if something catastrophic happens? I ask in all sincerity.

[anatess2]

41 minutes ago, NeedleinA said:

This is what I've always seen play out, both before the ACA and after it.
Hospitals and Doctors are in business, more often than not they are going to charge as much as they think they can get out of whomever is actually footing the bill.
In my observations, a person paying directly outside of insurance will usually be charged less, since a person paying out of pocket is more likely to monitor/care about their money than a person who simply says, "Just bill my insurance".

Before ACA, when I had my "hospital and surgical only" coverage, I would shop around for the procedure/lab that offered the least price.  For example, I would get a blood test for a well-check.  Any reputable lab is just as good as another because they don't interpret the results, the doctor does.  So, I would shop around for the place that gives me a good quote.  I would walk into the front office of the lab and ask for a price quote for this order code that the doctor wrote on the script.  I get blank stares.  I have to go talk to the lady in the back corner office somewhere who is in charge of billing the insurance guys.  So, they end up quoting me what the insurance pays them.  So I negotiated down from there pointing out how they don't have to file paperwork to the insurance for me, etc. etc.  It was hard work because most of the labs I talked to don't know how to deal with self-pay or didn't deal with self-pay  all.

My  GYN is the best.  He knows I'm self-pay so he writes me up a plan for the year on what he thinks I need to get done at the bare minimum and works with me on a price.  I get it done and his office bills me.  Easy peasy.  The holistic pediatrician is the same.  She's used to people doing self-pay because she used to not be listed in any network because of her holistic practice that the insurance doesn't want to cover.

[NeedleinA]

2 minutes ago, anatess2 said:

Before ACA, when I had my "hospital and surgical only" coverage, I would shop around for the procedure/lab that offered the least price.  For example, I would get a blood test for a well-check.  Any reputable lab is just as good as another because they don't interpret the results, the doctor does.  So, I would shop around for the place that gives me a good quote.  I would walk into the front office of the lab and ask for a price quote for this order code that the doctor wrote on the script.  I get blank stares.  I have to go talk to the lady in the back corner office somewhere who is in charge of billing the insurance guys.  So, they end up quoting me what the insurance pays them.  So I negotiated down from there pointing out how they don't have to file paperwork to the insurance for me, etc. etc.  It was hard work because most of the labs I talked to don't know how to deal with self-pay or didn't deal with self-pay  all.

My  GYN is the best.  He knows I'm self-pay so he writes me up a plan for the year on what he thinks I need to get done at the bare minimum and works with me on a price.  I get it done and his office bills me.  Easy peasy.  The holistic pediatrician is the same.  She's used to people doing self-pay because she used to not be listed in any network because of her holistic practice that the insurance doesn't want to cover.

Yep, exactly what I'm talking about.

[anatess2]

1 minute ago, NeedleinA said:

Yep, exactly what I'm talking about.

Oh, and let's not forget the most important thing.  The Gyn and the pediatrician actually thinks about what THEY think we need and not what the insurance says we need.

[NeedleinA]

3 minutes ago, anatess2 said:

THEY think we need and not what the insurance says we need.

Correct.
We had a child with insurance - bill to insurance 26k ish.
We had a child without insurance (per-existing condition when we changed companies), same hospital, same c-section, same doctors, our negotiated cost: $7,500

[NeedleinA]

Honestly, this thread has been an eye opener to me as I would have assumed the odd man out would have been the person who didn't have health insurance, but I feel I'm seeing the opposite play out? To get it or not get it, sounds like each side is gambling with what they think is best, but either way you look at it, it is a gamble.

I can't help it, but I'm having thoughts of food storage and the whole concept of why we are counseled to have it keep coming to mind.
I could save a bunch of money/space/time/effort by not having it, so then why are we told to have it?

I'm not a supporter of the ACA, I'm just a person trying to deal with the situation as it has been forced upon us all (in the US). I could go 5 years not paying for insurance and save $50k, but on the 6th year have have a catastrophic $300k event happen and instantly put me out $250,000 ($300k - $50 I saved).

Am I missing the math here?

Edited November 13, 2017 by NeedleinA

[omegaseamaster75]

......

Edited November 13, 2017 by omegaseamaster75

[anatess2]

1 hour ago, NeedleinA said:

Honestly, this thread has been an eye opener to me as I would have assumed the odd man out would have been the person who didn't have health insurance, but I feel I'm seeing the opposite play out? To get it or not get it, sounds like each side is gambling with what they think is best, but either way you look at it, it is a gamble.

I can't help it, but I'm having thoughts of food storage and the whole concept of why we are counseled to have it keep coming to mind.
I could save a bunch of money/space/time/effort by not having it, so then why are we told to have it?

I'm not a supporter of the ACA, I'm just a person trying to deal with the situation as it has been forced upon us all (in the US). I could go 5 years not paying for insurance and save $50k, but on the 6th year have have a catastrophic $300k event happen and instantly put me out $250,000 ($300k - $50 I saved).

Am I missing the math here?

My father went through 4 years of chemo-therapy for stage IV lung cancer.  No insurance.  The Family pitched in to get him treated.  He refused treatment at first because he said he is ready to go.  We told him we're not ready for him to go.  So we flew him to Texas to get into this clinical trial for Avastin.  Saved us a ton of money.  He begged to go home but the treatment was working - 3 years out of a 6-month-max life estimate with no indication that it was going to change for the worst so we tried to keep him in Texas and we continued to pool the Family's resources.   Finally he screamed at my sister, "You're making me a prisoner!" and he went on a hunger strike.  So we took him out of the trial to the dismay of all his doctors who begged us to let him stay and promised us all kinds of waivers for everything.  We sent him home and our costs skyrocketed but we persevered, family contributions from the extended family joined our resources and a year later he passed away. 

In any case, A STRONG FAMILY CLAN mitigates the risk of catastrophic events and things like welfare.  Out of my dad's many siblings, 4 have cancer.  2 became cancer-free after treatment, 2 died.  None of them have insurance.  The Family is the insurance.  

Interestingly, after my dad passed away and we started dealing with the aftermath, we found out he was a multi-millionaire.  He could've afforded his own care but it didn't even cross our minds that he could.  We just automatically pitched in.  My mom knew my dad has all kinds of businesses but she didn't even think they were worth anything.  She was happily living modestly and comfortably.  So we asked her what she wants to do with the money.  She said it's up to us kids because she doesn't need it.  We decided to keep the money invested for if mom needs catastrophic treatment.  If the money is still there when my mom passes, it's probably going to stay invested until one of us kids ends up in the poor house somehow.

So, in summary:

1. Strong Families is the answer to most everything.

2. Try to make as much honest money as you possibly can and live modestly so you can afford your own (or your family's) catastrophe.  Money doesn't make you evil.  You're the only one that can make you evil.

 

Edited November 13, 2017 by anatess2

[Guest]

2 hours ago, NeedleinA said:

Curious Carb, what is your plan if something catastrophic happens? I ask in all sincerity.

Two things:

1) I did have something catastrophic happen to me over ten years ago.  I went to the hospital's billing department and told them in all sincerity that there was no way I could afford this.  Is there any way we can work something out?  To pay a small amount per month wasn't even an option because we'd be talking about ten to fifteen years to pay it off.  And if they put too much pressure on me I will simply have to default because I simply can't pay it.  (So, I just wouldn't get any loans for the next seven years for my credit report to recover).  But if they could work out a deal, I would be willing to pay them as much as I could reasonably pay for.  They asked me how much I had.  I told them.  They said if they could get that much in the next two months, I'd be clear with them.  They thought, better a little than nothing.  We made a deal.

At that time, a short term thing like this event was able to be addressed in this manner.  But we still had the specter of the chronic illness over our heads.  That is just a matter of playing the odds.  Our age.  Our health record. Family history.  etc.  It's a gamble.  We took that gamble, and we've been winning so far.

2) Today, there is no reason to buy insurance.  The ACA specifically disallows denial of coverage for pre-existing conditions.  Now, there is no specter.  If it ever happens, we'll have to deal with it for 6 months to a year on our own.  Then we sign up for Obamacare or my job and PRESTO! I'm taken care of with the quality of the VA medical center .

Bottom line is that everything is a gamble.  And if I'm saving somewhere around $10,000/year because of my chosen route, then I can probably pay for much of what I need on my own.  If I find that we're having hospitalizations twice a year for all my family, then I'll find that money is drained pretty fast and insurance would make sense.  But as it is, I just have two to three years of savings and I will probably be able to pay for most things myself for one year.  Then we just do our best to stay safe and healthy.

I'm not necessarily saying this is the best route for everyone.  But for our family, the numbers we are dealing with, this made sense for us.  It's all about the numbers.

Incidentally, Mrs. Carb had a miscarriage some months ago.  We went to the hospital and received four different bills all of which totaled about $8,000 (it would have been more if I hadn't told them that we were stopping and going home).  After wheeling and dealing with them all, it went down below $4,000.  It took about six months to pay it all off.  But we managed.  So, even if you take that $4k out of the $10k, we were still dollars ahead for the year -- even after a big medical incident.

[anatess2]

8 minutes ago, Carborendum said:

Then we just do our best to stay safe and healthy.

This is what gets lost in a world of cadillac insurance.  All of a sudden it is cheaper to eat big macs everyday and proper nutrition and healthy lifestyles is considered unaffordable.  Wierd.

[Guest]

1 minute ago, anatess2 said:

This is what gets lost in a world of cadillac insurance.  All of a sudden it is cheaper to eat big macs everyday and proper nutrition and healthy lifestyles is considered unaffordable.  Wierd.

I am completely unfamiliar with anyone who actively thinks this.  "Yeah, I know smoking is unhealthy and means that I'll eventually have to get a lung removed.  But that's what health insurance is for."

Never heard that from anyone.

[anatess2]

3 minutes ago, Carborendum said:

I am completely unfamiliar with anyone who actively thinks this.  "Yeah, I know smoking is unhealthy and means that I'll eventually have to get a lung removed.  But that's what health insurance is for."

Never heard that from anyone.

You've never heard of "but fresh food is too expensive"?

Or 64 oz soda at the theater is cheaper per oz than a 12 oz.?

Or how about, 5 full plates at Golden Coral because it's a waste of money to only have one?

Edited November 13, 2017 by anatess2

[Guest]

2 minutes ago, anatess2 said:

You've never heard of "but fresh food is too expensive"?

Nope.  And fresh food is often less expensive, unless you're talking about "organic."

I realize that your earlier post was probably meant to support my view previously stated.  But I just found that particular claim to be a liberal talking point (yes, I realize you're quite conservative) that I found completely unbelievable.  I've never heard anyone think that they can justify an unhealthy lifestyle because they've got health insurance.  But I HAVE heard many women think they can have all the free sex they want because... Planned Parenthood.

Edited November 13, 2017 by Guest