A Question Regarding The ACA: AKA Obamacare

[easilyscan 1,014]

I have a friend who's been on it a couple of years because he retired @ 58 & his employer doesn’t offer healthcare insurance post retirement.

He's single, & his premiums averaged $150 a month in 2024 & 2025. The downside is that he has an annual deductible of $8000.00 & doesn't cover dental or vision even if the deductible has been met. His gross income is around 44K per year.

I see these ACA commercials & wonder how it works for these people, or if these are even real examples ?

 

The 1st family (man/woman/one child 3) gets healthcare for $57 per month *with financial help* 

Next is a single woman who gets coverage for $0.00 per month *with financial help*

Next is a single mom with one son. She gets coverage for $16 a month *with financial help*

Next is a single man who gets coverage for $0.00 per month *with financial help*

 

Question 1: The financial help they're referring to is the enhanced subsidies ?

The amount of subsidies you qualify for, are determined by your income. If the guy I know whose making 44K per year, has a premium of $150 per month, & the single man & woman featured on this ad get it for $0.00 per month, they must almost literally, have no income.

Question 2: Does anyone here know someone in that situation ?
Do they have a deductible ? If so, it certainly couldn't be anywhere near 8K per year like the guy I know. 

[Grace Under Pressure 169]

Actually the deductibles are likely 5K or more for plans with low premiums like those plans you listed. 

Premiums, deductibles, and copays are what patients pay. If your costs at the doctor and pharmacy are 5K per year or less, chances are you’re paying for all of that yourself, and paying for other people. 

As a 55 year old man, on a statin, who needs to see the doctor once a year. My costs should be around 500 bucks per year. 250 to see the doctor, 20 bucks per month for my prescription. 

In that scenario, paying more than 50 bucks a month for a monthly premium is crazy. And there’s a 5K deductible? C’mon.

They should just lower the Medicare age to 55. Healthy people like me, and your friend, can pay premiums into Medicare and make no claims for 10 years. I probably don’t even need to see a doctor for 10 years. I’ve gone that long before. 

[easilyscan 1,014]

39 minutes ago, Grace Under Pressure said:

Actually the deductibles are likely 5K or more for plans with low premiums like those plans you listed. 

Premiums, deductibles, and copays are what patients pay. If your costs at the doctor and pharmacy are 5K per year or less, chances are you’re paying for all of that yourself, and paying for other people. 

As a 55 year old man, on a statin, who needs to see the doctor once a year. My costs should be around 500 bucks per year. 250 to see the doctor, 20 bucks per month for my prescription. 

In that scenario, paying more than 50 bucks a month for a monthly premium is crazy. And there’s a 5K deductible? C’mon.

They should just lower the Medicare age to 55. Healthy people like me, and your friend, can pay premiums into Medicare and make no claims for 10 years. I probably don’t even need to see a doctor for 10 years. I’ve gone that long before. 

Thanks for the reply. I don't have time tonight, but I have a couple follow-up questions. Hopefully tomorrow.

[Strike 6,023]

41 minutes ago, Grace Under Pressure said:

 

They should just lower the Medicare age to 55. Healthy people like me, and your friend, can pay premiums into Medicare and make no claims for 10 years. I probably don’t even need to see a doctor for 10 years. I’ve gone that long before. 

You know the feds won't turn down extra money.  Feel free to send it in.  Lead by example.

[peenie 1,965]

It would be nice if ALL states offered Medicaid to people who have low income. States like California, Ohio, Michigan and New York do while states like: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming do not. You must be disabled or pregnant/have children in order to qualify. I think the rest of the states will offer Medicaid to people who fall under the poverty line (meaning, even men and women without children can receive Medicaid). Note: states with the most need don’t offer expanded Medicaid. It makes NO sense. 

Not to mention that it was Republicans that prevented the United States from getting universal healthcare when Obama and Democrats were fighting for it. Instead we have ACA. 

[Maximum Overkill 2,449]

2 hours ago, peenie said:

low income

How about the middle class? Racist 

[easilyscan 1,014]

@Grace Under Pressure

One follow-up question would be this. 
You figured even if their monthly premium was $0.00, they would have an annual deductible of at least 5K & I figured if they qualified for a plan with $0.00 for a monthly premium, their income must be extremely low. What happens if they suffer an illness that results in a $5000 bill, that they have no way of paying ?

I'm curious because one thing I know about Obamacare, is that premiums are based on your income, not on any assets like stocks, mutual funds, savings, etc.
Wondering if in this case, the hospital/clinic could go after that those type of funds ? (assuming they had them)

 

One more thing.

Quote

As a 55 year old man, on a statin, who needs to see the doctor once a year. My costs should be around 500 bucks per year. 250 to see the doctor, 20 bucks per month for my prescription

Glad to hear you're doing well, but what if you had the plan you thought would be fair (500 bucks per year) & suffered some type of catastrophic illness ?
Hypothetically, we’ll say it was short term & you recovered fully, but the bill was 150 K. 

Who would/should pick up the tab in a case like ? 

Regards

[Grace Under Pressure 169]

1 hour ago, easilyscan said:

@Grace Under Pressure

One follow-up question would be this. 
You figured even if their monthly premium was $0.00, they would have an annual deductible of at least 5K & I figured if they qualified for a plan with $0.00 for a monthly premium, their income must be extremely low. What happens if they suffer an illness that results in a $5000 bill, that they have no way of paying ?

I'm curious because one thing I know about Obamacare, is that premiums are based on your income, not on any assets like stocks, mutual funds, savings, etc.
Wondering if in this case, the hospital/clinic could go after that those type of funds ? (assuming they had them)

 

One more thing.

Glad to hear you're doing well, but what if you had the plan you thought would be fair (500 bucks per year) & suffered some type of catastrophic illness ?
Hypothetically, we’ll say it was short term & you recovered fully, but the bill was 150 K. 

Who would/should pick up the tab in a case like ? 

Regards

First one. For the illness that cost them $5000, the hospital or provider puts them on a payment plan. That’s how it goes. So I guess that means they “go after them”. Maybe it takes them 4 years to pay it off. $100 a month or so. 

Second one. The costs of $500 for me is cash. I pay the doctor $250 for my annual visit, $20 a month for my prescription. If I didn’t have an insurance plan, I’d be on the hook. That’s the risk. I’m in favor of catastrophic plans for this scenario. 

I worked for a large healthcare company in the Medicare Part D space for two decades. I have no problem saying this country is fked when it comes to health insurance. It’s absolutely anti-human. 

[easilyscan 1,014]

3 hours ago, Grace Under Pressure said:

First one. For the illness that cost them $5000, the hospital or provider puts them on a payment plan. That’s how it goes. So I guess that means they “go after them”. Maybe it takes them 4 years to pay it off. $100 a month or so. 

Second one. The costs of $500 for me is cash. I pay the doctor $250 for my annual visit, $20 a month for my prescription. If I didn’t have an insurance plan, I’d be on the hook. That’s the risk. I’m in favor of catastrophic plans for this scenario. 

I worked for a large healthcare company in the Medicare Part D space for two decades. I have no problem saying this country is fked when it comes to health insurance. It’s absolutely anti-human. 

I wish I could disagree with your last sentence, but I can't. 

 

Are current & future unfunded liabilities for Social Security and Medicare really 175 trillion ?

Yes, some analyses, particularly those from the U.S. Treasury Department's Financial Report of the United States Government, have reported unfunded liabilities for Social Security and Medicare in the trillions of dollars, with figures around $175 trillion cited in recent reports.

That answer is from google AI. Many people say AI is BS, but I think I'd be more apt to believe that over a politician.

 

 

[Grace Under Pressure 169]

Trump said on Truth Social that the insurance companies are evil and that the government shouldn't be giving them money. Does he know what Medicare is lol? 

What's even more ridiculous about that is that statement is that Medicare Advantage (MA) is essentially the same exact program as the ACA, the only difference is that MA is for people 65+. A government program, run by insurance companies.

They should introduce a younger, healthier cohort to Medicare Advantage. Say ages 50-64. That population has a much better loss ratio, i.e. they pay more in premiums than they take away in claims, vs. the group already covered, 65+. (There's also a 5% or so Admin fee that the insurance companies use to operate, including salaries.) Insurance companies would like to have that 50-64 population no matter what, they mostly have them captured under commercial plans and the ACA currently, but it's messy. They're losing out on gaps in that population.

Here's the thing for this year. If Trump wanted to help consumers at the expense of the "evil insurance companies" that he called them, he would cap the premium and deductible increases on the ACA that the insurance companies are offering for 2026, raising them by 250% or whatever the number is exactly. Tell the insurance companies, they are regulated after all, that the maximum premium increase overall is capped at 10%. Then offer to make them whole in January 2027 if they report a negative loss ratio (they won't need to, it will still be profitable).

Did anyone ask Trump why he's not doing that, but instead he is allowing the insurance companies to enact these premium increases to consumers? If the insurance companies are so "evil" like he says? No, they didn't. Because the people that would ask Trump that question don't even know how it works. 

[Fnord 2,524]

On 11/8/2025 at 6:23 PM, Grace Under Pressure said:

I worked for a large healthcare company in the Medicare Part D space for two decades. I have no problem saying this country is fked when it comes to health insurance. It’s absolutely anti-human. 

I worked in medical billing for a while; it was miserable. The thing that doesn't get talked about enough is how insurance companies are making medical decisions for their customers. They claim that is not the case. Bullshit. People live and die based on financial decisions designed to enrich shareholders. To call it grotesque is an understatement.

[seafoam1 3,421]

On 11/8/2025 at 7:23 PM, Grace Under Pressure said:

. I worked for a large healthcare company in the Medicare Part D space for two decades. I have no problem saying this country is fked when it comes to health insurance. It’s absolutely anti-human. 

I'm all good with my healthcare.

This country isn't focked, the lazy ass liberals are focked. You all want things for nothing. 

Screw that. Be a part of the solution and stop being the problem.