Difference between revisions of "User:Admin/healthcare"
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| − | Healthcare is so broken in the US. I'm | + | Even with the major advancements of the [[wp:Affordable Care Act|Affordable Care Act]] in 2010 Healthcare is (still) so broken in the US. (I'm on a mission to fix it.) |
A couple points made in this article with regard to your personal health care data: | A couple points made in this article with regard to your personal health care data: | ||
| − | *The state and federal governments | + | |
| + | *The state and federal governments know more about you than you do. | ||
*Your hospital and doctors know more about you than you do. | *Your hospital and doctors know more about you than you do. | ||
| + | |||
| + | Perhaps improving patient access to patient medical data would improve healthcare outcomes! | ||
| − | In | + | In the United States, individual health insurance is mandatory - or you will be fined when you file taxes. Of course everyone wants healthcare, so on the surface it's not too onerous to say that it's "mandatory". But, if you're not covered by an employer plan (because you were just laid off, self-employed, or work for a small employer with < 50 employees), then you must obtain health insurance on your own. It is rather insane to tie health benefits to employment when employment changes routinely - whereas healthcare is something that you want to be continuous, permanent, and stable over time. |
==MassHealth== | ==MassHealth== | ||
| Line 23: | Line 26: | ||
In order to determine eligibility (You must renew every year! Like doing taxes!) <ref>https://www.mass.gov/doc/130-cmr-502-health-care-reform-masshealth-eligibility-process/download</ref>, MassHealth initiates 'information matches'. They look you up electronically to match you in (emphasis added) | In order to determine eligibility (You must renew every year! Like doing taxes!) <ref>https://www.mass.gov/doc/130-cmr-502-health-care-reform-masshealth-eligibility-process/download</ref>, MassHealth initiates 'information matches'. They look you up electronically to match you in (emphasis added) | ||
| − | # '''the Federal Data Hub''', which matches with the '''Social Security Administration''', the '''Department of Homeland Security''', and the '''Internal Revenue Service'''; and | + | #'''the Federal Data Hub''', which matches with the '''Social Security Administration''', the '''Department of Homeland Security''', and the '''Internal Revenue Service'''; and |
| − | # '''other''' federal '''and''' state agencies '''and''' '''other''' informational services. | + | #'''other''' federal '''and''' state agencies '''and''' '''other''' informational services. |
What are these other (data) services? And what information do they have on me at say the Department of Homeland Security that would determine my health insurance eligibility? Since they try to automatically renew every year, and the recipient doesn't have to do anything if that match is successful, how does the recipient of benefits know that possibly the information is incorrect? | What are these other (data) services? And what information do they have on me at say the Department of Homeland Security that would determine my health insurance eligibility? Since they try to automatically renew every year, and the recipient doesn't have to do anything if that match is successful, how does the recipient of benefits know that possibly the information is incorrect? | ||
| − | What if you move from one state to another? One of the many things you need to do is also renew and replace all | + | What if you move from one state to another? Perhaps you live in a border town where the 'next state' is next door. One of the many things you need to do is also renew and replace all your health insurance and physician relationships in 45 days or less. It's just one of many examples why [[wp:Universal health care|Universal health care]] is the system in place in all other industrialized nations on earth (and even developing countries). |
| − | == Renewal == | + | ==Renewal== |
https://www.mahix.org/individual/ I assume this is the domain for the 'Massachusetts Healthcare Information Exchange' | https://www.mahix.org/individual/ I assume this is the domain for the 'Massachusetts Healthcare Information Exchange' | ||
| Line 38: | Line 41: | ||
{{#ev:youtube|EcwQIk9mb58}} | {{#ev:youtube|EcwQIk9mb58}} | ||
| − | == Assistance == | + | ==Assistance== |
| − | * You can call (and wait on hold, and not get the info you need) | + | |
| − | * You can visit an enrollement center (There are only 7 statewide. The nearest to me is over 30 miles away; approximately a 50 minute drive - during normal business hours so take an afternoon off work to get assistance.) | + | *You can call (and wait on hold, and not get the info you need) |
| − | * '''best option''' Make an appointment with a Certified Asistance Counselor (CAC), also called a 'navigator'. There are two agencies locally that are certified: '''Anna Jaques Hospital''' (Newburyport), and the social services agency '''Pettingill House''' (Amesbury) which has a food bank location in Salisbury. | + | *You can visit an enrollement center (There are only 7 statewide. The nearest to me is over 30 miles away; approximately a 50 minute drive - during normal business hours so take an afternoon off work to get assistance.) |
| + | *'''best option''' Make an appointment with a Certified Asistance Counselor (CAC), also called a 'navigator'. There are two agencies locally that are certified: '''[https://www.ajh.org Anna Jaques Hospital]''' (Newburyport), and the social services agency '''[https://pettengillhouse.org Pettingill House]''' (Amesbury) which has a food bank location in Salisbury. | ||
| − | == Affordable Healthcare == | + | ==Affordable Healthcare== |
Under the bi-partisan Affordable Care Act (ACA), your employer's plan is considered "affordable" in 2024 if the lowest-cost plan (meeting the <abbr title="A health plan meets this standard if it's designed to pay at least 60% of the total cost of medical services for a standard population, and if its benefits include substantial coverage of inpatient hospital and physician services. Individuals offered job-based coverage that provides minimum value and is considered affordable aren't eligible for an Advance Premium Tax Credit.">minimum value standard</abbr>) costs less than 8.39% of your household's income. So, if the crappiest plan meeting minimum standards offered costs slightly less than 10% of your 'modified adjusted gross income', then it's affordable <ref>[https://www.mahealthconnector.org/esi-affordability-calculator ESI Affordability Calculator]</ref>. | Under the bi-partisan Affordable Care Act (ACA), your employer's plan is considered "affordable" in 2024 if the lowest-cost plan (meeting the <abbr title="A health plan meets this standard if it's designed to pay at least 60% of the total cost of medical services for a standard population, and if its benefits include substantial coverage of inpatient hospital and physician services. Individuals offered job-based coverage that provides minimum value and is considered affordable aren't eligible for an Advance Premium Tax Credit.">minimum value standard</abbr>) costs less than 8.39% of your household's income. So, if the crappiest plan meeting minimum standards offered costs slightly less than 10% of your 'modified adjusted gross income', then it's affordable <ref>[https://www.mahealthconnector.org/esi-affordability-calculator ESI Affordability Calculator]</ref>. | ||
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{| class="wikitable" | {| class="wikitable" | ||
|- | |- | ||
| − | ! Adjusted Gross Income || 48,255 || 130,000 | + | !Adjusted Gross Income||48,255||130,000 |
|- | |- | ||
| − | ! 8.39% affordability threshold || 4,049 || 10,907 | + | !8.39% affordability threshold||4,049||10,907 |
|- | |- | ||
| − | ! Monthly threshold | + | !Monthly threshold||337||909 |
|} | |} | ||
| Line 62: | Line 66: | ||
An interesting note: 1/12 is 8.33% So, basically you are expected to pay one month of your income towards health insurance. And 2024 is the first year in a decade where the rate was below 9% | An interesting note: 1/12 is 8.33% So, basically you are expected to pay one month of your income towards health insurance. And 2024 is the first year in a decade where the rate was below 9% | ||
| − | {{References}} | + | <br /> |
| + | |||
| + | === New in 2024 and 2025 === | ||
| + | Individual income limit is $72,900 (was $43,470 last year) for the ''''ConnectorCare'''<nowiki/>' insurance plans. All insurance companies participating in the Mass Health Connector must offer ConnectorCare plans. ConnectorCare plans offer low- or no-cost premiums, lower co-pays and no deductible. | ||
| + | |||
| + | == Tools == | ||
| + | Get an estimate https://betterhealthconnector.com/get-an-estimate | ||
| + | |||
| + | Plan comparison [https://ma.checkbookhealth.org/hie/ma/2024/index.cfm? https://ma.checkbookhealth.org/hie/ma/2024/] | ||
| + | |||
| + | Healthcare plans are offered in "metallic" tiers like you're somehow winning medals in the Olympics instead of paying the world's highest costs for healthcare. The system is just another level of indirection. Personally, I think the lowest level of payout ('bronze') should start out at 80%, with additional tiers of 85, 90, and 95 - or even 100%. I mean why is it called 'platinum', better than 'gold', and only pays out 90%? Sounds like these plans are "platinum colored" rather than genuine platinum. | ||
| + | {| class="wikitable" | ||
| + | |+What Metal Tiers mean | ||
| + | !Tier | ||
| + | !Plan pays | ||
| + | |- | ||
| + | |Bronze | ||
| + | |60% | ||
| + | |- | ||
| + | |Silver | ||
| + | |70% | ||
| + | |- | ||
| + | |Gold | ||
| + | |80% | ||
| + | |- | ||
| + | |Platinum | ||
| + | |90% | ||
| + | |} | ||
| + | |||
| + | == Changes == | ||
| + | Someone must '''apply''', '''enroll''', and '''pay your first premium''' by the '''23rd of the month''' ''before'' your coverage can '''start the following month'''. | ||
| + | |||
| + | For example, enroll and pay by April 23rd for coverage to start on May 1{{References}} | ||
Revision as of 20:48, 15 May 2024
Even with the major advancements of the Affordable Care Act in 2010 Healthcare is (still) so broken in the US. (I'm on a mission to fix it.)
A couple points made in this article with regard to your personal health care data:
- The state and federal governments know more about you than you do.
- Your hospital and doctors know more about you than you do.
Perhaps improving patient access to patient medical data would improve healthcare outcomes!
In the United States, individual health insurance is mandatory - or you will be fined when you file taxes. Of course everyone wants healthcare, so on the surface it's not too onerous to say that it's "mandatory". But, if you're not covered by an employer plan (because you were just laid off, self-employed, or work for a small employer with < 50 employees), then you must obtain health insurance on your own. It is rather insane to tie health benefits to employment when employment changes routinely - whereas healthcare is something that you want to be continuous, permanent, and stable over time.
Contents
MassHealth[edit | edit source]
To obtain your own healthcare insurance, you can get it through Medicaid and/or the Children's Health Insurance Program (CHIP) if you qualify. Both of those federal programs are known at the state level as MassHealth. Although these are Federal programs, they are run and administered at the state level and so costs are different in each state.
One of the nuttiest things about MassHealth is that you can get some services through MassHealth (e.g. long term services and supports; behavioral health like psychological study) that are not available through commercial insurance. So, you can find yourself trying to qualify for Medicaid or CHIP just to get services you desperately need - but get denied or find the process so lengthy and complicated that it doesn't serve the need. Getting these services at all can be extremely difficult, very expensive and definitely complicated and delayed. This is why so many kids have "meds" - it is super expensive (thousands of dollars out of pocket if you can find the service) to figure out what might be going on in your adolescent child's developing brain, but super easy to get a prescription and "see what happens".
Health Connector[edit | edit source]
Whether or not you qualify for health insurance under Medicaid and/or CHIP, you may also need to obtain health insurance through a health insurance Marketplace. In Massachusetts, that marketplace is called Health Connector. Note: small employers with less than 50 employees can offer health and dental plans through 'Health Connector for Business'.
All these programs are combined in Massachusetts under one 'application' (if you're under age 65) https://mahealthconnector.org
In order to determine eligibility (You must renew every year! Like doing taxes!) [1], MassHealth initiates 'information matches'. They look you up electronically to match you in (emphasis added)
- the Federal Data Hub, which matches with the Social Security Administration, the Department of Homeland Security, and the Internal Revenue Service; and
- other federal and state agencies and other informational services.
What are these other (data) services? And what information do they have on me at say the Department of Homeland Security that would determine my health insurance eligibility? Since they try to automatically renew every year, and the recipient doesn't have to do anything if that match is successful, how does the recipient of benefits know that possibly the information is incorrect?
What if you move from one state to another? Perhaps you live in a border town where the 'next state' is next door. One of the many things you need to do is also renew and replace all your health insurance and physician relationships in 45 days or less. It's just one of many examples why Universal health care is the system in place in all other industrialized nations on earth (and even developing countries).
Renewal[edit | edit source]
https://www.mahix.org/individual/ I assume this is the domain for the 'Massachusetts Healthcare Information Exchange'
https://www.mahealthconnector.org/wp-content/uploads/MassHealthHealthConnector-Webinar-041024.pdf
Assistance[edit | edit source]
- You can call (and wait on hold, and not get the info you need)
- You can visit an enrollement center (There are only 7 statewide. The nearest to me is over 30 miles away; approximately a 50 minute drive - during normal business hours so take an afternoon off work to get assistance.)
- best option Make an appointment with a Certified Asistance Counselor (CAC), also called a 'navigator'. There are two agencies locally that are certified: Anna Jaques Hospital (Newburyport), and the social services agency Pettingill House (Amesbury) which has a food bank location in Salisbury.
Affordable Healthcare[edit | edit source]
Under the bi-partisan Affordable Care Act (ACA), your employer's plan is considered "affordable" in 2024 if the lowest-cost plan (meeting the minimum value standard) costs less than 8.39% of your household's income. So, if the crappiest plan meeting minimum standards offered costs slightly less than 10% of your 'modified adjusted gross income', then it's affordable [2].
For perspective, let's say you're single and look at a couple scenarios where your AGI last year was either 48,255 or 130K. The numbers are summarized in the table below.
| Adjusted Gross Income | 48,255 | 130,000 |
|---|---|---|
| 8.39% affordability threshold | 4,049 | 10,907 |
| Monthly threshold | 337 | 909 |
So, if your employer offers a health plan with a monthly premium of $337, you're not going to get any marketplace credits.
An interesting note: 1/12 is 8.33% So, basically you are expected to pay one month of your income towards health insurance. And 2024 is the first year in a decade where the rate was below 9%
New in 2024 and 2025[edit | edit source]
Individual income limit is $72,900 (was $43,470 last year) for the 'ConnectorCare' insurance plans. All insurance companies participating in the Mass Health Connector must offer ConnectorCare plans. ConnectorCare plans offer low- or no-cost premiums, lower co-pays and no deductible.
Tools[edit | edit source]
Get an estimate https://betterhealthconnector.com/get-an-estimate
Plan comparison https://ma.checkbookhealth.org/hie/ma/2024/
Healthcare plans are offered in "metallic" tiers like you're somehow winning medals in the Olympics instead of paying the world's highest costs for healthcare. The system is just another level of indirection. Personally, I think the lowest level of payout ('bronze') should start out at 80%, with additional tiers of 85, 90, and 95 - or even 100%. I mean why is it called 'platinum', better than 'gold', and only pays out 90%? Sounds like these plans are "platinum colored" rather than genuine platinum.
| Tier | Plan pays |
|---|---|
| Bronze | 60% |
| Silver | 70% |
| Gold | 80% |
| Platinum | 90% |
Changes[edit | edit source]
Someone must apply, enroll, and pay your first premium by the 23rd of the month before your coverage can start the following month.
For example, enroll and pay by April 23rd for coverage to start on May 1== References ==
