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An update for Softy
12-27-2013, 12:31 AM #16
Wayne5 Member
Posts:660 Threads:61 Joined:Nov 2013
Blue Cross Blue Shield Blue Advantage Bronze HMO 005 TX
Shop For Health Insurance

Cost Sharing Benefits
Other Plans

Plan Information
Company Blue Cross Blue Shield of Texas
State TX
Metal Tier Bronze
Plan Type HMO

Cost Sharing Benefits

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $5,000 $0
Deductible (Family) $12,700 $0

Coinsurance 20% $0

Out of Pocket Maximum (Individual) $6,250 $0

Out of Pocket Maximum (Family) $12,700 $0

Services In Network Out of Network
Primary Care Visit 20% Coinsurance after deductible $0
Specialist Visit 20% Coinsurance after deductible $0
In Patient Hospital Services 20% Coinsurance after deductible $0
Emergency Room Services 20% Coinsurance after deductible 20% coinsurance
Mental / Behavioral Health 20% coinsurance $0
Imaging (CT/PET Scans, MRIs) $250 copay $0
Rehabilitative Speech Therapy 20% coinsurance $0
Rehabilitative Occupational & Physical Therapy 20% coinsurance $0
Preventative Care $0 $0
Laboratory Outpatient and Professional Services 20% coinsurance $0
X-ray and Diagnostic Imaging 20% coinsurance $0
Prescription Drugs In Network Out of Network
Generic Rx 10% Coinsurance after deductible
Preferred Brand Rx 20% Coinsurance after deductible
Non Preferred Brand Rx 30% Coinsurance after deductible
Specialty Drugs 40% Coinsurance after deductible
- See more at: http://www.valuepenguin.com/health-insur...nK9FW.dpuf


Sorry it didn't cut and past well.
12-27-2013, 12:36 AM #17
Posts:4,763 Threads:1,046 Joined:Jun 2012
(12-26-2013, 11:12 PM)Softy Wrote:  80/20 is silver plan under obamacare,,,

it is not free,,,ever,,,

deductible is not 5000 dollars on silver plan,,,

not sure why employer is involved in your obamacare,,,

low sign up for obamacare is not from fear mongers,,,

sure that will be part of the lie spin...


Telling the truth has now become "fear mongering" to these stupid ğkking people
12-27-2013, 12:52 AM #18
Below Average Genius Member
Posts:2,257 Threads:197 Joined:Apr 2013
(12-26-2013, 11:00 PM)Wayne5 Wrote:  My wife just called with good news. She called her insurance guy at work and he confirmed that we are insured as of January 1. The other good news is that Blue Cross has waved our $.36 monthly payment (I assume because it would cost them much more to send us a bill than the $.36). She assures me that the plan is 80/20 (after we pay $5000)but I told her to call him back and confirm.

Last I heard only 14,000 people had gotten insurance in Texas through the exchange. We have 5,000,000 uninsured here. There's going to be a lot of people in trouble because they were talked out of the exchange by fear mongers.

Update TWO: While I was writing this the post, the postman came. I got a bill for $.03 from Blue Cross in the mail. So much for the insurance guy getting it right.


Pay up, buster!! chuckle.gif

I'd love to be there with a camera the day you go to use your insurance only to find out the provider demands their $5,000 up front.

Pray for me. hug.gif

Yeah, Whirling Bliss is a thing. ;-) http://whirlingbliss.com
12-27-2013, 12:58 AM #19
bohica Member
Posts:1,618 Threads:199 Joined:Feb 2011
Get your DR to rack up a bunch of inflated charges to meet the deductible fast.
If I can think of this, I'm sure others have.

I'm in my seventh decade on Earth. I know things.
12-27-2013, 01:03 AM #20
Softy Incognito Anonymous
Well,,,it ain't just Texas where folks aren't signed up,,,

the software for one thing,,,won't handle the traffic,,,

50,000 at a time,,,so the story goes,,,5 million without

insurance,,,and the obamas admitted such and said

cancelled plans can be reinstated,,,to mitigate the damage,,,

and this of course has not worked,,,and Wayne,,,don't

think that plan is obamacare,,,that plan pays nothing till

over 5000 dollars,,,ouch,,,you sure that isn't the employers plan???,,,

and they are paying for it???,,,and it is a Blue Cross plan,,,

not an obamacare plan...

12-27-2013, 01:06 AM #21
Wayne5 Member
Posts:660 Threads:61 Joined:Nov 2013
Nice to see a friendly face BAG! I think I can smell tar and feathers.

I fully expect they will, but we are saving thousands in premium cost that I will put away to pay the year after next deductible if needed and after that Medicare.

Its a good plan, if I don't have a stroke from posting on this forum.

12-27-2013, 01:06 AM #22
Softy Incognito Anonymous
that site compares plans,,,btw,,,

12-27-2013, 02:49 AM #23
Wayne5 Member
Posts:660 Threads:61 Joined:Nov 2013

Thanks to Jay for taking out my personal info.

I have proved that what I have been saying is true. I could get mad and storm off with my righteous indignation (that means justified anger) but I will not. I will stand and fight Satan for your very soils if I must. The measure of a man or woman is not what he does when he is right, it is what he does when he is wrong. When I am wrong I acknowledge my mistake and apologize. I don't think that's the behavior of a shill and a troll. If you take offense at the phrase "fear mongering" then I apologize, I could have used a better word. Let go of your hate, it really does lead to the dark side.

12-27-2013, 03:12 AM #24
JayRodney ⓐⓛⓘⓔⓝ
Posts:31,986 Threads:1,457 Joined:Feb 2011
(12-27-2013, 02:49 AM)Wayne5 Wrote:  Thanks to Jay for taking out my personal info.

No problems, I used to do this at FOIA hq. lol.gif

12-27-2013, 03:44 AM #25
Softy Incognito Anonymous
for your very soils if I must.

soils,,,wow,,,don't do that,,,

Ok,,,and I will assume you really got this through obamacare,,,

still doesn't look like all the rest of the stuff talking about obamacare,,,

or the plans under obamacare,,,and there are many sites showing

Texas obamacare with different ratios than your plan,,,and all the

national plans show the same for all the states,,,so forgive my

conclusions,,,glad it worked for you,,,and yeah,,,and like you I don't want

the people to get mislead by the deceivers,,,and still don't get why

this plan is different from the rest of obamacare,,,but certainly you

have been honest about this,,,so sorry for the rants,,,and guess it

meets the obamacare minimum bronze plan,,,so,,,maybe this is

helpful information,,,certainly more cost reduction,,,and how the poor

are going to pay the deductibles,,,or not pay as the case may be,,,

Buying health insurance is expensive, but paying the monthly premium isn’t the only cost involved. You also have to pay deductibles, copayments, and coinsurance each time you use your health insurance.

These additional out-of-pocket amounts are known as cost-sharing expenses. They can add up to thousands of dollars yearly if you use your health insurance a lot or have a high deductible.

Subsidies that help pay out-of-pocket costs like deductibles, copayments, and coinsurance. These are known as reduced cost-sharing subsidies and come in two distinct parts.

The first reduces your out-of-pocket maximum. Learn more in, “How the Subsidy to Reduce Your Out-Of-Pocket Maximum Works.”
The second, the one addressed here, reduces the amount you pay for deductible, copayments and coinsurance each time you use your health insurance.


12-27-2013, 03:58 AM #26
Wayne5 Member
Posts:660 Threads:61 Joined:Nov 2013
Ok ok, I'm a drama queen sometimes (but not in a gay way chuckle.gif ) I saved that link but I hope not to have to use it. I really hate doctors, I hope God doesn't make me sick just to give me an opportunity to love them. I think I'm done with healthcare, its making me sick.

Your a good man Softy. Thank you for you for what you have said.

And you are under no obligation to agree with me in the future. rofl.gif
12-27-2013, 04:34 AM #27
Softy Incognito Anonymous
(12-27-2013, 03:58 AM)Wayne5 Wrote:  Ok ok, I'm a drama queen sometimes (but not in a gay way chuckle.gif ) I saved that link but I hope not to have to use it. I really hate doctors, I hope God doesn't make me sick just to give me an opportunity to love them. I think I'm done with healthcare, its making me sick.

Your a good man Softy. Thank you for you for what you have said.

And you are under no obligation to agree with me in the future. rofl.gif

Well,,,I probably won't always agree with you,,,

and still wonder about what you got,,,and if you read the link above,,,

the subsidy for deductibles and such is only for silver tiered plans,,,

don't ask me why only silver,,,but yeah research before you buy...

12-27-2013, 04:43 AM #28
Softy Incognito Anonymous
Some health care expenses aren't included in your cost-sharing reduction. Your out-of-pocket expenses for things that aren't covered by your health insurance policy or aren't an essential health benefit won't be reduced. The balance-billed portion of care you get out-of-network won't be reduced, so stick with in-network providers to get the most from your subsidy.
Who’s Eligible for the Cost-Sharing Health Insurance Subsidy?

To be eligible for the reduced cost-sharing subsidy, you must:

Buy your health insurance through your state’s health insurance exchange.
Choose a silver-tier health plan.
Have an income from 100-250 percent of FPL.
Reside in the United States legally.
Not be incarcerated.
Have a tax filing status of married filing jointly if you’re married.

How to Apply for the Cost-Sharing Subsidy

Apply for the reduced cost-sharing subsidy through your state’s health insurance exchange while you’re shopping for health insurance. You can apply for the premium tax-credit subsidy and the reduced out-of-pocket-maximum subsidy at the same time. Be prepared to give the exchange information about your income, family size, and employer if you have a job.

from link above...




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