Levels of health care in the USA

For people between 18 and 65

  1. You're rich. You can afford the care you need
  2. You're well-to-do. Insurance companies are required to sell you a policy and you can afford it.
  3. You're on the edge of well-to-do. Insurance companies are required to sell you a policy, but it's going to hurt, and it's going to hurt some more if you're over 50 or get really sick.
  4. You're doing OK. Insurance companies are required to see you a policy and there will be a subsidy to help out. Getting sick will hurt your wallet. If you're unlucky and have a modest windfall, the IRS will demand the subsidy back.
  5. You're squeaking along. Insurance companies are required to sell you a policy but the subsidy won't be enough.
  6. Your family savings are circling the drain. (a) In Medicaid expansion states, the government pays your health care, but you may have difficulty getting the subcontracted care-managment companies to pay. (b) In Medicaid-limited states, you are SOL, and will have to rely on charity. Don't get sick.
  7. Your family savings are gone, or never existed. The government pays your health care, but you may have difficulty getting the subcontracted care-managment companies to pay. You have many other problems, and time spent working the health care system makes them worse. Don't get sick.

This is an improvement over the pre-ACA situation.

For people 65 and over

  1. You're rich. You can afford the care you need.
  2. You have retired well, were able to purchase supplemental insurance early, or have a retirement medical benefit. You will get most of the care you need, but may run out of money for long-term care, in which case, see "You're poor."
  3. You can afford Medicare parts B and D (A is automatic, and there is no C), but not much supplemental coverage. Your doctor visits are not covered. Some of your medications are covered.
  4. You cannot afford Medicare parts B and D. Hospitalization is covered, but not the ambulance in emergencies.
  5. You're poor. You are required to spend most of your savings on care and then Medicaid steps in.
Don't retire poor.

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