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Thread: "Can I still pay cash for medical treatment in 2014" ?

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    Default "Can I still pay cash for medical treatment in 2014" ?

    The very important question 'can I still pay cash for medical treatment after January 1st" was asked by a DD poster. I had assumed that all Americans were now aware of new ACA / IRS regulations that will be taking effect for 2014 and beyond, but to eliminate confusion I'll try to do a very focused recap.

    To answer the DD poster's question, yes you can choose not to purchase health insurance and instead continue to pay 'cash' for necessary medical treatments. In fact, a number of health care providers are restructuring their practices to specifically cater to patients wishing to pay 'cash' ... and in the process are able to significantly reduce the prices charged. See

    However, if you do choose not to purchase health insurance and instead continue to pay 'cash' for necessary medical treatments, the ACA will now require you to also pay a new IRS penalty tax. The amount of that tax is 1% of income for 2014, 2% of income for 2015, and 2.5% of income for 2016 and beyond. For a dancer or camgirl earning, say, $1000 per week, this will roughly translate into an additional $500, $1000, and $1250, in 2014, 2015, and 2016+ respectively, being ADDED to the tax bill you would otherwise be required to pay. To be crystal clear, this new tax comes as an addition to the federal income taxes, SSI 'self-employment' taxes etc. that are also owed.

    While it was 'hoped' that this new IRS penalty tax for failure to purchase 'qualified' health insurance would be postponed, this hasn't happened ... and with just 2 days left before 2014 arrives, it appears that the new IRS penalty tax will in fact take effect later this week as originally scheduled.

    Also, the ACA / IRS actually assesses the new IRS penalty tax for failure to purchase 'qualified' health insurance on a monthly basis ... beginning with January 2014. As such, any dancers and camgirls who choose to pay 'cash' for medical treatments in lieu of purchasing 'qualified' health insurance will also need to ADD $500 * 3/12 = $125 ( using the above example ) to each of their 2014 quarterly estimated tax payments to cover the IRS penalty tax beginning with the April 15th 2014 estimated tax voucher / payment. This will increase to $250 per quarterly estimated tax payment in 2015, and increase again to $312 per quarterly estimated tax payment in 2016 and beyond.

    The ACA also authorized the IRS to hire a large number of additional IRS agents for the specific purpose of enforcing ACA related tax provisions ( 16,000 new agents from some reports ). See . As such, quarterly estimated tax payments ( or lack of quarterly estimated tax payments ) are likely to receive far more IRS scrutiny in 2014 than they ever did before. Also note that the new IRS tax penalty adds a significant amount of new tax liability for dancers and camgirls whose 2014 earnings haven't changed much from their 2013 earnings. Failure to add the additional money to cover this IRS penalty tax liability may result in 'standard' quarterly estimated tax payments now falling short of the 10% 'error' threshold for estimated taxes paid versus actual taxes due ... which in turn can allow the IRS to assess an 'under-withholding' penalty in addition to the new IRS penalty tax and the 'normal' income tax and SSI tax.

    And for dancers and camgirls who choose to purchase 'qualified' health insurance coverage to avoid the new IRS penalty tax, it is equally likely that your quarterly estimated tax filings ( or lack thereof ) will also receive increased IRS scrutiny in 2014. After all, at this point in time, the IRS has no way to tell whether you have purchased 'qualified' health insurance or not, and those 16,000 new IRS agents have to focus their attention somewhere !!!
    Last edited by Melonie; 12-29-2013 at 07:18 AM.

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    Default Re: "Can I still pay cash for medical treatment in 2014" ?

    I am so glad you posted this. It simplified all the craziness that has been confusing me for months.

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    Default Re: "Can I still pay cash for medical treatment in 2014" ?

    Thanks a bunch melonie this helps alot. I was confused. This means I probaly won't have much of a return anymore but oh well. I just don't want to deal with health insurance right now when I can just go pay. I barely go to the doctor anyway so in the end not buying it and paying the penalty for me is cheaper. I have so many responsibilities already like house taxes and home insurance I just can't add anything else in right now. I hope they will change this back we shouldn't be forced to pay anything just because we don't want something what is this world coming to? Are we going to be told everything to do soon or one day because if so I don't even want to live to see it. This is supposed to be a free country.

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    Default Re: "Can I still pay cash for medical treatment in 2014" ?

    ^^^ I can't / won't comment on your personal opinion, but I will point out that ... there's no such thing as a 'free lunch'. The ACA provides for certain Americans to receive free health insurance via Expanded Medicaid, for certain other Americans to receive public exchange health insurance coverage at premium prices that are far lower than the amount of expected insurance payouts ( pre-existing conditions ), and for certain other Americans to receive taxpayer subsidies to defray some / most of the costs of their public exchange health insurance premiums ( incomes below 400% of the federal poverty level ). Somebody must pay for these things, and by working enough to earn more than 400% of the federal poverty level, plus choosing not to purchase 'qualified' health insurance, you have 'volunteered' yourself via the new IRS penalty tax.

    if you are choosing not to purchase 'qualified' health insurance coverage for yourself ... you will now need to start setting additional money aside to prepare for the higher estimated tax payment due this coming April 15th. This payment for federal taxes and Social Security ( a.k.a 'self-employment' tax ) due on Jan through March 2014 earnings now needs to increase by the amount of the new IRS penalty tax you must pay because you didn't purchase 'qualified' health insurance during Jan through March 2014 either.

    Since the majority of working Americans have health insurance coverage available through an 'employer', it is a statistical fact that self-employed Americans are far less likely to have health insurance coverage than 'employee' Americans ... thus far MORE likely that self-employed persons like dancers and camgirls will owe the new IRS penalty tax !!! As a result, based on my earlier comment, self-employed persons who fail to make quarterly estimated tax payments in 2014 are FAR more likely to receive IRS scrutiny, and potentially get hit with IRS 'under-withholding' penalties, in 2014 than in the past. This is logical since the total amount of money due to the IRS every quarter may now increase significantly by the addition of the new IRS penalty tax, since the IRS has effectively doubled the number of IRS agents on their payroll for the specific purpose of increasing tax enforcement of ACA related tax changes like the new IRS penalty tax, and since identifying non-payment / under-payment of estimated taxes by self-employed persons has a high probability of producing additional tax revenues for the IRS.

    Also, for any girls who are 'employees', either via a straight side job or through a club, generally speaking the 'employer's' paycheck tax withholding is NOT going to include any withheld money to go towards the new IRS penalty tax ... just the 'normal' federal and state income tax plus Social Security tax. This isn't a problem for full time 'employees' who purchase employer provided 'qualified' health insurance, but can be a major issue for part time employees, minimum wage employees etc. who are not offered ( or cannot afford ) employer provided 'qualified' health insurance. As such, if you choose not to purchase 'qualified' health insurance on your own, receiving a tax refund may now be a thing of the past due to the new IRS penalty tax.
    Last edited by Melonie; 12-29-2013 at 06:08 PM.

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    Default Re: "Can I still pay cash for medical treatment in 2014" ?

    If you're not able to find health insurance for less than 8 percent of your income, then you're not required to buy any and you won't be fined. If you're making approximately $50k and you're not able to find health insurance for less than $4,000 annually, you won't be required to buy any.

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    Default Re: "Can I still pay cash for medical treatment in 2014" ?

    Well I would make if i worked every day 36 grand a year from camming cause that lets me save and live comfortably it would be a little less than that from taking days off but if i worked every single day thats about 36 grand considering i met my goal every day and I have thus far. So I guess I may qualify for expanded medicaid coverage. What I meant by free mel was FREE to do what we want and not have to answer to people I mean if we don't want to buy a smart car we should be able to buy any car we want and if we don't want health coverage we should not have to pay just because we want to pay out of pocket. I understand imposing that penalty on people who abuse the system by going to the er and not paying the bills etc. Why if we pay out of pocket do we have to pay the price of it it just seems like we are going to be dictated in the future and every little thing we do we will not have full control of. This is the craziest law I have seen passed in my time. They can only get crazier from here.

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    Default Re: "Can I still pay cash for medical treatment in 2014" ?

    Quote Originally Posted by Melonie View Post

    And for dancers and camgirls who choose to purchase 'qualified' health insurance coverage to avoid the new IRS penalty tax, it is equally likely that your quarterly estimated tax filings ( or lack thereof ) will also receive increased IRS scrutiny in 2014. After all, at this point in time, the IRS has no way to tell whether you have purchased 'qualified' health insurance or not, and those 16,000 new IRS agents have to focus their attention somewhere !!!
    There aren't going to be 16,000 new IRS agents.

    http://www.factcheck.org/2011/02/irs...e-law-part-ii/

    The IRS is actually asking for more new workers than reported in an article by U.S. News and World Report — a story that has generated a lot of Internet buzz after being picked up by news outlets, such as Fox News and The Daily Caller. The IRS budget request for fiscal year 2012 shows that the agency is seeking at least 1,269 full-time equivalent employees (FTEs) at a cost of $473 million to help implement the Patient Protection and Affordable Care Act.

    But many of them are needed to deliver new tax credits, not to dun taxpayers. The agency is seeking to add 291 "revenue agents" — most of them (193) to "ensure accurate delivery of tax credits." The agency’s technology staff would see the biggest increase with the addition of 537 IT program analysts and specialists.
    Last edited by eagle2; 12-29-2013 at 07:42 PM.

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    Default Re: "Can I still pay cash for medical treatment in 2014" ?

    the IRS themselves requested 6,700 additional agents and one billion additional dollars during their 2014 budget hearings ...

    (snip)"WASHINGTON, D.C. — Still mired in scandal for its mishandling of nonprofit political groups, the Internal Revenue Service is prepping for a new role: chief enforcement arm of the Affordable Care Act.

    That task will require new agents — 6,700, the IRS figures — and more money — about $1 billion more than the current budget.

    Confronted with the tax agency’s 9-percent increase in its 2014 budget, House Budget Committee Chairman Paul Ryan, R-Wisc., blasted Deputy IRS Commissioner Daniel Werfel at a meeting of the House Committee on Ways and Means"(snip)

    ... thus while the 16,000 new agents may have overstated the situation ( which is why I hedged by saying 'some sources' ), the 291 additional agent figure would appear to grossly understate the actual situation.

    The accurate answer to this question can be ... 'more than last year', or ' a billion dollar's worth', or 'nobody outside the IRS knows for sure. And these agents were added for the specific purpose of enforcing new IRS regulations stemming from the ACA. Collecting the new IRS penalty tax clearly falls under that mandate.


    If you're not able to find health insurance for less than 8 percent of your income, then you're not required to buy any and you won't be fined. If you're making approximately $50k and you're not able to find health insurance for less than $4,000 annually, you won't be required to buy any.
    The unsubsidized premium price levels of public health exchange 'bronze' coverage wlll fall below the 8% 'loophole' for persons earning the minimum amount of income to disqualify them for taxpayer funded subsidies i.e. 401% of federal poverty level or ~$47,000 per year. Also note that the 8% 'loophole' does not count the costs of copays or deductibles, just insurance premiums. Thus virtually anyone earning $47k+ per year who chooses not to purchase ( unsubsidized ) health insurance will wind up paying the new IRS penalty tax.

    Additionally, individuals earning between 134-139% of federal poverty level or about ~$15k per year, and 400% of federal poverty level or about ~$46k per year, are eligible for tax credits which reduce the net cost of public health exchange insurance premiums to 'net' levels that fall below the 8% 'loophole' as well. Thus virtually anyone who earns more than $15k per year who chooses not to purchase ( subsidized ) health insurance will also wind up paying the new IRS tax penalty.


    So I guess I may qualify for expanded medicaid coverage
    To qualify for Expanded Medicaid coverage, max income level is 133-138% of federal poverty level, or about ~$15,000 for a single person. The reason for this is that state laws allowing for the 'recovery' of Medicaid expenditures made by the state from people age 55 and older ( originally intended for nursing home care ) are still on the books. Thus, combining Expanded Medicaid with those state laws means that Expanded Medicaid recipients may receive 'free' medical care from now until they reach age 55 ... but at that point the state Medicaid agency, which will have kept track of the total amount of Expanded Medicaid benefits paid out to that person over the past 10-20-30 years ( plus an annual 'administrative fee' ), can present a 'bill' for that total amount on that person's 55th birthday. If unable to pay in cash ( which is typically the case ), the state Medicaid agency can then place a lien on a house that person owns, as well as on any other assets that person owns, to 'recover' the costs of previously provided Medicaid benefits.
    Last edited by Melonie; 12-30-2013 at 10:41 AM. Reason: ate

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    Default Re: "Can I still pay cash for medical treatment in 2014" ?

    I was looking at the list of plans for New York State.

    http://www.governor.ny.gov/assets/do...ranceRates.pdf

    I was very surprised to see that in New York City there are plans for below $200 a month.

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    Default Re: "Can I still pay cash for medical treatment in 2014" ?

    Thanks so informative

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    Default Re: "Can I still pay cash for medical treatment in 2014" ?

    I was very surprised to see that in New York City there are plans for below $200 a month
    yes these are 'catastrophic only' plans which were supposed to only be made available to people under age 30. Note that most if not all fail to qualify for pairing with a Health Savings Account, since the 'actuarial value' is well below the newly mandated 60% minimum ... mostly because they don't provide coverage for much of anything except 'catastrophic' total annual medical expenses exceeding the plan's very high deductible 'trigger' amount i.e. $10,000+ out of pocket in a single year. They are, arguably, a good emergency 'backstop' as a companion to a 'concierge' health care provider being paid in cash.

    Also, if it matters, the lowest cost providers for 'catastrophic' only and other public health exchange insurance plans have an extremely limited list of 'network provider' doctors ... something on the order of 100 or so 'primary care physicians' for ALL of Manhattan, and maybe 5-10 doctors in average sized upstate NY cities. By 'pure coincidence', based on a quick look at the NY Fidelis member doctor website, most of these lowest cost 'network provider' doctors appear to be 'H1-B visa holders'. Please understand that this observation was NOT intended to impugn these doctors or the level of care likely to be provided, only to point out that reimbursement rates from these lowest cost health insurance companies have to be low enough to allow a 'break-even' with premiums of only ~$200 per month ... and for a doctor / practice to survive in that economic environment it sure helps for the doctor to have had most of their medical tuition paid for by the Chinese / Indian / Saudi / Russian government instead of via hundreds of thousands of dollars worth of student loans.
    Last edited by Melonie; 12-30-2013 at 05:46 PM.

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    Default Re: "Can I still pay cash for medical treatment in 2014" ?

    So if I make too much to qualify for medicaid and have a pre-existing condition then what health insurance can I be approved for?

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    Default Re: "Can I still pay cash for medical treatment in 2014" ?

    ^^^ any of the public health exchange 'bronze', 'silver', 'gold' or 'platinum' plans. Depending on your personal income level, the monthly premiums for these plans may be heavily taxpayer subsidized thus very cheap, or not subsidized at all thus very expensive. If you are under age 30 you will also qualify to buy very inexpensive but limited coverage 'catastrophic only' health plans through the public health exchange.

    An important note, however, for all of these public health exchange insurance plans. The more 'affordable' the insurance plan is, the higher the annual 'deductible' will be. Annual deductible for a typical 'Bronze' plan is reported to be ~$5,000 for an individual ( see ) ... meaning that until you have accumulated and paid out of your own pocket a total of ~$5,000 worth of medical bills ( in addition to the amount you'll be paying for monthly insurance premiums ) in the current year, your 'Bronze' insurance plan won't pay dollar one to your health care provider. Thus if your expected medical expenses are likely to fall far short of ~$5,000 per year, purchasing public health exchange 'Bronze' insurance coverage is arguably of little value. On the flip side, 'Platinum' plans have much lower deductible ( like $500 instead of $5000 ), but the monthly insurance premium could be north of $600 instead of $200.

    Arguably, in the case of both the 'Bronze' plan and the 'Platinum' plan, between the ( unsubsidized ) monthly premiums plus the annual deductible, you wind up paying something like $7,000 out of pocket. Thus the question arises whether it would be significantly less expensive in the long run for a young and health person to choose not to pay monthly health insurance premiums, to simply pay cash for medical treatment when needed, plus pay the 1% IRS penalty tax for choosing not to buy health insurance. But a person with a pre-existing condition that is certain to require thousands of dollars worth of medical treatments will have to 'do the math' regarding expected total costs of medical treatments, versus different annual deductibles, versus different monthly premium costs, plus different sized annual out-of-pocket 'caps' on non monthly premium related medical costs, to see which 'metal' plan provides the 'least of the evils' given your individual situation.

    Obviously, Expanded Medicaid coverage does not have a deductible ( or a monthly insurance premium ). And based on your reported income, you will not be given the option to purchase any of the public health exchange insurance plans if your reported income qualifies you for Expanded Medicaid. But, as discussed in other threads, Expanded Medicaid provided health care must now be thought of as a 'secured loan' from the state ... the costs of which the state will try to recover from recipients once they reach age 55 via placing liens on houses, by 'freezing' assets, etc.
    Last edited by Melonie; 01-04-2014 at 07:03 AM.

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    Default Re: "Can I still pay cash for medical treatment in 2014" ?

    Question about deductibles...

    If you find a plan with a co-pay, how does this factor into the usefulness of the plan?

    For example, before my families private insurance was cancelled (we opted to cancel instead of taking the HUUUUGE rate hike), when one of us went to visit the doctor, we paid a $25 co-pay and that was it. We never got a bill from the doctors office, and we only had to pay our co-insurance amount of 30% of a bill when we had to have lab work done or something similar - and it was only that 30% and we never came close to reaching the deductible yet we still only paid our co-payments and 30% co-insurance and nothing more.

    So while looking at these Obamacare plans, if I choose one that has a stupidly high deductible, but also has a co-pay for doctors visits (some do not have co pays, some do), should I expect the same thing as was happening for us on the private insurance plan?

    I am expecting to pay cash for medical treatment and eat the fine hoping and praying this all gets ummmm... worked out... perhaps. If I can get a reasonable price similar to what we were paying with private insurance and be able to count on the co-pay covering the visit and not having to meet the enormous deductible first, I might change my mind..... might.
    xoxo ~ Sarah




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    Default Re: "Can I still pay cash for medical treatment in 2014" ?

    Unfortunately my state is not offering expanded medicaid. I wish it was so that I could have it just in case until I begin making more or find a good , very good plan I like.

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    Default Re: "Can I still pay cash for medical treatment in 2014" ?

    I am probably just going to eat the fine too. which is too bad because I could use insurance right now but there's no way I can afford 600 a month for an average plan, much less pay 200 a month just to cover all my own medical expenses anyway! and I only have myself to worry about and I make a decent salary.

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    Default Re: "Can I still pay cash for medical treatment in 2014" ?

    So while looking at these Obamacare plans, if I choose one that has a stupidly high deductible, but also has a co-pay for doctors visits (some do not have co pays, some do), should I expect the same thing as was happening for us on the private insurance plan?
    from

    (snip)"The practice of upfront payment for non-emergency care has been spreading in the U.S. as deductibles rise. Now, the advent of the Patient Protection and Affordable Care Act is likely to accelerate that trend.

    Many of the plans offered through the law’s insurance exchanges have low initial premiums to attract customers, while carrying significant deductibles and other out-of-pocket cost sharing. The second-lowest tier of Obamacare plans in California, for example, carries a $2,000 annual deductible.

    Hospitals say they need to charge patients prior to treatment because Americans are increasingly on the hook for more of their own medical costs. And once care is provided, it’s often difficult for hospitals to collect.

    “It used to be taboo to look like you were looking for money at a time when you were supposed to be focused on patient care,” David Williams, president of Boston-based consulting firm Health Business Group, said. “It’s not taboo anymore.” (snip)

    (snip)"Doctors and hospitals at New York University Langone Medical Center collect co-insurance and deductibles upfront for inpatient and outpatient services, said Andrew Rubin, vice president for medical center clinical affairs and affiliates. The amount may be based on estimated cost of services. The practice helps clarify bills for patients and saves on administrative costs when it comes to collections, he said.

    “We get our money faster,” Rubin said in an interview. “As patients pay higher deductibles, we’re talking about potentially thousands of dollars. People get excited to buy a TV, but health care is a service they don’t like to pay for.” (snip)


    Bottom line seems to be that ACA 'network' health care providers are covering their asses regarding the significant probability that some number of ACA public health exchange insured patients are NOT going to be able / willing to cough up thousands of dollars in cash due to those health care providers to cover the costs of medical bills which ACA insurance doesn't pay i.e. the high annual deductible and the significant percentage co-pays. Thus if the needed medical procedure is estimated to cost, say, $1000 ... but the ACA insured patient has more than $1000 worth of their annual deductible yet to be paid ... the medical facility is likely to demand that the ACA insured patient pay them the $1000 up front before medical treatment is actually provided.

    If the ACA insured patient had already paid cash for enough medical bills to meet their $2-3-5,000 annual deductible, then for yet another medical procedure estimated to cost $1000, the health care provider would seek $200-$300-$400 cash up front from the ACA insured paitent before providing medical treatment ... depending on whether the ACA insurance plan has 20%, 30% or 40% co-pays.

    It would only be at the point where the sum total of out-of-pocket cash paid for medical treatments for that year exceeds the ACA insurance' annual 'cap' of $6-9-12,000 that ACA insurance would begin to pay for ALL additional medical treatment costs.

    However, the ACA insurance does have some exceptions i.e. a certain number of check-ups, mammograms, birth control prescriptions etc. are 100% covered by ACA insurance at no cost at all to the ACA insured person.
    Last edited by Melonie; 01-05-2014 at 05:53 PM.

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    Default Re: "Can I still pay cash for medical treatment in 2014" ?

    Unfortunately my state is not offering expanded medicaid. I wish it was so that I could have it just in case until I begin makin, the g more
    Again, keep in mind that while Expanded Medicaid would pay 100% of any medical bills resulting from your treatments now, the state Medicaid office will keep track of every dollar's worth of those payouts ... as well as an additional $2,000+ per year in 'administrative costs'. Even if you start earning more a few years in the future and are able to move to public health exchange or private health insurance, those Medicaid related costs will remain on the state's books. And once you reach age 55, the state can then try to collect those Medicaid costs ( with interest added ? ) from you all at once. If, for example, you had accumulated perhaps $20,000 worth of Medicaid treatments over the course of a few years, on your 55th birthday the state could send you a bill for that $20,000 ( plus 30 years worth of interest ? ). If you don't have the 'cash' available for immediate payment, the state could then move to place a lien on a home you had purchased, the state could 'freeze' $20,000 worth of other assets ( bank accounts, retirement accounts ? ) etc. and recover the amount from your estate upon your death.

    This is an 'unintended consequence' of Expanded Medicaid meets state Medicaid 'recovery' laws ( enacted to recover the costs of elderly people being placed in nursing homes at Medicaid's expense ). But prior to the advent of the ACA and Expanded Medicaid, it wasn't possible for a person under age 55 to qualify for Medicaid benefits if the person owned a home or significant other assets ... which made the instances where Medicaid cost 'recoveries' came as a 'shock' on the ( former ) recipient's 55th birthday extremely rare. However, with the asset 'tests' for Expanded Medicaid eligibility having been waived by the ACA, there are now expected to be literally millions of future instances of states 'recovering' the dollar value of Medicaid benefits paid out in the past when the person reaches age 55. This is likely to mean that millions of children of those ( former ) Expanded Medicaid patients will receive zero inheritances, as the houses and other assets owned by the ( former ) Medicaid patient parent are seized and liquidated by the state to reimburse Medicaid.

    See

    I actually had a young relative still living in New York tell me that he 'stretched' his estimated annual income to be higher than it actually was so that he could qualify for ( subsidized ) ACA health insurance rather than be placed on Expanded Medicaid ... because he doesn't expect to remain low income for the rest of his life, and doesn't want to be 'surprised' with a huge bill on his 55th birthday that could 'claw back' the house he is hoping to be able to buy and the money he is hoping to save.
    Last edited by Melonie; 01-05-2014 at 06:25 PM.

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    Default Re: "Can I still pay cash for medical treatment in 2014" ?

    So I am wondering if I need to go to the er say i get shot lol or cut or car accident and am pretty bad off how would they treat me? Do they try to save my life then once I am better I can come back and pay the er for the services or do they just let me die because I didn't bring say 10,000 with me cause I had no idea I would need the er that day lol. Just wondering.

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    Banned Melonie's Avatar
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    Default Re: "Can I still pay cash for medical treatment in 2014" ?

    ^^^ that's considered to be emergency treatment which health insurance providers are mandated by the gov't to provide to everyone regardless of ability to pay ... thus treat you now, seek payment from you later ... same as if you didn't have health insurance.

    The difference if you have ACA insurance versus no insurance is that, depending on the particular insurance plan, instead of owing the entire $10,000 you would owe 100% of the first ~$2-3-5, 000 ( the annual deductible ), plus 20-30-40% of the next ~$2-3-5,000 ( the co-insurance ), plus zero additional if your annual out of pocket 'cap' is less than $10,000. Well, that's only true if the treatment was provided by an ACA 'network' provider. If you were taken to a health care facility that was outside the 'network' your particular ACA plan covers, you'd wind up owing the entire $10,000. ACA insurance not paying ( much ) for 'out-of-network' medical treatments is likely to be a major problem for 'travelling' dancers, for college student dancers and camgirls covered by their parents' ACA insurance but attending school some distance from the parents' home county etc

    The news reports about health care providers seeking money up front pertained to 'scheduled' or 'non-emergency' treatments ... which fall outside of the gov't mandate for 'emergency' treatment, even though they are medically 'necessary'.
    Last edited by Melonie; 01-06-2014 at 04:26 AM.

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    Default Re: "Can I still pay cash for medical treatment in 2014" ?

    So good to know ty At least I will live if ever I need the er I have a- blood and have to have a special transfusion if ever I needed it so it helps to know they seek payment later or else I would be sol lol. Good to know and ty again u are a goddess seriously.

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    Default Re: "Can I still pay cash for medical treatment in 2014" ?

    There is one thing that I think everyone should keep in mind when deciding on being a direct cash customer vs. purchasing insurance. Cash customers without insurance often pay far higher prices for the same services than those who have insurance, even if the insured person is paying out of pocket because of high deductibles and/or non-coverage of specified services.

    The reasons for this are twofold. First, insurance companies negotiate pricing on a block basis for services for their members and have every incentive to keep the prices down, even if just to extend the amount of time it takes before customers blows through the deductibles. Second, the default rates on debts is much higher with uninsured cash payers, especially for hospitals, so they are playing the odds and build low recovery percentages into their cash pricing.

    This issue can extend even to prescription drugs. Even if you do not have prescription drug coverage as part of your plan, insurance companies often negotiate rates for ALL of their members. I got a taste of this when I went a year without medical coverage, while starting my business some years back, and paid top dollar the couple of times that I had to get prescriptions. Once I got a plan with a recognized carrier, I paid less than half for the same ointment from the same pharmacy, even though I did not have prescription drug coverage as part of my plan. This is why the pharmacies always want your insurance info. even when your particular plan does not provide prescription coverage - so they know what to charge you.

    I am not trying to scare anyone here. If you are young and healthy, you will still probably find that insurance is more expensive than the first year fine plus any cash medical expenses that you incur. But this is definitely something to consider as the deck is stacked heavily against uninsured cash customers who seek medical services.

    Just my

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    Default Re: "Can I still pay cash for medical treatment in 2014" ?

    this is definitely something to consider as the deck is stacked heavily against uninsured cash customers who seek medical services.
    ^^^ this is true for health care providers who are oriented toward insured patients. In essence, these health care providers sometimes use inflated 'self-pay' patient pricing as a means of recovering 'losses' they have incurred due to being forced to provide emergency treatment to uninsured patients who disappear or go bankrupt, a means of recovering 'losses' they have incurred due to Medicaid reimbursement rates being less than the actual cost to the health care provider to treat the Medicaid patient, etc.

    However, there is also a new group of health care providers who are taking this opportunity to 'sidestep' health insurance / Medicare / Medicaid issues by only treating 'self-pay' patients. Mainstream media refers to these providers as 'Concierge Medicine'. See

    (snip)"last year, Dr. Qamar decided to abandon VIP medicine and pursue a no-frills version of his practice, charging just $59 for monthly membership to his MedLion clinics (16 locations in five states) and $10 a visit—and never billing insurance.

    Dr. Qamar is part of a new and growing generation of concierge doctors who, in this era of health reform, see more opportunity in the middle class than they do in the jet set. The trend has bifurcated the retainer medicine industry: On one end, patients pay thousands of dollars a month for lavish celebrity-type treatment at traditional concierge practices. On the other, pared-down clinics charge roughly $50 to $100 a month for basic primary-care medicine, more accessible doctors, and yes, money savings for those looking to reduce their health spending.

    Of the estimated 5,500 concierge practices nationwide, about two-thirds charge less than $135 a month on average, up from 49% three years ago, according to Concierge Medicine Today, a trade publication that also runs a research collective for the industry. Inexpensive practices are driving growth in concierge medicine, which is adding offices at a rate of about 25% a year, says the American Academy of Private Physicians."(snip)

    The reason that 'Concierge' health care providers catering to 'self-pay' patients are able to charge such comparatively low prices are stated to be ...

    - they don't experience 'losses' from non-paying patients and/or below cost reimbursements from Medicaid / Medicare
    - they don't have to pay a back office staff to deal with health insurance company 'paperwork'
    - they don't have to pay attorneys and collection agents to try and recover unpaid medical bills.
    - they can also make 'discount' cash payment arrangements with local medical labs, specialists etc.

    general discussion at ... which incidentally mentions a monthly retainer of $50 per month for patients under age 45, and that the 'discount' cash price for a CT head scan is just $225 !!!

    In regard to prescription drugs at discount prices, some of the big box retailers are also now offering $4 prescription prices on hundreds of generic drugs.

    It would appear that the health care provider 'market' is quickly adapting to the new ACA / Expanded Medicaid dominated health insurance environment !!! A segment of that 'market' is clearly catering to near zero paperwork, near zero new rules and regulations, quick cash 'self-pay' customers. Thus 'self-pay' patients now have a new option that can potentially avoid the inflated cash price levels sometimes charged by 'mainstream' health care providers.
    Last edited by Melonie; 01-07-2014 at 09:09 AM.

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    Default Re: "Can I still pay cash for medical treatment in 2014" ?

    Melonie, good points all and I've also been tracking the concierge medical practice options for quite some time. During that year I referenced above, I actually checked one out. I think that they are decent options for a niche group, perhaps healthy people age 26 to 32 (or so) without kids, but I struggle to see their widespread acceptance in lieu of insurance options.

    Healthy young people (let's say 25 and under) are no more likely to pay a monthly fee to a doctor's office than they are to buy insurance anyway, even if the insurance is subsidized. But since they are all eventually going to be bludgeoned into buying health insurance eventually, I find the thought of them paying even more to a doctor's office even more unlikely.

    People with kids have too many potential medical issues, from pregnancy related expenses to needs for specialists (mother and kids) to hospital services (mother and kids) for this to be a practical alternative to insurance, especially with what we discussed above relating to the much higher costs charged for cash payers vs. those who are insured, even if the insured are paying a high deductible. As someone who, until recently, had a very high deductible plan, I used to receive monthly statements that showed me the retail prices vs. those negotiated by my carrier and I have to tell you that the differences were obscene in some cases. What I was paying out of pocket was bad enough, not only for routine care for my kids but also two different incidents that required after hours care (one to a hospital and the other to a specialist clinic), but the differences between that and what I would have been charged without the negotiated coop insurance pricing more than payed for my premiums for that time period, as high as they already were.

    As for older people, they start to have more complicated needs as they get older, from testing to medications and needs for specialists. Another place, again, where cash payers are severely disadvantaged. They are also at far greater risk for more serious medical issues. I am 43 and the thought of being out there without insurance coverage now is mind boggling. One bad event could wipe out my family and even a less serious event, involving specialists, lots of lab work and maybe even a hospital for certain testing, could cause serious economic damage under the current pricing models used for cash payers.

    Maybe this will change someday, particularly if specialists, hospitals and other medical support facilities change the way in which they charge for services. But, if anything, with the insurance mandate of the ACA, I'm just not sure that will ever be the case.

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    Default Re: "Can I still pay cash for medical treatment in 2014" ?

    ^^^ agree with all of your points, Rick. As you indirectly point out, when subsequent year increases in the size of the new IRS penalty tax for failure to purchase health insurance reaches the already approved 2.5% of gross income, dancers and camgirls earning $50k-$100k per year will be facing new IRS penalties of $1250-$2500 per year for the 'privelege' of paying cash for medical treatment plus paying the actual cash for the medical treatments themselves. At that point, the net costs of purchasing public health exchange health insurance versus paying cash makes the situation a 'no brainer' in favor of health insurance.

    Also, at that point ( when the full 2.5% tax penalty takes effect in 2016 ), dancers and camgirls in the $50k ballpark may be able to 'save' significant money by deliberately reducing their ( reported ) incomes to the $46k level that still provides eligibility for taxpayer subsidized public health insurance premium costs !!! Net of reduced income and SSI taxes, and reduced public health exchange insurance premiums, 'passing up' an extra $4k of annual income could very well result in a $6k reduction in taxes plus health related costs !!!
    Last edited by Melonie; 01-07-2014 at 12:23 PM.

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