Last week former president, George W. Bush had heart surgery. A preventive stent was placed inside his arteries to allow a continued flow of blood to his heart. The idea is to prevent a future heart attack to the former president.
Stenting is very popular among cardiologists for people who have already had a heart attack. However, it is apparently a controversial procedure for people who are not showing any signs of cardio-vascular disease. Many cardiologists say that the benefits of stenting can be achieved with medicine and there is no need for the invasive procedure.
If that is true, it would eliminate both the physical discomfort of recovery from surgery and the financial discomfort of paying for the expensive procedure.
“The debate has centered on both the cost of stenting, which can run as high as $50,000 at some hospitals, and its side effects, which can include excess bleeding, blood clots and, rarely, death. Opponents say the overuse of procedures like stenting for unproven benefit has helped keep U.S. medical care on pace to surpass $3.1 trillion next year, according to the U.S. Centers for Medicare and Medicaid Services.” Michelle Fay Cortez in Bloomberg News.
I am not a cardiologist. I am an insurance specialist. My job is not to make input into your diagnosis or treatment. My job is to help my clients pay for the medical decisions they make.
WHAT OBAMACARE WILL PAY FOR STENTING
With the National Open Enrollment about 7 weeks away, George W. Bush’s surgery allows you to get an idea of what Obamacare’s “Metal” plans will actually do.
All of the Essential Benefit Plans would help pay for your doctor, surgeon and hospital bills. The Bronze plan would pay 60% of the bills, the Silver plan would pay 70% of the bills and the Gold plan would pay 80% of the bills.
The problem is that you will be required to pay the portion of the doctor’s, surgeon’s and hospital’s bill that is not paid by your insurance plan. (Unless your household income is less than 250% of the Federal Poverty Level, don’t expect any help from the government.)
Fortunately, all of the Obamacare Essential Benefit Plans have Out-Of-Pocket caps. They require your insurance company to pick up the cost of the entire bill after you have paid a stated amount in deductibles and co-insurance. (For 2013 that amount is approximately $6300.)
WHAT OBAMACARE WILL NOT PAY FOR STENTING
Unfortunately, none of the Obamacare Essential Benefit Plans will pay for your bills while you are recovering. According to Web M.D. recovery from heart surgery can take 6-8 weeks.
That means that in addition to the $6300 of unbudgeted medical bills, you would have to be able to make 2 payments each for…
- Credit Cards
- Cable TV if applicable
You would also need to buy consumables such as food and gas.
It is a perfect example of why financial specialists advice you to have 3-6 months worth of income set aside in a Rainy Day fund before you start an investment strategy.
Unfortunately, most Americans do not have a Rainy Day fund. Many middle-class Americans live from one paycheck to the next. An emergency heart stent could cause them financial ruin.
Fortunately, there is a supplement to the Obamacare Essential Benefit Plans that would give you enough money to pay for what your health insurance does not pay your doctors, surgeons and hospital.
Critical Illness insurance pays you a lump-sum of money in the event you are diagnosed as having had a heart attack or stroke. You can use that money to pay your share of medical bills. A $10,000 policy is very inexpensive for most people.
If you do not have sufficient money in your Rainy Day fund, I would also encourage you to consider purchasing $10,000 – $20,000 more benefit to have the money to pay your non-medical bills while you are recovering if you are employed.
Ideally, you will speak with a local insurance agent to help you find Critical Illness insurance. However, I have provided a link at the bottom of this post for fellow Texans to shop for and apply for Critical Illness insurance.
I do not think that this supplement is for everyone. However, if you are dependent on your income and have had a blood relative suffer from heart attack or stroke, I highly encourage you to look at a minimal Critical Illness plan to supplement your Obamacare plan. (Especially if you have little to no Rainy Day savings.)