I would like to be able to have a wider range of plan options available that could save me money. I would also prefer to be able to pay for routine visits out of pocket and have insurance be for catastrophes only. I don’t need maternity coverage.
Right now our plans are so limited that I cannot find a plan that includes both the local hospital and a doctor I would want to go to.
I am dealing with a health insurance broker and she tells me that most of her customers trying to find insurance plans are very dissatisfied with the options.
@noname87 Unfortunately, no one can answer your questions. No one knows what’s going to happen. Several good bets, though:
The individual mandate will very likely be repealed, meaning that there will be fewer healthy people in the individual market especially. It's doubtful that insurers would be allowed to go back to declining sick people, but they may be able to charge more. Unknown if there will be a limit.
Expect the buy-across-state-lines to be part of the new plan, with the resulting race to the bottom. This could mean that healthy people could buy bare-bones coverage at a reasonable cost, and sick people will be priced through the roof and/or have exclusions as to what's covered. Preexisting conditions, for example.
When the dust settles, I expect it to look very much like it did before ACA: Young and healthy people will probably be OK-ish. Older and sicker people will be screwed.
Oh, that’s just so super about Medicare. My DH will turn 65 in October. He’s been staggering through the individual market for years, just waiting for the time his healthcare would finally be safe. Or so he thought until this week.
I am so sick of the turmoil and uncertainty and unceasing fear surrounding my family’s health insurance. It’s been going on for decades, stopped for two years, and now it’s starting up again, for D as well as DH.
I believe the insurance companies are already, in effect, charging more for those who are sick.
People who have high cost medical needs cannot afford a basic Bronze Plan where out of pocket costs are much higher.
So, people suffering from chronic disease or an ongoing medical crisis, are attracted to plans with much lower out of pocket charges and more comprehensive coverage.
Those who are “healthy” are attracted to plans with the lower costs & with a higher out of pocket share, hoping/gambling they don’t need to max out the patient’s share of the costs.
And, it appears the insurance companies are not offering affordable prescriptions for certain medications associated with high cost diseases. Sorry! This [expensive] drug is not covered on your plan, or your co-pay for this class of drug is…astronomical.
I seem to recall a news story? radio? podcast? in the last couple months where a patient was forced to stop an effective seizure medication she’d been taking for years, with success, because it was prohibitively expensive under her ACA plan. The med she switched to was affordable, but NOT effective at keeping her seizures at bay.
I hope I haven’t offended anyone; I very much share concerns about what will happen to health care costs and insurance and what has already happened to them.
Until 1997, my family had health insurance through my (now ex-)husband’s employer. Then he was fired. I think we went for a few years without insurance. Then we bought a plan. I was working but my employer resisted making my position officially half-time, thus depriving me of paid benefits, including a contribution to health insurance. Then H got another job (in 2004). That job also provided health insurance. In 2009, H was again fired. We were able to stay on the employer’s insurance under COBRA, and while it was expensive, it cost less than it might have at other times, because of a temporary federal law under which premiums were subsidized. When the COBRA coverage ended, we went to the open market. I worked with a broker, whose services were free to us (she was paid a commission by the insurance companies). Her help was invaluable. We had to fill out applications for each family member, and had to include information about every medical condition for which any of us had sought treatment for several years. We were able to get a plan but it was very expensive and there were exclusions.
In 2012, I was working more hours, and I got a new boss. She asked me (and each of my coworkers) what she could do to make our work experience better. I said, “Health insurance!” She went to bat for me and I’ve had a plan since. One daughter is aging out this year, so she and I are concerned about what will happen, although I did tell her that I (and her dad, if I can be sufficiently persuasive!) will help her with any health-care costs she incurs, no matter what happens.
“People who have high cost medical needs cannot afford a basic Bronze Plan where out of pocket costs are much higher.”
Is this really true though? When we priced plans, at least non-ACA plans, premiums for Platinum/Gold were astronomically higher than for Bronze. In our case, [Premium + OOP Max] for, say platinum, was significantly higher than [Premium + OOP Max] for Bronze. As in five figures of difference.
If you know you are going to hit the OOP max due to major health issues, is Bronze the better deal after all due to hefty premium savings?
I find a lot of the cost difference isn’t so much metal tier as breadth of network and accessibility of specialists.
However, the individual market is failing because the (unpopular) ACA individual mandate (an added tax* if one does not have insurance) was insufficient to bring enough healthy people in to avoid the adverse selection problem. Removing the individual mandate while keeping the prohibition on denial due to pre-existing conditions will simply accelerate the trend toward adverse selection and result in complete failure of the individual market.
*which is likely to be considerably lower than the cost of individual medical insurance plans for most people or households.
It is not surprising that you may find a higher deductible / OOP maximum plan to be competitive or less expensive even in the high use case (though it may not be the case in all situations). Higher deductible plans tend to result in lower costs because patients have more incentive to consider cost (self-rationing) when choosing medical services, just like when buying other goods or services. So insurance companies can price them accordingly. Of course a low user is likely to find the higher deductible plans less expensive due to the lower premium.
DH went and talked with his HR rep today. What they are saying is that while the govt may change the law, the employer has the prerogative to, for example, extend the timeline for removing people (if the 26 yo rule changes) or choose how long to give people to find other coverage if necessary. Granted, this is a very very large employer. But they have been clear that nobody is going to get thrown to the wolves or abruptly dropped, no matter what happens in 2017. LEgislation is one thing, implementation is quite another.
And it depends on who’s doing the implementing. That is very generous of your DH’s employer. Not all employers will be so generous. And who knows if individual-market folks will get any kind of help with transitioning.
I don’t even understand the idea of privatizing Medicare. My mom is 91, she just had a stroke and she has -Alzheimer’s. Oh, and she lives in NJ, a high-cost area. Would the Feds hand her money and ask her to buy insurance? Who in their right mind would insure her? And who in their right minds would think that a 91-year-old in a wheelchair with progressive dementia would be able to do comparison shopping?
Let me get this straight. I don’t have to buy insurance (no individual mandate), but then if I get sick the insurance company has to allow me to buy it at the going rate (no denying insurance for pre-existing conditions).
So then insurance will be prohibitively expensive for everyone. Basically this is a way to destroy the individual health insurance market.