Because my employer does not pay any of the premium for family members, my D has had an individual plan with CareFirst (Blue Cross) for more than 10 years. Once the ACA came along, it was grandfathered in. BUT last year, they jacked up the price of it by nearly 100% to force people into ACA plans.
Surprise, the ACA plan actually offers better benefits, particularly on prescriptions. I just got the letter about the price increase yesterday, “only” about 10 percent, but they are bumping her from a $250 deductible to $1,000. It’s frustrating to have to wait till Nov. 1 to see if there are any better plans out there for her.
“Pyramid scheme? That’s how insurance works.”
you can not buy auto insurance or flood insurance after the accident or flood. but you can now sign up for health insurance after you get told you need triple bypass surgery. that is technically not a pyramid/ ponzi scheme but it is absurd. you can get a diagnosis turn around and sign up for insurance and the company is going to have to write a check for 80-100,000 . why not do the same with auto insurance…call GEICO from the accident scene and tell them you need 2 million in coverage, you just had an accident and need them to cover you. it is the same thing.
Sigh. There is only one company on the marketplace in our county. It is an HMO and the only hospital in our little town is leaving the network next year. That means the nearest hospital on the plan will be more than 25 miles away, whereas our local hospital is about a mile from my house.
^^ Are there other options on the off exchange market? Sometimes insurers who do not offer a subsidized plan offer other plans for full pay via their websites. I’ve noticed that those have more robust networks.
You cannot sign up for health coverage after the Dx unless you wait until open enrollment, so that limits the immediate abuse, though that person in excellent health who chose to go without coverage, can enroll for all future coverage once their health situation change
Home, auto, and life insurance base the premiums and coverage on the item being insured and the risk. If you are 25 but have a $500k home located on the beach in prime hurricane territory, you’ll pay the same premium as the 65 year old next door. If you are the 45 year old six blocks from the water in a $200k house, you’ll pay less. If you don’t want replacement value, you can opt for a policy covering less. Everyone in the pool is paying for the coverages and benefits he wants. Car insurance is similar, with higher premiums for riskier drivers, more expensive cars, conditions within that state (snow, ice, tornadoes) More of a box than a pyramid, with everyone paying their share of the risk. Bigger risk, bigger premium.
For health insurance, with only a few exceptions, everyone is paying the same even if the risks are not the same. Healthy people pay the same as those in poor medical shape. Young pay as much as old. The entire program was set up so that the volume of healthy payers would subsidize the sick. That hasn’t happened. Healthy workers are in employer group programs and many who would like to be self employed or work part time or do something else are now, more than ever before, trapped by insurance to stay with the employer. There just aren’t enough $65k+ earners (no subsidies) buying off the exchanges and paying the full cost, and with the 2017 prenium increases of 50% or 100%, there will be fewer.
Yes,policies have to comply with ACA. I meant that the insurers can’t make ACA compliant policies profitable outside of group coverage. My kids had a pre-ACA policy that I thought was very fairly priced. They were healthy kids. I paid about $75/month each, and it covered 4 doctor visits, vaccinations, major medical, etc., but excluded transplants and pregnancy and experimental drugs. It even covered dental, vision, and hearing exams and treatment. If we exceeded the 4 office visits, I had to pay the full cost until I met the deductible, but received the negotiated rate (maybe $50 instead of $250 for an office visit?). I’m sure Blue Cross made money off the policy since in the several years we had it my kids each went to the doctor once or twice, to the dentist for cleanings, and that’s all I remember as claims, but I was paying an amount I felt represented the risk BC was taking.
That policy is no longer available because it didn’t cover pregnancies, didn’t cover pre-existing conditions, didn’t cover other things required by ACA. Blue Cross got rid of all the low risk policies and just designed one ACA compliant policy and the cost was the same for everyone, whether they are 10 or 110. The premium went sky high.
Kaiser seems to be pretty good at the ACA but many people don’t like Kaiser because of the ‘group medicine’ approach. However, I don’t think people are getting to keep their doctors, hospitals, preferred urgent care centers on their policies either. The ACA doesn’t force doctors to accept the insurance plans and many aren’t accepting them or taking new patients. My parents, on medicare, have to change their plan this year since their plan pulled out of the state. Luckily, their long term doctor will accept the new plan, but he doesn’t have to.
New York and Vermont are the only two states where age doesn’t make a difference for insurance premiums. It’s state law (not federal law) that premiums have to be the same for all ages.
Young don’t pay as much as the old for health insurance in my state. I believe the only thing ACA mandated was that women not be charged more for health insurance than men.
This isn’t true. That’s why they ask for your age.
“The entire program was set up so that the volume of healthy payers would subsidize the sick.”
This has always been true regardless of ACA. Same is true for other types of insurance. Those not having a fire or storm damage to their home and those not involved in accidents are subsidizing those who experience these events.
"Healthy workers are in employer group programs and many who would like to be self employed or work part time or do something else are now, more than ever before, trapped by insurance to stay with the employer. "
Not sure this is true but what IS true is those who have health issues and who would previously been uninsurable due to preexisting conditions can now leave their employers to find better or more rewardable jobs, retire early, or start a business.
“with the 2017 prenium increases of 50% or 100%”
This is an exaggeration. The vast majority are not seeing increases at these levels.
@twoinanddone With the pre-ACA policy you describe in post #110, what would have happened if your child needed a transplant or needed more than 4 apps due to a major health event? Either you’d be facing catastrophic bills or “society” would have been bearing that cost. There were a lot of hidden costs to the economy from uninsured or underinsured people (I’d argue your kids fell into the underinsured camp with that policy) before ACA.
ugh. I just looked at next year’s offering on the exchange. Only BCBS and Cigna (HMO only) in my county. If we keep the same low level bronze ppo plan, our premium (without subsidies) for two adults, two kids, goes from approx. $1100 to $1900 per month.
If they needed more than 4 office visits, I would have paid the negotiated office visit rate (which was $50 or $60) until I reached the deductible (which wasn’t terribly high, like $1500? maybe less), and then the stop loss kicked in, which I don’t remember if it was 80/20 or fully paid. If they needed a transplant? Just like other group policies of the time, that was an excluded procedure. Even now I don’t think transplants are required under ACA so yes, the cost falls to society, to fundraisers, to St. Jude’s. This was a plan just for children, and one of the big exclusions was pregnancy. It was a risk I took (but not a big risk as my kids were 10-13 years old). I couldn’t afford to insure against everything and wasn’t looking to have 100% coverage, but I thought the policy covered what we needed. For the years we had that policy, I know I paid more in premiums than my kids used in services. That’s how it is supposed to be because I’m not prepaying for medical services and hoping to break even, I’m paying to cover a risk and really don’t want to need that insurance. Another family may have had more claims than they paid in premiums during those years.
I pay for car insurance and I hope never to use it, hope never to have an accident. I’ve paid thousands and thousands in premiums over the years and had very few claims. I’m good with that.
I have seen people posting of 100% increases in premiums, from $400 to over $800 per month. No subsidies. I saw a couple post at 25-40%, but if it is $750 to $1000 per month it’s still a lot, and that person is still paying more than the 100% increase people. If there is no increase at all but the person was paying $1500 last year and is paying $1500 this year, still a lot.
I think there should be a basic level of coverage from the government (like medicaid) available to everyone, but if you want something different then you can pay for it. I know there are lots of problems with that, especially in getting doctors to be part of that system, but I don’t think this system is fair at all In some states there is no medicaid for low income, in others it is a very inclusive plan. Should a 25 year old get get everything covered, including dental care in Colorado but the 25 year old in Florida get nothing at all, not even a flu shot?
^Why not? We could gradually lower the eligible age from 65 until it covers everyone. I can’t imagine it’s so much more expensive than the subsidy. I am fortunate to have a retiree coverage. My kid will probably not be so lucky.
Because Medicare reimbursement rates are too low to cover actual costs. Because ACA policy reimbursement rates are also lower than ‘regular’ policy reimbursement rates. Because care providers can not survive on those reimbursement rates alone. They depend on cost shifting. Charge a ‘private’ person 4X the Medicare rate and you can afford to take Medicare patients.
The financial structure of the ACA can not work. It never could. Now, in the process it is weakening the underpinnings of Medicare and Medicaid. Providers are leaving the Medicare system in greater numbers.
It all sounded so good, unless one looked under the hood. Now the hood has popped open.