<p><a href=“http://www.coveredca.com/news/PDFs/CC_Health_Plans_Booklet.pdf[/url]”>http://www.coveredca.com/news/PDFs/CC_Health_Plans_Booklet.pdf</a></p>
<p>One thing I find interesting is Kaiser is not cheaper than other plans.</p>
<p>Page 118. Are vision and dental just covered for kids? The sentence mentioning vision and dental care is poorly written.</p>
<p>Didn’t read it carefully but I did notice that the insurance would cost my 28-year-old daughter less than she is currently paying…</p>
<p>Is your daughter in Calif?</p>
<p>I have looked at this and also participated in a phone survey.</p>
<p>As it stands our monthly premium for a family of 4 will go from a current Blue Shield PPO plan for $1100 to a Blue Shield EPO (fewer providers with a ‘gate keeper’ physician) for $1600/month. I’m not going to get into a discussions on the merit of ACA for those already doing ‘their fair share’ of paying into the system since the numbers speak for themselves.</p>
<p>Of interest is that two insurers - Aetna and United Health Care have announced they are pulling out of the CA individual plan market. And this is most likely just the beginning…</p>
<p>[Second</a> major health insurer pulls out of California market](<a href=“http://yubanet.com/california/Second-major-health-insurer-pulls-out-of-California-market.php#.UdY9GOustiU]Second”>http://yubanet.com/california/Second-major-health-insurer-pulls-out-of-California-market.php#.UdY9GOustiU).</p>
<p>Also, those that can have started to get cozy with concierge practices</p>
<p>[Why</a> concierge medicine will get bigger - Elizabeth O’Brien’s Retire Well - MarketWatch](<a href=“http://www.marketwatch.com/story/why-concierge-medicine-will-get-bigger-2013-01-17]Why”>Why concierge medicine will get bigger - MarketWatch)</p>
<p>Yes, Mr. Toad’s Wild Ride has just begun.</p>
<p>
That’s what it says: “pediatric services, including dental and vision care.”</p>
<p>Dietz199, Phone Survey? Who interviewed who?</p>
<p>Unh and aetna are not players in the individual market in Ca. It does stink that they wont play because it limits competition.</p>
<p>
Is that what you’ve been told, or what you anticipate? I have an individual Blue Shield PPO / Health Savings Account plan that is grandfathered in – it’s not offered in the future, but as far as I know I can keep the plan if I want. $3500 annual deductible. I pay $410/month now but I’m age 59 and it the existing plan will probably go up by about +$150/month when I turn 60. It looks like the exchange plans will cost a lot more for me, but as far as I know I’ll be able to keep the HSA as long as I maintain continuous coverage.</p>
<p>Re: [Why</a> concierge medicine will get bigger - Elizabeth O’Brien’s Retire Well - MarketWatch](<a href=“http://www.marketwatch.com/story/why-concierge-medicine-will-get-bigger-2013-01-17]Why”>Why concierge medicine will get bigger - MarketWatch)</p>
<p>PPACA appears to have little to do with the trend toward concierge medicine, since small non-concierge primary care practices have been getting scarce already, probably due to insurance economics (lots of small payments means a lot of administrative overhead per revenue dollar). Non-concierge primary care physicians accepting new patients are mostly found in large multispecialty practices, where the administrative burden is shared with the specialists, who get a ready source of referrals.</p>
<p>dstark: I was called by a company doing a survey for Covered California. It took about 20 minutes and asked details about ZIP code, income, family size, smoking, family health history,ages and pre-existing conditions (was anyone under long term care/therapy for any issues). At the end of the survey I was given a quote of $1600 for a Silver plan under Covered California and asked if this was an attractive option. Obviously a question I couldn’t answer since I have no idea at what cost- or even if - my current coverage will still be available.</p>
<p>What I found very curious is that after the 20 minutes of questions - which all were at least tangentially related to health care insurance I was asked as the very very last question whether I identified as LGBT. No idea why that would matter.</p>
<p>
</p>
<p>From the article:</p>
<p>
So while not a major player, these withdrawals will affect a number of people.</p>
<p>Blue Shield will NOT offer a straight forward PPO plan in my service area. I strongly suspect (and current broker has confirmed my suspicion) this is due to the fact that Sutter is THE major player in town and has merged with or absorbed much of the competition. Sutter enforces a ‘special contract’ whereby its charger rates are the billed rates thus making them anywhere from 3-5 times as expensive as say…Stanford.</p>
<p>Also, remember that rate band adjustments for age will be annual under ACA where as prior to it’s implementation they were on an approximately 5-10 year basis.</p>
<p>As far as HSA’s… again as per our broker who has been doing this for 35+ years…they fall into a grey area. ACA imposes limits on out of pocket expenses and HSA’s, by definition, have high OOP costs. According to straight forward numbers, they seem to not qualify under the new system. But that would certainly interject another big unintended consequence so who knows what will actually happen.</p>
<p>The booklet PDF linked above lists “family of four” premiums at about $1100 or less for a “silver” plan. The “family of four” consists of two 40-year-old parents and two children under the age of 21.</p>
<p>OOP maximum can be as high as $6350 individual or $12700 family, so there is certainly a reason to consider an HSA plan if offered.</p>
<p>I’ve also heard some negatives about Sutter. I called a hospital in my area that has recently been acquired by Sutter, to ask about costs for a certain procedure. I ended up talking to a really nice woman with the job title, “financial counselor” - she was wonderful, telling me my options and the costs. I was so happy that I thanked her profusely and said that I was going to keep her name and phone number handy. Then she told me that she was being laid off at the end of the month – apparently Sutter does not think her job is necessary any more, and plans to replace that function with an automated system or web site or something along those lines. Anyway, she then shifted into something of a rant as to how difficult things were becoming under Sutter. </p>
<p>I don’t really know many details beyond that – but I think your posts makes it clear that not all cost increases we see can necessarily be laid at the doorstep of either the ACA or the insurance companies – the health conglomerates are also a major player. </p>
<p>I do think that one way or another I am going to find myself paying a lot more for health insurance than I want to when I hit the 60-and-over age bracket. I guess if I have to go to the exchanges I’ll opt for the bronze plan (lowest rates) and just count the days until I am eligible for medicare. But hopefully I’ll be able to keep my HSA.</p>
<p>HSA’s will be allowed under the new system:</p>
<p>
</p>
<p>[HSA’s</a> and the Affordable Care Act](<a href=“http://insurance.about.com/od/healthgloss/a/Hsas-And-The-Affordable-Care-Act.htm]HSA’s”>Health Savings Account (HSA) Mistakes To Avoid)</p>
<p>
[HSAs</a> will thrive under the ACA ? News ? ConnectYourCare](<a href=“http://news.connectyourcare.com/2013/03/hsas-will-thrive-under-the-aca/]HSAs”>http://news.connectyourcare.com/2013/03/hsas-will-thrive-under-the-aca/)</p>
<p>So I’m pretty sure I can keep the HSA – what I don’t know is what will happen to my HSA rates – and how they will compare to the exchange rates. Again, for me part of the problem is that I turn 60 in 2014 – so for me the ACA implementation comes in tandem with entering the most expensive age bracket for health insurance.</p>
<p>I would add that even with the high deductible, my HSA has gone to paying 100% of basic preventive care (the stuff that the ASA mandates) - so I think I can finally afford that colonoscopy I’ve been putting off. So it may be that Blue Shield made some specific changes to the plan in order to make sure that it met ACA requirements.</p>
<p>The merging of practices into larger ones (e.g. Sutter Health) is likely advantageous for the providers in negotiating rates with insurance companies. Of course, this results in higher prices.</p>
<p>Calmom, have you seen the articles about medical costs in Time Magazine and the NYTimes?</p>
<p>If people have their own health care plans they do not have to buy an ACA plan. The question arises for me…will plans already in existence and ACA plans end up with similar pricing?</p>
<p>I just think that for me (self-employed, individual plan) - there’s no particular guarantee that the plan I now have will remain available. I believe that there are California state regs that would restrict the ability of my insurer to arbitrarily raise my rates, but I don’t think anything stands in the way of them simply deciding not to offer that particular policy any more – especially once the exchange is open. And why should a company that is fully participating in the exchange continue to maintain old-system policies that are more costly for them?</p>
<p>The promise of ‘if you like your plan you can keep your plan’ has already proved false. Our ‘grandfathered’ plan was discontinued last year. </p>
<p>We are currently a small business, with two employees - DH and myself. We qualified for a BS group plan which has increased in cost and decreased in benefits over the years. However the exchange option is even more costly with less coverage. Not sure what will become of our current plan. I’m not willing to go to an EPO option (vs PPO) so we may be forced to change.</p>
<p>DH will be 60 this year and this is reflected in the rates. I’m just sitting back waiting for the tidal wave to hit and will then try to determine the lay of the land.</p>
<p>It is my understanding the Insurers will be able to continue existing group coverages (even if they are not ACA compliant) past January 1, 2014. This waiver is an attempt to keep the exchanges from being flooded by a large number of now orphaned group members. However, I think the group needs to have 50+ members.</p>
<p>Another interesting question to which I have not received any clear answer is what constitutes ‘income’. As many on CC know the FAFSA and the CSS-Profile both calculate ‘need’ but the results (due to what is considered an asset and what is income) can be the difference very large. Which model with Covered California use?</p>
<p>Plans are discontinued or changed all the time.</p>
<p>My brother in law called Covered California and those prices that are posted are not official. Cant rely on those numbers.</p>
<p>By the way, my brother in law and my sister have pre conditions and would not be able to get healthcare in the private healthcare market without ACA. With ACA, they may be paying 30,000 a year for healthcare. So the choices are extremely bad or bad.</p>
<p>The exchanges won’t work unless they are reasonably affordable to those who are relying on them. If the premiums end up too high, then the only people who buy into the exchanges will be those who qualify for substantial federal subsidies – meaning that taxpayers will be paying indirectly. So it will amount to the same overall net effect as a government single-payer system coupled with an income-based premium (Like the “Medicare for all” plan that I would have liked to see). The only difference is that there will be $$ flowing to private insurance companies.</p>
<p>“The only difference is that there will be $$ flowing to private insurance companies.”</p>
<p>If the insurance companies werent involved, health care would cost my brother in law something closer to 20,000-24,000 rather than 30,000. My daughter might be out of a job however.</p>