<p>The existing thread on premium questions/comment has gotten so long… comments on this might be in there somewhere, so I apologize if they are and this has been discussed.</p>
<p>My ex-H retired a few weeks ago, leaving me and D2 without health insurance coverage starting Feb. 1. For the moment I have signed us both up for COBRA continuation, but need to determine a longer term strategy. Our options are:</p>
<ul>
<li><p>I can continue COBRA indefinitely (not sure why, but because I am a spouse I am eligible until I reach Medicare age – ~14 years). Cost: $535/month for this year. It is quite good coverage, no lifetime cap on coverage, max out of pocket is just a few thousand dollars. I plan to stick with the COBRA for a while for me, as I can’t go back once I give it up. Might eventually switch to an ACA plan, but holding off for now.</p></li>
<li><p>D2 is eligible for COBRA, also for $535/month, but she is only eligible for 18 months. She is 18 and in good health, although may be doing a medicine trial for ADHD drugs this summer. She attends college on the west coast, and we live in the Midwest.</p></li>
</ul>
<p>I thought we could probably do better cost-wise for D2 through the ACA, so have spent some time shopping on our state site. Problem is – every plan on the exchange has significantly higher out of network costs (we pay 40% out of network is the best I could find), and no cap on the out of network expenses we could end up paying. So an expensive hospitalization at college could end up costing a lot out of my pocket (if not driving me to bankruptcy). If she were in-state, the plans look pretty good. But there is not a single plan that seems designed for a college student out of state… Cost difference is very large on the plans (top priced plan on the exchange for her age is $190/month). But the downside that she spends 9 months a year out of network is a problem. Can’t find any fine print on the ACA plans for situations like this (the plan we could COBRA does describe treatment of situations like this quite specifically).</p>
<p>I hate to pay 2.5 times more for the COBRA, and in 18 months will need to make a change for her anyway… has anyone looked at this (or has it been discussed here and I missed it)?</p>
<p>I did look at her college plan. It has poor coverage here when she is home (and she is coming home next summer) and a lifetime cap of $500K, which also concerns me. Seems like there are no mid-range priced plans (~$300/month) that give decent coverage in both locations. I am going to call our state tomorrow and see if they have any suggestions (get ready for an hour on hold… I already talked to them once last week about another question). But wondered if anyone out here had any thoughts on this.</p>
<p>I did think of that, but am a little daunted by traversing yet another state’s website (took me quite a while to get through our own). Also not sure if it will let me be the person who signs her up, as I don’t have an address there. I guess I could call that state and ask… yet another long wait, I am sure.</p>
<p>You can shop for her on the state’s website, and then have her be the one who actually does the purchase.</p>
<p>Some state websites are pretty easy to navigate. The Fed one is also pretty easy. Then again, some state’s sites are disasters. Oregon doesn’t even have a functioning website, and I hear that Colorado’s requires everybody who wants subsidies to prove they aren’t eligible for subsidies.</p>
<p>If your daughter is not looking for subsidies, the easiest thing would be to work with an insurance agent in the area where her college is. It wouldn’t cost you anything.</p>
<p>I suggest a Blue plan, either Blue Shield or Blue Cross, they both SHOULD have access to the nationwide Blue network. Things are changing constantly and things are different in each state. Check the plans in your home & in your DDs school and see which state is better. I have many clients who have successfully used the blue network, but with ACA, there are definitely changes and you have to read and check carefully in your home state.</p>
<p>We’re having the same problem with DS, we live in NJ and he’s in college in DE. All the NJ BCBS plans are EPOs, with NO out of network coverage, so you need to make sure the Blue plans in your state will work out of state. I also looked into getting coverage in DE, but you need to be a resident and he lives in the dorm. I found one plan that may work, the most expensive silver one from Amerihealth. Our current plan is good till September, so we still have time. Good luck.</p>
<p>The ones on our state exchange do not say anything about the Blues network. Also… the psychiatrists in our area who will work with us on the ADHD medication trial are not taking new Blues patients (per our physician) because reimbursement is too low from the Blues. We are in a state that has had a heavy influence of PMOs for many, many years (Minnesota); every plan out there is a PMO-like plan (and I clicked on all of them that came up for her age group).</p>
<p>Her college is in California. It says on the site you need to be a ‘legal resident’ with a clickthrough document, but it is all about illegal alien residence, not from other states. I did some shopping on their website – it is less clear what caps are out of network for the plans there. I guess I will need to call both states.</p>
<p>wwwDOTehealthinsuranceDOTcom should let you browse the lists of policies available in each of the states. Just remember to change the zip code in the search function when you switch from one state to another. After you’ve found something likely, then go back to the state ACA websites. This saved me a boat load of frustration as our MD site is rather shaky.</p>
<p>Called our state exchange today – no help at all. Called a few of the insurance companies offering plans, and found that BCBS says their plans DO have access to the broader network across the US. But I have talked to BCBS twice today, and gotten different info both times (once I heard that only 1 of the plans on the state exchange “travels” to their broader network, but then heard from someone else that all of them do). The documentation on the plans and on the BCBS website does NOT explicitly say that, and in fact seems to contradict the statement that they all do. I feel like I am getting warmer – but am hesitating to buy a plan where the written materials on the website do not match what I am hearing from the reps. :(</p>
<p>Well, lerkin, interesting you should ask that. It turns out that they all do… but you can’t find that out on our state exchange website or even on the BCBS website when you look at the plan info out there (they have a section for our state exchange plans on their own BCBS website as well). But multiple phone conversations have convinced me that those plans DO include the BlueCard coverage. So I just purchased one of the BCBS plans (but had to call the state exchange number to do so). I think the learning experience here is if you want coverage across state lines, call your state’s BCBS company and talk with them. You can’t find the whole story on the exchange or even on their websites.</p>
<p>intparent, I can tell you how Blue Shield works in California: The out-of-network cap is $9500. In-network costs are applied to to that $9500 as well as to the $6500 max – in other words, if there is a combination of in-network and out-of-network, in most cases the max would be $9500. As long as you sign your daughter up for an PPO plan, then she could also use the Blue Card for services when back home over the summer, or if she ends up spending time out of state in future years. See: <a href=“https://www.blueshieldca.com/producer/ifp/products/networks.sp[/url]”>https://www.blueshieldca.com/producer/ifp/products/networks.sp</a></p>
<p>Assuming that your daughter is still your dependent, she would not qualify for subsidizies on the exchange – so you might find it just as easy to shop for an individual plan off-exchange directly from the insurer. The Blue Shield plans are the same both on and off exchange, so costs will not be different – though there’s an odd little wrinkle about dental coverage. It won’t make a difference for BS, but Anthem Blue Cross will tack on an extra charge for pediatric dental coverage that won’t actually benefit your daughter, but only for policies it sells directly. Anthem also has some off-exchange plans that are different than the on-exchange plans. Anthem also has higher out-of-pocket maximums for out-of-network coverage. (Apparently the ACA doesn’t specify a limit for out-of-network – so it’s a lot harder to nail down that info). </p>
<p>Right now you would probably find Blue Shield easier to work with than Anthem --they seem to have shorter hold times and are managing to process payments and mail out insurance cards faster. But that may be a temporary problem – it’s probably worthwhile for you to check out the plans available on the Anthem site as well as there are some more options to choose from.</p>
<p>She is in Claremont. The plan I signed her up for has a $1900 in-network deductible and about 20% copays on most items in-network. Out of pocket max in-network is $5,650. According the BCBS MN people I talked to, in-network includes the in-state MN network (which for this plan is a bit more restricted than the normal BlueCard network, but it is the clinics and hospitals we usually use anyway) AND the BlueCard network for out of state coverage as well. I checked, and the nearby hospitals her campus health clinic generally sends kids to are both on the BlueCard list, as are quite a few doctors of various types in the local community. Premium is $130.11/month.</p>
<p>I think these changes for ACA really are a work in progress. When the president announced in December that maybe you could keep your plan, I saw some states immediately say NO, they would not allow that, other states offer the old plan at significantly higher pricing and another state offer the 2013 plan in 2014 at 2013 pricing. Weird.</p>
<p>I also know a state where the cheapest plans are based on an in state network ONLY in the counties of the largest city, no where else in the state is a doc in network, even if they are a blue doc. BUT, those people still can access the Blue network, so they cannot go two cities over, but can go one state over and be in network!</p>
<p>To be sure, call the insurance company, get her policy #, specifically the first three letters, then try to “find a doc” and it will ask you to input those first three letters and you can see which docs accept that plan.</p>
<p>I know this is a hassle, but it really seems like the insurance companies are figuring out some of this as the go along.</p>
<p>I don’t think the states got to decide whether pricing would change if you got to “keep your plan”. What they got to decide is whether sub-standard plans could continue to be sold in the state or not for this next year. Anyway, that has nothing to do with our issue – we lost our health care because my ex-H retired, not because of anything to do with ACA.</p>
<p>In fact, in our state the cheapest ACA Blues plan also is using a network in the largest city (which we happen to live near and already use that network, so it works fine for us). But the higher cost plan outside that city network is only $10/month more to give you a stronger network across the state, although the deductible is somewhat higher. I almost bought that plan anyway (gives access to Mayo Clinic, which is attractive to me). But decided that was pushing the risk avoidance too far for a healthy 18 year old, and picked the plan with a more limited network in-state. Nice part is that we can change her plan annually if our needs change with no pre-existing condition issues.</p>
<p>I am still darned thankful that the ACA went into effect this year even if it was a headache to sort through the plans and pick one. No worse than helping my mom with Medicare Part D choices several years ago – I actually thought that was much worse.</p>
<p>intparent, can you tell me specifically how ACA benefited you anymore than the previous system. In reading your posts, I may have missed it.</p>
<p>“What they got to decide is whether sub-standard plans could continue to be sold in the state or not for this next year.”</p>
<p>Not really. They got to decide if non-grandfathered plans could continue to be sold. It has nothing to do with whether the plan is sub-standard, only if you owned the plan prior to March, 2010. You could have had the greatest plan in the world but if you didn’t own it before March, 2010, you would have lost it. Conversely, the plan could have been crap but if you owned it before March, 2010, you would have been able to keep it.</p>
<p>I should clarify, the state departments of insurance got to decide yes or no as to whether the insurance companies could or could not offer the 2013 plans in 2014. The insurance companies got to decide the pricing, I am not sure why, but I saw a case in one state where the 2013 plan’s premium would not go up at all and in a different state a client’s premium went up substantially in keeping the 2013 plan.</p>
<p>My understanding is that the reason many plans were cancelled is because they did not meet the minimum requirements for plans under the ACA. When you read the fine print, thinks like ambulance service, or even hospitalization :eek: were not included in some plans on the market. A lot of people learned the hard way that their plans did not cover basic services. I am happy with the opportunity to purchase a plan through the ACA exchange because I KNOW it meets those minimum requirements without having to try to anticipate and figure out everything I think it should cover. I have worked in health care for about half of my career, and even I have trouble keeping all the things I should look for in a plan in mind. So to me the peace of mind of knowing the plans had to meet those minimum standards to even be sold on the exchanges was a good thing.</p>
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<p>That is completely untrue. Only if your insurance company made a decision to cancel it, but they were in no way required to do that if the plan met the ACA standards. And the insurance company certainly could have modified the plans (and the premiums if required) if they wanted to in order to continue offering the plans that did not meet the standards. The only plans that had to be “grandfathered” were those that did not meet the minimum standards of the ACA. All others could stay as is on the market; it was up to the insurance company if they wanted to cancel them, but there is no requirement for that in the ACA at all.</p>
<p>Also, I am pleased that she did not have to prove she did not have any pre-existing conditions to purchase the insurance. It is good for her, but will be especially good for me if I eventually decide to move myself off COBRA in a year or two. Who among us reaches the age of 50 without something that would be considered pre-existing, and either wouldn’t be covered or would result in complete denial of coverage? I think in spite of the rollout issues, which are temporary and will be sorted by the next enrollment period, it is a pretty great thing.</p>
<p>By definition, grandfathered plans were set up before the date you are stating. But what the ACA says is that grandfathered plans must eliminate lifetime benefit caps, offer coverage to dependent children over age 26 and eliminate pre-existing condition exclusions in 2014, but they are exempt from most other ACA reforms. They did not have to be cancelled if they met those conditions. New plans set up after that date do have to meet all the ACA conditions. What the states were allowed to do was let insurance companies continue to sell even plans that did not meet those minimal reforms for this year. Some states chose to allow those post-March 2010 plans that did not meet the minimum standards to be sold for one more year; some states did not allow it.</p>
<p>Not that it matters in our circumstance. We were able to purchase a plan that we knew met minimum standards with no pre-existing condition or health verification check. If I want to do that for myself next year or the year after, I can do that. A year ago I wouldn’t have been able to. I am happy with the change in the law, it increases my affordable options and gives me consumer protections that I think are valuable.</p>
I am going to call our state tomorrow and see if they have any suggestions (get ready for an hour on hold… I already talked to them once last week about another question). But wondered if anyone out here had any thoughts on this.</p>