<p>We have a CDHP (HSA plan), and I have been happy with it. We pay the first $3100 of all costs (Rx is included in the deductible), then 20% up to $10,000 max OOP. I have not reimbursed us for much the past couple years, and we now have over $12,000 in the account. I am saving it for retirement … it will be there to pay for a medicare supplement or long term care insurance. The problem with the CDHP plans is that people who do not have any savings can get slammed if they have a major medical event before they have enough in their HSA to cover the deductible and max OOP. When I worked in group insurance, one of my accounts had employees who made minimum wage, and they were moving toward a CDHP … they ran a campaign for a year in advance, encouraging employees to do payroll deductions to begin an HSA account before the CDHP plan kicked in. Even people who make a lot of money don’t seem to have savings these days, so it seems like a lot of people have trouble with the CDHP plans.</p>
<p>I had a situation the other day that perturbed me. My son recently turned 21, and he can no longer go to his pediatrician (much to his disappointment). He has not yet been to another doctor. Last week, he got a sinus infection and needed antibiotics. I called around to try to get him into a doctor, but they all were “too busy” and suggested their urgent care facilities (that’s the latest thing here - the docs have UC’s associated with their practices, so they don’t see sick folks - they tell them to go to the UC). I called around, and none of the UC’s could tell me how much his visit would be. One of the receptionists said, “You have insurance, right? It will just cost the copay.” First of all, I haven’t met the deductible, so it’s 100% right now … and second, ***?? Seriously, does this woman not realize that SOMEONE is paying the full amount??? Either the employer (which is our case, since it is self-funded) or the insurance company … and either way, the cost gets passed along to everyone in the plan … higher costs translate into higher rates. So the idea that we can be savvy healthcare consumers is a pile of hooey.</p>
<p>“there is some provision in the law to count agreements like this to avoid penalty for no isurance,”</p>
<p>People who might decide to use doctors who have boutique practices still will want to have insurance. They could get in a car accident and need hospitalization, many surgeries, physical therapy, etc ., etc., etc. Or the might be diagnosed with a disease which they will need specialized doctors and care. So unless they are extremely wealthy and can afford to pay for hundreds of thousands of dollars for treatment - they will also have insurance.</p>
<p>About “boutique” practices: Aren’t these just providing service in the same way as <em>the old days?</em> I remember that in the past we all had to submit our own insurance claims after we received the doctor’s bill in the mail, and either we paid the doctor bill up front and took reimbursement from the insurance company ourselves, or had them send it directly to the doctor. We did all the paperwork, not the doctor’s office. Are <em>boutique</em> doctors different from this?</p>
<p>“I am sorry that your daughter had to go through this, but I don’t think that if ACA was in place during that time, the outcome would have been different.”</p>
<p>I don’t think so either. I do think the outcome would have been different in Canada. I’m no great fan of ACA, but if gets us closer to universal coverage, we will be in a better position then (and only then) to address the quality of care issues that have we have managed-to-care-less about for the past 50 years.</p>
<p>Re third world drugs, I just saw the Constant Gardener, based on a Le Carre novel, about Africans being used as unwitting subjects for clinical trials. Good movie. </p>
<p>Re boutiques. My brother received word from a doctor who was living his practice for one where for $2k annually you get same-day appointments, returned phone calls, and similar amenities–all related to doctor face-time. But anything beyond–labs, diagnostic services, surgeries, etc–is paid out of pocket or out of your insurance’s pocket.</p>
<p>One thing, you have to be a very good doctor to have that kind of practice, someone that people are willing to pay extra money for. Plus, if they know that people are paying out of pocket for all the rest, they might be a little more careful about how they spend it…instead of, “Hey, lets just run fifty lab tests because your insurance pays for it.” Or, “Let’s take care of this in the surgical center instead of my office, because your insurance pays for it either way.”</p>
<p>Geez, call me lucky, but I don’t get that sort of run-up-the-charges from my docs. They generally explain whether tests are needed and many times (no, make that usually,) I’ve had them explain why they are not. They do get very annoyed when I delay the mammo or colonoscopy. DH only had one situation - he didn’t think he needed the physical therapy. But frankly, he had brought that particular physical complaint to the doc. </p>
<p>If we really laid this out, do you all usually have subpar services and over-delivery re tests?</p>
<p>"The same dynamic explains why rates in New York’s individual market were so high. Only about 17,000 New Yorkers buy individual health plans in a state that has 2.6 million uninsured, Bloomberg News reports. State rules forced insurers to offer coverage to everyone, regardless of how sick they were, without forcing healthy people to buy insurance. That created an insurance market in which the people buying policies tended to be sick people who needed lots of medical care. The resulting coverage “was so expensive that nobody ever bought it,” Hasday says. “It was really the last recourse. I’m sure that the risk pool was horrendous.”</p>
<p>The above is getting fixed.</p>
<p>Ae are going to need a little more detail about these plans. Hopefully sooner rather than later.</p>
<p>the thing I really like best about what I’ve seen about the NY rates today is that the individual plans are affordable for the middle class. This is really excellent. A person who wanted to get away from a job they felt tied to could do so, and this is a thing that brings freedom.</p>
<p>I don’t see, yet, how ACA is going to help the minimum wage workers, yet, but maybe they’ll figure it out eventually.</p>
<p>OP, I really don’t see why you couldn’t just give your employees a raise in the amount of what you used to pay for their insurance and let them go into the individual market. It might be a better play all around.</p>
<p>“The state approved plans to be sold by 17 insurers, including UnitedHealth (UNH) Group Inc. and WellPoint Inc., the industrys two biggest carriers, according to a statement today by New York Governor Andrew Cuomo. The lowered rates mean that starting Oct. 1, a New York City resident who now pays at least $1,000 a month for insurance will be able to buy coverage for as little as $308, according to rates posted by governors office.”</p>
<p>“Some of the products may only contain a narrow option, and so members may not be able to see pre-chosen doctors or a hospital of their choosing, Mansfield said by phone. Overall, though, having more people insured would be an improvement.
State officials estimate that more than 600,000 people will buy coverage within the first few years at the lowered rates, according to the statement.”</p>
They should be eligible for expanded Medicaid in the states that have implemented it. </p>
<p>I don’t know what will happen in the states that are not expanding Medicaid. The ACA was written with the assumption that everyone below a certain threshold would qualify for Medicaid, and the federal government was picking up the lion’s share of the cost for the expansion. So that’s a part of the law that needs to be rewritten, but no chance of the present Congress doing that. There’s just going to end up with a serious imbalance in care options depending on what state a person lives in. We west coasters will probably see much close to universal coverage than some other regions of the country.</p>
<p>I think it’s a big shortcoming of the law, personally, given that this was really the original point of the law, imho. However, I suppose there will be pressure brought to bear on the states where the residents are not getting the same services as others and it will work itself out over time.</p>
<p>On a personal level, I am hopelessly confused. One thing I have figure out is that the exchange has an “open enrollment period” – probably from October 1 -mid February the first year, but maybe October 1-December in future years. You aren’t going to be able to simply sign up and move around outside the open enrollment periods-- so that’s why it won’t work to simply wait until you get sick before buying insurance. </p>
<p>I also am assuming that even if insurance companies can’t deny coverage due to pre-existing conditions, they probably will never have to give retroactive coverage, and there probably always will also be an exclusion period for coverage of medical expenses relating to pre-existing conditions. An exclusion period is a time frame – say 60 or 90 days – before benefits kick in. So a person who has decided to forego having insurance who is an accident or gets sick may have to wait until the next open enrollment period to sign up, and at that point may still have to wait for several months until benefits start to kick in. (So anyone planning to sign up for the Bronze plan with the idea that they can switch to Platinum if the need arises, can scratch that idea).</p>
<p>Re post #417: I think that this may be resolved temporarily via some sort of executive order or emergency regulation. They way the law is written, a family with income under 133% of the poverty line is not eligible for an exchange subsidy, because that person is supposed to get Medicaid instead. But with states leaving a gap in coverage, it seems to me reasonably that individuals who are not eligible for medicaid should at least be qualified for the same subsidy level as the next tier up of income. That’s still a hardship, as it forces really poor people to pay more than they can really afford – but at least it’s not impossible – and I can’t see any valid social or political reason to deny people in those categories those subsidies.</p>