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It will apply for the individual plans. The ‘deferred’ part is for those small employer group plans which are complaining about their rising costs. Obviously if those group plans are able to retain higher OOP’s for the coming year, it’s hard to see why their premiums would have to go up markedly. I’d think that the higher premiums would be associated with expanded coverage.</p>
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<p>This goes to Busdriver’s question about why the government can’t just fix what needed to be fixed, and leave the rest alone. In general, the problem is that health insurers like to insure healthy people, and they don’t like to insure sick people, and that’s largely the system we’ve had. You can’t blame them, exactly; they’re in business to make money, and they’ll make a lot more money if they only insure healthy people. Of course, healthy people get sick, and then it’s nice to have insurance; to some extent, that even helps the health insurers, because knowing there’s some probability they’ll get sick (or injured), even healthy people will want health insurance (although this is somewhat less true for the young, some of whom think they’re invulnerable, but eventually most people come around). </p>
<p>So the health insurers want to try to exclude the sickest people to the extent possible. They do this in several ways. First, they either flatly exclude people with specified pre-existing conditions from individual coverage, or they make such coverage so prohibitively expensive that no one can afford it. That’s now prohibited under the ACA. </p>
<p>Second, they write yearly and lifetime caps into policies if they can. Often the people buying the policies–either individuals or employers–don’t spend a lot of time thinking about the circumstances under which those caps could be exceeded, because they’re more focused on the premiums, the scope of the care that’s covered, the doctors and facilities they’ll have access to, etc., than about annual or lifetime caps. And they’re really happy to have health insurance, or to be able to provide it to their employees, not stopping to think that when insurance is most needed is in catastrophic situations, when costs are highest. But the annual and lifetime caps effectively mean that if the insured gets really, really sick, or has a preemie baby or something, they’re suddenly uninsured. Well, the ACA addresses that problem, too, by prohibiting annual and lifetime caps; but that certainly is going to raise some people’s premiums, especially people who have been buying insurance with annual or lifetime caps. </p>
<p>Third, in states where they can get away with it, the insurers will jerk around individuals and small businesses by jacking up their rates if some of the people covered under the plan do get seriously sick or otherwise incur large health care costs. I suspect in many cases the insurer doesn’t even want to continue the coverage, they just jack up the rates so high that it delivers the message that they don’t want your business anymore, so take it elsewhere. It’s harder for them to do that with large employers because the large employers typically offer them a large risk pool in which much of the variability in individual health care costs is likely to even out (in addition to which, many large employers self-insure, with the insurance company essentially just administering the plan to the employer’s specifications). But for individuals and small businesses it can be a big problem: you think you’re buying good coverage, but it’s only for a year, and if within that year someone incurs large medical costs, all bets are off and you may need to go shopping for coverage somewhere else for the next year, which in some cases may not be available, or it may be so expensive that you need to trade down to a less attractive plan.</p>
<p>This latter problem is addressed by a modified community rating system under the ACA. Instead of rating individuals, families, or small businesses on a case by case basis, insurers will need to set uniform statewide rates, establishing uniform rates for all individuals within specified age groups, and for all small businesses on a per-member basis (subject to some additional modifications which I won’t go into here). That means the small businesses that have been paying the lowest rates (often based on low average health-care costs of people insured under the policy) may see their rates increase, while those that have been paying the highest rates (based on high actual or expected health-care costs) will likely see reductions. Complicating matters, however, businesses may elect to “grandfather” health plans that were in effect on Nov. 26, 2012, i.e., to stay with the same plan rather than switching to a community-rated plan.</p>
<p>Bottom line, you can’t “solve the problem” (getting health insurance for uninsured sick people) without also affecting “the rest of it” (since “the rest of it,” at least in the individual and small-group market, consists largely of people who have had somewhat affordable health care coverage until and unless they get seriously sick or injured and need costly health care). </p>
<p>The link below is to a site that has a pretty good glossary of terms, very helpful in figuring out how the ACA is supposed to work:</p>
<p>[Adjusted</a> Community Rating - Health Reform Provisions](<a href=“http://www.uhc.com/united_for_reform_resource_center/health_reform_provisions/adjusted_community_rating.htm]Adjusted”>http://www.uhc.com/united_for_reform_resource_center/health_reform_provisions/adjusted_community_rating.htm)</p>
<p>^good posts calmom and BClintonK.</p>
<p>H is retiring at the end of the month. Our monthly health insurance deduction will go from $230/month for a United Health Care HMO to $4236/month. How does one pay for that? The least expensive plan for retirees will cost us $2736 a month with high deductibles and $1000 cap on prescriptions. Will sign up for one of the subsidized plan while waiting for medicare to kick in.</p>
<p>Wow, worrytoomuch, $4236/month?! That’s a lot.</p>
<p>Now, can you clarify: was the $230 a month the cost of your previous plan, or is it just what you were paying (but an employer also paid part of the costs)? How many people are covered by this payment? Is the $4236 the COBRA cost?</p>
<p>How are you going to sign up for a subsidized plan-- subsidized by who? Are you at 400 percent of the federal poverty level or less, so that you qualify for federal subsidies?</p>
<p>“It will apply for the individual plans.”</p>
<p>Calmom - have you seen the story in Forbes? They don’t seem to be making much distinction.</p>
<p>^^^^That’s the article I read</p>
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<p><a href=“http://www.forbes.com/sites/theapothecary/2013/08/13/yet-another-white-house-obamacare-delay-out-of-pocket-caps-waived-until-2015/[/url]”>http://www.forbes.com/sites/theapothecary/2013/08/13/yet-another-white-house-obamacare-delay-out-of-pocket-caps-waived-until-2015/</a></p>
<p>'Wow, worrytoomuch, $4236/month?! That’s a lot"</p>
<p>Please tell me there is an extra digit in there somewhere. That sounds impossibly high.</p>
<p>'There’s no such thing as a free lunch. If you ban lifetime limits, and mandate lower deductibles, and cap out-of-pocket costs, premiums have to go up to reflect these changes. And unlike a lot of the “rate shock” problems we’ve been discussing, these limits apply not only to individually-purchased health insurance, but also to employer-sponsored coverage. (Self-insured employers are exempted)."</p>
<p>In addition, self-insured employers will be hit with large fees, apparently just as a money grab. Can’t come up with another reason why.</p>
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<p>So these schools can no longer offer fake health insurance plans that don’t actually cover a student who gets pregnant and has a very premature baby, or a student who gets a bad kind of cancer, or a student who develops schizophrenia, or a student who has a car crash with a serious head injury.</p>
<p>Yeah, what a shame that the colleges can no longer offer those plans.</p>
<p>I went back and looked at the Forbes article. Those colleges were offering “health insurance” with a $10,000 cap! Forget covering a risky pregnancy; that wouldn’t, or would barely, cover a healthy pregnancy. I guess no young college women 18-22 ever get pregnant.</p>
<p><a href=“http://www.forbes.com/sites/theapothecary/2012/06/05/obamacare-increases-costs-of-college-health-plans-by-as-much-as-1112/[/url]”>http://www.forbes.com/sites/theapothecary/2012/06/05/obamacare-increases-costs-of-college-health-plans-by-as-much-as-1112/</a></p>
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<p>That is totally stupid. I can afford a $10,000 medical bill. I need insurance to protect me from financial ruin, ie a $100,000 medical bill, a $500,000 medical bill. I don’t need insurance to pay for every doctor’s visit and every prescription. I need protection from disaster.</p>
<p>Kid #2 was paying around $2300 per year for his university insurance. Now he has employer (mostly) paid. Kid #1 we just waived the $650 per semester (that does not provide year round coverage) insurance from school because he has private insurance for $100/month. My wife and I, age 60, pay $680 per month to Blue Cross Blue Shield of NC. They had a big meeting today to explain the ACA. I was going to attend, but finally figured that a pep rally at Bank of America stadium was probably not the best way for me to get answers to my specific questions about my situation.</p>
<p>busdriver - If I am not mistaken, you have what might be labeled as a Cadillac plan? I have read some stories recently where counties are asking the unions to cut back on their plans or give up pay raises in order to pay the taxes for the plans.</p>
<p><a href=“A Limit on Consumer Costs Is Delayed in Health Care Law - The New York Times”>A Limit on Consumer Costs Is Delayed in Health Care Law - The New York Times;
<p>It sounds to me like it is employee group plans it effects. According to the article it was businesses who asked the administration for the delay. </p>
<p>Also: "The grace period has been outlined on the Labor Department’s Web site since February, but was obscured in a maze of legal and bureaucratic language that went largely unnoticed.:</p>
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<p>What fees are these, busdriver?</p>
<p>10s of millions of dollars my company will be required to pay to the government because they are self insured.</p>
<p>So I’m assuming other self insured companies will all pay the additional fees, adding up to a lot of $$</p>
<p>How many in the nation are covered by employer plans?</p>
<p>It’s also worth noting that the money we pay out on medical insurance will now go to shoring up the value of our homes. Medical expense is the biggest single reason for bankruptcies which lead to the loss of a home. The majority of people who lost their homes due to medical issues had insurance, but the insurance ran out or the insurance company denied coverage. If your town is full of foreclosures, the value of your own house plummets as well. </p>
<p>I personally consider that if my neighbors can buy insurance, and that insurance won’t disappear when you get a long-term illness and the insurer cancels or covers up to $1mm before capping out, then that’s actually a type of insurance which helps me too.</p>
<p>What fees are these, specifically, busdriver? I found mention of a $1 per life covered PCORI fee to cover some data gathering, and a $63 per life covered fee, for the first three years of Obamacare, to cover reinsurance for new high-risk patients on the individual market, but those don’t add up to tens of millions of dollars for any company. What other fees are you referring to?</p>
<p>It is the Cadillac plan tax.</p>
<p><a href=“Health Care Law Raises Pressure on Public Unions - The New York Times”>Health Care Law Raises Pressure on Public Unions - The New York Times;
<p>Actually the fees I was referring to are in addition to the Cadillac fine. They hit companies that self insure, based upon how many people insured. It will cost my company more than 50 million, just for this fee. Now that doesn’t bother me so much, they seem to have plenty, but they are passing it on to the employees by reducing their coverage under the guise of trying to comply with no Cadillac coverage early.</p>