<p>calmom: I wonder how many CA residents remember the years of IOU’s and threatened IOU’s from Sacramento. In my particular circle of acquaintances - especially the younger ones - that was a shock. It scared not just a few into better planning so that refunds were non-existent or very very minimal.</p>
<p>Yes, it does take planning to not be owed a refund. But, for the average W2 wage earner it sure doesn’t take a sophisticated level of planning. If you own a small business with assets held only in the name of the business and have the ability to alter your taxable wages based on distributions, then the planning is a bit more sophisticated. But those are the folks who have the resources to do just that.</p>
<p>As a CPA I am dreading all this more every day. It will be a nightmare. W2’s won’t reflect the health coverage accurately. People won’t have what they need or will provide bad info. The IRS will issue incorrect notices (more than they do now It will be a vast wasteland of time which is written off.</p>
<p>Above poster is correct. Many (most?) taxpayers get scared when they get an IRS letter and want to pay it asap. Please don’t ever do this until you thoroughly understand the letter and are sure it is correct. At least half, if not many more, are incorrect. Lots of notices issued now about not being allowed the HSA deduction, even when the taxpayer has the Form 5498-SA, <em>which was filed with the IRS</em>, showing the contribution.</p>
<p>Time to retire Oh wait, I can’t afford the health insurance to do so!</p>
<p>"If the federal government wins the case, the current investing outlook remains unchanged. But if Oklahoma emerges victorious, things turn topsy-turvy.</p>
<p>Hospital stocks would likely plunge, especially those that operate in states that aren’t operating health insurance exchanges. Tenet Healthcare (NYSE: THC ) , for example, has hospitals in 10 states. Nine of those states opted against setting up their own exchange."</p>
<p>LasMa says: From what I know of concierge medicine, the target market isn’t the very sick who need lots of care.</p>
<p>Certainly the very sick who need lots of care are not the target market. What I want to know is whether they will become the actual market. The services concierge doctors offer are a lot more valuable to a person with a chronic disease than to someone like me who is basically healthy.</p>
<p>^ I am sure it works well for the chronically ill who are willing to pay extra for it like it was a small country club membership.</p>
<p>What is unsaid is that someone needs to have a comfortable living to pony up 1500 an year for the privilege of being able to visit the concierge doctor.</p>
<p>Some concierge doctors like to portray themselves as brave pioneers solving the problem of modern medicine. All they’re really doing is solving the problems of modern medicine for doctors.</p>
<p>“Certainly the very sick who need lots of care are not the target market.”</p>
<p>My husband’s doctor who is changing to “concierge” is an specialist (Diabetes, Metabolism & Endocrinology) so he has a bunch of people with a chronic disease. So in this case the very sick are the target market. And the people who can afford it will pay the extra 1650 a year because they are sick and they aren’t going to want to risk finding another doctor who can treat them.</p>
<p>Also, a concierge Dr. can function nicely as central control. If you are very ill, your concierge Dr. will see you that same day. They can then recommend/refer you to appropriate specialists (which can be in-network). Many Dr.'s have great relationships with other Dr’s. and their referrals go to the front of the line. In addition, if a patient has concierge medicine and also a good non-medicare/medical plan they will eagerly be accepted by other practitioners.</p>
<p>I’m still curious to see how ACCESS to care pans out for ACA plan members. If these insurance contracts pay a provider less than non ACA plans…well…if you were a provider which patient would you choose/move to the front of the line?</p>
<p>H went to a concierge Dr. for a very specific and limited program. It was an amazing experience. For a flat fee he received unlimited visits, was given a number of highly specialized tests based on the results of previous tests. And, this Dr. had an agreement with the labs that resulted in shockingly low costs (we ran them all through our insurance anyway just for interests sake).</p>
<p>When you talk about non-ACA plans, do you mean methods of paying for medical care other than insurance? Every health insurance plan has to comply with the ACA.</p>
<p>I’m referring to the contractual reimbursement amount based on CPT codes. For example, one provider in my BS network has a ‘special contract’. (they basically extorted BS into this because in some areas they are the only viable option and CALPERs relies heavily on them). One in network provider will receive $90 for the same CPT code this ‘special contract’ provider receives $330. I am NOT making up these numbers. I’ve tracked this particular issue for several years. Now, the same CPT code is reimbursed by Medicare/Medical (because in that system we are consider a rural county) to the tune of $35. If the ACA contracts reimburse at a Medicare rate it would be just stupid for providers to accept any significant number of these patients.</p>
<p>People who buy individual insurance policies through the exchanges are buying normal insurance policies from normal insurance companies. Just like other insurance policies, the in-network and out-of-network doctors and hospitals will be specified at purchase time. Insurance companies will be free to negotiate whatever rates they negotiate with doctors and hospitals. It’s not obvious to me, if BeWell Insurance was able to negotiate low reimbursement to doctors for some of its customers (the customers on the exchanges, for example) why it wouldn’t negotiate that same low reimbursement for all of its customers. Insurance companies are not in the business of paying doctors and hospitals any more than they have to.</p>
<p>People under 133% of poverty who are newly eligible for Medicaid (MediCal, in California) will be getting Medicaid. It will be like Medicaid is now, because it is Medicaid. Providers will be paid the Medicaid reimbursement, because they will be seeing Medicaid patients.</p>
<p>The reimbursement amount a provider receives depends on the contract a specific provider has with a specific insurance. For example, I have a BS PPO plan. When I go see an in network Dr. their charger rate and the subsequent contract (negotiated rate) varies significantly. CPT code XXX can have a charger rate of $330 (the charger rate is usually the same as the URC for network providers). Now what really matters to the patient is the negotiated rate which is the basis for insurance payment and patient co-insurance payments. Different providers have different negotiate rates. If a providers negotiated rate for CPT XXX is $330 and I have to pay 25% after deductible, this is significantly more than if the providers negotiated rate is $90 and I pay 25%.</p>
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<p>The question is WILL they be seeing low reimbursement patients. There are already practices and individual Dr.s which have closed their practices to Medicare/Medical patients because they just can’t afford it. If more low reimbursement patients come online…who will see them? Again, insurance coverage does not equal access to care.</p>
<p>If you were a provider and had a choice of patient A who would reimburse your practice $330 and patient B who would reimburse your practice $35 which one would you pick. How far can a practices charity extend?</p>
<p>Medicare/Medical was always meant to function as a cost sharing system - privately insured patients paid a premium thus making the average compensation when Medicare patients were factored in a viable option. This structure doesn’t seem to be valid anymore.</p>
<p>I do not know how the ACA plan reimbursements are structured. If they are closer to the current traditional private plans or if they are closer to Medicare/Medical. If the latter…I predict there will be a number of newly insured who will not be able to get an appointment.</p>
<p>Once again, when you talk about ACA plans and ACA contracts, what are you referring to? I am not aware of a thing known as an ACA plan. </p>
<p>I concur that some doctors do not see Medicaid patients. That existing problem may exacerbate with the influx of Medicaid patients under the ACA.</p>
<p>I am curious as to what the contracted rates will be for those plans offered via the exchanges…sorry for the lack of clarity…there are so many layers to this system and so many buzz words. </p>
<p>Do you know if the plans offered via the exchanges will reimburse providers at the same rate current ‘private’ (pre ACA/non exchage?) plans reimburse. I suspect not. This is based on the fact that at last check the CoveredCA website (which shows the exchange plans) did not offer a BS PPO option for my geographic area. I strongly suspect ( and have pretty much confirmed this with my broker) the reason for this is that the ‘special contracts’ provider could not get their required reimbursement rate and therefore will not participate in the BS plan. BS will only offer and EPO - which suspiciously leaves this particular LARGE VOLUME provider off of the in network list. Aetna and Healthnet did offer a PPO plan the last time I checked but they had higher premiums and I still don’t know if this major provider was included.</p>
<p>Again, this is just suspicion on my part…but it is based on years of tracking this stuff…both the reimbursement rates and the subsequent provider behavior.</p>
<p>CoveredCA came out today with their latest pricing info…I haven’t had the heart to check it out.</p>
<p>Really, this is a game…the sad thing is those least able to ‘play’ are the ones most in need. I’ve taken over all the Medicare Medicare supplement Medicare D stuff for the elders in our extended family. There is no way they could navigate this themselves.</p>
<p>The companies on the exchanges (for example, the companies in CoveredCa) all negotiate their own deals with the providers. There is no one “reimbursement rate”. There are only contracts between insurance companies and providers, just as there are for other health insurance policies people can buy.</p>
<p>dietz, @ #1574, you make an excellent argument for getting private for-profit companies out of the health insurance business.</p>
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<p>My wildly anti-ACA boss just got a refund from Blue Shield the other day, thanks to ACA. Second year in a row. I thought her head was going to explode. She simply can’t make that refund match up to her idea that ACA is the end of western civilization.</p>
It will be a vast wasteland of time which is written off.</p>