Affordable Care Act Scene 2 - Insurance Premiums

Parent Cafe
3021

<p>“Saw this article about how many doctors are participating in NY. Apparently doctors are not signing up. Doctors seem to be voicing many of the same concerns as our poster, Frugaldoctor.”</p>

<p>A response from the President of the Medical Society of NYS (Post got name of org. wrong) on the NY Post article:</p>

<p>“What the Post got right was our concern about the Exchange’s specifics. However, their omissions were misleading.”</p>

<p>Sam Unterricht, MD
MSSNY President </p>

<p>Here is the link to his full response: <a href=“http://www.mssny.org/mssnyip.cfm?c=f&nm=enews101813[/url]”>http://www.mssny.org/mssnyip.cfm?c=f&nm=enews101813&lt;/a&gt;&lt;/p&gt;

3022

<p>All of you posting about median income - those numbers seem high. Are those MHI numbers, or HUD income eligibility numbers (which are based on MHI)?</p>

3023

<p>HUD numbers.</p>

3024

<p>This is confusing. It’s time for us to pick our insurance plans for the year. I have a child who is 23 and is employed full time and has insurance through her work. She lives out of our state and her insurance covers the area she lives in and ours covers the area we live in. </p>

<p>I read here that our insurance has to cover her. I’m confused, can we drop her from our insurance? I can’t drop her on our enrollment election, which is on line, but is there a way my H can call HR and have them drop her from our insurance. The other thing the website says is that if we misrepresent our dependents, my H could be terminated. She has her own insurance and has no need of ours. </p>

<p>I do want to report here that my H’s company self insures and there have not been many changes to our plan or to our costs. Yes the price went up but less than 10% and the coverage is a bit different due to the ACA but not substantially.</p>

3025

<p>Emilybee, I read the explanation by Dr. Unterricht, and I have to admit that I am confused. He seemed to confirm everything that was said in the article, but then claimed its omissions were misleading. Only problem with that is these so-called omissions were generally regarding the functioning of the NY exchange, which was not the subject of the article. He didn’t contradict the fact that more than 2/3 of the doctors have not signed up for the exchange. I also wonder how many of the better known teaching hospitals in NY have signed up.</p>

<p>cpt, before selecting a plan, I would check the provider network to see if you like the selection of doctors and hospitals available for your son.</p>

3026

<p>Your insurance does not have to cover your employed daughter who gets insurance through her work! She has to have insurance. She does. Problem solved.</p>

<p>If she didn’t have insurance on her own, you could put her on yours. But she does have insurance on her own.</p>

3027

<p>I still don’t know what “2/3 of the doctors have not signed up for the exchange” would mean. Doctors don’t sign up for the exchange. Doctors sign up as providers for insurance company plans, or if they belong to provider groups, the groups sign up.</p>

3028

<p>Yes CF, I should have said it your way. Was just using shorthand. 2/3 of the doctors have not agreed to join the networks for plans on the exchange.</p>

3029

<p>GP, I didn’t have trouble understanding him. </p>

<p>“I spoke to the reporter for about 20 minutes. Our conversation focused on the low fees and the fees that have yet to be announced. I told him that physicians are uncertain if they can afford to participate and our patients are unable to determine if their physicians will be participating in the plans they are considering.”</p>

<p>"Yes CF, I should have said it your way. Was just using shorthand. 2/3 of the doctors have not agreed to join the networks for plans on the exchange. "</p>

<p>At this time.</p>

3030

<p>But then that brings us to, why are they asking individual doctors? That is, a doctor works for Provider Group X, but the individual doctor might well not even know which plans Group X is signed up for for 2014, or whether some of those plans are on the exchanges.</p>

<p>If I were a doctor who belonged to a group, I’d be leaving that negotiation to the negotiators, while I took care of patients.</p>

3031

<p>emilybee, aren’t you concerned by the statement you just quoted by the MSNNY President?</p>

3032

<p>Emillybee, my DH works for a major company and gets a very good health plan which is taken by a lot of hospitals and doctors. So, switching to something else, it becomes a question of what is covered by that plan and what doctors will take the insurance. Around here when you call for any appointment with any doctor, the first question asked is “what is your insurance carrier?”. We’ve never had any issues.</p>

<p>However, with the ACA options, I would not be surprised in the least that there will be doctors not signing on. NYC especially has a large number of Concierge practices, where there are many top name doctors who take NO insurance. You pay and you get what your insurance will cover of their services, and you do the reimbursement process yourself. There are enough people who are well to do and are willing to go this route. I don’t know of any of the top hospitals here that do, however. I have gone to a few specialty doctors for consultation that operate that way, but because I was referred by a doctor they knew they did the courtesy of charging me only what the insurance covered.</p>

<p>In London, Harley Street is famous for having such doctors who operate outside of what the insuracne covers. They charge what they please. NY does have such a segment, and whether it grows or not, we’ll see. </p>

<p>When managed care became prevalent and hospitals and doctors were asked to join networks and adjust their prices accordingly, many refused. Many have since had to relent as they lost too many patients that way. They found out that they were not so special after all that their patients were willing to pay the premium. I know a number of very well to do folks who still check the insurance lists, and will check out the doctors taking their insurance and are in network, first, so one has to be well connected and have some great rep for folks to pay a premium out of pocket to be treated by you. The times I have seen such doctors, as I said, they did reduce their prices to what my insurance would pay. I’m not anyone special, so if they woud do it for me, they have done it for others, and their office seemed to know exactly how to handle the process. </p>

<p>So I’m sure a number of doctors will sit this out and see if they can weather this. If it hurts their wallets enough, they’ll come around. My friends husband screamed long and loud when he had to join a network, some years ago, but he been made to heel. He’s screaming again, and who knows what will happen with this development.</p>

<p>I’ve checked out the NY marketplace, and the hospitals and doctor I’ve been using seem to take the insurances listed just fine. When I checked earlier, there were some insurances not under ACA that were not accepted by a number of doctors I know, and they curiously did not cover mental health issues which is required by NY state, but as a low cost state subsidized program (but not that low cost, still in the $400 a month range) they were given an exemption. It also had other holes in coverage that made me drop it from consideration. This is where COBRA coverage can be a benefit because one doesn’t have to go through all I did to check the comprehensiveness of the insurance. I have the time and ability; not everyone does. My son would not bother, and i wouldn’t trust him to do this, though I’ve made him go over what my research brought out. He’s young and foolish, and spoiled, I’m afraid. But I want him covered insurance wise as I don’t want to find myself having to make hard decisions if he needs medical treatment that is very expensive and not covered under life threatening provisions. </p>

<p>If enough people are on the exchanges, and many companies are changing to exchange like structures, by the way, many of the doctors will be goose stepped into cooperating. That’ s the way the market works. Time will tell. </p>

<p>My son will be age 26 in February, and the day he turns 26, he’s off our insurance. His income this year will be just over what the new Medicaid cutoffs will be, but he will be eligible for subsidies, unless he comes into a huge windfall. Without the subsidies, his premium cost was close to what COBRA woud charge, about $6K a year, and with a hefty deductioble and co pays and other limitations. Now he can go with a $6K deductible catastrophic coverage that is basically free with subsidies. And the silver plan has some nice choices for reasonable costs as well. Big change over what was out there in September. He will be able to afford his insurance now, and with some push from DH and me will be paying for it himself. Not possible without the subsidies.</p>

3033

<p>CF, most doctor groups are partnerships (at least where I live in NY) and the decision whether to accept an insurance plan or not is up to the partners (and not all the doctor’s in a group are even partners - some are associates.) The partners will be the ones who vote on it. I imagine once they get the fee’s the partner’s will decide which plans they will accept. </p>

<p>I’ve been in a PPO for 20+ years and not every doctor or group takes my insurance. I had to find doctor’s/groups which did and so that is who I go to. </p>

<p>I don’t know of any doctor who accepts every insurance plan.</p>

<p>GP, no, I am not concerned.</p>

3034

<p>Deb922, I just did our selections for next year, and I, too, now have a son who has his own insurance and lives out of state. We had to say he has insurance It asks. In our case, he could stay on our coverage at no cost, but his job has excellent insurance that is paid for him and is better for where he is living as he is with a company that deals with this sort of thing. One thing the insurance always asks is if anyone covered has other insurance and in our 23 year old’s case, he now has. I did not drop him because there is no cost benefit to do so, as once we select coverage for children, the cost is the same regardless of how many are covered, but it is now secondary insurance for him. So his health insurance is free of cost from two carriers, whereas my other son has to get his own in a short period of time. </p>

<p>Goldenpooch, I’ve been on the phone and computer for a long time checking out doctors and hospitals. It’s been a pain, and very difficult. I doubt many people will do what I’ve done to this degree, and I have found good selections for both my son for next year and our family. Though I did find a number of doctors who’ve yet to join the market, I’ve also found enough resources and the hospitals are just fine, including the best in the country, so I am feeling just fine about this. Which I was not In September. I was worried sick, and figuring we’d be paying out quite a bit next year, but it’s looking good due to ACA and the way NY has reacted so far. I 'm sure a number of the recalcitrant doctors will be joining when they lose their patients, just as it happened with manage care. </p>

<p>My friend who has had her doctor for many years, got notice that she is now going private. No insurance taken is what the letter said. You take care of the reimbursement yourself, and this move was so the doctor could take care of her patients the way she wants to, not the way the system is dictating. Well, my friend who is very well to do, and who has always recommended her doctor, barely blinked an eye and switched. So much for brand name loyalty. I was a bit surprised. Loved that doctor but not enough to have to go through the hassle of insurance reimbursements and paying that much more. Nope. </p>

<p>Now when you have to have a tricky surgery with a low survival rate, that’s when people are willing to pay that piper, but he’s still better get that money up front. I’ve known folks who have gone the concierge route and when the fees somehow were not collected up front, they have negotiated with those doctors and gotten them reduced.</p>

3035

<p>Goldenpooch, I quoted per capita income because you asked about me - and I am a single person who lives alone, so it doesn’t make much sense for me to compare my situation to a family or a household. Having two adult earners in a household instead of one usually increases income – but more important, having kids in the home is a HUGE difference in expense. </p>

<p>On the other hand, I did raise two kids and put them through college on my income --but I also borrowed money and it was a stretch. Things have gotten easier for me financially simply as the kids grew up and became self-supporting. That’s just a lot less money I need to spend every year. </p>

<p>The other factor is that when you are looking at the expense to live in a particular area, that figure is impacted largely by the cost of housing. But long-term homeowners live in their own self-created bubbles. Looking at median incomes or median expenses for an area never really tells you the whole story, especially in an area where housing tends to take the biggest chunk of income.</p>

3036

<p>'Emillybee, my DH works for a major company and gets a very good health plan which is taken by a lot of hospitals and doctors."</p>

<p>Then you have no need to concern yourself with what is available on the exchange as you and your H won’t need to purchase an individual policy. Plus, it seems from what you wrote that your son will get good insurance at a very reasonable rate on the exchange.</p>

3037

<p>Though for us, ACA appears to be a win-win, and it does benefit the low income family member so that he can afford insurance when would not be able to pay for it pre ACA, and so far in NY, the market has reacted the way it’s supposed to with the drastic premium drops for the draconian rates that were out there pre ACA, that doesn’t mean there aren’t those who will be paying more. If we did not have employer insurance, we’d have ended up with a sharp increase. We are in the income category that is expected to provide the subsidies to those like my son. It has to come from somewhere, and that is where one can expect to hear the screams. Also from those employers whose rates have gone up even more. I have a friend who has a small business, who pretty much decided that since he is just under the wire in having to provide insurance, he is not going to continue to do so. This decision was really made two years ago when premiums went up sharply for his company, and this year’s increase, made the decision final. Each employee including himself, will get their own insurance from the exchanges, and he will give everyone a raise on a prorata basis out what he feels he want so pay for health care. If it covers your premium or even goes over, great. If it comes out of pocket, too bad. For himself, he says he’ll be paying a bit out of pocket as will the higher payed employees. The lower paid ones are in the gravy. Overall he saves, since the company will no longer be footing the premium bill. He’s been running these numbers for over two years, and this looks like the final go since the market prices are now out. He is not in NY. The employees who have to pay more for probably less of a plan are upset, understandably. The others got a raise. But this way, their insurance is no longer connected to their jobs and is each employee’s concern and choice, which is something he has always believed should have happened, but where he lives, getting individual or family coverage on ones own was very expensive and difficult. Any preexists, and you are done. THe choices were not good, and navigating them was very difficult. With the exchange in place, it’s much easier for people to see the choices and go with them each year. </p>

<p>My doctor friends are very, very unhappy. They all predict a loss of income next year for themselves. Don’t know if it 's the case. Many have had to sign up because of their affiliations, but some are hedging. Some are seeing that they had better, or they’ll lose current patients who are checking to see if their doctor are on board, and are picking new doctors rather than new plans. </p>

<p>How all of this will shake out next year, I don’t know. Even more of a question is what it means for our country, all of us in the direction that health care will take. Will doctors’ salaries really go down to a point where people won’t become doctors anymore? Given the pay scales and job availabiliites for the health care industry as a whole, I don’t think so, but that’s my opinion. and I ‘m just saying… no expertise in this area. My friend whose husband is a doctor was shaking angry, saying that this will reduce her husband’ pay to about $85K a year. I don’t think so. That’s what some non MD healthcare workers are making these days, and doctors are needed to be directing a lot of this. There may be a slump and there may have to be a redistributions of where the doctors are. Here in the NYC suburbs and area, there are many, many doctors. Where I lived in the midwest, the MDs got a lot more respect, to the point that there was an aura around them, Not here, other than those at the top of the heap. I think becoming a physician will always give very good earnings, but not to the levels they were in the past.</p>

3038

<p>Cpt, I like your posts. I have a kid who lives in NY so I find your posts informative.</p>

3039

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<p>That’s not the way it works, as far as premiums go, if your son is healthy as I think you said he is. Premiums and subsidies are two different things. For premiums, young people and healthy people subsidize old people and sick people. For subsidies, richer people (and various groups paying new taxes) subsidize poor people.</p>

3040

<p>“If we did not have employer insurance, we’d have ended up with a sharp increase.”</p>

<p>Cpt, If you did not have employer insurance you would have been paying the outrageous cost for an individual policy and then seen your costs plummet with the introduction of the ACA exchange. </p>

<p>Yes, compared to your employer subsidized insurance these new policies are more costly - especially for those of us who don’t qualify for a subsidy (I wouldn’t qualify, either,) but comparing employer subsidized costs to individual policies on the exchange is like comparing apples to oranges.</p>