<p>GP, the doctors are not going to be paid medicaid prices for people like us.</p>
<p>Ok…I have been notified by another poster that my friend’s employer healthcare numbers look way too low. I have contacted my friend who has now backtracked and says he isnt sure. He is going to check. </p>
<p>Sorry in advance for any erroneous info.</p>
<p>GP…I will keep the Kaiser info in my mind. Thanks.</p>
<p>We had some experience with Kaiser involving a couple of week long hospitalizations after an emergency room situation and while I can’t get into all of it here and the outcome was quite good eventually, let’s just say it did not come without a fight.</p>
<p>Lots of emailing this doc and him having to check with that specialist and nobody returning calls and this treatment not working and that doc saying that’s all he can do and another doc saying no, lets try this. And then somebody else saying maybe if you drive 2 hours to the surgeon over there. And then her fixing it all up pretty well and disagreeing with the first two. A summary.</p>
<p>Oh, and frequently the doc you really needed seemed to be on vacation. Lots of vacations over there.</p>
<p>
</p>
<p>Yeah no kidding. Unless your friend is 22.</p>
<p>Here’s an article mini posted in the other thread, enjoy!</p>
<p>[Michael</a> Olenick: How My Experience with Healthcare.gov Shows ?Better? Software May Not Be the Solution « naked capitalism](<a href=“http://www.nakedcapitalism.com/2013/10/michael-olenick-how-my-experience-with-health-gov-shows-better-software-may-not-be-the-solution.html]Michael”>Michael Olenick: How My Experience with Healthcare.gov Shows "Better" Software May Not Be the Solution | naked capitalism)</p>
<p>This is what I get for trusting my friend… And he is so opinionated. :)</p>
<p>The out of pocket premium cost for our employer plan is $5700 a year with spousal and dependent coverage. The employer pays $12K towards it. It is a “silver” leve plan with a $3000 family deductible. We put in our max of about $7500 in the HSA to cover the deductible, co pays, anything else that can be covered, and if anything is left over, it can towards next year. Reduces taxes by about $2500 to have the HSA. </p>
<p>If you are assertive and can work the system well, as have another family member that can do the same, going Kaiser can work very well. The system just works very slowly at time, and you have to push them. If ACA reduces reimbursements much, Kaiser may be getting a lot of MD applications. I have savvy friends who have used Kaiser for years, and navigated through some hairy and scary health crises and gotten as good of care as through any insurance. It’s all about knowing how to work the system and being aggressive and proactive when you need to be.</p>
<p>Igloo, that website certainly has a point of view about our economic system. :)</p>
<p>“I personally havent seen a family doctor for over 10 years. I did have a cardiologist who I havent seen for 2 years. Anthem loves me. I promised my daughter I would start seeing doctors in 3 years.”</p>
<p>Unless you are getting blood tests elsewhere, that is crazy. Not that a family doctor can figure out a heck of a lot just by taking your pulse and blood pressure, and asking you how you are feeling, but the annual blood panel is important. You can eat well and exercise like crazy, but if you don’t measure, you don’t really know. You can detect so many things that you wouldn’t have had a clue about otherwise. If you have good insurance, it costs you 10 hours of fasting, a small co-pay, and a brief visit to the lab.</p>
<p>I’m sick of seeing people I know dropping dead in their fifties, and if there’s any way to avoid finding out you have a problem until it’s serious, why not do so? Ten years is DUMB. Listen to your daughter.</p>
<p>Too much information.</p>
<p>When I was seeing a cardiologist I was thoroughly looked at. Much more than regular checkups.</p>
<p>I’m good.</p>
<p>^^Okay, then. No real reason to see a GP, I guess.</p>
<p>Calmom or anyone else, I have a question about grandfather status. Obama today in Boston was explaining why some people lost their grandfather status. He said that if anyone lost their plan after March 23, 2010 it was because the insurance companies decided to cancel or downgrade your plan and were required to replace it with a better plan. In the same sentence he said if you liked the substandard plan you had prior to passage of the law, you could keep it. Not sure how you can reconcile these two thoughts if the insurance companies were allowed to downgrade your plan and take away your grandfather status</p>
<p>In my case I went from a substandard plan in 2012 (according to Obama) to even a worse plan with a higher deductible. Does this mean the insurance company wasn’t necessarily complying with the ACA law when they took away my grandfather status because they didn’t upgrade my plan? Can I argue that they are in violation of the law because my plan was downgraded instead of upgraded. Any thoughts?</p>
<p>[Obama</a> Clears Up “Confusion” About Obamacare: “Bad Apple Insurers” Responsible For Canceled Policies | RealClearPolitics](<a href=“http://www.realclearpolitics.com/video/2013/10/30/obama_clears_up_confusion_about_obamacare_bad_apple_insurers_responsible_for_canceled_policies.html]Obama”>Obama Clears Up "Confusion" About Obamacare: "Bad Apple Insurers" Responsible For Canceled Policies | Video | RealClearPolitics)</p>
<p>In order to comply with the new law, those policies were no longer legal. They can offer an upgrade, but it may cost more, since it is providing a higher level of the 10 basic services - ie, maternity, prescription, mental health, etc.</p>
<p>[Anthem</a> Blue Cross Will Discontinue California Health Plans »](<a href=“http://insuremekevin.com/2013/08/14/anthem-blue-cross-will-discontinue-california-health-plans/]Anthem”>http://insuremekevin.com/2013/08/14/anthem-blue-cross-will-discontinue-california-health-plans/)</p>
<p>“Can I argue that they are in violation of the law because my plan was downgraded instead of upgraded. Any thoughts?”</p>
<p>Wonder if your plan is now considered “better”. Even if it costs you far more, less coverage of services you use, with a higher deductible, perhaps it is “better” because it offers you treats such as maternity coverage and all sorts of goodies that you didn’t want. Meaning, perhaps it wasn’t about getting you a better plan, but making you pay for others to have a better plan. Just wondering, because it seems that downgrading your plan that was already not good enough would be against the law.</p>
<p>GP:
</p>
<p>GP, in your case you had a CHOICE. The insurance company did not “downgrade” your plan. You had the Blue Shield Saver 3500, which is a perfectly good grandfathered plan, and any one who had that plan before March 2010 and chose to keep that plan continuously in force can still keep it. (Though as I have told you multiple times on this thread, the premium rates on that plan are being raised significantly) </p>
<p>Blue Shield did not take anything from you. They merely raised premium rates, and perhaps you or your wife also moved into a higher age category. </p>
<p>In any case, in 2012, YOU made the decision that you didn’t want to pay the rates for your grandfathered plan that you had every right to keep, and YOU decided to switch to a different plan (one with a different deductible and schedule of benefits, and a different name). At the time you made that switch, you were aware that you were losing your grandfather status.</p>
<p>You are not someone who wants to keep the plan you had prior to the passage of ACA-- you are a person who voluntarily decided that you did NOT want to keep the plan, and you instead switched to something else. </p>
<p>You have already posted that you knew when you switched plans in 2012 that you were losing your grandfathered status. </p>
<p>You also did not have a “substandard” plan. Blue Shield of California passed through all of the ACA-mandates changes (like free preventive care) almost immediately on passage.</p>
<p>In the link dstark provided, Anthem seems to indicate that policyholders who had their plans downgraded were allowed to keep their grandfather status. Now I am really confused.</p>
<p>dstark,</p>
<p>If you move to Kaiser, there is good and bad. I am thrilled that the medical tests are mostly covered, the costs are low and the treatment is good. One of my family members had a fairly significant surgery that was state of the art + great outcome after years of chronic pain. Getting to have the surgery required more steps and time than I thought reasonable, however.</p>
<p>You have to be your own advocate and push them back a little. </p>
<p>An old friend with a baby born massively early on Kaiser ended up having child’s care mostly provided by Children’s s Hospital at no additional charge because he could get better care, there. </p>
<p>There are pros and cons with Kaiser. So far I am pleasantly surprised with most of family’s care there, with a few minor issues.</p>
<p>Calmom, read the link in dstark’s post. Anthem is allowing customers who voluntarily downgraded their plans to keep their grandfather status. Is this legal?</p>
<p>[Doctors</a> are skeptical and confused about Obamacare, survey finds](<a href=“http://www.cnbc.com/id/100900356]Doctors”>Doctors are skeptical and confused about Obamacare, survey finds)</p>
<p>A very interesting article. Scroll down to the section labeled “Nasty Surprises”</p>
<p>The article begins with the fact that doctors have no idea how much they are going to be reimbursed or how claims are going to be handled. </p>
<p>But the shocker is this: People will have three months before coverage can be cut off for non-payment of premiums. HOWEVER, the insurer is not obligated to pay claims for months 2 and 3. </p>
<p>The doctors (and presumably the hospitals as well) will have to eat those costs. No mention if the insurance companies will tell the doctors that their patient is not paying the premiums and could be dropped. </p>
<p>Doctors are going to be cherry picking patients who have employer-provided insurance or are rich or they are going to go to concierge practice with the upfront payment covering these risks. </p>
<p>And most doctors likely have no idea about this yet. </p>
<p>It also means that people can get 12 months of insurance for the price of nine.</p>
<p>SamuraiLandshark, thanks for the post. I think your experience is similar to what I see. Glad overall things are working out at Kaiser. </p>
<p>GP…</p>
<p>"In September, we will communicate to members on these plans that they can stay on their current grandfathered plans. They just need to keep paying their premiums. No other action is required. Or they can select any ACA-compliant plan during the initial ACA open enrollment that runs from October 1, 2013 to March 31, 2014.</p>
<p>The same options specified above will also be communicated to members on grandfathered guarantee issue plans.</p>
<p>Note: Grandfathered plans are those in effect on or before March 23, 2010 which your clients are still on. This also includes any of your clients who may have downgraded to a plan and still retained grandfathered status."</p>
<p>GP was your plan in effect before March 23, 2010?</p>