<p>I went ehealthinsurance.com and put in my info for pre-ACA plan in 2013 and a bronze plan in 2014. The rates per month increase $114 and the deductible goes from $750 to $6000. I can’t remember a year of my life when I spent $6,000 on health care. The ACA high deductible means I am essentially self-insured and I have the privilege of paying an extra $1,368 per year for nothing. The only benefit I can see is that pre-ACA copay is 30 % but bronze is 15 % for hospital bills. That’s not much benefit given the extremely high deductible.</p>
<p>Einsurance gave me fewer anthem plan choices than I could choose from on anthem’s own site and on the covered ca site.</p>
<p>I cant remember the story with einsurance in ca… But so far einsurance doesnt look like the way to go. </p>
<p>Plus no catastrophic plans. However, I did not click on the subsidy link so I have to go back. :)</p>
<p>Ok… Not happy with einsurance… Went back… </p>
<p>I thought if your premiums compared to income was a certain percentage you can buy catastrophic plans. I guess I will try anthem again.</p>
<p>On another note – I enrolled in a plan via Covered California today. I had a question and called the 800 line. My call was picked up immediately. I spoke with “Gwen” who confirmed for me that I would be able to change my mind and choose a different policy if I needed to, at least up until the time that I actually make the first month’s payment. Anthem still hasn’t published Network information – so I opted to go with Blue Shield for now, which costs +$50/month over the similar Anthem plan, because Blue Shield has agents telephone agents that talk to me. Anthem’s phone agents take down information, then tell me that I need to talk to a sales agent, which in turn sends me to voice mail, and I have had no luck in actually getting a call back that way. So Blue Shield wins out on customer service. (That’s not saying a whole lot – it’s like Blue Shield rates a C- and Anthem gets a D). </p>
<p>But I downloaded a summary of benefits and coverage on my new plan I found something that is BETTER than what I had before. Under my old plan, I had a $3500 deductible, with maximum out-of-pocket of $5000 per year in-network, but the maximum out-of-pocket was $15,000 out of network. The new plan is $4500 deductible, maximum in-network out-of-pocket of $6350, but the maximum out-of-network pocket is $9,350. </p>
<p>Given that the only time I am likely to meet any deductible is that if I am seriously injured or sick enough to require services that are likely to cost well over $10,000, this upper limit on my out-of-pocket might turn out to be a more tangible benefit than the deductible. You know, for those times when a person is so sick that it’s absolutely necessary to get treatment at UCSF instead of another hospital. (And yeah, I know that the insurance’s willingness to pay “100%” of every dollar over $9350 is kind of like a private college’s promise to meet “100%” of need – their definition of 100% might not match the out-of-network provider’s definition of 100% – but I’m a (retired) lawyer, I know how to deal with creditors.)</p>
<p>dstark – the Blue Shield site has a link to the catastrophic plan but I couldn’t figure out how to get a quote. But you can see the plan by going to the home page and clicking “Shop for a 2014 plan” and then on the next page clicking on the link to “Catastrophic.”</p>
<p>I don’t think that people would buy the catastrophic plans via the exchanges, except possibly if they are under age 30. I don’t think it would be possible for anyone who qualifies for a subsidy to get catastrophic because they can’t say that a plan is “unaffordable” – so by definition they would need to buy off exchange. </p>
<p>Here’s what Blue Shield says about the plan:</p>
<p>
</p>
<p>Calmom, interesting. </p>
<p>This is what I did. </p>
<p>Went to the Anthem website.</p>
<p>Family of 4. I know my premiums are about 1400 a month or 16800 a year. I said my income is 120,000 a year. That would mean my premiums are about 14 percent of my income. </p>
<p>That is above the threshold for penalties so I thought I would be offered catastrophic plans. I wasnt. </p>
<p>I try to post what I know. Sometimes with a little help from my friends. :)</p>
<p>In this case, I do not know. At the numbers posted would I be eligible for a catastrophic plan or not?</p>
<p>I haven’t been able to get quotes for catastrophic plans for my imaginary families either. I wanted to know what a catastrophic plan would cost for that Pennsylvania couple, but I couldn’t find a quote.</p>
<p>Puzzling CF. </p>
<p>“or those age 30 and above who can provide a certification that they are without affordable coverage, or experiencing financial hardship”</p>
<p>This is so vague…</p>
<p>“Financial hardship” is defined as having to pay more than 8% of your income for health insurance. You’re exempt from the penalty if you suffer from “financial hardship,” and if you can prove it to the insurance company they’ll sell you a catastrophic plan.</p>
<p>But I can’t find quotes about how much it would cost.</p>
<p>:)…thanks CF.</p>
<p>To Goldenpooch: I found California provider lists on the Anthem web site – it’s here:
[Anthem</a> Blue Cross :](<a href=“http://www.anthem.com/wps/portal/ca/popcontent?content_path=shared/f1/s0/t0/pw_e206382.htm]Anthem”>Anthem Blue Cross Blue Shield: Health Insurance, Medicare & More) </p>
<p>These are in PDF format, and I have no clue as to how complete they are – the page says the lists will be “updated on a regular basis”. I’m just sharing this because this is NOT on the home page nor is there any intuitively obvious way to find it. (But it’s enough info for me to confirm that I personally will stick with BS - absent any change in circumstances)</p>
<p>Calmom, what is missing from the list that causes you to stay at BS?</p>
<p>CF… Me too. Well… I was looking at a Cal family. </p>
<p>That anthem list looks a little thin for Marin. I wonder how accurate that list is. I know a father -son practice. The father is in the plan. The son isnt.</p>
<p>The Anthem list looks thin for Santa Clara County too.</p>
<p>Dstark – Mills Peninsula Hospital. It could get added back on, but it’s owned by Sutter and Anthem has a recent history of dropping Sutter from its networks, so I have reason to believe that it won’t happen. But I’ll check again before I actually pay the premium to BS – when I completed the online registration there was no request for payment. There was a message that said I would get a letter from Blue Shield in about 2 weeks – so we’ll see.</p>
<p>Calmom, thanks for the Anthem PDF file. That’s incredible you were able to find this. In my region, the network is a PPO, but I can’t tell if it includes doctors and hospitals from other regions. Do you think the PPO networks are now confined to your metropolitan area? Under the old plans, the PPO network covered the entire state, at least the providers that were in the PPO network.</p>
<p>Does Blue Shield have something similar, or do they list all the providers on their website. I have been too lazy to check it out. </p>
<p>You indicated that the maximum out-of-pocket for Blue Shield is $9,350. I think you have to take this number with a grain of salt. All charges in excess of the allowable charges are generally not counted toward the out-of-pocket threshold. That amount could be considerable.</p>
<p>GP, when you talk about the allowable charges, are you talking about out-of-network? Presumably the in-network charges are already negotiated, so there won’t be any nasty surprises there.</p>
<p>Yes CF, I am talking only about the out-of-network charges. The allowable charges negotiated for in-network doctors or hospitals are counted toward the deductible or the out-of-pocket maximum for out-of-network doctors or hospitals. Since the allowable charges are generally pretty low, most of the bills you receive from out-of-network providers will not be credited toward your deductible or out-of-pocket-maximum.</p>
<p>Edit: An example would be if you got a $50,000 bill from an out-of-network hospital, and the allowable charges were only $9,350. In this case, you would be liable for the entire bill.</p>
<p>Do you also have to pay the excess for out-of-network even after the deductible is used up? Is the out-of-network cost the same as the sticker price?</p>
<p>Yes, you are always responsible for the excess, so the out-of network cost is the sticker price less the allowable charges. If the allowable charges are less than the deductible, you are responsible for the entire bill. I have a feeling Calmom will say that many providers might voluntarily agree to limit their bill to the allowable charge. That may be true, but they are not obligated to do so.</p>
<p>It is actually worse than what I described in the previous post. In my current policy, I think they will only agree to pay 50% of the allowable charges for out-of-network expenses. Thus, it will take more than $18,700 of allowable charges before you satisfy the out-of-pocket maximum.</p>