<p>Interestingly, this happening with our companies was the main impetus for us going to individual plan in our family. When we added it up, as a family, it just made more sense to take the salary for us both and then get an individual family plan. We started doing this a few years ago. Also, and I think this is what most people ought to be able to have, we wanted to have the SAME coverage. We don’t each want to have different networks and different doctors, etc… I mean, come on! At some point some of this has to be about the person and their doctor. </p>
<p>The thing that really bugs me about this is, it is “only 5%” effected when it is those of us who pay for insurance, but it is “16 million will be insured!!!” when it is those who couldn’t get coverage before. It’s so annoying the spin games. Just say the facts the way they are.</p>
<p>Interesting that you chose drop coverage with the employer poetgrl. Were you able to get all the money tied to coverage?</p>
<p>If I dropped coverage, I get 100 a month. My insurance benefit OTOH is 350-400. It is a lot higher if I have family covered but I would only get 100 whether I waive myself or whole family.</p>
<p>I was not able to get all, but H was. His was significantly more expensive and a way better plan. Before we moved and he semi retired he was a measurable contributor to the company bottom line. Enough so he could get whatever he wanted, if you know what I mean.</p>
<p>But, mainly, the thing was if I went with mine and he went with his, we had different coverage. If we went with mine, we had coverage we wouldn’t pay for anyway. If we went with his, it was way more expensive than what people as healthy as we are needed to pay for the same coverage.</p>
<p>This doesn’t make sense to me as a comment. “Five percent of Americans will be newly insured” and “16 million people will be newly insured” are equally true or untrue. “Five percent of Americans will pay more for insurance than they would have absent the ACA” and “16 million people will pay more for insurance than they would have absent the ACA” are equally true or untrue. How is one of “five percent” and “16 million” more the way things are than the other one?</p>
<p>With a PPO plan…we should be covered at any hospital that Anthem has coverage in California…that includes UCSD.</p>
<p>The Blue Card is being discontinued. We are only covered in California and For emergencies out of state. My son is no longer covered in Cal except for emergencies. He has to buy a plan in NY.</p>
<p>The list of doctors that Calmom linked is pretty much the list. The list will grow as more doctors sign up. Doctors have signed up slower than expected.</p>
<p>No comment on Sutter. Didn’t know.</p>
<p>Annual out of pocket out of network cap is 33,300 for a family. </p>
<p>I forgot to ask about catastrophic plans for those that are over 30 and the premiums are over 8 percent or 9.5 percent or whatever the percent was…</p>
<p>I am not calling Anthem back. I was on hold for 35 minutes. Supposedly in Cal, if you use the coveredca site… It only takes 20 minutes to sign up for a plan.</p>
<p>You would call Anthem to verify the above before you purchase a plan.</p>
For a lot of employers, the ACA provides them an excuse to do something that they already wanted to do and may well have been planning on doing anyway. They all know that cutting health coverage makes them look bad, and most of them really don’t like looking bad. The ACA then becomes the same “reason” as “bad economy” or “industry standards” or other such nonsense. If an employer is doing reasonably well and if the ACA does not mandate it, then they are doing it because they want to do it.</p>
<p>How can this work, though? Insurance companies negotiate with hospitals about prices. How can a negotiation work if the parties can’t refuse an offer?</p>
<p>“The Blue Card is being discontinued. We are only covered in California and For emergencies out of state. My son is no longer covered in Cal except for emergencies. He has to buy a plan in NY.”</p>
<p>In NJ they have new small group plans for 2014 with an add on Blue Card. Is it just being discontinued in your plans, your state, or completely?</p>
<p>Maryland is the only state in which hospitals don’t negotiate with individual insurance companies. It’s called an “all-payer” system. The Maryland Health Services Cost Review Commission sets the rates. Maryland’s health care cost increases are among the lowest in the country. We have the lowest markup in the country (the difference between what is billed and what the care actually costs.) Maryland’s average markup is around 24.5 percent, compared to a 198 percent average nationwide.</p>
<p>Cartera, in Maryland can an insurance company nevertheless refuse to include a hospital in a plan? That is, suppose FangCo Insurance concluded that while Snooty Resort Hospital’s rates were consonant with its actual costs, FangCo didn’t think it should be paying for the twice-daily foot massages, lobster dinners and gold-plated bedpans at Snooty. Then could FangCo offer a policy that didn’t include Snooty?</p>
<p>I think I’d like to hang out at Snooty for those foot massages. I wonder why more states haven’t followed Maryland’s concept. That appears to be a useful idea.</p>
<p>On another note, I haven’t found a single hospital or provider in my area that hasn’t been a preferred provider for my insurance, BC. But if I was to lose my insurance, I don’t even know if BC is on the exchange. Our insurance commissioner only accepted four companies. Of course, I’m sure I could just get their policy off the exchange, as there doesn’t seem to be a reason to use it.</p>
<p>I actually like the way it’s set up here, though. I like that there are three plans at each metal tier. So, you can go with high/low/medium premiums, high/low/medium deductibles, and then, you can choose a very limited network, a less limited network and an any doctor anywhere plan.</p>
<p>If you price it up, there’s not much difference on when you have maxed out on your out of pocket including premium costs, but there are lots of choices, even if it’s only the nine. Some combination of that should work for you, if you don’t fall in that realm where it’s hard to pay and you’re just out of subsidy level.</p>
<p>What the hospitals can charge is regulated too. Hospitals are going for a rate increase now. They are not getting as much as they want but they’re getting something. I would think the insurer would include Snooty hospital but Snooty would only get what the other hospitals get for their care. Snooty might be doing those massages pro bono.</p>
<p>Thanks dstark for calling Anthem…better you than me. I like the answer about being able to use providers in EPO regions. Yesterday, when I was perusing the internet I thought I saw some literature indicating Anthem was keeping Blue Card. Later today I will find it and link it here. I think BS is keeping Blue Card.</p>
<p>Although you got a good answer, I don’t always trust these agents, so it will probably be wise to wait until we have further verification.</p>
<p>Saw the piece about hospitals around the country. What a mess!</p>