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<p>Indeed. And (for all kinds of reasons), the feds made the decision to go live with a ‘buggy’ system anyway.</p>
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<p>Didn’t I read somewhere that those insurers who were chosen to be the ACA-Exhange representative in a respective state could not longer offer a non-compliant plan in that state?</p>
<p>Yes, bluebayou. It was my understanding that is why many big players opted not to be part of exchange.</p>
<p>Anther potential problem of course is people who simply cannot afford the price hikes. Subsidies do not solve everything and subsidizing people with decent incomes to buy something they don’t want is, well, odd.</p>
<p>In the letter I received from BS, they also gave me a Dec 6 deadline to inform them that I will consent to the 3-month delay. So I guess I will have to make a decision by this date, unless the govt comes up with something else before then.</p>
<p>CF, you sound like having a surgical procedure is like finding the lowest cost plumber. I don’t know about you but sometimes I will hire the more expensive plumber, because I know full well the damage a less effective plumber can cause. And were not even talking about plumbers, but someone who is going to cut you open. Maybe I am crazy but I want the best surgeon, even if that means paying more for my insurance.</p>
<p>GP, I got the same letter, but I’ve already signed up for an exchange plan. </p>
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<p>Insurance doesn’t pay for the “best” and is not required to. For example, if your car is damaged, you generally don’t get to go to the best body shop in town – the insurance company will give you a list to choose from or else ask you to come back with several estimates. </p>
<p>There is nothing wrong with wanting the “best” but that is generally a privilege that people need to be willing to finance on their own. </p>
<p>The whole point of insurance is to provide everyone in the pool with “good enough” or “adequate” care, not the “best.” Everyone is entitled to the same thing, but everyone can’t have the “best.” </p>
<p>I’d think that the select few medical practitioners who really do have superior skills and the reputation to go along with it would tend to avoid being on any insurer’s network. Why should they ever agree to accept a reduced rate for their services when they can attract patients who are willing and able to pay the full cost? They can do better off-network, and offer specific services pro-bono to the truly needy from time to time if they choose to do.</p>
<p>Calmom, we are probably going around in circles on this, but my current plan allows me to go to the best providers if I so choose. I am still not willing to give this up if I can help it.</p>
<p>We are going around in circles. I’m still waiting for you to find the part in your old policy where there was a guarantee that the provider list would always stay the same. I’m pretty sure there will be very big rate increases on the grandfathered plans, and that there will be a trimming of their provider lists over time as well. The issue is not new-- I’ve already pointed you to articles showing a past history of difficulties between Blue Shield & the UC Hospitals over their contract.</p>
<p>GP, I’m sure you’re willing to pay more to have insurance that includes the most expensive providers. But I doubt if you’re willing to pay enough more that you would be willing to pay what that insurance would now cost, given that the insurers now can’t turn anyone away.</p>
<p>Most people who would sign up for such a plan would be sicker than you. And you would be paying for their expensive trips to Cedars Sinai for heart surgery. How much of a premium are you willing to pay to be in that group? Five times as much as your current insurance premium? Ten times as much? The sick people in your plan are going to need a lot of care (that’s why they picked your plan) and you have just signed up to provide it to them at the most expensive hospitals, with the most expensive doctors.</p>
<p>You say you want this plan, but if it were offered, I doubt you’d buy it.</p>
<p>^^actually, according to healthcare.gov “very big rate increases” are not allowed to remain a grandfathered plan. The website clearly says that to remain a grandfathered plan, it must not “substantially cut benefits or increase costs for consumers…” IMO, “very big rate increases” = substantial increase in costs to consumers…</p>
<p>But your broader point is correct: providers come and go within health plans.</p>
<p>Hey pooch, I guess you just have to suck it up. As people have explained, now it is necessary for you to pay far higher premiums and get worse care and fewer providers, in order to pay for everyone else. It’s just what has to be, maybe it’s a karma thing…you had it so good before, it’s only fair that you deal with the same low level of medical care as others (while paying for them too).</p>
<p>On another note, one of the state health care websites that had been considered to work quite well, is Washington state, where I live. They’d signed up a good number of people (a good number would be >5). Apparently they told people to submit their monthly income, to figure subsidies, but when they processed the request, they figured it as annual income. They gave 8K people that signed up either subsidies that they weren’t entitled to, or told them they’d get more than they should have. Now the letters are going out to all of these people expecting subsidies, informing them of the error. What a goat rope. Here I thought the brainiacs in my state had done a good job.</p>
<p>^ lol…too funny…I guess it’s not just on the federal level.</p>
<p>[Saving</a> Academic Medicine from Obsolescence - Benjamin P. Sachs, Ralph Maurer, Steven A. Wartman , and Marc J. Kahn - Harvard Business Review](<a href=“Saving Academic Medicine from Obsolescence”>Saving Academic Medicine from Obsolescence)</p>
<p>Bluebayou, I think you misunderstand the law as to premium increases. The grandfathered plans are subject to the same 80% rule as any other plan, but they certainly can increase rates in line with their mounting expenses. All of the grandfathered plans on the individual market, by definition, are closed to new customers and therefore the number of people in their risk pools will decline over time. It is also reasonable to anticipate that their risk pools will age – both because the member will get older as each year goes by, and because younger people are more likely to find exchange policies at more favorable rates; younger people are also more likely to qualify for subsidies. So the grandfathered polices are going to see mounting expenses-- to the extent that they keep the same overpriced providers within their networks, they will also have higher payout expenses than new, post-2014 plans. So there will be rate increases.</p>
<p>I’ve already confirmed from two separate sources that the particular plan that GP wishes he could go back to will have substantial rate increases at the next renewal point- but the precise numbers haven’t been announced yet.</p>
<p>Here’s a link you can check if you doubt me:
<a href=“https://www.ibx.com/health_care_reform/faq/grandfathered.html#q8[/url]”>https://www.ibx.com/health_care_reform/faq/grandfathered.html#q8</a>
<a href=“http://www.shrm.org/hrdisciplines/benefits/Articles/Pages/FAQs-Grandfathered-Plans.aspx[/url]”>Error;
<a href=“http://www.amerihealth.com/health_care_reform/faqs/grandfathering_plans.html#q8[/url]”>http://www.amerihealth.com/health_care_reform/faqs/grandfathering_plans.html#q8</a></p>
<p>(They all say that premium increases have no impact on grandfathered status)</p>
<p>I think you’ve mixed up the idea of shifting additional “costs” to the consumer, such as an increased co-pay or deductible, and setting premiums. The bottom line is that the “grandfathered” status act to prevent the company from making some types of changes that could help keep premiums down.</p>
<p>Wonder why GP’s plan that he wished to stay on will have substantial rate increases. I thought the ACA was supposed to bring the cost of healthcare down. In fact, people on this board have even mentioned how they’ve had the lowest increase in years, and even gotten rebate checks. Unless that was just a temporary respite, and now that the insurance companies have to take everyone, they are raising their rates dramatically to cover all.</p>
<p>And I would think that GP’s exact plan isn’t even offered anymore (or why would he be removed from it), so how can rates for a fictitious plan be compared?</p>
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<p>Because healthy young subscribers will leave for subsidies, perhaps?</p>
<p>GP is mooning after the girl, er, plan, he threw over a couple of years ago in favor of a different plan. He wants the first one back. The first one is still extant and grandfathered, but not for him because he gave it the mitten.</p>
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Again: because the pool will shrink, and the only people who will stay on the plan will be older, sicker people who want to keep seeing doctors at more expensive facilities, and who don’t qualify for subsidies or cheaper insurance via the exchange. New, healthy people can’t enter the plan; young people will tend to find better rates on the new plans; one-third of the participants on the grandfathered plans are eligible for subsidies on the exchange. </p>
<p>I mean, I’m ON the plan that GP wants to go back to (the one he gave up two years ago because the premium was too high). I’ve done the math, the rates on the exchange are roughly the same if you factor in an annual increase at the SAME level that Blue Shield has increased its rates every other year. </p>
<p>Additionally, a large segment of the pools on both plans (the one that I’m on and GP regrets leaving, and the one he is on now) are NOT grandfathered. That’s because historically Blue Shield increases its rates every year, and a lot of people have responded to rate increases by switching to less-generous, less-expensive plans; and of course, there are others who simply were late-comers to the plan.</p>
<p>I mean, it’s obvious that a smaller pool that allows people to see more expensive providers is going to have cost-control issues over time. </p>
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AFTER it has been in effect for a couple of years. But the grandfathered plans on the individual market are going to be like abandoned step-children – they will just get weaker and weaker as time goes on. It’s not the same with large employer group plans, because those plans can maintain grandfathered status while new employees come in. </p>
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I’ve gotten rebate checks too, but the rebate checks are always less than a single month’s premium. That just means that the insurance company is doing a good job of predicting costs, assuming that it wants to maximize premium dollars. </p>
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The accounting for each plan is internal – that is, my rates/rebate for plan A are determined by the spending on plan A in my region. </p>
<p>Again, GP wishes that he could go back and opt for a plan that will have fewer people than ever next year, and will have in theory have people seeking care at facilities that cost significantly more than the facilities serving the people in the other plans. Where is the influx of cash going to come from to keep that plan’s rates down? </p>
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NO, that’s the part you haven’t been paying attention to. GP was on Plan A with a $3500 deductible. The rates for Plan A went up, so in 2012 GP switched to Plan B with a $5500 deductible. I was on Plan C with a $5000 deductible but switched to Plan A back at the end of 2010, because the premiums were about the same but it looked like a better plan that the one I had. Both Plan A and Plan B are grandfathered plans that will continue to exist, but GP and I lost our grandfathered status when we switched plans after March of 2010. </p>
<p>In other words, neither one of us comes under the umbrella of Obama’s “promise” that we could “keep” our pre-ACA plans because both of us opted to give up our plans after ACA passage. </p>
<p>The plans will live on, but by definition the only people who can stay on them are people who were signed up on those exact plans prior to March 2010. That’s 4 years ago and the individual market is highly mobile - between 40-60% of subscribers on the individual market will change plans within a year. So the percentage of subscribers on the continuing plans who have grandfathered status has GOT to be vanishingly small – I’d be surprised if it were as high a 20%.</p>
<p>“In other words, neither one of us comes under the umbrella of Obama’s “promise” that we could “keep” our pre-ACA plans because both of us opted to give up our plans after ACA passage.”</p>
<p>I’m thinking that promise came with so many caveats and omissions, that very few people are going to be able to stay on their plans. True, I haven’t been paying attention to GP’s plans, I didn’t realize you were talking about an earlier plan that he is not on anymore.</p>
<p>Actually, I think I figured out the error behind the, “If you like your plan, you can keep it,” line that keeps coming up, over and over. I often make mistakes when I text. I use the letter “U” for the word “you”. Sometimes I type “U” instead of “I”, because the letters are right next to each other. I think what he actually meant to say all along is, “If I like your plan, U can keep it. If I like your doctor, U can keep him.” Not, “If U like your plan, U can keep it. If U like your doctor, U can keep him.” What a difference a vowel makes.</p>
<p>“GP is mooning after the girl, er, plan, he threw over a couple of years ago in favor of a different plan. He wants the first one back. The first one is still extant and grandfathered, but not for him because he gave it the mitten.”</p>
<p>Yeah, I get it now, I haven’t been paying enough attention to his plans. Your humor cracks me up, but I have no idea what it means to “give it the mitten”. I guess that means he dumped it. I’m always happy to learn a new and obscure phrase that I can use on my sister.</p>
<p>Here’s a link to what seems to be a balanced article about premium increases post ACA:
[Here</a> Are The Five Big Reasons Obamacare Changes Insurance Premiums - Business Insider](<a href=“http://www.businessinsider.com/here-are-the-five-big-reasons-obamacare-changes-insurance-premiums-2013-11]Here”>Here Are the Five Big Reasons Obamacare Changes Insurance Premiums)</p>
<p>(I could easily find dozens of articles that are more supportive of my POV, but I’m posting this one precisely because it takes a more neutral tone, looking at both sides of the coin)</p>