Affordable Care Act Scene 2 - Insurance Premiums

Parent Cafe
4161

<p>I think there’s probably a different dynamic going on in each state. Same big picture, different local facts. In California, a growing number of hospitals are falling within the for-profit Sutter network, and Anthem started squeezing the Sutter hospitals out of its coverage network long before ACA. Meanwhile, there has been a fairly long-standing, on-again, off-again relationship between Blue Shield & the UC medical system. In the end, its all about money. </p>

<p>So we’ll see how this all plays out. I agree that over time the networks are going to expand. I think part of the problem is that the insurers can’t really predict who will enroll-- one advantage to the insurer of restricting the networks for now is that it will discourage people like the poster cited by CF who wants to fund upcoming surgery from jumping onto whatever plan has their desired, expensive medical facility during open enrollment. People without ongoing, immediate health problems are far less likely to be tied to a particular doctor or network. Once open enrollment ends, then the cost/benefit analysis might shift somewhat.</p>

4162

<p>Theoretically, ACA is getting a lot more new people insured and no one exactly knows how many of them have the type of illnesses an MSK type facility will lose or gain. They have enough patients for now and based on how things work, when someone gets cancer, they are ready to sell the home and do whatever it takes to get treated at the best than worry about deductibles and/or out of networks (at least that’s what I would do for loved ones). So MSK is not losing their clout anytime soon.</p>

<p>Practically - When more people start showing up as out of network, some of doctors start complaining about not able to keep their current patients because they are out of network etc, they will find an intermediate ground from where they are now vs where ACA wants them to be to sign up. They will eventually arrive a tiered pricing like they did in Maryland.</p>

4163

<p>

[quote]
Are the actual benefits (coverage for certain medications, durable medical equipment, ect ect) different for different tiers of plans?/quote] As far as I can tell, not within a specific “brand” name policy. Between one company or another, or between different products offered by a single company, it may be different. All plans will cover the essentials required by law, but especially on the private market, there may be an advantage to the companies to offer some sort of enhanced plans that offer additional benefits. </p>

<p>

In most cases, I would say yes – you need to total up the premiums and add that figure to each tier level’s maximum out of pocket to come up wit the answer. The law imposes a maximum per-person in-network out of pocket of $6350, but some of the exchange plans have lower-- for example, in California, the Platinum maximum is $4000 (but of course buyers are paying more than that difference in premium dollars). </p>

<p>For lower income people eligible for high subsidies, the Silver plans are better, if they qualify for the reduced copays and deductibles as well as premium assistance.</p>

4164

<p>Partyhat, make sure you check in your own state.</p>

<p>I was told on this thread that all metal levels from any one insurer would have the same network of doctors. This is not the case in my state.</p>

<p>You need to check in your own state. The top four posters on this thread have posted over 40% of the posts and they are ALL from california, which may or may not be the same as in YOUR state.</p>

4165

<p>There is also another dynamic going on at the moment - insurers dumping doctors wholesale and blaming ACA. Sounds like it has happened in Connecticut and NY recently. It makes no sense but there is an uproar among the medicare community.</p>

<p>poetgrl - so you are officially signed up and done for next year? No extensions being offered in your state?</p>

4166

<p>I haven’t heard of any extenstions, tex. But we also moved. So, we have to get new insurance anyway.</p>

<p>We know which plan we will take, but are not going to pay until it’s time. But, it’s not going to be an issue for us since we aren’t doing dotgov. </p>

<p>I mean, this thing is very unpopular in this state. Nobody is going to try to make it easier on anyone, is what I see from my back porch.</p>

4167

<p>What is the leading cause for some states to have a plethora of insurance companies and plans to choose from while others have very little? Is it the number of policies they can sell, the number of high risk policies they are likely to get? </p>

<p>It seems, from my point of view, that high population states are getting all the benefits of this type of exchange plan with lots of choices and insurers while small states get very little choice. Would be nice if I could buy some of these great sounding plans across state lines. Does that seem likely to happen soon?</p>

4168

<p>southbel - is relocation a choice for you?</p>

4169

<p>I know the cost of the plan, how much the employer is paying and how much we are paying out of pocket. It’s about the same as on the exchange. Slightly less with employer in fact. It is info given to us. The employer pays $x of our premium and we pick the plan and have to pay the difference. $X is the cost that the company is paying for every single employee. We have to pick up the difference for spousal, family coverage, and in our case what costs are for any coverage as even the cheapest plan costs more than the $X and we went silver with maximum HSA contributions.</p>

<p>Really, this is no surprise that this is such a mess right now. It will settle down. I don’t like it, no, I do not, but it is a small step in the right direction, IMO, at least I so hope. I have major concerns about future implications of this that are terrible. But the mess and confusion, I knew would happen, and don’tunderstand why the big deal. Of couse, anytime government touches things like this, it is going to go haywire until things can be smoothed out. Look at the evolution of Social security and other government programs. Or really most new ventures. Always bugs in the system.</p>

4170

<p>'It seems, from my point of view, that high population states are getting all the benefits of this type of exchange plan with lots of choices"</p>

<p>Southbel, I wish your assertion was true, but I am living testament that it is not.</p>

4171

<p>

Not even remotely. Besides the fact we LOVE living here (we’re in Charleston SC), we really have roots here. My business is here and we’re purchasing our forever home this year. I’m finally getting my farm on the water. Plus, my parents are moving here and will be living on our property since they’re getting older now. We’ve committed to living here. I genuinely like our state and even agree with the way it’s ran. </p>

<p>On the insurance issue, without selling across state lines, there’s little incentive for insurers in smaller states. Perhaps this will change as time passes. After all, right now insurers have only their best guess on how their pools will look once people sign up. Just something I’ve noticed. Other small states seem to be suffering the same. My husband’s home state of WV has it even worse. There’s only one insurer in that state.</p>

4172

<p>Goldenpooch, what do you mean?</p>

4173

<p>I don’t see any ACA changes coming for employer based insurance. That will be fixed before millions of cancellation notices go out in Oct. 2014.</p>

4174

<p>Southbel, I have only two choices for health insurance and they are pretty much identical in almost all respects.</p>

<p>BTW, I know people who live in Charleston and they love it there.</p>

4175

<p>Southbel, the cost of insurance has gone done tremendously in NY state due to ACA and the exchange has a lot of choices. However, the majority of the top hospitals and doctors have not signed up for the exchanges. I think they will eventually. Many of them are just waiting to see if they can get a better deal if things are goiing change,etc, etc. Many are just plain mad about the whole thing. I live in an area with a lot of physicians and they feel they are going to get their pay cut is the bottom line here. More work, less money is what they see, so many are not jumping on this band wagon until absolutely necessary. As I said before, this happened when Managed Care came around. Many doctors flat out refused to sign. Hospitals refused to play ball. In some cases, the insurance companies did have to relent and up the reimbursements, change the policies. I know this because the children’s hospital was one that was not signing up at one point and insurance companies were excluding it from their networks causing a tense situations. Doctors wrote and protested that it was the only place that they could in good conscience practicing decent medicine send certain paitients, namely children, who need critical, specialized pediatric care. The networks in that case did relent. Most of the doctors, however, had to fold and join the herd when it became clear that they were expendable by their patients unlike that hospital. My friend’s husband 's practice was one of the last to give in, so I had a bird’s eye view of the process, as well as having one of the worst insurances at the time to have to use the Children’s Hospital which was the best venue by far for us with a child with cancer. My firend’s husband had a thriving practice where those with the money would frequent and they were affiliated with one of the best hospitals in the city, again high end. But when push came to shove, the patients fled and the practice dwindled down to a point where the decision was made to join the Managed Care networks. It took them two years of low revenues before they made that decision, but they were one of the last. My guess is some of the same will happen with ACA contracts and networks.</p>

4176

<p>^ paragraphs are your friends</p>

4177

<p>^^good line, I’ll have to remember that one.</p>

4178

<p>Yea, our S says, “Google is your friend. :)”</p>

4179

<p>Well, I said “Google is your friend”, back on page 100 of this thread, to Cardinal Fang, on the topic of how to find ACA regulations to answer whatever the question of the moment was at the time…</p>

<p>I like paragraphs and punctuation, too.</p>

4180

<p>A lot of stories that do not give out all of the pertinent facts with insurance lost. </p>

<p>Some years ago, my husband’s cousin had all kinds of medical problems. It turned out that the health insurance he had that he always professed was so great was close to worthless. It had a low ceiling, though it covered a lot of the routine things. Yes, he loved that it paid for this and that with a low co-pay, pretty much all the usual things, and he was low need anyways. Then he had a breakdown. No mental health coverage. He attempted suicide which caused a number of medical bills. The max was quickly reached and the rest was not covered either. Daughter got pregnant, whoops, no obstetrics covered there. We won’t even go into the fact that his kids all had rotton teeth and were in pain from that for many years and he could not afford dentists. So ACA has addressed a number of these issues by making policies cover mental health, obstetrics, pediatric dentistry and some other things that many people object to having to pay for the coverage when there are so many out there that are in need for the care for those conditons. It’s like saying because you don’t ride motorcycles, you don’t want to have medical care needed due to motorcycle accidents covered in your insurance because you don’t want your premium to cover that contingency. Heck, you may so anti motorcycles that you wish anyone who rode one would wipe self out. The problem with this is that you cannot control most of these things in others, and as a society they need to be covered medically when the need arises whether any individual wants it or not. So, insurances that do not have provisions that are now considered essential, in making coverage more uniform, are no longer allowed. It does give more of an apples to apples comparison of policies. But there is the loss of those policies that prefer to shut down rather than offer the provisions. For those who have this sort of insurance, yes, you will lose this now deemed inadequate insurance. </p>

<p>Also companies do not ever have to keep their insurance from year to year, and there is no law to force them to do so. They do have to offer something under certain circumstances that is compliant with the law. </p>

<p>To me, these things make sense. Just as some people just as soon not have insurance, there are those who have inadequate insurance. To me it’s a step in the right direction to have more uniform coverage so we truly know what we have and we all have something the same in at least that aspect. That the ACA cannot force hospitals, doctors, centers to accept the terms of certain policies is something that cannot be helped in that the authority to force something like that is beyond what was doable. The sheer magnitude of the coverage will be the impetus to getting on the system. But,yes, there is resentment, alot of here and alot of reason to want to sabotage what is coming. </p>

<p>As I mentioned above, Medicaid is not accepted by many doctors and health facilities. Certain chronic conditions, things expensive to fix but not life threatening, painful conditions cannot be addressed by those who are on Medicaid, which is why I don’t want my son on it. A reason so many on Medicaid clog our Emergency Rooms for non emergency reasons is that it’s the only place they can get an problem addressed. The lowcost/free clinics can mostly only do non invasive things. You need a procedure beyond that, you go to the ER and scream pain and refuse to leave and you get that ingrown toenail removed, or some other painful condition that requires some invasive and expensive procedure done so that they are rid of you. THough I shudder and am sick that it may come to this, when more people see who refuse to treat those who are the poorest, and the lack of care they get, they may understand what a dire problem we have regarding health care in this country. It may come to that–people going to ERs to ge a medical issue addressed when no doctor is in your network to address it, and scream “fire”.</p>