Affordable Care Act Scene 2 - Insurance Premiums

Parent Cafe
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<p>“I imagine that self-insuring saves money, or why would companies do it. I’m more than skeptical that it saves 50% over an equivalent group plan, if you make an honest comparison of the cost, the kind of comparison that a CEO would do before choosing to self-insure.”</p>

<p>Must save a bunch, otherwise they wouldn’t do it. I’m skeptical too. Skeptical enough that I just asked my sister (husband works at the same company, non-union) to look at her W-2 after dstark asked, “Busdriver11, how much does health insurance cost the non union employees of your company?”</p>

<p>For just her and her husband, the W2 says $14,640. Makes no sense to me whatsoever. Maybe they left a 1 off of mine, perhaps instead of 9K+, it’s 19K+. Or for some reason they’re messing around with the numbers. Insurance can’t possibly be so cheap, even if it’s self insured. It’s not like union employees cost less, the plans are administered by different insurers, but that shouldn’t be such a difference. Our plan is even a little better than hers.</p>

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<p>You put off something until it lands you in the ER ;)</p>

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<p>Or you pay cash for treatment, or negotiate a payment plan or ?</p>

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<p>If you’re in a financial situation to do that, SLS.</p>

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<p>We have had situations where we didn’t have coverage either and set up billing plans that lasted years. We weren’t in a position to pay it and it was terrible. </p>

<p>What I did notice was that certain things cost “less” than the negotiated rate for what insurance would pay. My sister and I were pregnant at same time - her uncomplicated delivery was more on insurance billing than my cash/billing plan which never made sense to me. </p>

<p>Except, now I get it. Sometimes hospitals would charge more for same services, depending on insurance or lack of.</p>

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<p>Unless it’s a gigantic medical crises negotiating and paying cash works, nicely. And, you’d be surprised by the deals you get. I paid 200-bucks when the doctor had billed 2-thousand to an insurance company that my H employer had cancelled without telling us. No insurance meant a big discount.</p>

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<p>The policy my kid has excludes ALL preexisting conditions forever. There is actual wording in the policy that says this. He called to,verify that there wasn’t a six mont or one year hold back for his preexisting condition (which is very well controlled and has been for the whole,time he has had it…about nine years). In addition he had previous coverage with another provider who covered,this…and there was no lapse in coverage.</p>

<p>So…YMMV with how older policies treat preexisting conditions.</p>

<p>I thought you HAD to buy a silver plan to get a subsidy. I didn’t think there were subsidies for gold or bronze plans.</p>

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<p>Hoping it never happens to you, but if you are in a situation where you don’t have the means to pay - asking for a discount or extended payment can work. I had a massive car repair that hit us by surprise when my husband was laid off.</p>

<p>I told the manager, and they cut a substantial portion off that bill. To the point where my faith was restored in humanity, and will forever be thankful to that kind man on that day. I am sure not every business or doctor’s office or whatever can do this, but you might be surprised.</p>

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<p>If you want a subsidy that goes beyond the payment of premiums, you have to buy the silver plan. </p>

<p>My kid who lives out of state had a couple of xrays taken. Maybe a cast. Cost was 3200 to 4000. Our cost was 800. My wife called the hospital and asked to negotiate the 800 lower. My wife was told no and the person on the line said she never heard of such a thing. We have negotiated bills lower with other hospitals. I would still ask in the future.</p>

<p>A friend paid for her cancer treatment over a multi year period.</p>

<p>Busdriver11, I dont think comparing your 9,000 policy with other plans is
an appropriate comparison. I think your sister’s husband’s plan is a better comparison. His plan should be better than what an individual should be able to buy on an individual exchange so comparing what your sister’s husband is going to pay in 2014 compared to a similiar plan on an exchange will be interesting.</p>

<p>The population of people in the individual market are a sicker population
so the costs should be higher in the individual market.</p>

<p>And this stinks thumper1…</p>

<p>“The policy my kid has excludes ALL preexisting conditions forever”</p>

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<p>Back to the ACA, this again brings up the question of how much medical care actually costs. For instance, we constantly hear ER treatment is very expensive. Having been in my share of ER’s I never quite understood this since if a child with a fever gets antibiotics at the emergency room or a doctors office the next day what is causing that 15 minute visit to be so much more expensive? We have an ER down the street that is usually empty. My son recently went there for 4 very expensive stitches and was home in an hour. He refused to wait till morning. </p>

<p>I’m still mad.</p>

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<p>I dont know what being mad is going to do for you. Might as well let it go.</p>

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<p>That was humor!</p>

<p>But I do still have the bill and in my opinion a bandaid would have sufficed.</p>

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<p>Fee for service medicine is wonderful for routine things or even minor not so routine things like stiches or infections. Ideally, I would prefer insurance for catastrophes but not the small stuff. The prices are greatly inflated when insurance pays.</p>

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<p>Flossy, the cost for the emergency room is for staff and equipment. If it happens that the emergency room is empty when you arrive, then it really doesn’t make much difference if they are treating a kid with a sore throat vs. sitting around doing nothing. But if the place is filled to capacity, with some patients in cardiac arrest or having seizures or other potential life-threatening emergency – then it’s a huge problem if people are coming to the emergency room for issues that could wait until morning. So they charge for the use of the facility.</p>

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<p>Also, since most of those people don’t ever pay I would guess those who do pay, pay more. But that doesn’t really make the care more expensive, they just charge more. </p>

<p>If I ran a restaurant and no-one came in for lunch I couldn’t just charge the next couple $1000 because my staff and equipment were there all day and yesterday some teenagers ran out on their bill. Interesting.</p>

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<p>Where did you get the idea that most people who go to the emergency room don’t pay?</p>

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<p>Oh, I got that idea from news reports about uninsured using the emergency room for routine care and then when they have no money the hospital writes it off. And from people I unfortunately know who have done this frequently. It happens.</p>

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<p>I see. You have no reason to believe that most people who go to the emergency room don’t pay. In fact, MOST people who go to the emergency room do pay, although some do not. Please be more careful with your statements. </p>

<p>Moreover, when an uninsured person goes to the emergency room, they are billed. If they don’t pay, the bill gets sent to a collection agency, and the person is hounded day and night, because that is how collection agents work. Nevertheless, some people do not pay their emergency room bills. But most people do pay.</p>

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<p>Sorry about the MOST. I do not know the number and expect it varies by location of the ER. But it’s certainly a big factor in the cost of emergency room care.</p>

<p>Many worried parents can be found in emergency rooms, thinking that their child’s fever, earaches, coughs and minor cuts all warrant an emergency room visit. But by far the biggest contributors to emergency room abuse are the uninsured, and to a lesser extent, those on Medicaid. Regular doctor offices do not have to treat uninsured people unless they can pay for the services at the time of the visit. Medicaid only allows 12 doctor visits a year. This can seem like a lot, but there are always parents with kids that get sick frequently. Emergency rooms typically treat everyone, regardless of ability to pay at the time of the visit. People know this and they use it to their advantage. -</p>

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<p>Thumper, the subsidy amount is set on the basis of the 2nd lowest silver plan in the region (assuming there are at least 2 to choose from) – that is the benchmark used to set the tax credit. But the person has the option to apply that same credit to any plan they choose.</p>

<p>So here is an example, involving a hypothetical 32 year old individual with a $34,000 income, living in San Francisco:</p>

<p>Benchmark Silver plan is Anthem Blue Cross.
Full cost premium is $349/month.
Subsidy is $83- which reduces the premium to $266. ($266/month is roughly 9.4% of annual income).</p>

<p>That person could opt to buy a Bronze policy from Anthem instead, with a premium of $261 a month – the $83 subsidy is portable, so it can be applied to reduce the Bronze cost to $178. It’s the difference between a $2000 and $5000 deductible, but the annual savings is $1,056 – so it might be worth the risk for someone who doesn’t expect to even meet the $2k deductible. </p>

<p>On the other hand, let’s say that the person does want Silver, but would prefer to have Kaiser. Kaiser’s full cost silver premium is $358 ($9 more than Anthem) – so that same $83 can be applied and the monthly premium would be $275.</p>

<p>The person could opt for Silver or Platinum as well. That doesn’t seem to make a lot of sense for someone with modest earnings, but it could be worthwhile to eliminate the deductible for someone who has a chronic condition that requires prescription medication and frequent doctor visits for monitoring. Blue Shield has a Gold policy available for $412 a month – with the $83 subsidy, that will be $329/month. Gold policies in California have no deductibles and a $19 copay for generic medication, $30 copay for routine doctor visits. The person is paying $63 more each monthly premiums, but getting the benefit of the copay and prescription drug benefits from day 1 - if those routine costs would run more than about $750 a year, then the person is probably better off with the Gold plan. </p>

<p>On the other hand, if the income was $28,000 instead of $34,000, the person would be eligible for what California calls an “Enhanced Silver 73” plan (meaning that the plan is the actuarial equivalent of the insurance paying 73% rather than 70% of all costs) - and a monthly subsidy of $183. The person is earning $6,000 less per year, but subsidy is only $1,200 more – so not particularly beneficial – but the “Enhanced” Silver plan has a $1500 deductible rather than $2,000. So the math to compare plans is a little bit different.</p>