Affordable Care Act Scene 2 - Insurance Premiums

Parent Cafe
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<p>Not about premiums, but about Autism and ACA coverage in California. Today I was told by the school that a diagnosis by a “doctor” was needed, and by regional center, that the doctor had to do the ADOS.</p>

<p>“Autism Diagnostic Observation Schedule”(ADOS)
<a href=“http://portal.wpspublish.com/portal/page?_pageid=53,288971&_dad=portal&_schema=PORTAL[/url]”>http://portal.wpspublish.com/portal/page?_pageid=53,288971&_dad=portal&_schema=PORTAL&lt;/a&gt;&lt;/p&gt;

<p>[Autism</a> Advocates Praise Covered California’s Expected Policy Change - California Healthline](<a href=“http://www.californiahealthline.org/capitol-desk/2013/9/autism-advocates-praise-covered--californias-expected-policy-change]Autism”>Autism Advocates Praise Covered California’s Expected Policy Change | California Healthline)</p>

<p>Not too long ago;
“Calif. Appeals Court Rules Public Insurance Must Cover Autism Treatment”</p>

<p><a href=“http://losangeles.cbslocal.com/2013/09/12/calif-appeals-court-rules-public-insurance-must-cover-autism-treatment/[/url]”>http://losangeles.cbslocal.com/2013/09/12/calif-appeals-court-rules-public-insurance-must-cover-autism-treatment/&lt;/a&gt;&lt;/p&gt;

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<p>LasMa, I wonder what you would say if you were in my shoes today. Are you grandfathered or do you have employer-provided insurance? I can’t see how anyone would be happy if they were facing a doubling in the premium, worse benefits and losing their favorite providers.</p>

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<p>I have employer insurance, but my husband and daughter have had an individual policy for 20 years. During that time, our premiums went up 18-20% per year, with a constant reduction in benefits. Before ACA takes effect in January, their combined deductible is $15K, on top of almost $10K in premiums. You have no idea how much medical care they didn’t get, because we couldn’t afford it. And the worst part, the part that made me grind my teeth at night, was that there wasn’t a dmn thing we could do about it*. Because of pre-existing conditions, we had no choice but to accept whatever Blue Cross wanted to do to us. We were trapped. </p>

<p>No, ACA is not perfect, far from it. We too will be paying more. I’m with calmom in believing that single payer would have been far better – easier, more efficient, and certainly cheaper. But personally, I welcome the fact that my family finally has some protections.</p>

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Because I’m not all that self-centered. </p>

<p>I am happy that my ex will be able to get insurance and will be able to get the surgery he needs. I am happy that my brother will qualify for MediCal. I am happy that my children will never again get phone calls from their ailing grandmother begging them to please lend their father money to pay his medical bills. I am happy that my grandson already has full coverage on Medicaid, and that if he ever gets diagnosed with a chronic illness, it will not prevent him from getting insurance in the future. </p>

<p>And my happiness goes beyond my own family – I’m just giving examples of the ways that an imperfect world touches me even if I am fortunate enough to have avoided running into extreme hardship myself. </p>

<p>I am happy when the system is fair and puts everyone on an equal footing. If I pay full cost for the plan I sign up for this month, it will still be much less per month than my ex was paying 2 years ago before his rates got jacked up so high that he could no longer afford to keep his insurance. Blue Shield used to charge differential rates based on health history. I could afford the preferred rates, but I don’t know if I could have afforded insurance if I didn’t qualify for those rates. </p>

<p>I will be happier still when there are no people being excluded from coverage because they don’t earn enough money and they live in states that refuse to expand Medicaid.</p>

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<p>LasMa, is your husband and daughter grandfathered or are they in my situation? </p>

<p>Calmom, you are calling me self-centered because I object to my premiums doubling, worse benefits and losing my preferred providers. Wow! Anyway, you didn’t answer my questions. How much is your premium going up?</p>

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<p>How about the 60 year-old couple who make $62,050 a year and now will pay 24% of their income for health insurance. Are they self-centered?</p>

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<p>I am covered by H’s insurance, provided by his former employer, who also covers our kids until they age out at 26. I am happy that we can buy our D an individual policy that will cover her pre-existing conditions, as will everyone else in our country who may have previously been excluded on this basis. I am also happy that people who work and don’t have employer policies will be able to get coverage and care before it becomes an expensive crisis, and they get care in the ER/ED. That is where lots of folks are getting care now when they gave no coverage. It’s a very expensive way to administer medical care.</p>

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<p>Our policy is being discontinued too, Goldenpooch. But it doesn’t matter; we were always going to go the exchange. Blue Cross is a despicable company which has caused us many years of agony, and we are overjoyed that we can finally get them out of our lives.</p>

<p>Besides, I want to do my part toward making the exchange successful by bringing my healthy young person into it. I’m thinking very long term here, because the only way her generation is going to be able to afford insurance during their adult lives is for our dysfunctional system to get fixed. If we had moved toward universal healthcare back when the rest of the world was doing it, we wouldn’t be in this fix now. But we are so very off-track that it’s going to be a long adjustment period, and will be painful for you, me, calmom, and many others. But it HAD to get fixed.</p>

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<p>Las Ma, how much are your premiums going up for your husband and daughter?</p>

<p>Edit: have you checked to see if they can keep their doctors in the exchange?</p>

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<p>Goldenpooch, I didn’t call you anything. You asked ME, " I don’t understand why you are happy with this, unless you think you are getting a huge subsidy."</p>

<p>I answered your question. You “don’t understand” how I can be happy unless someone is giving me money. I said that I don’t just think about myself. I didn’t say anything at all about you. </p>

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<p>Actually I’ve posted a bunch of details about my premium. My current premium is $400. The premiums for bronze plans in my area range from about $515-$665. The ones on the low end are HMO’s. Silver plans are about $720-$815. If the rates hold steady, then in 2015 I’ll probably be paying about $30 more for bronze, with a steeper climb for Silver. (I’m definitely getting Bronze, I’m just posting the Silver rates because I’d have to get Silver if I wanted something that I considered to be “better” than what I have now).</p>

<p>You seem to be asking everyone how much their own premiums are going up or whether they can continue to have their own doctors. I don’t understand why you think that others base their opinions on whether or not they are benefiting personally. I know a lot of people who will be very grateful to be see any doctor at any facility. I think the point of insurance is to provide the basics. That’s why I’m going to look into Kaiser.</p>

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<p>Calmom, I don’t understand why your rate is only going up $30 for a bronze plan? For a PPO Bronze plan, it appears to be going up by your numbers by over $200. I imagine you are getting a much higher out-of-pocket maximum (almost double) and you may not be able to go the doctors of your choosing. Unless you are getting a subsidy, I still have a hard time believing this is okay with you. It has nothing to do with altruism. My family is forced into a plan I don’t want and I resent it.</p>

<p>Also, is it okay for the 60-year-old couple who make $62,050 a year (hardly rich) to pay 24% of their income for their premium. Are they now happy because society (subsidized) is now benefiting at their expense?</p>

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<p>Is there anyone out there who is unsubsidized, and his/her premium is staying the same or going down? I don’t remember the authors of this law telling us the premiums were going up by a very considerable amount for all unsubsidized subscribers, or the plans would have lousy benefits and limited choice of providers.</p>

<p>Trust me, if I knew this, I would not have given up my grandfather status.</p>

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No, I said that in 2015 the plans will be $30 more than they will be in 2014 if they hold steady. They will keep on going up for me for the next 5 years. In year #6 I can go on Medicare instead. </p>

<p>The rates go up by age. I will have a birthday every year, so my rates will continue to go up accordingly.</p>

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<p>True. In the past 20 years I’ve never even come close to meeting my deductible. That was true when my deductible was $500 and it was true when my deductible was $5000. So now I will be paying for insurance that has a higher limit for money I won’t pay. </p>

<p>There are lot of things in life that I don’t get to have my own choice in, often because of finances. I don’t really like the crappy car I drive around in either. I bought it in 2004 for my kid, then kept it when she went off to college because it was better than the even crappier car I had before, which I gave to my son.</p>

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I don’t know how to make this any clearer. I care about people other than myself, and there are many things I value more than money. I am much more concerned about my offspring than I am about myself. I want my son to be able to get insurance and go to a doctor – any doctor – when he is ill. I want my daughter to have the freedom to quit her job and still has insurance if she someday has children of her own and decides that she doesn’t want to work full time when they are young.</p>

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<p>^^Yes. I know someone whose wife gets her insurance through work and he buys his through his small business. His premium is going from $307 a month (young) to $249. Not subsidized since their household income is pretty high. This for the silver plan so he’s thinking of getting a much better one. But he’s young, and healthy so rarely uses health insurance. Might stick with silver.</p>

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<p>3bm103, I would bet you that small business plan at $307 a month has far better benefits for a younger person (lower deductible and out-of-pocket maximum) than the silver plan.</p>

<p>Anyway, I still like to know if anyone personally (no hearsay) is getting a lower premium who is not subsidized.</p>

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<p>Goldenpooch, it is distressing to have to make this kind of fiscal adjustment in your golden years, no doubt. My own FIL at 85 has been paying $760/mo for his considerably younger wife’s health plan for the last several years and is counting the days until she’s Medicare eligible. Having her leave her job early was a fiscally daunting phenom, but we understood why they felt, given the age gap, that this might be their only “retirement” time together. :)</p>

<p>But to eventually straighten the system out, to make sure that YOU, for example, can’t be dropped of your former and apparently attractive plan the first time you REALLY need it, left to join, perhaps, the 70% rank of bankruptcies and people who suffer not being able to afford adequate care, for example, there has to at some point be an implementation where there is what amounts to a major market adjustment where the cost of heathcare reflects a fairly accurate proportion of income.</p>

<p>In my experience, as a small business employer, healthcare comprises about 15 percent of my “hard” overhead, and in many middle-income cases, about 20 percent of gross salary/benefit cost. But I think for most people those costs have been hidden or obscured a little by virtue of the fact that people tend to think of their “cost” as their employee portion, not the employer portion, and they may not be seeing directly the unchecked increases and clawbacks that occur each year in the hr department :)</p>

<p>Nobody’s happy about paying more – but some people feel from a big picture standpoint that in the end, this change has the potential to be worth the sacrifice. The execution of the implementation is another matter entirely, and the subsidy drop off seems steep to me where it should be graduated, but it is a gigantic undertaking and will require time to see te real and lasting impact.</p>

<p>By comparison, btw, if your insurance plan is like my insurance plan, in five years, your premiums would be where the exchange is quoting them now. (But by then, it wouldn’t affect you, because you’d be on Medicare.) I doubt your income would have matched pace, so if its any consolation, look forward to the fact that you’re only facing these premiums for a few short years.</p>

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<p>Now that I’ve looked into the actual numbers, we will pay double, higher deductible. </p>

<p>My biggest concern is that those who really need the insurance aren’t going to get it in many areas in the country. I hope they move to the states which are expanding Medicaid so that they will get insured. </p>

<p>It’s unfortunate that a large part if how this was put together has to do with keeping insurance companies profitable. For most of those who were uninsured, it seems a government insurance would have been better. </p>

<p>I don’t think this will work Even with the subsidies, the prices are going too high for those in the lower middle class and the working poor.</p>

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Nope. Same kind of coverage. He’s young and healthy and always had a plan with a high deductible and out of pocket. And this is not hearsay. One of my clients that I have been looking into healthcare options for. I’m his accountant.</p>

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<p>Poetgrl, if everyone who is unsubsidized is getting hit with the type of increases I am facing, I, too, don’t see how this law will survive.</p>

<p>Kmcmom13, you’re right it will be only 3 more years until Medicare. Unfortunately, I am not sure that will be a panacea. Many doctors in my community no longer see Medicare patients. Even though my premiums have skyrocketed, I am most worried about losing most of my preferred providers. I hope I don’t get sick because it is very distressing that I may not be able go to the doctors or hospitals of my choosing.</p>

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<p>Kmcmom13, I need to correct you about one thing: In Ca. you can’t be dropped by a plan on the individual market, unless you stop paying the premium.</p>