Affordable Care Act Scene 2 - Insurance Premiums

Parent Cafe
481

<p>

</p>

<p>Yes – all the people who were being charged higher than typical rates because of the way that insurance companies rated policies based on health histories. </p>

<p>It’s like this: there is median. Some people paid more than the median, some people paid less. </p>

<p>Many people who have been following this are somewhat relieved because the prices on the exchanges are somewhat lower than we expected them to be. We knew that the insurance companies wouldn’t be able to offer discount rates to everybody, because they are now required to insure everybody. Not just the people like me who never even run up their deductible – they have to insure sick people too. </p>

<p>A couple of years ago, I was paying about $330 a month for insurance and I thought that when Obamacare came in I would have to pay about $850. It didn’t even occur to me that I might be eligible for a subsidy – I thought the subsidies would be for poor people, like the families who have 0 EFC. The reason I had that $850 stuck in my head is that when I talked to other people my age, that seemed to be what they are were paying for insurance. I knew that I was getting a preferred rate and I had seen rate charts showing what my insurance company was charging others for the exact same policy – so I had an idea of what the average probably was. </p>

<p>It’s kind of like buying an airline ticket on Southwest. There is the regular fare, and the discount fare, and the super-discounted web only fare. I always buy the cheapest web only fare, but sometimes its not available. The fares keep changing and they go up as the flights fill. </p>

<p>If the government passed a law that said that the airlines had to charge everyone who bought a ticket in the same section of the plane the same price, then that means those super discount web only fares wouldn’t be available any more, and all the tickets would be sold for a price that is somewhere in the middle between lowest and highest right now. </p>

<p>I’m not advocating for a law like that, but I wouldn’t have a problem either. I think the current system of buying airline tickets is crazy, and maybe if all the tickets were the same price all the time it would be less complicated and less stressful to buy tickets. </p>

<p>You seem to want something that I think is very odd: you want a discount price for a first class ticket. You want to go to the most expensive hospitals in a different city from the one where you live. I understand why you want that… but I have a much harder time understanding why you think that you are entitled to that. </p>

<p>The way I look at it- I’ve been very lucky for many years. I have been lucky to be in good health, and I’ve been lucky to get insurance cheaper than all the people I know who are not in such good health. Now I am still lucky, because I am still in excellent health.</p>

<p>But insurance is going to cost me somewhat more. </p>

<p>Because in 2014 I will be paying something closer to what many other people have been paying all along.</p>

<p>I can live with that.</p>

482

<p>Calmom, I keep telling you I am willing to pay for a plan that allows me maximum choice. The problem is that there is no plan. My choices have been taken away from me, even though I am willing to pay. This has a Communist feel to it. </p>

<p>Also, since when does paying $8,200 a year such a great deal. You make it sound like somehow I benefited on the backs of other because I got to pay only $8,200 a year for a deductible of $5,200. I don’t think so. </p>

<p>Again, if had known that my premium would almost double for lousy benefits and limited choice, I would have never given up my grandfather status.</p>

483

<p>Calmom, you think the 60-year-old couple who makes $62,050 a year should pay 24% of their income? Where is the empathy for them or are they just roadkill?</p>

484

<p>Goldenpooch, in my opinion you put way too much stock in the superiority of teaching hospitals over community based hospitals. This is a side comment, so I apologize. However, I know a good bit about hospitals, and I can tell you that your strong preference for UCLA and Cedars may not be as well founded as you believe. </p>

<p>If I have a brain aneurism, I absolutely want to be at UCLA. But if I’m having my gall bladder out, give me a good 200+ bed community hospital any day. At the local hospital, you get a set of experienced physicians caring for you. At UCLA, with only an uninteresting gall bladder, you’d be in the hands of a bunch of residents for much of your care. No offense to all you parents of budding medical students, but we always say never have surgery the first week of July.</p>

485

<p>Hayden, I have a very good friend who had a deadly soft tissue sarcoma that required a very intricate and deep incision. His oncologist sent him to UCLA because the best physician in the world at performing these type of incisions was located there. Under Obamacare he is out of luck.</p>

<p>His local doctor told him it would require a graft from another part of his body. The guy at UCLA did not have to do a graft.</p>

486

<p>My issue with the pre-ACA sitution has been that even if you had health insurance through work, when you really needed it, unless that insurance was through your spouse’s work, you most likely would be out of luck, when you loose/resign from your job, because you are unable to work.</p>

<p>However, it appears now that with ACA you still have this problem - when you really need the best care, you cannot get it because of small network, unless you are getting an insurance through work (either through your spouse or through Cobra). </p>

<p>I am from the region where it appears the rates are quite low even for the platinum plans, but the network at the very first glance is tiny. What good does it do for anyone?</p>

<p>I also feel that thouse who cannot afford insurance without subsidies, should not be buying anything other than platinum plans, because if they cannot afford insurance premiums, how would they be able to afford huge deductible and copays? Bronze insurance is useless for those people.</p>

487

<p>

The rates on the grandfathered plans are going up too. I have verified this twice, both with an agent from Blue Shield and an independent agent who happens to have the exact same plan I do.</p>

488

<p>

</p>

<p>lerkin and Goldenpooch, you cannot extrapolate California to all states. All the plans on the exchanges in my state include all the teaching/tertiary care hospitals in a wide radius, so we are lucky in that folks here don’t have an issue with provider choice. I live in a major metropolitan area, so that means lots of other people are seeing the same broad selection of providers as before. </p>

<p>As LasMa and Calmom have previously said, it is not Obamacare making these decisions, it’s the insurance companies.</p>

489

<p>Hayden, maybe I will move to your state!</p>

490

<p>

</p>

<p>The government didn’t take your choice away. The insurance companies are choosing to narrow their network and exclude some hospitals that charge them exorbitant prices. </p>

<p>You know what? I don’t want my personal rates going up even higher in order to pay for some other people to go to hospitals that charge three times as much as others in my area. If one hospital charges $20,000 for a common procedure and another charges $80,000 for the same procedure – and I’m choosing to comparison shop before I write checks from my HSA … then I am very glad if my insurance company is keeping a lid on the prices. </p>

<p>What’s so special about your health needs that can only be served by Cedars Sinai or UCLA? Do you have some sort of obscure or complicated condition that can only be treated by uniquely qualified specialists?</p>

491

<p>Goldenpooch, you’d be better off in Kentucky, near a good teaching hospital. From what I’m hearing, their premiums are low and sign up is going smoothly. </p>

<p>Life is a trade-off. We spend a fortune heating our house in the winter. And we pay lower insurance premiums. Who wins?</p>

492

<p>Hayden,</p>

<p>I am not from California, but I do agree with you that two points do not make it a trend. I probably should have qualified my post with “in CA and MN”.</p>

<p>I disagree with you regarding the cause of the all these changes. In my opinion insurance companies are forced to make a choice because of ACA.</p>

<p>The way I see it, the dirty little secret with employer coverage was always that the pool was mostly healthy (the unhealthy ones for the most part lost their jobs after a while) and that is why insurance companies loved employer coverage and employers could offer subsidized insurance.</p>

<p>The private market mostly conisted of healthy people too because unhealthy people were kicked out.</p>

<p>So the way I see it, the exchanges are now going to get mostly those who are unhealthy or those who could not afford insurance before (but now cannot afford insurnace copay). Insurance companies because of ACA cannot price risk, so they offer tiny network (in CA and MN), which is not condusive to receiving health care (when you really need it). The exchange situation in MN and CA is a direct result of ACA, just like UCLA insurance companies do not want to go out of business.</p>

493

<p>Calmom, with all due respect, you are entitled to go wherever you want, but who gives you the right to tell me where I should go if I am willing to pay for a plan that allows it. Although you may be unsubsidized, I certainly don’t appreciate a subsidized policyholder who may be paying next to nothing for their insurance pontificating about what fully paying customers are allowed to do.</p>

494

<p>lerkin, I am afraid you are right. What a mess this is going to be.</p>

495

<p>Never had to be a mess. Lets make believe everyone is 65 and let us all sign up for Medicare. Employers would be free to provide Medi-gap coverage as a benefit or we could purchase it on our own.</p>

496

<p>

</p>

<p>I think a 60-year-old couple who makes $62,050 a year should be talking to a CPA to figure out what they need to do to reduce their AGI to $62,039. Maybe they can open an IRA. </p>

<p>Is that close to what you earn or do you earn a lot more? Because you said that you have an HSA, and if you fund your HSA to the max that’s a $7550 deduction right there. So that means that that the couple can be earning $69,500+ and qualify for a subsidy with the HSA writeoff. </p>

<p>(It seems a little like double-dipping to me but it is listed on page 26 of the Covered California application as an acceptable deduction, so I’m claiming mine). </p>

<p>

</p>

<p>I’m worried about the people in the 22 states that haven’t expanded Medicaid who earn too little to be qualified for subsidies. When they get brought on board I’ll worry more about the people who make a smidgen too much to get a subsidy.</p>

<p>Also, if that 60 year old couple came to me and asked my advice because of the hardship they were facing, I’d tell them to get the cheapest bronze HSA available in their area. In my area its Kaiser. In your area it’s Anthem. (Also, I can see that your rates in your region are significantly lower than mine - the Anthem policy that would cost the couple $1,044 in your region would cost $1265 in mine. Maybe your hypothetical couple should do some checking and move to an area where the insurance is cheaper. Like Nevada).</p>

497

<p>Calmom, I hope you weren’t serious about the couple moving to Nevada. You think this couple can afford the cheapest, lousy Bronze plan at over $12,000 a year or 20% of their income. Also, gaming the system by lowering your income to qualify for subsidies is not an acceptable answer or a solution for the unsubsidized policyholders who are getting the short end of the stick under this crazy law.</p>

<p>BTW, how are they going to afford contributing the $7,550 to an HSA account; now we are talking about allocating 30% of their income for health care.</p>

<p>Furthermore, these plans will continue to be unaffordable for the couple even if they were making $70,000 a year.</p>

498

<p>^ you make good points…I don’t think I have seen anyone post that their premiums are going down…my plan is up 50% next year and it’s solely because of the ACA.(although some would wrongly try to say it’s not)</p>

499

<p>“I have a very good friend who had a deadly soft tissue sarcoma that required a very intricate and deep incision. His oncologist sent him to UCLA because the best physician in the world at performing these type of incisions was located there. Under Obamacare he is out of luck.”</p>

<p>And if this person had non employer insurance, after he went to UCLA and got treated he would be dropped from his insurance and not able to get any until he turned 65 and could go on Medicare. If he was employed and then lost his job same thing (after Cobra would run out.) </p>

<p>In my opinion it is more important to know I will always be able to get insurance so my family doesn’t lose everything than be able to go anywhere I want to be treated. </p>

<p>It is also possible, in extenuating circumstances, that an insurance plan may cover if one must go out of network for treatment. There will still be the appeals process as far as I know - even for plans on the exchange.</p>

500

<p>I confess I have not read all 33 pages of this thread but would like to share a few things I learned after attending 2 ACA seminars. First, I think the impact of ACA varies depending on the state you live in. ACA is the same, but each state has their own health insurance board, which until now determined what provisions were required for acceptable policies sold in the state. </p>

<p>If your family’s modified AGI is < 4 times the FPL it is probably to your advantage to purchase insurance through the ACA exchanges. It is important to note (for income and subsidy determination) that the number of people in the family is based on the number of people listed on the tax return. D is 23 and we include her on our insurance plan but she is not on our tax return. For ACA ‘income’ and subsidy determination we are a family of 2 not 3. </p>

<p>We live in a rural state and the number and type of providers available in the exchange plans are limited. Even if you financially qualify for a subsidized plan it may not be the best plan for your family if someone in the family requires a specialized provider (e.g. board certified endocrinologist).</p>

<p>If your family doesn’t qualify for an ACA subsidized plan it would probably be best to purchase insurance through a private carrier. All plans are require to meet the ACA mandates but you can limit having to provide your private health and financial information by purchasing through a private carrier. Looking at the premiums and deductible costs (w/o subsidy) for plans on the ACA exchange in my state and comparing them to the plans offered by my current private carrier. It is slightly less expensive through my private carrier w/ the big advantage on having access to all providers.</p>