Affordable Care Act Scene 2 - Insurance Premiums

Parent Cafe
5261

<p>non-discernible increases in their benefits What I see is that the BCBS independent plans and my marketplace plans mostly have the same names. But apparently my state has negotiated to offer (sometimes arguably) better coverage for these plans, at a lower cost (I’m only looking at Silver,) through the Marketplace. You really need a line-by-line, to see, maybe a spreadsheet projecting how it would work for you, at various levels of service. Some is surprising. Haven’t wrapped my head around it all, yet.</p>

<p>Also confirmed about away-from-home. Emergencies are covered as I expected, from past experience. It’s not seen as discretionary. Probably some twists, but good enough for the scenarios I can envision.</p>

<p>Also, about seeing an out-of-network doc (eg, specialist.) The way it was explained to me (again, in line with what I’ve previously experienced,) is: if your doc feels OON Doc X or facility X is justifiable, BCBS will review it. This came up because of the talk here about high-rep cancer centers. So many here want Dana Farber (OOS but in network.) It leaves the possibility of an OON doc being involved. I think some will benefit from asking this sort of question, direct to the company and several times. </p>

<p>You can say, well my insurer is lousy, I can’t get a good rep, they promise all that, but what til it happens. Etc. But, my experience has already been that, with a savvy doc, it’s in how he/she handles it, explains his/her position. And, doing enough research to understand whether there is, in fact, separate from reputation, a good local alternative.</p>

<p>We talked about diagnostic imaging- my plan choices vary in coverage. “It’s all in the coding.” And, in the context. And how you pursue clarification. One plan says $600 co-pay if an ultrasound is done in a hospital. Turns out, that’s when, say, you choose to have that post-mammo U/S done at a hospital versus a different facility. They tell me inpatient or ER would fall under a different umbrella.</p>

<p>Point being, gotta ask til you have “enough” info to proceed.</p>

<p>Also saw a survey/commentary that was undated, so I won’t link it. Satisfaction vs dissat with ACA, in principle. When they broke down the questions to distinct issues, medical situations, expectations, the satisfaction rate rose 50% over the simple yes-no.</p>

<p>I have long thought some grumbling from the general public is from those who haven’t considered certain aspects, haven’t thought about the personal impact, just “Does it sound good?” or “Did I hear something bad on the news that makes me leery?” Or maybe heard their docs weren’t covered, haven’t checked enough out. I know some here have.</p>

5262

<p>I think the people in places like NH and RI are justifiably upset. In our state the prices are ridiculous, but the coverage is good. </p>

<p>It’s tough to do this federally I think. If we had fifty states on this thread we’d be talking about fifty different elephants, so to speak</p>

5263

<p>I just don’t think people have come to terms with how absolutely horrific U.S. health care has been to so many people for so very long. I’m no fan of ACA, and never have been, and I worry more about what happens a year from now than from the minor blips now. But I don’t EVER want to go back to the bad old days.</p>

5264

<p>“By definition, everyone who qualifies for Medicaid is either an adult living in poverty (or just barely above), or a child living in a home that is close to poverty level. Poor people get sick. They get seriously ill and need treatment, probably at a somewhat higher rate than rich people because of the overall impact of poverty on their lives. Many are poor precisely because they already sick.”</p>

<p>Except now, by definition, that is no longer true. You can have any assets whatsoever, and as long as your income is low enough, you get it. This is not a program for the poor any longer. This is a program that can include people who take a couple years off of work to go to graduate school, stay home with their kids, travel the world, or retire early. Certainly many people who manage to get paid without declaring it in their taxes can qualify. In my opinion, that’s wrong. This should stay a program for the poor.</p>

<p>In addition, I never understand why people talk about Medicaid as if it disappears at age 65, and the person gets everything covered by Medicare. Not true. You can receive both Medicare and Medicaid, which covers many of the things that you’d have to pay for if you only received Medicare.</p>

5265

<p>I agree Mini</p>

<p>In the places where I see the insurance wolf showing up, it bugs the heck out of me! But I really want people to have health care and I’m willing to pay more and have higher taxes for this. </p>

<p>I don’t love having higher taxes to fund the eight figure executive salaries. But we will get past that in short order I imagine. ;)</p>

5266

<p>Didn’t most people on Medicare by supplemental insurance? It was never considered a wonderful option for all health needs. This program shuffles the winners and losers and is causing some pretty dramatic upheaval already but it doesn’t even claim to cover everyone. Whether it’s better than the bad old days remains to be seen. It’s different.</p>

5267

<p>Calmom, really, like you, trying not to be surprised by later charges, when all this is reconciled in our taxes for 2014. Not to under-estimate MAGI, be socked later. All my prices are reasonable. Will take the subsidy. Small paybacks wouldn’t bother me. Just trying to control for some larger error, on my part. I was able to confirm that we are verified- and the rep went over my entries, line by line, and agreed with my logic. </p>

<p>All the plans I’m considering are BCBS. The low cost/low ded/low cap I can choose is a Silver HSA. Pay all charges (in-nwk, at negotiated rates) til you hit the deductible. Some like that; some won’t want to pay, say, $1000 up front-- when they could choose a plan with lower initial costs (co-pays) for more ordinary things. (But that HSA does have much lower deds/caps. Hmm.)</p>

<p>In our case, there is no one choice yet that is better, in absolute terms, than another. To be seen.</p>

<p>I also see how plans vary in price/coverage, for our details. Eg, one insurer that focuses on much lower income families, was not as competitive for our situation. It would be a mistake to just look at the superficial numbers and assume it is trying to rip us off- when really, it’s not the insurer for us.</p>

5268

<p>The HSA you are looking at is probably similar to mine: it pays -0- until you hit the deductible (except for the preventive care, which are provided almost free of charge in all plans – I say “almost” because my experience has been that when I go to the doctor for a routine checkup, she orders a panel of lab tests, and the insurance only pays for some - but then I get a bill from the lab that generally looks something like this:
Total charged by Lab: $520
Total allowed by insurance: $185
Amount paid by insurance under preventive benefit: $75
Patient responsibility (applied to deductible): $110</p>

<p>I’m making up the numbers, but this is pretty close to the pattern I see. </p>

<p>I think the HSA is a good option for people who tend to have relatively low annual expenses and have the financial ability to handle the deductibles and also fund the HSA account. People who can’t afford to fund the account are losing the chief benefit of the system, and would probably be better off choosing something with a copay schedule that better fits their needs.</p>

5269

<p>Busdriver11, in your last post, are you talking about medicaid?</p>

<p>I agree with this.</p>

<p>“I just don’t think people have come to terms with how absolutely horrific U.S. health care has been to so many people for so very long”</p>

<p>I think one of the biggest problems with the individual insurance market is it just isnt profitable enough unless the healthy and those that can afford to pay are skimmed off the
top.</p>

<p>Trying to insure the sick, the poor and those with preconditions is not profitable and so it wont happen unless there is market intervention.</p>

<p>I think this is why we see 15 million insured and 48 million uninsured. It is not profitable to insure those 48 million people.</p>

5270

<p>“I just don’t think people have come to terms with how absolutely horrific U.S. health care has been to so many people for so very long”</p>

<p>I find a comment like this very interesting. If any one of the posters in this thread got very sick, would you seek medical care outside of the US. The answer is no. None of you would leave the country. The best hospitals and the best medical care in the world is right here in the US. Ask all the people around the world who come to the US to be treated for cancer and other diseases.</p>

<p>My fear is this could easily change if we starve the best hospitals of sufficient funding.</p>

5271

<p>Calmom-
HSA 2000indiv/4000 fam deductibles. 3000 indiv cap, 6000 family.
Versus 3000/6000 and 5200/10400.</p>

<p>Is that a Yikes moment, for the ability to pay a co-pay versus cash? It’s cash only up to the 2000 ded, then 90/10 up to the 3000 cap. On the (annual) $800 higher plan, ER and ambulance (and doc visits beyond wellness) are flat fees, but no 90/10 til 3000 is reached. Cap 5200.</p>

<p>On a next higher plan, $1200 more than the HSA, ER, ambulance, imaging/diagnostic pix and labs are flat, no hosp daily co-pay-- but the coinsurance is 80/20, same 3k deductible, 5200 cap.</p>

<p>I got through this ring of fire- next is to spreadsheet it. Our ordinary medical is low enough, but DH went through a crisis in 2013 and D1 could have surgical needs, maybe, some day, maybe not. I could get kidney stones again. </p>

<p>Bottom line for me is I can wrap my arms around the core, now. But it really is a ring of fire. Think of the little guys, eg, who see an $18 rate (bronze, not on my list) and don’t realize they pay everything up to a 6 or 10k deductible. [My exchange tells me they are catching as many of these folks as they can, steering their thought processes. Hope so.]</p>

<p>I think, even without an HSA account, that plan is intriguing.</p>

5272

<p>Yes dstark, I was talking about Medicaid. Programs for the poor should be… very good programs for the poor.</p>

<p>I’m not blaming anyone who is taking advantage of the changes, it is the system we have in place now.</p>

5273

<p>Texaspg, I did not see your edit in post 5235 until now.</p>

<p>It looks like the govt is going to save money because states arent signing up for the medicaid expansion. The revenues are coming in and the expenditures are going to be less. </p>

<p>As far as the risk pool is concerned, as a country we can handle this issue. I wrote earlier about how the country would be affected on a macro scale.</p>

<p>On a micro, scale if the sign ups lead to a poor risk pool in the individual marketplace, how this is handled will decide the winners and losers. </p>

<p>Those that are in the individual marketplace do not have to carry the burden. They might.
I would like to see how this plays out before I freak out. :)</p>

<p>The employer healthcare market does not have to be impacted much from ACA. If it is, there are other issues at work. Like cost shifting.</p>

5274

<p>I felt like asking the Covered California board members yesterday if any of them were purchasing exchange plans. I wonder how many of them are in the individual market. It’s easy to dictate healthcare to a million people if you don’t have to drink from the same pool of water.</p>

5275

<p>Ok… But busdriver11, how many people with substantial assets are really going to sign up for medicaid?</p>

<p>There are always going to be scammers. Scammers are part of the costs of programs or business. </p>

<p>How many people buy dresses, wear them once for some outing and then return them?</p>

<p>I have a friend that used to work at Nordstrom’s.</p>

<p>Should Nordstrom’s close?</p>

<p>I used to wait until the starter left at Golden Gate Golf Course in SF so I could play for free. I am pretty confident golfers are still doing that.
Should the golf course shut down?</p>

5276

<p>Forgot to mention, I’m supposing the assets test will gradually be phased in, in some way. If it’s in the plan, I don’t know. But, first things first. Big boat to maneuver into dock.</p>

5277

<p>I don’t think people who take Medicaid now with assets are scammers. At all. They will merely be working within the new system. Certainly if you can get better care, as in my state, it will be the new norm.</p>

5278

<p>Well… We will see.</p>

<p>Playing around with assets may have a cost too. Might not be worth it to try and qualify for medicaid.</p>

5279

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<p>I don’t think the people struggling to get insurance in the first place are those on the receiving end of “the best medical care in the world.”</p>

5280

<p>But there is no asset test anymore, right? So many people might not have to play around. The smart people with extra cash already converted everything to Roths, so no income on those assets ever. I’m not saying a lot of wealthy people are really going to apply for Medicaid, but if the cost of insurance goes way up, with less in network providers, people qualify for Medicaid, why not? Why stick around in a job till age 65, waiting for Medicare?</p>