<p>I have a logic question. I am looking at this closely, running some samples. My lowest cost Silver (HSA) has low deds and caps. Max OOP 3k/individual. Next Silver = higher cost, higher ded and higher max OOP, 5200. Why wouldn’t one go with the HSA? The premium cost differential is about 1k/year lower for the HSA.</p>
<p>Am I missing something here? Seems I would be paying more monthly for the possible benefit of lower costs, *pre-deductible?<a href=“Sick%20visits%20at%20100%%20vs%20flat%20fee.%20It%20could%20rack%20up.%20But%20only%20up%20to%203k,%20on%20the%20HSA.”>/I</a> If all goes well, we wouldn’t spend that 1k annual difference out of our pockets.</p>
<p>In-network Rx are included in deductible (versus a flat fee, from the get-go, for the 2nd Silver.) But both include Rx in the OOP max.</p>
<p>Worst case, on the HSA, I could go to ER, pay full cost- but only up to my ded, then 10% up to the cap. The 2nd Silver = flat fee. In-patient and Outpatient, both are 10% co-ins after deductible, one capped at 3k, the more expensive plan at 5200.</p>
<p>Nice Community Hospital is going to be able to handle most things. Maybe I might get some rare disease that would be better handled by Cedars, but if I do, (1) maybe my insurance plan will recognize that cases of growing a third leg with purple spots on it are better handled at a specialty hospital and (2) even if they don’t recognize that without prodding, they might recognize it if I pushed them. Meanwhile, the plan that only has Nice Community Hospital is much cheaper.</p>
<p>If that’s the fact pattern, I think insurers are right that most people will go for the cheaper plan over the plan with more providers.</p>
<p>Many people are going to be grateful to have any plan at all; and many are just going to look as far as the facility or doctor they already are using. I don’t think very many care about specialty hospitals in different cities for conditions they don’t have and don’t want to have.</p>
<p>Personally speaking, I was not thrilled with my experience delivering a baby at Cedars. They brought me the wrong baby from nursery and then didn’t match up bracelets following security protocol when released from hospital. ;)</p>
<p>So much of this conjecture is not knowing what we do not know about ACA. </p>
<p>Before, we could lose our insurance after getting diagnosed with a big illness. Premiums rose out of control each year. We had to fight to get claims covered. </p>
<p>So now we have a system where we are guaranteed insurance if we can buy it and continue making payments. Costs will will go up each year, and some will lose their insurance because they cannot pay. </p>
<p>We might lose our doctors with shrinking networks. Others might get access to doctors for their networks. </p>
<p>I am still concerned about less doctors being available in ling term due to not enough doctors projected in coming years. </p>
<p>I guess we will have to wait to see what happens with employer based coverage in 2014.</p>
<p>California is a high cost state - not only for employers, but residents. If we opt to stay in California and I ever need to purchase individual health again - will look carefully at out of pocket costs, deductibles and monthly premiums. I will not only look at premium costs, because all it takes is one illness to double out of pocket costs if you end up in hospital even one day a year for a family member. Getting older with three kids means that risk is higher than one subscriber alone.</p>
<p>Yeah, i recognized mistake right off as nurse handing me baby. Then told her wrong baby and she was terribly embarrassed since didn’t check wristband. </p>
<p>When we consider whether the people now getting coverage will suffer long waiting times for appointments, we need to separate out the people who are buying private insurance from the people who are newly enrolled in Medicaid.</p>
<p>For the people who are getting private insurance, their networks may be small, but people with new private insurance are going to be a small subset of all the patients covered by those providers. So the providers are not going to see a significant increase in patient load, and therefore the new patients shouldn’t be seeing a significant increase in wait times. Say for example Nice Community Hospital served half a million people, and now it serves 510,000. Not much difference there.</p>
<p>Medicaid is a different story. In some areas there is already a shortage of providers who take Medicaid, and that can only be exacerbated by the new enrollees. OTOH, waiting a month to get a doctor’s appointment is better than not being able to get one at all because you have no insurance.</p>
<p>I love seeing how some posters view several sides. And am personally frustrated by those who only see doom.</p>
<p>I had Cadillac insurance and sometimes had to wait for a non-urgent appointment. When it is urgent, my doc’s office gets me in- with my doc, another or the NP or PA. If your doc doesn’t allow for this, you have a core issue with that practice. Imo.</p>
<p>It’ll be interesting to see how hospitals and ERs respond to this. Let’s say you are running a hospital with an ER that is ending up full of patients who should have just been seen by a regular doctor at the office, who wanted to see a regular doctor at the office but couldn’t get an appointment, and who had Medicaid to cover their visits to doctors’ offices.</p>
<p>Do you throw up your hands in despair? Or do you say, hmm, it would be cheaper and easier for everyone concerned if I set up clinics that these patients could go to, using their new coverage, instead of funneling them to my overcrowded emergency room? Maybe clinics staffed by non-physician providers who would be capable of handling the kind of minor issues that you don’t want to see in your emergency room?</p>
<p>It’s one thing if people are showing up in emergency rooms because they can’t pay for doctor visits and know they have to be treated at the emergency room. You can’t tell such patients to go to a doctor’s office, because they can’t afford it. It’s quite another thing if people are showing up in emergency rooms when they wanted to visit a doctor and had coverage for it. If you tell those people, here is where you can get an appointment, they will get the appointment, because by hypothesis, they wanted the appointment in the first place.</p>
<p>It would be smart to set up minute clinics or walk in clinics attached to pharmacies or freestanding near hospitals - train and hire more Physician Assistants and Nurse Practitioners who can deal with the patients with minor issues. </p>
<p>Easier to do in areas with less population impact - harder with dense populations and crammed cities. Where would you build them when real estate is at a premium or simply the med center has achieved it’s maximum available footprint? I would rather go to a clinic for a UTI or possible strep or things like that. It is terrible to feel bad and then have to sit for 2-3 hours in a waiting room filled with sick people who may infect me with something worse than what I already have!</p>
<p>So you are saying that the doctors in the networks for “private” subscribers are different from the doctors in the networks for exchange and Medicaid subscribers? That was not my understanding.</p>
<p>Obamacare brings 48 million (the number I read keeps changing) previously uninsured people into the patient market. That is a lot of new patients if they all choose to utilize the product they are paying for or get for free.</p>
<p>The number we care about is not how many people are currently uninsured (48 million) but how many people will now start to visit doctors offices and other care providers and who were not previously getting medical care (a number which is far smaller than 48 million, probably by two orders of magnitude). If a person currently goes to the emergency department for medical care, but now is able to go to a doctor’s office or clinic instead, we don’t need any more doctors for that person. They were already seeing doctors. We might need fewer doctors, because the person might be able to be seen by a non-physician provider.</p>
<p>We will need more doctors or other care providers for the people who were not seeing any care provider and now can. We’ll probably see some kinds of care farmed out, as we already are with things like flu shots in pharmacies. We’ll see some shortages of providers somewhere. We’ll see more pressure to allow non-physicians to do more things, and we’ll see more pressure to allow doctors trained in other countries to practice here.</p>
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