<p>
I can’t find any law that says that. The only law that requires insurers to sell during open-enrollment periods specifically applies to plans offered on-exchange, and insurers who are offering such plans, whether or not those plans are sold on or off exchange. </p>
<p>What happens with a company like Cigna in California which has opted to sell individual policies without participating in the exchange – I don’t know. It may be more a matter of state regulation than federal.</p>
<p>okay, but why are you only getting a new plan for two months? Is this because of your kid in NY? Are you planning to put her on your new plan and hoping the out of network coverage will be sufficient in case your kid needs medical care in NY?</p>
<p>Cigna will be selling individual off-exchange plans in Ca. next year and I know they are not subject to medical underwriting.</p>
<p>This is very interesting. If the open enrollment period is only subject to exchange plans and there is no medical underwriting next year (I can’t find anything suggesting there will be medical underwriting for any plan), then a person can choose to pay the penalty and go uninsured until they get sick, when, if they are smart, will promptly enroll in an off-exchange plan. If this is the case then why am I buying any plan now?</p>
<p>Edit: I see you’re now saying that the open enrollment period is subject to off exchange plans if the insurer sells plans on the exchange. It must also apply to Cigna because there is no medical underwriting for their 2014 plans.</p>
<p>I thought I was pretty clear. My kid has a job and will receive employer based health care in March.</p>
<p>I answered these questions already.
I dont want to keep writing about this. This is getting ridiculous.</p>
<p>I am not going to keep writing about this.</p>
<p>“People who have been living in the bubble of having employer-provided healthcare given to them for next-to-nothing may be used to it, but not people buying on the individual market – at least not for non-wealthy people buying on the individual market. We’ve gone to HMO’s or to very high deductible plans years ago because we couldn’t afford the premiums on the cadillac plans that many with employer-provided insurance take for granted.”</p>
<p>You seem to be thinking and speaking for an awful lot of people.</p>
<p>At least in my state, apparently most policies used to cover our best hospitals. Not anymore. Besides hiking the premiums and deductibles on these policies, the insurance companies are also greatly narrowing the providers. Before this, these were not just hospitals for the wealthy, they were for everyone. Until they fix this so the insurers allow more hospitals, these will be for those with group insurance and Medicaid only.</p>
<p>“And those of us who opted for high-deductible because we can’t afford a high premium are also cost-conscious – we don’t want to go to the most expensive facility in town when the first $5000 or whatever of any bill is coming straight out of our pockets.”</p>
<p>Sometimes, visiting a provider at one of these hospitals would only cost a co-pay, with no deductible to be met. And for serious issues, you’d pay a lot more than that at any hospital. This is a case of insurers saving money on the backs of the individual policy holders, nothing more. It can’t be explained away as something that doesn’t affect people. I don’t know why anyone would pretend that anyways.</p>
<p>Okay dstark, whatever.</p>
<p>“And those of us who opted for high-deductible because we can’t afford a high premium are also cost-conscious – we don’t want to go to the most expensive facility in town when the first $5000 or whatever of any bill is coming straight out of our pockets.”</p>
<p>If you go to any hospital anywhere you will easily meet your deductible. And when you really need a hospital that is about the least likely time to be price-shopping isn’t it? This is starting to look like a 3-tiered system. Medicaid. Exchange. Off-exchange. That makes sense because of the cost-cutting incentives and subsidies built into the ACA and supporters are basically acknowledging this but I don’t think most people realize it yet.</p>
<p>Flossy, in Ca it is a 2-tiered system, because all the insurers have decided to make the networks for off exchange plans identical to exchange plans. This is one reason why I am pis*ed. Why should I be limited to the same junk the exchange subscribers are getting, when I am paying much more than them.</p>
<p>Because 40-million people need your help? Sigh!</p>
<p>Busdriver11, employers dont want to pay these exorbitant prices either.</p>
<p>[Cedars-Sinai</a> stands out for steep pricing - Los Angeles Times](<a href=“http://articles.latimes.com/2013/may/17/business/la-fi-cedars-hospital-prices-20130517]Cedars-Sinai”>Cedars-Sinai stands out for steep pricing)</p>
<p>These expensive hospitals are part of the high costs.</p>
<p>“Moreover, ever-increasing hospital prices have helped fuel higher healthcare spending.”</p>
<p>GP, you are confusing two different concepts: “open enrollment” is a period during which an insurer must accept all applicants. Outside of an open enrollment periods, the company isn’t required to accept any applicants, so the question is: will a person be able to buy any insurance at all. Let’s say hypothetically a person simply opts to stay uninsured because he is healthy and irresponsible, and then in June is diagnosed with a chronic disease and decides to go shopping for insurance. </p>
<p>Does any insurance company have to sell to him? The answer to that is clearly “no”. </p>
<p>Is any insurance company allowed to sell to him? I think the answer to that is yes, but the insurance companies aren’t crazy. They aren’t going to be accepting all comers outside of open enrollment periods – if they did, then they would become a magnet for people who are waiting until they get sick to sign up. </p>
<p>So the insurance company that opts to sell outside of an open enrollment period is going to set up some rules about who it sells to. One thing that appears to be specifically allowed under ACA is the imposition of a waiting period: Mr. Irresponsible can sign up in June, but he might have to wait until September until anything is covered. I’m not sure how long the waiting period can be, because the law prohibits a waiting period of more than 90 days for group coverage, but doesn’t seem to have any provision addressing whether an insurer selling individual coverage can ever impose waiting periods. </p>
<p>So the question is: under what circumstances will the private, non-exchange participating company want to sell insurance outside the exchange-set open enrollment periods? I don’t see them doing that unless they have a way of protecting themselves.</p>
<p>Calmom, I agree with your last post. In effect, all plans, on or off exchange, will probably not allow enrollment until the time period as stipulated by law (ACA).</p>
<p>“Busdriver11, employers dont want to pay these exorbitant prices either.”</p>
<p>These aren’t just premium priced elite hospitals, such as you are talking about, dstark. These hospitals include the University of Washington Medical Centers, Swedish Hospital system, Virginia Mason, Children’s and Cancer Care Alliance.</p>
<p>I suspect the hospitals will all sue to provide access (Children’s Hospital has already filed suit against the insurance commissioner), and public pressure will be strong enough to force these major hospitals back into network.</p>
<p>Busdriver, I know for a fact that Children’s Hospital in Seattle was dropped from some employer-group coverage before ACA-- or that some employers opted to shift to plans that did not include Children’s in order to save costs. I know because that was what happened to my son: his employer plan covered Children’s when he signed his wife onto it, but during the company’s next open enrollment that plan was no longer available. However, my son & wife were allowed to stay on the old plan (or at least continue with the planned delivery at Children’s) because she was already pregnant – this was in late 2009 and early 2010, before passage of ACA. </p>
<p>Now my son did not work for a company that was large enough to self-insure, or offer its employees Cadillac-level plans – it was a company with about 500 employees – so not a “small business” either, but certainly not able to compete in the insurance market with a company that employees thousands, or tens of thousands. So it’s quite possible that the trend toward downsized networks or more restrictive plans was more apparent among some types of employers than others. </p>
<p>But it’s not new, nor is it something that has started with ACA.</p>
<p>“and public pressure will be strong enough to force these major hospitals back into network.”</p>
<p>Then insurance is going to cost more…</p>
<p>“But it’s not new, nor is it something that has started with ACA.”</p>
<p>It is new with respect to the individual PPO market in Ca.</p>
<p>dstark, the headline of the Cedar Sinai article does not reflect the highly nuanced explanations given by various experts in the article, including the executives of Cedar Sinai. There were very good reasons given for Cedar’s higher prices. One thing they pointed out among many is that 90% of their revenues had nothing to do with their prices.</p>
<p>Assuming that insurers are forced to accept these expensive hospitals into their networks, who is going to pay for it?</p>
<p>“Assuming that insurers are forced to accept these expensive hospitals into their networks, who is going to pay for it?”</p>
<p>Who is paying for the 40 million people getting subsidies?</p>