<p>SL… Out of network charges are extra…</p>
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<p>This is a good point. We are paying for subsidies; the money for the subsidies doesn’t come from the fairies.</p>
<p>But the point is not relevant when considering premiums, and why they are higher or not under the ACA, and why they are higher or lower in different states. The insurance companies set the premiums, and they don’t care if their policyholders are subsidized. They get the same payment for the same person whether that person is a millionaire with no subsidy, or someone earning at the poverty level whose entire premium is subsidized.</p>
<p>So premiums in a plan that happens to have a lot of subsidized people won’t be a nickel more expensive than premiums in a plan that has the same age mix of people, but all of them unsubsidized. </p>
<p>Nobody is paying anyone else’s subsidies out of their insurance premium. We are paying for the subsidies out of the general fund that all taxpayers pay into. So as far as subsidies are concerned, people who are buying individual insurance are not facing any unique burden.</p>
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<p>The ebri study does say that 68.5% of all workers in firms with 50+ employees are covered by self-insurance. </p>
<p>86% of workers in employers will 1,000+ employees are covered by self-insurance.</p>
<p>42% of workers in employers will 100-999 employees are covered by self-insurance.</p>
<p>Surprisingly (at least to me at least) is that 12% of firms with <50 employees are also self-insured. </p>
<p>The study notes that 50 is the magic number for analysis because that is when ACA kicks in.</p>
<p><a href=“http://www.ebri.org/pdf/notespdf/EBRI_Notes_11_Nov-12.Slf-Insrd-RetRdines.pdf[/url]”>http://www.ebri.org/pdf/notespdf/EBRI_Notes_11_Nov-12.Slf-Insrd-RetRdines.pdf</a></p>
<p>We got our 2014 rate notice from BCBSNC. This is for our existing plan that was cancelled, but now we are able to renew it for 2014. In fact, if we do nothing it will automatically renew. Our current monthly premium of $680 will be $908 next year , a 33% increase. The ACA plan that we were to be automatically migrated to was going to be over $1500 per month. As I have said previously, our gameplan is to research the ACA plans and sign up for one and we will most likely qualify for subsidies so I still expect a much lower net cost next year. We shall see.</p>
<p>NJRes - Will you be able to get the tax credit if you buy it for 908? I assume it is a question of paying but collecting it at the end of the year.</p>
<p>No, the $908 is my 2014 premium for my current nonACAcompliant plan, so no subsidies will be available if I renew my current plan. This year’s premium= $680. Next year’s will be $908. This is what happens if I do nothing. This option didn’t exist until the recent change adopted by the NC insurance commisioner and BCBSNC decided to go along with it. </p>
<p>What I will do is sign up for a new ACA plan, some time in the next 2 weeks… or maybe 1 week, before dec 15, although did they extend the deadline to Dec 23?</p>
<p>Yes, deadline was extended to the 23rd.</p>
<p>I would assume you can get a tax credit (deduction?) but I suppose you need to be self employed.</p>
<p>Emilybee, and bluebayou, I am blown away by how many people in the employer based market are covered by their employers’ self insurance. There are a lot of ramifications because of this. </p>
<p>Without having a lot of time to think about this, </p>
<p>Mu first thoughts are … we are not going to single payer in this country and I dont mean this in any political way. There are over 50 percent of workers covered by self insured firms and that is a cheap way to go. So why have single payer? Why would 50+ percent of workers put up with that change? That is something to think about but not debate here. </p>
<p>The fact that so many workers are covered by self insurance firms tells me that those workers that arent, but still have coverage from employers, are a more expensive group. </p>
<p>So… CF is more likely to be right that those who get insurance in the individual market place thru an exchange are less costly than those workers who dont work for self insured firms.</p>
<p>So…Because the workers are more costly, I can see a large movement of workers that lose employer based coverage and end up on an indiviidual exchange. This doesnt mean these workers are going to see large increases in costs. </p>
<p>Bluebayou, you can pm me if you think I am full of crap. 
or you can post here… But you better behave yourself. :)</p>
<p>There are built in increases in costs every year the way healthcare is set up in this country. 7.5 percent increases a year, sucks. Incomes are not increasing that much. We need to get costs down, otherwise, we, as individuals, and as a society are just going to spend more and more money on healthcare. </p>
<p>I wonder how many people know their company is self insuring them. The insurance companies administer the accounts so I wonder how many people know? </p>
<p>A friend of mine works for one of the largest companies in the world. I saw his w2. I read some of his insurance info. I still have no idea. It is not my plan though.
It is my friend’s plan. He doesnt know. I guess he doesnt really need to know either. :)</p>
<p>The KFF link earlier today, employer bene survey, does looks at sorts of coverage per (their) categories of businesses- how may lower paid employees, who’s self insured, etc. Interesting charts.</p>
<p>SL, I can’t point to a link, but many people never reach their deductibles (another actuarial detail that factors into how they are set, I’d guess.) If you anticipate not hitting 5k, if you expect just doc visits, maybe some extra labs or imaging, maybe the lower per doc fees make sense (thanks, calmom.) </p>
<p>For comparison, our mid-Silver is 3000/6k, 5200 indiv max OOP/10.4 family. **Remember, this can be lower than on the plans you buy direct, based on cost-sharing. (Standard BC for us would have been 6350/12.7 max OOP.) Flat fee for docs (I think $20/$40.) Wellness lab tests are covered, diagnostics at 10% after ded. Basic 10% co-insurance. And so on. </p>
<p>If something big happens, I am more comfy with a 10% co-ins (and $200 ER flat fee) than a larger %. I projected nuumbers at a few possible levels of care needed. I had initially looked at it as SL did- what could be my worst bite in a year. But, for us, it comes out pretty par between the HSA and the mid-Silver-- unless more than one of us had something seriously wrong and we had to pay up to the family max.</p>
<p>In my case, it’s as if the exchange took the BCBS offerings (I mean coverage categories) and changed them to what the exchange wanted. Not even “as if.” They did. So look for that. Eg, on one plan, BCBS has an inpatient co-ins and the exchange shows it as $0. Silver. Not one I was interested in, so I didn’t pursue.</p>
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<p>Sorry, I just assumed that the knowledgeable and educated on cc were in-the-know. (After having spend 20+ years in medical economics, it was just common knowledge in our work.)</p>
<p>But don’t forget, that many of these self-insured (and employer insured) plans are sub-standard, according to the regs of ACA. (I’m willing bet, for example, that few, if any medical plans contained pediatric dental coverage, or first dollar for Rx.)</p>
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<p>Not sure I understand this point.</p>
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<p>For sure, particularly since the Longhorns lost today. :D</p>
<p>“I can see a large movement of workers that lose employer based coverage and end up on an individual exchange.”</p>
<p>Or those companies will move to self insuring. </p>
<p>Most people likely have no idea. </p>
<p>I know that New York State doesn’t self insure - and I cannot see anytime in the near future the state not offering employer health insurance. Heck, they still have pensions! ;)</p>
<p>When I worked for bank of america, I didnt know if the company self insured or not. It was a long time ago. A very very long time ago. </p>
<p>“I know that New York State doesn’t self insure - and I cannot see anytime in the near future the state not offering employer health insurance. Heck, they still have pensions!”
:)</p>
<p>“But don’t forget, that many of these self-insured (and employer insured) plans are sub-standard, according to the regs of ACA. (I’m willing bet, for example, that few, if any medical plans contained pediatric dental coverage, or first dollar for Rx.)”</p>
<p>Not forgetting. I am also not forgetting that you think the mandatory benefit package is not economical in the short term.</p>
<p>The paragraph you dont understand bluebayou…I am assuming that the people who work for self insured companies are healthier than those that dont. And the most unhealthy in the individual market are going to end up on medicaid… Thus the paragraph.</p>
<p>From emilybee’s link… I read a few things that draw me to that conclusion. Like this…</p>
<p>"Starting in 2014, most Americans will be required to have medical coverage. Under the law, health insurers cannot deny coverage or charge higher prices to people who are sick. But stop-loss insurance, for catastrophic claims, is not regulated as health insurance.</p>
<p>Stop-loss carriers often require employers to identify employees who have been treated for certain expensive conditions, including H.I.V. or AIDS, cancer, diabetes, obesity, sickle-cell anemia, heart attack, stroke and complications of pregnancy. The carriers may limit or deny coverage for those conditions or those individuals."</p>
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<p>I don’t follow this reasoning. Insurance companies do underwriting for each company, don’t they? So unless a company thinks it’s better at being an actuary than people who are paid to be actuaries, it’s not going to beat out insurance companies on pricing risk. </p>
<p>Rather, I assume that companies self-insure because they want to avoid paying insurance company profits. They are cutting out the middleman, just as they might by having in-house lawyers instead of hiring an outside law firm. In exchange for cutting out the middleman, they are accepting a certain level of risk that their employees will have unexpectedly high costs. Companies that self-insure re-insure against individual high claims (so do insurance companies), so the risk here is that there will be an unexpectedly high number of smaller claims. </p>
<p>So companies with sicker employees are just as likely to want to self-insure as companies with healthier employees. If companies are insuring their employees’ health, then they’re paying the expected total value of claims either way, whether they self-insure or whether they purchase insurance plans. Having healthier employees shouldn’t make a company more likely to self-insure.</p>
<p>ah, got it dstark.</p>
<p>Personally, I don’t read it the same way. And I have no opinion on your assumption – of course, I’d get bounced off this thread if I posted an opinion – because I haven’t seen any data to support it or refute it.</p>
<p>Only 16% of large employers offer insured plans. What you seem to be suggesting is that they do not offer self-insurance because they can’t obtain it. Not sure I believe the causality.</p>
<p>As emily points out, some large governments do not self insure. I would guess that is for both political reasons, and because they made a large bet on fully insured managed care in the 70’s and 80’s, and don’t want to change their employees out of such plans.</p>
<p>fwiw: at my former Fortune 100 company, we did not purchase re-insurance for high cost claims. But that was a capital-intensive company. A labor-intensive company would probably find a different pov.</p>
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<p>Not really. There are plenty of profits built into ASO contracts. The middleman that gets cut out is ins. marketing, and individual state mandates and state premium taxes.</p>
<p>Ok… The companies with sicker employees cant buy the reinsurance at economical rates.</p>
<p>“Stop-loss carriers often require employers to identify employees who have been treated for certain expensive conditions, including H.I.V. or AIDS, cancer, diabetes, obesity, sickle-cell anemia, heart attack, stroke and complications of pregnancy. The carriers may limit or deny coverage for those conditions or those individuals.”</p>
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<p>Their expected payout is more, so they should be paying more. But they’re going to be paying that more whether they buy insurance or they self-insure and buy reinsurance. The expectation of higher payouts doesn’t go away when you pass it on to the insurance company. There’s no magic here.</p>
<p>So companies with sicker employees are just as likely to want to self-insure as companies with healthier employees. </p>
<p>I don’t quite understand all the attention to the health of the employees in this discussion - when most employers also cover families.</p>
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<p>I don’t know what ASO stands for.</p>
<p>If a company self-insures, are they exempt from the ACA mandates for other insurance?</p>