<p>Saw a story about 17% of marriages in Washington state being same-sex in the last year.</p>
<p>Are the same-sex couples eligible for subsidies?</p>
<p>CF, I am saying that sometimes buying health insurance does not equal self insurance +'stop loss insurance. </p>
<p>And when self insurance plus stop loss insurance is not cheaper than just buying insurance it doesnt work. And I am saying this is more likely with firms that have employees or employees with families that are sicker…</p>
<p>Do you disagree with this?</p>
<p>ASO = Administrative Service Contract.</p>
<p>Instead of processing claims themselves, large employers Contract with large insurance companies for their PPO/EPO/HMO networks (which gives the employer the PPO discounts) and then just pay the insurance company an Administrative fee to process claims. The fee can be a % of claims paid. The risk of claims is all on the employer. </p>
<p>Obviously, the big insurers (Aetna, Cigna, UnitedHealthCare, the national Blues), are not processing claims for free. Their profit is the % of claims paid, less the direct costs for a claims office (large employers can have a dedicated claims office), and some allocation for overhead.</p>
<p>This is similar to what Medicare does/has. (Medicare outsources some claims processing to larger insurance carriers.)</p>
<p>“Are the same-sex couples eligible for subsidies?”</p>
<p>If their combined income qualifies them for a subsidy, then yes. Just like hetero married couples.</p>
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<p>Why? Who is mispricing here? Because pretty obviously, health insurance cost should be the expected cost of the claims less than X plus the expected cost of the claims greater than or equal to X. Plus whatever it costs to process those claims and profit, of course, but we’re assuming that the processing cost is the same either way.</p>
<p>So the state exchanges have to grant the subsidies to same-sex couples who are married, even if the state itself doesn’t support same-sex marriage? Is that because subsidies are a federal benefit?</p>
<p>One reason is because there are different players in the health insurance market and the self insured- stop loss market.</p>
<p>Different players, different views about risk and how to price it.</p>
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<p>If I were in a company that computed the cost for self-insurance including reinsurance, and found out it was greater than the cost of just buying insurance, I’d buy the insurance but I’d also take a good look at my computations. A good, hard, long look. Insurance companies are not in the business of losing money, so why are they offering me these premiums that I think are way too cheap?</p>
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<p>Yeah but the health insurance company is reinsuring too… Why is the insurance company getting a better quote than my company for reinsuring the very same employees?</p>
<p>“So the state exchanges have to grant the subsidies to same-sex couples who are married, even if the state itself doesn’t support same-sex marriage? Is that because subsidies are a federal benefit?”</p>
<p>I think so since it’s a federal benefit (the subsidy) and DOMA was overturned. But I haven’t researched it - just going off the top of my head from what I remembered reading, and I’m too tired now to do a google search.</p>
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<p>Yes, the US Supreme Court has held that the federal government cannot discriminate against same-sex couples who are legally married under the laws of the state where they were married. See: United States v. Windsor, <a href=“http://www.supremecourt.gov/opinions/12pdf/12-307_6j37.pdf[/url]”>http://www.supremecourt.gov/opinions/12pdf/12-307_6j37.pdf</a></p>
<p>"</p>
<p>CF, I can guess. The insurance company has more business so it gets better rates. Maybe the insurance company puts packages together.</p>
<p>Maybe the insurance company doesnt reinsure.</p>
<p>Covered California provides consumer contact info to brokers:</p>
<p>[Covered</a> California gave consumers’ contact info to agents - latimes.com](<a href=“Covered California gave consumers' contact info to agents”>Covered California gave consumers' contact info to agents)</p>
<p>The application asks you to include:
</p>
<p>No gender specified.</p>
<p>On self-insurance, the “paying into the system” I was referring to in my earlier post is the $63 per policy (employee) reinsurance (stop gap) fee, which I see now has been delayed for two years. So so much for my naive comment that “even self-insured companies will make a contribution…” Presumably they will, eventually, but in the mean time, THIS is riddiculous:
Sigh.</p>
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<p>I find this frustrating. Frustrating because this constant loophole wrangling perverts the policy intent and inherent logic that would otherwise render it practical…that of course serves corporate interests but doesn’t really serve the other 99 percent of us :)</p>
<p>Why oh why can’t we have a little team spirit about such things instead of constantly undermining a cohesive notion of society. This amounts to another form of corporate welfare. I have a new resect for Pope Francis after his recent in-house speech about the deification of corporations and the implications on society :)</p>
<p>^^Actually, the $63/head is itself a form of “corporate welfare”, since its sole reason for existence is to bail out the insurance companies for adverse selection and their own actuarials guesses, i…e, they priced their products too low.</p>
<p>And of course, in addition to opposition from self-insured corporations, opponents of this fee are unions who run their own insurance plans.</p>
<p>I was wondering about that non-compliant insurance plan poetgrl purchased. I found this article about the California insurance situation. (Sorry, non-Californians. But one in eight Americans live in California, so it’s not like I’m talking to a tiny group.)</p>
<p>It is legal to market an non-compliant insurance plan that starts in 2013 and continues to 2014. Both Cigna and Aetna are marketing such plans. Provided the purchaser can pass the underwriting, they are likely (certain?) to see lower rates than they would get with compliant plans. When the plan renews in December 2014, it will have to become ACA-compliant.</p>
<p>There’s one little catch. ACA-compliant plans can’t raise your rates in the middle of the year, but non-compliant plans can. Jason Andrew, CEO of an insurance agency, says in the article that Cigna will probably raise rates early in 2014.</p>
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<p>[Canceled</a> Insurance? Pre-ACA Plans Still Available, Could Save You Money | State of Health Blog from KQED News](<a href=“| KQED | News, Radio, Podcasts, TV | Public Media for Northern California”>| KQED | News, Radio, Podcasts, TV | Public Media for Northern California)</p>
<p>Anyway, Californians, buying the Cigna plan, if it’s offered in your area, would probably save you money. The article doesn’t say anything about the networks.</p>
<p>Let me preface my upcoming rant by saying I wholeheartedly support universal access to affordable healthcare. But, two weeks from the deadline, the federal marketplace is not working! Who creates a system where the edit button doesn’t work? Who creates a system that doesn’t let you go back a page? Why have a Live Chat option when all they are going to tell you is to call the marketplace? And when you call the marketplace, they tell you that all they can suggest is that you try to log in later and see if it works then! However, they do apologize profusely.</p>
<p>Obviously, we fall into the 20% category of those who will still have problems with the federal marketplace. I am so frustrated right now. I thought I had the glitches licked when I deleted the 1st app, and started a new one. It all seemed to be going smoothly, until I got to the review page and I see that it says that my D doesn’t expect to file a 2014 tax return. Well, yes she does. But the Edit button doesn’t work. Everything else is correct.</p>
<p>After 30 minutes on hold, the marketplace rep tells me he can’t see the app in the system at all. So, besides the edit button malfunction, they are having a system problem as well. Says that since I’ve already got an app in the system, (although apparently invisible!) they don’t want to create a new one over the phone. They are so sorry and know it’s frustrating, but try again later.</p>
<p>So, tomorrow I will try again. If it still won’t work, I’ll delete this 2nd app, and call them back and apply over the phone. My question for those who have used the Marketplace is, once you submit your application, what happens next and how soon? Does it automatically calculate the subsidy and then show you all of the plans that are available? Or do you have to wait for the subsidy determination and then log in to see your options? If so, how long does it take to find out the subsidy?</p>
<p>If you read this far, sorry for the rant.</p>
<p>At least when I did it, after I got the app to submit the subsidy was calculated instantly and I was able to pick out a plan right away. It was much, much quicker than doing the app. It helped that I knew exactly what plan I wanted.</p>
<p>Wow, IllinoisMom, that sounds very frustrating. No need to apologize for ranting; you’re entitled to a good rant.</p>
<p>Other people have found that they get better results if they remove (delete) an application and start over. I see that you tried that once, but your second application still has an error and the edit functionality is broken. Do you think you put in the data correctly and the system screwed up your daughter’s data? Or do you think you inadvertently put in the wrong information for your daughter? If the latter, if you think you made that small typo, then your fastest recourse might be to, sigh, make yet another application. </p>
<p>This suggestion is not meant to defend a broken system that doesn’t let you edit the information if you make a mistake. I’m just trying to suggest what seems like it might be the fastest workaround, if you think you accidentally put in the wrong information for your D. If you put in the right information and the system encoded it wrong, then I have no suggestion; doing the application again would just reproduce the bug, I fear.</p>
<p>If online marketers didn’t allow for editing of incorrect information, I would never be able to buy anything online; I doubt if I even get through half of my online purchases without making some mistake somewhere. The Edit button not working is an egregious failure.</p>