<p>None of the grandfathered Blue Shield plans has annual caps. I doubt any of the grandfathered Anthem plans has annual caps. It is true that ACA eliminated lifetime caps. My cap before 2010 was $6 million. I wasn’t too worried about it.</p>
<p>Cardinal Fang do you have a factual source indicating Wellpoint tried to rescind the policy of every woman with breast cancer?</p>
<p>dstark, the proposition is a waste of time and money. The law states that insurers must return 85% of the premiums to its policyholders.</p>
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I prefer a nonprofit in theory, but “nonprofit” doesn’t necessarily mean “cost effective” or “efficient”. It may be that the competitive market forces combined with the 80/85% rule and economies of scale impact overall budgeting concern. Anthem has committed to operate networks in all 50 states – Blue Shield of California is, as the name reflects, a California-only operation. </p>
<p>Also, I noticed after checking several region that the pricing lineup is different at different at different tier levels. It’s variable and not entirely consistent, but in general Anthem seems to have underbid in the Bronze category, but tends to be among the highest cost plans in the Silver, Gold and Platinum categories. As a marketing strategy, that might not be a bad strategy: offer a cut rate to buyers who are shopping in the basement, but focus on perceived value for the shoppers who seem more focused on quality.</p>
<p>Calmom, I wouldn’t call it quality since the networks are identical for all the plans with each insurer. Differences in deductibles, co-payments and out-of-pocket maximums is a coverage issue, not related to quality.</p>
<p>I think a problem is that when you call an insurance company, you are not necessarily getting the correct answer for you and your family. You might be also getting someone’s (potentially wrong) opinion.</p>
<p>I’m hoping this is correct, but when I called Anthem BC about how the ACA would affect my 23 year old (offered insurance at his company), the lady told me to keep him on our policy. She said, “He’s already covered on your policy for no extra charge, and it’s great insurance. Why take him off”? Made me wonder why she would encourage this net negative for the company. But these are individuals we are dealing with, and you could get a different opinion every time you call.</p>
<p>I asked my insurer as well whether to have S get his own policy that his employer would pay 66-75% of the premiums for. Have been repeatedly candidly told that unless he had super high bills we were better off saving our $$$ and just keeping him on our excellent policy until he aged out at 26. We chose to follow that excellent advice that matched my understanding. </p>
<p>I have often gotten different answers from my insurer over the decades I’ve had them. When its important, I get things in writing from them, especially once I get the answers I like. For me, it’s like other things, I persist as needed until I get answers that make sense to the best of my reading and then get written confirmation. It takes time and persistence. </p>
<p>Am not surprised that a few days into the ACA with all the confusion of the shutdown that there is some difficulty getting solid answers. The policies aren’t effective until Jan1. Patience seems good to me.</p>
<p>GP, you’ve missed my point with my reference to perceived value and quality. I’m not going to take the time to explain. I was referring to basic marketing concepts. I was also responding to a point made by DStark, which is why I took the time to quote the statement I was responding to.</p>
<p>Elective is not the same as not needed surgery. Some elective surgery are cosmetic surgery and are not covered in most plans ( private or not). Others are needed surgery but are elective because they are non- emergency surgery. Even some cancer surgeries can be elective surgeries because they do not pose immediate danger to the patient.</p>
<p>…no, only in a week or so. Yes, the patient can wait if he is not dying today. That is why Canadians have been coming to Detroit, they are out of luck now.</p>
<p>"Now they can’t do that. But they could do it before, and they did. "</p>
<p>Many large employer plans never kicked out anyone and in fact all preexisting conditions were allowed after 90 days of insurance. If they wanted to control costs, the employers would sometimes play games and eliminate those that cost them the most in premium increases during work force reductions. The plans do show lifetime caps though.</p>
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<p>Yes, we have cleared this up- thanks, as usual, to Calmom - and realized there are two accepted usages depending on industry. There is the medical definition of non-emergent, and there is the managed care definition used by health insurance companies where “elective = non-medically necessary” definition.</p>
<p>Some good, tho partial, data on enrollment, as well as the host of glitches.</p>
<p>[Measuring</a> Obamacare enrollment is actually kind of tricky](<a href=“http://www.washingtonpost.com/blogs/wonkblog/wp/2013/10/07/measuring-obamacare-enrollment-is-actually-kind-of-tricky/]Measuring”>http://www.washingtonpost.com/blogs/wonkblog/wp/2013/10/07/measuring-obamacare-enrollment-is-actually-kind-of-tricky/)</p>
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<p>Yes, but aren’t you a retired LAWYER? </p>
<p>I have Phd and can read scientific publications with math in them that will blow average person’s mind, but for the life of me I cannot read through COMPLICATED contracts, like health insurance, without suddenly developing ADHD. </p>
<p>Besides, it is not like there was a choice before ACA to freely find insurance provider with a good contract. And IMHO it is not like there is really a choice now.</p>
<p>I’m going to pause for just a minute and reflect on what a difficult task the insurance companies have in setting their prices. Given a customer mix, the actuarial calculations are routine, but they don’t have good information about who will sign up for each plan. And they can’t even say that they’re OK if some plans are underpriced, and some are overpriced, because if a plan is overpriced they have to give refunds.</p>
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<p>Anthem might think that people who buy Bronze plans are healthier, and therefore Anthem can shade the Bronze premiums down, whereas people who buy other metals are more likely to have expensive conditions. It’s all about guessing who will sign up for which level.</p>
<p>(One thing I really like about the exchanges is how easy it is to compare different plans.)</p>
<p>Well, I’ve gotten further with my enrollment today than I have in the past. Created a profile, etc. Still hitting various glitches, and not getting through to where I can actually see plans.</p>
<p>The administration has botched the rollout, IMHO. The fact that this happens with private companies’ launches all the time (and it does) doesn’t make that OK – it isn’t OK. That said, a botched rollout doesn’t tell you anything about the quality or value of the ultimate product. If two months from now, I still can’t sign up in time for coverage on Jan. 1, I’ll be very upset. But for now, this is an irritating PITA that is a small price to pay for the right to buy real coverage that enables me to be an entrepreneur. As long as I get that in time, I’ll tolerate these errors.</p>
<p>calmom, maybe they should’ve turn over the web design to Canada 
It might have been more cost effective while sparing everyone from frustartion. Hopefully, this isn’t a harbinger of what’s to come.</p>
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<p>Solely as an FYI, the main contractor for the federal insurance exchange is CGI Federal, a unit of CGI Group, and data services contractor is Quality Software Services, Inc., a unit of UnitedHealth Group. This is from an NYT article which notes as examples that SimCity completely failed after an upgrade and that United/Continental’s merger of reservation systems took weeks to work after opening. We forget these things don’t work perfectly right away. </p>
<p>I could list examples forever. Apple has had trouble with synching “core data” since icloud opened. You can find lots of developer anger about that.</p>
<p>Sorry, lol. Got late in the conversation.</p>
<p>Interestingly, the links on insurance company websites for agents/brokers to use to access the marketplace in federally run marketplace states has been removed and they hope it will be available mid-month.</p>
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<p>What does this mean? Is it that if I went to an insurance agent, and in our meeting we concluded I should sign up for a policy on the exchanges, then the agent would say, “OK, let’s pull up the forms here…” and then the agent wouldn’t be able to do it?</p>