<p>The insurers are negotiating lower rates of reimbursement for ACA plans and they should not be able to do that. They also should not be able to limit the networks so that ACA plans are second rate to the same plans they offer off the exchange. There should not be a big enough difference between Medicaid/Medicare/private insurance rates so doctors have incentives to not take Medicaid. That is also something the states can regulate.</p>
<p>Well, there goes the cost-cutting, then.</p>
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<p>Why not? This is the very art and essence of cost control. You may think that the state has a interest in protecting the hospital’s unnecessary fifteenth MRI machine, the marble walls, the hospital executive’s fourth home, and the cardiac surgeon’s European vacation, but I do not. </p>
<p>Preventing insurers from negotiating prices down is exactly opposite to the interests of patients.</p>
<p>Nysmile…</p>
<p>Magnacare helps companies self insure?
How does Magnacare work with companies that have very few employees?</p>
<p>Looks interesting…</p>
<p>Even though when you go to their web page, you see the info about self-insurance, it looks to me like Magnacare also provides traditional insurance.</p>
<p>Yes. It also provides regular insurance for our small business. When we heard about our bank moving to magnacare for their employees, it reassured us that it was a good fit for health care in our area. They have many employees and did their own research on the plan. We used their judgement combined with our own research and info from a well respected insurance broker. It gave us the best coverage with the biggest network and lowest copays and deductible for the money. It gave us and our employees the ability to keep our doctors as well as many other choices of docs and hospitals. It doesn’t limit us the way the plans offered on the marketplace would have (I’m speaking only about the available plans on the exchange for small businesses in our area).</p>
<p>The insurers are no longer allowed to deny coverage for expensive pre-existing conditions. Nor are they allowed to base rates on a person’s health history. So they are eliminating from the networks the doctors and hospitals that care for the sickest and most expensive patients.</p>
<p><a href=“http://www.magnacare.com/documents\MagnaCare_Understanding_Self-Insured_Group_Healthcare.pdf[/url]”>http://www.magnacare.com/documents\MagnaCare_Understanding_Self-Insured_Group_Healthcare.pdf</a></p>
<p>So NYSmile, you have traditional coverage? </p>
<p>Your oop maximums are similar to those that buy exchange plans? Better than those that buy on an exchange?</p>
<p>Insurance plans are required to treat all conditions that come up, including expensive conditions.</p>
<p>Yes, but let’s say they halve the number of cardiologists in the network. Wait times for appointments will go up, so the insurer pays for fewer appointments per year.</p>
<p>Maybe wait times will go up, maybe not; that remains to be seen. The cardiologists who see patients on narrow-network plans are not seeing only patients on narrow-network plans. If you consider all the patients who would see cardiologists, the majority would probably be Medicare patients. Of the ones under 65, the large majority would be patients with employer insurance. Only a tiny fraction of all cardiac patients are patients with individual insurance bought on the exchange. That small minority is not going to be able to drive up wait times.</p>
<p>The insurers have to find ways to offset the costs of taking the people with pre-existing conditions. Cutting networks is one way. Fewer doctors in a plan mean fewer visits than can be scheduled. The huge deductibles are another way. The typical person will never use the annual deductible of $5,000 which is the average for the Bronze Plan. And when people realize that they have to pay those deductibles OOP, not just a co-pay, they will not go to the doctor as often.</p>
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<p>Of course, they should negotiate. They should not be able to establish classes of patients in those negotiations by reimbursing those treating ACA patients less. The is not in the best interests of patients, as evidenced by doctors refusing to care for medicaid patients. When states reimburse significantly lower for medicaid patients, they are creating these classes.</p>
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<p>Where is the evidence that any insurer is doing this? Insurers want to negotiate the lowest prices for everyone-- and consumers want insurers to negotiate low prices. It may be that insurers are playing off low price versus other benefits (network size, for example) differently for on-exchange plans versus plans offered solely off-exchange, but that should be legal. </p>
<p>Narrower networks are not limited to on-exchange plans, as Goldenpooch has informed us repeatedly and at great length.</p>
<p>There are lots of reports of insurers negotiating lower rates for doctors treating patients through exchange policies. This is a separate issue from the narrowed networks. If these reports are not true, the doctors are very confused and think they are true.</p>
<p>I thought this was pretty well known by now. It’s been covered a lot.</p>
<p>[Insurers</a> Cut Doctors’ Fees in New Health-Care Plans - Yahoo Finance](<a href=“http://finance.yahoo.com/news/insurers-cut-doctors-fees-health-015500812.html;_ylt=A0SO8zHjz71SXmgAlQBXNyoA;_ylu=X3oDMTEzdnRjZmFhBHNlYwNzcgRwb3MDMQRjb2xvA2dxMQR2dGlkA1ZJUDMxOV8x]Insurers”>http://finance.yahoo.com/news/insurers-cut-doctors-fees-health-015500812.html;_ylt=A0SO8zHjz71SXmgAlQBXNyoA;_ylu=X3oDMTEzdnRjZmFhBHNlYwNzcgRwb3MDMQRjb2xvA2dxMQR2dGlkA1ZJUDMxOV8x)</p>
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<p>There are lots of reports of Death Panels too. That doesn’t make the reports true. </p>
<p>What IS true is that insurers think people buying on the exchange are price-sensitive, and will select the lowest price plan. (Insurers believe this because it’s true.) Therefore, if an insurer wants to get people on the exchange to buy their plan, they have to make it lower priced. One way to get that lower price is to negotiate a lower price with providers, often in exchange for exclusivity.</p>
<p>Employers want lower prices too, which is why networks have been getting narrower in employer supplied insurance as well.</p>
<p>I want insurers to negotiate on my behalf. I don’t want them to blindly accept any price the provider decides they can charge.</p>
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<p>Magnacare does not sell insurance on the individual market. </p>
<p>The PPACA was passed as a way to address the needs of individuals who could not get affordable insurance on the individual market, because they did not have access to group employer insurance, and also to provide a path for smaller employers to purchase competitively priced plans. At the same time the PPACA wanted to preserve the employer-subsidized market – which it accomplishes both by mandating that larger employers continue to insure their employees, and by giving the smaller employers an affordable option if they don’t already have one. </p>
<p>You really are comparing apples to oranges if you come in as an employer and announce that your employer-purchased group plan is better than whatever your agent was able to find on the SHOP exchange market. </p>
<p>I’m glad for you and your employees that you found a good group plan.</p>
<p>But your comments have absolutely nothing to do with Obamacare. You and your employees are part of the 80% (or whatever) who have the option to keep whatever plan they have and are not directly impacted by ACA.</p>
<p>I thought SHOP was selling group plans. What is SHOP selling, then?</p>
<p>SHOP is selling group plans for small businesses on the exchange which are eligible for a 2-year, up to 50% tax credit.</p>
<p>So in essence, the poster (NYSmiles I think?) found a better price (after the 50% tax credit, I wonder?) outside of the SHOP from a company that typically focuses on larger, self-insured employers. This part is unsurprising to me. </p>
<p>What I would be interested in seeing is what, if anything, happens to that plan and network come 2015 when other aspects of employer insurance kicks in.</p>
<p>The non-competitive SHOP plans in this case were quite possibly HMOs with small networks not geographically germane. To illustrate what I mean, the CHEAPEST SHOP plan in my area have a VERY limited HMO network that also only includes a narrow geographic band of providers.
The most expensive, “premium” silver, premium gold and platinum plans are PPOs with a full statewide network and out-of-state/out-of-network coverage comparable to my existing employer plan.</p>
<p>For a single family age 35, there’s about $500 - $600/mo difference between the two extremes.</p>