<p>actingmt: Hi. Yes, I’m in NY (way out on LI---->almost at the tip of eastern LI). We’re also own a small business. In our area, the networks offered on the NYExchange stink. Why buy a plan when the local doctors won’t take it?
We received the “your plan is being discontinued as of 12/31/13 letter” and had to search for a new plan for our family and employees. The plans offered for small businesses in our specific area were useless. We ended up using a local insurance broker who helped go through our options. I am so glad we listened to him because everything that he predicted has happened. We ended up choosing a plan not on the exchange and so far, so good. The plan we chose allows us to buy different levels of the plan for different people. For example: we can have the gold plan while offering the silver plan to our employees. The price was very competitive and the coverage is very good. Actually, it’s excellent compared to what we would have had if we purchased via the exchange. We have access to Stony Brook Hospital, our local hospital, and Sloan Kettering. The exchange plans do not provide this coverage. We can keep our current doctors. So can our employees.<br>
Good luck to anyone in our specific area who ends up with a policy from the exchange. They are going to have a hard time finding a local doctor (or hospital for that matter) that will accept the insurance.</p>
<p>I’ll say it again—for people in other areas, perhaps the ACA plans will work. This isn’t the case for our specific location.</p>
<p>Nysmile, with all due respect, you had a small business plan and just bought another small business plan. You did not have an individual plan and you did not buy an individual plan.</p>
<p>What does that have to do with anything? ACA spouts that it will offer affordable good plan options for small businesses too, not just for individuals. </p>
<p>Whether someone in our area buys an individual plan on the exchange or whether a small business purchases one on the exchange, the plans are not accepted by the local doctors or hospital in our specific area. </p>
<p>nysmile, sounds like your Obamacare experience is great. You were able to buy a plan for yourself and your employees that works for you, that covers the doctors you want, and whose price is “very competitive.” How was your price this year compared to last year?</p>
<p>nysmile, you were looking at SHOP plans rather than individual plans, is that correct? So you are saying that employers who try the SHOP exchange in your area will be disappointed to discover that the plans there are poor, because of the narrow networks?</p>
<p>“Emilybee, I ask because you’re wrong about exchange plans having similar network coverage to group plans in NY. I have found numerous articles discussing the problems with the NY Exchange and its narrow networks.”</p>
<p>I read that article when it was first published months ago. That article is about NYC. I said in my area. I can only speak to that. I am 150 miles from NYC and it’s another world. NYC has some of the highest prices in the world for medical care and so networks on the exchange have to be much narrower there. My neck of the woods that isn’t so. There are plans which have narrow networks and plans with broad networks. There were 19 or so pages with 10 plans on each page offered in just my area. </p>
<p>There is also this in every policy on NY’s exchange: </p>
<p>"The provision is in all policies offered through NY State of Health, and applies to conditions that are life-threatening, or degenerative and disabling, for a transition period of up to 60 days. Health Republic may extend the period and maintain the continuity of care for longer, depending on individual circumstances.</p>
<p>“When members call the plan and ask, they will find there is substantial flexibility,” Anselm said. "</p>
<p>“Another solution for Jackson would have been to cancel the policy and choose a new one through NY State of Health before the end of open enrollment on March 31. That’s an option for all plans purchased through the online market, within 10 days of receipt of the policy.”</p>
<p>There are plans on the exchange which have her doctors. She just didn’t do enough research and went for the least expensive plan. And I know the Co-op plan is the least expensive because I looked at the plan on the exchange. </p>
<p>No, I am not going to purchase insurance on the exchange. I am not even allowed to as my H’s coverage costs less than 9% of our income. </p>
<p>Yes, the plans offered there for small businesses in our area just don’t cut it. The networks are too limited.
They may be fine for businesses located somewhere else, but not here.</p>
<p>We should compare apples and apples and oranges and oranges. Small business plans were much better in NY than individual plans pre-ACA. </p>
<p>There were 17,000 people covered with individual plans in NY pre-ACA. Now… There are 250,000 newly insured New Yorkers with individual or medicaid plans. NY keeps track of the newly insured. In addition, 150,000 New Yorkers switched plans from somewhere to individual or medicaid.</p>
<p>New York is ahead of projections. My son lives in NY. He has a bronze plan which is priced very well if you are over 40. My son is not that old. However, with subsidies his costs arent that bad.</p>
<p>I dont know if an individual can buy a magna care plan? Can an individual buy a magna care plan?</p>
<p>There was a time when it was billed as cure to all our ills, with everything nice kept, everything unwanted cast aside, and a bonus prize of $2500 in the pocket of the average family.</p>
<p>Time’s passed, promises have been parsed and found wanting… what’s surprising about the average person wondering if the horse has any sound teeth left at all?</p>
<p>We ended up purchasing a Health Republic small business plan not on the exchange (magna care list of providers). Our priorities in choosing a plan were:
current and other local doctors accepted the plan
local hospital accepted the plan
Stony Brook accepted the plan (should something complicated arise in the future)
Sloan Kettering accepted the plan (should Cancer arise in the future)
Decent prescription coverage
Stony Brook specialists accept it
cost</p>
<p>The plans on SHOP didn’t fit our priority list. Maybe the plans offered on SHOP will work for people living elsewhere. They don’t seem to fit for people in our local area.</p>
<p>Nysmile, this is similar to your plan, correct? You have the magna care network?</p>
<p>"PrimarySelect
Pick a primary physician, and deductibles and co-pays won’t get in the way of seeing him or her. You still get direct access to the full MagnaCare Extra network of primary, specialty, and facility services, without a referral from your primary physician.</p>
<p>Additional benefits, such as acupuncture, have also been included in the PrimarySelect plans.</p>
<p>PrimarySelect plans are offered at the silver, gold and platinum levels."</p>
<p>Is this your network?</p>
<p>“We’re proud to be using the MagnaCare Extra network to give our members access to thousands of doctors, the full range of specialists, almost every hospital throughout our service area, all types of laboratory and imaging providers, urgent care centers, community health centers, and other healthcare providers. With more than 70,000 providers in our network, care is always within reach.”</p>
<p>^ I don’t believe individuals can buy magna care plans. edit: I stand corrected. But it’s late and I am tired so just going by memory here. </p>
<p>Yes, barely anyone in NY could afford individual coverage before ACA. They had no choice but to go without. I don’t know why the group policies like the Writer’s Guild mentioned in the Times article are no longer available. I didn’t reread the article so just going by memory so don’t recall if a reason was given. </p>
<p>I remember a lot of small business used to get insurance through the Better Business Bureau here but I think, but not 100% sure, that it’s been several years since those plans have been available. </p>
<p>Dstark, Yes. I thought we had the EPO, but we don’t. We don’t have to select a primary care physician. However, if we do, we don’t have to pay anything to see him/her. Seeing how our current primary care physician (as well as our employees’ current primary care physicians) accept the plan, it makes sense to declare a primary care physician. I went for a 6 month follow up last week and my cost was $0! Amazing to me.</p>
<p>“No, I am not going to purchase insurance on the exchange. I am not even allowed to as my H’s coverage costs less than 9% of our income.”</p>
<p>Wrong, you’re allowed to go to the exchange. No rule saying spouses can’t go to the exchange. You will have to pay the full amount for the limited coverage, just like those poor slobs who don’t have the access to group coverage. Tell me exactly where you live and I will do the research myself to see if the individual plans on the exchange are as good as the group plans.</p>
<p>“There is no way an unsubsidized subscriber, who is paying thousands of dollars more per year for insurance than the subsidized, should have the identical insurance or even worse.” </p>
<p>Why should they not have identical insurance? The policy costs the same amount. </p>
<p>As for a worse policy - anyone can purchase any policy offered on the exchange. They are not forced to buy a particular policy. </p>
<p>“Wrong, you’re allowed to go to the exchange. No rule saying spouses can’t go to the exchange. You will have to pay the full amount for the limited coverage, just like those poor slobs who don’t have the access to group coverage. Tell me exactly where you live and I will do the research myself to see if the individual plans on the exchange are as good as the group plans.”</p>
<p>I stand corrected then. But I am still not going to purchase a plan off the exchange because I have insurance coverage. If I didn’t I would purchase off the exchange. </p>
<p>By now you should be able to figure out where I live without my telling you, so go ahead and look. </p>
<p>Goldenpooch, how would you know the group premiums for employers where emilybee lives, in order to compare group insurance and individual insurance? We know, because she told us a few months ago, that her husband’s employer-provided insurance is expensive indeed. </p>
<p>CF, mine is not even the most expensive plan we could purchase in my area. The state pays they same amount but the employees share are more on several plans. </p>
<p>And with that I am done for the night. I’m exhausted. Later all. </p>
<p>CF, are you seriously arguing with me that the exchange plans on the individual market are as good (have same networks) as employer-provided group plans? Read the article to which linked in an earlier post. </p>
<p>Also, any plan provided by the state will definitely be superior to the individual market in 2014. Just ask the public employee unions to see if their members are willing to take the Obamacare plans.</p>