<p>"The problem LF is that last post of yours where you suggest that plans were not all that different pre-Obamacare and now. That (at least for Ca and many other states) is completely inaccurate. The plans on the individual market were much different before Obamacare. The network coverage is like day and night. I’ll stick with my statement about a lot of inaccurate stuff being posted here. "</p>
<p>Crazy Train is a great song. </p>
<p>CF, please answer the question. What are the deductibles for one person for medical care and drugs. Is all outpatient care subject to the deductible. What does a 35-year-old’s premium have to do with our discussion. You are saying my insurance premium is great compared to Mr Fang’s policy and I am trying to ascertain if this is correct.</p>
<p>This stuff gets invasive, GP. And you’re presuming you’re savvier. She didn’t ask you to analyze her choice. </p>
<p>I’m saying, it doesn’t matter what the deductibles are, because the deductible could be zero and your plan would still be better. Assume the deductible is zero. Notice that your plan is still way better.</p>
<p>What is the relevance of the 35-year-old’s policy? Simple. In employer health insurance, the premiums are the same for everyone. That is, the premiums for the many 23-year-olds who work where Mr. Fang does are the same as the premiums for us. When comparing an employer premium to a individual premium, one has to pretend that the insurance premium is for someone the average age of the employees at the company, which at Mr. Fang’s company is early 30s. In other words, Mr. Fang’s company was paying $679/month for each employee and each dependent, even though Mr. Fang works for a company with mostly young healthy employees. </p>
<p>CF, no, the deductible is very important and so is the out-of-pocket maximum. I will fill in the blanks since you refuse to do it. If I had bought a non-HSA plan with a $250 deductible for both drugs and medical care with a very low out-of-pocket maximum and much of my outpatient care was exempt from the deductible, I would have paid a ton more money than what I was paying. However, I chose to purchase a HSA, high deductible plan which was much cheaper. In your case, the employer is paying the premiums so you’re very happy with the low or no deductible plan you have. I had to purchase a very different plan than you since I was paying for it.</p>
<p>Here is the big difference, last year someone in the individual market had the same Cadillac network of providers you are now currently enjoying. Now, this subscriber in the individual market is probably paying as much as Mr. Fang’s employer if they chose the gold or platinum plans and are stuck with a Yugo network.</p>
<p>It’s a day of victory in our house! Back in December, D applied through the federal exchange and was directed to Indiana Medicaid. Except that Indiana is one of the resister states which didn’t expand Medicaid (the governor apparently has heard from his displeased constituents, and is now trying to figure out if there’s a way he can expand without his constituents knowing it has anything to do with ACA lol). As it turns out, D wasn’t eligible, but Indiana wouldn’t tell us that until late February, which of course was far too late to get January coverage. </p>
<p>So she reapplied through the marketplace and was given the opportunity to purchase a plan, with subsidy, which she immediately did. That coverage was effective March 1. Problem was, she incurred some medical bills in January based on the belief that since she had done everything she was supposed to do, she was covered on January 1. </p>
<p>At the same time she enrolled, she appealed the original marketplace decision sending her to Medicaid – very easy, done over the phone in 2 minutes. The marketplace eventually agreed, and sent instructions to Anthem to backdate her coverage. TODAY we finally heard from Anthem – she is officially covered as of January 1! So she can now re-submit those bills. And of course, going forward she has good coverage which she can afford (although I’m pretty sure she’s not allowed to go to Picasso Hospital 
).</p>
<p>There probably aren’t a lot of people on this particular thread who went through the federal exchange, but for what it’s worth: It’s a bureaucracy, and a brand new one, so it’s far from perfect. I hope next year, they will be able to do a better job knowing if an applicant will be eligible in a particular state (D was directed to Medicaid based on her income, but she didn’t meet Indiana’s other requirements). I also hope that the appeals process works a little more quickly. And of course, it would be nice if Anthem devoted more resources to this. OTOH, I have to say that almost without exception, the healthcare.gov reps were knowledgable and helpful. The only time I ran into problems reaching them was during the late March crush. Other than that, I got through immediately every time. It probably helps that they’re open 24/7; most of my calls were late at night. But they were quick to understand our problem, and to know what had to be done. I also appreciate more than I can say that under ACA, that Anthem didn’t have discretion about backdating the coverage. </p>
<p>It’s been a 4 month saga, and I wish this could have been done more quickly. But I was assured that it would finally be done, and it has been. It’s a strange feeling to me to have an advocate in our relationship with Anthem. One more thing for which we are very thankful. </p>
<p>Congrats to your D and great that they backdated her coverage. </p>
<p>I think a lot of the Guvs who have been resistant to expanding Medicare are eventually going to have to come around because their constituents are going to demand it; and they want answers as to why their fed. tax dollars are going to other states for this program while they are left out in the cold (except in wingnut states like Oklahoma and Kansas.) </p>
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<p>Not if your premium plus your entire deductible was still less than our premium. Which it was.</p>
<p>We have a friend who bought individual insurance for his family. His networks are the same as ours. So, in other words, once again you are wrong, GP. Will you please stop assuming that what is true for you, in your area, is true for everyone everywhere?</p>
<p>“We have a friend who bought individual insurance for his family. His networks are the same as ours.”</p>
<p>What area in Ca.? With all due respect, this is an untruth ( I could of said lie but I want to be respectful).</p>
<p>A little more research leads to this conclusion (subject to change as time goes on). Looks like we will be going to the individual market, looks like we will need to purchase the most expensive plan. And, from a quick market analysis of our business…looks like the market will allow us to basically pass all our additional costs on to our customers (we’ve been pretty price sensitive). By additional costs I mean the increase in premiums and the estimated increase in deductible, co-insurance etc.</p>
<p>Funny thing, our customers are college students - so I guess it will be the tuition paying parents - footing our increased health care costs. Do I need to send anyone a thank you note?</p>
<p>Well it’s what he said: he wanted to go to X medical group, and X hospital (same ones we go to) and his insurance covers those places.</p>
<p>Let me teach you the significance of the deductible as it relates to the insurance premium. I went to covered Ca. and priced a bronze plan and a platinum one for my wife and me. The bronze plan cost $1,110 a month and the platinum cost $1,965 a month. The major difference between the plans is the deductible.</p>
<p>Also, you’re wrong about my premium and deductible not being more than your premium. I had $10,400 of deductibles between my wife and me. Divide the $10,400 by 12 and add it to my premium and the cost comes to $1,545 a month. I believe you said the premium for Mr Fang’s employer is $1,279.</p>
<p>“Well it’s what he said: he wanted to go to X medical group, and X hospital (same ones we go to) and his insurance covers those places.”</p>
<p>Now your being disingenuous, CF. You said in your previous post they had the same provider network as you. This statement is saying something quite different. They don’t have the same network as you. You should try to be more precise in your posts.</p>
<p>Why would anyone be stupid enough to buy the plan that costs $10,260 more to avoid a $10,000 deductible? There is nobody who would be better off buying the platinum. </p>
<p>Because the out-of-pocket maximum for a platinum plan is $8,000 for two and $12,700 for a bronze plan.</p>
<p>Dietz, you don’t have to answer this but what service do you provide college students?</p>
<p>This is what happens when the govt starts messing with your healthcare.</p>
<p>“A fatal wait: Veterans languish and die on a VA hospital’s secret list”</p>
<p><a href=“http://www.cnn.com/2014/04/23/health/veterans-dying-health-care-delays/”>A fatal wait: Veterans languish and die on a VA hospital's secret list - CNN;
<p>@dietz199 - why do you think you need to purchase the “most expensive” plan? Do you mean a Platinum plan? Do you or your husband have expensive, chronic heath care needs requiring frequent doctor visits or reliance on expensive prescription meds?</p>