Affordable Care Act Scene 2 - Insurance Premiums

Parent Cafe
13501

<p>If your friend is between 55 and 64 he isn’t getting free Medicaid so much as a loan against his assets. MA is one of the states who are going after estates to recover their money.</p>

<p><a href=“Iowa State Recovery: Will Medicaid take my house? - Consumer Reports”>Iowa State Recovery: Will Medicaid take my house? - Consumer Reports;

<p>“Of the states that are currently expanding Medicaid, 10 have been reported as saying that they plan to try to recover more than long-term care costs: California, Colorado, Iowa, Massachusetts, Nevada, New Jersey, New York, North Dakota, Ohio, and Rhode Island.”</p>

13502

<p>Thanks, AlbionGirl. He is younger than 55 but I will send this article to him.</p>

13503

<p>Here is an interesting article how the MA Connector brought its director to tears.</p>

<p><a href=“Connector chief brought to tears describing backlog - The Boston Globe”>Connector chief brought to tears describing backlog - The Boston Globe;

13504

<p>"Not a chance. "</p>

<p>So, GP, what do you plan to do about it - instead of just whining on this thread? </p>

13505

<p>LasMa - your time line is pretty close to mine. When I described the indemnity model (no networks, insured pays doctor directly and then submits claim and hopes for reimbursement) – that is how I remember it working from my childhood when my parents had medical bills (and how they explained insurance to me) – and also my first policy, which I probably bought in 1977 when I graduated from law school. I’m thinking that I was buying as an individual, but it was probably a group policy offered through the State Bar or some other professional organization. (“Group” in the sense that they offered me a specific rate). I have a specific recollection of paying bills and then waiting for the insurance check to reimburse me.</p>

<p>HMO’s go as far back as 1945, when Kaiser was established – but I do think it was in the 80’s that there was a strong move in favor of that model. </p>

<p>I think things shifted to the PPO model in the early 80’s, because I believe I had a PPO when my son was born ('83). Probably changed insurance when I got married, and I would have looked for something that covered maternity for obvious reasons. I remember having to verify that the OB group would take my insurance, and that I could use the hospital where I chose to deliver.</p>

<p>That policy only paid 80% of hospitalization and it came back to bite me when my son was born – somehow I hadn’t accounted for all of the charges the hospital would pile on, especially since they charged me for expensive services I didn’t get. (I delivered in the labor room, but they tacked on separate charges for labor room and delivery room; I had my son rooming in with me, but they added on nursery charges.) – Whatever the insurance paid, I was left with about $5K plus in billing, which was negotiated down to about $3500 after I disputed those extra charges. </p>

<p>After that I switched to a PPO plan with Blue Cross (long before Wellpoint was on the scene) that paid 100% hospitalization, so by the time daughter came along, no worries.</p>

<p>But I do remember an issue with providers with my husband – he had an eye problem and went to 2 or 3 ophthalmologists and no one could diagnose it. Finally he wanted to go to a specialist at UC Med, but that doctor wasn’t on the plan – so I remember he paid out pocket for the consult. </p>

<p>Every time I switched plans there was a detailed medical questionnaire to fill out. By the 1990’s our premiums and deductible were getting hard to manage - that’s when an agent said that she could save us money by putting us on different plans. My husband went on one plan with one company, and then I had a plan with Blue Shield, and each of my kids had a separate Blue Shield plan. That would have been around '94. The agent had tried to get us all on one plan, but my husband was turned down by Blue Shield for medical reasons. (History of a heart murmur, I think.). </p>

<p>Once we are on separate plans, I put myself on the highest deductible available, and then put the kids on low deductible plans. At some point down along the line I discovered that I was being overcharged for my daughter’s plan because she was supposed to be the lowest (healthiest) rate category, and they had shifted her up – I called to complain and they reduced the premium, but not retroactively. Turned out we weren’t the only ones, because a couple of years later I got a check in the mail as a result of a class action lawsuit on behalf of all of the people who were overcharged that way…</p>

<p>While stayed with BS, generally no more underwriting as long as I stayed within the same plan-- but if I shifted from one BS plan to another I would have to fill out a medical questionnaire. </p>

13506

<p>“but if I shifted from one BS plan to another I would have to fill out a medical questionnaire.”</p>

<p>Only if the plan had a lower deductible.</p>

<p>I noticed you are now saying that you never had to undergo a medical exam at the request of the health insurance company.</p>

13507

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<p>GP, you remind me of my daughter when she was in elementary school. She was a great one for zeroing in on the literal words that were spoken, in order to squirm away from the clear meaning of what was said. (She outgrew that by high school.)</p>

<p>I short-handed my statement, but for you, obviously it must all be spelled out. So I will amend my statement: Until ACA came along, I have never been able to get individual insurance without answering health questions and/or submitting to an exam and/or providing medical records. Even when I did not have to submit to an exam or provide records, the insurer reserved the right to ask for both. </p>

<p>I will spell out the larger point for you as well, since you seem to get lost in minutiae: Before guaranteed-issue was the law, insurers would not insure you until they were comfortable that they knew your health status. Sometimes they made this determination by a questionnaire, sometimes by an exam, sometimes by records, sometimes by some combination of the three. </p>

<p>Geez. </p>

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<p>“Sometimes they made this determination by a questionnaire, sometimes by an exam, sometimes by records, sometimes by some combination the three.”</p>

<p>And I am telling you this determination for me was never made by an exam or by records. Apparently, in the retelling of the story, it wasn’t for Calmom, either.</p>

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<p>And I just said that exams and records weren’t always used. Are you telling us there were no health questions on the application? They didn’t care about your past diagnoses, treatments, medications?</p>

13510

<p>“Yes, it’s a wonderful thing to be so poor that you qualify for Medicaid.”</p>

<p>Except…that isn’t true, is it? It is no longer Medicaid for the poor. I have no idea why people keep insisting that it is.</p>

<p>Donald Trump could qualify for Medicaid if he structured his income as such. And if he was in the state of Washington, he could generally get better health care on Medicaid than if he had a private or group plan. Bummer for everyone else who has to pay for it, yet gets worse benefits. By the time the feds are through expanding Medicaid, Carlos Slim could fly one of his many private jets over the border and qualify.</p>

<p>I’m not sure why we are accepting this. Why the states are celebrating as many people as possible getting Medicaid, yay, a victory! Let’s get as many people on expensive government benefits as possible, what a great thing. Medicaid should be a program for the POOR, for people who have low income and assets, and truly need it. Hopefully temporarily. It’s not like we have much extra in state and federal funds available to spend, why celebrate spending as much as possible?</p>

13511

<p>busdriver, I agree that the wealthy shouldn’t get Medicaid. I’m not aware that this is a large problem, but to the extent it is, it should stop. Of course, in order to do that, people would be required to report not just their income, but also their assets. Something tells me that would be a no-go.</p>

13512

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<p>No, that’s still very much true. </p>

<p>Could you structure your income in such a way? Sure. I don’t think it’d be worth it to 99% of the people COULD do this. </p>

<p>For most of the poor, prior to the ACA, Medicaid was not an option unless you were pregnant, had young children, or were a young child. </p>

13513

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Actually, as far as I can recall, part of the insurance application process involved signing a release to allow the insurance company to get those records. </p>

13514

<p>It’s not just that the wealthy shouldn’t get medicaid, it’s also the middle class. This is supposed to be for the poor.</p>

<p>Yes, I could structure my income to receive medicaid, though it would be ugly, and I wouldn’t do it. Some people will. If they are close, they’ll do it in a minute. And when people start getting benefits, they never want to give them up, and will factor it into any employment decision. We should be protecting people when they are poor, permanently or temporarily. Not expanding it to every one we can.</p>

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I am having a hard time seeing how a truly wealthy person could manage to "structure’ their income so that it is under 133% of the FPL. See: <a href=“Federal Poverty Guidelines - Families Usa”>http://familiesusa.org/product/federal-poverty-guidelines&lt;/a&gt;&lt;/p&gt;

<p>Don’t rich people have passive income? (Interest, dividends, etc.)</p>

<p>And if it is so easy for them to eliminate all their income, wouldn’t it be even more beneficial to them to do all that structuring so they don’t have to pay income taxes either?</p>

13516

<p>busdriver, as I understand it, the reason Medicaid was expanded (in some states) to include people who weren’t living at poverty level was because you don’t have to be at poverty level to find premiums unaffordable. $500 or $1000 a month is simply out of the question for millions of Americans, even if they are not technically poor. Those people would fall through a hole – too rich for Medicaid, too poor for private insurance. (Millions of people HAVE fallen through this hole in the Medicaid resistor states.)</p>

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<p>Meanwhile, one of those Medicaid resister states, just attracted Toyota Corporate headquarter away from Southern California taking the 5,300 jobs with it. I don’t know how the states are going to afford increased numbers on Medicaid. Already it costs more than K through 12 education for the states. Once the federal money runs out, watch out.</p>

13518

<p>“Actually, as far as I can recall, part of the insurance application process involved signing a release to allow the insurance company to get those records.”</p>

<p>Yeah, but they didn’t do it. Probably because it would have been nightmare to process and review medical records for more than a million people. It was done by the honor system which is why you had some rescissions for people who didn’t accurately report their medical history. And before we jump on that bandwagon, be sure to tell us what percentage of those insured were affected by rescissions.</p>

13519

<p>Sure, I’d expect corporate America to be attracted to states which provide the least services to their citizens. That’s nothing new. Hopefully Toyota pays its employees enough that they don’t need to go on Medicaid.</p>

13520

<p>Medicaid is only expanded to 133% of income. For a household of 2, that is $20,921; household of 4 is $31,721. I don’t really consider that “middle class” though, admittedly, it IS 1/3 higher than poverty. </p>

<p>Over half of all people on any type of welfare are off it in less than 2 years. I don’t think that translates into people never wanting to get off benefits. </p>