<p>Flossy, I see your point. The difference is, however, that the consequences are individual insurer decisions, not structural reactions from industry as a whole. As an example, lots of the problems the Californians are experiencing may be problems there and in other places, but I haven’t heard any of those problems in our specific state.</p>
<p>Nothing in ACA forced Anthem to be so tardy about posting accurate provider lists. Nothing in ACA forced Anthem to understaff its phone lines so woefully that it took me more than 6 hours to pay the first month’s premium. </p>
<p>Laws incentivize many things without force. Some intended. Some not so much. But, many are foreseeable. In this case, no-one cared about one whit about details or even facts and they were quite clear about that so many more problems should be expected. And, let’s not forget, most of this gigantic law is still on hold.</p>
<p>Our people have been trying to reach marketplace number to find out why a spouse was not included by the insurance (visa case) and they have not been able to reach them for several weeks. It looks like they have cut back staffing drastically or else I can’t see a reason they need to be so busy 40 days after the deadline.</p>
<p>actingmt, not every insurer had those problems. Anthem chose to respond in a particular way to the law which applied to all of them. Hopefully they will choose to do a better job next year. But after all, it’s Anthem, so I’m not holding my breath. </p>
<p>“ACA is good but it makes businesses do bad things.”</p>
<p>No, ACA doesn’t make them do bad things. They choose to do things which are good for their bottom line (and their shareholders.) I’m quite baffled that people would rather their employer be in charge of what plan(s) they can have instead of picking their own plan. </p>
<p>The best thing for everyone, imo, is that health insurance in the future is completely decoupled from employment. The risk pools would then include the whole population and providers would have to accept at least some of the plans in their area or else not have any patients - or only the few who could afford to self insure. </p>
<p>But, of course, some media hue and cry was so fear inspiring about what a ‘whole pop pool’ would mean to the, you know, hard fought freedoms and all in this country. </p>
<p>None of the Anthem-like issues in my state either. Dang, they could have written things more clearly. When I looked at the provider lists for Santa Cruz and Davis, the table is structured much like mine. But mine has a button for coverage out of area (so I can set my home and check out of state, in my case.) The EPO could have the same and respond, “No coverage out of area.” Make it freaking clear. But, nooo.</p>
<p>Californians need to complain- as someone said, insurance commisioner, your govt reps, everybody. The more people who make noise, the louder it gets- and harder to ignore. </p>
<p>I am committed to helping my buddy fight this to the extend they wish to pursue the issue.</p>
<p>Now, I have my own issue…</p>
<p>The first comparison look at premiums/plans in the individual market and the group market show the following…</p>
<ol>
<li> There are many more group plans (HN and BS) than there are individual plans</li>
<li> Group plans are slightly more costly than individual plans</li>
<li> Nothing is clear on the network differences between group and individual</li>
<li> Nothing is clear on what makes an employee…</li>
</ol>
<p>From the data I have now and my understanding of it…H and I could hire a W2 - DE9C employee, offer them health insurance and become an official group. And that is the ONLY clear thing. Here is what is unclear…(for groups under 50)</p>
<p>The average number of hours worked has to average to 30/week So, it seems a book keeper for 10 hr/week and given health insurance would not be considered a qualifying employee for group insurance. I seems I could hire 3 book keepers at 10/week and offer them insurance and they would still not qualify me as a group. I could hire 1 book keeper for 30/week and that would work. Or, I could hire one for 15 hours and another for 16 hours and offer insurance because according to ACA group math I now have 1 qualifying employee.</p>
<p>It gets better, different carriers have different minimum percentage participation requirements. If I have 3 employees, some carriers mandate 50% participation, other mandate a higher percentage. However, if the employee opts out because of other coverage they still count toward the minimum percentage.</p>
<p>So, as part of the discussion of unintended consequences…it seems that hiring someone less than 30 hours a week and being a good employer by offering insurance is not only unattractive, it is actually bad for business. Employees can opt out of the insurance plan if they provide proof of other coverage (through a spouse), so I can hire a 30 hr person who I KNOW will opt out and it would be beneficial to the company. And, given part time hours at minimum wage…these employees that might have been covered by a kind employer are not going to the Medicade system. Really???</p>
<p>Since it looks like at the least we can sign up for a healthnet plan in the individual market and pay only 60% more than we are paying now for a higher OOP plan (group insurance seems to have premium increases in the same percentage area)…I can spend the next year driving a number of brokers, carrier reps, Covered CA reps and tax accounts slightly batty. - I hope all those folks have mental health coverage …</p>
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<p>Actually, by requiring a medical loss ratio of 85%, the ACA did in fact ‘force’ insurers to reduce Sales & Admin expense. </p>
<p>BB, that’s no excuse. Those of us who tried to hunt down EPO clarity saw a variety of documents they did put out, some attempt to make it all look reasonable, even enticing. Yet almost none of that made clear sense. </p>
<p>don’t claim for it to be an excuse, lf. It’s micro-economics 101. It is naive to assume that companies don’t respond to economic incentives/disincentives.</p>
<p>The ACA forces companies to reduce Sales and Admin expense, so whatever they might have done to improve their websites is reduced. (Granted, the insurance company webs site listing of docs has NEVER been correct. But then ACA and Covered Cal knew that going in.)</p>
<p>Dietz, thanks for that incredible summary of how to qualify for a group plan now. Only a govt bureaucracy could come up with something so byzantine. Unlike some of the other posters, Dietz is on the front lines dealing with the nitty-gritty of the consequences of this law. I don’t know about other states but Obamacare has made healthcare insurance more complicated than rocket science in Ca. </p>
<p>Bluebayou hit indirectly the exact point which I think will be the fight down the road. The question will be, what constitutes medical care and what constitutes administrative cost and profit? The insurers are limited to 15% admin & profit. Profit will be somewhat easy to identify. But if you have staffers on the phone to support physicians’ provision of care, answer insureds’ questions, and other types of medical-related interactions is that administration, or is it in fact assisting the medical treatment? Watch this space. </p>
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<p>Dietz, that is absolutely false information. Either your friend asked if the son could get a separate subsidized policy; or your friend was given wrong information (by insurer? by Covered Cal?) ; or your friend asked the wrong question or is misunderstanding and relaying it wrong to you. </p>
<p>There is no limitation on individual coverage for a dependent, either before or after ACA-- other than some financial drawbacks to having separate coverage. </p>
<p>A person who can be claimed as a dependent on another’s tax return is not eligible for a subsidy or a tax credit. So for subsidy-eligible families, a separate policy doesn’t usually make a lot of sense. But if that dependent is a kid with serious potential medical problems, who happens to live in a region offering better insurance choices than the region where the parents live, then spending $200 or so a month extra on that person’s premium might be a very good idea, under those particular circumstance. </p>
<p>The fact that your friends “asked” and were given such clearly wrong information makes me more suspicious of the overall scenario. I am thinking that the friends are either asking the wrong questions or talking to the wrong people. </p>
<p>Thanks for clarifying the separate policy issue. I don’t know if they asked for a subsidized policy or just a separate policy in general. I am getting this info second hand. I’ll pass on what I learn here.</p>
<p>Friend clarified…if S goes on his own policy he will be Medicaid since he has not income…Not an option with which the family is comfortable. Also, they were told if the PRIMARY subscriber moves they could change plans, but not if a dependent moves. Calmom - is this your understanding?</p>
<p>Okay…more info…H was told by CC rep when asking about the EPO geographic limitation…well, these are new plans and we don’t really know much about them</p>
<p>When wife logs on to her BS EPO account and puts in the Davis Zip code, up pops the Sutter hospital as ‘in network’. No indication of geographic constraint. I think they will win this case. But…major major fail on both BS, ACA and the California State entity tasked with approving these plans.</p>
<p>Dietz
Would this student have coverage through the UC Davis Health Insurance Plan? It looks as though the students are automatically enrolled unless they sign a waiver.</p>
<p><a href=“Insurance”>http://shcs.ucdavis.edu/insurance/</a></p>
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<p>I don’t think that’s true at all – see the answer to question #7 on this page: <a href=“http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/Medi-CalFAQs2014b.aspx”>http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/Medi-CalFAQs2014b.aspx</a></p>
<p>Here is a link to the regulation cited: <a href=“42 CFR § 435.603 - Application of modified adjusted gross income (MAGI). | Electronic Code of Federal Regulations (e-CFR) | US Law | LII / Legal Information Institute”>http://www.law.cornell.edu/cfr/text/42/435.603</a></p>
<p>But in any case if the parents don’t want the kid on Medi-Cal and understand that the premium can’t be subsidized, they could have the kid apply to and purchase the policy directly through the insurer, rather than via Covered Cal. Same plan, but if the subscriber isn’t eligible for a subsidy, there’s no particular benefit to buying a Blue Shield policy via the exchange. (Anthem is the notable exception at this point, as they essentially tack on a dental surcharge to all of their off line policies - so direct purchasers end up paying more than the full cost charged to non-subsidized exchange purchasers)</p>
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<p>Yes, that would be true for the whole family – but that’s why I think there has to be a mechanism for the college kid to get coverage in his own community via the insurance company. They can’t have it both ways-- and for purposes of ACA, the definition of “household” generally equates to the taxpaying unit – so a married couple with 3 kids is a “household” --but 5 unmarried adults sharing a house would not be. So it isn’t a matter of where each person lives – it’s a matter of whose tax return the social is tied to. (With something of an exception for the up-to-age 26 contingent). </p>
<p>Blue Shield historically had an “out of area” coverage procedure for colleges students or other insured’s who were temporarily residing away from their home address-- so it’s puzzling to me why that wouldn’t apply it the case of an EPO. (See this - for the CalPers plan - <a href=“Health insurance plans | Blue Shield of California”>Health insurance plans | Blue Shield of California; )</p>
<p>Now it may be that the procedure requires some paperwork that didn’t take place in this case-- but my point is ha there has to be some provision for household members who are residing elsewhere, whether that is a college student or a spouse who is living in another part of the state for a job assignment. </p>
<p>Does the son live in a dorm or in an apartment or house in Davis? If the son has a firm, off-campus address --then what is to stop the family from claiming the Davis address as the primary “household” address and moving the whole family to a plan based on that address. Because Davis is a PPO county, the parents would then be able to get care in Santa Cruz or any neighboring county. (I’m not saying that they should do that – that’s just where the rationale of one-address-per-family would tend to lead in the EPO situation.)</p>
<p>Here’s the details of the UC Davis plan. Even if he is not signed up he might want to inquire if he would now be eligible.</p>
<p><a href=“http://shcs.ucdavis.edu/pdf/UC_Davis_SHIP_1314.pdf”>http://shcs.ucdavis.edu/pdf/UC_Davis_SHIP_1314.pdf</a></p>