Affordable Care Act Scene 2 - Insurance Premiums

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<p>Really, this thread is re-opened? And the same folks will keep saying the same things?
If they want to provide covered care, why not join the networks? We have heard ad nauseum about how unfair the network issues are, how about we dissect the doctors charges, their choices re essential versus fluff, and their takeaway salaries- and any reluctance, despite their stated “:commitment.” . Sorta like folks like to lay blame for higher tuition on faculty and admin pay.</p>

<p>I hope the survey asked the about ACA, since there is no “Obamacare,” that’s the pejorative term. And I hope we are all smart enough to realize any study of the situation just out of the gates is not a predictor of care and ease of delivery going forward. My appt in Feb or so, I had to tell the clerk my co-pay, Oh, nooooo, that nasty O’care. My appt last week, she had the new details down pat. Told me as I walked up what my co-pay would be. When I visited another doc, she had the coverage and charges printed by the time I finished my sentence. </p>

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<p>LF: Oh noooo…The poster that revived this thread has never posted here before. Silly them, they must have thought a thread titled ‘Affordable Care Act Scene 2 - Insurance Premiums’ which is 951 pages long was the appropriate place to mention their 57% premium increase. Which is real honest to goodness money to them since they do not qualify for subsidizes. I suspect there will continue to be posts relating to premium issues. </p>

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<p>“I hope the survey asked the about ACA, since there is no “Obamacare,” that’s the pejorative term.”</p>

<p>I use the term, “Obamacare” because “Affordable Care Act” is an euphemistic term given by politicians to sanitize the law or make it sound like something it isn’t. There is nothing affordable about this law for millions of unsubsidized people or even the subsidized who have to pay huge deductibles. </p>

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<p>Dietz, the thread was locked before, don’t know if it’s lje who got it reopened. And I take lje at his/her word: the plan they now have is going up. Not different than another poster’s plan (LM or CF?) charges going up to move the DH out of it. None of us yet know what lje’s options actually are . (And I hope no EPO ideas unless it works for them.) But I know you see several sides of this big issue.</p>

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<p>I’d just note that a 57% premium increase doesn’t mean much if we don’t know what the premium was before, what the source of the insurance was, and what it is now. Also the age rating, if any, for the old policy vs. new. For example, if I had been able to keep my old policy – no changes, no ACA the premium would have gone up 62% for me because I turned age 60. Big leap up from the 5-year, 55-59 bracket that I was rated at before. </p>

<p>I am pretty sure that if Obama had never been elected president and ACA had never passed., I would still have turned 60 this year. </p>

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<p>"The poster that revived this thread has never posted here before. "</p>

<p>Only a mod can reopen a locked thread and I don’t think Ije is a mod - it would say so under his/her username and it’s not there. </p>

<p>"If they want to provide covered care, why not join the networks? We have heard ad nauseum about how unfair the network issues are, how about we dissect the doctors charges, their choices re essential versus fluff, and their takeaway salaries- and any reluctance, despite their stated “:commitment.” . Sorta like folks like to lay blame for higher tuition on faculty and admin pay.:</p>

<p>Good point. </p>

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<p>I got the COBRA numbers from Mr. Fang’s employer. Just for your interest, here is what one Silicon Valley employer pays per single employee per month for insurance. Their employees’ average age is probably in the early 30s. Notice this premium is not age-rated; the company pays the same amount for each employee whether they are just out of college or approaching retirement (not very many of the latter at this company).</p>

<p>Anthem EPO $605
Anthem PPO $575
Kaiser HMO $415 (Northern California)
Kaiser HMO $330 (Southern California)</p>

<p>I’m not including the numbers for spouses and families, but they are commensurate. Employee plus spouse is about 10% more than twice the employee number, presumably because married employees are older than single employees, on average.</p>

<p>I don’t know why Kaiser is so much cheaper, and I don’t know why Kaiser in Southern California is so much cheaper than Kaiser in Northern California. </p>

<p>The most expensive private individual insurance plan for a 32-year-old in my area on eHealth is from HealthNet, and costs $520. </p>

<p>A young person who leaves a high tech employer should not take COBRA. But old folks like us are way better off with COBRA. A comparable private insurance premium for someone in my age bracket would be about $1000/month. Thank you, young employees, for subsidizing us. Work hard!</p>

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<p>“Unable”? Being out of network is under the doctors’ control. They were perfectly able to provide care, by joining the networks. They chose not to. They should stop pretending this is out of their control, and you, GP, should also stop pretending it is out of their control.</p>

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<p>My ACA experience for today:</p>

<p>Some of you may recall that I live in a one-doc burb, and it turns out that my doctor (whose primary qualification beyond being a licensed MD is that she maintains an office here in town) will not be taking my new ACA plan. I had a minor medical issue in January, 2 doctor visits and an antibiotic prescription, insurance processed it as out-of-network, applied UCR to my high deductible/ HSA plan, which was pretty close to what I would have paid out-of-pocket for an in-network doctor. Doctor does not balance bill. </p>

<p>However, in the course of all of this my MD also finally got around to submitting the bills for my annual physical last summer (via the prior insurance) and it turns out that the doctor has a policy of scheduling 2 visits rather than 1 for the physical, whereas the insurance only pays for 1. (I knew I had 2 visits, I just didn’t know that one was being charged and coded as a medical visit rather than preventive care, thereby eliminating the free annual physical that ACA promises.</p>

<p>Also, neither here nor there, I wasn’t entirely satisfied with outcome of my last visit – not a big issue by itself, but bottom line, local doctor isn’t earning any “pay extra” points right now. (As opposed to, say, local chiropractor who isn’t covered by insurance but fixed my back right up, and to whom I am happy to shell out $45 any time the back pain becomes more than a mild annoyance). </p>

<p>So now for my big adventure: Log into insurance web site and pull up list of doctors. Kind of confusing and site is hard to load, so somehow I end up on Sutter Health web site instead. Do zip code search for “adult primary care” within 10 miles of my home, restricted to doctors who are accepting new patients. There are 115 names. </p>

<p>At 4pm, on a Thursday, I call up the first number on the list to make an an appointment for an annual physical. Receptionist takes all my info, turns out they already have my name in the computer system so it’s a little faster than expected. Receptionist takes down insurance info and verifies coverage.</p>

<p>Next, schedule an appointment. I’m asked to choose a doctor (there are 9 doctors listed on the first page who all share the same phone number and work on the same floor of the medical building). I stick with #1. on the list. </p>

<p>Of course I know from reading the newspapers and this thread that it will be a very, very long time to get an appointment. Months, at least – right? I tell the receptionist that there’s no particular hurry.</p>

<p>Receptionist: how about next Tuesday?</p>

<p>Me: Do you have an afternoon appointment?</p>

<p>Receptionist: How about 12:45?</p>

<p>Me: Is there anything later in the day?</p>

<p>Receptionist: We can schedule you for the last appointment of the day at 3:45.</p>

<p>Me: Sounds good.</p>

<p>So the “find a doctor” with Blue Shield of California doesn’t seem to be all that difficult. </p>

<p>I’ll report back next week as to the horrors I will surely encounter when experiencing my first routine physical under my terribly restricted Obamacare network. </p>

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<p>A number of insurers have filed notice that they plan to offer plans in in more states. New Hampshire, which now has only one, Anthem, in the individual market, may get two more. </p>

<p><a href=“Insurers Once on the Fence Plan to Join Health Exchanges in ’15 - The New York Times”>Insurers Once on the Fence Plan to Join Health Exchanges in ’15 - The New York Times;

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<p>Individual, or small business? Grandfathered, or not grandfathered?</p>

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<p>@LF, no it wasn’t me who got it re-opened. It seems to have been going strong for some time now. Apparently my post struck a nerve with you and you were gracious enough to give me the benefit of the doubt that I am telling the truth…
@ Calmom, I have no reason to lie or mislead so I will lay it out for you…our premium is currently just under $1500 a month for my husband , daughter and I, and it will be around $2200 . We pay it all, no company to pay it for us. So I think I have the right to be upset</p>

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<p>@Cardinal Fang, it is under the name of our business by we pay it , and not grandfathered. We could barely afford the premium as it was, let alone how it will be. My agent works hard to accommodate us and juggle the quarterly reports since we are a seasonal business. Suffice to say that it has been a struggle to even KEEP the coverage we have , let alone offer it to any employees. The company we deal with is a subsidiary of BCBS of NJ , since they cancelled us a few years back, at the beginning of the changing regulations…we have to have employees, most of whom are minors on their parent’s plans submit surveys , proving they are covered elsewhere. No easy task ….we have to technically offer it to employees that work over 29 hrs a week, although we do not have to pay…no one who isn’t covered from a spouse or parent’s plan wants it , but I have to jump through hoops to prove that. We cannot expand our business because of the law.
This law hurts real people and there are a lot of people out there that just don’t understand that</p>

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<p>lje 62, on this thread anyone who has a problem with premium increases or network issues with Obamacare is a first class whiner or doesn’t know what he or she is talking about. You are obviously a selfish person who has no concern for your less fortunate fellow citizens. Just so I don’t get into trouble, I am being sarcastic.</p>

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<p>OK, so this is a small business plan. What does your agent say about you switching over to individual plans? Would that be more expensive?</p>

<p>What about if only your daughter switched over? If she is not your dependent, she could potentially be eligible for a subsidy.</p>

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<p>My daughter is 17…I have a meeting next week , but I could tell by the tone of my agent that it’s not good. She has had our backs and knows how we stand, and knows we don’t lie to obtain something we aren’t entitled to…we have always looked into individual plans and this is the way that works out the best in terms of premiums…my children have always been on my husband’s plan while I have been on a separate plan . It’s been like that for as long as we have had health insurance , and we have had to change plans several times.</p>

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<p>Because it is managed care. You have Kaiser, you go to Kaiser. You don’t go anywhere else unless Kaiser decides that that you ought to – or unless it’s an emergency and you are out of range of Kaiser.</p>

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<p>Lje will soon see whether there are whiners or ignorant folks and form her own impressions. Lje, you can lay out some of your options here and a few will weigh in with some analytical thoughts. </p>

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So is that $2200/month for the same combination – you on one plan, husband & kids on another?</p>

<p>Did your old, personal plan include maternity coverage? </p>

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<p>And how will anyone’s analytical thoughts help me with paying for my ridiculously high premiums ? I am not a " whiner " I am a small business owner that has held on by a thread from the economic downfall of 2008 , had my business suffer the effects of hurricane Sandy and trying to support my family. We are hard working people who give a lot back to our community. My opinions were formed long ago when it came to ACA, but cemented by the news of our 57% rate hikes….and our co-pays are steeper than a lot of people that have their plans paid largely by their employer</p>