<p>lje62 We are also a small business…who no longer qualifies for group insurance under Obama care because we are a husband and wife LLC. There is a chance we will slide by for another year since I’ve been told by our agent BS of CA will keep us as a small group unless we are one of the 10% or so pulled for audit and re-certification. I’ve check individual plans. We now pay $1400/month for H, S, D and myself. It has a $2500/pp deductible. What we have to look forward too is $2200/pp premiums (if we want to keep our doctors) and 6K deductibles plus a much higher out of pocket maximum. Yes, this is really truly ugly for what some will say is an ‘insignificant’ number of people. Welcome to the insignificant group…you have good company.</p>
<p>$2200 is indeed very high, so high that it is possible there might be a cheaper option that you would prefer, particularly since your policy has steep co-pays. That’s why I was asking whether you had checked out buying on the individual market rather than the small business market.</p>
<p>I’m guessing you live in an expensive insurance state like NJ. I thought my California premiums were high until I looked at NJ’s whopping premiums.</p>
<p>Lje, not in paying, of course. But perhaps ideas for your decisions. We’re not suggesting you go with the $2200 plan. If you’ve been with this thread a while, you know others her had hikes in the past due to pre-existing conditions. Others were forced off certain plans. As Calmom said, her rates would have gone up based on age. Mine went up 50% last summer, when we lost our group coverage and went direct. (Cobra would have been an increase of more than 2.5x.) Some of us looked for our options, ran the numbers, (for long term/annual, estimating usage, weighing, etc.) I hope you find something that works for you. </p>
<p>thank you dietz199 ! I have been hearing about this for some time , but we were coasting along until now, when our renewal comes up. We just can’t swing it, and I don’t think we can qualify for subsidies. Even if we do, I resent being placed in this position. Although we have struggled to hold on to our plan, we have somehow managed…maybe because I have driven the same car for 11 years and cut back in other ways…but I DO NOT WANT THE GOVERNMENT TO PAY FOR ME. It’s humiliating to be put in this position when it wasn’t what we have worked for for all of these years.
I am not in the camp of feeling superior to people with less than we have , but I don’t think we should be punished any more than we already have.
Fact : If we fold as a company , more people will be on the government dole …how will that be a good thing ?</p>
<p>LF. NJ laws for health insurance have forbidden exclusion for pre-existing conditions, long before ACA was passed. It is a non-issue in our state. We pay lower rates in my part of the state than our neighbors to the north, outside of NYC because doctors charge more there. </p>
<p>If you’re in NJ, you could buy individual insurance (unsubsidized) for your family for less than $2200 per month. I’m not saying it would be as good for you as what you have now. But if cost is a concern, you might end up paying less, particularly if your family is generally healthy. Of course, you’d want to check the networks of the policies you were considering, to make sure that the doctors you would want to see would be covered. And you’d want to work the tax numbers, if your small business insurance currently counts as a business expense.</p>
<p>I’m just sayin’, don’t accept the word of the insurance agent without making sure there is not a preferable alternative you are overlooking.</p>
<p>I will explore all options , but I am confident with my agent. I have had to negotiate and compare plans for a long time and while I can research on my own, my current agent and the company she works for is the best in our area. She is an agent that goes above and beyond and has been an exemplory rep . I don’t want to be shut out of our medical practice for pcp coverage…ugh</p>
<p>I believe NJ is also a state that formerly let kids stay on their parents plans til 30. Just saying.
What’s that old line? “There are 8 million stories in the naked city.” We don’t want you to be "punished’ either. But there’s a context in this thread that some believe others are heartless and blind, that the only solution is to throw out ACA, that some of us are smug about our “advantages.” (Despite the fact that, over time, we openly detailed our own challenges.) That denies some of the hardships we’ve been through, too. The compromises we didn’t expect. Nothing against you, lje. Not at all. But there has been a lot of “us and them” here. </p>
<p>lje62 If you search on my recent posts you’ll find the story of a friend who changed plans from a small business to Covered CA on her own. The surprises were very very unpleasant and expensive. They have lost doctors, their college children who live in different towns have NO coverage unless it is deemed an emergency, and they are now thousands of $$ out of pocket (10K the last time we had coffee - I bought the coffee). Do NOT do this on your own. If you have a trusted agent - as you say you do - go with them. </p>
<p>I’ve gathered more personal examples of misinformation, incomplete information and just plain wrong information given by the ACA navigators. If your broker gives you bad info…you call them up, have a discussion and get the problem fixed. If a navigator gives bad info…oh well…sucks to be you…better luck next time…‘we suggest you change plans during the next open enrollment period…have a nice day’. Stay with your agent! Doing this by yourself with navigator ‘assistance’ is like paddling a rubber boat through shark infested waters while dragging chum. </p>
<p>Dietz 199, I’m in NJ like lje62. The choices here are not very good for individual plans: NJBCBS, Oxford, Aetna and Health Republic offer only EPOs/HMOs which don’t work for college students out of state. The only choice left is a POS regional or national plan from Amerihealth, near the top of the rates. Cheaper just won’t work.</p>
<p>Our broker has transferred our account from office to office and person to person over the last few years. Last month, they transferred us to a different company altogether. I’m still hoping to keep our small group plan for our business but I’m not hopeful.</p>
<p>How about, for NJ parents of out-of-state college students, purchasing insurance for the student in the state where they go to school, and then going with the cheaper HMO/EPO for the rest of the family? Wouldn’t that be a possibility? </p>
<p>CF, I looked at doing this last year for my daughter who goes to school in Mass…it’s always been a hassle for her to use the insurance up there. It was too expensive . Now I am worried because she has an appointment this summer to have her wisdom teeth removed and I think we will already be ousted from our plan ( which is , BTW jbsmom, Amerihealth ) </p>
<p>Just returned from the hair dresser…been with her for 25+ years. She was relating her tale of woe. Her individual rates have shot up by 50%, her deductible has shot up to 6K and her OOP costs for the urgent shoulder surgery is now at 7K. She’s been with BS for 40 years! </p>
<p>Hmmm…I’m just hanging with the wrong crowd I guess…need to find those who are subsidized or on Medical and get some ACA and collect some ACA happiness stories.</p>
<p>This system works for the totally or almost totally subsidized subscriber who didn’t have insurance in the past, or those with preexisting conditions who were locked out of the individual market, or the ideologues who are going to support it no matter what evidence (even if it is compelling) is presented to question the efficacy of the law. For the millions who don’t get subsidies or have a problem with the very narrow networks, tough luck. You’re on your own.</p>
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<p>Blue Shield doesn’t sell policies in California with that high of a deductible, unless she is getting catastrophic coverage. Even with the catastrophic plan, the maximum OOP would be $6350. </p>
<p>And I’m rather astounded that your hairdresser doesn’t qualify for premium subsidies. See: <a href=“http://money.usnews.com/careers/best-jobs/hairdresser”>http://money.usnews.com/careers/best-jobs/hairdresser</a> </p>
<p>Calmom, after 25 years in the business it is not at all surprising that a talented cosmetologist is not making just above poverty wages. Well, it shouldn’t be. Maybe, she owns the salon. Maybe., she’s married. Maybe, she works alot but in that case she can always cut back and be subsidized.</p>
<p>The big news today was the Medicare sex-change ruling. We are beyond nuts in this country, now.</p>
<p>calmom: my hair dresser doesn’t qualify for subsidize because she is a very diligent and hard worker. I travel 75 minutes each way to visit her…she is that good. She has clients that have been with her for as long as I have, we come from mile and miles away. It takes 6 weeks to get an appointment. So, I guess, all that diligent effort disqualifies her from subsidies. Not sure what is more offensive…the assumption that she should be poor enough to qualify…or the now accepted societal attitude that it’s honorable to do so. And, as an very informed consumer you must know that OOP costs are always above the stated maximum because of the fine print…Hey, that second X-ray…not medically necessary and thus OOP but not toward the max. That prescription, filled while you are in considered an in-patient at the hospital…not covered. Oh, the sling, not from a preferred source…sorry, anything over the UCR is OOP and again not toward the max…shall I go on? Really…shall I…???</p>
<p>Yes, maybe if she is smart she will cut down to below the threshold and qualify for subsidies. Argh! What type of system encourages THAT behavior. (dependence = good for someone)</p>
<p>And…FWIW…because of her shoulder surgery she is unable to do most tasks…so…this stupid stupid woman has hired an assistant to make sure she can keep her clients until she is once again able to work at full speed.</p>
<p>Ugh…Ugh…Ugh…Ugh…Ugh…this is STUUUPID!</p>
<p>And…I will not elaborate so don’t ask…but H just figured out a business move which, if implemented would most likely put us into Medical territory!!! Good grief what a fluster cluck…but…hey…it’s working…carry on…</p>
<p>Oh brother. Thread hasn’t gotten anywhere in a long while. </p>
<p>Dietz, are you going on Medicaid? You’re kidding, right?</p>
<p>Lje, I appreciate your loyalty to your agent. I too loved my agent. However, earlier in this process, my agent confessed to me that I actually seemed to have more info on ACA than he’d gotten, and that my assumptions about switching our small business to individual coverage appeared to be dead on, with offsetting pay raises for employees. To honor my relationship with our agent, I did have him credited on the exchange for each conversion…you can do that so your agent gets a commission by getting his or her numbers to enter.</p>
<p>I’m not eligible for subsidy, but the move did in fact lower our premiums a tich but did increase our deductible and OOP limit a bit. However, I am in Michigan, which seems to have a wider network and lower premiums than some other states. When we used to pay $2300 as a business, it was for coverage for TWO families with a 1,000 pp deductible, 80% PPO. This is a good baseline for reference, as the plan was fully pooled under BCBS. The plan was available for small businesses through a local association.</p>
<p>While I understand that NJ appears to be another matter, I have a hunch that there may be more cost-effective options available to you of which your agent might not actually be aware. So I would suggest participating in the decision with your own exploration of options as well, and simply crediting your agent either way via the entry of her numbers via the exchange should you elect to go that route.</p>
<p>As my agent explained, the bald fact is that since he worked so in depth with LARGe groups and grandfathered plans, he just didn’t have as much info about small biz approaches as someone with a highly vested interest would, such as yours truly 
However, since we shared information and discussed the process a lot, he has since not only confirmed much of what I did as sensible, but has been able to guide others in similar situations.</p>
<p>Best wishes. I know how much it sucks to face these kind of premium hikes because prior to ACA, my pooled plan bloated from $740 per family to $1128 in five years!</p>