<p>Seems the only people who do not suffer are the sick, the poor, the newly hired navigators and the exempt. Problems could have been solved without this embarrassingly glitch-ridden, costly craziness. Sheesh! It’s just nuts!</p>
<p>Yes, calmom, I meant family policy, purchased at the exchange. Or at a insurance provider like ehealth or even directly with insurance companies. Since the individual/family policies selling now are ACA compliant, I am wondering what happens to premiums across the board - both employer provided and individually purchased. </p>
<p>In the past, we all know how policy pricing changed from year to year, and it never favored the purchaser. Rates rose, people lost policies for many reasons. </p>
<p>So what happens from year to year now that everyone has to purchase a policy or pay a penalty, with certain exceptions? Who wins? It seems to me the insurance companies will win, again. Will we, as consumers, be priced out of market, entirely? </p>
<p>What hapoens if a family lets their insurance lapse because they cannot pay their insurance premium? Can they get reinsured? Will a company be able to jack up their rates, or will they have to wait to reestablish their insurance? </p>
<p>I am trying to be careful here with TOS. This is not a political point of view. It is an honest question.</p>
<p>Also, it is true. While google is your friend, we have spent 1500 posts here trying to get answers, and this is what I would call a more knowledgable group of consumers. If we are confused by the variables, then it would be a shame to lock this thread. I have read dozens of articles and ran hypotheticals in a multi state area, and still find many questions remain for me. I would imagine it is the same for many others here.</p>
<p>“Busdriver, do you realize how much better that new policy is than anything that is available on the individual market? The best ACA plans – platinum - are rated to pay 90% for in-network stuff (forget the out-of-network). The 70% that you find upsetting for out-of-network equates to the standard Silver plan for in-network . Bronze is 60%.”</p>
<p>No, the 70% is for in-network. She said there’s virtually no coverage for out of network. I don’t know what “virtually no coverage” means. That doesn’t sound like a great deal, bumped down from 90%, does it?</p>
<p>“This really is the insurance equivalent of railing about the rising cost of caviar at the gourmet market. I understand that your sister still feels sticker shock, but the point is that what your family has been taking for granted is a different reality than what most people experience when it comes to health insurance”</p>
<p>This is not very accurate. Going from 90% coverage/$250 deductible, to 70% coverage/$2500 deductible is not railing about the price of caviar. That seems an odd example. Is 70% coverage/$2500 deductible, no out of network coverage a good deal? Perhaps she should just shut up about what will probably cost her thousands of dollars next year, because the company saw a chance to pay less?</p>
<p>Here are the regulations governing QHPs, which are insurance companies offering plans of the exchanges:
[45</a> CFR 156 : HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES [ 45 CFR 156 ] : (PUBLIC WELFARE [ 45 CFR ])](<a href=“http://cfr.regstoday.com/45CFR156.aspx#45_CFR_156p200]45”>http://cfr.regstoday.com/45CFR156.aspx#45_CFR_156p200)</p>
<p>This one’s for you, Goldenpooch:</p>
<p>(a) General requirement. A QHP issuer must ensure that the provider network of each of its QHPs, as available to all enrollees, meets the following standards—</p>
<p>(1) Includes essential community providers in accordance with §156.235;</p>
<p>(2) Maintains a network that is sufficient in number and types of providers, including providers that specialize in mental health and substance abuse services, to assure that all services will be accessible without unreasonable delay; and,</p>
<p>(3) Is consistent with the network adequacy provisions of section 2702(c) of the PHS Act.</p>
<p>Thanks for the pointer to Code of Federal Regulations, calmom. I haven’t yet found a regulation saying that the premium increases have to be linear. Then again, I also haven’t found, in the Code of Regulations, the rule about 3:1. So I’ll keep looking.</p>
<p>busdriver – my H’s employer changed to an insurance plan where out-of-network reimbursement suddenly dropped down to 70% of Medicare rates, and had a whackingly large deductible – years before the Affordable Care Act was created. </p>
<p>Our school district’s insurance consultant (who advises the district on insurance options and who manages the bidding process for the district to determine which companies will be selected) was telling us ten years ago that networks were narrowing as a way of controlling costs, and that traditional out-of-network coverage was going to become increasingly expensive. Under the old system, insurers paid 80% (or some %) of “usual, customary and reasonable fees” – but then the patient was responsible for any remaining balance. There was always a lot of argument about what constituted UCR fees, and several insurance companies lost big class action lawsuits because of manipulating the UCR data in their favor. The settlements required that they change how they calculated UCR, but it didn’t prevent them from simply making out-of-network reimbursements much more difficult to come by. </p>
<p>I consider my out-of-network coverage to be next to useless, especially if it was for anything involving hospitalization or surgery. But, that was all part of the change that accompanied the incredible increase in health care costs over this past 20 year period. </p>
<p>How does ACA coverage handle a 17-year-old student away at college in a different state?</p>
<p>That is my question - how do you cover dependents out of state? Will the colleges not accept the insurance and demand you buy the school policy? Will the schools have a policy anymore?</p>
<p>Tex. I’m sorry if I’m crossing the line.</p>
<p>I’ll just voluntary get off the thread. I don’t want to give you a headache.</p>
<p>SamuraiLandmark,</p>
<p>Eventually, as more and more people become insured including healthy people, insurance rates should increase close to healthcare cost increases. </p>
<p>So, if healthcare costs rise 5 percent a year, insurance costs should rise 5 percent a year. There will be small increases in costs for aging in addition.</p>
<p>So…if healthcare costs are brought under control the better for consumers. </p>
<p>The first couple of years prices may change more up or down depending on how many people and how healthy they are sign up. The insurance companies dont really know how many people are going to sign up and how healthy they are. The companies have ideas but they dont know. Over time the insurance companies will know and costs to the consumer will adjust.</p>
<p>CF, thanks for referring me to the regulations. I guess I would ask how the state could have approved the current insurance companies now selling policies on the exchange without knowing who were in their networks.</p>
<p>“busdriver – my H’s employer changed to an insurance plan where out-of-network reimbursement suddenly dropped down to 70% of Medicare rates, and had a whackingly large deductible – years before the Affordable Care Act was created.”</p>
<p>I’ll bet that was unpleasant, wasn’t it? I would imagine you were very unhappy. Changes that immediately cause employees thousands of dollars a year in extra costs are painful to deal with. While some might think, “Those who have employer health insurance are just lucky to have them, so when your benefits greatly decrease, tough luck…join the rest of us,” I’d imagine the employee thinks of it more as a significant pay cut. These loss of benefits only help the companies profit, not anything else. I understand why they are trying to pay as little in benefits as possible, but it certainly doesn’t help the employee feel better when it is sudden.</p>
<p>Sudden changes are definitely uncomfortable. But, I can’t put the blame entirely on the insurance companies – even large companies with self-funded plans (where they simply pay an insurance company to administer their plan and the company retains all the decision-making power of what is covered, and to what extent) have undergone a lot of changes in the past 10 years. When I was doing school budgets the increases year-to-year for employee health coverage were staggering, and they basically ate up most of what we’d otherwise been able to pay in salary increases.</p>
<p>
They only “suffer” if you decide that one arbitrary classification (by age) is more significant than any other way that insurance companies could categorize applicants. Historically they have rated by age categories, so we think of that as being appropriate, but it’s an arbitrary classification. That is, there are many 50 year olds who are in better health than much younger people. </p>
<p>You could just as easily design a system that was the same price for everyone, with income-based subsidies there to ease the burden on younger people, who are likely to earn less. I’m not sure that the end result would be any different from an actuarial point of view. Actually, I think that might be more workable because then the subsidies could be targeted to a more narrow income & premium range, and you wouldn’t have the incentive for older folks to cut their income that we’ve been talking about. That is, if every adult’s policy old or young was $450 a month, then there might not be anybody facing the loss of a huge subsidy with a minor increase of income – and that might save money overall. The youngsters working at jobs paying $22K a year would still have the benefit of the subsidies, so they wouldn’t pay as much.</p>
<p>Anyway, my point is that to talk about what group “suffers” by age is no different than my deciding I am “suffering” by having to pay for potential maternity coverage at age 59. The difference is that not everyone will have babies (and not everyone will need triple bypass surgery) – but everyone will continue to get older as long as they live. So the 25 year old can take comfort in the knowledge that one day he will be a 60 year old. (I mean, every 25 year old with a paycheck can see that there is money coming out to pay for Medicare and Social Security – so there already is something of a pay-it-forward mentality built into our payroll and tax system)</p>
<p>Cardinal Fang, try this link: <a href=“http://www.gpo.gov/fdsys/pkg/FR-2013-02-27/pdf/2013-04335.pdf[/url]”>http://www.gpo.gov/fdsys/pkg/FR-2013-02-27/pdf/2013-04335.pdf</a> - maybe around page 13412 to start. Note that the structure of the document starts with commentary, and then the regs are printed at the end. Makes for good bathroom reading. ;)</p>
<p>There are all kinds of possibilities as to what ACA is going to mean for cost of insurance, how companies are going to handle the insurance, how the medical professionals are going to react. We can try to predict, guess, have opinions, but really, only time is going to tell. This is not engraved in stone. As things don’t work, they will hopefully be changed. </p>
<p>This Act is not what I personally wanted in terms in many ways, but it is a step towards getting more people covered. As I mentioned before, Social Security was not in the form as it is today when first introduced. In fact, my own parents were not covered by SS. Nor were the parents of any number of my friends. My DH’s father, who a doctor was able to opt out. Now, most everyone who works, files taxes is covered, like it or not. So there will changes and the changes will see saw, and subject to tug of wars between various camps. </p>
<p>But the Act is in place at this point in time, and we need to learn how it works, and point out the pitfalls in it so that they can be corrected.</p>
<p>The other day, I did the age breakdowns for a National Access Premium Silver POS on the insurance website, since I still can’t get on the exchange.</p>
<p>Age 20 - 218.20
Age 21 - 313.62
Age 30 - 390.00
Age 40 - 439.14
Age 50 - 613.70
Age 60 - 932.57
Age 64 - 1030.85</p>
<p>It’s three times age 21 for the max for a 64 year old, minus one cent.</p>
<p>jbsmom’s numbers aren’t linear – so either I am mistaken about the regulations in general, or I may have been looking at info related to the California exchange rules that doesn’t generalize to other states. The 3:1 ratio for age 64/21 is in the federal rules. With a linear progression you should be able to subtract the age 21 premium from the age 64 premium, then add back half of that and have that equate to the premium at age 43. That would equate to about $672 – and we can see that even at age 50 the premium is less, so that particular range looks like there is slower incremental premium growth in early years with very steep acceleration after age 50.</p>
<p>Reading the link calmom gave shows what a complicated job it was to establish all the rules, and why lawyers have jobs. That’s not a criticism; some things are complex and the decision-making cannot be simplified. It’s fascinating reading.</p>
<p>For example, the ACA allows insurers to charge more for tobacco users. But what counts as a tobacco user? How often do you have to use tobacco? What if you quit last week? What about pipe smokers, and people who dip snuff? What about ceremonial use of tobacco? How can insurers verify if people are telling the truth?</p>
<p>Somebody has to come up with specific answers to these questions.</p>
<p>As an aside, has anyone noticed an uptick in the amount of insurance ads in their area? It seems like every other commercial is for insurance now- both radio and tv… something I don’t remember pre-exchange. I remember a few BCBS commercials but nothing on this scale. It seems that insurance companies are now legitimately trying to compete in a way I don’t remember before this.</p>
<p>The regulations mention a specified, state-determined “age curve” that the insurers must use. If a state doesn’t determine a curve, the HHS has a default. I think that’s the premium progression. Don’t have time to read all the regulations right now.</p>
<p>calmom, I probably shouldn’t have used the word “suffers.” What I was trying to get at was the idea that an insurer could use a different age curve, and make money on some age groups by providing more attractive rates for those age groups.</p>