<p>CF, I’m about as vigilant an anti-smoker as they come, but I don’t like the tobacco/premium issue for exactly that reason. What about the smoker who quits? who is trying to quit? What about the young man I know who successfully gave up smoking paper cigarettes in favor of his e-cigarette – it will be years before the science is in on the health impact of th e-cigarettes. Plus I think it is unfairly singling out one group with bad health habits vs. another. What about drinkers? What about couch potatoes? </p>
<p>I think that if the government doesn’t like smokers, then they can add extra taxes to tobacco toward funding ACA – let the smokers pay their fair share of their own health problems by the cost they pay for a pack of cigarettes – that would result in a more honest accounting of cigarette use anyway.</p>
<p>Re 1519 – thanks – that explains it. I either misunderstood or misremembered the reference to the age curve, or else I saw something in the Covered California regs that fits the “state determined” rule. Math isn’t my strong suit anyway.</p>
<p>romanigypsyeyes, the tv ads for insurance are exactly what you would expect. It will die down in April. The insurers now have an opportunity to sign up new customers, but they have to compete in a shared marketplace with others who are selling identical policies. If they can reach the customer through an avenue outside the exchange itself, that gives them the opportunity to sign up a customer before that customer has a chance to go online and compare rates.</p>
<p>There are always many Medicare Advantage ads January through March because that’s the open-enrollment period. I think the ads now are the same idea.</p>
This is interesting I just found out that in my area the networks ACA available providers (no names, just categories) are somewhat misleading (e.g. Endocrinology providers does not mean X number of Board certified Endocrinologists but includes PAs, nurses, pharmacists, and general docs identified as having interest/self study in diabetes. How patients are triaged to which provider is undetermined and once assigned to a provider does he/she remain your primary provider or will the provider change with subsequent visits. </p>
<p>The number and type of providers are not issues for those in metropolitan areas but in rural areas it is a big concern causing many folks to opt out of the ACA exchanges unless they are in a position to receive major subsidies.</p>
<p>Policies on the exchange have to be available to people of all different ages, but I don’t think that there is anything that prevents an insurer from disproportionately marketing to younger enrollees. I’d be surprised if they didn’t. </p>
<p>It might be the case that they provide benefits that are more attractive to younger people, and fewer of the benefits that would be most attractive to those in their 50’s or 60’s – like Cedars Sinai or highly regarded cancer hospitals – but perhaps including notable Children’s Hospitals. I could see families with kids (which generally would have younger parents) being a whole lot more attracted to a plan that included Children’s Hospital than I would. </p>
<p>Lots and lots of ways of having facially non-discriminatory policies that are quite discriminatory in actual effect. </p>
<p>In the same way, you could have a broader network in areas where you feel you have good cost control, and a narrower network in areas where you lack cost control or where there are known disproportionately high usage rates, and as a result engineer your enrollment to pull more people from areas with better cost control.</p>
<p>TutuTaxi – I think you are confused about how a network functions with PPO plan. Patients don’t get “assigned” to a provider - they choose from a list of in-network providers. They do not nee a referral or assignment to a specialist -again, they can choose from anyone on network. So if your network has 3 board certified endocrinologists and whole slew of PA’s, nurses, pharmacists, gp’s – it would be up to you which to choose. </p>
<p>The observations you have would apply to HMO’s, or at least some HMO’s — generally in an HMO you can’t see a specialist without a referral from your designated primary doctor – you can tell the insured which primary doctor you want, if you already have a doctor and that doctor is in-network. But that would be one reason that someone might choose to pay extra for a PPO rather than an HMO. </p>
<p>Keep in mind that if you truly need specialized services that cannot be provided in network, the insurance company will authorize and pay for out-of-network services - its just that their idea of necessary might be different than yours. But not every issue requires intervention of a specialist.</p>
<p>Calmom’s link is a goldmine of information for people who want to waste time when they should be writing programs or doing dishes. Turns out, an insurance company that wants to increase premiums has to apply for a rate increase, explain why they need it, file reams of paperwork, and post the reasons for the rate increase on their website. And I think the request can be turned down.</p>
<p>“The number and type of providers are not issues for those in metropolitan areas but in rural areas it is a big concern”</p>
<p>True, but this has been an issue in rural areas for a long time already. Obamacare is failing to fix the problem (among others); it isn’t causing it.</p>
<p>^If we are paying for Obamacare as much as I think we are, merely not causing the problem or improving only modrately is not satisfactory. Some people are getting peanuts and happy about that. I am happy for them But I don’t think we are getting what we pay for as a nation. I think the silent winner in this is the insurance industry. That 85% rule is a joke IMO. They are a huge industry, about 30% of GDP? We tell them, “Thau shall make profits not exceeding 15%” and they will be good boys and do it for you?</p>
<p>I think most who support ACA see it as an incremental step to reach the final destination. I believe it is better for many people than the previous system.</p>
<p>What happens if your family is insured under your plan and during the year your kid turns 26? For example, your kid turns 26 in Aug 2014. Does the insurance company notify you and how does the 26 year old buy insurance outside the enrollment period?</p>
<p>tom, I hope you are right. I don’t know how easy it would be to get to the final destination once the industry gets the taste of easy money. They will get in the way using every means possible. I am assuming there is no easy money in the final destination.</p>
<p>dstark, I am sure there provisions to accomodate life changes. people can get fired, or divorced, babys born outside enrollment periods, etc.</p>
<p>dstartk – I expect that a child turning 26 counts as a “qualifying event” the same way it does now for HSA elections and flexible spending plans the IRS has their fingers in. Other qualifying events (marriage, getting a job that has health insurance, having a baby, divorcing, losing a job that has health insurance, …) also give you a window to make changes after the qualifying event.</p>
<p>This year our D graduated from college and a few weeks later started a full-time job with (amazingly) good insurance. H notified his HR department that she was no longer our dependent for insurance purposes, they linked us into a “qualifying event” page that required a bunch of information, and a couple weeks later he got notice that his “qualifying event” had been approved, and that he had a 2 (?) week window during which he was allowed to change the amount of his HSA deduction for the year, the amount of his limited FSA (129 plan) deduction for the year, and to drop D from our insurance plans. Some qualifying events (like marriage) require proof, but in the case of dropping a dependent they just took his word that she had new insurance coverage.</p>
<p>I dont see how you get to any ‘final destination’ except for a lot of ugliness and pain. And debt. </p>
<p>Charles Blahous has an article today about all of the financial assumptions in Obamacare that are not failing into place. CLASS has been delayed, Individual Mandate wont raise as much as a projected, the employer penalty has been waived for 2 years, the Medical Device Tax is not expected to survive, nor is the 'Cadillac health insurance plans since is it opposed by unions. </p>
<p>All of that means ACA is massive underfunded.</p>
<p>Arabrab, igloo, thanks. There must be a way 26 year olds are treated. Just havent seen how it is going to work.</p>
<p>Also there is the issue whether a kid buys insurance through his school or stays on his parents plan? I am sure it will become clearer what to do about this issue.</p>
<p>It has been asked what happens when a kid lives out of state? I would like to know that too.
I can see the choices as the kid buying a plan in the state where he resides for in network purposes being better, but then as a family, deductibles and out of pocket maximums may increase. I am not sure…This is where inertia comes in. Maybe I will just do the easiest thing whether it is the better way to go or not. :)</p>
<p>I think the insurance companies will periodically ask us to update family members’ insurance info. BCBS already harassed me about this. I have insurance with BCBS through my employer starting July 1, 2013. They sent me snail mail asking me to update my family info last month. I ignored it. They sent a second request. They asked speficic details: subscriber, group ID and member ID for health, dental and drug, innsurer’s address, employer’s info, starting coverage date.</p>
<p>Your age, for the ACA, is your age on the first day of the plan. So if you enroll your 25-year-old child on your insurance for 2014, and they turn 26 on January 2, 2014, they are still covered for the whole year.</p>
<p>Same thing for your premiums. If you turn 60 on January 2, you are covered at the 59-year-old rate for the whole year.</p>