<p>I think for clarification – it’s important to understand that the income notices are going out in cases where the government has data that contradicts the information provided by the insured individuals. The only data the government could possibly have at this point is past years’ tax returns, so these are probably cases where the taxpayers reported income for 2013 was significantly higher than their 2014 estimate, or where there is a change in filing status between married/single or household size. </p>
<p>I don’t know why I even bother posting here since no one probably reads this thread anymore and no one is changing his/her mind about Obamacare. But because I am a masochist, I am going to leave this letter from one of the best internists in my community to the Wall Street Journal. Now I am sure many here will question my claim about the reputation of his practice, but I can assure those who haven’t already made up their minds - this guy is an excellent doctor.</p>
<p>"Your article “Health Plans Limit Choice of Doctors” (Marketplace, Aug. 15) outlines the dramatic changes in the health-insurance marketplace, driven by ObamaCare, that will force patients to see doctors they don’t want to see and be admitted to hospitals that they don’t like. The government and the insurance companies are ignoring the reality of the health-care process most patients receive in this country.</p>
<p>Physicians aren’t just conduits to hospital admissions; they are men and women who put great energy into keeping their patients out of hospitals by keeping them healthy. The cost advantages of this process are enormous. And yet as the insurers and the government force larger numbers of patients into the crowded waiting rooms of overloaded primary-care doctors, many of whom are quitting their practices, the result is the funneling of more patients into already-inundated emergency rooms, followed by admissions into hospitals where costs are skyrocketing.</p>
<p>The solution is for the government and insurance companies to change course and begin creating a positive relationship with primary-care physicians so they may not only lower the costs of health care but actually improve the process of saving lives. A good start would be to create financial incentives that allow patients to see doctors they actually like so they will be more likely to follow preventive-care guidelines that avert expensive emergency-room care and hospitalization. Shouldn’t that be what health care is all about?"</p>
<p>Roger C. Dunham, M.D.</p>
<p>Santa Barbara, Calif. </p>
<p>Obamacare networks to stay limited in 2015</p>
<p><a href=“Obamacare doctor networks to stay limited in 2015”>Obamacare doctor networks to stay limited in 2015;
<p>Front page article in LA Times today. Here are some quotes:</p>
<p>“Finding a doctor who takes Obamacare coverage could be just as frustrating for Californians in 2015 as the health-law expansion enters its second year. The state’s largest health insurers are sticking with their often-criticized narrow networks of doctors, and in some cases they are cutting the number of physicians even more, according to a Times analysis of company data. And the state’s insurance exchange, Covered California, still has no comprehensive directory to help consumers match doctors with health plans.”</p>
<p>“Health Net has proposed the most dramatic change for 2015, the data show. It’s dumping the PPO network that Edwards and others purchased and switching to a plan with 54% fewer doctors and no out-of-network coverage, state data show.”</p>
<p>“In addition to shedding doctors, California’s biggest insurers have promoted more restrictive policies known as EPO, or exclusive-provider organization, plans. Unlike a more generous PPO, an EPO typically does not provide any coverage for out-of-network providers. Consumers would be responsible for the full charges if they left their network.”</p>
<p>Here is some good news for Blue Shield customers in the Bay Area:</p>
<p>“In response to complaints, particularly in the Bay Area, Blue Shield is giving customers more flexibility to see doctors outside the 26 counties where it sells EPO policies. That move expands its EPO network to 28,357 physicians statewide in 2015 — though fewer than 4,500 of those doctors are based within the counties where the plans are sold.”</p>
<p>Thanks, GP. The comment by Dr. Dunham was interesting and a concept I hadn’t read anywhere before. That a patient who likes his/her doctor is more likely to follow his/her guidelines on preventative care. </p>
<p>Excellent article GP. True indeed. </p>
<p>Just thankful we get to keep our plan one more year - no word on the cost yet. Ugh.</p>
<p>We lost our plan this year as it’s not ACA complient. Sigh. And looking over the new plans is not giving me any joy…</p>
<p><a href=“For Many New Medicaid Enrollees, Care Is Hard to Find, Report Says - The New York Times”>For Many New Medicaid Enrollees, Care Is Hard to Find, Report Says - The New York Times;
<p>@bookreader Our plan is not ACA compliant in that as a H and W business we no longer qualify for group coverage. This type of group coverage worked the same as large groups. No pre-existing condition clauses, no raising of rates based on usage (rates could be raised for an entire class - age, location or policy related). However, due to some extensions, exemptions and shenanigans (CA wanting to contain the damaging effect of people being dropped from the plans they liked ) Blue Shield has been able to keep this plan/group in place for the past two post ACA years. The term is ‘grandmothering’. </p>
<p>The ACA will no longer allow for family groups. One must now hire a W2 employee. We are a rather politically ineffective lobbying group so frankly… we were put on the chopping block. H and W and all small family businesses (there must be a non related W2 employee in the group, even if the business were to consist of H, W and several adult children and grandchildren, it still doesn’t qualify) will be thrown into the individual market. Obviously the individual market needs paying bodies to make it work, sacrifices must be made. L-) </p>
<p>And to the posters who have insisted over and over again that the small group structure was not reflecting actual costs, was benefiting from unfair exclusions (remember NO pre exisiting conditions) etc. I ask this…given the opportunity for a big, bad and greedy insurance company to dump a group/policy/structure that is losing it $$$…wouldn’t these heartless bottom line driven companies jump on it in a nano-second? And yet, here we are with a two year extension which allows us to keep the plan we liked all along.</p>
<p>We have two options for when the eventual ‘dump’ happens. It is becoming more common for management companies to ‘hire’ one of their paying customers. This customer - now employee - is compensated in such a way that the end effect is a net zero to the management company but the new employee gets group coverage. Or, we ‘hire’ 
the needed body to fulfill the group requirement. </p>
<p>Either way, the decision is one election cycle away…the rules of the game will change again.</p>
<p>Exactly @dietz199 . We are in the same situation H&W business and no W2 employees. You are correct that ‘we’ ahve an ineffective political lobby - we are all too busy trying to keep the business going to spend time lobbying! ACA puts us in a very uncomfortable position. I truly wish that our elected congressmen had to use the health care system that they require us to us. I think there’d be changes quicker than you could blink! And those changes would be for the better.</p>
<p>Big news from H’s company which has always offered very generous health insurance coverage and was self-insured. It is getting out of the insurance biz and we will be choosing coverage on what is apparently its own little exchange: two insurance companies are participating. We will have only a two week open enrollment period at the end of October to choose. No word yet on what kinds of coverage will be offered and information about premiums will not be available until open enrollment begins. There will be meetings at work and online before that. Our big concern is that we have a son on an expensive biologic (Remicade) which cannot be stopped and started because of immune reponse so we need continuity of coverage for him. I am choosing to be optimistic (well, that’s my default position anyway) and believe that we will end up with acceptable coverage at an acceptable premium. I await developments.</p>
<p>Is your H’s company a large or small employer, Wellspring?</p>
<p>It’s a large privately held company. About 10,000 employees counting subsidiaries worldwide.</p>
<p>Wellspring, I’m wondering why your H’s company is no longer self-insuring. I don’t see why that decision would have to do with ACA: self-insuring vs. using an insurer is not about what benefits are being offered, but about whether the company or the insurer ultimately pays the provider. </p>
<p>I hope your son’s meds are covered in a new plan available to you. Chron’s? I’ve read (and I think it’s been pointed out here) that some insurers are playing despicable games with expensive meds. Instead of putting some meds that treat a condition in the cheap box and some in the expensive box, to steer people with that condition to the cheaper drug, the shady insurers put all the meds in the expensive box. It’s a slimy and arguably illegal attempt to keep away people with that expensive condition.</p>
<p>@Wellspring ,if you don’t like the two plans that are offered, then you’ll need to look in The Marketplace. Pack a lunch - it’s a time-consuming process. </p>
<p>@Wellspring, if you do need to check private individual insurance, you might consider using a broker. It’s free for you. They might already know about drug coverage in the various plans, so you don’t have to do the tedious research yourself.</p>
<p>The change has nothing to do with the ACA, as far as I know. It’s a private exchange with two insurance companies participating, no word yet on how many different plans might be offered. The company cites “predictable costs for the company,” “more choice for you” and “savings for all” as the reasons for the change. I don’t know yet whether we have to buy a family plan or three individual plans on this private exchange. We are aware that we can always go to the federal Exchange (no state exchange here) to buy a plan for son. Interestingly, he may at the same time qualify for employer coverage at his job although we had assumed we would continue to keep him on H’s employeer insurance because it was a known quantity and we knew the Remicade would be covered. Hah! </p>
<p>And I have a broker I can call if we go outside the company–used to work with them at a former job. So I’m hopeful it will all work out.</p>
<p>Predictable costs for the company-- definitely true
More choice for you-- but not very much more
Savings for all-- ha ha ha ha ha</p>
<p>You can go to the exchange to buy a plan for your son, and you can also take a look at the off-exchange individual policies. There might be a difference. Also, if your son is not your dependent, he might be eligible for a subsidy on the exchange.</p>
<p>Could he get a subsidy if he is offered employer provided insurance?</p>
<p>If he is offered employer provided insurance by his own employer, then he could not get a subsidy (I think there are some asterisks about affordability and maybe coverage here though). But if the insurance we’re talking about is his father’s employer’s insurance, and he is not a dependent, then he could still be eligible.</p>