<p>Looks like the ‘unlucky’ may eventually end up being winnowed.
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<p>katliamom, first question – does Colorado have its own exchange, or do you use the federal exchange?</p>
<p>It has its own exchange, LasMa.</p>
<p>OK. First, does it have an estimator, where you anonymously enter your family and financial info? This will tell you if you’d be eligible for a subsidy.</p>
<p>Subsidy or not, be careful to chose a plan with a deductible that’s reasonable for your health and finances, katliamom.</p>
<p>Enrollment and premium pricing is going to be an interesting time, this year, dstark. This is the second (fresh and from an impeccable source) piece I’ve seen that indicates last years pricing was a little bit of a shell game, which contributed mightily to participation.
I think the NYT is admitting, with the last, that there’s a huge cost to the preventative care and it crowds out what the desperately ill might really need to be screened for. Reinforcing that there’s no perfect solution, no matter how much some might wish it so.
<a href=“http://www.nytimes.com/2014/10/18/us/unable-to-meet-the-deductible-or-the-doctor.html?src=twr”>http://www.nytimes.com/2014/10/18/us/unable-to-meet-the-deductible-or-the-doctor.html?src=twr</a></p>
<p>That other piece I mentioned is just as interesting:
<a href=“Some with health insurance still prefer charity care”>Some with health insurance still prefer charity care;
<p>The Houston Chronicle article is behind a paywall, so I can’t find out what Ms. Martinez’s story is. But I’ll once again remind everyone that subsidized people with low incomes (who are presumably the people who are eligible for charity clinics) get subsidies for their deductibles too, provided they buy Silver plans. They do not have $5000 deductibles, even if you do. They also get subsidies for their copays.</p>
<p>^specifically for an 87 plan, we’re talking $250 deductible and $2,000 Out of Pocket max at up to 200% of FPL for an individual. I know this because I helped my son enroll last year when he lived in another city at a lower paying job.</p>
<p>At the lowest income level (after Medicare), the deductible is $0 with $1,000 max out of pocket.</p>
<p>The people with lower subsidies, eg above 200% of fed poverty level, can in fact have out of pocket maximums of 4k individual (with deductible of $1700), or at 70% actuary value, yes, up to the $5,500 OOP Mac.</p>
<p>So, those with greatest need have reduced deductibles and out of pocket maximums should something catastrophic happen.</p>
<p>However, it is absolutely true that people who receive modest subsidies, eg. those above 250% FPL, need to be prepared to have cash on hand to cover higher deductibles just as the rest of us do. This is why I think an HSA is so valuable…it conditions you to save, pay for, and recognize the cost of healthcare. </p>
<p>I know quite a few lower income people who don’t really think twice about going to a $100 concert, a night on the town, paying exorbitant cell/data bills out of their meager incomes…but who somehow think a trip to emerge or doctor will be free. We were trained to think this way when there was no transparency to healthcare costs until you were in trouble 
I believe that is how in part this market has inflated in expenditure beyond all reason and comparative to other countries.</p>
<p>None of the foregoing necessarily makes healthcare “universally accessible” the way it is in single payer/complete government coverage countries. The healthcare we now have is what you get in a “market” where the purveyors are regulated into not constantly bamboozling individuals (though through networks, they’re still trying) – in actually providing true coverage. The sooner that becomes clear to all citizens, the better equipped they will be to consider their options and make sensible decisions around healthcare access.</p>
<p>I read the print version awhile back and found the paywall when I looked for the link, CF. If you suspect there’s something that disagrees with my point - the cheap plans that pumped last year’s enrollment numbers aren’t cheap if you actually try to use them - just google a full sentence of what I quoted and you’ll find the full piece.</p>
<p>kmcmom - if you (talking about your 'lower income people here) don’t blink at 100 buck concert tickets, expensive restaurant tabs, or unlimited data plans for your Iphone, you shouldn’t be asking me to kick in for your birth control. </p>
<p>(Myself, I’ve got an archaic Samsung flip that’s still kicking after being dropped in with the onion rings I was cooking one night.)</p>
<p>cata, could you be a little more precise about what you meant by this: “the cheap plans that pumped last year’s enrollment numbers aren’t cheap if you actually try to use them.” My DH got a plan with X dollar co-pays, and that’s exactly what he’s been paying all year. My D, who gets a subsidy, has smaller co-pays, and that’s exactly what she’s been paying all year. In both cases, prescription prices have been as advertised. Both have had zero co-pays with preventive care. </p>
<p>DH has a fairly high deductible, which we don’t anticipate he will come close to meeting. We made that decision consciously, weighing a higher deductible against a lower premium, in view of his anticipated health needs this year. But if he does have a lot of medical bills between now and the end of the year, we will pay up to the deductible. That’s what we signed up for, with full knowledge that it was a possibility. If there’s a change in his health in the future, we may opt for higher premiums and lower deductibles. That tradeoff is the nature of insurance. We also choose higher-than-normal deductibles for our auto and homeowners, which keeps the premiums lower. Over the years, we’ve come out far ahead.</p>
<p>From the NYT piece linked previously:
The first paragraph acknowledges Fang’s correct but if the point was to get the uninsured to buy in with low-cost, ‘priced-right’ plans, then keeping the goodies locked up in the more expensive option seems like something that won’t encourage repeat enrollment from those without expensive preexisting conditions. Time will tell, but by happy coincidence, won’t even begin to until after mid-November. </p>
<p>Second, third, and fourth paragraphs illustrate how the low-cost guy/girl got screwed, because we all know - by now - how narrow the networks are - along with why.</p>
<p>You’re happy, LasMa, and I’m glad, but there you are. The happy enrollees are the one’s that both knew beforehand what they needed and were willing to pay for it. I’m not sure any of this resembles insurance in any meaningful way but the NYT still manages to portray those who didn’t play the game well as victims in need of relief. </p>
<p>You know, what’s missing from that piece is a simple observation. That: if a doctor with a degenerative condition and other health problems was blindsided by the narrow network issue, there’s a whole slew of less savvy consumers sucking air right now. </p>
<p>Not at all the kind of customer businesses count on as repeats. </p>
<p>There’s also the detail that you can do your homework and check that the doctors you want are in your plan by going to the website to check. Then comes reality when you learn that the insurance website is inaccurate and the dr you looked up is no longer in that plan and the website is outdated. Or that dr is in network but isn’t accepting new patients (a detail that is not on the website).</p>
<p>I have not personally had this problem (yet!) but I have read articles (some posted in this thread) aboat those who did run into this problem. </p>
<p>It’s still important to recognize that not all networks are narrowed or with adequate coverage located hours away.<br>
Our website does indicate whether a doc is accepting new patients. I had checked tn multiple ways that my docs would be covered (before confirming my state doesn’t have this issue)- doc staff, doc billing office, and the insurer.</p>
<p>You have to both look back at the last few years, to see what sort of med expenses and needs you have. (Could be little, could be something recurring or ongoing.) And then play what-if. Part of that is random (what if I break my leg?) And part is any conditions you do have which haven’t acted up in the past few years but could. You need to put pencil to paper and see what works. It’s not just a matter of monthly costs and it’s not just ded or max oop. </p>
<p>If you stay healthy, you wouldn’t reach that ded or max oop. Maybe it’s worth it to go with higher numbers there. Otoh, if you know something could crop up, maybe the lower ded/max are worth a few more dollars monthly. Have to try to figure that. </p>
<p>What’s actually missing from that piece is what might have happened to the same patient without caps, without insurance, or what the actual cost of a group/employer plan that covered all the out-of-network stuff ;)</p>
<p>Its missing from the piece because there’s no way to know, except that there are many many pre-ACA stories to give a clue. </p>
<p>What these examples show is not an outright failure of ACA in comparative terms. These examples show that insurers seem to need more regulation, not less ;)</p>
<p>We need ACA-II, then ACA-III to get rid of all nonsenses.</p>
<p>cata, well, the reason Dr. Love is going over her deductible is right there in the story – she’s going out of network. Insurance companies are required by law to make sure that their network is adequate; i.e., that all of their subscribers can get to providers within a reasonable distance and a reasonable time. Dr. Love’s insurer is in violation of the law, obviously. Several California insurers are being investigated by the state, and sued by subscribers, for this same violation. Dr. Love’s beef is with her insurer, not ACA. </p>
<p>kmcmom13 states it correctly:</p>
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<p>It was in what I quoted, too. If you want to persist in believing that the narrow networks are simply because insurers are intentionally malicious and only because of that, I can’t stop you. There may be someone else out there that would benefit from this though, so I’ll quote it:
</p>
<p>The irony of blaming predictable consequences on too little regulation, after passing a 2,400 page bill that spawned nearly 11,000 pages of regulation, is darn near breathtaking. So breathtaking it’s easier to believe y’all are just pulling my leg. L-) </p>
<p>We had pages and pages were we discussed that, in some palaces, for some sorts of geographies, for some sorts of reasons, insurers will narrow networks to reduce their costs in various ways. </p>
<p>One can examine (ie, not just react to a notion) how increasing eg, the number of specialists in County X in California will increase costs for individuals in the pool. That’s a different challenge than saying, look, so-and-so said “premiums could spike.” Will they?</p>
<p>And, you have to understand that while this could happen or that sounds scary, without precision, it’s just talk. And that no matter how many pages the documents add up to, not everyone is having these “deal-breaker” network issues this chat keeps focusing on.</p>
<p>It makes no sense that arbitrary state lines determine networks. The doctor in the story is in a remote town, Moab, Utah. Her doctors are in Grand Junction, Colorado, which is much closer than Salt Lake City, Utah. She should be able to buy a policy in Colorado.</p>