<p>Cartera, no deductibles but there is co-insurance?</p>
<p>“Through the exchange, I can get a zero deductible plan from Carefirst for $596 per month.”</p>
<p>That was sounding like an awesome deal to me, until I realized that had to be for one person, not a family. Either that or highly subsidized.</p>
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No they aren’t. They are far less complicated than anything that existed before, because they all have to cover the same basic benefits. No more pouring through a policy to see whether it covers mental health or maternity (common exclusions in the past).</p>
<p>All the plans pay for preventive care, no charge.</p>
<p>All the plans have a maximum annual out of pocket of either $6350 for a single policy, $12,700 for family - or something less. </p>
<p>So you need three pieces of information: monthly premium, deductible, out-of-pocket max. </p>
<p>From there you can figure the minimum and maximum cost for your policy.</p>
<p>Minimum is the sum of all the premiums – you’ll pay that no matter what. </p>
<p>Maximum is your premium total plus the out-of-pocket maximum.</p>
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<p>Then you want a Bronze. It will cost you less out-of-pocket under either scenario. Premiums are lower, and if the health care costs are $500, most years you won’t even begin to get near the deductible. For the $20K expense, your total costs will be your premium dollars plus that out-of-pocket max – so you’ll still come out ahead with the Bronze.</p>
<p>It’s the people in the middle - the ones who know that they will have $8K or $12K every year in expenses, or the ones who have fairly low medical bills but rely on expensive prescription meds who might benefit from the other plans. They could come out ahead if they don’t have meet a high deductible before the insurance starts to pitch in – and I think particularly the ones with high prescription drug bills might want the benefit if the reduced prices on a prescription without a high deductible to meet.</p>
<p>Cartera45, you had a health insurance plan with no prescription coverage? Did I read that correctly?</p>
<p>texaspg, there are specific regulations that have been developed to address the multi-state situations. I’ve scanned through them so I know they are there, but I haven’t taken the time to actually read or study them, so I can’t tell you in more detail how they work. But suffice it to say for now that this issue has been anticipated and there is a way that it will be addressed.</p>
<p>Yes, there is co-insurance.</p>
<p>CF, I wish I had known you were taking that class – we could have had our own study group! (I took the class “with” my daughter, so I did at least have some one to chat with). I agree the production values on that class were the best I’ve seen – I signed up for a class in neuro-ethics but dropped it because it was simply the prof talking into the camera (and talking, and talking). But I’m also taking a refresher class in Introductory Stats from a prof at Princeton- he’s very well organized, and while the class lacks the humor and pizazz of the Ariely course, the lectures are easy to follow and achieving my goals.</p>
<p>The thing I love about Coursera is that it’s all free-- so if you don’t like a class, you can just drop it, no problem. Plus it is amazing in the forums how many people all over the world are working hard at the classes, even without the commitment of having paid tuition or having to worry about grades. </p>
<p>And to bring this back to topic: isn’t it cool how the Coursera people managed to build a complicated web site that does a lot of stuff but is easy to navigate and actually works? I bet they could do a lot better job of selling insurance.</p>
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<p>Yes, that fits what I said – the OOP maximum is when the insurance starts paying 100%</p>
<p>Your “co-insurance” numbers don’t make sense – there must be a co-pay – that is, if the insurance for the Bronze paid everything after the $5000 deductible, then there would be no way for anyone to reach the OOP max – the patient still needs to be paying something.</p>
<p>What state? (It might be easiest for me to look up the plans you are talking about)</p>
<p>“texaspg, there are specific regulations that have been developed to address the multi-state situations.”</p>
<p>I believe poetgrl is affluent, knows enough lawyers and has multiple homes across the country and can figure out the most economical option available to her. I am giving her ideas to see what she comes out with. :p</p>
<p>“The employer plans are a different animal – so those can continue without interruption. Most people with employer-provided insurance are not directly impacted by ACA.”</p>
<p>Calmom, I don’t think this is accurate. Small business insurance will be either grandfathered or non-grandfathered, just like the individual market. If the small business employer plans (less than 50 full-time employees) are non-grandfathered, they will have to go to the SHOP exchange or purchase ACA-compliant plans directly from the health insurance company. I am told there will be more choices for small business, such as plans with expanded networks, as opposed to the limited choices in the individual market. Also, most employers will have the opportunity to renew their plans before Jan 1, thereby not having to comply with the law for one more year. </p>
<p>As for the large group market, it, too, will have to become ACA-compliant as well as comply with the affordability requirements (employees cannot pay more than 9.5% of their salary). However, because the Administration delayed the group mandate for large businesses, much of this won’t go into effect for another year. Also, in 2015, spouses who are offered insurance could have to pay 100% of their premiums and will not be eligible for any subsidies even if they qualify for them.</p>
<p>The bottom line is that employees will not be spared many of the changes that people in the individual market are now dealing with. It just will happen in many cases one year later.</p>
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<p>Did you take Coursera courses in the beginning? There were plenty of bugs and issues. But also, the difference between what Coursera had to write and what the people writing the exchanges software have to write is the difference between a building a sand castle and building a cathedral.</p>
<p>I love Coursera; I’m on my tenth class now. I’ve TAed several of their courses, and they asked me to TA three or four different ones this fall (but I’m only TAing one). I even took the Coursera course on the ACA.</p>
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<p>Unless they don’t. Is a colonoscopy when you have previous polyps preventative care or treatment? Anthem Blue Cross says, and I quote, “once you have one polyp, all future colonoscopies are treatment, not preventative, and subject to the deductible”. </p>
<p>Same thing for cholesterol testing if you have a “hypercholesterolemia” diagnosis on your medical charts.</p>
<p>I will be very, very surprised if there is a different interpretation for the exchange plans.</p>
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<p>I figured that part out five years ago. I was happy with my BRONZE plan… until the letter arrived last week informing me that I can’t keep it. The exchanges offer five different bronze plans. I’ve got to to compare the deductibles, out of pocket max, co-pays and provider networks. </p>
<p>There are some major questions from downloading the PDF files for each of these plans. For example, they say that out-of-network charges are NOT covered. Does this mean if I have an accident on vacation out of town that I really have ZERO coverage?</p>
<p>Goldenpooch, you seem to be fixated on the idea that grandfathered plans are vastly superior to anything on the exchange. Not sure where you got this idea.</p>
<p>Re small businesses – which comprise 96% of American businesses, according to Forbes – SHOP will be a good thing, since it will give them some of the same buying power that large businesses have. In addition, many small businesses will be eligible for tax credits under ACA. And remember, they are not required to provide insurance at all if they choose not to. </p>
<p>As for large businesses, the vast majority are already ACA-compliant and will be unaffected by the law other than some minimal paperwork. So, again according to Forbes, something like 0.2% of US businesses are going to see a major negative impact. </p>
<p>And to the extent that ACA begins to rein in the double-digit annual increases that have been routine for several decades, all businesses will benefit.</p>
<p><a href=“http://www.forbes.com/sites/theyec/2013/04/22/is-the-affordable-care-act-really-bad-for-business/[/url]”>http://www.forbes.com/sites/theyec/2013/04/22/is-the-affordable-care-act-really-bad-for-business/</a></p>
<p>BTW, the new cost estimator preview function on the Obamacare website (that lets you check prices without creating an account) does NOT provide accurate pricing. It is much lower than the actual price of the same plans from Blue Cross’ website or by actually creating an account at the Obamacare website (no subsidies involved, just straight pricing).</p>
<p>For example, a plan that actually costs $461 a month was $267 on the estimator. I don’t know if this inaccuracy should be viewed as a feature or a bug…</p>
<p>“As for large businesses, the vast majority are already ACA-compliant and will be unaffected by the law other than some minimal paperwork.”</p>
<p>Do you have a source for the above?</p>
<p>“Goldenpooch, you seem to be fixated on the idea that grandfathered plans are vastly superior to anything on the exchange.”</p>
<p>Well, I guess I can only speak for myself at this point. If I was given the choice of keeping my plan or going to the exchange, I know which one I would choose. I read today that Blue Shield of Ca, sent letters to 60% of their individual subscribers (I think around 200,000 policyholders) cancelling their policies on Jan 1. I wonder how many of the 40% will voluntarily give up their grandfather plans. I guess we will have to wait until next year to find out, if Blue Shield chooses to release the information.</p>
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But that’s not new – that’s how insurance has always worked. The difference is that at least now we can get that first visit (or first segment) without cost – I mean, a few years ago when I asked what a colonoscopy would cost me, the best answer I could get was at least $3000… so I passed on it. That was $3000+ I didn’t have, so that meant no test at all. If I was in the situation of paying -0- for the diagnostic part by $$$ for the polyp-removal part, I’d at least know that there was an actual medical issue being treated-- as opposed to a very expensive screening test.</p>
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Well you are lucky that you have 5 to choose from – in California there is one. The same plan can be bought from 3 different providers, but there is one. </p>
<p>But again, the math is fairly simply: figure out the minimum and the maximum. The provider networks are a different matter – that still isn’t settled here and that’s the reason I haven’t signed up yet - but that’s really the fault of the insurance companies and not the exchange. (The companies are still negotiating with providers and don’t have their networks complete yet, but they also aren’t forthcoming with that information … which creates even more confusion).</p>
<p>Interesteddad - here’s a handout that answers your questions about out-of-network emergency care – the law does required that those services be paid:
<a href=“http://www.familiesusa.org/health-reform-central/september-23/Emergency-Care.pdf[/url]”>http://www.familiesusa.org/health-reform-central/september-23/Emergency-Care.pdf</a></p>
<p>Calmom, three and a half years ago I had a colonoscopy and it was covered 100% by my Blue Shield of Ca. HSA plan. I was told by Blue Shield that they were covering all preventative care before the deductible for all their plans.</p>
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<p>My old plan, the one I liked and am not allowed to keep, paid for the first colonoscopy without deductible, as preventative care. So I’m not sure what benefit I will be getting from a fancy new plan with the same coverage? :)</p>
<p>The only thing that counts as preventative for me is my annual physical and, I suppose, a tentanus shot every umpteen years.</p>