<p>Goldenpooch, the ACA was passed in March 2010, which is 3 1/2 years ago. The preventive care requirements were effective almost immediately. </p>
<p>I was giving an example from earlier than that. And it involved Blue Shield. It was before I had an HSA, and I got an HSA within a year after they were first established. </p>
<p>But I’m glad to know that you already took advantage of an ACA benefit! Think how much you would have paid without ACA!</p>
<p>The first one is covered. That’s preventative screening. But, if they find a polyp during the first one, all subsequent colonoscopies are medical diagnostic, not preventative screening and, therefore not covered under the preventative screening. They will be subject to the deductible which, in my case, means I pay the entire cost out of pocket. I guess it all boils down to the definition of “free preventative care”.</p>
<p>Continuing to advise that “you want a bronze plan” fails to take into account the network and doctor limitations on the bronze plans, as if the only possible concern could be your premium. </p>
<p>When one has Crohn’s Disease, colonoscopies are never preventative. With my HSA, I’m fine with getting one early in the year. Then I hit my max out of pocket early in the year and am done for the rest of the year. </p>
<p>A few other things I don’t know if anybody has mentioned in the 125 pages here… </p>
<p>Another advantage for the businesses under 50 employees is that they no longer have to be signficantly affected if one of their employees becomes seriously ill. In a company that size, if one of their employees were to have a very expensive disease- brain cancer, serious stroke requiring lots of rehab, etc. their premiums would have quickly become unmanageable for their entire company. You’re better off being in that larger community risk pool. </p>
<p>I do have employer sponsored insurance but have been limited on job choice because I knew I was uninsurable due to pre-existing conditions before ACA. I recognize I’d pay more now if I used the exchange, but I would be able to get insurance, which opens up a lot of employment opportunities as a consultant, a contractor or in hanging my own shingle. That’s a relief to me.</p>
<p>interesteddad, we are in a similar situation our current plan ends May 31, 2014. We have always purchased high deductible / low premium plans. In 30 years there has only been one year where we actually met our deductible and the insurance company had to start paying 50% of less than $2000. We have never hit our max ‘out of pocket’. All we really want is catastrophic coverage. Since we are not eligible for any type of subsidy and want to select our providers and maintain some level of privacy regarding our financial and health information we will not be going into the exchanges. We will purchase a policy (albeit ACA mandated and thus expensive) through our current carrier.</p>
<p>DH emailed me this AM (we’ve been discussing HSA’s and wondered if our current plan is HSA eligible which is COBRA coverage as he transitions to contract/retirement): </p>
<p>“FYI, I called Blue Cross Blue Shield to ask if our health plan qualifies as a High Deductible Health Plan. They were clueless. They said they think HSAs are only available through an employer, and that I should ask my company. When I told them HSAs were available at many financial institutions, they told me to call the financial institution.”</p>
<p>It’s a strange new world out there and I think Calmom gives the best info of anyone out there. KUDOS! And thanks again =).</p>
<p>“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>In NJ all small business plans (2-50 employees) were eliminated since they were non compliant. Our company was not given the option to renew before Jan 1, we can keep the plan we have until our renewal next September or choose a new one for January 1. Other employers we have spoken to, with the same plan, have been told to get a new one by Jan 1. </p>
<p>Looking at the website of BCBS, there are no plans with expanded networks, instead the networks are shrinking with some plans having hospitals now designated as Tier 1 or Tier 2 (which used to be in network and now has a higher co-pay). Before almost all plans were PPO or POS with out of network coverage and out of state coverage, now it’s mostly EPO with no out of network and no out of state coverage. That makes it difficult for us with a student out of state.</p>
<p>As to out of network emergency services, some of the plans I have researched in NJ have out of network emergency room coverage, NO out of network ambulance coverage and NO out of network hospital room coverage. The Patient’s Bill of Rights doesn’t address hospital room coverage, just emergency services. So if you have a heart attack on vacation out of state, you may or may not be covered for a hospital stay? If your plan paperwork says no out of network hospital room coverage, I would think you are not covered.</p>
<p>There seems to be a big difference state to state regarding doctor choices. I don’t understand why this is the case. Why would doctors in Maryland, for example, be fine participating in the exchange and doctors in other states not be? Are the states that set up the exchanges themselves more likely to have better doctor participation than those who held their breath?</p>
<p>people buying new plans should really like at the HSA plans if offered. It’s like a “super Roth IRA”, meaning tax deferred and tax deductible. Even if you don’t have the funds to contribute to both a Roth and HSA, it might be better to fund the HSA and skip the Roth.</p>
<p>Say your premium is $10k, you con contribute $6,550 for a family plan to a HSA. That is tax deductible, so for example, if your fed and state tax liability is 30%, that’s $1,965 savings making your premium actually only $8,035. </p>
<p>At some point you will need that money to pay for medical expenses, if not, at age 65 you can withdraw without a penalty, but have to pay tax on the interest.</p>
<p>There are many ways to invest these funds, mutual funds, aggressive, conservative, ect. I’m pleases with hsabank.com</p>
<p>It’s interesting to hear all the different ways this is being handled, even by the same insurers, in different states. </p>
<p>Nobody has given me useful information on this thread pertaining to my state. So, be careful about Internet info. Make sure you check in your own state. And make sure you don’t assume anything. </p>
<p>The calculators are not useful. You have to get your own quote for your own situation.</p>
<p>I don’t understand how calling the federal hotline to enroll makes sense. How can one compare plans? Does the person take down all the info and then send the person the info by mail? Or do they quote them all of the info over the phone? Will it sound like all the speed-speak of terms used in radio ads at the end of the ad?</p>
<p>“But calling the federal hotline, seeking local in-person assistance or mailing a written application, as Obama recommended, won’t make it easy for consumers to check details of health insurance plans they can buy.”</p>
<p>CTTC, no kidding! I want to see and compare many plans. How can you do that over the phone? Not to mention the not so minor detail that I wouldn’t be able to trust anything I hear verbally that I did not see in print. My one experience with using the federal hotline - a few days before the October 1 rollout - was absolutely frightening. The person I spoke to did not know what a “subsidy” referred to in the context of the ACA.</p>
<p>NJres, did you figure out if you are going to receive a subsidy? If so, are you going to choose a silver plan? </p>
<p>I have a kid that lives out of state. I guess I am going to have to call Anthem to discuss in network and out of network issues. Not that I always get the best most accurate information from Anthem… :)</p>
<p>^Not to mention the inefficiency of it all. If website crashed because of too many people logging in, what would that do to phone lines? Busy signals all day long?</p>
<p>In today’s LA Times, when asked why the doctor networks were so limited in California and insurance spokesman said “You can’t offer a Lamborghini to someone making minimum wage”.</p>
<p>That doesn’t explain why Maryland is making that offer. My D’s specialist is at the top of everyone’s list with regard to top docs and he’s in the network. One of my best friends came here for a double lung heart transplant and sees the best and they are all in the network. Why couldn’t California negotiate as well as Maryland?</p>
<p>It could be that California has many more uninsured. And many of the hospitals have to treat uninsured illegal immigrants so they raise their prices for those that have insurance. So those hospitals become ‘expensive’ and are dropped from the network. </p>
<p>The article didn’t deal with that issue. It talked about the fact that the plans are not graded as they are when buying on the private market. They say they can’t be given a quality grade at this time because the networks are so different and smaller than previously.</p>