<p>I think it has to do with the per capita income in the state. Maryland, being so close to DC is very wealthy. California is wealthy, sure, but it has a huge impoverished population and a massive uninsured population. </p>
<p>This whole thing is being run on how to pay for those who cannot pay. So if you have less people you are carrying, you can pay the higher priced docs. </p>
<p>This is why some states have a lot of different bronze, silver, gold variations and Cali has so few. One size fits all</p>
<p>ETA. One upside to the one size fits all approach is that it’s easier for California residents to figure out what is going on. The downside is going to be these incredibly restricted doc networks.</p>
<p>So you’re saying that the state of California only included insurers who offered low rates, and the other insurers were just not included on the exchanges? I think that might be right, but I haven’t seen any articles on how exactly California picked the insurers for the exchanges. Anyone have cites?</p>
<p>Several insurers in California opted not to be part of the exchange. They just withdrew entirely from the individual insurance market in this state.</p>
<p>CF, I thought the insurance companies chose to be in the exchanges, not the other way around. I know in NJ Aetna backed out in September, but have stayed in the individual market, just not the exchange.</p>
<p>"SARAH VARNEY, BYLINE: Perhaps the lesson of California’s efforts to keep insurance premiums in check is, carry a big stick. State lawmakers had granted those running the state marketplace considerable power to negotiate on behalf of about 5 million Californians who don’t get coverage through their jobs.</p>
<p>And negotiate, they did. Nearly three dozen health plans submitted bids. The state rejected those that were priced too high, or skimped on doctors and hospitals; and picked four of the largest commercial insurance companies and a handful of regional health plans."</p>
<p>It seems counterintuitive, but I keep seeing mentions of which insurance companies were selected to be on California’s exchanges. For example:
[Health</a> Net Selected to Participate in Covered California Health Insurance Exchange - DailyFinance](<a href=“Stock Portfolio & Tracker - Yahoo Finance”>Stock Portfolio & Tracker - Yahoo Finance)</p>
<p>“The difference also leads to a wide disparity in the numbers of plans, from just seven in Alabama to 106 in Arizona, according to HHS’ analysis. But HHS spokeswoman Joanne Peters says the situation is still much better than it was before the law took effect.”</p>
<p>“Mary Chalmers, 62, lives in rural California where she just has two plans to choose from even though California has 12 insurers participating on the exchange. The same “silver” plan costs $62 more a month in her hometown of San Luis Obispo than in Los Angeles. Thanks to a subsidy, however, the self-employed investor’s premium for an individual policy will drop from the $467 she pays now a month to about $100 a month.”</p>
<p>I did a little investigating on plans offered in my area of NYS and there are too many choices, imo. I put in my internist and my gyno and got 5 different insurers and a choice of 58 plans. The cheapest Bronze premium was $270/month (without subsidy) for a 57 year old with a $3000 deductible. You can compare 3 different plans at a time which is a nice feature. If I needed to purchase off the exchange I would obviously have to do a lot more research on which plan would work the best for me. </p>
<p>There was also a Platinum tier plan for $375 a month (most of that tier was $500ish/month) with no deductible and out of pocket max of $1400. It’s a Co-op option (which I don’t know much about.)</p>
<p>Update: As I promised in post #1678, here’s the essence of my conversation with the Advanced Resolution Center. While they missed the deadline they gave themselves by 2 business days, the rep was very polite and friendly. She said that the system should allow an applicant to estimate their future income, without specifying an employer. She said the reason it wouldn’t accept D’s estimate was a glitch in the system and it will be corrected. She couldn’t see the answers I had entered because I had not actually submitted the application yet. Her suggestion was to wait a few days and then try again.</p>
<p>I also told her I couldn’t access my file at all. Another glitch, she said. Wait a few days.</p>
<p>OR, call them and apply over the phone. When I said I would need to be able to see the different plans that would be available, she indicated that once they created a submitted app, the plans should be visible to us on the website. (That doesn’t give me a lot of confidence given the current state of the website!) </p>
<p>She was really encouraging the phone option, but I told her that I would wait until Nov 1st to try to log on again. If it’s still not working then, I’ll call them back and see what the prognosis for the website is.</p>
<p>I am a firm supporter of the ACA (despite some structural problems), but these glitches are an embarrassment. I expected minor problems at rollout time, but to still be locked out 3 weeks in is ridiculous. I really hope they can get their act together soon.</p>
<p>Let me be clear: I don’t think this makes this “good” or “bad,” better or worse. For someone who couldn’t get insurance before, a narrow network is better than no doctor at all. But this is what BS says about how they are covering California:</p>
<p>
</p>
<p>I think it’s a good strategy if you have to insure a lot of people who can’t really afford a lot of insurance. avoid the expensive providers. </p>
<p>But, that means, saying, “Get the bronze plan” isn’t necessarily the right choice for everyone. It’s a little more complicated.</p>
I’ve seen no difference of any company having different networks between one metal tier or another. Some companies offer different options, like a choice between EPO / PPO/ HMO – but as far as I can tell, within companies, the networks for the same type of plan are the same. </p>
<p>There are some situations in some markets where a particular company may not be offering plans in all metal tiers. </p>
<p>I think there has been some misunderstanding because of media reports as to restricted networks. It is not really logical or cost-effective for a company to restrict its network based on metal tier level, because that just complicates their ability to negotiate contracts with providers. The networks are being restricted overall because the companies are trying to negotiate contracts with lower overall pay scales or other limitations. For example, from what I can figure Blue Shield of California has no desire to cut the UC Hospitals out of its networks (an agent told me that they were “surprised” that the UC hospitals “decided” not to renew with them) – but I’m sure that UC’s decision was based on contractual demands from BS that they felt were untenable.</p>
<p>Is there any news yet regarding when the provider networks will be available for consumers to view?
Btw, thank you, calmom, for your continued information and education on this thread.</p>
<p>Sounds like Blue Shield is playing hardball with the UC hospitals. As they should. The whole argument for keeping private companies involved in our health system is to let the marketplace work. Competition to lower prices is our market, at work.</p>
<p>I don’t offer this as a justification for choosing the ACA over, let’s say, single payer. We’re not supposed to be re-litigating that here, and in any case I would have preferred single payer. My point is merely that given that we have private insurers involved, in the system that we now have like it or not, we should expect and want the private insurers to try to lower costs. Picking hospitals that charge less over hospitals that charge more is one way to lower costs.</p>
<p>Right. But Calmom, what I’m saying is that an exchange plan might not be the best plan for interested dad in New Hampshire, where the exchange plans have incredibly restrictive networks. Given the pricing, unless he will get a subsidy, he will be better off in private insurance, as will I. </p>
<p>The only advantage to the exchange is if you will get a subsidy, as far as I can tell so far.</p>
<p>Given that is the intended client base of the exchanges, this is actually not a criticism, just an observation of how it is working.</p>
<p>Actually, NH only has one insurance provider in the exchange: Anthem Blue Cross. When I shopped the individual market a while back there was only one more company and they weren’t competitive with Anthem for me.</p>
<p>Anthem has dropped my local hospital from the network effective Jan 1. Another case of I like my plan but I can’t keep it!</p>
<p>I want the catastrophic plan. It’s pretty much like my current plan which has a $5950 deductible and a $5950 max out of pocket, only the numbers jump to $6350 for the new catastrophic plan. It can be purchased for the same price either thru the exchange or direct from Anthem. And the premiums are a bit lower than my current premiums (to reflect the extra $400 a year in out-of-pocket. Alas, I’m not eligible…</p>
<p>The Bronze plan charges more. To get to the “60% of average person’s health care cost” they jimmy around with lower deductibles and co-pays above the deductible, but below the same max. That is of no benefit to me whatsoever. Realistically, if I ever get to the deductible, it will be because I’ve had a major illness/hospital stay and that will put me into the max-out of pocket limit anyway.</p>
<p>To their credit, I have found a page on Anthem’s site that lets me compare all of their individual plans, both within the exchange and outside the exchange (“quick apply”)</p>
<p>Not so in Florida. The FloridaBlue PPOs are either BlueSelect or BlueOptions plans. Not a single one of my physicians or specialists are in the BlueSelect network but all of them are in the BlueOptions network. The other two companies offering PPOs are Aetna and Cigna. All of their plans do use the same network of doctors.</p>
<p>There are 138 plans to choose from in my county in Florida. Can you imagine having to make a decision among that many plans? The website is supposed to let you filter the plans displayed so that you can only see PPOs or cost-sharing reduction eligible plans, or those with deductibles below a certain amount. But that filter feature isn’t working so you can only view 30 plans on a page with no way to advance to the next page – the Next 10 Results button is missing! I’ve tried to report the issue but the people on the phone help line don’t seem too interested. They just want to answer questions about the ACA.</p>
<p>Moonchild, at this point I think that Anthem is playing games – by playing games I mean I don’t think they have completed their network yet, but they aren’t telling that to customers either This is rumor territory, but I found a comment from an insurance agent online to the effect that there is “more tension than usual between carriers and providers during negotiations.” and a statement that negotiating could “go on right up to the Jan. 1, 2014 starting date.” </p>
<p>I was able to get direct answers from Blue Shield by phone and also verified what they told me online at their web site, so I think their online directory is now current, or close to it. </p>
<p>The Anthem Bronze HSA in my area is $50/month less than BS, but given my experiences with Anthem so far, if things don’t get better with Anthem in terms of info I’ll stick with BS. I considered Kaiser but it only took a few minutes on their web site for me to realize that it wouldn’t be a good fit for my personality. I mean, the bottom line is that I am willing to pay extra for good customer service for other things in my life, and while I wouldn’t say that BS deserves a medal in that area, they seem to be more more responsive and easier to work with than the others. (In other words, the seem to be the least worst). </p>
<p>One advantage of the new system is that I know I can change in a year. So if it turns out that Anthem does pick up the same networks and there is still a price differential in policies a year from now, I can always switch. </p>
<p>The other big question for me is whether or not I will be subsidy eligible. It’s just quite confusing with various issues related to self-employment. Based on the AGI of my 2012 return, I am eligible right now, but that’s $5000 I could owe to IRS in a year if I took the full advance subsidy. So I’ll probably pay full cost and just hope for a refund down the line. The alternative might be to bank the money – I could take the same amount of money, put it into a 15-month CD, and then cash in the CD in 2015 to pay the taxes, but interest rates are so negligible that I think I’m better off to just to charge everything on credit cards with generous cash-back or airline miles rewards.</p>