Busdriver The way they were doing rescissions wasn’t just a scam; it was totally illegal. But the money they saved by not paying claims far outweighed the fines and judgments they regularly incurred. And in fact, they told congress point blank in 2009 that they intended to keep right on doing it. So this is one of the many valuable protections that the law now gives all of us.
Actually, with some employer provided insurance they do ask VERY nosy questions and a lot of personal health history. In order to qualify for a discounted rate on the monthly insurance payments by employees, I know of major employers who have their employees fill out quite extensive health “surveys”. It’s not mandatory but you won’t get the discount without doing so.
Whether or not one company required employees to fill out a history in advance doesn’t mean “people with employer provided insurance never had to go through this.” And even if a company didn’t require that up front, when requesting prior auth for a diagnostic or a procedure or when medical forms were submitted for reimbursement, there could be all sorts of questions meant to identify pre-existing conditions. And the definition of pre-existing was darned loose.
Yes, the pre-ACA individual medical insurance market was very problematic. Basically, insurance companies looked suspiciously at applicants thinking that they have pre-existing expensive conditions and are only buying when they know they need something expensive (adverse selection), while individuals lived in fear of minor errors (sometimes on someone else’s part) causing the insurance company to rescind the policy just when it is needed (even for something where the alleged pre-existing condition is not relevant).
“Actually, with some employer provided insurance they do ask VERY nosy questions and a lot of personal health history. In order to qualify for a discounted rate on the monthly insurance payments by employees, I know of major employers who have their employees fill out quite extensive health “surveys”. It’s not mandatory but you won’t get the discount without doing so”
Getting a discount is different from having to answer those questions in order to get or keep your insurance. Unless it is massively more expensive to get the insurance without the discount, I guess.
I should have specified union based insurance, where the company must cover everyone at the same rate no matter their condition (as delineated by contract). I have no idea what non-union companies covered for their employees. An entirely different deal when you work under an enforceable contract.
- Yes, we did apply for, and receive private healthcare before ACA. It was a one-time application and annual renewals involved one mouseclick. We were also able to switch to a higher deductible/higher co-insurance (lower premium) policy with a single mouseclick, with the understanding that switching to a more generous policy would require a new application with full scrutiny of our medical history. With the ACA application I found it a bit annoying to repeat information that they presumably had every year, that's all.
- I realize the subsidy increase I am seeing is unique to my county in NC. I just had no idea that subsidies were adjusted along with the changes in rates. BCBSNC got a lot of healines about their 32.5% rate increase. I don't recall reading that subsidies were going to be adjusted a similar amount.
NJRes, at one point, I did a comparison with Raleigh and the net prices for age and MAGI were pretty much the same as in my state (which has an exchange and strong oversight.) It’s hard to compare because the specifics differ.
Looks like my own rates will go down 30%. Some of that may be because I overestimated MAGI for 2015.
And you can look at my different offerings, for my details, and see how my insurer is pushing people to HSA, with a lower deductible/max OOP, and lower co-insurance, for a lower premium. I’d have to pay for office sick visits up to the deductible (again, at the insurer’s lower rate,) but the comparison of this vs a higher monthly looks okay, when I project.
The next closest Silver is only $15 more/month, OV are $20, but with a higher max OOP. I don’t think most of us need to worry quite as much about the max, unless there’s a dire crisis, but I’ve dealt with an issue in the past that could easily run 3k, if it flares. At our ages, one has to look at this from several angles. Or if we’re insuring our kids.
For the subsidies, the idea is we figure out how much a family can afford to pay, and that’s the max they have to pay if they buy the reference plan. If the plan costs more, the family gets a subsidy for the difference. And then for any other plan they might choose instead, they get the same amount of subsidy they’d get if they bought the reference plan.
It makes more sense if you think of it that way. If the premiums go up this year, well, the family can still afford what they could afford last year. And if the premiums go down this year, well, then the family doesn’t need as much subsidy as they needed last year.
I applied for individual coverage back in 2008 and the application was 4-5 pages long. It asked everything about your health for the past 10 years. The questions for the current system are quick and easy. All you need is your age, zip code, smoking status, and a few other things. The average person could fill out the entire form under 10 minutes.
I live in Milwaukee county and it is one of the most competitive markets. We have 5 insurers in the county and I believe the state overall has 12 or so.
I am going to change plans for 2016. I am changing from WPS to United Healthcare and it will be $6 cheaper. While there are several insurers, United Healthcare is now the only one in the area with a wide provider list. WPS is now only offering plans through their narrow network subsidiary. I do not have the cheapest silver plan. The cheapest one through Molina is $73 cheaper.
Learned something new today: the Feds issued a rule and confirmed it in a notice – ACA-compliant insurance plans will no longer be able to have any member of a family have out-of-pocket costs greater than the allowable out-of-pocket maximum. With our old plan (ACA-compliant) I ditched family coverage because the deductible was 2 or 2.5 times the individual deductible, and so you had to hit a truly startling amount of expense before a high deductible plan paid a dime. It was better for Mr. Arabrab to use the coverage from his employer, and for me to obtain my own coverage. Plan years starting on or after 2016 have to follow the new rule:
http://www.modernhealthcare.com/article/20150915/NEWS/150919927
Call me disgusted. Son lives in AZ. The individual exchange plans there are HMOs. He has one doctor…an eye specialist…who isn’t on any of these plans. It’s an annoyance. Why do they all have to be HMO plans?
^^^^There was a small group of posters (myself included) who raised the concern of ACA provider networks being limited and restrictive. The voice of concern was generally drowned out and classified as naysaying and ACA ‘hating’.
Providers need to make a living. They simply can not afford to take on patients with insurance contracts that provide for substandard reimbursement rates. In order to make plans on the individual market ‘affordable’ something needed to give…and that was the robustness of the previous provider network. Add to this the increase in Medicaid patients - Medicaid is notorious for low reimbursement rates - and you have a brewing storm. Those ‘good’ expansion States that jumped on the Feds ‘free’ money are beginning to experience the financial impact.
Ironically, the ACA will lead to an even greater two tier health care system. Those who have large group insurance through their employers will continue to enjoy a robust provider network - able to access the best care across State lines if needed. Those in the individual market will continue to see rate increases, provider network limitations and rising costs.
So, the reason for
is the attempt to keep the appearance of the AFFORDABLE portion of the ACA. We’ll, at least for appearances sake until the next election cycle passes.
Yes, I remember it well! My local ACA exchange plans are also only HMOs.
[/quote]
People with large employer plans often sit back so self-satisfied. ACA problems don’t affect them. But they can preach to the others. Those on the government dole for employer insurance (fed workers, state workers, local workers - particularly fed and union-choked state workers) have entirely too-generous plans. They should be made to bear more of the costs of their exorbitant plans. (Why should the taxpayers cover the overwhelming majority of the premium for someone’s kid who has insurance available through their own employer? And the same for covering spouses who could get their own insurance through an employer?)
It’s really simple economics, thumper. We can ration by price, or we can ration by service. Prior to ACA, it was mostly the former, and now we are moving towards the latter. (Jonathan Gruber, MIT economist, makes that quite clear, as do other health economists.)
P.S. I’m a big fan of Kaiser in California… dunno about HMO’s in AZ.
btw: I’ve been saying that for all the years that I’ve been on cc. But there are just those that want to believe in the free lunch.
As a public employee, I have a job. I’m not in the dole. I also pay taxes at the same rate as everyone else.
And my government employer does not pay the overwhelming majority of the cost for my kids, or for my spouse. My spouse and I both work for the state, in fact, and we have separate plans because they do pay the large majority of an employeees premium. They pay some for ependents just as many employers do.
Others may vary. But there are 50 states and hundreds of not thousands of other public entities. They no doubt vary a lot in terms of how generous they are. Just as private employers do.
And as I said earlier my plan is not even close to being subject to the Cadillac tax so it’s not that outlandishly good. I’m quite grateful to have it, as are most people with good insurance.
When we previously called naysayers out, it was for under informed generalizations, even running back to 2013, before the info came out.
Even now, some will claim their challenges or issues are why the whole is flawed. Rarely do folks identify or share enough that others can see or advise. Your income, your plan choices, the different deductibles, etc, to learn more than that some poster is dissatisfied.
Nor do some seem to understand how your state plays a role, how your state may be the target not ACA.
I’ve been wrestling with insurance plans today. I had a BlueCross BlueShield PPO which is no longer available for 2016. Blue Cross will only offer HMO plans in my geographical area … same with other insurance companies.
I’m healthy and just last year searched for a physician I can call on if needed. I did not particularly like the first one I met, so tried another (last Oct.) but he had disappeared from the medical group by Dec. I transferred to another doctor in the same group and think I’ll be happy enough (though I’ve only met his NP - really liked him). Guess what -he’s not a provider on the HMO Blue Cross offers. Am I really up to looking once again? I know I should have a doctor but this would be my fourth new patient visit in little over a year. Forget all the rest of it for the moment: I hate this. (Rant over … at least, on line.)
Our COBRA ends at the end of this year, so we have to go on the individual market. I’m looking at prices for different levels.
I see that I could get a Platinum plan from the insurer we like (Blue Shield) for about $1400/month per person, and a Silver plan for $850/month per person.
So, for $550/month extra over the Silver, or $6600/year, I could get the Platinum plan. And the Platinum plan still has a max out of pocket (OOP) of $4000. That’s not worth it for me.
But my question is, how is that worth it for anyone? The legal max OOP is $6250. Doesn’t the max out of pocket include copays and coinsurance? So what person would be better off with Platinum? Wouldn’t I have to spend the entire out-of-pocket maximum, and more, to lower my out of pocket costs? Am I missing something here?
What “sounds like” a higher level of coverage may not be when one really needs to draw on services. My “lowest deductible” Gold option, eg, would get me to the max OOP faster, through 20% coinsurance, etc. That matters to me, if something were to happen. And it costs much more.
Platinum, 2800/month for two? You’d already be paying 13,200 more in premiums, even if you don’t have one need for med services. Who does it work for? Dunno. My questions is: why pay that 13k to maybe (or maybe not) save 2250 on the max for one of you?
I laid it out on a spreadsheet, each of the main bullets (don’t skip them, they’re a big part of your reaity-check/overview) and total annual Prem. Then, the hypotethicals I might reach: that annual $ plus the full Ded and then that annual $ plus the MOOP for each plan.
So, the Gold plan (for one) with the 1k deductible and 4k max costs 3450 more just in premiums. If I did have a crisis and reach the max OOP, total cost $10,100. In contrast, a Silver that “could” total 7850 in annual premiums and max. OV cost $20 and the co-ins is 10%
But most of us will fall in-between. So for Silver, I also figured what if I racked up 2k in charges. Or 5k. And HSA vs PPO.
Lots of effort? Yup. But a comfort level when I do choose. There’s no way to compare just by what plan A seems to cost vs Plan B. The ones I feel sorry for can’t even weigh this way, in the first place. I think most on this thread can. Find what works for you.
That’s my question: who does this work for? I can’t come up with any health scenario where we’d be better off with the Platinum. No spreadsheet is going to reveal to me that paying $13,200 more per year is worth it to save $4500. Am I missing something here? Are there some costs that I’d save on that aren’t included in the out of pocket maximum? Doesn’t the out of pocket maximum include copays and coinsurance?