Here's a statement of the obvious: The opinions expressed here are those of the participants, not those of the Mutual Fund Observer. We cannot vouch for the accuracy or appropriateness of any of it, though we do encourage civility and good humor.
@davidrmoran- I think that's perhaps a bit unfair, or maybe you just missed her point: When you "get sick" (cancer, say) you should just depend on your own family and maybe your church or some other private organization. Sounds right to me!!
@msf- Thanks much for your explanations. Appreciate your fine work, as usual! Your observations re unfair rescission - "the practice where an insurer finds some excuse (other than deliberate fraud) to void a policy. Insurers routinely did this (apparently starting about a decade ago) to people who dared to get sick. (When they said a policy was for healthy people, they weren't kidding.)" really rings true. I'd be very interested to know if Mona had ever made any substantial claim on her insurance, and if so, what sort or reaction she received from her carrier.
You may not always get what you pay for, but for sure you never get what you don't pay for.
By the way, I'd like to thank and commend FundStudent for starting this extremely interesting thread. He (she?) may just have set a record for both FundAlarm and MFO- I can't recall a first post ever generating so many thoughtful responses and number of viewers. Nice job.
msf, thanks for adding the detail, which I trust answered Old_Joe's question to his satisfaction.
davidmoran,
"Mona, thanks very much for responding, honestly and frankly; and yes, I can see why your plan was noncompliant, as some would argue it certainly should be and have always been, with no mental health, no preventive, and with level-of-current-health pricing"
1. My plan met my needs.
2. I am now paying significantly more for an inferior plan for my needs.
3. I am no longer the decision maker to purchase a plan for my needs. I can only afford the "least expensive" ACA plan and I am penalized if I do not purchase it.
3. I was told by your President that I could keep my plan. Under no circumstances would I have voted for him if knew he was lying to me.
2. I am now paying significantly more for an inferior plan for my needs.
You've told us how the old plan was inferior (e.g. it did not pay for mental health care), but that it didn't matter because you weren't using those services. You've not said how the current plan falls short of your needs. Likewise, it doesn't matter if it falls short on features you don't use.
3. I am no longer the decision maker to purchase a plan for my needs. I can only afford the "least expensive" ACA plan and I am penalized if I do not purchase it.
If that "least expensive" plan is costing more than 8% of your household income, you are not penalized for failing to purchase it. Based on the information you have provided (old plan costing $225/mo, new plan costing three times as much), your income would have to be at least $116,250 $101,250 in order to be required to purchase this "least expensive" plan.
(8% of $116,250 is $9,300, i.e. $775/mo.) (8% of $101,250,250 is $8,100, i.e. $675/mo.)
Also based on your statements, for 2014 and 2015 you do and will have a hardship exemption from the penalty, regardless of your income. In addition, you are allowed to to purchase a catastrophic coverage plan should you choose to do so.
On December 19, 2013, CMS issued guidance indicating that individuals whose policies are cancelled because the coverage is not compliant with the Affordable Care Act qualify for a hardship exemption if they find other options to be more expensive, and are able to purchase catastrophic coverage. This hardship exemption will continue to be available until Oct 1, 2016, for those individual whose non-compliant coverage is cancelled and who meet the requirements specified in the guidance.
3. I was told by your President that I could keep my plan. Under no circumstances would I have voted for him if knew he was lying to me.
Mona
So far, nothing you've stated forced your previous plan to be terminated. Insurance companies terminate plans all the time - and they love to blame someone else.
Medically underwritten plans were not required by ACA to be terminated. For example, in Pennsylvania, Highmark BC/BS wrote: "Highmark has decided to offer members in its existing grandfathered, medically underwritten individual plans the option to renew and continue coverage in these plans in 2015.
Preventive service mandates do not apply to grandfathered plans. (That's a link I've given before.)
Mental health and substance use disorder benefits mandates do not apply to grandfathered plans.
Seems like Blue Cross didn't feel the old policy was much of a win/win. Not enough to choose to keep it going.
@Mona, There're lies and there're lies. I am not sure this piece below has all of the details 100% correct or up to date about timing and grandfathering, although the comments are chiefly rightwing spittle and thus no help as to the facts. (msf might know.)
msf leads me to see that your insurance company at their option made it so you could not continue your plan.
I do enjoy the heated quotes, not from anyone here, from elders irate that they are effectively paying for maternity coverage. I know civics is not taught so much anymore in high school, but something lightly touching on group tradeoffs, rights, civic duties, all that stuff, which would include what insurance is and does, might be in for a revival. I myself have been in many rich-town meetings, that sacrosanct American tradition supposedly, and heard people go off about how their insanely high property taxes (which is altogether true, mine too) have to go toward the public schools when they do not have any young children, damn it. Seriously.
The detailed responses by msf certainly illustrate why I found it impossible to determine prior to the passage of ACA whether it was an improvement, or not. It also goes a long way towards explaining why some members of Congress who voted for it responded (essentially) that it would have to be put into effect before they would know how all of the details would actually work.
To those who ridicule that response, I suggest that it is quite unreasonable to expect each and every person sent to Congress to become an expert in multiple fields of incredible complexity, whether it be defense, space exploration, environmental science, or medical care. We do not have a government of technocrats: we have a government of citizen representatives. The best that can be expected of such an arrangement is that they examine complex issues with an open mind, and make their best effort to enact laws which would appear to be for the common good.
Unfortunately, we evidently cannot even come close to meeting that relaxed requirement.
A few things are obvious in this debate:
• There are quite a number of powerful pharma-medical interests involved, all of whom needed to be persuaded that their financial interests would not be severely compromised.
• The effort necessary to accomplish that meant that the specific details would of necessity be extremely complex.
• Like any complex system, the odds of getting it exactly right out of the box, without need for tinkering ("optimization", as the techies would say) are so formidable as to be insurmountable.
• There was, and is, a political group who are in principle absolutely set against any effort by government to interfere with or even moderate the financial interests referred to above. This group may be the more honest: there are additional political actors who are determined to prevent ACA from being successful simply because it was proposed by a president whom they loath, for a range of reasons.
I really can't much improve on rono's input:
"My main problem with the ACA is that it did not go nearly far enough and was a sell out to big pharm, the AMA and the hospitals and particularly the health insurance industry.
Whoever said that providing health care services should be a 'for profit' industry? Rubbish. Having to lose a leg or arm, or your sight, or even your life, because you can't afford it is obscene. Now, if you want a nose job - pay for it. Otherwise, we need a 'one pay system' to make this work and we need it yesterday."
If, in addition to a basic "one-pay" system there were options for individuals or groups to pay for "enhanced" service levels, that would be just fine too.
Regards to all- this has been a well-conducted discussion, and I appreciate it.
" people go off about how their insanely high property taxes (which is altogether true, mine too) have to go toward the public schools when they do not have any young children, damn it. Seriously."
This probably happens elsewhere too but in WA state, the high property taxes are not enough for the schools so we are told. School districts put out levies each election cycle and make threats that teachers will be laid off and class sizes will skyrocket unless the levy is passed. Never mind the bloated administration in the school districts. If the levy fails, they keep pushing it back onto the voters over and over until it does pass. A lot of support from public govt employee unions is the key to this ramrodding of levies down the throats of voters when they have voted twice or three times on the issue. The school districts should learn about compromise.
@ JohnChisum : Maybe your state WA. , as mentioned, should take a look at how WI. & how Gov Walker is handling the Govt. employee unions. I'm not saying it's right, just saying..... Back to investing, Derf
@JC A problem in Mass. is that teachers finally make good money, really good money, per seniority and extras and whatnot, and do not retire but keep on. This also means many kids get extremely high-level instruction, often, and not just in the rich suburbs, with faculties in some disciplines (history) that small colleges would be pleased to include. As a former teacher, a current sometime local sub (which I love, but not much even ad-hoc teaching involved anymore), ex-spouse of a real good veteran of decades, I am the opposite of a teacher basher, but yeah, budget compromise along with lower, seriously lower raises would go a long way. I'm now close to being one of those elderly suburban cranks who go off about teacher raises in public forums.
Walker is a disgrace no matter how you feel about public unions. Good grief.
"msf leads me to see that your insurance company at their option made it so you could not continue your plan"
davidmoran,
More distortion and twisting by msf. My plan was around long before the ACA. Then the ACA was born and my plan became non-ACA compliant. My insurance company didn't make my plan non-ACA compliant. The ACA made it non-ACA compliant.
My insurance either didn't or couldn't make my plan ACA compliant. They claim they couldn't. But if msf says it was at my insurance companies option, then you can bank on it!
@Mona- I'm really trying to understand the issues here, and I'm not at all sure how to reconcile msf's statement: "Medically underwritten plans were not required by ACA to be terminated.", for which he gives an example (although in Pennsylvania) with your position that "My insurance either didn't or couldn't make my plan ACA compliant. They claim they couldn't."
It seems to me that msf's statement is pretty straightforward, and logically, must either be true or not true. If not true, end of discussion. But if true, then the responsibility for your predicament would seem to be with your insurance company, not ACA.
The other questions of suitability or alleged inferiority are really secondary to that main issue: Who killed your plan- ACA or your company, blaming ACA?
While I have absolutely no clue to that answer, I have to acknowledge that I've had a number of experiences with insurance companies where their actions were, to say the least, misleading bordering on dishonest. It's certainly within the realm of possibility that the insurance company said "couldn't" but really meant "didn't want to".
In any case, before this is fight is over we are most likely all going to need "mental health services" just to stay sane.
Just my two cents: you maybe thinking twice before buying it...you are probably betting on your life if you don't get sick. if you are less than 40 years old, you probably don't need health insurance unless you are involved in many major sport activities/or if you have many pre-determined health conditions [like diabetes or obesity or heart problems/joint problems etc....] My advise is if you don't go to the doc more than once/yr more likely you don't need health insurance. Furthermore, many Docs now take cash and it maybe cheaper than getting health insurance. Many of my friends whom are little younger don't really buy health insurance and they are betting if they get sick they will bet that they would pay the penalty. Beside if you are involved in car accidents, there's auto insurance anyways.
Young people don't buy a lot of things they (think) they "don't need", and do buy a lot of things they certainly don't need....the learning curve is slow
OJ, allow me to reconcile those two statements about medical underwriting. They're not in conflict - they address different issues.
One, which Mona is writing about, is whether her old plan conformed or could be made to conform to ACA rules for new plans. I've no problem accepting that it could not.
The other is whether, given that, the ACA required BC to terminate the plan. The answer to that is no, at least not just because it was medically underwritten (and not because it lacked mental health coverage or preventive care coverage). So I asked for a reason why the plan could not be grandfathered.
The flip side of this is whether the ACA forced Mona to purchase a plan with "half the benefits" or pay a penalty. Here I quoted directly from the federal government - that she was exempt from penalty if she chose not to buy, and she had the option of purchasing a catastrophic plan if she wanted.
Since she's only named benefits in the new plan that were absent in her old plan (such as a wellness visit), it seemed fair to ask which half of the benefits of the old plan were lacking in the new plan. And whether those missing benefits mattered. (Mona, I hope that clarifies my statement that you excerpted above.)
Just my two cents: you maybe thinking twice before buying it...you are probably betting on your life if you don't get sick. if you are less than 40 years old, you probably don't need health insurance unless you are involved in many major sport activities/or if you have many pre-determined health conditions [like diabetes or obesity or heart problems/joint problems etc....] My advise is if you don't go to the doc more than once/yr more likely you don't need health insurance. Furthermore, many Docs now take cash and it maybe cheaper than getting health insurance. Many of my friends whom are little younger don't really buy health insurance and they are betting if they get sick they will bet that they would pay the penalty. Beside if you are involved in car accidents, there's auto insurance anyways.
The greatest value of insurance IMHO is for risks that you cannot afford. I feel people do need insurance against the rare but extremely expensive possibilities - that in the future you are found to have a treatable but expensive disease/condition, that you are hit by an uninsured driver, that your plane crashes, whatever. That's what catastrophic insurance does, and it's available to anyone under 30.
Above 30, live with full insurance, or make sure that all your money is in employer plans, because you're risking bankruptcy, and that will protect your money.
I do agree with you that there's no need to overuse the health care system - insured or not.
@Mona- I'm really trying to understand the issues here, and I'm not at all sure how to reconcile msf's statement: "Medically underwritten plans were not required by ACA to be terminated.", for which he gives an example (although in Pennsylvania) with your position that "My insurance either didn't or couldn't make my plan ACA compliant. They claim they couldn't."
It seems to me that msf's statement is pretty straightforward, and logically, must either be true or not true. If not true, end of discussion. But if true, then the responsibility for your predicament would seem to be with your insurance company, not ACA.
The other questions of suitability or alleged inferiority are really secondary to that main issue: Who killed your plan- ACA or your company, blaming ACA?
While I have absolutely no clue to that answer, I have to acknowledge that I've had a number of experiences with insurance companies where their actions were, to say the least, misleading bordering on dishonest. It's certainly within the realm of possibility that the insurance company said "couldn't" but really meant "didn't want to".
In any case, before this is fight is over we are most likely all going to need "mental health services" just to stay sane.
Have a nice Thanksgiving! OJ
Hi Old_Joe,
I was hoping not to go in more detail as to my opinion on who killed my plan, but I will. Hopefully that in turn, will address your observation, and then I will try to expound a bit.
It's kind of like it depends what the meaning of the word "is" is. I had an underwritten health care plan (I trust you now know what an underwritten plan is and msf didn't include distortion in his/her explanation). For many years I had the same health care plan. Then the ACA was invented and my plan did not meet the ACA's requirements. So my plan no longer could be purchased. So who killed my plan? I will start out by saying that the ACA did, but end my post on different note. Who do I blame? Well, the answer is not so simple either. I will start out by saying I blame the ACA, because without the ACA, I have every reason to believe that I would, as I had for many years, continue to purchase my same health care plan. However, again, I will end my post on a different note.
But of course, it is not all that simple. What I do not fully know, is if, in some way, the insurance company could have modified my plan to comply with the ACA. This is very complex on many levels. As you may remember, after insurance companies announced they were dropping non-ACA plans to comply with the law, and in fact did in many markets (I recall about 300,000 members in Florida alone), came the big uproar in mid 2013. As a consequence, Obama flip flopped and said to the affect that with compliant modifications to your plan, you can keep it. Could all the insurance companies in all states make all their plans (underwritten) ACA compliant? The simple answer that that is no. Why? Many of the non-ACA plans were already being dismantled by the insurance companies because they were non-compliant, and could not or would not reinstate them.
Could not or would not?
As you may know, health insurance is controlled by the states, through the state insurance commissioner. Some state insurance commissioner's would not approve the insurance companies to reinstate their plans. Other state insurance commissioners did, with the caveat that the plans become ACA compliant.
Of course, I can't answer the "would not", but I am sure there were a myriad of reasons. A few I can think of, include:
1. They already started to dismantle their underwriting department and it was not feasible to go back. 2. They were pleased, because now they had fewer health plans to administer. More profit. 3. There was little competition and the benefits to them by dropping a number of plans were greater than the risk of losing members.
None of this detracts from the fact that the ACA was the initiator and in my case the insurance commissioner did not allow my plan to be reinstated.
Who killed my plan? The ACA, the state insurance commissioner, and while I do not know, I would be naive to believe that the insurance company didn't play a roll.
Who do I blame? The ACA, the state insurance commissioner, and the insurance company because I would be naive to believe that they didn't play a roll.
With this I will end my participation in this discussion.
Old_Joe, a nice Thanksgiving to you and everyone else too.
@johnN Yup, one is betting not upon their actual life; but whether they can afford out of pocket costs for something in the major category of a life altering event. Not unlike one does not need insurance on their house if the mortgage is paid and there are not any other monetary liens on the property. BUT, would that decision; to not maintain home insurance, be the proper thing to do ???
Young or old by age, body or house; insurance is insurance. Tis the policy holder wagering against the insurance carrier of who will "win" year to year.
Two years ago, a co-worker; age 45, without known heart problems had a serious heart attack. He survived, which is the good news. Had he not had health insurance, his wallet money would not have been so happy. The total bill from all medical parties involved for 5 days was $64,000. 'Course, he didn't have to negotiate a "cash" price for after the fact services rendered; but I don't imagine that the final cost would have been less than 50% of the original bill.
And accidents, which may require more medical attention than a trip to the local emergency center, happen all of the time. I suggest that the "young ones" are more likely to have "accidents". Especially if they are D.I.Y. folks around their home. I took many more "chances" with things when I was younger. Fortunately, I was never seriously wounded from my adventures; but I know too many who have had serious injury while working around the home.
With all the noise about plans being cancelled, I did a little checking. (David, that was a great Salon article, and it was one of the comments - that 5M policies were cancelled, that got me looking.)
It's dense and chock full of citations, figures, and discussions. But if you care about getting a clearer picture of what was required, what happened, numbers, uncertainty (just as with, say, economic data figures), etc. it's a great read.
"Recent survey data indicates the number of persons affected by cancelled policies was about 1.9 million persons, less than the often cited 4.8 million estimate. ... The number of people with non-group policies who became uninsured following last October’s cancellation of policies is similar to what occurs in the normal churn of the non-group market."
"November 14, 2013, President Obama announced an administrative fix to the cancellation of individual insurance policies. The fix allowed insurers to renew for one year individual and small group policies in effect on October 1. The insurer and broker community designated renewed non-compliant policies “grandmothered policies.”
From the earlier piece:
"Among nongroup plans offered in 2013 that were not compliant with ACA standards, some were amended, some were cancelled, and some were granted “grandfathered” status and are not required to comply with the new rules if enrollees were holding the policy continuously before and since the passage of the ACA and insurers did not substantially change benefits or costs. Some insurers, however, chose to cancel policies that would otherwise have been legally grandfathered for business reasons, such as low enrollment or an enrollee group with high average cost, leading to unsustainable premiums. In fact, the non-group market has historically been highly volatile, with just 17 percent retaining coverage for more than two years."
And about that reported 5M cancellations (also from the earlier article):
"The Associated Press reported that millions of cancellation notices for existing nongroup market plans had been sent in 32 states and the District of Columbia, but this estimate has several major limitations.
"First, the methodology used to collect and verify the data was not specified, nor were the methods used to determine whether a state was included or excluded from the estimate. The Washington State Insurance Commissioner recently criticized as “inaccurate” the statement that 290,000 people in the state had their individual policies canceled.
"Second, the number of cancellations reported may include cancellations of both comprehensive health insurance and limited benefit plans. However, limited benefit plans, such as “cancer only” plans, are not an alternative to comprehensive health insurance and should not be included in the estimate."
Since she's only named benefits in the new plan that were absent in her old plan (such as a wellness visit), it seemed fair to ask which half of the benefits of the old plan were lacking in the new plan. And whether those missing benefits mattered. (Mona, I hope that clarifies my statement that you excerpted above.)
msf,
I am going to violate a rule that I never have before, by making a post on a discussion after saying I would not. I would only do this for you! However, I will not violate it a second time.
My old plan had a significantly lower out-of-pocket yearly maximum, a reasonable primary care doctor visit co-pay (now I need to meet a high deductible), a reasonable specialists visit co-pay (now I need to meet a high deductible), lower co-pay percentage for hospitalization after meeting a lower yearly out-of pocket maximum, a lower co-pay percentage for outpatient surgery after meeting a lower yearly out-of pocket maximum, and so on.
As I said, I continue find YOUR choice of words misleading. I am at a loss why you would say "it seemed fair to ask which half of the benefits of the old plan were lacking in the new plan", because I never said any were.
Let me try to summarize for you. My old plan had richer benefits that were important to me (see my second paragraph), at a far less monthly plan cost.
Hello, I have been following this thread with great interest because I am in the same position as Mona. I am a 58 year old female, who has no health conditions, takes no prescription medication, never smoked, has kept 5'7" frame at 125 lbs. through proper diet and exercise and my health insurance premiums increased for next year from $420/month to $670/month because Emperor Obama thinks I need maternity coverage, mental health coverage, as well as pediatric health and dental. All I want is coverage from catastrophes, which is what insurance was originally designed to do. I resent the fact that I have to pay these exorbitant costs to insure others who smoke, drink, and prefer to watch television and eat potato chips rather than exercise! I don't need Obama, Reid and Pelosi to take care of me...I can take care of myself and make my own decisions. I agree with you totally, Mona. It's very discouraging and causing me undue stress that I have to exercise away every day!!
As a long-time self-insured ("nongroup") individual policy holder of numerous serial policies, I thought I'd add a couple of comments from my experience. 1. The BCBS policy I held before passage of the ACA in 2013 was continued unchanged into 2014, and BCBS tells me it will continue into 2015. It is not compliant with ACA. Us "grandfathered plan"-holders continue on a parallel path to ACA. 2. It's my impression that insurance company heads were deep in discussion with each other both before and after passage of the ACA as to how they would change, withdraw, or extend products (I do not mean collusion but general industry chat about problems and potential solution pathways). They were not, as far as I could see, caught (terribly) off-guard. They did have to create new products rapidly in the latter half of 2013. 3. For the first 10-15 years of self-insurance, I changed insurers every 3 years as costs increased, and went through new underwriting to enter a new plan with a new insurer. 4. For about 10 years, I stayed with the same company but went through new underwriting ca. every 3 years when the plan I was in was cancelled by the issuer, without any explanation other than "the plan will no longer be available." The company was extremely opaque in all matters. 5. For 2014, BCBS took 96% of enrollees on the health care exchange in my state. Its one major challenger has upped its game, added a portal and better-trained service agents, has as large a network of providers, and offers similar benefits at 20% below the BCBS premium. The competitor is positioned to capture a much greater share of the health exchange enrollee market in 2015.
I thank everyone for contributing to a broad discussion of a most important issue, and hope all have a good Thanksgiving weekend.
As I said, I continue find YOUR choice of words misleading. I am at a loss why you would say "it seemed fair to ask which half of the benefits of the old plan were lacking in the new plan", because I never said any were.
Let me try to summarize for you. My old plan had richer benefits that were important to me (see my second paragraph), at a far less monthly plan cost.
Mona
Mona, I appreciate the response.
You had written that that your new plan had "three times the cost with half the benefits". Perhaps that means to you the same benefits (payments for doctor visits, hospital care, etc.), but with higher copays/coinsurance. And "3x" has now become "far [more]." As you said, words can be misleading.
With respect to doctor visits, your new plan provides free preventive care - costing less than under your old plan. And while you may have to pay more for treatment visits, you emphasized what great health you are in. You presented one side of the equation but ignored the other.
I'm not ascribing malice here. Simply observing the natural tendency of people to emphasize losses and minimize gains - that's why MFO and other ratings (including M*) give greater weight to downside risk. It's what people focus on.
Finally, let me note that my policy was also cancelled. My insurer was truly one of the "good guys" (to avoid clutter, I'll not document that here), and still it was cancelled. So there is not a question about it being unwilling to do whatever was necessary under ACA.
The only policy I can purchase that my specialist participates in costs about $1K/year more (at each metal level) than the BC/BS plan, which in turn is one of the higher cost plans available. At that price, I'm better off paying for the doctor out of pocket, on a non-negotiated rate. (I've already spoken to him about getting a cash discount and he declined.)
Somewhat higher premiums, no coverage for a current doctor, no PPO, probably a gatekeeper (some EPOs are available), loss of a nationwide network (which I had used, coast to coast, when traveling), inferior (higher deductible/copay) drug plan. But also a competitive marketplace where some plan costs dropped between 2014 and 2015. And a state legislature that may make tweaks in the future.
jN, with the healthy young, apart from out-of-the-blue leukemia or ectopic pregnancy or something similar where you would be really glad to be insured, the chief thing in my experience of that cohort is trauma and exertional accident. All it takes is one ACL repair, achilles/peroneal tendon tear, a fall onto extended arms with major shoulder damage, spine hit, and you will be looking at some necessary and high costs. Much less head trauma. So with respect I would suggest yours is the worst advice possible.
As for Emperor Obama, this is pricelessly comical, approaching the Godwin law of the web. As if Obama really has or ever had, beyond promotion, much to do with any of this Heritage Foundation / Romney conservative concoction --- one of the very few smart and progressive things to come out of that movement, and bully for them.
As for what to do with the undeserving, well, that's the oldest problem in the books. The thing is, little5bee, you know what Those People do, don't you, when their Fritos and cigs make them sick? They go to the friggin ER, precisely as backpedaling Mitt said they could do. And you do know who pays for that ultimately, right?
So to hell with Pelosi and BO and all the other Dems you vilify, great, but that has nothing to do with nothing here, your health or anyone else's.
@little5bee: I can sympathize with your frustration, but not in assignment of blame to individuals for what a profit-driven industry, possibly in a state without reasonable competition for one heavyweight issuer, is more likely responsible for.
I do have one question, in three parts: Does your state mandate annual free well-woman exams? If so, who pays for them? Should those past childbearing age be excluded?
The amount of misinformation floating around is staggering. Like the 5M policies cancelled. Even (and perhaps especially) the press gets it wrong. I'm as susceptible to errors as anyone else and welcome corrections (you've seen me correct my own posts in this thread). It's a complex system, and easy to misunderstand.
With that, let me address a couple of recent posts:
In order for a pre-ACA plan to be "grandfathered", i.e. allowed to continue because it did exist prior to ACA, it is not required to make changes. Just the opposite. If a plan were to change too much (even if it hiked rates more than a smidgeon above the rate of medical inflation) it would be disqualified.
So if an insurer chose to cancel a plan, it's not because it couldn't/wouldn't change. (Sort of by definition that would make it a new/different plan.) It either chose to cancel the plan voluntarily (e.g. because its users were dropping out on their own, as is typical in the industry), or because there was something seriously "wrong" with the plan - such as unfairly rescinding policies, or having an actuarial value under 0.6 (i.e. it wasn't covering much of your expenses anyway).
ACA plans are allowed to charge smokers 50% higher premiums. Maybe that's not enough to cover the additional risk (I haven't looked at actuarial tables, and would welcome data). I saw one press article saying the figure was 15% - probably transcribing a conversation and misheard 50% as 15%.
Comments
You may not always get what you pay for, but for sure you never get what you don't pay for.
Regards- OJ
? You know the cartoon of the guy standing in front of his burning house telling the just-arrived firefighters 'No, thanks, I'm a libertarian.'
http://imgc-cn.artprintimages.com/images/P-473-488-90/60/6002/5QQQG00Z/posters/david-sipress-no-thanks-i-m-a-libertarian-new-yorker-cartoon.jpg
davidmoran,
"Mona, thanks very much for responding, honestly and frankly; and yes, I can see why your plan was noncompliant, as some would argue it certainly should be and have always been, with no mental health, no preventive, and with level-of-current-health pricing"
1. My plan met my needs.
2. I am now paying significantly more for an inferior plan for my needs.
3. I am no longer the decision maker to purchase a plan for my needs. I can only afford the "least expensive" ACA plan and I am penalized if I do not purchase it.
3. I was told by your President that I could keep my plan. Under no circumstances would I have voted for him if knew he was lying to me.
Mona
$116,250$101,250 in order to be required to purchase this "least expensive" plan.(8% of $116,250 is $9,300, i.e. $775/mo.)(8% of $101,250,250 is $8,100, i.e. $675/mo.)
Also based on your statements, for 2014 and 2015 you do and will have a hardship exemption from the penalty, regardless of your income. In addition, you are allowed to to purchase a catastrophic coverage plan should you choose to do so. CMS, Insurance Standard Bulletin Series - Extension of Transitional Policy through October 1, 2016 (March 5, 2014).
Even Fox knew about this. So far, nothing you've stated forced your previous plan to be terminated. Insurance companies terminate plans all the time - and they love to blame someone else.
Medically underwritten plans were not required by ACA to be terminated. For example, in Pennsylvania, Highmark BC/BS wrote: "Highmark has decided to offer members in its existing grandfathered, medically underwritten individual plans the option to renew and continue coverage in these plans in 2015.
Preventive service mandates do not apply to grandfathered plans. (That's a link I've given before.)
Mental health and substance use disorder benefits mandates do not apply to grandfathered plans.
Seems like Blue Cross didn't feel the old policy was much of a win/win. Not enough to choose to keep it going.
There're lies and there're lies. I am not sure this piece below has all of the details 100% correct or up to date about timing and grandfathering, although the comments are chiefly rightwing spittle and thus no help as to the facts. (msf might know.)
http://www.salon.com/2013/11/15/no_obama_didnt_lie_to_you_about_your_health_care_plan_partner/
msf leads me to see that your insurance company at their option made it so you could not continue your plan.
I do enjoy the heated quotes, not from anyone here, from elders irate that they are effectively paying for maternity coverage. I know civics is not taught so much anymore in high school, but something lightly touching on group tradeoffs, rights, civic duties, all that stuff, which would include what insurance is and does, might be in for a revival. I myself have been in many rich-town meetings, that sacrosanct American tradition supposedly, and heard people go off about how their insanely high property taxes (which is altogether true, mine too) have to go toward the public schools when they do not have any young children, damn it. Seriously.
To those who ridicule that response, I suggest that it is quite unreasonable to expect each and every person sent to Congress to become an expert in multiple fields of incredible complexity, whether it be defense, space exploration, environmental science, or medical care. We do not have a government of technocrats: we have a government of citizen representatives. The best that can be expected of such an arrangement is that they examine complex issues with an open mind, and make their best effort to enact laws which would appear to be for the common good.
Unfortunately, we evidently cannot even come close to meeting that relaxed requirement.
A few things are obvious in this debate:
• There are quite a number of powerful pharma-medical interests involved, all of whom needed to be persuaded that their financial interests would not be severely compromised.
• The effort necessary to accomplish that meant that the specific details would of necessity be extremely complex.
• Like any complex system, the odds of getting it exactly right out of the box, without need for tinkering ("optimization", as the techies would say) are so formidable as to be insurmountable.
• There was, and is, a political group who are in principle absolutely set against any effort by government to interfere with or even moderate the financial interests referred to above. This group may be the more honest: there are additional political actors who are determined to prevent ACA from being successful simply because it was proposed by a president whom they loath, for a range of reasons.
I really can't much improve on rono's input:
"My main problem with the ACA is that it did not go nearly far enough and was a sell out to big pharm, the AMA and the hospitals and particularly the health insurance industry.
Whoever said that providing health care services should be a 'for profit' industry? Rubbish. Having to lose a leg or arm, or your sight, or even your life, because you can't afford it is obscene. Now, if you want a nose job - pay for it. Otherwise, we need a 'one pay system' to make this work and we need it yesterday."
If, in addition to a basic "one-pay" system there were options for individuals or groups to pay for "enhanced" service levels, that would be just fine too.
Regards to all- this has been a well-conducted discussion, and I appreciate it.
OJ
>> I was told by your President
Mine? Huh? You know how I vote? And you are not a US citizen?
I hope your secret knowledges apply to investing too
This probably happens elsewhere too but in WA state, the high property taxes are not enough for the schools so we are told. School districts put out levies each election cycle and make threats that teachers will be laid off and class sizes will skyrocket unless the levy is passed. Never mind the bloated administration in the school districts. If the levy fails, they keep pushing it back onto the voters over and over until it does pass. A lot of support from public govt employee unions is the key to this ramrodding of levies down the throats of voters when they have voted twice or three times on the issue. The school districts should learn about compromise.
I'm not saying it's right, just saying.....
Back to investing, Derf
A problem in Mass. is that teachers finally make good money, really good money, per seniority and extras and whatnot, and do not retire but keep on. This also means many kids get extremely high-level instruction, often, and not just in the rich suburbs, with faculties in some disciplines (history) that small colleges would be pleased to include. As a former teacher, a current sometime local sub (which I love, but not much even ad-hoc teaching involved anymore), ex-spouse of a real good veteran of decades, I am the opposite of a teacher basher, but yeah, budget compromise along with lower, seriously lower raises would go a long way. I'm now close to being one of those elderly suburban cranks who go off about teacher raises in public forums.
Walker is a disgrace no matter how you feel about public unions. Good grief.
As for ACA, check out items 8 and 9 here, Structure and especially Pundits. Gah.
http://krugman.blogs.nytimes.com/
davidmoran,
More distortion and twisting by msf. My plan was around long before the ACA. Then the ACA was born and my plan became non-ACA compliant. My insurance company didn't make my plan non-ACA compliant. The ACA made it non-ACA compliant.
My insurance either didn't or couldn't make my plan ACA compliant. They claim they couldn't. But if msf says it was at my insurance companies option, then you can bank on it!
By the way, no, I do not how you voted
Mona
msf,
I see that you told us that my old plan was inferior, but I do not recall saying that. I said my plan met my needs.
Are you saying that my old plan was inferior because it did not cover mental health services and ACA compliant plan do?
Mona
It seems to me that msf's statement is pretty straightforward, and logically, must either be true or not true. If not true, end of discussion. But if true, then the responsibility for your predicament would seem to be with your insurance company, not ACA.
The other questions of suitability or alleged inferiority are really secondary to that main issue: Who killed your plan- ACA or your company, blaming ACA?
While I have absolutely no clue to that answer, I have to acknowledge that I've had a number of experiences with insurance companies where their actions were, to say the least, misleading bordering on dishonest. It's certainly within the realm of possibility that the insurance company said "couldn't" but really meant "didn't want to".
In any case, before this is fight is over we are most likely all going to need "mental health services" just to stay sane.
Have a nice Thanksgiving!
OJ
and do buy a lot of things they certainly don't need....the learning curve is slow
One, which Mona is writing about, is whether her old plan conformed or could be made to conform to ACA rules for new plans. I've no problem accepting that it could not.
The other is whether, given that, the ACA required BC to terminate the plan. The answer to that is no, at least not just because it was medically underwritten (and not because it lacked mental health coverage or preventive care coverage). So I asked for a reason why the plan could not be grandfathered.
The flip side of this is whether the ACA forced Mona to purchase a plan with "half the benefits" or pay a penalty. Here I quoted directly from the federal government - that she was exempt from penalty if she chose not to buy, and she had the option of purchasing a catastrophic plan if she wanted.
Since she's only named benefits in the new plan that were absent in her old plan (such as a wellness visit), it seemed fair to ask which half of the benefits of the old plan were lacking in the new plan. And whether those missing benefits mattered. (Mona, I hope that clarifies my statement that you excerpted above.)
Above 30, live with full insurance, or make sure that all your money is in employer plans, because you're risking bankruptcy, and that will protect your money.
I do agree with you that there's no need to overuse the health care system - insured or not.
I was hoping not to go in more detail as to my opinion on who killed my plan, but I will. Hopefully that in turn, will address your observation, and then I will try to expound a bit.
It's kind of like it depends what the meaning of the word "is" is. I had an underwritten health care plan (I trust you now know what an underwritten plan is and msf didn't include distortion in his/her explanation). For many years I had the same health care plan. Then the ACA was invented and my plan did not meet the ACA's requirements. So my plan no longer could be purchased. So who killed my plan? I will start out by saying that the ACA did, but end my post on different note. Who do I blame? Well, the answer is not so simple either. I will start out by saying I blame the ACA, because without the ACA, I have every reason to believe that I would, as I had for many years, continue to purchase my same health care plan. However, again, I will end my post on a different note.
But of course, it is not all that simple. What I do not fully know, is if, in some way, the insurance company could have modified my plan to comply with the ACA. This is very complex on many levels. As you may remember, after insurance companies announced they were dropping non-ACA plans to comply with the law, and in fact did in many markets (I recall about 300,000 members in Florida alone), came the big uproar in mid 2013. As a consequence, Obama flip flopped and said to the affect that with compliant modifications to your plan, you can keep it. Could all the insurance companies in all states make all their plans (underwritten) ACA compliant? The simple answer that that is no. Why? Many of the non-ACA plans were already being dismantled by the insurance companies because they were non-compliant, and could not or would not reinstate them.
Could not or would not?
As you may know, health insurance is controlled by the states, through the state insurance commissioner. Some state insurance commissioner's would not approve the insurance companies to reinstate their plans. Other state insurance commissioners did, with the caveat that the plans become ACA compliant.
Of course, I can't answer the "would not", but I am sure there were a myriad of reasons. A few I can think of, include:
1. They already started to dismantle their underwriting department and it was not feasible to go back.
2. They were pleased, because now they had fewer health plans to administer. More profit.
3. There was little competition and the benefits to them by dropping a number of plans were greater than the risk of losing members.
None of this detracts from the fact that the ACA was the initiator and in my case the insurance commissioner did not allow my plan to be reinstated.
Who killed my plan? The ACA, the state insurance commissioner, and while I do not know, I would be naive to believe that the insurance company didn't play a roll.
Who do I blame? The ACA, the state insurance commissioner, and the insurance company because I would be naive to believe that they didn't play a roll.
With this I will end my participation in this discussion.
Old_Joe, a nice Thanksgiving to you and everyone else too.
Mona
Yup, one is betting not upon their actual life; but whether they can afford out of pocket costs for something in the major category of a life altering event. Not unlike one does not need insurance on their house if the mortgage is paid and there are not any other monetary liens on the property.
BUT, would that decision; to not maintain home insurance, be the proper thing to do ???
Young or old by age, body or house; insurance is insurance. Tis the policy holder wagering against the insurance carrier of who will "win" year to year.
Two years ago, a co-worker; age 45, without known heart problems had a serious heart attack. He survived, which is the good news. Had he not had health insurance, his wallet money would not have been so happy. The total bill from all medical parties involved for 5 days was $64,000. 'Course, he didn't have to negotiate a "cash" price for after the fact services rendered; but I don't imagine that the final cost would have been less than 50% of the original bill.
And accidents, which may require more medical attention than a trip to the local emergency center, happen all of the time. I suggest that the "young ones" are more likely to have "accidents". Especially if they are D.I.Y. folks around their home. I took many more "chances" with things when I was younger. Fortunately, I was never seriously wounded from my adventures; but I know too many who have had serious injury while working around the home.
A great report (and a great site I'm embarrassed to say I wasn't familiar with) is at HealthAffairs: http://healthaffairs.org/blog/2014/06/17/cancelled-non-group-plans-what-we-know-now-that-we-did-not-know-in-october/
It's dense and chock full of citations, figures, and discussions. But if you care about getting a clearer picture of what was required, what happened, numbers, uncertainty (just as with, say, economic data figures), etc. it's a great read.
I also recommend an earlier HealthAffairs post (cited in the newer one):
http://healthaffairs.org/blog/2014/03/03/how-many-nongroup-policies-were-canceled-estimates-from-december-2013/
A few excerpts:
"Recent survey data indicates the number of persons affected by cancelled policies was about 1.9 million persons, less than the often cited 4.8 million estimate. ... The number of people with non-group policies who became uninsured following last October’s cancellation of policies is similar to what occurs in the normal churn of the non-group market."
"November 14, 2013, President Obama announced an administrative fix to the cancellation of individual insurance policies. The fix allowed insurers to renew for one year individual and small group policies in effect on October 1. The insurer and broker community designated renewed non-compliant policies “grandmothered policies.”
From the earlier piece:
"Among nongroup plans offered in 2013 that were not compliant with ACA standards, some were amended, some were cancelled, and some were granted “grandfathered” status and are not required to comply with the new rules if enrollees were holding the policy continuously before and since the passage of the ACA and insurers did not substantially change benefits or costs. Some insurers, however, chose to cancel policies that would otherwise have been legally grandfathered for business reasons, such as low enrollment or an enrollee group with high average cost, leading to unsustainable premiums. In fact, the non-group market has historically been highly volatile, with just 17 percent retaining coverage for more than two years."
And about that reported 5M cancellations (also from the earlier article):
"The Associated Press reported that millions of cancellation notices for existing nongroup market plans had been sent in 32 states and the District of Columbia, but this estimate has several major limitations.
"First, the methodology used to collect and verify the data was not specified, nor were the methods used to determine whether a state was included or excluded from the estimate. The Washington State Insurance Commissioner recently criticized as “inaccurate” the statement that 290,000 people in the state had their individual policies canceled.
"Second, the number of cancellations reported may include cancellations of both comprehensive health insurance and limited benefit plans. However, limited benefit plans, such as “cancer only” plans, are not an alternative to comprehensive health insurance and should not be included in the estimate."
msf,
I am going to violate a rule that I never have before, by making a post on a discussion after saying I would not. I would only do this for you! However, I will not violate it a second time.
My old plan had a significantly lower out-of-pocket yearly maximum, a reasonable primary care doctor visit co-pay (now I need to meet a high deductible), a reasonable specialists visit co-pay (now I need to meet a high deductible), lower co-pay percentage for hospitalization after meeting a lower yearly out-of pocket maximum, a lower co-pay percentage for outpatient surgery after meeting a lower yearly out-of pocket maximum, and so on.
As I said, I continue find YOUR choice of words misleading. I am at a loss why you would say "it seemed fair to ask which half of the benefits of the old plan were lacking in the new plan", because I never said any were.
Let me try to summarize for you. My old plan had richer benefits that were important to me (see my second paragraph), at a far less monthly plan cost.
Mona
I have been following this thread with great interest because I am in the same position as Mona. I am a 58 year old female, who has no health conditions, takes no prescription medication, never smoked, has kept 5'7" frame at 125 lbs. through proper diet and exercise and my health insurance premiums increased for next year from $420/month to $670/month because Emperor Obama thinks I need maternity coverage, mental health coverage, as well as pediatric health and dental. All I want is coverage from catastrophes, which is what insurance was originally designed to do. I resent the fact that I have to pay these exorbitant costs to insure others who smoke, drink, and prefer to watch television and eat potato chips rather than exercise! I don't need Obama, Reid and Pelosi to take care of me...I can take care of myself and make my own decisions. I agree with you totally, Mona. It's very discouraging and causing me undue stress that I have to exercise away every day!!
1. The BCBS policy I held before passage of the ACA in 2013 was continued unchanged into 2014, and BCBS tells me it will continue into 2015. It is not compliant with ACA. Us "grandfathered plan"-holders continue on a parallel path to ACA.
2. It's my impression that insurance company heads were deep in discussion with each other both before and after passage of the ACA as to how they would change, withdraw, or extend products (I do not mean collusion but general industry chat about problems and potential solution pathways). They were not, as far as I could see, caught (terribly) off-guard. They did have to create new products rapidly in the latter half of 2013.
3. For the first 10-15 years of self-insurance, I changed insurers every 3 years as costs increased, and went through new underwriting to enter a new plan with a new insurer.
4. For about 10 years, I stayed with the same company but went through new underwriting ca. every 3 years when the plan I was in was cancelled by the issuer, without any explanation other than "the plan will no longer be available." The company was extremely opaque in all matters.
5. For 2014, BCBS took 96% of enrollees on the health care exchange in my state. Its one major challenger has upped its game, added a portal and better-trained service agents, has as large a network of providers, and offers similar benefits at 20% below the BCBS premium. The competitor is positioned to capture a much greater share of the health exchange enrollee market in 2015.
I thank everyone for contributing to a broad discussion of a most important issue, and hope all have a good Thanksgiving weekend.
As for Emperor Obama, this is pricelessly comical, approaching the Godwin law of the web. As if Obama really has or ever had, beyond promotion, much to do with any of this Heritage Foundation / Romney conservative concoction --- one of the very few smart and progressive things to come out of that movement, and bully for them.
As for what to do with the undeserving, well, that's the oldest problem in the books. The thing is, little5bee, you know what Those People do, don't you, when their Fritos and cigs make them sick? They go to the friggin ER, precisely as backpedaling Mitt said they could do. And you do know who pays for that ultimately, right?
So to hell with Pelosi and BO and all the other Dems you vilify, great, but that has nothing to do with nothing here, your health or anyone else's.
I do have one question, in three parts: Does your state mandate annual free well-woman exams? If so, who pays for them? Should those past childbearing age be excluded?
This is a thought experiment.
With that, let me address a couple of recent posts:
In order for a pre-ACA plan to be "grandfathered", i.e. allowed to continue because it did exist prior to ACA, it is not required to make changes. Just the opposite. If a plan were to change too much (even if it hiked rates more than a smidgeon above the rate of medical inflation) it would be disqualified.
So if an insurer chose to cancel a plan, it's not because it couldn't/wouldn't change. (Sort of by definition that would make it a new/different plan.) It either chose to cancel the plan voluntarily (e.g. because its users were dropping out on their own, as is typical in the industry), or because there was something seriously "wrong" with the plan - such as unfairly rescinding policies, or having an actuarial value under 0.6 (i.e. it wasn't covering much of your expenses anyway).
The ACA was passed in 2010, not 2013. Some of the provisions (like free preventive services) kicked in almost immediately (for newly created plans only).
http://www.hhs.gov/healthcare/facts/timeline/timeline-text.html
ACA plans are allowed to charge smokers 50% higher premiums. Maybe that's not enough to cover the additional risk (I haven't looked at actuarial tables, and would welcome data). I saw one press article saying the figure was 15% - probably transcribing a conversation and misheard 50% as 15%.
Pediatric dental care is one of the 10 essential benefit in the ACA. Curiously though, it is not required. That doesn't mean that the insurers are offering any plans without this benefit (and I'll almost surely be stuck with it), just that ACA doesn't require it.
http://www.nytimes.com/2013/12/17/health/a-gap-in-the-affordable-care-act.html?pagewanted=all