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.
Some thoughts (trying not to be too negative or political):
Insurance even streamlined and standardized (see, e.g. Medicare) is a complex product, and what is here doesn't convey lots of necessary information. (If one doesn't think insurance is that complicated, why does everyone here seem to criticize annuities as too complicated?)
What is here is just basic price data. States should have published these basic figures months ago. Some did, e.g. California and New York. This new site simply serves up those price tables in interactive (survey) form.
The sorts of basic information that would make this useful include: doctor networks, drugs covered (and at what tiers), deductibles, coinsurance, and out of pocket maxs. How plans really work get a lot more complex, but this would be a good start, and could also fit into the this new "read only" system.
I was disappointed that the insurers (or states) didn't provide this level of information well before October 1. The information was obviously available (if insurers had plan prices, they also had plan details), and I think I found one insurer who provided doctor network information in September.
The original intent was clearly to have a fully functional, integrated system available Oct 1 - meaning something that could keep your personal data so that you wouldn't have to keep reentering it each time you went back to look around, let alone buy. Something that would help estimate your subsidized price (as you noted, this is lacking). And of course, something that would let you buy after you'd done all your window shopping.
Providing price data helps give people a warm fuzzy feeling (or cold chills, depending on the figures, I suppose). But it does little else, so ultimately, this system IMHO winds up being a political band aid.
People who won't get subsidies are allowed purchase insurance (bronze/silver/gold/platinum) directly from insurers. From what I've seen, private insurers weren't fully set to go on October 1, either. Yet some individual states have done a pretty good (not perfect) job of getting things going - so the problems do not appear to be inherent in the ACA, but in the particular implementations - both federal and private.
Thanks for the link. At least it's a positive start. I hope they'll add the other basic information shortly, so that people really can window shop intelligently.
You mentioned two states New York and California who have their own exchanges, my state (Iowa) chose not to do their own exchange so the price data was hard to come by unless you opened an account on the federal exchange.
New York and California are two of the best states in terms of regulating insurance for the benefit of consumers. Even if they weren't operating their own exchanges, they would have made sure that the insurance companies filed their plans well in advance and had the data available.
I came across this article because I decided to look for info on Iowa plans that were not part of its health exchange. Those plans won't show up on the link you provided, and can often be better for people who won't get subsidized. The Reuters article gives the example of an Iowa woman who could get a plan on the exchange for $511, and with her subsidy it would cost $400. But she was able to find a similar off-exchange plan (no subsidy) for $373.
From the article: "Some of the off-exchange plans don't even have their rates listed yet."
I'm confident that isn't true in states like NY and Calif. For example, here's the list of rates that New York State published last July, listing the rates for both on and off exchanges. (In NYS, rates don't vary by age, so don't look for ages in the tables.) http://www.dfs.ny.gov/about/press2013/pr1307171_health_rates_2014.pdf
My suggestion would be for you to check all the approved Iowa insurers for their off-exchange rates as well as looking at the fed site for on-exchange rates. So far, all I've been able to find is a list of the six insurers that are on the exchange. Some or all of them may offer plans off-exchange; there could be other insurers out there as well.
Going through all the questions it only asked if my age was over or under 50. I'm not sure this is accurate as there are supposed (?) to be more age segments than only two.
Reply to @msf: Thanks msf. I live in NY state, so your cost list was very interesting and quite possibly timely for me. I'm going through yet another down sizing at my work place so I may be needing a new HC plan soon. Our retirement benefits plan stopped paying for retirees health care years ago. They offer a "cobra" plan to retirees and spouses instead. From what I see from the NY state cost list, these exchange plans may be cheaper and better deals than the cobra plans offered to us.
On a side, I can only think that the people in states that have not set up their own exchanges may end up getting screwed, cost wise, by their own representatives. And for nothing more than political reasons. Hope that's not the case.
Reply to @MikeM: Be advised that Aetna dropped out of the exchange (for individual policies) after NYS published this list. (It also dropped out in a few other states.) As far as I know, the rest of the data is still accurate.
Regarding state vs. federal exchanges. The system is not as black and white as the main stream media (and many politicians) would lead one to believe. As one example, aside from pure federal exchanges and pure state exchanges, there are federal-state partnership exchanges. These are where the implementation of the exchange is at the federal level (i.e. the system where no one can log in), but many of the responsibilities and choices are handled by the states. Such as determining what plans are qualified under the ACA for that particular state. See p. 3 on: http://www.cms.gov/CCIIO/Resources/Files/Downloads/hie-blueprint-11162012.pdf
I do not qualify to have subsidized health insurance, and I found that I could purchase more affordable coverage by getting non-ACA health insurance. I bought a 1 year non-ACA plan for 12/15/2013 to 12/15/2014. If I had waited until 1/1/2014, I would have been forced to buy ACA health insurance which is 68% more expensive. ACA is a misnomer.
So, if you currently have health insurance, you can renew your existing non-ACA plan for 1 year, thereby delaying the purchase of the more expensive ACA plan.
My understanding (see, e.g. this KFF graphic) is that unless you purchase a plan that meets the ACA requirements (bronze level or above), or purchase a grandfathered plan, you are subject to the penalty. That is, it is not sufficient to have insurance - you must have an adequate level of insurance to avoid being penalized. Plans such as McD's mini-med plan would not be adequate.
With respect to grandfathered plans, there is nothing magical about purchasing them prior to 2014 - they remain grandfathered forever, so long as they follow certain rules. (See Q1 in this FAQ on grandfathered plans.)
On the other hand, my own plan has moved the start date from Jan 1, 2014 to Dec 1, 2013, which suggests there may be some rule pertaining to plans in force (not necessarily grandfathered) before 2014. Something I need to investigate further.
"You may also have a plan that, although not grandfathered because you bought it more recently, lacks some of the benefits that will be required of all individual plans come 2014. Until then, insurance companies can sell plans that don’t cover essential health benefits such as mental health or maternity care. They can exclude coverage of your pre-existing conditions, in some cases indefinitely. If you have such a plan, you can keep it as is until whatever point in 2014 it expires, at which time the plan will have to add in all those required benefits."
“Companies are reaching out to currently insured people offering, in effect, to delay the new market reforms until late in 2014 by renewing their existing plan,” said Karen Pollitz, a health insurance expert with the Kaiser Family Foundation (no relation to the HMO).
"Health plans are sending hundreds of thousands of cancellation letters to people who buy their own coverage, frustrating some consumers who want to keep what they have and forcing others to buy more costly policies..."
Reply to @SlowLane: Fantastic! Thanks a lot. I got the notice earlier this week that my plan would be starting earlier, figured it was something like this, but hadn't been able to find the information you did.
You noted: "I have been hurt immeasurably and the promise given to me was broken."
I do not place this link as a political statement; but as an overall view of the total and complete "cranial/rectal" inversion from this legislation. I do hope some arses get kicked in the coming elections. Sadly, not quite sure who in the hell one is supposed to vote for anymore.
Click the word "comments" at the end of the text, if you have a lot of time. Currently, the comments are arriving faster than I have time to read them.
Reply to @catch22: A lot of posting on Twitter that NBC yanked that piece down and replaced it with a edited version. I would suspect they got a phone call from 1600 Pennsylvania Ave.
Edit: it appears the previous comments section was wiped clean. There was over 3000 comments originally, now just over 700 at this moment.
Reply to @JohnChisum: To NBC's credit, it did not yank down the old version. (The NYTimes Public Editor wrote a column a week or two ago about the problems with electronic media, in particular the NYTimes.com, doing what you suggested NBC did. In the olden days, one had "extra" editions of "real" newspapers - the old and new hard copies coexisted, in perpetuity. Even I remember both City and Late City editions of the NYTimes, where the latter had corrections/edits.)
The link that Catch gave points to the old version (with its 3498 comments as of now). That old version in turn links to the newer version (with a separate 1519 comments, as of now).
Reply to @msf: That sounds reasonable. While I could not tell any real difference in the versions, the comments section change was very obvious. It didn't take long for that to fill back up though.
As to Obama's claims, I feel they were misleading, deceptive, but not outright lies. What follows will, I'm sorry to say, sound much like Clinton's assertion that the truth depends on what the meaning of "is" is.
First, the percentage of people who can't keep their current policies is fairly small - certainly not zero as Obama claimed. It is small because well over 90% of the current (pre-ACA) market is not individual policies (the ones at issue according to the NBC report). I base that on this 2009 study citing a 2009 EBRI study that 9/10 of non-elderly Americans with private health insurance (e.g. not Medicaid) get it via their employer. Throw in VA, Medicaid, Medicare, and that 10% drops to an even lower percentage. Of these few (in terms of percentage) people with privately purchased individual policies, not all are being forced to switch. http://ahip.org/individual-health-insurance-survey-2009
That doesn't alter the absolute nature of the claim ("most" can keep their policies is still not the same as "all" can).
Here's where we get into the meaning of "is". I'll discuss this by analogy. The ADA (Americans with Disability Act) grandfathers existing buildings - they don't have to change to provide access to the disabled. And they're allowed to make minor changes, still without complying. But if they make a major change, then they must comply - put in ramps, elevators, etc. The theory is that these are no longer the "same" buildings, but they have changed in character and are thus subject to the ADA.
Same idea with ACA. Policies, including individual policies, are grandfathered. Here's how healthcare.gov describes grandfathering: https://www.healthcare.gov/what-if-i-have-a-grandfathered-health-plan/ (There are a few conditions that even grandfathered plans must comply with, but those conditions, I believe, kicked in prior to 2014, so they wouldn't disqualify plans that people still have in 2013.)
Just as a building that has substantial changes is no longer regarded as the "same" building, policies with substantial changes can be viewed as "new and improved" policies, not the "same" ones. Thus, with or without ACA, arguably it is the insurer, who, by virtue of altering the plan, killed the old one, making it impossible for you to keep it. However, in the absence of ACA, it would have been able to offer you the replacement plan, even if it didn't provide all the ACA essential health benefits.
As I said, this explanation of who is instigating the cancellation sounds a lot like defining "is".)
Taking this one step further - in 47 states, I believe, insurers are allowed to offer early renewal - that is, offer you the option of renewing your policy in December 2013, instead of January 2014. If you do so, you get to keep your plan, with all its holes, for another year. (Thanks again to SlowLane for this info; I also found an article in last Saturday's NYTimes saying the same thing.) That the insurers are generally not offering this to individuals goes to the question of who is forcing the cancellation, at least for now.
So, did the Obama administration know, even expect, most plans to fail the grandfathering test? Yes. Was the hope that these plans would fade away, sooner rather than later? IMHO definitely (especially since the regs were tightly written). Did the law force them to fail? Arguably no.
I wish I had more time to study your post, but I don't.
However, I would like to say a few things. Here in Philadelphia, Blue Cross has cancelled over 45% of their individual plans. Mine is one.
In Florida, Blue Cross has cancelled over 300,000 individual plans. In the state of New Jersey, over 800,000 individual plans have been cancelled by various insurance companies. While these are numbers, they represent real faces and real people.
I had a Blue Cross HMO plan that met my needs. While it was pricey at at $480 per month (single), I had all the access I needed to my fine physicians at the University of Pennsylvania, with a co-pay of $20 to the primary care physician and $50 to a specialist. No deductibles.
While Blue Cross of Philadelphia could have augmented my plan with one or two of the 10 essential elements of the ACA (which by the way I do not need), instead they opted to cancel it. Why? Because they could and reduce their risk.
Now I am faced with two options:
1. Blue Cross or Aetna (the only two in town...so much for increased competition) will allow me to apply for an underwritten policy for 2014, so long as it is approved and implemented by December 1 or December 15. All the plans are high deductible ($2,500 for the ER, hospital, and out-patient services and then I pay 25% up to $5,000) with higher co-pays. The monthly premium, if I am approved, is in the $450 range, the approximate same monthly premium that I am paying on my current (cancelled December 31) plan. Blue Cross and Aetna had no problem adding the essential elements to those plan that I do not need.
2. Go to the marketplace. With my Modified Adjusted Gross Income of approximately $51,000, I am entitled to no subsidies. For approximately $700 per month, I can get a Blue Cross Silver Plan, which covers 70%. Far inferior to my current plan at a cost of $480 per month which meets my needs and far inferior to an underwritten plan at a cost of approximately $450 per month.
Regardless if my MAGI is $51,000, $501,000, or $5,501,000, the Silver plan on the Exchange or directly through Blue Cross or Aetna, is approximately $700 per month. However, if my MAGI was $30,000, I would entitled to an approximate 50% subsidy! Sounds like I am being incented to earn less income; doesn't it?
Of greater importance, I would like to know how I am going to make ends meet, paying the additional $225 per month (under ACA), not taking into account the "guaranteed" or $2,500 yearly deductible of another $208 per month ($2,500 / 12 = $208). While center city Philadelphia is expensive, how about the person in the likes of New York, Washington, Chicago, Los Angeles, and San Fransisco on a MAGI of $51,000? The ACA does not adjust for cost of living.
Please understand, one of the very important reasons I voted for President Obama, is because he explicitly said that if I liked my current health plan, I would able to keep it.
I guess you are right; it's kind of like the definition of "is". President Obama didn't say Blue Cross couldn't cancel my health care plan.
In any case, I am a river without a paddle. But who cares, it's not your problem...yet.
Reply to @Mona: Great reply Mona. It also appears that we have less choice of plans. I for one would like to see a plan that covers only Major Medical which is really the big need for insurance. I'll pay for the doctors and meds as my doctors will charge me less for cash payment and I would insist on generic medicines only. Most of us need help when it comes to major illness or injury. Leave that to insurance. The premiums should be reduced on that basis.
Reply to @Mona: what have a thoughtful response to a difficult problem. If you attack the process you probably didn't like the law in the first place if you attack the impact of the law that is a real problem that is worth debating. I hope when this all shakes out the impact on you is not that great.
Reply to @Mona: Hi Mona. I'm still looking at the information for Pennsylvania (I try to know what I'm talking about, and the lack of readily available info for Pa. is disturbing).
What I have found is that Coventry was supposed to be one of the insurers competing statewide, but that it was acquired by Aetna just last May. That sort of consolidation is happening nationwide. (For example, if I've got the ownership right, WellPoint owns Anthem which in turn bought up Blue Cross/Blue Shield in a slew of states - though not Pa.) It's no consolation, but I think that industry consolidation has a lot to do with the lack of competition.
FWIW, unlike Edwards, who was out first with a health care plan, or Clinton, who largely mimicked Edward's plan, Obama campaigned on a plan that did not require a mandate. This was obviously unsustainable, and it demonstrated that he was either ill-informed or pandering. While he changed his rhetoric once elected and he had to get a real plan in place, I don't recall him campaigning with a viable proposal. See, e.g. this article from The Atlantic: http://www.theatlantic.com/politics/archive/2012/06/how-obama-broke-his-promise-on-individual-mandates/259183/
There are supposed to be plans available in Pa. off-exchange (i.e. sold outside of the marketplace) in 2014, not just ones that begin in December 2013. So far I haven't been able to find them in Philly. (Hence my allusion to lack of info.) Part of why this is important is that from what I've been reading, while the exchanges have limited "open enrollment" periods (through March 31 for 2014), one can purchase insurance "off exchange" any time. So something you might do as a stop gap is purchase short term insurance (typically good for six months), and then purchase ACA-compliant insurance off-exchange.
The scant pricing information offered by healthcare.gov (without actually qualifying for insurance) shows silver BC HMOs in the $400 range, BC PPOs in the $450 range, and Aetna plans (PPO, HMO) in the $500 range for single, age 50+ people in Philadelphia. I can't check on your particular doctors (no clue who they are - don't want to know), but Hospital at Univ. of Pa. is included in the BC HMO Silver network (though if one gets the less expensive BC HMO Silver Proactive (Tiered) HMO, the hospital is in Tier 3, meaning a huge deductible as you stated.
Your pricing data ($700) is likely much more accurate than the $400ish quote that I got from the fed exchange site, since that only considers ages over/under 50, and in most states (45, I think, including Pennsylvania), prices vary by age.
My takeaways: - Obama didn't deliver what he campaigned on (which was impossible to deliver - insurance-based universal coverage w/o a mandate) - You should (in theory) have more options, perhaps off-exchange, than you listed, though those options may only affect your ability to get bronze/silver/gold plans later in 2014 (off-exchange) and may or may not give you more plan choices (quite likely not more insurance companies)
Finally, regarding NYC, I did post a table of insurance prices for NYS, by region. In NYC, a single (of any age) can purchase a bronze plan for as little as $312 through the Health Republic Co-op (listed as Freelancers in the NYS table) I mentioned above. Lack of competition and higher prices seems to be a regional thing, without a pattern I've discerned yet. (That is, nothing as obvious as just remote rural areas being higher priced or lower priced for that matter.)
Unfortunately, I do not have much more to add, but I would like to address a few points in msf's post.
One. Here in center city Philadelphia, while we probably have more teaching hospitals than any other city (possibly Boston has more) and there has been some consolidation in the hospital landscape (for example University of Pennsylvania purchased Pennsylvania Hospital, the oldest hospital in the United States, and Graduate Hospital), I do not recall any consolidation with health care insurance companies.
As far back as I can remember, the only two providers have been Blue Cross and Aetna. With the ACA, United Heathcare was to compete, but for reasons that I do not know, they decided against entering Philadelphia. My guess is that with the vast and complex heath care structure in Philadelphia and surrounding areas, it would be very expensive to set up their infrastructure, and they did not see an acceptable return on their investment.
Two. I'm not quite certain what you mean by "There are supposed to be plans available in Pa. off-exchange (i.e. sold outside of the marketplace) in 2014, not just ones that begin in December 2013". As mentioned in my post, Blue Cross and Aetna are offering underwritten plans with high deductibles (ER, hospital, MRI, CT scan, etc.) for December 2013 and all of 2014, so long as they approve your application by November 20 and the policy is implemented by December 1 or December 15. I know this statement is factual. I do not know why these underwritten plans can not start January 1 and do not know why both Blue Cross and Aetna said these underwritten plans will not be available in 2015 (only ACA plans will be available, either directly through Blue Cross or Aetna or through the Exchange).
Three. I am 57. The prices I found on healthcare.gov for the highest deductible Silver PPO (I have no idea why all the PPO's are less expensive than the HMO's. It's always been the reverse) you mentioned, are lower than what I have found. More significantly, I have two friends who are insurance brokers and have vast knowledge of the plans, and they said the prices I obtained from heathcare.gov are only estimates. They added in order to get true pricing you first need to sign up and create your profile. Then you will see the true costs, which will be higher.
Four. Yes, a Bronze plan is available now. While I am not certain, I have been told by the insurance broker that it is far more expensive than the $312 price you mentioned for New York. That said, a Bronze plan, which covers 60%, is FAR inferior to my current plan, more expensive than my current plan, and at 60% coverage, is really a "catastrophic" plan. In fact, there is only one ACA plan below a Bronze and that is a catastrophic plan. This may fit the needs of JohnChisum, but it does not fit my needs. What I find ironic about these lower level tier plans, is that I am told they were designed for folks like me who could not afford a higher level richer benefit plan. So lets assume I go out and purchase a Bronze plan because that's all I can afford. Then I am in a car accident and end up in the ER, or get Kidney stones (which I have had two times in the past 5 years) and the doctor orders an MRI, or a myriad of things requiring in-patient or out-patient services. How do I afford the high deductibles, when I can hardly afford the plan? The lower tier plans are better for someone who HAS financial resources and wants to "self-insure".
Anyhow, I have been calling Senator Casey's (D) and Senator Toomey's (R) office every day. Interestingly, I can get through to Senator Toomey's office in Washington every time I call, but I have yet to be able to get through to Senator Casey's office in Washington, so I call his various Pennsylvania offices daily. I am not confident that this will be helpful, but it is all I can do.
Hi Mona. Let me try to clarify what I was saying (not that I'm sure it will assist you, unfortunately).
One - The reason why I checked on access to Pennsylvania Hospital was to use it as a very crude proxy for access to your doctors (whom you said were associated with U of Penn.)
Regarding insurers - HealthAmerica of Pennsylvania is a subsidiary of Coventry Health, which as I noted above, was just acquired by Aetna. According to Coventry's own site, it still offers HealthAmericaOne individual plans that begin in 2013 (but none for 2014).
Not saying these work for you, just that there really may be other insurers around (and also that there's been consolidation). The HealthAmericaOne 2013 plans and prices I get when I input your data (age, gender, and 19019 as a proxy for a Philadelphia zip) include: Rewards $5000 - $246/mo QHDHP $3750 - $284/mo QHDHP 90% $3000 - 290/mo Rewards $2500 - $322/mo QHDHP 100% $2500 - $326/mo Choice1 $4000 5-12 $328/mo QHDHP 90% $1500 - $347/mo Rewards $1750 $361/mo Choice1 $2000 5-12 $374/mo QHDHP 100% 1250 $399/mo Choice1 $1250 5-12 $422/mo Copay 90% $2000 5-12 $495/mo Copay 80% 5-12 $561/mo Copay 100% $1200 5-12 $595/mo (and a couple at $900+/mo)
I've embedded links to sample brochures, so that you can see the general structure of each type of plan. They're all PPOs. The Rewards plans seem to be high deductible plans with "rewards" (incentives on the order of $100) for actions like completing a risk assessment. The Choice1 look similar to the high deductible plans, except the out of network copay percentage is significantly lower, and they cover tier 1 drugs without a deductible (just a copay).
Regarding teaching hospitals - not that I think quantity equates with quality, Philly has a large number (14?), perhaps exceeding Boston (13? or 12-14? depending on whether you count Cambridge and the greater region). NYC (all five boroughs) has about 35, though NYS has been trying to shut one of them down recently (LICH).
Two - off-exchange plans. As near as I can tell (sorry, not going back to find my sources now), individual plans that don't comply with ACA can be sold until 2014, and can run only through 2014. That would explain why you cannot renew these plans in 2015. Off-exchange plans are plans offered, well, "off" or outside the exchanges, otherwise known as the marketplace. Insurers are allowed to offer ACA-qualified plans on the exchange, off the exchange, or both, but if they offer them both on and off, the prices for the same plans must be the same in both channels.
So there may be insurers who offer plans only off the exchange - thus you won't know about them from searching the exchange. Buying insurance is a lot like investing in bonds - no centralized marketplace (other than the exchange). If you want to buy a bond, you need to go to different brokers and check their separate inventories. Likewise, if you want to buy insurance, you have to go either directly to the insurer or to multiple brokers (to check their "inventory", i.e. which insurers they carry).
Unfortunately, so far I haven't been able to find insurers offering off-exchange plans in 2014 for Philly. Here's HealthAmericaOne's description of plans and rate sheets for Pennsylvania off-exchange plans, but the counties covered don't include Philadelphia.
Still looking, but not hopeful.
Three - Knowing that healthcare.gov figures were estimates, and that the costs you gave were higher, I had estimated your age around 60, and had already been using that in engines (like the Coventry site).
Here's a site that tries to give the exchange plan prices based on age and county: http://www.valuepenguin.com/ppaca/exchanges/pa They seem to come out a bit higher than the range you gave (around $450), but perhaps it's getting closer. It's certainly more detailed, as it provides information about each of the plans.
Four - ACA permits actual catastrophic plans, but only for people under age 30, or if you qualify for a hardship exemption (not the same as exemption from penalty). Bronze plans differ in that they often have lower deductibles (albeit still high), and on average, pay for a greater percentage (60%) of health costs than the catastrophic plans - thus the higher premiums for bronze.
For example, Keystone HMO Bronze covers an unlimited number of primary care visits with a $40 copay, and any specialist visits with an $80 copay. Likewise, it covers x-rays, tests, etc. with co-pays. It is only for hospitalization/ER, etc. where the high deductible come into play. In contrast, Independence Personal Choice Catastrophic, which costs only about $25 less/month covers just three primary care visits before deductibles kick in - and they apply to all tests, doctor visits, etc. as well as hospitalization/ER.
Getting insurance that covers hospitalization with low deductibles is very expensive these days - so one has to carefully weigh the risk vs. what one could afford. For myself, with the insurer I'm using, I found that the HDHP (HSA-compatible) plan actually gave the best protection. If my only expenses were even a half dozen trips to the doctor and tests, it was cheaper than plans that let me pay just co-pays (after including the difference in premiums). If I had a bad accident and would hit the cap on expenses (regardless of plan), the HDHP was still better - it had the lower cap. It's only in the middle range (moderate cost, such as outpatient surgery) where the HDHP came out worse for me. As you said, it's a matter of what one can self-insure for. And depending on where you live, and the plans available, YMMV.
A final note ...
- http://www.healthpocket.com/individual-health-insurance This seems like a reasonable site but still lacks some details. Also, I'll swear that it had been showing me plans like HealthAmericaOne for Philadelphia yesterday, but now says that only Aetna, Independence BC and Capital BC service the area (confirming your point about only two carriers being available now).
Again, good luck in your search for a plan that works for you.
msf, folks like you, Bob C, Charles, and a very select few others have the skills, knowledge, and most important, the willingness to share your gifts and resources with the MFO community. All of you are an immense and treasured community resource, and I wanted you to know that it is very much appreciated.
Best to you- OJ
I forgot Scott, and it goes without need to say it- David.
I am familiar with the underwritten plans offered by Blue Cross and Aetna. I am also familiar with the pricing you address. As I have done my DD, please keep in mind that these prices assume you have not taken an aspirin in 10 years. While my medical history is mostly clean over the past 4 years, I have encountered Kidney Stones two times in the past 5 years as well as other minor conditions.
Aetna has a 5 year look back period and Blue Cross a 10 year look back period. I already tried to get Aetna's PPO High Deductible 3000 (HSA Compatible) and what started out as a $257 per month quote, turned into a denial because of my history of Kidney Stones.
We are on the same page and for the time being, it is what it is. I continue to forge ahead and try to be positive. However, while I born at night, I was not born last night. There is no question that I will end up with health insurance, but there is equally no question that it with me more expensive than my current plan and far inferior.
I got a kick out of Kathleen Sebelius' response to Congressman Fred Upton today during the Congressional hearings. The Congressman accused Obama of breaking a 2009 promise that people with insurance could keep their current plans and said "They are now receiving termination notices, and for those who lose the coverage they like, they may also be losing faith in their government". Sebelius defended the administration "by describing hundreds of thousands who have received cancellation notices as the victims of a market long known for discriminating against the sick, cancelling policies and selling inadequate insurance". And: "The individual market ... anywhere in the country has never had consumer protections. People are on their own. They can be locked out, priced out, dumped out, by insurers, Sebelius said".
So now I get it. The insurance companies can do whatever they please, whenever, and the government has no say; EXCEPT when the government mandates the insurance companies to include the 10 essential elements of the ACA.
Reply to @Mona: That was quite the deflection by Katherine Sebelious and they wonder why people are upset. I do hope you find an answer for your needs.
Reply to @Mona: "I guess you are right; it's kind of like the definition of "is". President Obama didn't say Blue Cross couldn't cancel my health care plan."
Um.... I mean, he doesn't mention Blue Cross specifically, but he says you can keep your plan about 20 entirely different times in the video below.
Reply to @scott: A couple of years ago, the company I worked for cancelled its health insurance altogether. I should know - I'm the one who wrote the notes to the insurance company with all the cancellation info.
After seeing this video, I'm wondering how I managed to duck all the Secret Service agents who surely were out there ready to blow my head off to stop the cancellation.
Comments
Insurance even streamlined and standardized (see, e.g. Medicare) is a complex product, and what is here doesn't convey lots of necessary information. (If one doesn't think insurance is that complicated, why does everyone here seem to criticize annuities as too complicated?)
What is here is just basic price data. States should have published these basic figures months ago. Some did, e.g. California and New York. This new site simply serves up those price tables in interactive (survey) form.
The sorts of basic information that would make this useful include: doctor networks, drugs covered (and at what tiers), deductibles, coinsurance, and out of pocket maxs. How plans really work get a lot more complex, but this would be a good start, and could also fit into the this new "read only" system.
I was disappointed that the insurers (or states) didn't provide this level of information well before October 1. The information was obviously available (if insurers had plan prices, they also had plan details), and I think I found one insurer who provided doctor network information in September.
The original intent was clearly to have a fully functional, integrated system available Oct 1 - meaning something that could keep your personal data so that you wouldn't have to keep reentering it each time you went back to look around, let alone buy. Something that would help estimate your subsidized price (as you noted, this is lacking). And of course, something that would let you buy after you'd done all your window shopping.
Providing price data helps give people a warm fuzzy feeling (or cold chills, depending on the figures, I suppose). But it does little else, so ultimately, this system IMHO winds up being a political band aid.
People who won't get subsidies are allowed purchase insurance (bronze/silver/gold/platinum) directly from insurers. From what I've seen, private insurers weren't fully set to go on October 1, either. Yet some individual states have done a pretty good (not perfect) job of getting things going - so the problems do not appear to be inherent in the ACA, but in the particular implementations - both federal and private.
Thanks for the link. At least it's a positive start. I hope they'll add the other basic information shortly, so that people really can window shop intelligently.
Unfortunately, some other states are not so vigilant. (I don't know where Iowa stands; this is a general remark.) Here's a column from Reuters today talking about how one should wait before buying in any case:
http://www.reuters.com/article/2013/10/23/usa-health-exchanges-idUSL1N0IC0YO20131023
I came across this article because I decided to look for info on Iowa plans that were not part of its health exchange. Those plans won't show up on the link you provided, and can often be better for people who won't get subsidized. The Reuters article gives the example of an Iowa woman who could get a plan on the exchange for $511, and with her subsidy it would cost $400. But she was able to find a similar off-exchange plan (no subsidy) for $373.
From the article: "Some of the off-exchange plans don't even have their rates listed yet."
I'm confident that isn't true in states like NY and Calif. For example, here's the list of rates that New York State published last July, listing the rates for both on and off exchanges. (In NYS, rates don't vary by age, so don't look for ages in the tables.)
http://www.dfs.ny.gov/about/press2013/pr1307171_health_rates_2014.pdf
My suggestion would be for you to check all the approved Iowa insurers for their off-exchange rates as well as looking at the fed site for on-exchange rates. So far, all I've been able to find is a list of the six insurers that are on the exchange. Some or all of them may offer plans off-exchange; there could be other insurers out there as well.
Finally, note that Iowa released its Health Insurance Exchange rates by Oct 2, if not earlier. Here's a link to a posting of the rates on that date:
http://www.medicoverage.com/health-insurance-blog/iowa-health-insurance-exchange
On a side, I can only think that the people in states that have not set up their own exchanges may end up getting screwed, cost wise, by their own representatives. And for nothing more than political reasons. Hope that's not the case.
Regarding state vs. federal exchanges. The system is not as black and white as the main stream media (and many politicians) would lead one to believe. As one example, aside from pure federal exchanges and pure state exchanges, there are federal-state partnership exchanges. These are where the implementation of the exchange is at the federal level (i.e. the system where no one can log in), but many of the responsibilities and choices are handled by the states. Such as determining what plans are qualified under the ACA for that particular state. See p. 3 on:
http://www.cms.gov/CCIIO/Resources/Files/Downloads/hie-blueprint-11162012.pdf
Interestingly (for Hogan) Iowa is one of the seven states that is participating in a federal-state partnership exchange. Here's the whole breakdown by state (17 state run, 7 partnerships, 27 federally run):
http://kff.org/health-reform/state-indicator/health-insurance-exchanges/
So, if you currently have health insurance, you can renew your existing non-ACA plan for 1 year, thereby delaying the purchase of the more expensive ACA plan.
With respect to grandfathered plans, there is nothing magical about purchasing them prior to 2014 - they remain grandfathered forever, so long as they follow certain rules. (See Q1 in this FAQ on grandfathered plans.)
On the other hand, my own plan has moved the start date from Jan 1, 2014 to Dec 1, 2013, which suggests there may be some rule pertaining to plans in force (not necessarily grandfathered) before 2014. Something I need to investigate further.
http://consumerreports.org/cro/news/2013/08/keeping-grandfathered-plan/index.htm
"You may also have a plan that, although not grandfathered because you bought it more recently, lacks some of the benefits that will be required of all individual plans come 2014. Until then, insurance companies can sell plans that don’t cover essential health benefits such as mental health or maternity care. They can exclude coverage of your pre-existing conditions, in some cases indefinitely. If you have such a plan, you can keep it as is until whatever point in 2014 it expires, at which time the plan will have to add in all those required benefits."
“Companies are reaching out to currently insured people offering, in effect, to delay the new market reforms until late in 2014 by renewing their existing plan,” said Karen Pollitz, a health insurance expert with the Kaiser Family Foundation (no relation to the HMO).
http://www.kaiserhealthnews.org/Stories/2013/October/21/cancellation-notices-health-insurance.aspx
I have been hurt immeasurably and the promise given to me was broken.
Mona
You noted: "I have been hurt immeasurably and the promise given to me was broken."
I do not place this link as a political statement; but as an overall view of the total and complete "cranial/rectal" inversion from this legislation. I do hope some arses get kicked
in the coming elections.
Sadly, not quite sure who in the hell one is supposed to vote for anymore.
Click the word "comments" at the end of the text, if you have a lot of time. Currently, the comments are arriving faster than I have time to read them.
Take care of you and yours,
Catch
ACA Health Policy info update
Edit: it appears the previous comments section was wiped clean. There was over 3000 comments originally, now just over 700 at this moment.
The link that Catch gave points to the old version (with its 3498 comments as of now). That old version in turn links to the newer version (with a separate 1519 comments, as of now).
This is, unfortunately, only a surprise to those who chose not to inform themselves of what to expect. For example, NPR (via the California Report) reported this last August.
http://blogs.kqed.org/stateofhealth/2013/08/26/obamacare-to-force-millions-to-upgrade-insurance/
As to Obama's claims, I feel they were misleading, deceptive, but not outright lies. What follows will, I'm sorry to say, sound much like Clinton's assertion that the truth depends on what the meaning of "is" is.
First, the percentage of people who can't keep their current policies is fairly small - certainly not zero as Obama claimed. It is small because well over 90% of the current (pre-ACA) market is not individual policies (the ones at issue according to the NBC report). I base that on this 2009 study citing a 2009 EBRI study that 9/10 of non-elderly Americans with private health insurance (e.g. not Medicaid) get it via their employer. Throw in VA, Medicaid, Medicare, and that 10% drops to an even lower percentage. Of these few (in terms of percentage) people with privately purchased individual policies, not all are being forced to switch.
http://ahip.org/individual-health-insurance-survey-2009
That doesn't alter the absolute nature of the claim ("most" can keep their policies is still not the same as "all" can).
Here's where we get into the meaning of "is". I'll discuss this by analogy. The ADA (Americans with Disability Act) grandfathers existing buildings - they don't have to change to provide access to the disabled. And they're allowed to make minor changes, still without complying. But if they make a major change, then they must comply - put in ramps, elevators, etc. The theory is that these are no longer the "same" buildings, but they have changed in character and are thus subject to the ADA.
Same idea with ACA. Policies, including individual policies, are grandfathered. Here's how healthcare.gov describes grandfathering:
https://www.healthcare.gov/what-if-i-have-a-grandfathered-health-plan/
(There are a few conditions that even grandfathered plans must comply with, but those conditions, I believe, kicked in prior to 2014, so they wouldn't disqualify plans that people still have in 2013.)
Just as a building that has substantial changes is no longer regarded as the "same" building, policies with substantial changes can be viewed as "new and improved" policies, not the "same" ones. Thus, with or without ACA, arguably it is the insurer, who, by virtue of altering the plan, killed the old one, making it impossible for you to keep it. However, in the absence of ACA, it would have been able to offer you the replacement plan, even if it didn't provide all the ACA essential health benefits.
As I said, this explanation of who is instigating the cancellation sounds a lot like defining "is".)
Taking this one step further - in 47 states, I believe, insurers are allowed to offer early renewal - that is, offer you the option of renewing your policy in December 2013, instead of January 2014. If you do so, you get to keep your plan, with all its holes, for another year. (Thanks again to SlowLane for this info; I also found an article in last Saturday's NYTimes saying the same thing.) That the insurers are generally not offering this to individuals goes to the question of who is forcing the cancellation, at least for now.
So, did the Obama administration know, even expect, most plans to fail the grandfathering test? Yes. Was the hope that these plans would fade away, sooner rather than later? IMHO definitely (especially since the regs were tightly written). Did the law force them to fail? Arguably no.
Hi msf,
I wish I had more time to study your post, but I don't.
However, I would like to say a few things. Here in Philadelphia, Blue Cross has cancelled over 45% of their individual plans. Mine is one.
In Florida, Blue Cross has cancelled over 300,000 individual plans. In the state of New Jersey, over 800,000 individual plans have been cancelled by various insurance companies. While these are numbers, they represent real faces and real people.
I had a Blue Cross HMO plan that met my needs. While it was pricey at at $480 per month (single), I had all the access I needed to my fine physicians at the University of Pennsylvania, with a co-pay of $20 to the primary care physician and $50 to a specialist. No deductibles.
While Blue Cross of Philadelphia could have augmented my plan with one or two of the 10 essential elements of the ACA (which by the way I do not need), instead they opted to cancel it. Why? Because they could and reduce their risk.
Now I am faced with two options:
1. Blue Cross or Aetna (the only two in town...so much for increased competition) will allow me to apply for an underwritten policy for 2014, so long as it is approved and implemented by December 1 or December 15. All the plans are high deductible ($2,500 for the ER, hospital, and out-patient services and then I pay 25% up to $5,000) with higher co-pays. The monthly premium, if I am approved, is in the $450 range, the approximate same monthly premium that I am paying on my current (cancelled December 31) plan. Blue Cross and Aetna had no problem adding the essential elements to those plan that I do not need.
2. Go to the marketplace. With my Modified Adjusted Gross Income of approximately $51,000, I am entitled to no subsidies. For approximately $700 per month, I can get a Blue Cross Silver Plan, which covers 70%. Far inferior to my current plan at a cost of $480 per month which meets my needs and far inferior to an underwritten plan at a cost of approximately $450 per month.
Regardless if my MAGI is $51,000, $501,000, or $5,501,000, the Silver plan on the Exchange or directly through Blue Cross or Aetna, is approximately $700 per month. However, if my MAGI was $30,000, I would entitled to an approximate 50% subsidy! Sounds like I am being incented to earn less income; doesn't it?
Of greater importance, I would like to know how I am going to make ends meet, paying the additional $225 per month (under ACA), not taking into account the "guaranteed" or $2,500 yearly deductible of another $208 per month ($2,500 / 12 = $208). While center city Philadelphia is expensive, how about the person in the likes of New York, Washington, Chicago, Los Angeles, and San Fransisco on a MAGI of $51,000? The ACA does not adjust for cost of living.
Please understand, one of the very important reasons I voted for President Obama, is because he explicitly said that if I liked my current health plan, I would able to keep it.
I guess you are right; it's kind of like the definition of "is". President Obama didn't say Blue Cross couldn't cancel my health care plan.
In any case, I am a river without a paddle. But who cares, it's not your problem...yet.
Mona
Hi Mona. I'm still looking at the information for Pennsylvania (I try to know what I'm talking about, and the lack of readily available info for Pa. is disturbing).
What I have found is that Coventry was supposed to be one of the insurers competing statewide, but that it was acquired by Aetna just last May. That sort of consolidation is happening nationwide. (For example, if I've got the ownership right, WellPoint owns Anthem which in turn bought up Blue Cross/Blue Shield in a slew of states - though not Pa.) It's no consolation, but I think that industry consolidation has a lot to do with the lack of competition.
ACA was supposed to stimulate the creation of competing Co-Ops (such as Health Republic Co-Op in NY, NJ, OR), but they don't seem to have been created in all states/counties.
FWIW, unlike Edwards, who was out first with a health care plan, or Clinton, who largely mimicked Edward's plan, Obama campaigned on a plan that did not require a mandate. This was obviously unsustainable, and it demonstrated that he was either ill-informed or pandering. While he changed his rhetoric once elected and he had to get a real plan in place, I don't recall him campaigning with a viable proposal. See, e.g. this article from The Atlantic:
http://www.theatlantic.com/politics/archive/2012/06/how-obama-broke-his-promise-on-individual-mandates/259183/
There are supposed to be plans available in Pa. off-exchange (i.e. sold outside of the marketplace) in 2014, not just ones that begin in December 2013. So far I haven't been able to find them in Philly. (Hence my allusion to lack of info.) Part of why this is important is that from what I've been reading, while the exchanges have limited "open enrollment" periods (through March 31 for 2014), one can purchase insurance "off exchange" any time. So something you might do as a stop gap is purchase short term insurance (typically good for six months), and then purchase ACA-compliant insurance off-exchange.
The scant pricing information offered by healthcare.gov (without actually qualifying for insurance) shows silver BC HMOs in the $400 range, BC PPOs in the $450 range, and Aetna plans (PPO, HMO) in the $500 range for single, age 50+ people in Philadelphia. I can't check on your particular doctors (no clue who they are - don't want to know), but Hospital at Univ. of Pa. is included in the BC HMO Silver network (though if one gets the less expensive BC HMO Silver Proactive (Tiered) HMO, the hospital is in Tier 3, meaning a huge deductible as you stated.
Your pricing data ($700) is likely much more accurate than the $400ish quote that I got from the fed exchange site, since that only considers ages over/under 50, and in most states (45, I think, including Pennsylvania), prices vary by age.
My takeaways:
- Obama didn't deliver what he campaigned on (which was impossible to deliver - insurance-based universal coverage w/o a mandate)
- You should (in theory) have more options, perhaps off-exchange, than you listed, though those options may only affect your ability to get bronze/silver/gold plans later in 2014 (off-exchange) and may or may not give you more plan choices (quite likely not more insurance companies)
Finally, regarding NYC, I did post a table of insurance prices for NYS, by region. In NYC, a single (of any age) can purchase a bronze plan for as little as $312 through the Health Republic Co-op (listed as Freelancers in the NYS table) I mentioned above. Lack of competition and higher prices seems to be a regional thing, without a pattern I've discerned yet. (That is, nothing as obvious as just remote rural areas being higher priced or lower priced for that matter.)
Wish I could offer more suggestions or hope.
Thanks for taking the time to reply.
Unfortunately, I do not have much more to add, but I would like to address a few points in msf's post.
One. Here in center city Philadelphia, while we probably have more teaching hospitals than any other city (possibly Boston has more) and there has been some consolidation in the hospital landscape (for example University of Pennsylvania purchased Pennsylvania Hospital, the oldest hospital in the United States, and Graduate Hospital), I do not recall any consolidation with health care insurance companies.
As far back as I can remember, the only two providers have been Blue Cross and Aetna. With the ACA, United Heathcare was to compete, but for reasons that I do not know, they decided against entering Philadelphia. My guess is that with the vast and complex heath care structure in Philadelphia and surrounding areas, it would be very expensive to set up their infrastructure, and they did not see an acceptable return on their investment.
Two. I'm not quite certain what you mean by "There are supposed to be plans available in Pa. off-exchange (i.e. sold outside of the marketplace) in 2014, not just ones that begin in December 2013". As mentioned in my post, Blue Cross and Aetna are offering underwritten plans with high deductibles (ER, hospital, MRI, CT scan, etc.) for December 2013 and all of 2014, so long as they approve your application by November 20 and the policy is implemented by December 1 or December 15. I know this statement is factual. I do not know why these underwritten plans can not start January 1 and do not know why both Blue Cross and Aetna said these underwritten plans will not be available in 2015 (only ACA plans will be available, either directly through Blue Cross or Aetna or through the Exchange).
Three. I am 57. The prices I found on healthcare.gov for the highest deductible Silver PPO (I have no idea why all the PPO's are less expensive than the HMO's. It's always been the reverse) you mentioned, are lower than what I have found. More significantly, I have two friends who are insurance brokers and have vast knowledge of the plans, and they said the prices I obtained from heathcare.gov are only estimates. They added in order to get true pricing you first need to sign up and create your profile. Then you will see the true costs, which will be higher.
Four. Yes, a Bronze plan is available now. While I am not certain, I have been told by the insurance broker that it is far more expensive than the $312 price you mentioned for New York. That said, a Bronze plan, which covers 60%, is FAR inferior to my current plan, more expensive than my current plan, and at 60% coverage, is really a "catastrophic" plan. In fact, there is only one ACA plan below a Bronze and that is a catastrophic plan. This may fit the needs of JohnChisum, but it does not fit my needs. What I find ironic about these lower level tier plans, is that I am told they were designed for folks like me who could not afford a higher level richer benefit plan. So lets assume I go out and purchase a Bronze plan because that's all I can afford. Then I am in a car accident and end up in the ER, or get Kidney stones (which I have had two times in the past 5 years) and the doctor orders an MRI, or a myriad of things requiring in-patient or out-patient services. How do I afford the high deductibles, when I can hardly afford the plan? The lower tier plans are better for someone who HAS financial resources and wants to "self-insure".
Anyhow, I have been calling Senator Casey's (D) and Senator Toomey's (R) office every day. Interestingly, I can get through to Senator Toomey's office in Washington every time I call, but I have yet to be able to get through to Senator Casey's office in Washington, so I call his various Pennsylvania offices daily. I am not confident that this will be helpful, but it is all I can do.
In the mean time, thanks for listening.
Mona
Hi Mona. Let me try to clarify what I was saying (not that I'm sure it will assist you, unfortunately).
One - The reason why I checked on access to Pennsylvania Hospital was to use it as a very crude proxy for access to your doctors (whom you said were associated with U of Penn.)
Regarding insurers - HealthAmerica of Pennsylvania is a subsidiary of Coventry Health, which as I noted above, was just acquired by Aetna. According to Coventry's own site, it still offers HealthAmericaOne individual plans that begin in 2013 (but none for 2014).
Not saying these work for you, just that there really may be other insurers around (and also that there's been consolidation). The HealthAmericaOne 2013 plans and prices I get when I input your data (age, gender, and 19019 as a proxy for a Philadelphia zip) include:
Rewards $5000 - $246/mo
QHDHP $3750 - $284/mo
QHDHP 90% $3000 - 290/mo
Rewards $2500 - $322/mo
QHDHP 100% $2500 - $326/mo
Choice1 $4000 5-12 $328/mo
QHDHP 90% $1500 - $347/mo
Rewards $1750 $361/mo
Choice1 $2000 5-12 $374/mo
QHDHP 100% 1250 $399/mo
Choice1 $1250 5-12 $422/mo
Copay 90% $2000 5-12 $495/mo
Copay 80% 5-12 $561/mo
Copay 100% $1200 5-12 $595/mo
(and a couple at $900+/mo)
I've embedded links to sample brochures, so that you can see the general structure of each type of plan. They're all PPOs. The Rewards plans seem to be high deductible plans with "rewards" (incentives on the order of $100) for actions like completing a risk assessment. The Choice1 look similar to the high deductible plans, except the out of network copay percentage is significantly lower, and they cover tier 1 drugs without a deductible (just a copay).
Regarding teaching hospitals - not that I think quantity equates with quality, Philly has a large number (14?), perhaps exceeding Boston (13? or 12-14? depending on whether you count Cambridge and the greater region). NYC (all five boroughs) has about 35, though NYS has been trying to shut one of them down recently (LICH).
Two - off-exchange plans. As near as I can tell (sorry, not going back to find my sources now), individual plans that don't comply with ACA can be sold until 2014, and can run only through 2014. That would explain why you cannot renew these plans in 2015. Off-exchange plans are plans offered, well, "off" or outside the exchanges, otherwise known as the marketplace. Insurers are allowed to offer ACA-qualified plans on the exchange, off the exchange, or both, but if they offer them both on and off, the prices for the same plans must be the same in both channels.
So there may be insurers who offer plans only off the exchange - thus you won't know about them from searching the exchange. Buying insurance is a lot like investing in bonds - no centralized marketplace (other than the exchange). If you want to buy a bond, you need to go to different brokers and check their separate inventories. Likewise, if you want to buy insurance, you have to go either directly to the insurer or to multiple brokers (to check their "inventory", i.e. which insurers they carry).
Unfortunately, so far I haven't been able to find insurers offering off-exchange plans in 2014 for Philly. Here's HealthAmericaOne's description of plans and rate sheets for Pennsylvania off-exchange plans, but the counties covered don't include Philadelphia.
Still looking, but not hopeful.
Three - Knowing that healthcare.gov figures were estimates, and that the costs you gave were higher, I had estimated your age around 60, and had already been using that in engines (like the Coventry site).
Here's a site that tries to give the exchange plan prices based on age and county:
http://www.valuepenguin.com/ppaca/exchanges/pa
They seem to come out a bit higher than the range you gave (around $450), but perhaps it's getting closer. It's certainly more detailed, as it provides information about each of the plans.
Four - ACA permits actual catastrophic plans, but only for people under age 30, or if you qualify for a hardship exemption (not the same as exemption from penalty). Bronze plans differ in that they often have lower deductibles (albeit still high), and on average, pay for a greater percentage (60%) of health costs than the catastrophic plans - thus the higher premiums for bronze.
For example, Keystone HMO Bronze covers an unlimited number of primary care visits with a $40 copay, and any specialist visits with an $80 copay. Likewise, it covers x-rays, tests, etc. with co-pays. It is only for hospitalization/ER, etc. where the high deductible come into play. In contrast, Independence Personal Choice Catastrophic, which costs only about $25 less/month covers just three primary care visits before deductibles kick in - and they apply to all tests, doctor visits, etc. as well as hospitalization/ER.
Getting insurance that covers hospitalization with low deductibles is very expensive these days - so one has to carefully weigh the risk vs. what one could afford. For myself, with the insurer I'm using, I found that the HDHP (HSA-compatible) plan actually gave the best protection. If my only expenses were even a half dozen trips to the doctor and tests, it was cheaper than plans that let me pay just co-pays (after including the difference in premiums). If I had a bad accident and would hit the cap on expenses (regardless of plan), the HDHP was still better - it had the lower cap. It's only in the middle range (moderate cost, such as outpatient surgery) where the HDHP came out worse for me. As you said, it's a matter of what one can self-insure for. And depending on where you live, and the plans available, YMMV.
A final note ...
- http://www.healthpocket.com/individual-health-insurance
This seems like a reasonable site but still lacks some details. Also, I'll swear that it had been showing me plans like HealthAmericaOne for Philadelphia yesterday, but now says that only Aetna, Independence BC and Capital BC service the area (confirming your point about only two carriers being available now).
Again, good luck in your search for a plan that works for you.
Best to you- OJ
I forgot Scott, and it goes without need to say it- David.
Hi msf,
Thanks for the "good" information
I am familiar with the underwritten plans offered by Blue Cross and Aetna. I am also familiar with the pricing you address. As I have done my DD, please keep in mind that these prices assume you have not taken an aspirin in 10 years. While my medical history is mostly clean over the past 4 years, I have encountered Kidney Stones two times in the past 5 years as well as other minor conditions.
Aetna has a 5 year look back period and Blue Cross a 10 year look back period. I already tried to get Aetna's PPO High Deductible 3000 (HSA Compatible) and what started out as a $257 per month quote, turned into a denial because of my history of Kidney Stones.
We are on the same page and for the time being, it is what it is. I continue to forge ahead and try to be positive. However, while I born at night, I was not born last night. There is no question that I will end up with health insurance, but there is equally no question that it with me more expensive than my current plan and far inferior.
I got a kick out of Kathleen Sebelius' response to Congressman Fred Upton today during the Congressional hearings. The Congressman accused Obama of breaking a 2009 promise that people with insurance could keep their current plans and said "They are now receiving termination notices, and for those who lose the coverage they like, they may also be losing faith in their government". Sebelius defended the administration "by describing hundreds of thousands who have received cancellation notices as the victims of a market long known for discriminating against the sick, cancelling policies and selling inadequate insurance". And: "The individual market ... anywhere in the country has never had consumer protections. People are on their own. They can be locked out, priced out, dumped out, by insurers, Sebelius said".
So now I get it. The insurance companies can do whatever they please, whenever, and the government has no say; EXCEPT when the government mandates the insurance companies to include the 10 essential elements of the ACA.
My head is spinning
Mona
http://www.hulu.com/watch/550560
I hope everything works out okay, Mona.
Hi Scott,
Thanks for the link. I needed a laugh!
I appreciate both your and JohnChisum's words of encouragement.
I'll be fine and hopefully with time my edge of bitterness will wear off.
Mona
Um.... I mean, he doesn't mention Blue Cross specifically, but he says you can keep your plan about 20 entirely different times in the video below.
A couple of years ago, the company I worked for cancelled its health insurance altogether. I should know - I'm the one who wrote the notes to the insurance company with all the cancellation info.
After seeing this video, I'm wondering how I managed to duck all the Secret Service agents who surely were out there ready to blow my head off to stop the cancellation.