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Obamacare - cost is not Affordable

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  • Don't really have time to dig up more articles...buying a new house! But just wanted y'all to know my premiums went up 25%. Going to shop around when I have time. If anyone finds a GREAT deal, please let us all know! Thanks!

    A strange thing happened when I compared the BCBS site and Healthcare.gov. The subsidy on BCBC was 91/mo and 377 or 277 (I forgot) on Healthcare.

    I'm going to wait until Nov to see if it changes.

  • edited October 2015
    @Dex I plan on shopping at ehealthinsurance.com. That's where I found the Aetna plan last year. I'm also going to look at Costco.com. In my area, they offer Assurant...could possibly be a better rate than Aetna. I don't think any quotes will be accurate until tomorrow, Nov. 1st. They are not in the health insurance biz per se, but I'm also going to talk to USAA.
  • There wouldn't seem to be much reason why quotes would (or could) change once posted.

    This is an industry heavily regulated by each state. Insurers have to file rate requests (at least for requests above 10%), states dictate their final rates.

    The scare stories (that came out months before Halloween) about 40%+ rate increases were based on those filings. Of course they didn't represent the final rates - they represented the money grabs that the insurance companies were making.

    As the NYTimes article davidrmoran cites points out, some states take an active role and hold prices down. But the others still review the requests and set the precise rates. (Tennessee insurers requested a 36% average increase and the state apparently gave insurers other than Humana their full request or more, so it does matter whom you put into state government.)

    No last minute fudging by the insurers.
  • @msf aetna doesn't have the 2016 rates up yet on its website. The only reason I got notification early is because I am up for renewal. I've checked Costco and ehealthinsurance, as well, and the new rates aren't posted at those sites, either. Should be there tomorrow, or Monday at the latest.

    At any rate, I think I'm going to wait a bit and see if my offer is accepted on the new house. I believe I have till Jan. 16, so there's no point in renewing at my current address if I'm going to move.
  • You do have until mid January, but that insurance isn't retroactive, so you'll be risking a coverage gap in January. (I've done that myself in the past, pre-ACA, to save on premiums, but you have to be in good health and recognize the risks. The older one gets, the less that seems like a risk worth taking.)

    I tried to get an early jump on 2016 planning, so I dug through my state's insurance department's site for filings well before the rates were published on the insurers' websites. Not recommending that you do that (not recommending that to anyone, especially someone busy with a house closing); just saying that there are ways for the compulsive/obsessive among us to deal with these little obstacles:-)
  • beebee
    edited October 2015

    @little5bee: In my area, they offer Assurant....

    I had Assurant Health (I believe they are a owned by Times Insurance) for the 2014 & 2015. both years I was outside the marketplace versions. For 2016, Assurant will not offer Health Insurance. Here's the announcement:

    assuranthealth.com/about-assurant-health/news-articles/assurant-to-exit-health-insurance-market-to-support-specialty-protection-products-and-services

    I prefer PPO to HMOs and I'm looking for HSA eligible plans. I'll chime with my options and choice as I hope others do.
  • @bee WHAT!! That is bad news...they were quite competitive with Aetna. I agree...let's keep this thread going and help each other out. The more people we have digging for info, the better.
  • fwiw, which may not be much, I have car/home/umbrella through Costco (Ameriprise), and they make sure the carrier is extremely competitive with anyone. So if I were not on Medicare, I would probably go with Costco without much further investigation. Odd how they perform such an 'almost public' service.
  • @davidrmoran Maybe Obamacare should be Costcocare. Probably would be run a lot more efficiently and economically. Just kidding....I know Costco has a demographic/economic advantage. But, perhaps as an advisor?
  • Yeah, their policies should be adopted by any number of institutions. I believe PotUS gave them a big shoutout a year or so ago, IIRC.
  • fwiw, which may not be much, I have car/home/umbrella through Costco (Ameriprise), and they make sure the carrier is extremely competitive with anyone. So if I were not on Medicare, I would probably go with Costco without much further investigation. Odd how they perform such an 'almost public' service.

    Nice to hear your experience with Costco is that they make sure their carrier of insurance is extremely competitive, because that is not my experience. I have found the likes of Travelers and 21st Century to be at least 10% less. Also, last year I had my HVAC system replaced and their Lennox carrier was a few thousand dollars more than my local Lennox dealer. Regarding travel services, I always get better rental car rates through BreezeNet, although I will say if you go through Costco Travel, you will get a one class upgrade on a car.

  • Well, I have not done anything like your level of research, though Ameriprise was cheaper than similar deals out here for the bundled service, like geico, progressive, liberty and such, a few years ago when I checked. Thanks much for chiming in; most interesting. I suppose to be a truly diligent consumer I should revisit various competitors next year.
  • edited October 2015
    Failing--- state cooperative health insurers. When all have fallen, it will be a corporate health care "plan" for you. Without price controls, they will charge what they desire; everyone will "qualify" for the plans, but few will be able to afford them. And so it goes, and so it will continue to go.

    http://www.forbes.com/sites/theapothecary/2015/10/29/why-obamacare-co-ops-are-failing-at-a-rate-of-nearly-50/

    "Cooperative health insurers (or co-ops) created under a federal grant and loan program in the Affordable Care Act seem to be falling like dominoes.

    It started in February, when CoOportunity Health, which operated in Iowa and Nebraska, was ordered into liquidation. In July, Louisiana’s insurance department announced it was shuttering that state’s co-op. The following month brought news that Nevada’s co-op would also close. On September 25, New York ordered the shutdown of Health Republic Insurance of New York, which had the largest enrollment of all of the co-ops. Then, within the space of a week in mid-October, the number of failures doubled from four to eight, as state insurance regulators announced that they were closing the co-ops in Kentucky, Tennessee, Colorado and one of the two in Oregon. Last week came news that South Carolina’s co-op will be closed, followed this week by the announcement that Utah’s co-op is also being shut down.

    In sum, of the 24 Obamacare co-ops funded with federal tax dollars, one (Vermont’s) never got approval to sell coverage, a second (CoOportunity) has already been wound down, and nine more will terminate at the end of this year.
    So what is behind this, so far, 46% failure rate?"


    Think gas savings. Uh-huh.... sure, no problem, we're good to go. But could you walk me thru all this, again--- just where are we going, exactly?
  • So what is behind this, so far, 46% failure rate?

    To a pretty fair degree, that Congress changed the rules on risk corridors in midstream so that many insurers were deprived of expected payments from the risk corridor program.

    Gotta love HealthAffairs.org - some of the clearest, most detailed information around. Here's a long excerpt from their post on risk corridor claims (updated, Oct 1). I recommend also reading their earlier brief (linked to from the first) describing what risk corridors are, how they work, what the controversies are, etc.

    I've rearranged paragraphs to reduce the context needed.

    The risk corridor program is intended to assist insurers whose claims significantly exceed their expectations, and thus their premium collections. State insurance departments have allowed insurers to take their anticipated risk corridor collections into account when evaluating the financial stability of those insurers. Some of these insurers may face financial difficulties given the small payout of risk corridor funds that will be available at this time.

    It is generally believed that healthier enrollees have remained in noncompliant coverage under the transition plan program, and that this has disadvantaged insurers offering ACA-compliant plans. The administration modified the parameters of the risk corridor program for 2014 to attempt to help insurers affected by this factor. This has increased the amount owed to insurers.

    Under the 2015 “Cromnibus” budget bill, Congress specified that payments out to insurers under the program during 2015 could not exceed collections. Thus, as already mentioned, payments in 2015 for 2014 will be paid out at 12.6 percent of claims, assuming full collections of contributions owed.


    Bottom line - grandmothered plans siphoned off healthy participants, causing higher expenses that the risk corridor program was designed to cover, until Congress changed the rules.

    The Forbes article mentions Oscar and CareConnect as non-CO-OP programs that haven't folded (because of VC and hospital funding, respectively). What it doesn't say is that both of these insurers underpriced Health Republic - the largest CO-OP failure. (Many reports claim that CO-OPs are failing because they underpriced the market.) And despite their lower prices, they captured a pittance of the market (2% for CareConnect and 5% for Oscar, vs. 19% for Health Republic).

    http://info.nystateofhealth.ny.gov/sites/default/files/2015 NYSOH Open Enrollment Report.pdf (see p. 19)
  • @msf On the Costco.com health insurance site, the "tax credit eligible" plans...which I assume are the subsidized plans...cost considerably more than the non-subsidized plans. What is the reasoning behind this?
  • Ya gotta give me somethin' to work with - a zip code, a state, a description of a non-eligible plan. All I see in my area are plans for 2015, and all are tax credit eligible. Site I'm using is: https://www.costcoquote.com/indv-quote

    Best guess, shooting blindly, is that the other plans are short term plans, designed to be used between "real" coverage. Something like that might be good for you in January if you wait until January to enroll in ACA (starting Feb 1).

    Keep in mind that to actually get premium tax credits, you have to enroll through your state's (or the federal) exchange. Which means that any 2016 plan eligible for tax credits should show up on the exchange (perhaps in about 4-7 hours, depending on your time zone).
  • @msf My question is basically...does one have to be subsidized in order to get a tax credit eligible plan? Can someone paying full fare (me) get a tax credit? If so, it might actually be worth it for me to have higher premiums and get a tax credit...I would have to run the numbers.

    Yes, I'm going to wait till tomorrow and revisit the site...but it appears that Costco.com might have the best prices for my situation.
  • msf
    edited October 2015
    All metal plans should be tax credit eligible, so the answer to your first question should be "no", they're open to everyone.

    I'm not sure I understand your second question - premiums are subsidized via tax credits. If you're asking can you get the tax credits retroactively, the answer is yes. The IRS writes:

    It’s your choice:
    If you are eligible for the credit, you can choose to:
    Get It Now: have some or all of the estimated credit paid in advance directly to your insurance company to lower what you pay out-of-pocket for your monthly premiums during 2014; or
    Get It Later: wait to get the credit when you file your 2014 tax return in 2015.

    If Costco shows a plan that's also offered on the exchange (as I assume all tax credit eligible plans are), the price cannot be any different between Costco and the exchange. There are reasons to go off-exchange, but lowering costs for the same plan isn't one of them.

    http://www.insure.com/health-insurance/buying-health-insurance-outside-exchange.html

  • http://www.zanebenefits.com/blog/bid/270938/What-Is-My-Individual-Health-Insurance-Tax-Credit

    according to above link, I would not be eligible for a tax credit, based on income. So, my original question is...since the "tax credit eligible" plans are for lower income people, why do they cost more than the plans for people not eligible? If someone has a lower income, the tax credit (subsidy) would not offset the higher premiums for these plans.
  • All ACA metal plans (i.e. except catastrophic) offered on an exchange are tax credit eligible. These are plans for everyone.

    Are you talking about a metal (ACA-qualified) plan or some other plan? Non-exchange qualified health plans are typically more expensive. For example, in the article I linked to about off-exchange plans, it says that California Anthem PPOs are only offered off-exchange. PPOs are usually more expensive than the EPOs (Anthem offers EPOs on exchange).

    On the other hand, if you're talking about non-qualified plans, you're comparing apples and oranges. You may not even be able to buy one (they are usually allowed to exclude people with pre-existing conditions). Of course plans like those would be cheaper (also non-renewable). After you pay a penalty for not having a qualified plan, it might not be so cheap after all.
  • Addendum: I have not figured out marketing strategy of insurance companies. I know one insurance company (generally one of the lowest price ones in its region) that in 2015 offered its plans on-exchange in several counties, but only off-exchange in another. It may have been testing the waters (most of its providers were three counties away, but it was building up its network). Who knows? In 2016, it's on-exchange.
  • msf: All ACA metal plans (i.e. except catastrophic) offered on an exchange are tax credit eligible. These are plans for everyone.

    When I checked last year for the adult son of a friend of mine, we learned that his taxable income was too low to qualify him for the credit. And because he lives in a state that has so far refused to enlarge their Medicaid program, he doesn't qualify for Medicaid either. He just learned today that his grandfathered health insurance premium will rise by 34% in 2016 but will still be less than any of the ACA plans. It's hard not to believe that he's paying more as a result of the ACA.
  • edited November 2015
    Jim0445 said:

    :
    It's hard not to believe that he's paying more as a result of the ACA.

    That if ACA had never come into existence, or got repealed by the crazies, his healthcare costs would be lower?

    >> And because he lives in a state that has so far refused to enlarge their Medicaid program, ...

    Surely this is part of it, no? If he is poor enough to quality otherwise.

    Sorry not to be quite following here.
  • It's hard not to believe that he's paying more as a result of the ACA.
    I don't think his increase is directly tied to the Patient Protection and Affordable Care Act.

    To counter some of the strategic presentism abounding in this thread, I offer some of my own experience. Well before the PPACA came into existence, I received two increases, both more than 30%, in the same year in my private-pay plan, with no change in my health whatsoever (no claims, no meds, nada).

    This year (and next) my grandfathered private-pay plan (with a different insurer, this time the Blues) was scheduled to go up massively. I slid into Medicare just in time.
  • edited November 2015
    Costco has the prices up for 2016. My Aetna plan is the same price as Aetna quoted...to the penny. If I move, however, the Aetna plan is $50/month more, but I can get a Humana plan for only $20/month more. That seems strange, because I think the county I would be moving to has a younger demographic than my current county.

    @msf I think I was looking at some sort of "bridge" policy for a life-changing event till the 2016 rates were posted. Don't see those "tax credit eligible" plans anymore.

    @everyone ehealthinsurance.com has a comparison tool where you can analyze up to 4 plans side by side. Very helpful to me.
  • I have a friend who is an insurance agent in Iowa. He told me that Iowa Wellmark BCBS's experience in 2014-2015 is that people signed up, got insurance, got medical treatment and then cancelled their insurance. BCBS was out about $10 million in Iowa due to this. My Colorado BCBS is going up 30% in 2016.
  • DaveC said:

    I have a friend who is an insurance agent in Iowa. He told me that Iowa Wellmark BCBS's experience in 2014-2015 is that people signed up, got insurance, got medical treatment and then cancelled their insurance. BCBS was out about $10 million in Iowa due to this. My Colorado BCBS is going up 30% in 2016.

    @DaveC If they did this, did they still have to pay the penalty?
  • Jim0445 said:

    When I checked last year for the adult son of a friend of mine, we learned that his taxable income was too low to qualify him for the credit. And because he lives in a state that has so far refused to enlarge their Medicaid program, he doesn't qualify for Medicaid either.

    ACA was designed to coordinate expanded Medicaid coverage and tax credits, so tax credits were only included in the plan down to the level of income for expanded Medicaid coverage.

    The ACA provided a lot of levers for state control (though making Medicaid expansion optional was not an intended lever). Unfortunately (IMHO), some states are choosing to limit access to health care.

    Others are moving in the opposite direction. A little known provision of the ACA provides a third alternative for people below 200% of the poverty line (aside from Medicaid and ACA qualified plans). These Basic Health Program (BHP) plans are low (or no) premium plans that cover 87% to 94% of the cost of care. (To put that in perspective, platinum plans cover 90% of care.) So far, only Minn. and NY have implemented these. Here's a description of the NY plan ($0 deductible, premiums between $0 and $20/mo).
    Jim0445 said:

    He just learned today that his grandfathered health insurance premium will rise by 34% in 2016 but will still be less than any of the ACA plans. It's hard not to believe that he's paying more as a result of the ACA.

    It's possible that the plan would cost even more but for the ACA. Very few provisions of the ACA apply to grandfathered plans (e.g. they don't have to accept everyone, they don't have to provide unlimited coverage on an annual basis, etc.). And the ones that do apply kicked in years ago, so they wouldn't account for a jump in 2014, 2015, or 2016.

    Starting in 2011, the ACA requires all plans (including your friend's grandfathered plan) to spend at least 80% of the premiums on real medical expenses (or refund the extra premiums). That part of the ACA is likely holding down the plan's increases. Without the ACA, the plan would be free to raise premiums even more and keep the money for itself.

  • DaveC said:

    I have a friend who is an insurance agent in Iowa. He told me that Iowa Wellmark BCBS's experience in 2014-2015 is that people signed up, got insurance, got medical treatment and then cancelled their insurance. BCBS was out about $10 million in Iowa due to this. My Colorado BCBS is going up 30% in 2016.

    This demonstrates the rationale and need for the insurance mandate. So long as people can game the system without penalty, they increase costs for everyone.

    What you were told is similar to, but slightly different from what I've read. Namely that costs jumped in 2014 because many new subscribers were people with preexisting conditions that needed medical care. In filing rate increases for 2016, many insurers said that they expect their costs to continue increasing. But there are some other insurers that made the opposite projection in their filings. They said that the mass of new people are now in the system, so they requested smaller increases.

    The comment you posted raises and interesting if somewhat depressing thought. Just as the insurance mandate ("penalty", if you will) serves as protection against people gaming the system, so do high deductibles. High deductibles front load the insurance cost, so that people who want to hop in, get treatment, and hop out still pay much of the year's total cost of ownership (premiums plus deductibles).

    Sort of like front end loads. Once you've paid the load, you tend to stay around (unless the fund's no good, and then why did you buy it in the first place?)

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