Just found out I have to change again. Humana dropping out of Louisiana. Will know more in November, or whenever they start listing the plans.
[quote=“GTFan, post:20, topic:31, full:true”]The folks that get screwed, yet again, are the ones that don’t get subsidies because they make too much money. They’re the ones that have been yelling loudest about the ACA, with good reason.
[/quote]
But don’t the ones that make too much money most likely have a job that includes medical, and if not, can’t they better afford to buy individual coverage to begin with? Never understood the issue some people have with the ACA when it’s basically the same as Medicare, but for younger people.
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Not when they’re self employed.
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What do you mean? ACA probably helps SE people more than any other group. Before ACA my premium was set to go to over $800 a month. Now it’s $155.
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With a subsidy? Or without?
I have been on/off ACA and fall into the non-subsidy area. I’ve also bought coverage for myself and my wife prior to ACA.
The Good: ACA coverage is much better than I used to get buying direct from insurance companies. Coverage as in, things that you need/use that are covered and paid by insurance.
My plans prior to ACA were catastrophic coverage. I also remember when an insurance application was set up to give you coverage but exclude pre-existing conditions. It made lapses in coverage or shopping around nearly impossible. I personally would never carry catastrophic coverage ever again.
The Bad: The premium is not anywhere near $155 for myself. Add in wife/kids and the numbers keep climbing. We were around $550 a month for healthy 30 somethings with an infant when we left the ACA. I know those plans are now over $600.
Most people (myself now included) who are smart enough to realize that premiums are gone into the ether as soon as you pay them are actively seeking out the lowest cost plan and self insuring. Something that is more difficult/costly to do with the ACA in place.
SE people (at least here) had more options and lower costs. Was the coverage worse? You betcha. But you’re asking Humans to think rationally about something as complex as health care. Instead they’re hating the lack of plan choice and the cost increase.
I’ll let you know I’m a big, big fan of the ACA. The implementation of it I’m not at all excited about.
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It’s no where close to Medicare, which covers everyone old enough. The ACA covers a thin slice of the population, some 5-10% consisting of the self employed, people with part time jobs and no health benefits, early retirees, and anyone too sick to work and not married to someone with a group plan from their spouses’ employer. The very sick are a much much larger fraction of this risk pool and guaranteed coverage causes huge pricing problems since they are only spreading the cost of subsidizing those peoples’ care on a 1/10 of the whole population instead of all of it like Medicare.
As such, the individual ACA market may converge on Medicaid for all depending on how things go. The big problem with the ACA implementation is that it wrecked the individual market by requiring guaranteed coverage of very sick people. From the insurer’s perspective, any price you pick is too low for premiums and you’ll lose money when/if the only people who buy it are sicker than that.
As a consequence, in my area for example there are no PPO plans offered at all since the ACA came into effect, and all the networks for individual plans, exchange or otherwise, are very very limited. No out of network coverage, no out of state coverage, the good hospitals and cancer centers are getting dropped every year. What good is coverage if it’s bad enough you wouldn’t use it, and expensive enough you’d rather save your money and take your chances?
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As such, the individual ACA market may converge on Medicaid for all depending on how things go.
I agree. Limited networks and long waits but everyone has coverage. In many markets there is only one exchange insurance company anyway, and if you live in a rural area you’ll have to drive an hour or more to get to the clinic. So for purposes of universal coverage, this is fine. It’s not “seeing your own doctor” but it’s better than declaring bankruptcy after an accident or long illness.
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I think that they will sell the plans from Nov. 1 to Dec. 15, so on Nov. 1 we should be able to see what we can “choose from” in our county and income level.
In the last 4 years, especially the first 3 years of that time, with my marketplace insurance policy, they covered very few doctors in my county and no medical facilities/radiology screening centers/hospitals at all in my county. I have had to drive 60 or 70 miles one-way to do just about anything. And in this time, I’ve had to have several surgeries, regularly visit a number of specialists, and have many imaging and blood tests. It has not been as convenient as being able to do all this in my own county would have been…
but it must be said that I have been generally pleased with the level of care that I’ve received, although I’ve had to be very diligent, and to really be my own “case manager”, as, otherwise, a lot would have fallen through the cracks regarding my care, abnormal test results would not have been noticed if I hadn’t brought them up, and mistakes are continuously being made on my medical records. (But that general sloppiness is probably par for the course in most insurance networks across the country, sadly.)
Anyway, now, after 4 years, after I put in a lot of research to choose from the available doctors and a lot of faffing around to get on new-patient lists, I’ve collected together some doctors who (mostly) are not bozos and who “know” me at least slightly, some of whom have done complicated surgery on me so I feel kind of connected to them —
but my insurance company of the last 4 years is leaving my state at the end of 2017, and the only possible marketplace company that is going to operate in my county has an entirely different doctor/facility network, so everything I’ve built up in the last 4 years: relationships, medical records, online patient portal, floor plan knowledge (and even driving-direction and parking knowledge) for me and for my relatives of hospitals and facilities, the doctors’ trust that when I say “I am noticing x happening” that x is really happening and needs to be checked into… well, all that is going to go up in a puff of smoke in 10 weeks.
[And right when I may well need another complicated surgery pretty soon (but it probably wouldn’t be possible to get it scheduled before Christmas, because of what’s involved for it).]
When I first heard that the cost-sharing subsidies had been abolished (in their current form) a few days ago, my heart sank. I actually couldn’t sleep until about 5 am that night because I didn’t know what was going to happen to the insurance situation in my county/state – I didn’t know if the only company that was scheduled to offer 2018 plans in my area would pull out of the marketplace at the last minute on the basis of that surprise announcement.
However, since then, I’ve read a number of articles about it, and I checked out some of the information from the filings that were made to my state’s insurance department by the insurance company that proposed to serve my county in 2018, and I am not so worried now that the company might pull out before Nov. 1st, because in their July-September filings to my state, they ALREADY had planned for the 2018 cost-sharing subsidies to be ended by the federal govt., so they proposed to raise their rates 20-25% to compensate for that. They were going to charge that much extra anyway, whether or not the subsidies were actually cancelled by the federal govt.
I think that my state’s officials had told that company they had to share the increased costs across all plans and levels, so they didn’t just load up the silver plans with the high rate increases (like insurance companies could do in California, for example), they raised the cost of all the plans by an average of 20-25%.
To the people who think that well-paid and/or “professional” people don’t need to use the marketplace insurance, because surely their company would offer an employee insurance plan, or they would be rich enough to buy a plan on the (now-disappeared) individual market, a couple of weeks ago I had a meeting with a highly-educated ‘professional’ service provider who probably earns quite a lot compared to most people in my region, who heads a company that employs about 25 people, and at the end of our meeting, that person said to me, “Hey Oppidum, do you by chance have marketplace insurance?” I said, “Yes”. “They” then said, “I do too… my insurance company is leaving the state’s exchange.” I said, “Mine is the same one”. “They” looked at me with a concerned expression and said, “What are we going to do next year? What is going to happen? Is there going to be anything in our county? Isn’t this a mess?” I said, “I know!”
In the last couple of weeks, I have asked some of my doctors’ staffpeople if, come January, their offices will refer me to equivalent doctors in the new provider network, and I was told that their system has a policy not to give any referrals outside of their system, and I will be on my own to identify and choose new doctors and facilities.
I don’t know if my actual physicians might be a bit more open with me one-on-one in appointments about who of their colleagues they would recommend I move to, because I haven’t wanted to bring it up with them until I had more certainty about what my county’s insurance provision was going to be.
I’ve been waiting to see one specialist for 9 months for my first appointment with her, and I saw her last week finally. She told me I’d need to have several more appointments, which I was expecting her to say, then I explained that my marketplace insurance with her entire group ends in 10 weeks, and my county would not be offering any plans with her group, so I’d have to change all my providers soon. She looked entirely surprised, like she didn’t know that was going to happen to any of her patients! It’s really amazing, the low level of knowledge people in my state have about the whole situation. It is rarely on the local news, it is very rarely in the papers. Even if it’s mentioned in the local media, the not-as-bad situation of the county that my state capital is located in is usually described and assumed to cover most area listeners/readers, although that county’s situation is quite different from my county’s (which is in the back of beyond). [I think that the state capital’s county is going to have 2 or 3 providers for 2018, and one of them does feature the provider network that I’ve been in for the last 4 years.]
Anyway, I said on a few threads earlier this year (on FW; they are linked in the OP above I think) that I was seriously worried that my county and maybe neighboring counties wouldn’t have a marketplace option at all for 2018, and that the federal govt and/or my state’s govt might come down hard on the whole marketplace system (which they would be delighted to do), so I might have to move to another state to have necessary healthcare.
It looks as though, probably, something is going to work out for my county, although I have no idea how expensive the options are going to be. I’m at an age where the price is higher…
I also don’t know how limited the network is going to be – if it’s really limited and features mainly the providers who are based in my county, I wouldn’t want to have an involved surgery at the one (third-tier) hospital here, and regarding the specialty of the main surgeon I would need, there were only 2 of those surgeons working in my county before now, and I found out two weeks ago that one of them has just retired, and the other one apparently has limited experience with my issue. But I’m hoping that the provider network is going to extend across several neighboring counties, which seems reasonable to expect.
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I wish you the best of luck. Once you know more about 2018, it may be worth inquiring with your preferred doctors for their cash rates, or keeping them in mind if you can argue with your new insurance company that they are a local, qualified option and no other such ones are offered in network. I understand that’s a possible line of attack against these narrow networks, but it’s similar to your description of being both the patient and the case manager - lots of appeals, paperwork, checking details, etc.
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“I think that my state’s officials had told that company they had to share the increased costs across all plans and levels, so they didn’t just load up the silver plans with the high rate increases (like insurance companies could do in California, for example), they raised the cost of all the plans by an average of 20-25%.”
And that is why the healthy unsubsidized people are going to leave the ACA. If the huge increase was contained to the silver plan, then healthy unsubsidized people can still choose the bronze or gold plans and still remain insured. The cost-sharing subsidy people are restricted to the silver plan as that is the only plan that offers cost sharing subsidies so why raise the rated on the other plans?
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[quote=“Mars, post:31, topic:31, full:true”]
And that is why the healthy unsubsidized people are going to leave the ACA. If the huge increase was contained to the silver plan, then healthy unsubsidized people can still choose the bronze or gold plans and still remain insured. The cost-sharing subsidy people are restricted to the silver plan as that is the only plan that offers cost sharing subsidies so why raise the rated on the other plans?[/quote]
Yes, you are right, in those states where the insurance companies were directed by the state govt. (or decided on their own) to raise their costs across the board to make up for the govt’s ending the cost-sharing subsidies on the silver plan for lower-income customers, including raising the costs substantially on plans and on income levels that didn’t qualify for those subsidies in the first place –
this is going to serve to upset the “healthy unsubsidized people” and encourage them to come to the conclusion that marketplace insurance is way too expensive and unfair.
Due to the formulas they use, in the states where the new extra costs to make up for the cost-sharing subsidy shortfalls were heaped upon the silver plan only, apparently the fed govt will end up paying for most of the $ loss of the cost-sharing subsidies for the lower-income people who choose the silver plans (and I’ve read several articles saying that it will cost the govt even more doing it this way than it would have cost them if they had kept the original cost-sharing subsidies), and this will leave the original-price bronze and gold plans to generally be a good value for people who didn’t qualify for the cost-sharing subsidies, upsetting them less about marketplace insurance in general. For those people, purchasing a gold plan might cost even less than a silver plan.
The answer to your question of, “so why raise the rates on the other plans?” is that this is deliberate on the part of the decision-makers who want the marketplace insurance system to upset customers/citizens, and subsequently to fall apart. It furthers their objectives to increase the costs dramatically for the unsubsidized people and to scare the hitherto-subsidized people into not understanding what is going to happen to their health coverage.
I don’t think that stating it was deliberate is a political or controversial statement, it’s just reality; the main decision-maker on taking away the cost-sharing subsidies was bragging yesterday in the media that by doing so, he has destroyed the marketplace insurance system and it doesn’t exist anymore.
I’m not sure how it could not exist; I mean, I hope it still exists…
But, as the British say, “a week is a long time in politics”,
and 2 weeks (which is how long it will be until the marketplace enrollment period opens on Nov. 1) is an eternity in our current wacky and unpredictible system.
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[quote=“xerty, post:19, topic:31, full:true”]
So here is a nice matrix…
http://acasignups.net [/quote]
Thank you for linking to that site - it has some good information – I think I’d visited the site before, but I made the assumption that maybe it was a bit spammy or iffy due to the way the graphics looked a little amateur – but now that I have read around on there a bit, I see that their data appears reputable and they are spending a huge amount of time in researching how each state is going to be affected.
Of course there are about 4 different ways the states have decided to manage how their marketplace insurance companies cope with the last-minute major changes announced last week, making the whole thing very complex.
Another article on the Silver plans and how they should be avoided in many states if you aren’t getting the relevant subsidies.
As a side note, observe that the individual market here is 11M people, nearly all subsidized, on the exchanges and another 7M off exchange who aren’t. The 30-50% annual price hikes we keep seeing are in part a consequence of the death spiral in rates when you try to load all the costs of the very sick and poor onto some fraction of this 18M person group, which is less than 10% of the country’s population.
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Yeah the real solution, which no one has the political will to do, is to eliminate the advantages that employer-provided insurance has so we can have large pools of insured in every state. Right now there’s lots of little pools so the risk is not spread as well as it could be, and folks are stuck in jobs they may not want because of insurance.
I’m very concerned that there’s not going to be a whole lot of insurers left in the ACA exchanges for 2019. With these insane rate increases folks without subsidies are not going to be buying insurance.
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2018 rates are available on the federal marketplace so you can preview the pain:
Looks like the average price hike is 38% for the benchmark Silver plan (which was also up 25% for 2017 from 2016). Good news for AK, AZ, and ND customers and bad news for pretty much everyone else without a big subsidy. IO, WY, UT, and NH are up 50-70%.
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38% increases… 
I have read that in some situations the gold plans can be cheaper than the silver due to the subsidizies that were killed. I found a gold that is a better deal than silver from Kaiser. Its only a ~300 more a year but thee deductible is $3000 less.
With regard to the avoiding Silver strategies discussed above, there are some updates to the states and some of their changing cost allocation approach to the CSRs expenses. You might double check this one in case your state changed at the last minute:
Also, if you’re looking for group options despite being single (“self employed”), check out this thread for some of companies that aggregate small businesses and offer benefits including PPOs at least in some cases.
My understanding is that the insurance is marked up a fair bit going through these intermediaries, but given how overpriced the ACA plans are for normal people, you can probably got about the same level of coverage but with a decent national network.
Ugggh Previewing plans in New Orleans / Orleans Parish. Exactly zero of any doctors I’ve ever seen are included. Even on the most expensive plans. Probably going to take the absolute cheapest plan and just see who I want on a cash basis. And this is with a partial subsidy.
I do wonder if the provider networks will evolve or this is it.
WSJ: Insurers Leave ACA Markets; Some Premiums Will Jump
https://www.wsj.com/articles/insurers-to-leave-aca-markets-report-confirms-1509401571
The number of insurers partici-pating on the federal exchange, known as HealthCare.gov, will drop to 132 in 2018 from 167 this year, according to the Department of Health and Human Services analysis. As a result, about 30% of consumers will have only one insurer to pick from, up from 20% this year.
The average monthly premium for one of the most popular, middle-priced plans on the exchange—a key metric for premiums around the country—will increase by 37% for a 27-year-old consumer across states that rely on Washington to run their exchanges, according to the HHS