Another craziness that benefits ACA policyholders is the Medical Loss Ratio rebate. We got a whopping $835 back from Ambetter this year because they failed to make their 80% min payout on claims vs. premuims rcvd the last 3 years. The crazy part is that even though this is a heavily subsidized Silver policy courtesy of Uncle, the customer gets the entire rebate back based on the total policy cost (i.e. Uncle gets nothing even though he paid for 90%+ of it). For us this meant that the policy was free this year, and it’s expected that the rebates will be even higher next year because insurers jacked up prices too high in the last 3 years.
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I dont know you to be a liar. So i believe you are just confused.
ACA is a mess and did nothing to help the market. I think two things are wrong with your assumption thats its better. You are comparing what you have now n the cost now. Thats apples n oranges. Compare where we would without ACA in 2019 vs where we are 2019 ACA.
Then tell me about if its better. Its not.
The other is. Megacorp adjusted your compensation to X. How thats broken down is essentially irrelevant isnt ?
You get some more in your check n less on the insurance package. For sone others leas check n more insurance is better. Soooooo … megacorp wasnt really bad for insurance.
Unless you were dumb enough to take a job below market rate WITH BAD INSURANCE.
I agree that it’s “a mess”. But I most certainly am better off now than I would’ve been without it. I havent paid a penny in health insurance costs in 4 years. There’s simply no way that happens without the ACA. Apples to apples. I think it’s asinine that I have to kick in literally nothing, but I’m happy to take full advantage of it while I remain eligible.
I really dont understand how the rest of your rambling was remotely relevant.
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This is a crazy statement. It’s nearly impossible to compare allowed health coverages (or even just the employer contribution raw $ portion) when comparing job offers, . And they can always change them the next year or even mid- term, because concrete “benefits” are not part of the agreed to salary.
IMO, better to do away with employer ‘sponsored’ health care altogether, then really have a free market (letting everyone deduct it like employer healthcare is now). Not that this will ever happen.
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ACA definitely created winners and losers. I’m a winner, since my cable bill is more than my health insurance premium for two people, age 50+.
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Its not though. They actually give you a benefits statement.
So i dont know where you got the idea you cant figure it out.
They can change insurance next year or even in the middle of the year. Yeah … they can do that with salary too. But i guess thats to hard to figure out too.
Who are you people … and what have you done with the smart ppl from FW.
The smart people from FW figured out how to take advantage of what’s offered, no matter how big of a mess you may think it is.
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Guilty as charged!! Not smart…
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It’s better for US, dude. Try some reading comprehension, I made no claim that it’s better for all.
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LoL. You are purposely being poor on paper so the govt will give you subsidies.
So you can retire early.
I got it.
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Yep. Comparing the employer contribution is imperfect because, in the case of self-insured employers, it will depend on the employer’s risk pool (that is, an employer with an older/less healthy risk pool may contribute a lot but still have poor coverage). The proper way to compare would be using the actuarial value of each plan, but I know of exactly one private-sector employer who openly provides that number (Digi-Key, an electronics distributor, whose plan has an insane 97% AV). I have never seen or heard of any other employer making the plan AV available, and certainly not at the job offer stage.
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Yeah, and? The small number of ERs that take advantage of the law does not mean the law is a failure. I’ll take the guaranteed issue that came with the ACA over the drop you for having a cold then dump you into the high-risk pool crap that came before it.
That one feature alone made ACA worth it, and no Repub that values getting reelected will take that away no matter what happens next.
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It seems like that just tells you what portion of “covered services” they pay, which is pretty useless information by itself. What’s more important from a health insurance rather than from a service plan angle is what services are actually covered by the plan, how limited the required network is (if any), etc. This isn’t even covered in the summary plan description, and maybe not even in the full documents if you request to see them where they only have a printed copy available in HR for inspection.
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That’s true. The AV helps with knowing the financial part of the coverage, but as you said, doesn’t tell you how good the network is, pharmacy formulary, etc. I would note though that due to the ACA, there is effectively a sort of “floor” for types of things covered (like hospitalization, doctor’s visits, etc.). The essential health benefit requirements may not directly apply to self-insured plans, but to some extent, they are indirectly required via the stick of the employer mandate and penalty. This was resolved in the earlier days of the ACA when some employers were pretending to comply with the mandate (and avoid the associated penalties) by offering junk plans that didn’t even cover inpatient hospitalization.
The SPD and plan document should explain what services are covered, but you are correct that they usually do not provide any significant information about the network, just a delegation to the insurer they hired as an administrator. One note though: HR may try to tell you that you can only inspect those documents in person and cannot take a copy home, but as a plan participant or beneficiary, you do in fact have the right to request and receive copies of the documents. The relevant law is 29 U.S.C. § 1024(b)(4). This includes not only the SPD (which is only a summary, as the name implies) but also the controlling plan document (which falls under an “instrument under which the plan is established or operated”). This right not only applies to the participant (i.e. the employee), but also to any beneficiary (someone who may be eligible for coverage under the plan, such as a spouse or adult child under 26). The definitions in 29 U.S.C. § 1002 are also writtten broadly enough to cover not only a current participant/beneficiary, but someone who may become entitled to benefits in the future (for example, a new employee who is not yet benefits-eligible but will be eligible after meeting a 30-day requirement).
Edit note: since you mentioned SPD, it was clear you were talking about a self-insured ERISA plan. The above only applies to such plans. Other (state) laws will apply to insured plans.
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Looks like that Cadillac plan tax to fund the ACA is going away for good, having been delayed repeatedly and never implemented. Guess all those subsidies are coming out the investors now via the NIIT rather than pooling the risks across the group insurance market like they originally proposed.
Another thing to watch out for generally - insurance company’s medical procedure approval being revoked after the fact or after telling you or the doctor that it would be covered.
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I know someone that went thru this scenario. Fortunately, she kept meticulous records, has been with the company for decades, and held a senior position. Since the company was self-insured, they ended up paying what was originally promised.
Supreme Court upheld the challenges to the law, now that the “tax” part had been removed given there is no longer a penalty for not buying insurance. The ruling was not on the merits, but on standing to bring the case.
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I apologize for my sieve-like memory, but wasn’t it the “tax part” that made it legal to begin with?