[quote=La Jolla Renter] . . . They average family was suppose to save money on Obama care. What happened? Doctors, insurance companies, and hospitals are all crying they aren’t making any money.
Who is making all the money??? I think the industry could use some transparency.[/quote]La Jolla Renter, what happened is the money is being wasted on bohemoth, bureaucratic, grossly incompetent exchanges and expensive public websites that still don’t work properly. Provider reimbursements have gone way down since 2013. I know this because I have compared my EOBs from my PPO BEFORE Obamacare (Aetna, who left the CA individual market at the end of 2013 with 5 other carriers) with my “obamacare” EOBs from my current PPO, Blue Shield of CA, a Covered CA plan. For the exact same procedures, I have found the reimbursement to providers to be 25-50% of what it was pre-ACA. On one biennial scan that I most rely on (my third, taken Oct ’15, the allowed reimbursement was so low that my scan report from IHS was just 2/3 of a typewritten page versus the detailed 9-12 page scan report Sharp did the first 2 times, with photos. Of course, Sharp won’t participate in exchange plans unless you sign up for one of their EPO plans. I’ve already lost 3 longtime providers out of 8. Two of them “retired” because they could no longer afford their overhead with the low allowable reimbursements under ACA and both of them actually had owned their own medical bldgs in SD for decades! They couldn’t even afford to pay their staffs on the new level of reimbursements and so they just decided to close up shop! The 3rd one just dumped all patients (new and old) that were on exchange plans.
The carriers participating on the exchanges are now flush with cash collecting exorbitant premiums from everyone and the gubment, in the form of subsidies (to make up for all the “very sick” people they were required to cover) and offering very narrow networks to their members located in HUGE population centers (like SD). I already have a primary care physician (one of the best in town) but he’s over 70 as well and could just decide to throw in the towel tomorrow …. cuz he can. I would HATE to have to find another primary care provider in this climate who is actually accepting new patients in a crowded market while being an exchange planholder!
Whoever thought up the ACA and put together this legislation had to be complete idiots. Certainly, they must have figured that providers were going to bow out if exchange-covered patients weren’t worth their time. And also that insurance companies can’t operate at a loss for any length of time when they are required to take anyone who applies to them and pays their premiums! The PTB is attempting to control too many moving parts by using gubment mandates and gubment cramdown on private industry (Big Insurance and providers that we, as patients need worse than they need us), and, suffice to say, this isn’t going to end well. It’s a race to the bottom but the carriers and the providers have already proved to everyone straight out of the gate that they don’t have to play and will not play if the conditions don’t suit them.
Our only hope right now is to get into office a presidential candidate who will see to it that this fiasco is scrapped in short order :=0 I don’t care how many “super-delegates” there are right now or who they are (currently) “pledged to.” Your vote counts, people, so VOTE in the primaries AND the general election … no matter what happens. Change your voter registration, if you have to. The deadline to (re)register to vote in the CA primaries is May 23 (although if you re-register that late, you will probably have to vote in person). Anything is better than the royal, unfixable mess we have today that is the “ACA.”
Okay, back to Cigna. They’re one of the six carriers who left the CA individual market at the end of 2013 but as of November 2015, came out with those three Bronze plan offerings for SD with one of them being an HSA compatible plan. Based upon the info you provided, your current coverage sounds most similar to a Silver 70 plan on the exchange.
There are 8 silver plans on the SD exchange. Their deductible is $2250 + $250 pharm ded. Their maximum out-of-pocket is $6250 (yours may be significantly lower).
The monthly premiums on the CC cost calculator for a silver 70 plan are as follows:
age 35: $274 to $373 (PPOs $327 & $346)
age 40: $286 to $390 (PPOs $342 & $362)
age 45: $323 to $440 (PPOs $387 & $409)
age 50: $400 to $544 (PPOs $478 & $505)
age 55: $499 to $680 (PPOs $597 & $631)
A big problem is the very possible narrower networks offered on these plans compared to what your current plan offers. The reason I put the PPO premiums in parenthesis is because you stated that you did not want to be forced to get a referral from a PCM in order to see a specialist. There are now TWO PPO’s to choose from on the SD exchange for 2016, BSoC and Anthem Blue Cross (which is rated lower than BSoC but is the more expensive plan of the two).
If I were you, I would compare the coverage details of each standard silver PPO (and maybe gold PPOs as they have no deductible) to the one you have and their prices for your age to get an idea what they cost on the exchange with or without a subsidy, depending on if you qualify for one. Then if I found one I was interested in, I would look on their list of providers for my doctors and decide if it was worth it to leave my “grandfathered plan.”
It’s easiest to use the “shop and compare tool” (above link) to do this exercise because Cigna will not quote you premiums for an off-exchange plan unless you fill out their form online and send it to them.
