Costco Aetna Health Insurance now available in CA

[joec]

Just wanted to get people’s opinion if they have any on Costco now offering health insurance in CA through Aetna…

Wife had Aetna previously at a job and was ok with it. Currently use Blue Shield and think they are ok, but really expensive (we’re self employed). I’m really also considering moving to a high deductible plan for myself since I rarely use health care and am probably considered healthy (non-smoke, not overweight, no real problems historically).

Can’t say I really like how Blue Shield operates in general, but that’s probably true for everyone about their health insurance company.

Thoughts and opinions? It seems our regular doctors are in the plan from their website so shouldn’t have to change doctors neither, but figure I can bank a lot of money in these accounts instead of paying a higher premium…

[jpinpb]

Do you have a link? How much is the coverage w/Costco? What are the terms?

[spdrun]

If you own a small business or are sole proprietor, does Freelancer’s Union have any plans in CA?

[Hatfield]

Interesting that you should post this now.

Costco used to offer individual health insurance plans through UHC/PacifiCare for its business members. I enrolled up in 2006 and am still with them today. About three or four years ago I received a letter stating that this program was no longer being offered to new subscribers, but UHC/Pacificare would continue to honor existing policies.

A few weeks ago I received a notice that UHC/Pacificare was terminating all individual policies at the end of this year. Apparently the California insurance exchange opens in October with policies starting the first of the year. So I’m going to be shopping for health insurance in the fall.

[joec]

Here is the link about it, I put in my info and found only a few plans available so not sure if those offered are a good choice.

You can start here:
http://www.costco.com/services.html

A link points to:
https://www51.aetna.com/iqs/costco/aimquote.do

Also business health here as well:
http://www.costco.com/business-health-insurance.html

This was just advertised in their monthly mag last month so was curious how good/bad this is.

[carli]

Yep, I have recent experience with this. We applied for a quote on the Costco/Aetna individual (family) coverage as soon as it was available in late Jan, as our current policy through Anthem/BC renewed us for Feb 1st with a 28% increase (same increase I believe went to all individual policy holders). We only want high deductible health insurance to cover catastrophic care…we go into it knowing we’re going to pay for all else out of pocket and just search for the lowest premium and highest deductible.

This year, we shopped it around by getting quotes from a broker, who told us that in his experience, the Health Net policies offered through the Farm Bureau (yes, you have to join the CA Farm Bureau to get them!) were currently the lowest cost. In addition to his Health Net quote, we got the Aetna/Costco quote so that with our Anthem/BC renewal, we had a total of 3 to compare.

For all 3 carriers, we went with their highest deductible plans, which were all $5000-$6000 per individual or $10,000-$12,000 for a family. We basically just compared the worst-case scenarios for each plan and took at look at our out-of-pocket maximums. Plans had minor trade-offs in coverage but all offered one full physical per year w/out incurring deductible or coinsurance but the rest was subject to deductible/coinsurance. I can’t recall what the various prescription drug coverage options were, but very similar (I think all were subject to deductible/coinsurance).

So the way it turned out was that it was basically a wash between all three. The new Aetna/Costco plan was the most expensive, believe it or not, but I think it was only by about $40/mo.

For all these plans, you get a quick estimate up front, which usually looks decent, but then you have to spend quite a long time (especially if you have 4-5 in your family like us) filling out extremely detailed medical info for each person going back 5 full years in medical history (UGH!) and afterwards, the simplest issues can cause their underwriters to rate you up. One of our kids was rated up for infrequent visits to a dermatologist. She’s a typical teen who wants to keep her skin flawless so she takes Retin-A to keep pimples at bay and they came back with a 30% increase in her rate with a diagnosis of acne. It’s all so silly because with a $5000 deductible, the insurance company never pays out on any of these minor claims anyway, but you still have to report them, of course.

So in the end, it made most sense for us to just stay put…we could’ve saved $30ish a month to move, but in my mind, it’s better to build a longer track record with one insurer as the underwriters do consider longevity of policy when they rate you in the future. Also, it’s the old adage of staying with the devil you know versus going with the devil you don’t know.

One more thought…you probably know this, but if you form an LLC or S Corp for any type of business and buy the insurance through the business, your rates will be substantially lower.

We’re going to be interested in seeing what the new federal health care laws will bring next year for individual policies. Health care in our country is one of the biggest conundrums ever – seems almost too complex to solve for so many reasons (let’s not even get started on that!)

Good luck finding decent options.

[joec]

Many thanks for your detailed experience. Yeah, I wasn’t too impressed with the 5 plans offered which mostly looked exactly the same with different deductibles. On the positive, it looks like at least all of them had maternity which was actually really hard to search for last go around. I’ve also noticed a lot of companies don’t even seem to want your business and you’re right, individual plans are extremely expensive. It’s really disappointing compared to what I’ve been used to 20-30 years ago.

We’re probably going to move to an s-corp this year so maybe I will wait for that to happen before changing as it is time consuming.

I tried to get my son off my plan since they seem to want to charge him my rates even though he should be a lot cheaper. They wanted to do a full underwriting again and you have to complete all the paperwork, etc…again…just to split up the plan. It’s like a land grab with these companies. It’s probably not just them and the environment we are in in terms of health care, but it does really suck I think. I had a family member suggest we run all these mental tests when my son was really young and I shut that down because I was worried about what you mentioned as well…They might see something and just deny, raise premiums etc…

Sorta like making random or small insurance claims on a car or home, you really have to be wise with your health insurance too and avoid it if it’s not a huge deal.

[spdrun]

Is there no way to get onto a group plan as a self-employed individual in CA, either through a “union”/”guild” or through a professional organisation of some type?

The detailed health-history bullshit makes me very thankful to live in a community-rating state, albeit one with pretty expensive insurance. Had some stomach problems a few months ago and wanted an endoscopy to rule anything bad out and check for hiatal hernia. Went in, got it paid for without risk of prejudicing future insurance ratings or any such nonsense.

Hoping that Obamacare will make things relatively straightforward for the rest of the US.

[njtosd]

A number of doctors I’ve seen don’t accept Aetna. Haven’t had that problem since switching to blue shield. Even if you have a high deductible, it’s still a pain to report out of plan payments and you don’t receive the insurers negotiated rates. We went to an HSA plan and so far, so good.

[carli]

spdrun,

Yes, there are better/cheaper health care plans for those who are self-employed. But there are few options for those of us who retired early (before being eligible for Medicare) but haven’t formed a business, or are still looking for employment after COBRA runs out, etc.

Also, I believe CA does have what’s considered a community rated plan options but since that plan is the last resort for many, the community pool has become expensive and the broker told us it would be way worse than what we pay (just under $600/mo for a family plan w/deductibles around $5000/each or $11,500/family – no picnic but doable).

We’ll see what Obamacare brings – could be more (due to richer mandated benefits and introduction of higher risk pools), could be less (due to having more people to spread the risk around). But, I’m a believer that something had to be done and his plan is a good first crack at it so kudos to him for making it happen, even if we do end up personally paying more than now.

[David J]

I believe this is the official California site for the future plans:

http://www.coveredca.com/

Here is a PDF with some more details:

http://www.healthexchange.ca.gov/Documents/CC%20Video%20Slides%20FINAL%20021313.pdf

[bearishgurl]

It appears Joe C decided he wasn’t interested in the Costco plan. From the looks of things, he’s probably better off leaving “well enough” alone.

I’ve been an Aetna Advantage (PPO) member (HDHP) since 2004. I medically qualified thru their own salespeople in PA. I didn’t use a broker.

I just had a chance to review my (HDHP) policy and it appears mine is *better* than Costco’s “Preferred Network 5,500 Deductible Plan” (which it most resembles) in a number of ways.

These differences are for In-Network providers:

My Annual Deductible is $5K/$10K. Costco’s is $5,500/$11K.

My Coinsurance Maximum is $3K/$8K. Costco’s is $5K/$10K.

My Annual Out-of-Pocket Maximum is $8K/$20K. Costco’s is $10,500/$21K.

My Emergency Room copay is $100 (waived if admitted). Costco’s is $350.

My Generic pharmacy price is $15 copay (ded waived). Costco’s is $15/$20 (at Costco only). I can fill mine anywhere at this price. (I’ve actually gotten them at $5 and $9 in the past, depending on what they were.)

My Preferred Brand pharmacy price is $35 copay (ded waived). Costco’s is $30/$35 (after ded).

My Non-Preferred Brand pharmacy price is $50 copay (ded waived). Costco’s is $40/$50 (after ded).

Here’s Costco’s Aetna brochure. Wait to load:

https://www51.aetna.com/iqs_contentMgt/consumerPortal/assets/pdf/CA/CA_Costco_Broch_020113.pdf

I also have this additional coverage (which may or may not be a part of Costco’s plans – they don’t state):

Urgent Care Clinic copay is $50 (ded waived).

Up to 30 days Hospice – 30% (after ded) $10K max lifetime benefit.

Routine Cancer Screening (as ordered by dr) – 100% (ded waived). (I’ve already had two colonoscopies pd for by Aetna as a cost of abt $2200 for both.)

Ambulance – 30% (after ded) $2K max annual benefit.

Organ Transplant – 30% (after ded)

Hearing Aid – $200 every 36 mos (ded waived)

The rest of my coverage is the same as that of the Costco plan.

Fortunately, I don’t have to cover any dependents … only myself.

********************************************

Note that I am “grandfathered” into this policy. Even though my premium has gone up >12 times since 2004, I would be a fool to switch carriers until I am Medicare-eligible, at which time I’ll buy a MC supplement and “Part D” prescription coverage (that is, IF MC is still around, then) :=0.

And I may not need to switch then, either.

http://www.aetnamedicare.com/foundplans.jsp?0.8760750378390612

It’s interesting to see how my carrier has insidiously shaved benefits from their plans since the law has required them to accept any applicant, regardless of pre-existing condition. For many of these new applicants, the carriers obviously can’t know in advance exactly what to charge them in premiums, due to the unpredictable nature of their ongoing medical bills. All they can really do is issue this subset of applicants a policy and “play it by ear” as to how much to raise their premiums every 6-12 months :=0

[bearishgurl]

[quote=David J]I believe this is the official California site for the future plans:

http://www.coveredca.com/

Here is a PDF with some more details:

http://www.healthexchange.ca.gov/Documents/CC%20Video%20Slides%20FINAL%20021313.pdf
[/quote]

Yikes!!

I just ran the “Covered CA” calculator on myself and found that my premium with the “state pool” would be just $1 mo less than I am currently paying with a potential of nearly $5K more coming out-of-pocket annually!

http://www.coveredca.com/resources/calculating-the-cost/

This is no bargain for persons who are already covered by (grandfathered) individual policies.

My premium would have to be raised the maximum allowable over the course of a few years while the “Covered CA” premiums stayed flat in order to make it worth my while to switch (assuming I wasn’t already MC-eligible, lol). I just don’t see this scenario happening in tandem :=0

[UCGal]

[quote=David J]I believe this is the official California site for the future plans:

http://www.coveredca.com/

Here is a PDF with some more details:

http://www.healthexchange.ca.gov/Documents/CC%20Video%20Slides%20FINAL%20021313.pdf%5B/quote%5D
Thanks for the links.

The calculator at the first link is good. It matches what the kaiser family foundation calculator estimates.

Note that the income is MAGI not AGI. (Includes some extra, normally tax excluded stuff)

[no_such_reality]

Ouch, that’s pretty harsh. Family of 3 or 4 is $1149/month with $12,800 out of pocket. Medicaid carries until an income of $32,500. At $32,500, out of pocket is limited to $4500 (a lot if you make $32K) and you’re premium estimate is $81/month.

At $47,100, out of pocket jumps to $10,400, premium running $247/month. At just before $59K you jump to $12,800 and your premium is still only $395/month.

Next cutoff is $94,200. At $94,201, your prior tax credit goes from $403/month to $0. Which corresponds to 400% of poverty level.

[Author]

Posts