Costco Aetna Health Insurance now available in CA

[dumbrenter]

this plan is for poor people

[bearishgurl]

[quote=dumbrenter]this plan is for poor people[/quote]

I get the qualifications for Federal help to pay their premiums but what I DON’T get is how the average “poor person/family” is going to pay nearly $13K out-of-pocket if one of them just happens to land in the hospital.

They’ll just end up getting a medical judgment lien against them. If they don’t own any property, it will prevent them from ever buying any.

Medical providers are notoriously aggressive in collecting unpaid bills.

So what’s the point? Right now, CA hospitals can’t refuse to treat the uninsured. If they don’t qualify for Medi-Cal, the hospital seeks “charity care” for them to pay some or most of their bill and then usually writes the rest off.

The “poor” who have no aspirations to buy RE don’t really care about their credit ratings.

All the “CoveredCA” program is going to do is “spread the pain” of the low-income chronic medical-care users (not necessarily “sick”) among the carriers who currently write policies in CA, who will in turn raise the premiums (again and again, as in the past) of their current individual policyholders who are “grandfathered” and thus “trapped.” The vast majority of these policyholders had to “medically qualify” for their policies.

“Poor people” have no business using HDHP’s, IMHO. But the only other alternative is to issue them more comprehensive plans similar to the Kaiser HMO model but “ration care” for them and who would decide what to ration? It’s a slippery slope.

[earlyretirement]

I was just thinking about what other options are out there for healthcare coverage. I signed up with Kaiser Permanente 2 years ago. I own my own company so I self-insure my family. Prior to that I lived abroad and bought private medical insurance that was amazing! Expensive but really great and rivals anything I’ve had in the USA.

As with others, they keep raising the prices each year. We have a plan which covers my wife and I and our two kids. Keep in mind my wife and I are still fairly young and our kids are just 3 and 4. We pay almost $1,600 a month now for coverage.

When we first got it I thought they were pretty good. I liked the technology aspect of Kaiser where you take a blood test and you get emails instantly as each result comes back. It keeps track of all your prescriptions and you can order online. All your physical information is all online. Heck, you can even email with your doctor with them responding fairly quickly.

What I found about Kaiser is they are GREAT for preventative type stuff. Free immunizations for the kids. Free annual physicals, etc. But if you have any more serious type issue or have to get referred to a specialist they kind of drag their feet.

Plus when our kids are sick (nothing serious but just fever, flu, etc) they almost never can see their own physician who is really great. We almost always either get stuck seeing a nurse or some other random doctor as their doctor never can get them in besides annual exams, etc.

I’m lucky as though it’s a small world, my primary care physician just happens to live down the street from me in the same development. So if I need anything he always gets back to me quickly.

We are young and healthy and mainly got it because we have young kids, and we plan on maybe having more kids and there weren’t a whole lot of options out there. $1,600 a month ($19,000 a year) is quite a bit to pay for mediocre medical coverage.

It just doesn’t seem like there are too many great options for individual coverage if you self-insure.

Does anyone else have any good options besides this Costco that they can recommend based on personal experience?

[spdrun]

Amazing — doctors using e-mail 🙂 Most of the ones that I’ve dealt with (including a professor of quite high repute who invented several new surgical procedures) have been awful technophobes when it came to digital communications.

This being said, they’ve always been quick to fit me in and schedule tests when needed — no waiting for months for simple tests, as I heard happens in some places.

I’m not a fan of the HMO-does-everything-and-you’re-fucked-if-you-want-to-go-out-of-network model of doing things.

[bearishgurl]

[quote=earlyretirement]I was just thinking about what other options are out there for healthcare coverage…[/quote]

ER, you seem like you might be a good candidate for an HDHP.

$1600 mo seems high to me for an HMO for a healthy young family of four. But of course, I am not your underwriter.

I’m guessing, of course, but if you all are truly healthy, I would think you could get a ~11K/$20K ded HDHP plan for ALL of you for $600-$800 mo.

I don’t know about the other carriers, but with Aetna Advantage, you can STILL get preventative health services for $0 (no copay/no ded). In CA, as of July 1, 2012, pregnancy is treated like any other medical issue . . that is, ins cos can no longer refuse to cover it.

http://www.littler.com/publication-press/publication/stork-has-landed-california-employers-must-maintain-and-insurers-must-

This bill, commencing July 1, 2012, would require every individual
health insurance policy to provide coverage for maternity services for all insureds covered under the policy.
This bill would become operative only if AB 210 of the 2011-12 Regular Session is also enacted.

see: http://www.leginfo.ca.gov/pub/11-12/bill/sen/sb_0201-0250/sb_222_bill_20110912_enrolled.html

and: http://www.leginfo.ca.gov/pub/11-12/bill/asm/ab_0201-0250/ab_210_bill_20111006_chaptered.html

I even got a rate hike of $34 mo commencing July 1, 2012, with a nice letter telling me how I now have maternity benefits :=D

I just wonder who was helping to pay MY healthplan premium when I was in family-raising mode! Alas, it was likely no one but me and my employer :=0

With an HDHP, you certainly would have no problems seeing a specialist as there are no “gatekeepers” in PPO plans.

IOW, if you were diagnosed with cancer and wished to be treated by the Mayo Clinic in MN or the MD Anderson Cancer Center in TX, you would certainly be welcome to do so, without interference from your carrier. In addition, if any of these providers were “in network,” you would receive the “in-network” benefit as opposed to the out-of-network benefit.

A big difference from your HMO would be $40 (PCP) and $50 (Specialist/urgent care) copays as your HMO copays are likely much less.

If you were a healthy family, you would have to go to the doctor 1-2 times per week, per person in order for your $1600 monthly HMO premium to really be worth it, IMO.

This is just my .02, for whatever it’s worth to you, ER.

[earlyretirement]

Thanks so much BG. I will check out that option you mentioned. Appreciate the advice.

[bearishgurl]

I got a letter from my carrier yesterday that Aetna is leaving the individual market in CA on 12-31-13. They will return all CA applications for new policies still in their possession on 6/24/13. Apparently, they did not want to upgrade their CA HDHP policies to conform with PPACA standards to roll out on 10/1/13.

www calhealth net/Aetna_leaves_California_individual_health_market.htm

http://insuremekevin.com/2013/06/19/aetna-drops-individual-health-insurance-in-california/

They will still write and service large employer-sponsored health plans in CA (employers of over 50 employees) and will be giving up approximately 49K (part of them “grandfathered”) individual policyholders in CA, like myself.

I’m going to have to avail myself of the state-run “silver plan,” and can hopefully qualify for a smallish tax credit to help pay for it. It’s going to be about 65% more expensive than my current plan and have higher copays than I have, higher generic prescription costs and higher costs for tests and X-rays. Only it’s OOP annual cap is lower, but only by $1600.

In any case, I cannot address this issue until CoveredCA rolls out the particulars after 10/1/13, i.e. which carrier for which plan (YES, there’s a HUGE DIFFERENCE between carriers) and choice (or lack thereof) of providers.

It’s time to finish scheduling whatever expensive tests I think I’ll need for the next few years NOW as their costs are going to go w-a-a-a-ay up for me after 1/1/14.

Meanwhile, I got another $35 rate hike beginning July 1, 2013, (the 13th rate hike I’ve received since 2004, when I signed up).

I’ve gotta get my “money’s worth” now, as I’ve been relatively “healthy” and haven’t used much more than preventative services over the years.

Now, I’ll be “lumped in” by age and smoking status ONLY on the state-run exchange with my “brethren,” many of whom did NOT take stellar care of themselves over the years or had/have addiction issues which were/are, not surprisingly, now causing them major health problems. I won’t be able to obtain a healthcare premium based upon my OWN health status and level of healthcare usage (which requires effort and diligence to maintain) ever again, unless the PPACA is somehow overturned.

The days of having to medically qualify for a healthplan and premium-level (as I did) are now OVER, folks.

I believe the original intent of of “Obamacare,” FKA “Clinton-era failed healthcare-reform,” was for the healthy to pay enough in premiums to subsidize the non-healthy. I don’t have a problem with this, in theory, for cancer treatment for a deserving patient who is simply unlucky or to contribute to a program such as “Healthy Families” (CA low-income children’s coverage) but SO MANY health problems in adults (including some cancers) are self-inflicted. This is why I believe every healthcare plan applicant should be underwritten individually. Otherwise, the “system” is VERY unfair to the disciplined vegetarians, tree-hugging yogis, gym rats and otherwise athletically-inclined individuals who have never had addiction problems.

Based upon the uninsured (by choice) with whom I’ve talked to, I don’t think the healthcare reform mandate for coverage is going to be successful as there are no teeth in any laws to collect fines from those who don’t comply with obtaining and keeping coverage. In addition, many residents of SD County have Sentri passes and go to MX regularly for medical/dental treatment and have done so for many years.

Interesting times we live in, folks :=0

I hope I don’t have any big health issues next year and am able to obtain coverage with a decent carrier. Otherwise, there is just more incentive for the retired and soon-to-be-retired-but-still-under-age-65 group (of which I’m a member, lol) to leave the state in search of better carriers with better plans who are participating in state and Federal healthcare exchanges.

For example, if I am required by CoveredCA to pay ~$550 per month for some BS nearly-worthless plan run by “Health Net,” I’m going sign up but be out of here as soon as I can, folks.

The providers in CA populous counties have got to be disgusted beyond belief that Aetna and CIGNA are not participating in the state-run exchange and that Aetna is leaving the state (exc for employer-sponsored plans). I guess these two giants want to stay alive until the initiation of the PPACA shakes out and the quantity and quality of the actual poor and sick (or just sick) new applicants is known.

Of course, all the other states will be watching the results of CA’s exchange closely, as being the most populous state, CA is the “testing ground” for this debacle … err … experiment.

[SD Realtor]

From a strict financial standpoint, it would be foolish for a young twenty something to enroll in a plan. Simply pay the fine and walk away would make much more sense while somewhat more risky.

[bearishgurl]

I just noticed insurance giant United Health is also not participating in CA’s state-run healthcare exchange. That’s three giants and counting.

And I wonder who will bail out by the end of 2014, primarily due to overall quality of new sign-ups in Covered CA. It’s going to be very interesting to watch. Whatever, the case, we are moving towards a monopoly on healthplan insurers in CA.

This does NOT bode well for keeping rates down going forward :=0

And I agree with SDR. If I was 20-something, otherwise “healthy,” and not covered by a parent or employer, I would use community clinics (whose fees are on a sliding scale) and borrow unexpired prescription antibiotics occasionally from my friends and family before I paid $200 + month for a nearly worthless plan 🙂

This is ONE of the reasons why Obamacare’s “theory” of the healthy insureds’ premiums subsidizing the unhealthy insureds’ premiums isn’t going to work out well.

At that age, that money is better directed to a student loan or savings to buy a vehicle.

[outtamojo]

Left-over antibiotics? Don’t you know that between one of you not finishing out your prescription and the other not getting a whole prescription you are helping to create resistant super-organisms?

[bearishgurl]

[quote=outtamojo]Left-over antibiotics? Don’t you know that between one of you not finishing out your prescription and the other not getting a whole prescription you are helping to create resistant super-organisms?[/quote]

outtamojo, that’s kind of wacky. I though that only happened to people who overuse antibiotics.

In any case, LOTS of people have repeated refills left on common antibiotic prescriptions which they don’t fill because they are “better” now and don’t want to overuse antibiotics. Those refills could ostensibly be filled for your 20-something brother or friend who is uninsured and needs them.

[SD Realtor]

I think the monopoly you are referring to is a single payer system which has always been the non stated vision. These are the incremental steps to get there.
It couldn’t be done in a single swipe back in 2009 but everyone knew that this would be the natural progression.

For all the engineers who think they are safe with the plans that their big corporate giants provide for them, in the long run it will be more profitable for these employers to opt out as well and turn all the employees over to the system.

Again, if you simply follow the path to highest returns for either the corporate entity or the healthy individual, dumping people into the system is the best alternative. In the long run the only alternative will be to have substantially higher penalties for those who do not opt in and for corporations or the system will break. Even without breaking, the system meanwhile will swell with millions of people each year (including those with fresh citizenship) and overall quality will diminish.

It is very simple, at some point the sheer numbers do not get supported given cost parameters, and the number of those contributing. The result is a ever lower bar that is the common denominator.

[no_such_reality]

[quote=bearishgurl]I just noticed insurance giant United Health is also not participating in CA’s state-run healthcare exchange. That’s three giants and counting.[/quote]

The state’s four largest health insurers — Kaiser Permanente, Anthem Blue Cross, Blue Shield of California and Health Net Inc. — were all selected.

http://articles.latimes.com/2013/may/23/business/la-fi-mo-covered-california-health-plans-20130523

Frankly, Aetna was a non-competitive bit player in the private insurance market having less than a 5% market share.

[bearishgurl]

[quote=SD Realtor] . . . It is very simple, at some point the sheer numbers do not get supported given cost parameters, and the number of those contributing. The result is a ever lower bar that is the common denominator.[/quote]

This is my greatest fear. Having lost four immediate family members from illness, I fear losing access and choice. For example, I feel that if I wish to be treated for cancer at a program offered by the Mayo Clinic, MD Anderson or Johns Hopkins and am willing to travel, I should have that option. I didn’t take care of myself all these years and pay my own premiums to wait 1-hour plus in waiting rooms with tons of patients (some of them sick) with their strollers in tow because they didn’t get baby sitters, only to be seen for five minutes max by an overburdened provider who hasn’t taken a lunch break.

I don’t want to belong to a plan which gives little choice of providers to a multitude of *new* sign-ups in a given locale.

And I don’t want to wait 10 months + for a date to get elective surgery.

Also, I feel most of the best doctors in SD are 60-plus years old. Many of these doctors (a few of whom are my current providers) are undoubtedly going to become incredibly frustrated with all the red tape dealing with the exchange and their *new,* possibly sicker patients going on the plans when they need care and then letting their plans lapse . . . repeatedly. And I fear they will also become disgusted with the low reimbursement rates due to very high administration costs in the state exchange bureaucracy. This will prompt them to throw in the towel and “retire” (because they can!) leaving the newbies and well-oiled medical-office machines (who give 2-3 mins to each patient after a 40+ min wait) to pick up the slack.

I just have a vivid recall of how the old SD Naval Hospital used to run (in Balboa Park) with shower curtains hanging a foot-plus from the floor separating patient rooms and the “pharmacy” set up exactly like a bus stop with a little window outside with a number machine and benches to sit and wait in front. I’ve come a lo-o-o-o-ong way since then and don’t want to relive it :=0

[bearishgurl]

[quote=no_such_reality] . . . Frankly, Aetna was a non-competitive bit player in the private insurance market having less than a 5% market share.[/quote]

NSR, Aetna IS a giant. It just lost most of its in individual market share in CA since 2011 because it has always been more picky on who it underwrites. It is NOT more expensive for those who take care of themselves but it is more expensive for the masses, thus, so many CA individual policyholders left Aetna in recent years and signed up elsewhere after getting repeated rate hikes … as I did. Aetna is nationwide … and believe it or not, a LOT of states have a “perceived” overall healthier population than CA … at least perceived through the eyes of insurance companies. Almost ALL of Aetna’s CA rate hikes since 2010 (and probably other health insurance companies as well) have been due to the fact that they couldn’t deny coverage at will … like they had been doing for years.

Believe it or not, it is NOT WORTH it for insurance companies to even collect a $1100, $1500 or $2100 a month premium on a LOT of “guaranteed-issue” new sign-ups.

I’m not stumping for insurance carriers here … just stating facts.

Now, they will actually have to cover members of this population for as little as ~$550 per month (most of whom will have tax credits to pay most of the premium)!

I haven’t checked which companies in the exchange will be administering the Medi-Cal plans but it is my understanding that the Medi-Cal masses will be waiting for the same care in the same waiting rooms as the self-insureds and employer-insureds.

Currently, the Medi-Cal masses, for the most part, use their own community clinics for office visits.

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