Costco Aetna Health Insurance now available in CA

[The-Shoveler]

My two cents, I think Obamacare will be a complete disaster,
They should have held out for the full monty, a UK type of health plan,
this will be much worse than doing nothing.

[no_such_reality]

BG, I used to work in insurance. Aetna is huge as a company, huge in the corporate insurance realm, but as an individual insurer, they’re a bit player in California.

If you’re perfectly healthy with no risk factors, you can get a competitive plan from them. But at a less than 5% market share, Aetna decided not to compete.

A bunch of other companies did decide to compete.

[quote]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.[/quote]

Since as a society, we’re not really willing to say let them die in the street. There’s a ton of reasons why companies will not insure people.

As for those guaranteed losers, well, some one is eating it already today before ACA. The person is you. Like it or not, your premium already is that much higher, the bills from the ER are 5-10X what they should be because only 1 in 5 or 1 in 10 people seeking treatment have the ability to pay.

Or, we can go Dickenesque, let them die in the street. Don’t show up anywhere without your med-card or med-chip and don’t lose conciousness, no proof of pay, no treatment. Hope you don’t die.

As for wanting treatment where-ever, whenever and speedily. You can always pull out cash. In fact, if more people did, I suspect you’d find medical care is actually a lot cheaper and suddenly, you really decide do you need that $3000 patented cancer screening.

At the root of the issue is insurance is about spreading risks. When the insurers, can drop your coverage, deny coverage due to pre-existing conditions, etc, there really isn’t a level playing field. Not among consumers, but between consumer and seller.

An easier fix probably would have been to simply exclude the ability to factor pre-existing conditions, limit insurance groupings to zip code or larger geographic regions, all in, all or nothing. Not even smoking, IMHO.

Why? Because once you say smoking, then frankly, you start the rectal exam of every choice you make. You want health insurance, sure, he’s your car monitor so we know if you speed or not.

[outtamojo]

[quote=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.[/quote]

What you describe as overuse is more accurately described as inappropriately prescribed such as when a pediatrition gives in and just gives antibiotics for sinus infections to placate parents.
If your doctor is allowing you to refill an antibiotic prescription after 1 course does not help- run away fast, he/she is a whackjob. Only in special cases ie TB should there be refills on antibiotics. So the “lots of people” you know that are being given antibiotics with multiple refills are basically seeing nutjobs for doctors.
Please, google what the CDC says, before we unkowingly help add to
the list of super-organisms
hospitals are required to routinely test for upon admission and discharge.

[Essbee]

[quote=outtamojo]

What you describe as overuse is more accurately described as inappropriately prescribed such as when a pediatrition gives in and just gives antibiotics for sinus infections to placate parents.
If your doctor is allowing you to refill an antibiotic prescription after 1 course does not help- run away fast, he/she is a whackjob. Only in special cases ie TB should there be refills on antibiotics. So the “lots of people” you know that are being given antibiotics with multiple refills are basically seeing nutjobs for doctors.
[/quote]

+1. Agreed. Generally, if the first round of antibiotics didn’t work, the organism is resistant and you need a different antibiotic for round 2.

There are maybe a few other exceptions. Example: a patient who repeatedly gets a skin infection (cellulitis) related to lymphedema may have a standing order for antibiotics with a refill. At some point, some patients with repeated cellulitis or repeated urinary tract infections may be actually put on prophylactic (preventive) antibiotics for long term use, as well.

[bearishgurl]

Off the top of my head, I was thinking about the several young people I know who received antibiotics (with at 3-4 refills) to treat acne. In some cases, if the antibiotic didn’t work, they got a prescription for another one and the old one (and all its refills) hasn’t expired. Several of these types of drugs are very similar to one another.

All I was trying to say was that a twentysomething can probably make it through their twenties without health insurance. Women can actually self-pay at a standalone birthing center and/or get temporary CMS if they’re pregnant. Lots of people do. If they get into a vehicle accident, hopefully one or both of the parties has adequate insurance to pay their medical bills.

Back in my day, and probably up until 1996 (when the welfare reform laws were enacted and CA’s “Healthy Families” came about), young people who were not minors and had jobs with no benefits didn’t typically have any health coverage. And most of us are still alive to talk about it.

I just think “Obamacare” coverage is overblown (too comprehensive) and too expensive for the masses. For example, most people will never use mental health coverage and a LOT of the people with HDHPs were happy with their coverage and PPO choices and could easily pay the deductibles and co-insurance if something major should happen to them. And segments of the population who can’t get pregnant (children, males and sterilized and older females) shouldn’t be charged in their premium to subsidize maternity benefits, IMO (since coverage in this area is now the law in CA).

“Obamacare” is having the effect of dismantling a “system” that, IMO, wasn’t really broken. It is only broken for the people who couldn’t get coverage. That segment could have been served with state risk pools already in place. A program with the risk pools could have been put in place which charges premiums based upon income (or a combination of assets and income). A lot of that segment is the self-employed, who I feel, could have paid a $600-$800 mo ~reasonable health premium (in light of their health condition) at the expense of vacations, consumer spending, newer cars, etc. A lot of these people HAVE the money every month for ~reasonable premiums but they want to spend it on something else instead. I don’t feel sorry for most of these folks because I’ve been a single mom the entire time I paid my own health premiums and know exactly what I had to do every month to keep them paid. We’ve all got the same problem.

The Medi-Cal/CMS segment was ALREADY GETTING healthcare services, mostly with the contracted providers for these state and county plans. Except for low hospital reimbursements, it wasn’t broken. No doctor who didn’t want to accept Medi-Cal patients has been forced to. I knew one person on CMS who had to wait 9-10 months for eye surgery but them’s the breaks when you’re “indigent.”

If a person is otherwise healthy now, i.e. achieved a remission from cancer, they shouldn’t be considered to have a “pre-existing” condition. For the most part, I agree that “pre-existing conditions” should not be considered in the underwriting process.

Sometimes, when an individual has a terminal illness or has (self-inflicted) cirrhosis, the result is death. Yeah, folks, that’s what happens. Whether that person is me, you or a longtime homeless person, the result is the same. I just feel, as a society, that we can’t (and shouldn’t) try to fix everyone’s medical problems on the backs of others who take personal responsibility for their health.

I’ve posted before here more than once that if I’m diagnosed with Stage 4 or “terminal” cancer, I’m going to accept it and enjoy whatever life I have remaining. It isn’t worth it to me to undergo treatment which might prolong life for two weeks or two months if the quality of that life will be very poor. At that point, I won’t even care if my taxpayer-supported health plan is willing to send me to clinical trials all over the place.

There comes a time when a terminal (or nearly terminal) patient has to realize they are just unlucky (have bad genes) or did it to themselves and gracefully accept their fate.

The next thing we’re going to hear is that “Obamacare” is going to pay $45K+ for gastric-bypass and lap-band surgery for *new* signups because this group refuses to try to lose weight on their own. Then we’ll have to hope they don’t have expensive post-surgical complications or won’t gain any of the weight back.

You may think the above paragraph sounds judgmental, but I know two people who have lost well over 100 lbs each ON THEIR OWN. And they both accept full responsibility for exactly how they gained it all. It can be done. Accepting full responsibility for one’s health is the key.

Back over nine years ago, I obtained my present health coverage for a $92 mo initial premium (which only lasted six months) through a lengthy underwriting procedure where I:

-had to provide all my medical records;

-had to sign a waiver stating that I understood I would have no maternity care;

-had to provide my family history

They then sent a local nurse to my home where she:

-looked closely at the condition of my skin, hair and eyes and made a report;

-took my blood pressure;

-listened to my heart and then took an EKG reading;

-moved my limbs around to determine my range of motion;

-took five vials of blood and wrapped it up in a special refrigerated box in front of me to mail it off to an east-coast lab;

-brought her own scale which she used to take my height and weight; and

-took several photos of me top to bottom in front, side and rear view.

It then took two more months for them decide if they wanted me and to confirm the premium that was quoted to me.

***

Now, here we are in 2013 and nothing’s changed, except that I’ve been lifting weights several times per week for 4.5 years and am in better shape. I haven’t used the plan anywhere near the degree of what I paid into it and now they are “dropping me” because it’s not profitable enough for them to do biz in CA anymore. I now pay them nearly 4X the premium I did when they first covered me. Most of my rate hikes were since “Obamacare” was announced in 2010 where our President, in trying to “sell” the PPACA to to the public, told the nation, “If you like your insurance plan, you can keep it.”

We all now know the outcome of that (infamous) statement.

I know I’m not alone and won’t be alone. I reread this thread and discovered Pigg Hatfield got a similar letter to my recent termination letter back in February from Pacificare (part of United Healthcare). This is really everyone’s problem now.

Since none of us can control the speed and direction of this train wreck, I’ve decided I’m going out with a bang. Since I may never be able to see my (renowned) doctors again, I’ve scheduled three (expensive) “preventative” exams/tests for 2013 and will schedule the fourth by the end of the week. At least I will have all these results by EOY (for just $50 out-of-pocket, folks) and KNOW the exact condition of my health before I subject myself to the watered-down vagaries of semi-socialized medicine for 65-80% more in monthly premium :=]

[no_such_reality]

[quote=bearishgurl]
“Obamacare” is having the effect of dismantling a “system” that, IMO, wasn’t really broken.

If a person is otherwise healthy now, i.e. achieved a remission from cancer, they shouldn’t be considered to have a “pre-existing” condition. For the most part, I agree that “pre-existing conditions” should not be considered in the underwriting process.

[/quote]

That’s why it’s broken. They are. In fact, you are borderline un-insurable if you have had it. You could be like some previous posters here and carry high expense, high deduct, high copay and a bazillion exclusions.

But that’s really, just the lottery. Except, unlike the lottery, you’re almost guarantee winner. As a female, you have 1 in 3 chance of developing cancer, regardless of how healthy you think you’re being. As a male, it’s 1 in 2 chance.

As a couple, that’s a combined 83% chance one or the other is getting something. Once that something comes up. Don’t lose job, don’t get a gap in coverage. And even if you have your insurance, hope you can still make the new premium payments, because your premium is now base on the ‘I’m a cancer patient’.

As for losing your plan, that as Aetna’s choice. As for your costs increasing, it’s a combo of factors. The first is your age, the plan cost go vertical even before ACA, part is ACA.

America had the best system, as long as you didn’t get sick and survive. It works wonderfully as long as you get sick and die.

America also has a huge problem. You exemplify it. You want to go were-ever for what-ever treatment you think is warranted and you want someone else to pay. The insurance. That’s extremely expensive.

I understand your complaint, but I’ve known too many people that basically have lost that die roll and now can’t get insurance, or have prohibitive costly insurance. They were just like you, up until that melanoma spot showed up.

[bearishgurl]

You bolster my argument, NSR, that something could have been done to eliminate “pre-existing conditions” from underwriting criteria and allow those people you’re discussing here to obtain a ~reasonable $600-$800 monthly premium through the state pool. The state could have put a program in place JUST FOR THEM to help with premiums to get their premiums down to a manageable level.

We didn’t have to dismantle the entire system and lose several major carriers as a byproduct. (I’m watching with bated breath as more carriers decide it makes “good business sense” for them to leave CA.) For example, CA has a VERY large, diverse population with hundreds of thousands of new immigrants who will be able to avail themselves of tax credits to use to pay their health premiums thru Covered CA.

I lost an immediate family member from Stage 4 melanoma. It’s a swift and sure death. I myself have had a non-malignant skin cancer removed. This is another one of those diseases that is entirely preventable by taking personal responsibility for one’s skin in the sun and paying attention to changes in one’s skin.

Individual policyholders SHOULD have the freedom of choosing between an HMO, PPO or a simple catastrophic plan. They’re paying the ENTIRE premium! It’s a free country, NSR. If some policyholders want the freedom to choose a provider in another state who belongs to their plan or join a clinical trial in another state or country and/or they are willing to pay the out-of-network difference, that’s their perogative.

At first blush, “Obamacare” appears to be (insidiously) eliminating these health insurance freedoms that Americans have long enjoyed.

[SK in CV]

[quote=bearishgurl]I lost an immediate family member from Stage 4 melanoma. It’s a swift and sure death. I myself have had a non-malignant skin cancer removed. This is another one of those diseases that is entirely preventable by taking personal responsibility for one’s skin in the sun and paying attention to changes in one’s skin.

[/quote]

Bullshit. It is neither a swift and sure death, nor is it entirely preventable.

My brother has had it twice. First time more than 10 years ago. Second time 18 months ago. He’s still alive, with no signs of it. Neither are all melanomas preventable.

You’re lucky you’re healthy. I’m sure you like to attribute it to your healthy lifestyle. It’s still just luck. My aforementioned brother is my twin. Thirty years ago he was a professional athlete and weighs less now than he did when he played. Never been a pound overweight. Has worked out at least 3 days a week since he was in his teens. Eats a healthy diet. Barely drinks and has never smoked (even weed). Never spent the 1,000s of hours in the sun that I did. He’s probably spent 75 days in the hospital over the last 15 years. He has now, or has had at least 4 different things that could have, or could still kill him with no notice. None of them are lifestyle related. Has a defibrillator permanently installed in his chest so he doesn’t spontaneously go into v-tach. (It’s gone off at least 3 times, maybe more, since he had it installed almost 10 years ago. He doesn’t even mention it anymore.)

So be happy and count your blessings. But don’t for a minute think that your good health is just because you took care of yourself. So do a lot of other people who aren’t near as lucky as you.

[no_such_reality]

[quote]Individual policyholders SHOULD have the freedom of choosing between an HMO, PPO or a simple catastrophic plan. They’re paying the ENTIRE premium! It’s a free country, NSR. If some policyholders want the freedom to choose a provider in another state who belongs to their plan or join a clinical trial in another state or country and/or they are willing to pay the out-of-network difference, that’s their perogative.[/quote]

You can still buy whatever policy you want through the private markets.

If you go through the health exchange, they’re standardized.

Will the insurance industry adapt? Sure, and yes, companies will choose not to offer plans that have just a handful of clients.

[quote]I lost an immediate family member from Stage 4 melanoma. It’s a swift and sure death. I myself have had a non-malignant skin cancer removed. This is another one of those diseases that is entirely preventable by taking personal responsibility for one’s skin in the sun and paying attention to changes in one’s skin.[/quote]

Sorry to hear that. As for melanoma being preventable, not really. Unless you consider clueless behavior before age 10 and before the sun was consider really harmful reckless. There’s plenty of studies basically shown your risk factor can be porked by one sunburn.

Prevent death sure, that’s diligence, aggressive treatment. Prevent occurrence, nope.

As for a simpler just exclude pre-existing conditions, yea they could have, it’s just a variation on what’s been done. But without a bunch of new enrolls, subsidized, your premiums would be even higher.

[bearishgurl]

[quote=SK in CV][quote=bearishgurl]I lost an immediate family member from Stage 4 melanoma. It’s a swift and sure death. I myself have had a non-malignant skin cancer removed. This is another one of those diseases that is entirely preventable by taking personal responsibility for one’s skin in the sun and paying attention to changes in one’s skin.

[/quote]

Bullshit. It is neither a swift and sure death, nor is it entirely preventable.

My brother has had it twice. First time more than 10 years ago. Second time 18 months ago. He’s still alive, with no signs of it. Neither are all melanomas preventable.

You’re lucky you’re healthy. I’m sure you like to attribute it to your healthy lifestyle. It’s still just luck. My aforementioned brother is my twin. Thirty years ago he was a professional athlete and weighs less now than he did when he played. Never been a pound overweight. Has worked out at least 3 days a week since he was in his teens. Eats a healthy diet. Barely drinks and has never smoked (even weed). Never spent the 1,000s of hours in the sun that I did. He’s probably spent 75 days in the hospital over the last 15 years. He has now, or has had at least 4 different things that could have, or could still kill him with no notice. None of them are lifestyle related. Has a defibrillator permanently installed in his chest so he doesn’t spontaneously go into v-tach. (It’s gone off at least 3 times, maybe more, since he had it installed almost 10 years ago. He doesn’t even mention it anymore.)

So be happy and count your blessings. But don’t for a minute think that your good health is just because you took care of yourself. So do a lot of other people who aren’t near as lucky as you.[/quote]

SK, this isn’t the same brother that worked “outside” as a SD cop, is it?

Actually, SK, I do NOT take my health for granted. I have always been pretty athletic but have gotten more diligent about taking better care of my health in the last ~7 years (since three of my immediate family got sick and died at fairly young ages). My mom died 18 years ago at barely 60 yrs old from heart disease, after two balloon angioplasty procedures, one catheterization and one (failed) double-bypass surgery. On her death certificate, she was listed as one pound more than me and one inch taller. My very successful younger sister’s “luck” happened to run out in the prime of her life (age 46). She was diagnosed with Stage 4 cancer and died in less than 10 months, but only because she valiantly tried to save herself with assorted lethal “cocktails” and various “off-label” (traditionally used for other types of cancer) chemo. She was inoperable so was given only six months to live and wanted to see her kids graduate from HS so decided to grab at straws. Three out the four of her last months were nothing short of horrible for her (and the rest of us) until she gave up the drugs when she learned she was nearing death.

My dad DID have his advanced melanoma removed in surgery but it came back very fast and wiped him out. By the time its (advanced) metastasis was rediscovered (~one yr after surgery), it was too late. He had originally waited TOO LONG to get diagnosed after noticing changes in his skin and ended up having a very large tumor removed. After his melanoma surgery and recovery, he became tired and depressed over the untimely deaths of my siblings and didn’t get regular ct scans over the ensuing months. (He had already survived a different cancer ten years earlier after one l-o-o-o-ong year on chemo, while still working.) It was just all too much for him and I think he really didn’t want to know the status of his health anymore. He worked up until two weeks before his death and died at 73.

All of my relatives were well-insured and it didn’t matter.

I have one brother left who is five years younger than me. He wasn’t doing so well physically but “retired” a year ago and has been getting a lot of exercise and doing much better since then.

My family has a long history of three related cancers and complications from diabetes and heart disease so I DO consider myself lucky … so far. I have to continue to be diligent regarding my health or I will undoubtedly meet with the same fate. And I might, anyway, even if I begin running marathons tomorrow :=0

We can’t choose when to die or what will kill us but we can certainly do the things that are within our control to feel better and live as long as possible, given the genes with which we are dealt.

[SK in CV]

[quote=bearishgurl]SK, this isn’t the same brother that worked “outside” as a SD cop, is it?

[/quote]

No, it’s not. The (now former) cop is my younger brother. He’s a physical mess too, but all from work related injuries. I was referring to my twin brother. He’s had plenty of injuries too, but none life threatening.

[bearishgurl]

[quote=no_such_reality]You can still buy whatever policy you want through the private markets.

If you go through the health exchange, they’re standardized.

Will the insurance industry adapt? Sure, and yes, companies will choose not to offer plans that have just a handful of clients.[/quote]

nsr, I’ve already talked to a couple of brokers. The insurance companies have already “adapted.” Neither of them advocated signing up for ANY plan until after October 1 when Covered CA provisions will be more “fleshed out.” They can’t guarantee that ANY plan a CA resident signs up for today will even be in existence in 2014 or throughout 2014.

They will be able to advise on which plan within the exchange is the best plan for an individual or family to sign up for.

Obamacare is “here” and I have to take my statutory six-months notice of continuing coverage from my carrier and wait it out until the fourth quarter of 2013, when I will be able to apply on the exchange.

[bearishgurl]

[quote=SK in CV][quote=bearishgurl]SK, this isn’t the same brother that worked “outside” as a SD cop, is it?

[/quote]

No, it’s not. The (now former) cop is my younger brother. He’s a physical mess too, but all from work related injuries. I was referring to my twin brother. He’s had plenty of injuries too, but none life threatening.[/quote]

LOL. I’ve heard a lot of complaints on this forum over the years about how all these “spoiled” cops from CA law enforcement agencies take “lavish” early retirements to endlessly play golf, travel and hang out with their brethren. I posted here a couple of times that the disability rate of retired cops is REALLY HIGH and the death rate a few months/years after retirement is also very high.

I don’t think very many were listening because this issue still comes up at least 1-2 times per month.

[no_such_reality]

Show us the data BG, because CalPERS calculates that cops life expectancy is longer than the general public.

[bearishgurl]

SK, your brother is very fortunate to have survived two? bouts of melanoma. This disease tends to spread like wildfire causing it to advance to an untreatable stage quickly. He must have been paying attention and sought treatment very early on.

[Author]

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