Costco Aetna Health Insurance now available in CA

[no_such_reality]

[quote=bearishgurl]
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.
[/quote]

BG, the reality is they never could guarantee any plan would be here next year, whether this year, or five years ago.

Companies readily dropped plans and changed plans all the time. In fact, that’s why I get multiple notices about changes to my plans every year.

GM invented the mini-van. They no longer sell mini-vans.

Likewise, they’ve discontinued many car makes and entire car lines.

Yes, there’s a big change coming. The insurance companies are reacting to making new plans targeted to an insurance pool that is much larger.

You choose poorly. You chose a cheap provider that has bailed on you. If you would have chosen Kaiser, or one of the others, you’d still have insurance.

Fickle isn’t it. Which is why the changes in ACA, while expensive, are needed. I don’t say that to be petty or mean. It’s just one more way insurance companies are fickle and a person finds themselves suddenly hung out to dry by them. For many, it’s when they actually get sick.

Even without ACA, given Aetna’s private insurance market penetration, I wouldn’t have been surprised to see them bail on really any changes. Most major companies divest themselves of anything that isn’t a material cash cow if they’re not one of the top three in the market.

You can count yourself as fortunate or unfortunate, but essentially, when Aetna saw they couldn’t cherry pick in California so that people could pay far more than they use, Aetna decided to leave. I would say you’re very fortunate to have been in a position to be cherry picked. And very fortunate that the common random event didn’t come up to have Aetna decide they no longer wanted to cherry pick you.

[bearishgurl]

[quote=no_such_reality] . . . Yes, there’s a big change coming. The insurance companies are reacting to making new plans targeted to an insurance pool that is much larger.

You choose poorly. You chose a cheap provider that has bailed on you. If you would have chosen Kaiser, or one of the others, you’d still have insurance . . .[/quote]

Actually, nsr, you probably haven’t been around long enough to know that Aetna was never a bit player in CA OR a “cheap provider.” Aetna’s PPOs in SD were managed by CCN for nearly 20 years, until CCN was bought out and Aetna formed what we now know as their “Advantage Plans” (PPO), which are both HDHP and comprehensive.

http://firsthealth.coventryhealthcare.com/about-first-health/

I had an Aetna HDHP through my govm’t employer for over 13 of those years with Champus Standard (now Tricare) picking up right behind them. With both, I could see the best providers from a big selection of local providers and pay only the first $150 of my medical expenses out of pocket every year (my Champus deductible). I didn’t care about the Aetna $500 deductible (this was “high” back then) OR their coinsurance requirements because Champus picked up the slack. The situation was the best of both worlds and many military dependents who worked for local govm’t did this. In addition, I had a comprehensive Aetna Advantage PPO at a law firm I worked at after taking deferred retirement. Many SD firms today still offer Aetna Advantage. I liked it so much that I formally applied for it after I left because I didn’t want to pay COBRA rates for it. Aetna is still here in CA but ONLY for its “enterprise” clients. They are only terminating the CA individual policyholders.

I wouldn’t have Kaiser if you gave it to me. I had two co-workers who were almost killed over there in Allied Gardens in that bldg Kaiser calls their “hospital.” In addition, they performed wrong operations (removed wrong organ) on two SD residents in the eighties and these cases were tied up in court for years. I could go on. They’re well known for being incompetent and their “system” has been well known for not being able to tell the right hand from the left hand. Coworkers who subscribed to Kaiser told me they rarely ever saw the same doctor twice and the doctor turnover was phenomenal. Their “urgent care clinic” wait was often several hours in a room full of sick people. Often times they were met by a PA or NP for an appt and never saw the doctor they made the appt to see, or any doctor, for that matter.

You do whatever you want and have a nice life, nsr. I’ll stick with a PPO with choice … as I always have and if I happen to draw an “HMO” in the “Covered CA lottery,” I will keep it for one year only, which is just enough time for me to make my exit from this great state of ours. I don’t care much now and at that point, I won’t care at all. There are several back bedrooms available to me here if I should find an intermittent compelling need to visit, both here and in NorCal. Those interstates out there run in both directions and I know how to find CA cuz I’ve had lots of practice. It’s all good 🙂

Thank you and good night.

[no_such_reality]

BG, once again, a wall of words.

Aetna in the private plan realm was a bit player they barely had 5% market share. In corporate plans, they’re huge. They’re still here in corporate plans.

I myself pay more to carry a PPO, because I want the choices too. What you’re seeing is just how expensive those choices are going to be. And keep just hoping your 1 in 3 number doesn’t come up.

Luckily, ACA will protect you from realizing what that really would have meant.

[CardiffBaseball]

Curveball of a question.

In these days of sequestration looming, in the defense world, what do you guys think of working for an insurer? I’ve seen a few things in my niche at a couple of Blue Cross type places, are they in a fairly safe growth mode for now or do we expect that all to grind to a halt soon.

BTW my wife went Stage 4 earlier this year with Mets to the spine. My company plan went to this excruciatingly high-deductible type plan where our max out is now 9000 on top of about 5k in premiums and of course you do get nickle-dimed on stuff. Seems like I always make just enough to avoid deducting medical expenses, but with all the gas and tolls to MD Anderson downtown, it takes a toll.

The thing is my youngest is 16 now entering his Jr. year and she’s going to fight as long as she can she wants to see him graduate, much like the post above. The worst thing is she’s continued to work but we are looking at how she can opt out of that. Certainly if another Bone Met comes along she’s got to file for disability and get out of there. (her working pays for the child’s HS however).

Anyway I see some insurers out there are ramping up in my area. Kind of tempting but I don’t know what the future holds with them. Single Payer would of course kill them off right?

[no_such_reality]

Cardiff sorry to hear it, I hope for you family she gets to enjoy graduation.

I think some of the bigger insurance groups, like Blue Shield will survive, they’ve got very good actuarial processes to estimate what they’re getting. Kaiser priced themselves out of playing, but that was intentional, whether it’s a cynical we don’t want the first year cost or a realistic knowledge of the capacity of their network or both is TBD.

Me personally, I think some of the smaller ones (and many winners of the covered plans are smaller), may find themselves swamped, they’re really looking at explosive growth. The big opportunity and big risk.

You’re in a tough spot, really needing stability and flexibility.

Unfortunately, starting this year, for those under 65, the medical deduction moves up to 10% of AGI.

[bearishgurl]

[quote=CardiffBaseball] . . . BTW my wife went Stage 4 earlier this year with Mets to the spine. My company plan went to this excruciatingly high-deductible type plan where our max out is now 9000 on top of about 5k in premiums and of course you do get nickle-dimed on stuff. Seems like I always make just enough to avoid deducting medical expenses, but with all the gas and tolls to MD Anderson downtown, it takes a toll.

The thing is my youngest is 16 now entering his Jr. year and she’s going to fight as long as she can she wants to see him graduate, much like the post above. The worst thing is she’s continued to work but we are looking at how she can opt out of that. Certainly if another Bone Met comes along she’s got to file for disability and get out of there. (her working pays for the child’s HS however). . . [/quote]

Cardiff, my heart goes out to you and your family. My sister was able to work until the experimental stuff she tried as a last-ditch effort did her in (<3 mos before she passed). She had enough terminal leave to cover her premiums for the following two months and a week of hospice care. She only stayed (carrying her "fanny pack" of poison every day and then 2-3 days per week) because she was the COO of an entire division and felt indispensable but I think her employer would have understood if she had decided to go out on disability. I was with her when she decided to spend over an hour talking to her colleagues all over the country on speakerphone to say her final thank yous and good-byes just six days before she passed and I had to leave early on because I just couldn't handle listening to all these grown men and women lose it in between laughing and recounting memories with my sister.

Her employer arranged their own memorial service for her in which over 500 of her present and former colleagues, contractors and vendors came from all over the country to pay their last respects.

You were wise to put your spouse on your company plan even though she may have access to her own coverage. This will give her more flexibility in how to spend her precious time going forward.

Your son will be okay, even if he has to finish HS at a public school.

Hang in there, Cardiff. I'm thinking of you and your family and I'm sure many other Piggs are too 🙂

[CardiffBaseball]

Thanks BG, it’s not always easy. I don’t like having to watch her weaken. A big strong 5’10” swimmer girl, deadlifting 280 at the crossfit down in Encinitas, just a few years back, now getting weakened with each passing day. She’s 45 her sister died at 42 of Ovarian, I am just hoping she hangs on long enough to bury her parents though they seem very at peace with everything. Stage IV people, know there isn’t a cure so they stop going to the pink ribbon walks. At this point it’s all about surviving as long as you can.

She told me please don’t put in my obituary that she “went peacefully”. She fought like a mofo, is what it ought to say.

[TemekuT]

My heart goes out to both of you – BG and CardiffBaseball. I have the same situation with my beloved baby sis, who has always been vigilant about diet, weight, exercise. She was diagnosed with stage IV cancer 2 years ago at age 47 and is fighting with all she’s got. Thankfully, when she was struggling financially in the prior 2 years, she did not cancel her PPO and now has many care choices and can be selective about her treatments. I believe my sis will benefit from Obamacare and I am fine with helping her and others similarly stricken.

On the other hand, I will now have to contribute to relatives, acquaintances, and strangers’ future medical costs due to their laziness, lack of discipline and bad choices. I have some relatives that take cholesterol meds and blood pressure meds, but indulge almost daily in bacon, egg, and donut breakfasts. I get to watch as the metabolic syndrome they obviously have transforms into diabetes. They regularly circle around parking lots to get the spot closest to the restaurant door, where they consume pizza or fried chicken, followed by sugary and fatty desserts. They have packed on the pounds around their middles, and it’s not attractive being 50 lbs overweight.

Now my sis, that’s just genetic bad luck, but I do resent paying for others’ preventable conditions.

BG – I also have an individual AETNA PPO and received the letter, and am confused about what to do. I take great care of myself, with a very healthy diet and lots of exercise. I am slim, and have no conditions at 55+. It’s not always fun to haul myself out of bed early like I did this morning, walk a few miles, and then breakfast on oatmeal, but I do it because I want to be a healthy oldster.

[no_such_reality]

Looks like United Health is also bailing on the individual insurance market. Pretty amazing to think they only had 8000 individual plan members.

United Health to exit Individual California Insurance Market

Wow, quite a bit of real info in that article. Blue Cross, Blue Shield and Kaiser have 87% of the individual market in California. Aetna had 5% and United, had 2%.

[quote]Outside California, UnitedHealth said it expects to participate in about a dozen exchanges across the country for individuals or small-business customers.

“We continue to evaluate opportunities and make decisions regarding exchanges on a state-by-state basis,” said company spokeswoman Cheryl Randolph.

California has been more aggressive than other states in forcing insurers in the exchange to compete more directly on price by establishing uniform deductibles and benefits across four main product categories. In response, many insurers have squeezed hospitals and physician groups for better rates and formed smaller networks of medical providers to hold down premiums.[/quote]

So in a nutshell, they don’t want to play where people can compare apples to apples.

[FlyerInHi]

I’m with you temeku.

The reality is that we all end up paying for people’s irresponsibility one way or another.
I chalk it up to to the cost of living In America, just like businesses call some expenses the cost of doing business in a certain environment.

I hope that, with obamacare, insurance companies will develop and encourage prevention programs designed to save costs and improve long term health.

You are my hero Temeku. The problem in America we have a culture that doesnt’t appreciate people who are consistent in doing all the right things all the time. We worship people who have stories of reaching peaks, crashing, and recovering again and again. They get all the attention and money. I completely understand your resentment.

But fear not, temeku. You will win because you will live well and enjoy life. I tell my old buddies that past glory is no indication of future well-being. You have to work on it and unless you build strength of character and discipline early on, it gets harder and harder with age.

[CA renter]

Cardiff,

I am so sorry to hear about your wife’s situation. May you and your family stay strong and enjoy every moment of every day together, and I sincerely hope you have many happy days/years together. None of us ever knows when our time is up, even if we’re perfectly healthy today. No matter how hard some people try to convince themselves that they have control over it all, it is 90% luck — I’ve seen too much to think otherwise. Fuck cancer. 🙁

[CardiffBaseball]

[quote=CA renter]Cardiff,

I am so sorry to hear about your wife’s situation. May you and your family stay strong and enjoy every moment of every day together, and I sincerely hope you have many happy days/years together. None of us ever knows when our time is up, even if we’re perfectly healthy today. No matter how hard some people try to convince themselves that they have control over it all, it is 90% luck — I’ve seen too much to think otherwise. Fuck cancer. :([/quote]

Damn right!! The difference is she is absolutely facing, we all know we are going to die, but in the back of our minds we’ll make it to 75 or whatever. Whereas the Stage IV person is having to face it head on for a while.

[CA renter]

Absolutely, Cardiff. We’ve had a number of similar situations in my family as well. I’ve been really depressed for the past few hours after reading your post. It is so, so wrong. My heart goes out to you guys. If I had just one wish in life, it would be finding a cure for all cancers. That f’ing disease sucks.

[bearishgurl]

[quote=CardiffBaseball]Thanks BG, it’s not always easy. I don’t like having to watch her weaken. A big strong 5’10” swimmer girl, deadlifting 280 at the crossfit down in Encinitas, just a few years back, now getting weakened with each passing day. She’s 45 her sister died at 42 of Ovarian, I am just hoping she hangs on long enough to bury her parents though they seem very at peace with everything. Stage IV people, know there isn’t a cure so they stop going to the pink ribbon walks. At this point it’s all about surviving as long as you can.

She told me please don’t put in my obituary that she “went peacefully”. She fought like a mofo, is what it ought to say.[/quote]

Hey Cardiff, my sister was a woman in a “man’s world” very early on and she would have advised us to have her epitaph read the same as your spouse told you, “I fought like a mofo.” I spoke at length in a eulogy for her where we transported her remains to be buried in her “flyover state” hometown.” She was such an inspiration to me which, to this day, reflects who I am now. I didn’t have the education or experience that she possessed but gained so much from having her in my life (although mostly telephonically due to distance in the years preceding and up to her death) as she resided in the state of MD (near DC).

Keep on keepin’ on, Cardiff. Your spouse needs your support right now. My earlier post was predicated on your earlier post:

http://piggington.com/life_insurance#comment-222246

I just felt at the time of my post that your spouse having progressed from Stage 1-2 to Stage 4 in ~7 months was not a positive sign. However, none of us know our “time is up” until death is imminent.

Keep on being the great support that you are to your spouse, Cardiff. That is what she needs right now. Her parents have undoubtedly seen a lot of “stuff” in their lifetimes and are more accepting of the inevitable cycles of life … and death.

[bearishgurl]

[quote=TemekuT]My heart goes out to both of you – BG and CardiffBaseball. I have the same situation with my beloved baby sis, who has always been vigilant about diet, weight, exercise. She was diagnosed with stage IV cancer 2 years ago at age 47 and is fighting with all she’s got. Thankfully, when she was struggling financially in the prior 2 years, she did not cancel her PPO and now has many care choices and can be selective about her treatments. I believe my sis will benefit from Obamacare and I am fine with helping her and others similarly stricken.

On the other hand, I will now have to contribute to relatives, acquaintances, and strangers’ future medical costs due to their laziness, lack of discipline and bad choices. I have some relatives that take cholesterol meds and blood pressure meds, but indulge almost daily in bacon, egg, and donut breakfasts. I get to watch as the metabolic syndrome they obviously have transforms into diabetes. They regularly circle around parking lots to get the spot closest to the restaurant door, where they consume pizza or fried chicken, followed by sugary and fatty desserts. They have packed on the pounds around their middles, and it’s not attractive being 50 lbs overweight.

Now my sis, that’s just genetic bad luck, but I do resent paying for others’ preventable conditions.

BG – I also have an individual AETNA PPO and received the letter, and am confused about what to do. I take great care of myself, with a very healthy diet and lots of exercise. I am slim, and have no conditions at 55+. It’s not always fun to haul myself out of bed early like I did this morning, walk a few miles, and then breakfast on oatmeal, but I do it because I want to be a healthy oldster.[/quote]

TemekuT, it appears we’re both in the same boat. I have spoken to a third broker in SD last week and he told me that, even though Covered CA’s website and charts do not indicate that tax credits are available for anything but the “Silver Plan” (2nd from the bottom plan), he was certain they would be available to help pay for the Gold or Platinum Plan. I have a few unanswered questions about ALL of the plans on the exchange, mainly regarding access and choice. I understand the differences in the co-pays and all of the plans offered by Covered CA have low deductibles. But I’m wondering if access and provider choice are the same on all of them. If it is, then the Silver Plan would be the way to go because it is, by far, the cheapest. But if access and choice are better or much better on the Gold or Platinum plan, then those plans merit looking into.

I’m waiting to see which of the exchange’s plans will be administered by CA carrier Anthem Blue Cross. That will undoubtedly be the plan with the most choice.

I don’t care as much about the cost of copays but want preventative care (incl periodic “expensive” tests) covered at least 75%.

The “Bronze Plan” appears to be geared towards 20-somethings (who generally have little need for any services outside of basic preventative care).

I’m also in the 55-60 age group and, at first blush, it appears the top three plans on the exchange will have monthly premiums between $557 and $866 month (abt 50%-250% higher than my current mo premiums). Even though I currently have a higher deductible ($5K) and coinsurance requirement ($3K), I have the ultimate in nationwide access, the ultimate in provider choice and 100% of my preventative care is covered (incl “expensive” tests and scans). In addition, my copays for office visits are less than those on the “Silver Plan.” (My particular plan configuration is “grandfathered” and thus hasn’t been offered to new enrollees since before the PPACA became law in March of 2010.)

I’m so sorry to hear about your sister, TemekuT. My sister never drank or smoked but was a road/sky warrior 8-12 business days per month for many, many years so had to learn to regularly sleep on planes, live in hotels and dine in restaurants alone or with colleagues for nearly every meal. When she returned home, she spent her precious time watching her kids sporting events and readying her suitcase for the next trip instead of going to the gym. She even traveled extensively while expecting and a few weeks after the births of her children. Luckily, she had competent caregivers and a supportive spouse, who took care of her until the end. In hindsight, I feel her lifestyle took a toll on her health in that it possibly contributed to a late diagnoses. She wasn’t obese but became a little overweight in her forties. I believe her cancer was inherited but will not know for certain for at least another year when I will be able to return to the east coast and pay for genetic testing. I’m worried about my kids as well and, even if it skips me, I’m worried about my nieces and nephews.

If a “single-payor system” is the direction this country ends up taking, I don’t have a problem either with subsidizing the health premiums of unlucky people like our sisters. But I’m with you in that I don’t want to subsidize the premiums of people who are eating, smoking, drinking and drugging themselves into early graves.

Due to the sheer volume of currently uninsured people in CA who will qualify for tax credits to obtain health coverage on one of Covered CA’s plans, I just feel their need will be great. Throughout 2014 and 2015, (if this group continues to consistently pay the monthly balance of their premiums after their tax credits), they will become established with primary care providers and specialists. In doing so, they will be taking up a LOT of appointment time (meaning a 45 min appt instead of 5-15 mins) because many of them haven’t seen a health provider in decades and will undoubtedly encounter many surprises. I just feel these provider groups will be swamped and not know how far apart to space appointments and possibly have to stay open evenings and Saturdays to accommodate all the new insureds, along with their regular longtime patients. Going to the doctor will be like going to traffic court. These problems will severely lessen the quality and quantity of care for everyone, IMHO, if the provider list for all of the exchange’s plans are the same.

If the above happens, not only do I see a lot of (very established) providers retiring or relocating, I see a lot of boomers leaving large CA urban areas and flocking to the “nicer” rural areas (ex: Lake Tahoe, Mammoth Lakes, Mendocino, Solvang … even the Rockies) where there aren’t so many people (the previously uninsured and newly-minted US citizens) vying for appointments with the same provider groups. I’ll be right behind them.

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