Costco Aetna Health Insurance now available in CA

[joec]

[quote=bearishgurl]

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.[/quote]

Not sure if anyone has used their ACA coverage yet, but I HAD Anthem Blue Cross thinking they had a good network, but their coverage and doctor/hospital access is EXTREMELY limited. Also, based on the law, ACA coverage should be the same as their regular plans in terms of doctor/hospital access so if they don’t have it in ACA, they probably would not have it even if you purchased outside of ACA (no idea on grandfathered plans).

There was just an article published this week I think investigating that they misled consumers in CA as to which doctors they even had access to so I’d recommend everyone who has Anthem to check to see if they can even access the doctor they wanted to. I know I signed up specifically for Anthem since the doctor was on the list, but low and behold, it was a lie and they weren’t.

I changed our plan right after I couldn’t be seen. Also, getting support and talking to ANYONE at Anthem is incredibly hard and they are the WORST company to deal with. I’m still waiting for a billing issue currently.

We eventually went with Sharp Health since it’s much smaller and when you call, someone picks up immediately actually and you aren’t in a phone tree…It was also cheaper amazingly.

They AREN’T national though so if you have to pick someone who is, you’re more limited…(honestly, who needs national anyways?)

I never hated Kaiser, but it seems like a lot of people do (like my wife) and I’ve probably picked them instead if not for Sharp.

[SK in CV]

[quote=joec]
Not sure if anyone has used their ACA coverage yet, but I HAD Anthem Blue Cross thinking they had a good network, but their coverage and doctor/hospital access is EXTREMELY limited. Also, based on the law, ACA coverage should be the same as their regular plans in terms of doctor/hospital access so if they don’t have it in ACA, they probably would not have it even if you purchased outside of ACA (no idea on grandfathered plans).

[/quote]

I’ve seen a lot of articles and comments (elsewhere, not here) indicating a lot of confusion about “ACA plans” or “Obamacare plans”. With minor exception, all private insurance is now ACA compliant, irrespective of whether the plan is provided through an employer, purchased on a state or the federal insurance exchange, or purchased privately outside the exchanges. Effectively, ALL insurance is now an “ACA plan”.

In some states, some carriers have identical plans available both in and outside the exchange. And identical means identical, the exact same provider network. But there is no requirement that carriers offer identical plans off the exchange. In some states, carriers offer no off-exchange policies. And there is no requirement that provider networks be similar. Nothing about this is new. Big carriers like Anthem and Aetna have always had dozens of plans and each one had their unique provider network. Often providers will contract for some carrier plans but not others.

[joec]

[quote=SK in CV]

I’ve seen a lot of articles and comments (elsewhere, not here) indicating a lot of confusion about “ACA plans” or “Obamacare plans”. With minor exception, all private insurance is now ACA compliant, irrespective of whether the plan is provided through an employer, purchased on a state or the federal insurance exchange, or purchased privately outside the exchanges. Effectively, ALL insurance is now an “ACA plan”.

In some states, some carriers have identical plans available both in and outside the exchange. And identical means identical, the exact same provider network. But there is no requirement that carriers offer identical plans off the exchange. In some states, carriers offer no off-exchange policies. And there is no requirement that provider networks be similar. Nothing about this is new. Big carriers like Anthem and Aetna have always had dozens of plans and each one had their unique provider network. Often providers will contract for some carrier plans but not others.[/quote]

Yes, you are very correct that all plans are now ACA compliant.

Someone correct me if I am wrong here, but I’ve read that if a provider network isn’t contracted to be offered through ACA, they also won’t be offered through private purchase directly outside ACA neither.

So this point you mention isn’t correct from what I’ve seen and have personally experienced first hand:

”
Big carriers like Anthem and Aetna have always had dozens of plans and each one had their unique provider network
”

I’ve read that the networks are the same whether it’s ACA or private purchase.

I don’t know about employer plans since that’s probably totally different.

My point being:

My kids wanted to use Sharp facilities via Anthem Blue Cross outside of ACA. Anthem isn’t contracted with Sharp currently so if you have Anthem, you can’t go to a Sharp Rees-Stealy Hospital/Medical facility (again, I don’t know about employer plans).

Maybe someone with Anthem Blue Cross (non-employer since I think that’s a totally different market) can state they HAVE been able to use Sharp Hospitals with Anthem…but when I called Anthem, they couldn’t find anyway to get that so we had to all switch…

Again, this is from my own real life experience as I was rejected actually AT the Sharp hospital so take it for what it’s worth.

[UCGal]

I was pricing insurance this week to determine if I wanted to go COBRA or ACA exchange. The coveredCA website was less helpful than the einsurance.com website. On einsurance they let you filter options by whether you’re ok with a more limited network.

I found that my employer plan, even at full COBRA prices – is a much better deal than what I can get via an unsubsidized private plan. Equivalent plan outside of COBRA is $700 more per month. Proof again, that employers can use their negotiation to get better deals. I was comparing Kaiser Permanente prices, since I’m a satisfied Kaiser customer.

[bearishgurl]

[quote=joec][quote=bearishgurl]

[snip] [/quote]Not sure if anyone has used their ACA coverage yet, but I HAD Anthem Blue Cross thinking they had a good network, but their coverage and doctor/hospital access is EXTREMELY limited. Also, based on the law, ACA coverage should be the same as their regular plans in terms of doctor/hospital access so if they don’t have it in ACA, they probably would not have it even if you purchased outside of ACA (no idea on grandfathered plans).

There was just an article published this week I think investigating that they misled consumers in CA as to which doctors they even had access to so I’d recommend everyone who has Anthem to check to see if they can even access the doctor they wanted to. I know I signed up specifically for Anthem since the doctor was on the list, but low and behold, it was a lie and they weren’t.

I changed our plan right after I couldn’t be seen. Also, getting support and talking to ANYONE at Anthem is incredibly hard and they are the WORST company to deal with. I’m still waiting for a billing issue currently.

We eventually went with Sharp Health since it’s much smaller and when you call, someone picks up immediately actually and you aren’t in a phone tree…It was also cheaper amazingly.

They AREN’T national though so if you have to pick someone who is, you’re more limited…(honestly, who needs national anyways?)

I never hated Kaiser, but it seems like a lot of people do (like my wife) and I’ve probably picked them instead if not for Sharp.[/quote]

joec, I have a Blue Shield of CA Platinum PPO from Covered CA. It took a l-o-o-ong time to get my membership card, but so far, I am happy with it and they have paid 90% of the bill for one “expensive test” so far in 2014 and all my current providers take the plan. I just found out that Sharp Rees Stealy is not on their provider list (not sure about Sharp hospitals) when I tried to access care in a local Sharp Rees Stealy Urgent Care clinic a few weeks ago on a weekend. They sent me to a nearby “US Healthworks” urgent care clinic who treated my minor injury just fine and I’m all healed up now.

IIRC, Sharp Platinum EPO was going to be ~$125 per month more for me and I needed national provider access, due to being on the road several weeks per year. Blue Shield of CA belongs to the BCBS National Provider Directory in the 48 contiguous states and even worldwide:

http://provider.bcbs.com/

Absent needed emergency care while out of county, Sharp EPO only covers the bills of providers within their EPO …. all located in San Diego County.

[SK in CV]

[quote=joec]Yes, you are very correct that all plans are now ACA compliant.

Someone correct me if I am wrong here, but I’ve read that if a provider network isn’t contracted to be offered through ACA, they also won’t be offered through private purchase directly outside ACA neither.

[/quote]

It doesn’t work that way. Provider contracts (i.e., contracts between carriers and providers which outline how much providers will be paid for each service) are different, or at least can be different for each policy. Carriers don’t offer contracts on every policy to every provider and providers don’t necessarily accept each contract offered. So even if a carrier offers a similar policy both on and off an exchange, their reimbursement contracts to providers can be different for each, possibly resulting in at least slightly different provider networks. All perfectly legal.

[joec]

[quote=bearishgurl]

joec, I have a Blue Shield of CA Platinum PPO from Covered CA. It took a l-o-o-ong time to get my membership card, but so far, I am happy with it and they have paid 90% of the bill for one “expensive test” so far in 2014 and all my current providers take the plan. I just found out that Sharp Rees Stealy is not on their provider list (not sure about Sharp hospitals) when I tried to access care in a local Sharp Rees Stealy Urgent Care clinic a few weeks ago on a weekend. They sent me to a nearby “US Healthworks” urgent care clinic who treated my minor injury just fine and I’m all healed up now.

IIRC, Sharp Platinum EPO was going to be ~$125 per month more for me and I needed national provider access, due to being on the road several weeks per year. Blue Shield of CA belongs to the BCBS National Provider Directory in the 48 contiguous states and even worldwide:

http://provider.bcbs.com/

Absent needed emergency care while out of county, Sharp EPO only covers the bills of providers within their EPO …. all located in San Diego County.[/quote]

Thanks for sharing…and confirming what I found out since in December, Anthem actually listed them as a provider as well.

We wanted to use the Sharp Rees-Stealy hospitals (and also Rady’s Children) since my kids have been going there since birth and Anthem Blue Cross and Blue Shield just didn’t offer them at all…so we switched.

Glad to hear you’ve been happy with it so far and your current medical professionals still takes your Blue Shield.

Just hate dealing with any issues with the Blue companies since it takes so long to get anyone on the phone.

[joec]

[quote=SK in CV]

It doesn’t work that way. Provider contracts (i.e., contracts between carriers and providers which outline how much providers will be paid for each service) are different, or at least can be different for each policy. Carriers don’t offer contracts on every policy to every provider and providers don’t necessarily accept each contract offered. So even if a carrier offers a similar policy both on and off an exchange, their reimbursement contracts to providers can be different for each, possibly resulting in at least slightly different provider networks. All perfectly legal.[/quote]

I was just commenting on what’s even accepted, not any rate/payments or reimbursement contracts. More of the “Do you take [fill in the blank insurance plan]?”

So as an example, I was saying if, say UCLA medical center doesn’t take Blue Shield ACA, then no matter what Blue Shield health plan you have, UCLA medical will never take it since they don’t have a provider/insurance contract with Blue Shield.

At least that’s what I’ve read.

Again, this is all self purchase and company plans might be different.

[SK in CV]

[quote=joec]I was just commenting on what’s even accepted, not any rate/payments or reimbursement contracts. More of the “Do you take [fill in the blank insurance plan]?”

So as an example, I was saying if, say UCLA medical center doesn’t take Blue Shield ACA, then no matter what Blue Shield health plan you have, UCLA medical will never take it since they don’t have a provider/insurance contract with Blue Shield.

At least that’s what I’ve read.

Again, this is all self purchase and company plans might be different.[/quote]

Nothing has changed in that regard. It has nothing to specifically to do with the ACA. (And again, almost ALL policies are now ACA policies.) Telling a provider that you have Blue Cross is rarely sufficient. Blue Cross has dozens of different types of policies. Some providers may take all. Some take none. And some take only selected policies. It is all about reimbursement rates. That’s how the decision to accept insurance is made.

You might remember a few years ago, I think it was Scripps who decided not to accept Blue Cross. (It may have been another large carrier.) It was huge news in the industry. It was all because their reimbursement rates weren’t high enough.

[bearishgurl]

[quote=joec][quote=bearishgurl]

joec, I have a Blue Shield of CA Platinum PPO from Covered CA. It took a l-o-o-ong time to get my membership card, but so far, I am happy with it and they have paid 90% of the bill for one “expensive test” so far in 2014 and all my current providers take the plan. I just found out that Sharp Rees Stealy is not on their provider list (not sure about Sharp hospitals) when I tried to access care in a local Sharp Rees Stealy Urgent Care clinic a few weeks ago on a weekend. They sent me to a nearby “US Healthworks” urgent care clinic who treated my minor injury just fine and I’m all healed up now.

IIRC, Sharp Platinum EPO was going to be ~$125 per month more for me and I needed national provider access, due to being on the road several weeks per year. Blue Shield of CA belongs to the BCBS National Provider Directory in the 48 contiguous states and even worldwide:

http://provider.bcbs.com/

Absent needed emergency care while out of county, Sharp EPO only covers the bills of providers within their EPO …. all located in San Diego County.[/quote]

Thanks for sharing…and confirming what I found out since in December, Anthem actually listed them as a provider as well.

We wanted to use the Sharp Rees-Stealy hospitals (and also Rady’s Children) since my kids have been going there since birth and Anthem Blue Cross and Blue Shield just didn’t offer them at all…so we switched.

Glad to hear you’ve been happy with it so far and your current medical professionals still takes your Blue Shield.

Just hate dealing with any issues with the Blue companies since it takes so long to get anyone on the phone.[/quote]joec, I just sent for a Blue Shield PPO Provider Directory for San Diego County and it was instantly e-mailed to me. ALL the hospitals in the county are in their network, including Rady Children’s and Sharp Mary Birch (Sharp’s specialty hospitals), including ALL standalone surgical centers and facilities in the county.

Blue Shield’s Urgent care providers are either US Healthworks or Doctor’s Express (and a few independents here and there where neither of these two exist). Sharp Rees Stealy and Sharp Mission Park providers work exclusively for Sharp (EPO) and thus are not on Blue Shield’s provider list.

I think Blue Shield has to cover all facilities because they have a very wide range of providers in each specialty, some of whom have been practicing for decades and have rights to practice at multiple hospitals and so they have to follow where the providers on their list choose to practice for a particular procedure.

Blue Shield of CA PPO definitely has more providers to choose from than any other healthplan on the exchange and was available in more regions than any other carrier. HOWEVER, Sharp EPO’s computer system amongst themselves ties together the care of a single patient at multiple facilities and therefore likely prevents mistakes. It’s a good system IF you are not planning on leaving the county, don’t travel for weeks at a time by road and generally don’t spend too long at a time away from home (“home” being SD County). The Gold and Platinum Sharp EPO plans are very pricey (esp for my demographic).

And yes, Blue Shield takes a l-o-o-o-ng time to answer the phone … or at least they did before April 30. (I used to put them on speakerphone and keep working.) They are HQ in SF but they opened up a HUGE warehouse-like call-center in Lodi last September where they hired thousands of newbies to take calls from Covered CA applicants. It was a real mess for a few months because their computer and Covered CA’s computer weren’t able to “talk” to each other. I haven’t called lately because I finally got taken care of. It took 120 days to get my membership card from my October 2013 application date. And I still didn’t have pharmacy benefits until the end of April, but they reimbursed me for my out-of-pocket expense in the interim.

You were with Anthem (HMO or EPO) and that is a completely different animal than Blue Shield of CA PPO. In CA, the two organizations are not related to one another (as they are in other states).

[bearishgurl]

[quote=SK in CV][quote=joec]I was just commenting on what’s even accepted, not any rate/payments or reimbursement contracts. More of the “Do you take [fill in the blank insurance plan]?”

So as an example, I was saying if, say UCLA medical center doesn’t take Blue Shield ACA, then no matter what Blue Shield health plan you have, UCLA medical will never take it since they don’t have a provider/insurance contract with Blue Shield.

At least that’s what I’ve read.

Again, this is all self purchase and company plans might be different.[/quote]

Nothing has changed in that regard. It has nothing to specifically to do with the ACA. (And again, almost ALL policies are now ACA policies.) Telling a provider that you have Blue Cross is rarely sufficient. Blue Cross has dozens of different types of policies. Some providers may take all. Some take none. And some take only selected policies. It is all about reimbursement rates. That’s how the decision to accept insurance is made.

You might remember a few years ago, I think it was Scripps who decided not to accept Blue Cross. (It may have been another large carrier.) It was huge news in the industry. It was all because their reimbursement rates weren’t high enough.[/quote]

All Sharp facilities and providers (except for emergencies) stopped taking Tricare Standard and Prime back in about 2004 but I noticed they have gone back to accepting them. My college-bound kid is on Sharp Healthplan but will be transferring to Tricare Prime beginning 10/1/14 (beginning of fiscal year for the Federal Govmt) as they will be leaving the county in late September.

[joec]

Yeah, I have no experience with Blue Shield, but Anthem (Blue Cross) was a very negative experience…

Blue Shield seems much better in terms of their provider and doctor access.

[no_such_reality]

[quote=UCGal]I was pricing insurance this week to determine if I wanted to go COBRA or ACA exchange. The coveredCA website was less helpful than the einsurance.com website. On einsurance they let you filter options by whether you’re ok with a more limited network.

I found that my employer plan, even at full COBRA prices – is a much better deal than what I can get via an unsubsidized private plan. Equivalent plan outside of COBRA is $700 more per month. Proof again, that employers can use their negotiation to get better deals. I was comparing Kaiser Permanente prices, since I’m a satisfied Kaiser customer.[/quote]

It depends on employer my former global pharma company had very good benefits not state employee plans good but the full cost is very high as in north of two grand a month for family. It’s literally difficult to find a private plan that costs that much without going to extremes

You also need to control variables. Employers have the “family” plan that doesn’t count how many people. The employer plan also doesn’t care about your age. You in effect you are directly subsidized by or subsidizing your younger family corners or older family coworkers depending on the mix

[UCGal]

[quote=no_such_reality]
You also need to control variables. Employers have the “family” plan that doesn’t count how many people[/quote]

You’re right about that. But with 2 kids, we’re not a huge family.

I think the factor was adult ages. I did some what if’ing.. and it appears my husband’s age was a bigger factor. Employer coverage doesn’t include ages of adults in the pricing. (It can’t – age discrimination, etc.) ACA and privately contracted insurance considers age and smoking status.

We’ll have a gap of one year between when COBRA runs out and he qualifies for Medicare… so we’ll have to budget extra for that year. But we can make the adjustments we need with planning.

[no_such_reality]

[quote=UCGal][quote=no_such_reality]
You also need to control variables. Employers have the “family” plan that doesn’t count how many people[/quote]

You’re right about that. But with 2 kids, we’re not a huge family.

I think the factor was adult ages. I did some what if’ing.. and it appears my husband’s age was a bigger factor. Employer coverage doesn’t include ages of adults in the pricing. (It can’t – age discrimination, etc.) ACA and privately contracted insurance considers age and smoking status.

We’ll have a gap of one year between when COBRA runs out and he qualifies for Medicare… so we’ll have to budget extra for that year. But we can make the adjustments we need with planning.[/quote]

Ah. Yea the brutal year. The CoveredCA site was wonderful for pricing that in. It was pretty scary to see the steepness of the premium curve between 55 and 65. Insurance goes up more than 50% not including annual increases.

If at mid 40s your plan is $1000 a month, a 60 year old is looking at$2000
I’m curious on a the what if. Have you priced your equivalent plan on private as if you where both 40? How’s it compare to cobra

[Author]

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