- This topic has 28 replies, 8 voices, and was last updated 8 years, 1 month ago by
bearishgurl.
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April 7, 2016 at 11:49 AM #21932April 7, 2016 at 12:05 PM #796522
spdrun
ParticipantIs that legal for them to raise rates without prior notice?
April 7, 2016 at 12:58 PM #796525La Jolla Renter
ParticipantI probably got something in the mail and didn’t pay a lot of attention to it.
April 7, 2016 at 5:19 PM #796529bearishgurl
ParticipantLa Jolla Renter, on a “grandfathered” plan such as yours, I believe the carrier only has to give 30 days notice by letter of a rate hike. In that letter, they have to tell the policyholder what their new premium will be, eff: [month] 1, [year].
Since your $2950 deductible doesn’t appear to match any of the ACA-compliant plans on the exchange (your deductible alone is between silver and bronze levels but other benefits of your plan could be closer to gold level), if you could list here the particulars of your plan and the age you will be at the time of the rate hike, I might be able to tell you if $840 month seems “fair.”
If you were thinking of taking out a Bronze plan on the exchange, do you have an active HSA to pay your big expenses from and fill in the gaps until you hit your deductible if you experience a high-use year?
You should be aware that Cigna now offers a bronze HSA plan in SD off-exchange as of 11/15/15 as well as two other bronze plans, one of which mirrors bronze exchange coverage.
I’m not certain in your case but I think you may have to wait until “open enrollment” beginning mid-October 2016 to sign up for coverage eff: 1/1/17.
If you don’t qualify for a “subsidy” to help you with your premium, I don’t think it is worth it to sign up for a plan on the exchange as Covered CA is extremely incompetent, bureaucratic and difficult to deal with.
If it only costs $1500 month for the 3 of you to be on your spouse’s Kaiser plan, isn’t that cheaper than paying $840 month for your own plan? Is the reason you’re not on her plan because you don’t want Kaiser? (I wouldn’t want Kaiser so that’s why I’m asking.) It’s not for everyone.
April 7, 2016 at 7:25 PM #796530Participantbearishgirl,
I looked at my policy online. Looks like I have a $40 copay, and 70% in network and 50% out of network for most items.
My wife and kid’s grandfathered kaiser plan is 600 something a month. I looked into getting on her plan but it wouldn’t save me much. I think we are happy with the care at Kaiser for my son, and she is happy personally, but I hate the idea you have to go see your primary to go see a dermatologist etc.
It just seems that there is a better strategy out there. For example, maybe get the highest possible HSA detectable plan, join a concierge doctor group, get an executive physical over at sharp every other year ($2,500), see the specialists you want and negotiate cash rates. Obviously, the above is not cheap. I’m okay with spending $750 a month, but I want something for my money.
Right now, I’m spending 10k a year in premiums for myself and I can’t get into an urgent care.
I learned years ago that it was cheaper to negotiate cash for an mri on my knee, than go through my insurance.
They average family was suppose to save money on Obama care. What happened? Doctors, insurance companies, and hospitals are all crying they aren’t making any money.
Who is making all the money??? I think the industry could use some transparency.
April 7, 2016 at 8:19 PM #796533gzz
ParticipantWhen I shopped small business plans on the exchange, Kaiser was about 200/mo per person, the next closest was $400.
The HSA plan is pretty nice, all my preventative, co-pay, and dental expenses become pre-tax and I am saving up for inevitable future expenses. $3300 a year off my AGI means about $1400 off my taxes, so really I am paying about $230/mo for myself – 110/mo tax savings from the HSA – reduced AGI from the premium itself of 100 = $20/mo for my cheap Kaiser Bronze coverage.
It was so cheap I just decided to cover 100% of employee premium, easier to pay $1200/year per employee ($700 including lower K-1 income and lower taxes) than deal with making them pay themselves and having to figure out how to autodebit their payroll.
April 7, 2016 at 8:48 PM #796534no_such_reality
ParticipantSomething is out of whack, are you north of 60?
On the exchange, a gold PPO with blue shield is $753 at age 55. At 60 that jumps to $920. If you’re sub-55, your premium is platinum level PPO plan premiuml level. Granted exchange networks kind of suck. That sa me gold PPO for a 50 year old is only $605.
The late 50/early 60s are brutal with the cost curve going very steep for age premiums.
For an HSA your deductible is low, that’ll. greatly push up the cost. What’s your out of pocket max?
April 7, 2016 at 8:56 PM #796535Participant[quote=La Jolla Renter] . . . They average family was suppose to save money on Obama care. What happened? Doctors, insurance companies, and hospitals are all crying they aren’t making any money.
Who is making all the money??? I think the industry could use some transparency.[/quote]La Jolla Renter, what happened is the money is being wasted on bohemoth, bureaucratic, grossly incompetent exchanges and expensive public websites that still don’t work properly. Provider reimbursements have gone way down since 2013. I know this because I have compared my EOBs from my PPO BEFORE Obamacare (Aetna, who left the CA individual market at the end of 2013 with 5 other carriers) with my “obamacare” EOBs from my current PPO, Blue Shield of CA, a Covered CA plan. For the exact same procedures, I have found the reimbursement to providers to be 25-50% of what it was pre-ACA. On one biennial scan that I most rely on (my third, taken Oct ’15, the allowed reimbursement was so low that my scan report from IHS was just 2/3 of a typewritten page versus the detailed 9-12 page scan report Sharp did the first 2 times, with photos. Of course, Sharp won’t participate in exchange plans unless you sign up for one of their EPO plans. I’ve already lost 3 longtime providers out of 8. Two of them “retired” because they could no longer afford their overhead with the low allowable reimbursements under ACA and both of them actually had owned their own medical bldgs in SD for decades! They couldn’t even afford to pay their staffs on the new level of reimbursements and so they just decided to close up shop! The 3rd one just dumped all patients (new and old) that were on exchange plans.
The carriers participating on the exchanges are now flush with cash collecting exorbitant premiums from everyone and the gubment, in the form of subsidies (to make up for all the “very sick” people they were required to cover) and offering very narrow networks to their members located in HUGE population centers (like SD). I already have a primary care physician (one of the best in town) but he’s over 70 as well and could just decide to throw in the towel tomorrow …. cuz he can. I would HATE to have to find another primary care provider in this climate who is actually accepting new patients in a crowded market while being an exchange planholder!
Whoever thought up the ACA and put together this legislation had to be complete idiots. Certainly, they must have figured that providers were going to bow out if exchange-covered patients weren’t worth their time. And also that insurance companies can’t operate at a loss for any length of time when they are required to take anyone who applies to them and pays their premiums! The PTB is attempting to control too many moving parts by using gubment mandates and gubment cramdown on private industry (Big Insurance and providers that we, as patients need worse than they need us), and, suffice to say, this isn’t going to end well. It’s a race to the bottom but the carriers and the providers have already proved to everyone straight out of the gate that they don’t have to play and will not play if the conditions don’t suit them.
Our only hope right now is to get into office a presidential candidate who will see to it that this fiasco is scrapped in short order :=0 I don’t care how many “super-delegates” there are right now or who they are (currently) “pledged to.” Your vote counts, people, so VOTE in the primaries AND the general election … no matter what happens. Change your voter registration, if you have to. The deadline to (re)register to vote in the CA primaries is May 23 (although if you re-register that late, you will probably have to vote in person). Anything is better than the royal, unfixable mess we have today that is the “ACA.”
Okay, back to Cigna. They’re one of the six carriers who left the CA individual market at the end of 2013 but as of November 2015, came out with those three Bronze plan offerings for SD with one of them being an HSA compatible plan. Based upon the info you provided, your current coverage sounds most similar to a Silver 70 plan on the exchange.
There are 8 silver plans on the SD exchange. Their deductible is $2250 + $250 pharm ded. Their maximum out-of-pocket is $6250 (yours may be significantly lower).
The monthly premiums on the CC cost calculator for a silver 70 plan are as follows:
age 35: $274 to $373 (PPOs $327 & $346)
age 40: $286 to $390 (PPOs $342 & $362)
age 45: $323 to $440 (PPOs $387 & $409)
age 50: $400 to $544 (PPOs $478 & $505)
age 55: $499 to $680 (PPOs $597 & $631)A big problem is the very possible narrower networks offered on these plans compared to what your current plan offers. The reason I put the PPO premiums in parenthesis is because you stated that you did not want to be forced to get a referral from a PCM in order to see a specialist. There are now TWO PPO’s to choose from on the SD exchange for 2016, BSoC and Anthem Blue Cross (which is rated lower than BSoC but is the more expensive plan of the two).
see: http://www.coveredca.com/shopandcompare/2016/
If I were you, I would compare the coverage details of each standard silver PPO (and maybe gold PPOs as they have no deductible) to the one you have and their prices for your age to get an idea what they cost on the exchange with or without a subsidy, depending on if you qualify for one. Then if I found one I was interested in, I would look on their list of providers for my doctors and decide if it was worth it to leave my “grandfathered plan.”
It’s easiest to use the “shop and compare tool” (above link) to do this exercise because Cigna will not quote you premiums for an off-exchange plan unless you fill out their form online and send it to them.
April 7, 2016 at 9:03 PM #796536Participant[quote=no_such_reality]….The late 50/early 60s are brutal with the cost curve going very steep for age premiums.[/quote]Uhhmmm, yeah. I just got slammed going into to 2016 :=0
[quote=no_such_reality] What’s your out of pocket max?[/quote]This is the $64M question, here.
April 8, 2016 at 4:30 AM #796539moneymaker
Participantyes the basic cost of medical care is exhorbitant, that is the real problem. I don’t know what I would do if I didn’t have coverage from work or if I lose coverage between now and when I turn 65.Definitely can’t afford to pay out of pocket as an individual these days. I guess the ACA requires coverage, does anybody know if there is Mexican insurance that is cheaper, since we live so close to the border? That would still leave the problem of emergency room visits and they are the worst as far as costs.
April 8, 2016 at 6:01 AM #796540ParticipantI get catastrophic type situations and chronic conditions, but it seems like any major employer plan is pushing $1500-$1800 per month for a family combined costs
Are families really racking up $20k in medical bills a year?
It seems like there should be a fairly cheap option where the individual pays the first $6500 of any expenses and then anything after that is covered. It doesn’t match bronze tier actuarial cost structure.
For a family structure it at $12k or $18k then 100% coverage. If your below 400% FPL give the money back on taxes.
Cut the billing bureaucracy which seems to be half of every doctors office I’ve been in recently. Literally there’s more people working the phones and insurance payments than treating people.
April 8, 2016 at 12:05 PM #796546Participant[quote=no_such_reality]I get catastrophic type situations and chronic conditions, but it seems like any major employer plan is pushing $1500-$1800 per month for a family combined costs
Are families really racking up $20k in medical bills a year?
It seems like there should be a fairly cheap option where the individual pays the first $6500 of any expenses and then anything after that is covered. It doesn’t match bronze tier actuarial cost structure.
For a family structure it at $12k or $18k then 100% coverage. If your below 400% FPL give the money back on taxes.
Cut the billing bureaucracy which seems to be half of every doctors office I’ve been in recently. Literally there’s more people working the phones and insurance payments than treating people.[/quote]NSR, AFAIK, it has been law in all 50 states for at least the past 20 years to provide health coverage for one’s children. If that coverage was CHIP or “Healthy Families” and the parent(s) qualified for these programs, then that constituted “child coverage.” Every employer with 50 employees or more offered coverage for both an employee and their child(ren) because it was the the law, even before ACA.
Workers complaining of high premiums being deducted for medical insurance from their paychecks are obviously covering a spouse with a healthplan. The law does not require employers to cover a spouse’s medical premiums because it is presumed that every non-disabled adult is responsible for themselves. Some employers cover part of a spouse’s health premium as part of a comprehensive benefit pkg they offer employees but more and more employers in recent years will not offer to cover any of the spouse’s premium but still offer group coverage to employees’ spouses if the employee wants it.
If you or anyone else is paying the high premiums you describe here for “family coverage,” you really have nothing to complain about. It wouldn’t be fair to your single coworkers (parent or non-parent) if you rec’d a cash benefit for full coverage for two (expensive) adults and they didn’t get compensation to equalize their health benefits with yours. Every worker has the choice on whether to cover the spouse or have the spouse work enough hours to obtain their own coverage. It’s as it should be.
If the “family premiums” your employer is requiring you to pay cause your health premium deduction to be more than ~9.5% of your gross income and thus is “unaffordable,” then your spouse is certainly welcome to sign up for an exchange plan and possibly receive a “subsidy” to help them pay his/her monthly premium in lieu of working enough hours to receive their own coverage.
https://www.shrm.org/hrdisciplines/benefits/articles/pages/what-is-affordable-coverage.aspx
Yes, “families” can easily rack up $20K+ of medical expenses per year without any of them ever setting foot in an emergency room!
Yes, I agree about the large staffs needed today in medical offices to wade in the “billing bureaucracy.” That was the chief reason given in letters by my two longtime providers for “retiring” from practicing medicine after the advent of the ACA. It IS ridiculous that there are more humans working as billers for the typical 2-6 physician/PA medical office (both inside the office and contract workers) than there are actual medical providers in that same office.
April 8, 2016 at 1:49 PM #796551ParticipantSolution: public insurance. Where most procedures are covered by ONE plan with KNOWN pricing. Makes billing much simpler.
There will still be private plans available for non-routine stuff not covered by the public insurance.
April 8, 2016 at 2:00 PM #796552Participant[quote=spdrun]Solution: public insurance. Where most procedures are covered by ONE plan with KNOWN pricing. Makes billing much simpler.
There will still be private plans available for non-routine stuff not covered by the public insurance.[/quote]I wouldn’t have said this two years ago, spd, but I’m leaning more towards the idea of “universal `coverage'” . . . as long as I would be able to buy a supplement to see any provider I wanted to wherever I wanted to or have any treatment I wanted to.
April 8, 2016 at 3:37 PM #796556Participant[quote=no_such_reality] What’s your out of pocket max?[/quote]This is the $64M question, here.[/quote]
My Plan is a Grandfathered old PPO Share Plan. The out of pocket max is $8,850 for both in and out of network. 40 copay office visit, 10 generic prescription, 35 brand name with a 575 deductible.
I called today to see if I could raise the deductible. I can raise it from 2,950 to 8,850 and go from 840 a month to 518 a month. Max out of pocket 8,850.
I asked if this qualified as a HSA plan and the guy said it should, to check with a bank. ???
fyi, I am 50. perfect health. (knock on wood)
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