The Sadowski’s

[spdrun]

Sadly, one plow through coveredca debased me of any fantasy of retiring when I saw what happens to my health premiums heading into my 50s with a family.

If you have a paid-off home where you’re paying “prop 13” taxes plus a rental or two, can you “manage” your income to qualify for the subsidy/6% cap?

[no_such_reality]

[quote=all][quote=no_such_reality]Sadly, one plow through coveredca debased me of any fantasy of retiring when I saw what happens to my health premiums heading into my 50s with a family.[/quote]

Do you know why there is big difference in premium between plans in the same tier? I am looking at HMO 90 – Molina is 20% more than HealthNet and Anthem BlueCross is another 15% more expensive than Molina.[/quote]

Similar to real estate’s location location location, for health plans it’s network, network, network.

The health exchange plans suffer from limited networks. Blue Cross plan has one of the better networks compared to it’s corporate plans, where you you are limited to about 50% of the doctors for choices compared to the corporate they offer.

LA Times Article on limited doctor choice in Health Exchange Plans.

[quote]In Los Angeles County, for instance, Health Net customers in the state exchange would be limited to 2,316 primary-care doctors and specialists. That’s less than a third of the doctors Health Net offers to workers on employer plans. In San Diego, there are only 204 primary-care doctors to serve Health Net patients.

Other major insurers have pared their list of medical providers too, but not to Health Net’s degree. Statewide, Blue Shield of California says exchange customers will be restricted to about 50% of its regular physician network[/quote]

For me, frankly, I look at the Kaiser numbers. Not because I’m a big fan of Kaiser-care, I’ve never had them, but because they’re the 800 lb gorilla in California and I suspect they really do know what they’re doing with their pricing. IMO, I expect Kaiser’s numbers next year to do a typically health care inflation raise and suspect the other ‘cheap’ plans are going to jump to where Kaiser is on pricing.

[spdrun]

#4. The Sadowski’s would have been fine if they did not refi and make the above purchases. Their original loan was only $260k. At 7% interest, monthly payment was at $1700. Dateline pointed out the husband was still able to pull in around $3000 per month doing odd jobs. Plus the wife was also working as well. They would not have been able to save, but certainly they were able to get by.

Someone made a good point in the YT comments. Fine, even if his monthly nut was up to $4000/mo, could they have rented out 3 out of four bedrooms for $2000/mo total, thus bringing down their expenses to $2000/mo?

No “worse” than living in a 1-bedroom flat, and they might have gotten to keep the house.

[Coronita]

[quote=all][quote=no_such_reality]Sadly, one plow through coveredca debased me of any fantasy of retiring when I saw what happens to my health premiums heading into my 50s with a family.[/quote]

Do you know why there is big difference in premium between plans in the same tier? I am looking at HMO 90 – Molina is 20% more than HealthNet and Anthem BlueCross is another 15% more expensive than Molina.[/quote]

Double check which provider is accepted where. I’m not saying that’s the reason, but I think certain providers are dropping the top medical facilities..

Fine if you don’t need to go there. Sucks if you do…

http://articles.latimes.com/2012/sep/21/business/la-fi-hospital-costs-20120921

Cedars-Sinai and UCLA cut from Los Angeles health plan
About 2,200 city workers and family will lose their doctors as Anthem Blue Cross pares pricey providers.

Also,

http://www.giangolainsurance.com/blog/bid/67667/Anthem-Blue-Cross-Blue-Shield-Kicks-Cleveland-Clinic-Out-of-Network-The-Biggest-Obamacare-Side-Effect-in-Ohio

Anthem Blue Cross Blue Shield Kicks Cleveland Clinic Out of Network (The Biggest Obamacare Side Effect in Ohio)

A couple weeks ago I attended a mandatory, in person training for Anthem Blue Cross Blue Shield at their office in Youngstown, Ohio. The purpose of this training was to teach their independent agents the ins and outs of their new health insurance plans and make sure we understood the scope of all their changes.

Boy there were there some big ones.

It seems like forever, but I have been saying things like “it’s going to get crazy” or “it’s going to be nutty” half joking, half serious. Mostly I was trying to convey the fact you would be buying your health insurance in a completely new way starting today. Those differences, mainly created by Ohio’s Health Insurance Marketplace, where what was going to create the “craziness.”

However, I completely underestimated how far these changes would go, to the point Anthem would, in a sense, throw away one of their biggest competitive advantages.

[NOTE: I was required by Anthem to sit on this information after the meeting, they had not yet gone public with it and requested brokers not say anything]

One of the biggest shockers of this “network shake up,” as I’m calling it, is that Anthem decided to hitch it’s post healthcare reform wagon to University Hospital system in northeast Ohio and exclude The Cleveland Clinic, the largest hospital system in the state, from it’s network.

Let that sink in for a second.

I’ll repeat that one more time. The Cleveland Clinic is no longer in Anthem’s primary network of hospitals under the Affordable Care Act.

I think the irony to this is people actually believed that providers would just allow people with pre-existing conditions to get more healthcare and pay less. Sure, you’ll pay the same premium as everyone else…. But you won’t be able to go use the facilities you count on because those facilities won’t be in the network anymore 🙂

I think a lot of us smelled a rat… SD Realtor was one of them I believe… Looks like we were right….

Things will be even more fun once employers start cutting/paring down their employer provided health plans, especially for folks with pre-existing conditions… Interesting times we live in….

[Coronita]

[quote=flu][quote=all][quote=no_such_reality]Sadly, one plow through coveredca debased me of any fantasy of retiring when I saw what happens to my health premiums heading into my 50s with a family.[/quote]

Do you know why there is big difference in premium between plans in the same tier? I am looking at HMO 90 – Molina is 20% more than HealthNet and Anthem BlueCross is another 15% more expensive than Molina.[/quote]

Double check which provider is accepted where. I’m not saying that’s the reason, but I think certain providers are dropping the top medical facilities..

Fine if you don’t need to go there. Sucks if you do…

http://articles.latimes.com/2012/sep/21/business/la-fi-hospital-costs-20120921

Cedars-Sinai and UCLA cut from Los Angeles health plan
About 2,200 city workers and family will lose their doctors as Anthem Blue Cross pares pricey providers.

Also,

http://www.giangolainsurance.com/blog/bid/67667/Anthem-Blue-Cross-Blue-Shield-Kicks-Cleveland-Clinic-Out-of-Network-The-Biggest-Obamacare-Side-Effect-in-Ohio

Anthem Blue Cross Blue Shield Kicks Cleveland Clinic Out of Network (The Biggest Obamacare Side Effect in Ohio)

A couple weeks ago I attended a mandatory, in person training for Anthem Blue Cross Blue Shield at their office in Youngstown, Ohio. The purpose of this training was to teach their independent agents the ins and outs of their new health insurance plans and make sure we understood the scope of all their changes.

Boy there were there some big ones.

It seems like forever, but I have been saying things like “it’s going to get crazy” or “it’s going to be nutty” half joking, half serious. Mostly I was trying to convey the fact you would be buying your health insurance in a completely new way starting today. Those differences, mainly created by Ohio’s Health Insurance Marketplace, where what was going to create the “craziness.”

However, I completely underestimated how far these changes would go, to the point Anthem would, in a sense, throw away one of their biggest competitive advantages.

[NOTE: I was required by Anthem to sit on this information after the meeting, they had not yet gone public with it and requested brokers not say anything]

One of the biggest shockers of this “network shake up,” as I’m calling it, is that Anthem decided to hitch it’s post healthcare reform wagon to University Hospital system in northeast Ohio and exclude The Cleveland Clinic, the largest hospital system in the state, from it’s network.

Let that sink in for a second.

I’ll repeat that one more time. The Cleveland Clinic is no longer in Anthem’s primary network of hospitals under the Affordable Care Act.

I think the irony to this is people actually believed that providers would just allow people with pre-existing conditions to get more healthcare and pay less. Sure, you’ll pay the same premium as everyone else…. But you won’t be able to go use the facilities you count on because those facilities won’t be in the network anymore 🙂

I think a lot of us smelled a rat… SD Realtor was one of them I believe… Looks like we were right….

Things will be even more fun once employers start cutting/paring down their employer provided health plans, especially for folks with pre-existing conditions… Interesting times we live in….[/quote]

It get’s better if you have children…. Need specialized children’s healthcare? Good luck there….

http://pnhp.org/blog/2013/10/08/seattle-childrens-hospital-excluded-from-most-exchange-plans/

Seattle Children’s Hospital excluded from most exchange plans…Majority of Washington’s Health Benefit Exchange Insurance Plans Fail to Cover Care at Seattle Children’s; Hospital Sues Seeking Adequate Network Coverage for Children and Families

http://www.kaiserhealthnews.org/Stories/2013/September/26/narrow-insurance-network-missouri-exchange-marketplace.aspx

Patient advocates say the exclusion of one of Missouri’s top hospital systems from policies offered by the region’s biggest insurer under the Affordable Care Act could hinder treatment for some patients and force others to switch doctors.

The network for the Anthem BlueCross BlueShield plans, which will be sold through Missouri’s “Obamacare” marketplace, does not include BJC HealthCare and its 13 hospitals — among them Barnes-Jewish Hospital, the area’s premier academic medical center, and St. Louis Children’s Hospital.

Barnes Jewish Hospital in St. Louis, Mo. (Photo by Matt Hurst via Flickr).
“That is a major concern for a lot of reasons,” said Andrea Routh, executive director of the Missouri Health Advocacy Alliance. “Children’s Hospital, which in my mind is an essential community provider, is part of that network. If they’re not including the Children’s Hospital, care for children could really be compromised.”

Anthem confirmed Wednesday that policies sold through Missouri’s online insurance marketplace, scheduled to open for enrollment Oct. 1, will not include BJC.

[spdrun]

A lot of hospitals are still working out arrangements with companies offering plans through the exchanges. Everyone needs to give this a few months…

[all]

Heh, it’s all in the fine print. Now I need to figure out which insurer works with a provider that I might need once I get sick.

[all]

[quote=spdrun]A lot of hospitals are still working out arrangements with companies offering plans through the exchanges. Everyone needs to give this a few months…[/quote]

ACA looked good until I’ve heard that my company will be unloading the corporate plan and dumping us onto the exchange. Kind of like the rotten apple I bought for breakfast this morning.

[spdrun]

Heh, it’s all in the fine print. Now I need to figure out which insurer works with a provider that I might need once I get sick.

And how is this different from what we had pre-ACA? If anything, this is a strong argument for public insurance that’s accepted by 90+% of hospitals and doctors.

[spdrun]

ACA looked good until I’ve heard that my company will be unloading the corporate plan and dumping us onto the exchange. Kind of like the rotten apple I bought for breakfast this morning.

Personally, I’d rather have the extra $ or have them kick in for an outside (exchange or otherwise) plan — at least I’d be able to carry it between jobs or if I lose work. The sooner insurance is divorced from employment, the better for everyone. Employees because it will be portable and not dependent on continued employment, employers because a car mechanic or restaurant owner shouldn’t need to be a benefits manager (and isn’t necessarily best suited to be one).

[all]

[quote=spdrun]

Heh, it’s all in the fine print. Now I need to figure out which insurer works with a provider that I might need once I get sick.

And how is this different from what we had pre-ACA? If anything, this is a strong argument for public insurance that’s accepted by 90+% of hospitals and doctors.[/quote]

I was under impression that ACA is going to provide some clarity. Wasn’t that the whole idea behind the metal levels?
I did not have to deal with it until now – the company would pick the plan and reduce my options to binary, take it or leave it. I am sure choice is good for smart people, but not for simpletons like myself.

[all]

[quote=spdrun]

Personally, I’d rather have the extra $ or have them kick in for an outside (exchange or otherwise) plan — at least I’d be able to carry it between jobs or if I lose work. The sooner insurance is divorced from employment, the better for everyone. Employees because it will be portable and not dependent on continued employment, employers because a car mechanic or restaurant owner shouldn’t need to be a benefits manager (and isn’t necessarily best suited to be one).[/quote]

I agree about separating health insurance from the employment. I also support your single payer position. Unfortunately, I am forced to deal with here and now in addition to dealing with hypothetical (I prefer hypothetical… in that realm I’m great and fearless warrior. Here and now not so much).

The company will bump our salaries to match the cost of premium. There is the after tax/before tax issue. There is also issue of having to go back every year to get a raise just to match the increase in the premium. As I said, ACA looked very nice after the initial 5-minute cursory review.

[Coronita]

[quote=spdrun]

Heh, it’s all in the fine print. Now I need to figure out which insurer works with a provider that I might need once I get sick.

And how is this different from what we had pre-ACA? If anything, this is a strong argument for public insurance that’s accepted by 90+% of hospitals and doctors.[/quote]

HUGE difference for people that had an employer sponsored plan.. See that’s the problem. A good percentage of people with employer sponsored plan had nowhere near any sort of provider restrictions (as long as it was a PPO plan)… Furthermore, because most employer plans were group plans, they didn’t discriminate against employees with pre-existing conditions either.

This is the point most people who were self- insured don’t understand because your health plans where crappy to begin with. That part hasn’t changed (maybe gotten a little worse for some),

The biggest red herring will be all the people employed by larger corporations who might eventually lose their employer sponsored health plan when employers starting dropping coverage throwing folks onto the exchanges, with insurance plans on the exchanges excluding some of the hospitals needed by people with pre-existing conditions… Something that wasn’t the case when you belonged to a larger/pooled employer defined plan…People with pre-existing conditions that are employees have a LOT to lose in this arrangement…

Currently, a lot of the big employers self-insure (Qualcomm being one of them…They only hire United Healthcare to administer their plans)…Other such companies the same way….So the impact probably won’t be immediate.. But leave things as is, everything will move this way eventually…

[joec]

I think over the next 3 years at least, the ACA plans will have a ton of issues. However, you can put me in the camp of this will eventually sort itself out…I’m all for single payer as well like 100% of the other top 20 industrialized nations or some number where it works…at least better than our crappy system now.

If top or specialized hospitals want to drop people on ACA since they are, say for profit or what not…I say let them. If the 1% or 10% can pay the higher prices, by all means, let those people do it. If you had a condition that no one else can treat, well, I’m so sorry for you that your issue is that specialized or unique.

I’d be the first to say if it cost me and my family say 5-10 million to possibly extend my life, I’d be the first to put a stop to that and sign the rest of the half of my life over. Maybe this is the downside of the ACA or Obamacare, but I think there should be cost limits for everything. Like I see people try to prolong the life of a pet and spend say 5-10k to do it when the dog has cancer, just make his/her last moments as comfortable as possible and move on. In the end, we all WILL die anyways. People die everyday as well. No reason IMO to bk your family or everyone else in America to try to save you.

My reason for the 3+ years is because the universal healthcare in Massachusetts took, I’ve heard 3 years+ before things started to work and stabilized. This one is on a much larger scale so expect more “reports” of problems, dropped coverage, death panels, etc…I’m all for it.

In the end, being a supporter of some universal health care solution (and I’m NOT a democrat or a Obama supporter), at least something is being done now.

Like many others have said, if you are anywhere familiar with shopping for health insurance yourself, if you had any pre-existing condition, you WILL be dropped or charged something so insane, you’d be bankrupt before long. The stress of even getting covered is insane as well.

Again, all his is coming from someone who has rarely, if ever used much hospital services and I have never to my knowledge stayed in a hospital neither for a day. For young (< 25) people, it sucks you have to pay more, but eventually, you'll be 35/45/55...and you will be glad you have healthcare. In the end, if a hospital drops 80-90% of their patients, good luck trying to stay in business and I'm all for it and more power to them if they can stay in business after that. I'd also love to see healthcare just dumped from companies since it sucks to have to stay at a job just to get the healthcare. I think what I'm hoping to see is ACA mostly works, companies see it, decides to raise people's pay a little, dump all coverage across the board, ACA gets more funding, insurance companies can lower rates with all these younger/healthier workers...and the US has joined the rest of the world in how healthcare is done and life is good...more or less, in health care finally. 🙂

[spdrun]

Personally, I’d rather the money be spent saving the few % of people who do need million $ procedures to prolong their lives than on military adventures, expensive surveillance systems, and payoffs to parasitic government contractors. We waste enough money on the violence industry that could be spent saving lives instead. If we have to throw certain “allies” under a bus to do so, so be it.

[Author]

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