[bearishgurl]

In my case, I don’t want to have an EMT, ski-patrol member, search-and-rescue member or person I’m with have to sit on hold with a toll-free number to first find out “where I’m supposed to go” if I’m injured or fall ill (that is, IF he/she can actually GET cell phone service, lol). I want the 2-5 doctors available within a 50-mile radius of where I am to be able to treat me, even if that is in a helicopter or on-site and they rushed from home to do so. And I want the emergency providers to know that their agency will be reimbursed by my carrier, so I get the best care. I want them to take me where THEY think (in their best judgment) that I should go and take me to the most convenient place for THEM to get me to (for stabilization). After I get to the (likely small regional) hospital, I don’t want my providers there to be told that I’m not eligible to be flown to a particular trauma center or to be treated in xyz hospital by xyz provider who will fly in to perform surgery on me.

Blah, blah … you get the drift.

In a nutshell, I want CHOICE. And for that, I will settle for a higher deductible if I have to in order to afford the premium.

You pay for exactly what you get in this life.

[bearishgurl]

[quote=bearishgurl][quote=no_such_reality][quote=citydweller]I’ve just been looking at the Covered California sight and it appears I don’t qualify for any tax credits (I’m single with good income). However, it looks like I can sign up for the Kaiser Bronze 60 HSA HMO for $392 per month ($4,500 deductible and maximum out of pocket for one person is $6,350). I currently have an individual plan thru Anthem/Blue Cross which costs $720 per month ($2,950 deductible and max out of pocket is $11,810).

It has been years since I’ve even reached my current deductible, so the cheaper plan seems like a good idea.

I have a couple questions, Does anyone have experience with Kaiser and would you recommend it? Also, does “maximum out of pocket” really mean what it says? In other words, once I’ve spent $6,350 in medical bills in one year, is EVERY other bill paid by the insurance?[/quote]Any reason you’re not looking the Anthem/Blue Cross EPO or HSA/EPO that is cheaper than the Kaiser one? Kaiser has 7 million members in California. Basically, 1 in 5 Californians is covered by Kaiser. Your service level will be largely dependent on your ability deal with the system. There’s horror stories, but horror stories are common place across any group that is that large.

As for OOPM, yes and no. The kicker is they’ll cover the bills that are medically necessary. So no optional treatments once you hit the limit, but if you get hit by a bus, you’re covered.[/quote]nsr, there is a good reason why the plans you are suggesting (above) are “cheaper.” My research on them indicated that they have virtually zero out-of-network coverage. I’m not sure how that applies to emergency coverage but as a road traveler, I’m concerned that these carriers wouldn’t cover my bills at all, even if I was moved from an EMT to a regional hospital from a rural area where I sustained a medical incident or injury.

If one spends 46+ weeks per year in a large metropolitan area because they are a “worker bee” (ex: SD County) and takes “staycations,” drives to nearby cities in populous counties or only flies to other large metropolitan areas within the CONUS, these plans can work for them.

But they don’t work for campers, hikers, off-roaders, skiers, road travelers and/or those with friends/relatives residing in rural areas of the country for whom they regularly visit.[/quote]

Both of the bolded plans suggested by nsr are EPO’s and thus do not have out-of-network coverage.

http://www.ehow.com/facts_5003224_what-epo-health-plan.html

All EPOs and the Kaiser HMOs are inferior to citydweller’s current Anthem/Blue Cross PPO.

I agree that a Kaiser HMO can contract out a patient within their service areas to a specialist provider which they do not have locally available. I’ve seen this happen a few times with co-workers on their plans. I also agree with UCGal in that Kaiser HMOs cover emergencies while the planholder is traveling within the US (not sure out of country). As far as Kaiser’s 60% HSA plan mentioned here by citydweller which will be featured as a “Bronze Plan” on CA’s exchange, it is anyone’s guess if this particular plan will cover out-of-network providers. This particular plan seems as if it may have been “watered down” specifically for CoveredCA and not one of Kaiser’s typical HMO plan offerings.

In spite of citydweller’s $700+ mo current premium, I really think he (or she) should think twice before leaving his current plan to purchase one on CoveredCA, especially since he states that his existing policy has been “grandfathered” and that he won’t be eligible to receive tax credits in 2014.

There are no longer any more PPO plans available which have quite the level of coverage and features of a “grandfathered” plan. Break out your magnifying glass, folks, as the devil is in the details :=0 They have ALL been “dumbed down” in various (insidious) ways to be marketed on the state’s exchanges, since the carriers can no longer discriminate as to who gets covered. That’s the major reason why Aetna, Cigna and United Healthcare have decided to dump their indiv policyholders located in CA on the state’s exchange, IMO.

citydweller was obviously medically underwritten at one time (upon application).

[bearishgurl]

Thanks for responding so quickly, LA. I guess SOME residents still have internet svcs, lol.

Yes, CO has always planned for the “100-yr floodplain.” They have made many improvements in the rivers going through cities in recent decades but there is always that chance of flooding, due to snow runoff from the mtns, which drains all summer and into the fall, mixed with new rain. My mother’s house, a few miles west of dtn Denver, was just over 100 yds from a rushing river which had been dredged and rehabbed with islands over the years since we sold it about 18 yrs ago. The four houses closest to the river on her street flooded in 1976 but are still standing today (there were no basements allowed on that block back in the early ’50’s, when it was built).

http://www.casfm.org/papers/Colorado_Approximate_Floodplain_Guidelines.pdf

http://www.fema.gov/floodplain-management/flood-insurance-rate-map-firm

I recall Stapleton (Airport) being situated on a slightly higher plateau. Sorry, but I didn’t review our old pms and thought your ‘hood was on the site of old Fitzsimmons Army Hospital.

I saw Alameda and Havana flooded in a video, which is pretty close in and wondered about the surrounding areas.

Glad your area is okay.

[bearishgurl]

I just placed a PM to longtime Pigg LAAFTERHOURS, who bought a house in East Denver (close to the Aurora line) earlier this year. I’ve asked him to respond here as to the status of his neighborhood. Not sure if he’ll get the msg, though.

Not sure about his area … it’s pretty flat over there.

[bearishgurl]

Between yesterday and today, I placed calls to three CO friends and they all went to VM. They’re not answering e-mail, either.

Still trying to get status. I’m kind of worried about two of their houses but the third should be ok.

Haven’t heard status on the Swift feedlots. Hopefully, they put a lot of head of cattle on the train to NE a few days ago (before it derailed). The water level in Evans doesn’t look good.

[bearishgurl]

I would highly recommend that all parents if minor children sign up for a term-life insurance policy while still relatively young and healthy. Yes, you DO have to medically qualify for the policy but the premiums, and sometimes the level, are fixed for a set number of years.

http://www.afba.com/Insurance/Products/Life-Insurance/Level-Term.aspx

Up until age 50, I had a policy with the above organization which some of you may be eligible for.

http://www.afba.com/Insurance/Products/Life-Insurance/Product-Eligibility.aspx

Their term-life policies are underwritten by John Hancock. At age 50, I applied for one of their 20-year level-term policies that had recently become available.

http://www.afba.com/Insurance/Products/Life-Insurance/Select-Term.aspx

At the time of this second application, they put me through a LOT to qualify, however, and their policies are MUCH higher for smokers and slightly higher for former smokers and those who can’t pass a cholesterol test but are otherwise healthy.

http://www.afba.com/Insurance/Products/Life-Insurance/Select-Term/Medical-Requirements.aspx

In the end, I successfully rec’d a level-term policy for $250K coverage for just $47 mo (their ultra-preferred rate) until the age of 70.

If your children have already gone through or are nearly finished with college by the time you reach age 50, you will have less of a need to try to qualify for a term life policy at that age.

There are several other companies with similar term-life offerings but upon perusing AFBA’s site this morning, I noticed that my same policy with them costs ~$100 mo for an approved applicant today. So, rates seem to have gone up quite a bit since I applied. Level-term is the best kind of coverage to have, IMO, because it avoids rate hikes at all the five-year age marks.

And, of course, those who already own a whole-life policy can never have it taken away as long as they pay the premiums or own it outright. However, these policies don’t have near the coverage of a term life policy.

[bearishgurl]

There is still potential for flooding of Swift’s low-lying (and severely-crowded) feedlots (most of them) located just west of Kersey, CO (subject of the OP).

We’ll know more by Sunday night/Monday morning. If Weld County makes it thru this time “intact,” then the flash-flood danger for the area has probably passed.

. . . Keith Maxey, director of the Colorado State University Extension office in Weld, said he’d received reports of a Fort Lupton dairy that, despite efforts to get livestock to higher ground, lost several calves in the rising waters. . .

http://www.greeleytribune.com/news/local/8102880-113/greeley-flood-weld-flooding

[bearishgurl]

[quote=njtosd]Here’s my concern – let’s say you find out you have a (significant) genetic disease. Do you now have an obligation to disclose that fact when applying for health/life insurance? . . . [/quote]

The above emphasized quote is no longer true for health insurance applications, nj. It hasn’t been true since President Bush signed the Genetic Information Nondiscrimination Act of 2008 (GINA) into law on May 21, 2008.

http://www.genome.gov/27026050

In any case, now “pre-existing conditions” (as is the presence of an inherited disease) will no longer be used to underwrite a health insurance policy or plan under the HCRA.

This is only fair since none of us were able to “choose” our parents :=0 Discrimination against persons with an inherited disease (or the propensity for one) aligns right along with race/nationality discrimination.

[bearishgurl]

[quote=njtosd]Here’s my concern – let’s say you find out you have a (significant) genetic disease. Do you now have an obligation to disclose that fact when applying for health/life insurance? I have a friend whose mom has huntingtons disease … He doesn’t want to get tested for fear he’ll have to disclose it the results (he has a 50/50 chance). And even if you don’t have health life insurance issues – maybe there are some things you don’t want to know -[/quote]

True, nj. But many people have active “level-term” or “decreasing-term” policies until age 70, issued while young and healthy. Who really cares if you don’t have life insurance anymore after age 70?

For these people and other people with family histories of certain cancers, I think it is prudent for a “healthy person” to find out if they have a propensity to develop certain cancers in order to be proactive for their health the future. Many times, this “proactivity” is the difference between life … and an untimely death (ex: the presence of breast or colon cancer genes).

I’m not sure the tests MM will sign up for are the most accurate way to approach this, however. The best way is to convince your sick 1st or 2nd degree relative to sign up to donate cancer tissue (which will be preserved in paraffin until their relatives are financially ready to conduct testing for the presence of very specific genes … or instability thereof). The sick relative can agree to do this prior to surgery or prior to death. The post-mortem tissue donation, taken within three hours of death, still leaves the body viewable from its casket, if that’s what the relative has chosen.

For a suspected inherited-cancer victim, this is the greatest give he/she can leave behind to their children and siblings.

Sorry to be morbid here, but this is the way it’s done.

[bearishgurl]

[quote=no_such_reality][quote=citydweller]I’ve just been looking at the Covered California sight and it appears I don’t qualify for any tax credits (I’m single with good income). However, it looks like I can sign up for the Kaiser Bronze 60 HSA HMO for $392 per month ($4,500 deductible and maximum out of pocket for one person is $6,350). I currently have an individual plan thru Anthem/Blue Cross which costs $720 per month ($2,950 deductible and max out of pocket is $11,810).

It has been years since I’ve even reached my current deductible, so the cheaper plan seems like a good idea.

I have a couple questions, Does anyone have experience with Kaiser and would you recommend it? Also, does “maximum out of pocket” really mean what it says? In other words, once I’ve spent $6,350 in medical bills in one year, is EVERY other bill paid by the insurance?[/quote]

Any reason you’re not looking the Anthem/Blue Cross EPO or HSA/EPO that is cheaper than the Kaiser one? Kaiser has 7 million members in California. Basically, 1 in 5 Californians is covered by Kaiser. Your service level will be largely dependent on your ability deal with the system. There’s horror stories, but horror stories are common place across any group that is that large.

As for OOPM, yes and no. The kicker is they’ll cover the bills that are medically necessary. So no optional treatments once you hit the limit, but if you get hit by a bus, you’re covered.[/quote]

nsr, there is a good reason why the plans you are suggesting (above) are “cheaper.” My research on them indicated that they have virtually zero out-of-network coverage. I’m not sure how that applies to emergency coverage but as a road traveler, I’m concerned that these carriers wouldn’t cover my bills at all, even if I was moved from an EMT to a regional hospital from a rural area where I sustained a medical incident or injury.

If one spends 46+ weeks per year in a large metropolitan area because they are a “worker bee” (ex: SD County) and takes “staycations,” drives to nearby cities in populous counties or only flies to other large metropolitan areas within the CONUS, these plans can work for them.

But they don’t work for campers, hikers, off-roaders, skiers, road travelers and/or those with friends/relatives residing in rural areas of the country for whom they regularly visit.

[bearishgurl]

[quote=citydweller]I’ve just been looking at the Covered California sight and it appears I don’t qualify for any tax credits (I’m single with good income). However, it looks like I can sign up for the Kaiser Bronze 60 HSA HMO for $392 per month ($4,500 deductible and maximum out of pocket for one person is $6,350). I currently have an individual plan thru Anthem/Blue Cross which costs $720 per month ($2,950 deductible and max out of pocket is $11,810).

It has been years since I’ve even reached my current deductible, so the cheaper plan seems like a good idea.

I have a couple questions, Does anyone have experience with Kaiser and would you recommend it? Also, does “maximum out of pocket” really mean what it says? In other words, once I’ve spent $6,350 in medical bills in one year, is EVERY other bill paid by the insurance?[/quote]

citydweller, I haven’t had the chance to look at CoveredCa’s charts on your behalf, but would surmise you are a “boomer.”

Do you have an HSA at present? That “Kaiser Bronze 60 HSA HMO” is nowhere near equivalent to your present coverage, IMHO. Not only do you currently have a much better carrier, your deductible is much lower than the Bronze plan (lowest, cheapest plan on the exchange). You also likely have a PPO with a large choice of providers. As a “boomer,” you’re likely not going to want to go from “choice” to “locked into an HMO.”

An HSA makes the most sense if you know you will have W-2 or taxable self-employed income to fund it going forward.

What is troubling to me, though is that you stated your present out-of-pocket maximum is $11,810, which is a typical out-of-pocket cost for a family plan, not an individual plan.

Was your policy “grandfathered” by Anthem/Blue Cross, citydweller? In other words, was your policy already in effect in March 2010, when the HCRA was signed into law? Something doesn’t seem right with you having a (very reasonable) $2950 deductible and a soaring $11,810 maximum out of pocket requirement. That is, in effect, an $8,860 annual coinsurance requirement!

In all of the plans I’ve ever seen offered on paper, the coinsurance requirement was 75% or LESS of the deductible.

Is your coverage part of a family plan, citydweller? And how are you figuring out your current out-of-pocket maximum expense?

In the absence of the answers to those questions, I think you should leave well enough alone for now, citydweller. ESPecially if you have a “grandfathered” plan and are 55+ years of age. There are worlds of difference between a Kaiser HMO (ESP a 60% one that needs the infusion of MSA $$) and an Anthem/Blue Cross PPO.

“Open enrollment” for CoveredCA runs though March 2014, IIRC. Your coverage is not going away so you have plenty of time to make a decision for 2014. And of course, there’s always 2015.

If my old, “grandfathered” coverage wasn’t “going away” on 12/31/13 (my carrier, Aetna is leaving the state), I wouldn’t even be remotely interested in signing up on the exchange.

[bearishgurl]

[quote=no_such_reality][quote]”Depending on income you may earn outside of Trader Joe’s” — i.e., another job — “we believe that with the $500 from Trader Joe’s and the tax credits available under the ACA, many of you should be able to obtain health care coverage at very little if any net cost to you,” Bane wrote in the memo.[/quote]

Actually, much more cost effective for Trader Joes to let the government pick them up. I just punched it into CoveredCA.com and assumed $18K/yr in income (29 hours a week at $12) and came up with a 87% silver plan for $63 a month. Of which Trader Joes is kicking in $500.

Basically, out of pocket cranks in at $20/month for an 87% of costs health coverage.[/quote]

What age of employee did you punch into the website?

And how are you figuring that the “out-of-pocket” for an “87% Silver Plan member” will only be $20 month?

[bearishgurl]

[quote=FlyerInHi]GE and IBM and big companies ending retiree health benefits has been a gradual shift for a long time. It would have happened with or without obamacare.

Retirees should be so lucky that there is a a fallback different than being left out in the cold.

I have a relative who is about to retire from IBM in New York after about 40 years. We talk about it all the time. There is a seniority level. The more recent employees get different benefits than decades long employees.[/quote]

Medicare Part B, MediGap Coverage and Part D (Prescription Coverage) combined are a LOT cheaper per month than a comprehensive health plan for a 50-65 yo or even a HDHP (which, except for the “Bronze Plan” are now going away).

I have an Aetna Medicare Supplement Chart dtd 1/1/13 in front of me showing premiums as low as $90 mo (Plan “N”) to $129.60 mo (Plan “F”) for age 65 living in all SoCal zip codes. They charge $107.48 to $110.06 for Medicare Part B.

The 2013 Aetna Medicare Premier RX Chart (part D) shows premiums from $86.20 to $122.40 for SoCal ($118.40 mo in SD County). For example, generic drugs are $5 – $33 and preferred brand-name drugs are $45. Their annual drug-coverage cap is a generous $4750.

The total 2013 Part B/D premium PLUS the Plan “F” supplement (the best one) in SD County costs $355.48 mo ($107.48 + $129.60 + $118.40) for a 65 yo.

SoCal is a fairly high-cost region for medical costs. It can’t cost those companies in the OP THAT MUCH MORE, if any more than SoCal for Part B/D coverage plus Medigap coverage. I agree that the move to dump these retirees into the marketplace with an allowance was just to prevent them from absorbing any future rate shocks (just in case “Obamacare” blows up in smoke and more revenue from the Medicare programs are sought to make up the difference) :=0

Nearly all the big carriers offer a Medicare Advantage Plan (Part C, which includes Parts B, D and Medigap coverage) in the large metropolitan areas, which have slightly higher premiums but appear to have too many built-in constraints and gatekeepers in my opinion … they work kind of like “Tricare for Life.” However, the patient doesn’t have to fool around with medical bills because they never see any.

In any case, I’m going to “go away” to a rural-ish area where these types of plans aren’t available.

(This posted was slightly edited later when I discovered I read the Medicare Supplement chart wrong.)

[bearishgurl]

[quote=no_such_reality][quote=SK in CV][quote=spdrun]The real question is “why was the Obamacare law written in such a fucking boneheadedly stupid fashion?”

Instead of making subsidies end at 400% of FPL, they should have gradually tapered subsidies to zero depending on family income, number of dependents, etc[/quote]

It is gradually tapered.[/quote]

Not really, at 299% of FPL, you get a $986/month Tax credit, at 399%, you get $863/month credit, at 400% FPL, you get $0.

IOW, two 64 year olds making $62,039/year get a $863/month credit where as those same two at $62,040/yr, get $0/month credit.

The benefits taper much better in the 100% to 200% FPL range, but a quick cliff shows up at the higher ages for 400% and it’s a $5000-$7000/year difference.[/quote]

Regardless whether an applicant can qualify for any subsidies at all, Covered CA premiums are HUGE improvement from what the individual plans are currently charging. I know a 62 yo female in SD who is in GREAT shape and currently paying over $1100 mo for indiv coverage. She will undoubtedly do MUCH BETTER on the exchange.

Other states premiums are lower than CoveredCA, but they do not necessarily correlate to a state’s perceived level of cost of living. Since the carriers themselves did the pricing, the exchange pricing is based upon the usage level of the various age groups in different states. For example, some states have a much higher percentage of lifetime smokers than does CA and also higher levels of obesity, diabetes and heart disease due to regional diets and cultural habits and traditions.

[bearishgurl]

[quote=no_such_reality]I’m still worried about the expense curve between ages 55-65.

That silver/enhanced silver/gold plan is a little squirrely. If you’re really expecting a hospital visit, then Platinum may be more cost effective. The silver has a deductible and the gold doesn’t and the cost difference is the amount the deductible. Silver has a higher primary care visit but a lower brand drug expense after a $250/deductible. Then there are minor difference in the cost of certain coverage items.[/quote]

I looked at this also, nsr, I’m in that age group and the details are a bit sketchy at this point. The SD broker I talked to back at the end of June told me that I may very well qualify for the Platinum Plan for $212-$222 mo out-of-pocket based upon the cursory data I gave him. I’ve got to look at the “Enhanced Silver” (not sure if I can borderline-qualify), Silver, Gold and Platinum plan differences a little more closely.

I don’t really know if the two CA premium PPO carriers, Anthem Blue Cross and Blue Shield of CA will be administering the “Enhanced Silver” Plans, which are just a step up from MediCal/CMS (which will be administered my Molina Healthcare). In addition, I cannot use Sharp Health Plan or Anthem EPO because they do not have out-of-network coverage and I am in rural areas out of state for several days or weeks each year. We do not yet know which of the plans on Covered CA these two plans will administer. In any case, I will only choose a PPO and am less concerned about the deductible as ALL of them on CoveredCA are lower than my current deductible plus coinsurance.

I’ve recently had to fill two prescriptions where I was prescribed brand names but due to the brand names going to cost me 10-15 times as much as the “equivalent” generic, I had the pharmacist try to get permission from my drs to fill it generic. My drs did not want to write the generic prescription but verbally did so to the pharmacy at my request. I don’t really know if generics are inferior or not. I guess it depends on what it is. And of course, for many drugs, there is no substitute generic.

I was paying just $318 earlier this year out-of-pocket for my healthcare premium until I decided to formally “retire” to get my healthcare allowance started. After I did so, my premium went wa-a-a-ay up. So $212 to $222 after tax credits and HC allowance (versus ~$80 for an “enhanced silver plan”) won’t kill me and will likely be worth it in the long run.

It has been my experience that you pay for exactly what you get in this life.

[Author]

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