Obamacare...(new title): GOP DEATH PLAN: Don-Ryan's Express

[daveakl]

I've posted about my family's bcbs plan.

Wife and I are both self employed. 

4 kids. We make about 130k pre tax.

Our plan has gone from $700 pre Obama care to over $1400 per month. Have not received the latest numbers yet.

It's the same plan we had before Obama care. The other plans in our area (NC) either don't let us keep the same doctors or have crazy high deductibles and/or copay.

It's tough when 17k goes to insurance off the bat and then we have a cap of 15k per year for the family on out of pocket. After taxes about 30% of our pay goes to health care.

[twa]

My wife got to keep her heart specialist, of course she has to go thru my Vietnamese/Cajun primary Dr to get there,

 

I like him even if he hides in the corner from me 

[nonniey]

2 hours ago, TheGreatBuzz said:

My wife keeps telling me I'm in for a rude awakening when I retire.  Right now I don't pay crap and am 100% covered for everything without any copays.  Gotta love the military.  

Bad part is the crap service.  Once while trying to diagnose what turned out to be a kidney stone they told me I may have Lou gherics disease.

People need to remeber that before advocating for government run health care.

Oh you'll still be better off than civilians even after you retire. You get Tricare for Life or Tricare Standard. That is just about $600 a year.

Edited October 26, 2016 by nonniey

[TheGreatBuzz]

7 hours ago, nonniey said:

Oh you'll still be better off than civilians even after you retire. You get Tricare for Life or Tricare Standard. That is just about $600 a year.

Ye but from what I hear the VA isn't exactly knocking it out of the park with their service either.

[Zguy28]

A friend just showed me a letter from her BC/BS provider that said her current $700/month premium was going to $1400. I'm about to do open enrollment here and I'm almost afraid to see. Its gone up a lot over the last 5 years.

[tshile]

32 minutes ago, Zguy28 said:

A friend just showed me a letter from her BC/BS provider that said her current $700/month premium was going to $1400. I'm about to do open enrollment here and I'm almost afraid to see. Its gone up a lot over the last 5 years.

You have to be careful with information like that.

From what I've read, for the vast majority of people, their current plan may have a huge increase but they are supposed to have access to other equivalent plans that range from cheaper to not much more expensive. So it's entirely possible someones current plan is going up double (like your example) but when all is said and done, provided they actually bother to look and compare cost/benefits, they'll not have to deal with that increase.

It sounds like the people that are screwed are the ones in states where their current plan is going up significantly and the number of plans available has dropped to very few (as few as 1) and so they have no choice.

Insurance is about pooling risk so it's possible a plan that wasn't popular (or had the risk % skewed way int he bad) is simply pricing itself out of the market and a person on that plan simply needs to change.

I've yet to find a real good detailed breakdown on the situation where plans are going up dramatically and the options are so few people are stuck with the increase. I'm curious how much of it is due to the state refusing to expand medicaid, what the risk break down looks like for that state, what the % of people on the exchange compared to % of people opting out or using employer coverage looks like, etc.

For example, from the NY Times article I linked on the other page

Quote

“The number of people eligible for tax credits will increase” as premiums rise next year, and the amount of assistance will also increase, Kevin Griffis, a spokesman for the Department of Health and Human Services, said.

Under the federal health law, insurance plans are classified in four levels: bronze, silver, gold and platinum, depending on the amount of coverage.

“If every returning consumer nationwide selected the lowest-cost plan within the same metal level they picked last year, average premiums — taking into account financial assistance — would fall by $28 per month, or 20 percent, compared with 2016,” Kathryn E. Martin, an acting assistant secretary of health and human services, said.

(underline and bold added by me)

This seems to be a part of the issue the media isn't reporting on very well. Or it just gets buried 10 paragraphs into the article at a time when people go off headlines (every article I find mentions the 20+% increase in the headline...)

Be careful taking bait headlines and extrapolating that out to be the summary of the situation. If Kathryn Martin is to be believed, most people should have the option of lowering their monthly premium cost...

[twa]

But what is the difference in networks ect between those metal plans?....and prescription costs, deductibles?

is your required primary or hospital gonna be in another town or even county?

Keep your Dr and lower your rates my ass. 

I've put off looking at the new marketplace.

[tshile]

1 minute ago, twa said:

But what is the difference in networks ect between those metal plans?....and prescription costs, deductibles?

is your required primary or hospital gonna be in another town or even county?

Keep your Dr and lower your rates my ass. 

I've put off looking at the new marketplace.

All important questions that each individual has to evaluate for themselves and one cannot simply rely on another person's position/experience because everyone's will vary.

You certainly can't rely on baiting headlines.

Insurance is complicated. Painting with broad brushes and trying to sum things up in few, short sentences doesn't do anyone any good for their situation.

It doesn't help that, from what I've seen, the brokers/agents are clueless. They seem more a salesman than an informed party acting in your best interest.

 

[Kilmer17]

10 minutes ago, tshile said:

All important questions that each individual has to evaluate for themselves and one cannot simply rely on another person's position/experience because everyone's will vary.

You certainly can't rely on baiting headlines.

Insurance is complicated. Painting with broad brushes and trying to sum things up in few, short sentences doesn't do anyone any good for their situation.

It doesn't help that, from what I've seen, the brokers/agents are clueless. They seem more a salesman than an informed party acting in your best interest.

 

Agents are abandoning the Health Ins field in the thousands.  My Agency no longer offers any health policies (except supplemental) because of the bureaucratic nightmare involved in A- maintaining the license B- navigating the constantly changing state and federal guidelines and C- the marketplace.

 

It's not worth it anymore.

 

On another personal note.  My wife's school board insurance is going to double in cost next year for their family plan.  I'm sure most teachers and families can afford that extra 4 grand a year for insurance.  NOTE- This is not an Obamacare issue other than the fact that is caused by the market eff up that IS an Obamacare issue.

[nonniey]

2 hours ago, TheGreatBuzz said:

Ye but from what I hear the VA isn't exactly knocking it out of the park with their service either.

That is not the VA, that is your insurance - basically same as what you have now but you'd use civilian doctors.

[Corcaigh]

My anecdotal experience is that through aggressive shopping around over the past few years our company costs have stayed the same. It's a pain for our HR folks to work with the broker on this every year but we're getting results.

[tshile]

7 minutes ago, Kilmer17 said:

Agents are abandoning the Health Ins field in the thousands.  My Agency no longer offers any health policies (except supplemental) because of the bureaucratic nightmare involved in A- maintaining the license B- navigating the constantly changing state and federal guidelines and C- the marketplace.

Meanwhile hospitals are jumping into the game and completely cutting out the middleman that are insurance agencies. Some are listed as the best plans available nationwide in terms of coverage and cost.

The entire industry is changing. You can find good and bad. Again, you have to look at every specific situation with all the details. It's easy to pick bits and pieces and paint all sorts of different pictures.

An example: When it first started we had tons of people ****ing about their plans being canceled. They were simply renamed because they had to add a few items to meet the requirements and their internal system wouldn't allow them to alter the plan they had to make  "a new one" and "cancel" the one they weren't able to offer any longer (or it was just easier on their internal process to do it this way.) Lots of details missing from the "my plan was canceled" nonsense we saw going on everywhere.

It's a very complicated situation right now... our politicians and media aren't doing any of us any favors in trying to weed through it either.

4 minutes ago, Corcaigh said:

My anecdotal experience is that through aggressive shopping around over the past few years our company costs have stayed the same. It's a pain for our HR folks to work with the broker on this every year but we're getting results.

I'm curious how much our situation is a result of no one putting in enough time/effort to get this sort of result.

I'd care but I'm not on their plan, so I'm not actively involved in the discussions. It's hard to jump in and essentially accusing people of not putting in the required work (whether that's what you mean to do or not, that's how it comes across to some people.)

[thebluefood]

Admittedly, I don't know much about the ACA but I do know this:

-I turn 26 next year and will be off my parent's insurance plan

-I live in a state that has not only been hostile toward the ACA from the start but now has limited options (i.e. a single option: BlueCross/BlueShield unless you live in a few counties)

-I'm pulling two, part-time gigs and can barely make ends meet as it is so I'm not sure how much subsidies will help me out and I cannot afford the penalty for not having health insurance if it goes through

-It's highly unlikely my hours are going to increase at either job before my birthday

-I have an Adderall prescription that, while not perfect, has saved my life because it actually helps me focus on my priorities

-I'm kinda sorta starting to lose my mind

For God's sake can we please do something about this (notice the "we" here because I know I have to do my part but we've got to do this together)?

Edited October 26, 2016 by thebluefood

[CBass1724]

For-profit healthcare is the devil.

[bearrock]

14 minutes ago, thebluefood said:

-I'm pulling two, part-time gigs and can barely make ends meet as it is so I'm not sure how much subsidies will help me out and I cannot afford the penalty for not having health insurance if it goes through

 

Your subsidy is a function of your income.  Basically, your premium is capped at between 2 to 9.5% of your income depending on where you fall on the 133% to 400% of the federal poverty guideline.  If you make more than 400% of the guideline (appx 45K for household of 1), no more subsidies.  Another thing to keep in mind is that subsidy is doesn't change no matter what plan you choose.  Meaning you can opt for a bronze plan and still get the same subsidy, which means less premium than if you had chosen silver or above.  Also, if your major concern is a no-brainer, documentable, specific prescription drug, consider Kaiser.  Usually much cheaper.

Good overview here https://www.valuepenguin.com/understanding-aca-subsidies 

On the premium increase, medical loss ratio cap was supposed to slow down the increase, but lots of states have gotten waiver approved by HHS (essentially the state market is not competitive enough).  Also, by capping insurance company profit at 15% premium, you have just removed a big incentive on the part of the insurance company in reigning in medical costs (think they want to make 15% of 1 Billion or 10 Billion?).

I would support a change allowing people to buy into medicare early.  Participants could pay medical cost + overhead (I think it was like 4%) + 5% profit for medicare system and it would still beat most, if not all, private insurance.  If private insurance stops caring about negotiating better rates to pad its profits, get out of the way and let government enter the field.  Medicare was better at cost negotiation before ACA and it is running circles around private insurance after ACA.  

[thebluefood]

3 minutes ago, bearrock said:

 

Your subsidy is a function of your income.  Basically, your premium is capped at between 2 to 9.5% of your income depending on where you fall on the 133% to 400% of the federal poverty guideline.  If you make more than 400% of the guideline (appx 45K for household of 1), no more subsidies.  Another thing to keep in mind is that subsidy is doesn't change no matter what plan you choose.  Meaning you can opt for a bronze plan and still get the same subsidy, which means less premium than if you had chosen silver or above.  Also, if your major concern is a no-brainer, documentable, specific prescription drug, consider Kaiser.  Usually much cheaper.

Good overview here https://www.valuepenguin.com/understanding-aca-subsidies 

On the premium increase, medical loss ratio cap was supposed to slow down the increase, but lots of states have gotten waiver approved by HHS (essentially the state market is not competitive enough).  Also, by capping insurance company profit at 15% premium, you have just removed a big incentive on the part of the insurance company in reigning in medical costs (think they want to make 15% of 1 Billion or 10 Billion?).

I would support a change allowing people to buy into medicare early.  Participants could pay medical cost + overhead (I think it was like 4%) + 5% profit for medicare system and it would still beat most, if not all, private insurance.  If private insurance stops caring about negotiating better rates to pad its profits, get out of the way and let government enter the field.  Medicare was better at cost negotiation before ACA and it is running circles around private insurance after ACA.  

Thanks for the heads up. This stuff is still new and overwhelming to me and I need to buckle down and get on it. This seems like a good place to start. 

[tshile]

3 minutes ago, bearrock said:

 

 Medicare was better at cost negotiation before ACA and it is running circles around private insurance after ACA.  

 

Yes, they just cut rates for readmission and arbitrarily cut for first time admission to whatever they felt like. Because when you're the #1 source of income, with no way for the other side (the hospital/doctor) to actually fight you on it (other than voting for new representatives to change the law) you can do that.

The ramifications have been cheaper (in quality not just price) medical equipment being purchased, higher patient-to-nurse/tech ratios, a gutting of management, and various other cost reduction measures. It isn't just cheaper healthcare, there are consequences to the way they chose to do this.

the HCAHPS system, and tying it directly to medicaid/care reimbursement, sucks and is stupid.  You only get to see that if you're actually responsible for working on the floors, with the patients, and dealing with the HCAHPS reports though.

[TheGreatBuzz]

2 hours ago, nonniey said:

That is not the VA, that is your insurance - basically same as what you have now but you'd use civilian doctors.

Then why does anyone go to the VA?  I haven't researched any of it because I'm still a few years away but I thought the deal with Tricare is that if there is a VA clinic in your area you HAVE to go there first.

[nonniey]

31 minutes ago, TheGreatBuzz said:

Then why does anyone go to the VA?  I haven't researched any of it because I'm still a few years away but I thought the deal with Tricare is that if there is a VA clinic in your area you HAVE to go there first.

I'm just now going through retirement process but that is not my understanding on how it works. You can use the VA and so can Vets not on Tri-care for some things but believe you can go to any doctor that accepts Tri-care. 

[Dont Taze Me Bro]

3 hours ago, TheGreatBuzz said:

Then why does anyone go to the VA?  I haven't researched any of it because I'm still a few years away but I thought the deal with Tricare is that if there is a VA clinic in your area you HAVE to go there first.

 

3 hours ago, nonniey said:

I'm just now going through retirement process but that is not my understanding on how it works. You can use the VA and so can Vets not on Tri-care for some things but believe you can go to any doctor that accepts Tri-care. 

VA is not health insurance, it's a benefit, so you don't have to choose it first.  While active duty, you would have Tricare (standard, prime, etc.).  When you retire from active duty, you have to change your options to another Tricare plan (IIRC).  And if you are eligible for VA and have Tricare, then you can pick where you want to go.  So as long as the provider is contracted with Tricare, it's not a problem.  If I'm not mistaken, you are only eligible for VA benefits after you retire from active duty.  

When you qualify for Medicare, your Tricare plan would then change to Tricare For Life, which then acts as a supplement to Medicare, so Medicare would have to be billed first.  Then when claims cross over to Tricare, it would pick up the remaining charges at 100%.  

If you are eligible for Medicare and VA benefits, then you can choose to get the services (if authorized by VA) at a VA hospital or facility.  Or you can choose to have them done at a facility/office where they accept Medicare.  

If you have all three (VA benefits, Medicare and Tricare For Life) then you can pick and choose if you want to get coverage through the VA or through Medicare.

Edited October 26, 2016 by Dont Taze Me Bro

[nonniey]

2 minutes ago, Dont Taze Me Bro said:

 

VA is not health insurance, it's a benefit, so you don't have to choose it first.  ......

Much better explanation than my meager flailing.

[TradeTheBeal!]

6 hours ago, Corcaigh said:

My anecdotal experience is that through aggressive shopping around over the past few years our company costs have stayed the same. It's a pain for our HR folks to work with the broker on this every year but we're getting results.

 

My experience has been similar.

[twa]

3 minutes ago, TryTheBeal! said:

 

My experience has been similar.

 

Have you changed to higher deductibles,PPO to HMO ect?...or just different ins companies

[AlvinWaltonIsMyBoy]

19 hours ago, daveakl said:

Wife and I are both self employed. 

I'm self employed living in NC as well.  I'm a liberal, but Obamacare has been an absolute disaster in our state.  

I'm grateful that people with pre-existing conditions can get the coverage they need, but I see and hear of many stories like yours from my family and friends.  Under no circumstances should any family have to bear these kinds of financial burdens for healthcare.  It's criminal.  

[skinsmarydu]

38 minutes ago, AlvinWaltonIsMyBoy said:

 It's criminal.  

LSF said that healthcare for profit is criminal years ago.  I agreed with her way back then.