ObamaCare Info

[j's m]

I have yet to get on the NJ government exchange, but I did look at the insurance company's individual plans. I only found one plan that has an out of network component. Is anyone else finding this is their state? What do you do with an out of state student?

What happens when we travel to Disney? The plans cover "emergency room" out of network but not ambulance out of network, and what if you need to stay in the hospital?

 

[Gracie09]

I have yet to get on the NJ government exchange, but I did look at the insurance company's individual plans. I only found one plan that has an out of network component. Is anyone else finding this is their state? What do you do with an out of state student?

What happens when we travel to Disney? The plans cover "emergency room" out of network but not ambulance out of network, and what if you need to stay in the hospital?

Out of network doesn't mean out of area. Most insurance companies have networks across the country. For example I have Empire Blue Cross/Blue Shield (NY based). I live in NJ and use the Horizon Blue Cross/Blue Shield network. If I travel in Fl I use Florida Blues network. When I was in school on my parents insurance, they were aetna. I lived in Louisiana so I used the Aetna providers in that area.

As for out of network emergency rooms, there is a law that all hospitals and insurance companies must cover true emergencies in the ER. That is so someone having a heart attack doesn't try and go across town to a covered ER instead to a local ER.

 

[deedisneydream97]

Tried on Tuesday to get onto the site. Ended up freezing computer. Okay...figured I'd give it a few days. Started again today at 1:15 this afternoon. It took two hours to finally get to my "state" page (NJ). Went thru the procedure to create login info (was a little worried....but then it said SS number was optional). BTW, I am doing this right now for info purposes only...unemployed young adult is on our plan to the tune of nearly $400/month, but good med coverage including prescriptions with low co-pays, low deductible ($200 at the most) and no out of pocket. Am very excited about the prospect of "free or low cost coverage" for him (yes, I know nothing is free, others are paying for the cost of "free" but this family is FAR from being freeloaders....things are just not good for young adults right now). Anyway, once we got the log-in name and password thing set up, it went to the "confirm your address page". Did that, clicked on "save and continue"....page would not load...at 5:15 pm, decided to click on the "live chat" button.....finally got a response at 5:35 "please wait, we are busy helping other people". Finally got a "person" at 5:55, got a cut and paste message about how excited they are to provide coverage but the site is very busy...blah blah. My question "if I leave this page and turn off the computer, will I lose all of the login info it took four hours to get". Response "sorry it's not working". Us: "Yeah, i can see it's not working. However, my QUESTION was will I lose this info if I leave the page." Five minutes later I get a response: "I don't know". and then "Are there any other questions i can help you with"? Us: "No....since I can't get past this page, I don't know what else to expect".

By the time this "chat" was completed it was 6:16 p.m. 5 hours...and we still have absolutely no idea what this "wonderful plan" contains. We also tried to go the the NJ websites...got some info, but no idea how much each plan's monthly cost is....because the computer again froze. According to our local paper, only 25 people were able or wanted to sign up with one of the three "exchanges" in NJ.

I seriously feel sorry for those that are not computer savvy....plus, who has time to constantly run back and forth to the computer to see if the page has loaded? We are trying to make budget plans....our own costs and pre-tax med benefits are changing.

I saw that someone mentioned early on in this thread that they thought Obamacare was going to be "free". My other offspring (mid-twenties) also thought that it was going to be "free".....this is what happens when people don't watch or pay attention or get sucked into websites that appear to be informative newsites but are really just opinions and not real facts.

At least my frustrations trying to figure out My Disney Experience was for a fun and recreational purpose. And am so excited to trying out my magic bands soon.

 

[j's m]

Out of network doesn't mean out of area. Most insurance companies have networks across the country. For example I have Empire Blue Cross/Blue Shield (NY based). I live in NJ and use the Horizon Blue Cross/Blue Shield network. If I travel in Fl I use Florida Blues network. When I was in school on my parents insurance, they were aetna. I lived in Louisiana so I used the Aetna providers in that area.

As for out of network emergency rooms, there is a law that all hospitals and insurance companies must cover true emergencies in the ER. That is so someone having a heart attack doesn't try and go across town to a covered ER instead to a local ER.

Our current BCBS is a PPO that allows the Horizon network, it has the PPO suitcase. The new 2014 plans are EPO not PPO and I'll bet you can't go to out of state networks. Even the doctors lists are way smaller than our old PPO, a lot of doctors are not participating with the exchange plans.

 

[lauradis]

Our current BCBS is a PPO that allows the Horizon network, it has the PPO suitcase. The new 2014 plans are EPO not PPO and I'll bet you can't go to out of state networks. Even the doctors lists are way smaller than our old PPO, a lot of doctors are not participating with the exchange plans.

What's made in nj stays in nj lol nj friend said that . Guess they really really don't want you to leave.

 

[Gracie09]

Our current BCBS is a PPO that allows the Horizon network, it has the PPO suitcase. The new 2014 plans are EPO not PPO and I'll bet you can't go to out of state networks. Even the doctors lists are way smaller than our old PPO, a lot of doctors are not participating with the exchange plans.

I've had epos in the past and have been able to use doctors and hospitals in other states that were part of the network, in this case it was bc/bs. The network is a nationwide network not a local network just like my cell phone is on a nationwide network not a local one so I don't pay roaming when I leave the area.

 

[disneychrista]

Is there any way to get coverage for only ONE person in a family ?

My 20 year old daughter will need to get coverage. But as far as I can see they are only offering coverage for the entire household. So it will cost over $400/month for bronze coverage (lowest level).

My other daughter lives with her boyfriend. Coverage for the two of them will cost twice as much as it would if they could get individual coverage.

I still don't know how this is suppose to be affordable coverage for everyone.

 

[lauradis]

Is there any way to get coverage for only ONE person in a family ?

My 20 year old daughter will need to get coverage. But as far as I can see they are only offering coverage for the entire household. So it will cost over $400/month for bronze coverage (lowest level).

My other daughter lives with her boyfriend. Coverage for the two of them will cost twice as much as it would if they could get individual coverage.

I still don't know how this is suppose to be affordable coverage for everyone.

You should be able to add her to your family plan , because she is unmarried and under 26

 

[tinker&belle]

Is there any way to get coverage for only ONE person in a family ?

My 20 year old daughter will need to get coverage. But as far as I can see they are only offering coverage for the entire household. So it will cost over $400/month for bronze coverage (lowest level).

My other daughter lives with her boyfriend. Coverage for the two of them will cost twice as much as it would if they could get individual coverage.

I still don't know how this is suppose to be affordable coverage for everyone.

I don't know your exact situation, but you should be able to add both girls to your plan if you have insurance if they are both 26 or under.

 

[disneychrista]

I don't know your exact situation, but you should be able to add both girls to your plan if you have insurance if they are both 26 or under.

You should be able to add her to your family plan , because she is unmarried and under 26

My employer does not subsidize family coverage so the cost to add dependents is quite high. Silly us, assumed affordable health care was going to as it is named affordable.

 

[lauradis]

My employer does not subsidize family coverage so the cost to add dependents is quite high. Silly us, assumed affordable health care was going to as it is named affordable.

Sorry dear I'm just happy that my hubby's employer has decided to keep spouse in the family plan this year.

It will work out maybe she will get low rate if she make under 400 percent of wages

 

[pantherlj]

My employer does not subsidize family coverage so the cost to add dependents is quite high. Silly us, assumed affordable health care was going to as it is named affordable.

If you're employer offers dependent coverage you aren't eligible for a subsidy. Check out the catastrophic plan - it's for people under 30. That will probably be the least monthly rate option.

 

[barkley]

Out of network doesn't mean out of area. Most insurance companies have networks across the country. For example I have Empire Blue Cross/Blue Shield (NY based). I live in NJ and use the Horizon Blue Cross/Blue Shield network. If I travel in Fl I use Florida Blues network. When I was in school on my parents insurance, they were aetna. I lived in Louisiana so I used the Aetna providers in that area.

As for out of network emergency rooms, there is a law that all hospitals and insurance companies must cover true emergencies in the ER. That is so someone having a heart attack doesn't try and go across town to a covered ER instead to a local ER.

the new law says that insurers cannot require that the healthcare provider furnishing emergency services be an in-network provider HOWEVER, they MAY apply the deductible that is generally applicable to out of network benefits for emergency services provided out of network. hospitals in an emergency cannot deny care, insurance companies can however apply the same rules they apply to any out of network coverage.

 

[barkley]

I have yet to get on the NJ government exchange, but I did look at the insurance company's individual plans. I only found one plan that has an out of network component. Is anyone else finding this is their state? What do you do with an out of state student?

What happens when we travel to Disney? The plans cover "emergency room" out of network but not ambulance out of network, and what if you need to stay in the hospital?

with out of state students (even in state students who live outside your region) you really have to look at the plans, and weather they have providers both where you live and where your student attends.

what you're seeing on the out of network rules is what we have had to deal with for years, as have several of our friends (limited choices on the coverage our employers offered). with some (who have college students out of state) they keep them on their network provider plans and the kids do all the routine appointments when they are home on breaks, if there's an emergency the parents have to bite the bullet and plan on paying the deductible and co-pays for out of network coverage. others have found it more cost effective to put their kids on separate plans that have networks where they attend college.

also-you have to look at (for emergency treatment) what is covered-with many if not most plans it's assessment and stabilization, and that's it. for on-going treatment it becomes out of network, even in some instances if you have a plan that has nationwide preferred providers. it doesn't mean they are taking new patients. a friend's son had a nasty injury to his leg. his parent's coverage (which is in line with the new laws) covered the portion of the e/r and hospital bills for assessing and stableizing the injury but the ongoing follow up care and therapy wasn't available in his area b/c the coverage didn't have providers in the area so he had to take a semester off school to go home where providers were available. in my neck of the woods we have laundry lists of providers on the insurance company's website for our region, but locals on the plan will tell you that many of the providers haven't taken new patients in years, and the plans are in no hurry to add more:

when we travel out of state we purchase travel insurance to help offset any unforeseen emergencies.

 

[j's m]

Barkley, I'm just really angry that the plan I have with the BCBS PPO "suitcase" that lets me use it countrywide in BCBS networks, is being cancelled. You know, the plan I was told I could keep if I liked it. I'm angry because individual and small group plans are so cookie cutter that they don't apply to our situation (at 63 I don't need maternity and my DS is too old for the dental and vision coverage I wish we had before.)

I just worry about things like getting hit by a car, appendicitis, fall down the steps, etc. (can you hear the helicopter blades whirring?) Out of network ambulance isn't covered by all plans but 1. My MIL and DM are in a nursing home across the parking lot from the hospital. IN network ambulance cost is over $ 600, I can't imagine how much out of pocket out of network ambulance could cost for a several mile trip.

I know the college supplied insurance second semester is around 800, but I know it doesn't cover ACA rules. So how much will it be a year from now? The college is about 40 miles away, but next state. He does come home for routine care, labs, etc but it's the emergencies that crop up. The policies I've seen say "emergency room" care is covered out of network. If you have a broken leg, they stabilize you and send you home to an in network hospital? There are so many crazy scenarios with this new insurance.

Somehow this affordable insurance is going to cost us way more, with additional college insurance, travel insurance and whatever else pops up. I truly think is going to be scary for too many of us.

 

[mikek]

I've had epos in the past and have been able to use doctors and hospitals in other states that were part of the network, in this case it was bc/bs. The network is a nationwide network not a local network just like my cell phone is on a nationwide network not a local one so I don't pay roaming when I leave the area.

I have no idea what the exchange plans are as I have not gotten that far but FYI you have to be very careful with out of network- from previous experience- they have different levels.

-one level is JUST the local insurance companies list which is typically just in state and edges of adjoining states (if anything out of state- NJ plans might have SOME DR's in NYC and Philly as an example)
-second level is that list PLUS the same companies affiliates in any other state an affiliate exists (one of the problems with the existing insurance system that does not appear to be fixed is there is no such thing as a national carrier. There's ~50 BCBS members. Amerihealth, cigna, humana, aetna, etc set up different subsidiaries in each state becasue of the stupid rules. AND frequently they bail on some states all together- so for instance there is no such thing as a Humana subsidiary in NJ so there is no DR list in this state at all.
-third level- you can go to "out of network" Dr.s

this happens to people retiring all the time- they get hosed becasue they move to a state where there is no local affiliate where they move for the insurance company at the place they retired from.


I believe the BCBS system is probably the ONLY nationwide provider with something even close to a presence everywhere in the US.

Also sometimes they do have something akin "roaming" agreements with other providers. For example "health republic' is a brand new provider in nj- they dont have their own network so they're roaming on qaulcare. But as an example qualcare only exists in NY, NJ, PA, and DE so you wont find a provider in Florida.

 

[barkley]

Barkley, I'm just really angry that the plan I have with the BCBS PPO "suitcase" that lets me use it countrywide in BCBS networks, is being cancelled. You know, the plan I was told I could keep if I liked it. I'm angry because individual and small group plans are so cookie cutter that they don't apply to our situation (at 63 I don't need maternity and my DS is too old for the dental and vision coverage I wish we had before.)

I just worry about things like getting hit by a car, appendicitis, fall down the steps, etc. (can you hear the helicopter blades whirring?) Out of network ambulance isn't covered by all plans but 1. My MIL and DM are in a nursing home across the parking lot from the hospital. IN network ambulance cost is over $ 600, I can't imagine how much out of pocket out of network ambulance could cost for a several mile trip.

I know the college supplied insurance second semester is around 800, but I know it doesn't cover ACA rules. So how much will it be a year from now? The college is about 40 miles away, but next state. He does come home for routine care, labs, etc but it's the emergencies that crop up. The policies I've seen say "emergency room" care is covered out of network. If you have a broken leg, they stabilize you and send you home to an in network hospital? There are so many crazy scenarios with this new insurance.

Somehow this affordable insurance is going to cost us way more, with additional college insurance, travel insurance and whatever else pops up. I truly think is going to be scary for too many of us.

I get you.

dd attends college near our home, and she pays a mandatory health fee but the coverage doesn't meet the aca rules so we have to cover her under ours. ours is a grandfathered plan so it doesn't have to meet aca.

dd get's no free preventative coverage under either, and there's almost no preferred providers in our area under our plan. her college's coverage has a very limited network of providers, none of whom are preferred under our insurance. so i'm thinking we need to sit down and start figuring out what provider she would go to for what situation

 

[barkley]

I have no idea what the exchange plans are as I have not gotten that far but FYI you have to be very careful with out of network- from previous experience- they have different levels.

-one level is JUST the local insurance companies list which is typically just in state and edges of adjoining states (if anything out of state- NJ plans might have SOME DR's in NYC and Philly as an example)
-second level is that list PLUS the same companies affiliates in any other state an affiliate exists (one of the problems with the existing insurance system that does not appear to be fixed is there is no such thing as a national carrier. There's ~50 BCBS members. Amerihealth, cigna, humana, aetna, etc set up different subsidiaries in each state becasue of the stupid rules. AND frequently they bail on some states all together- so for instance there is no such thing as a Humana subsidiary in NJ so there is no DR list in this state at all.
-third level- you can go to "out of network" Dr.s

this happens to people retiring all the time- they get hosed becasue they move to a state where there is no local affiliate where they move for the insurance company at the place they retired from.


I believe the BCBS system is probably the ONLY nationwide provider with something even close to a presence everywhere in the US.

Also sometimes they do have something akin "roaming" agreements with other providers. For example "health republic' is a brand new provider in nj- they dont have their own network so they're roaming on qaulcare. But as an example qualcare only exists in NY, NJ, PA, and DE so you wont find a provider in Florida.

this is what I live day to day. my former employer only offers one plan to anyone that moves out of their region of northern California. it's a ppo, and while they claim to be nationwide and have an affiliate here it's almost non existent. everything is out of network because the providers they have in network haven't taken new patients in years (and many on the list are out of practice or dead). the affiliate is so detested by providers in our area that many have a flat out policy that they will not bill. patients must pay the bill in full and seek reimbursement (so we get billed full market rate, then insurance company takes their formulary to decide what the reasonable charge for a service is-and after deductibles and co-pays we get our reimbursement-maybe 30% of the supposed 70% out of network coverage).

 

[mikek]

.... the affiliate is so detested by providers in our area that many have a flat out policy that they will not bill. patients must pay the bill in full and seek reimbursement (so we get billed full market rate, then insurance company takes their formulary to decide what the reasonable charge for a service is-and after deductibles and co-pays we get our reimbursement-maybe 30% of the supposed 70% out of network coverage).

in interesting story about why there is MUCH wrong with the current system (that we're now dumping tons more people into) comes from the dermatologist my family happens to use.

The guy has a thriving practice. But he REFUSES to take anyone's insurance. None. Zero zip. You pay him up front and then get reimbursed.

Because of this he has just TWO employees running his practice. There's a receptionist/shceduler. And a bookkeeper/accountant/office manager. The bookkeeper will even fill out any insurance claim forms for you and mail them for you but that's the end of it. He doesn't need 15 people in the back office that argue with insurance companies all day long over getting paid. It's basically him, another Dr., and the nurses/techs that work with them. it's totally refreshing that there is not a fleet of people in the office at the front of the practice arguing on the phone all day about payment from insurance comapanies.

it's a complete pleasure. He takes however long you need, never rushes you. There's never a giant wait, you basically get in +/- 5 mins of your appt time. I love the place.

So what does he charge? Since there's no fleet of people in the front office he needs to support, it's totally reasonable. It's akin to what you would pay a plumber or electrician or anyone making an honest days pay. It's totally fair, reasonable, i can't say how great.

Since he charges one set of reasonable fair rates, my insurer (we've used him under 2 different plans) have never once balked at his rates. It's always deemed "fair and reasonable" and then they pay it like any out of network.

So if he can exist quite well like that, then why can't we blow up the current system and start over with something more reasonable, where there is a single price for service from the same dr? Not a medicare rate, medicaid rate, bcbs rate, cigna rate, cash rate, uninsured patient rate, etc, etc. There's so much wasted resources dealing with all the nonsense bookkeeping that you could probably cut healthcare costs in america by 10% tomorrow if you blew up the payment system and made it like any normal service.

 

[disneychrista]

If you're employer offers dependent coverage you aren't eligible for a subsidy.

For tax purposes neither of my adult daughters are considered dependents. Why should they be considered dependent for the AHCA?

The more I learn about this so called "Affordable Health Care" the less it makes sense. I am all for getting coverage for all Americans but those who can not afford it now still won't be able to afford it.