ObamaCare Info

[mikek]

I think that both the insurance companies and the government are guilty of lying.

The claim that "if you like your plan, you can keep it" should have had "if it meets the standards we have dictated" somewhere in the small print.

Insurance companies, OTOH, are using dictates such as 100% coverage for preventive care, birth control prescriptions and routine mammogram coverage as legitimate reasons to dump plans that don't include them. My insurance rates are going up because my plan has to cover maternity care under the new law. I'm post-menopausal. Why do I need maternity coverage? I don"t. But the law dictates that my policy must include it.

thing is supposedly they can get 'grandfathered' in as long as the plan existed prior to the time the ACA was passed. So supposedly they can continue not to cover those things as long as they don't make any substantive changes. (I think they can adjust premiums as long as they maintain 80/20 rule but no other out of pocket can get worse as an example)

What's more intriguing in the case of NJ BCBS is they had an 'affordable care act handbook' that said as of 1/1/2011 all renewals were getting all the new coverages mandated by obamacare. And my rates went up a pile big enough that made sense (15-20% a year since obamacare despite the 'statistics' saying should just be 5-6%).

So not only should NJ BCBS be allowed to keep their old plans open if they want, they even one upped it and added all the extras anyway. Now all of a suddent they "cannot" renew? It doesn't add up. Either they are lying, or the feds changes something, or BCBS misinterpreted something early on and made a bad move that disqualified them from grandfathering.

I dont know but i'd love to find out the truth.

 

[mikek]

A few people on another chat board have reported that on or off exchange prices are the same.

"I believe the law requires that every company on the exchange also offer identical plans off-exchange, for the same prices as the on-exchange twin policy. Off exchange they can also offer additional plans which comply with ACA requirements, so some exchange providers are offering some different alternatives off-exchange."

Of course, it probably doesn't apply to our great State of New Jersey.

Amerihealth's website has one more plan (I think an HMO off the top of my head in the 3 medal categories) that is not listed on the obamacare spreadsheet that someone was kind enough to post above. So looks like they at least are offering one additional plan- but BCBS seems to match the spreadsheet (although i didn't look supper carefully- I just say EPO and gave stopped looking hard- that's too scary for our household with our history)

 

[j's m]

So for 19 years, I've been paying for someone else's large family. Say thank you, Mike.

 

[mikek]

So for 19 years, I've been paying for someone else's large family. Say thank you, Mike.

to be fair I've only had more than the 2.06 average kids for the past ~7 years.

But THANKS!

It is fairer this way but really wish they could have warned me (and really really wish that my BCBS existing plan was still going to exist)

and again, i just keep wondering how this is so poorly implemented. They could have just warned people what to expect. But instead they had the pricing a few days before the excahnges opened and refused to post it on the website, and still today most people can't even look at the exchange to see the prices.

Imagine your Mike Brady. You're an architect making something over median income- well off enough that your wife can stay home (ssshhhhh- lets ignore alice for the moment). But you aren't so loaded that you own anything more than a station wagon and your kids share bedrooms (well at least until greg gets that groovy attic apartment- lol). You've been paying 1500 a month for middling coverage and now it's going to up to 2100 a month. Next thing you know you take in that little sickly cousin with the glasses and your at 2325. with that little sick bugger your are sure to top out the out of pocket at 12,700. So maybe you made 120 grand a year but you just shelled out 36k for healthcare.

Carol is gonna have to get a job or they need to send that cousin back to where he came from!

 

[mom2rtk]

to be fair I've only had more than the 2.06 average kids for the past ~7 years.

But THANKS!

It is fairer this way but really wish they could have warned me (and really really wish that my BCBS existing plan was still going to exist)

and again, i just keep wondering how this is so poorly implemented. They could have just warned people what to expect. But instead they had the pricing a few days before the excahnges opened and refused to post it on the website, and still today most people can't even look at the exchange to see the prices.

Imagine your Mike Brady. You're an architect making something over median income- well off enough that your wife can stay home (ssshhhhh- lets ignore alice for the moment). But you aren't so loaded that you own anything more than a station wagon and your kids share bedrooms (well at least until greg gets that groovy attic apartment- lol). You've been paying 1500 a month for middling coverage and now it's going to up to 2100 a month. Next thing you know you take in that little sickly cousin with the glasses and your at 2325. with that little sick bugger your are sure to top out the out of pocket at 12,700. So maybe you made 120 grand a year but you just shelled out 36k for healthcare.

Carol is gonna have to get a job or they need to send that cousin back to where he came from!

If you're going to send Oliver back, at least call him by name.

 

[mikek]

If you're going to send Oliver back, at least call him by name.

You're outta here OLIVER!

(best laugh i've had in a while - thanks!!!!!)

 

[lauradis]

You're outta here OLIVER!

(best laugh i've had in a while - thanks!!!!!)

But sicky nerds grow up to be bill gates.

 

[Colleen27]

Most of what DR said is spot on, at least in the short term, and taken 1 step further why the administration is not going to move on the individual mandate. Looking small scale, let's say 10 friends decided to for a health care COOP. They figure each person has $500 worth of medical bills a year and 1 random person has $5,000 worth of bills. So, that's $10,000 worth of expenses split across 10 people or $1,000 a year. Let's suppose an 11 person wants to join the group. They have medical bills of $20,000 every year. It's now $30,000 in expenses split across 11 people or $2,700 per year. Costs for everyone went up. This is where "Adverse Selection" and the need for "Individual Mandate" comes in. If 3 of the 10 people decided, "why am I paying so much?" and drop out, you now have on average $27,000 (the 500 less per person + some years of no $5,000) of expenses split across 8 people. So the premium climes to $3,375. That may cause more "healthy people" to look elsewhere raising the premium again.

There is another reason the administration cannot budget on the individual mandate - without it, the prohibition on pre-existing condition exclusions and denials of coverage cannot function. If 3 of your 10 people decide it isn't worth paying for insurance when they're healthy but sign up for a new policy after a diagnosis of cancer or diabetes - possibly advanced enough to require significantly more complicated care than if it had been detected at a routine check-up - the math quickly becomes impossible.

My advice to you is since you're "just under" 200% FPL look at how the plan changes if you make 200%-250% of FPL and see what happens if your family income increses. Legally, it looks like you're supposed to inform them midyear and they'll change the subsidy midyear if your income changes significantly in either direction. You may affect your decision from amongst the varous silver plans offer in your state.

I'm playing with the calculators to try to plan for just that possibility. In the last decade, our family income has swung from barely above the poverty line to about 250% of FPL. I'm projecting a "best case" income scenario right now, on the premise of planning for the worst, hoping for the best, and I'm trying to find more about reporting mid-year changes and other wrinkles that I'm sure will pop up given our sometimes wildly unpredictable income.

I know the drug testing failed in Florida but expand it to include nicotine and alcohol.

Dave Ramsey says people are poor because they do the things poor people do. I think there is some truth to that, ok, a lot of truth.

I'm not sure testing for legal substances would get past any judicial challenge, and although I see why the idea has appeal I think that is as it should be. I personally would like to see drug testing expanded to include the oft-abused prescription drugs that are the most rampant addiction in my area/experience, but because they are legal and many addicts "score" legally via unethical doctors it is nearly impossible to police.

As far as why the poor are poor, I don't think that matters. Why one individual is poor is entirely irrelevant when our economy needs millions of working poor to keep operating. Yes, some could better their situations by making different choices and some could have done so with better choices in the past but are more or less "trapped" today, but addressing the individual just makes it easier to overlook the broader reality of a service economy. Even if everyone makes good choices, we need some of them to flip burgers, ring up groceries, change oil, and stock shelves.

Colleen27, yes, under the ACA a 24 year old living at home can get a subsidy, or medical assistance, or a BHP (basic health plan, if the state you are in opts to have one). The household income thing is a bit more complicated and actually factors in who you can claim as a dependent.

Good to know. Thank you.

But i think perhaps you are in for something of a rude awakening with the obamacare plans- there doesn't really seem to be "family coverage" anymore - you basically seem to be charged for each individual. I priced 3 of the 4(I think) NJ providers on their websites. All now assign a cost per person. My cost for example was around 400, my wife was about 20 more (she's only a year older and i thought age wasn't supposed to matter so i think it could be more for women?) and my kids were each 1-200 bucks. I've NEVER seen anything like that in the past and we've had our share of insurers over the years looking for any edge. I think it has something to do with how they sometimes figure things like subisides and the 9.5% thing on a per person basis- cant really say.

In fact- you might have really hit on something that explains the large increase in plan prices for me - i have a family of 5. Probably family plans where based on the average family size which was less than 5 people. Now that they charge per person I'm actually paying for the 5th. Perhaps that is what's going on????

It is. The Michigan BCBS site has this wording "Premiums are charged for all adult children ages 21 and older and for the three oldest dependent children under age 21.". I hadn't realized that change - I was wrong about that advantage to keeping adult kids on a family plan - but it is probably why some families are seeing such huge premium increases.

I'm not sure why it isn't hitting us harder - maybe because we had a plan that covered maternity care and therefore charged a lot more for me than for DH, which they aren't allowed to do any more? I still need to read the fine print and pick a plan based on the details of coverage and networks, but the pre-subsidy pricing I'm seeing is within 5-10% of what we'd been paying which is about what I expect to see since I last checked prices in Dec/Jan.

 

[j's m]

You can now look at plans without registering.

Go the healthcare.gov and the bottom/center of the page under Top Content is preview plans and prices.

NEVER MIND, it gives ONE price per plan. I asked for parent and child DID NOT GIVE AGES and it gave a price. Fat lot of good that did.

 

[johde]

I'm playing with the calculators to try to plan for just that possibility. In the last decade, our family income has swung from barely above the poverty line to about 250% of FPL. I'm projecting a "best case" income scenario right now, on the premise of planning for the worst, hoping for the best, and I'm trying to find more about reporting mid-year changes and other wrinkles that I'm sure will pop up given our sometimes wildly unpredictable income.

I'm not sure why it isn't hitting us harder - maybe because we had a plan that covered maternity care and therefore charged a lot more for me than for DH, which they aren't allowed to do any more? I still need to read the fine print and pick a plan based on the details of coverage and networks, but the pre-subsidy pricing I'm seeing is within 5-10% of what we'd been paying which is about what I expect to see since I last checked prices in Dec/Jan.

The plans I'm looking at that 200%FPL line makes a big different.

"Normal Plan"
________ 150%-200% 200%-250%
Deduct -----$750 --------- $2,500
CoIns -------10%---------- 10%
OOP Max.----$1,750 --------$3500
OfficeVisit -----$30 ----------$40


"HSA Plan"
------------150%-200% 200%-250%
Deduct -------$1,150 ------- $2,000
CoIns ---------- 0% ----------10%
OOP Max. -----$1,1150 ------$4,000

Crossing that line makes a big difference.

Having maternity is probably a bit part of it. Being a single man, it a feature I'll never need but will start paying for next year.

You can now look at plans without registering.

Go the healthcare.gov and the bottom/center of the page under Top Content is preview plans and prices.

NEVER MIND, it gives ONE price per plan. I asked for parent and child DID NOT GIVE AGES and it gave a price. Fat lot of good that did.

I found that today as well. It helped me immensely, assuming it's comprehensive. It confirmed what I have 3 companies to choose from in the exchange. I'd found premium and coverage information for 2 of those plans for my age from other websites and a phone call. The third one I've found basic information but not everything yet. I can stop trying to get logged into Heathcare.gov for the time being and let them get things worked out.

It also helped me most confirm why a couple of subsidy estimators were significantly different. The big county in our region has access to additional plan options. KFF was estimating subsidy by region, the other one (MedMutual.com) was doing it by county, but may work only for their coverage area. Using the estimate for subsidy from MedMutual, the "second lowest silver plan" I could find, priced out right where it should. Where using KFF, I was always getting higher premiums.

 

[mikek]

You can now look at plans without registering.

Go the healthcare.gov and the bottom/center of the page under Top Content is preview plans and prices.

NEVER MIND, it gives ONE price per plan. I asked for parent and child DID NOT GIVE AGES and it gave a price. Fat lot of good that did.

exactly- and they are almost lying. I suspect the people that program the thing have all drank the kool aid and so they just assume the prices will be lower for everyone and no one could possible be paying more under the beloved system.

there's a GIANT disclaimer that says the word "lower" 3 times implying the prices you actually pay will be lower. Not once does the giant box say HIGHER.

yet for plenty of people it will be higher.

for example- when i use the healthcare.gov premium estimater the 5th cheapest plan is "Horizon Advance EPO Silver" and the feds say it will cost me 986.34 but on the hotizon site where it checkes my and my wifes ages and number of kids its 1298.12. THIRTY TWO PERCENT SHORT!!!!!!

 

[Robbi]

I don't know if y'all know this bit of information:
Many people signing up for health care in Florida through the Affordable Care Act have been shocked when they have to give proof of their credit score before they finish the process.

Anne Packham, one of many people licensed by the state to help people navigate the governments website, said on Tuesday that the credit check occurs so providers can make an educated decision about who to insure.

If someone is defaulting on all of their bills they may not want to have them as part of their health plan, said Packham, the lead Navigator in Florida.

Before Obamacare, this was routine with insurance companies. It surprises me that it will still be in effect. This will exclude even more people. I wonder if they'll be charged the tax if they apply and then are turned down.

Also, this is probably not news after the NSA, etc. but enrolling in Obamacare allows the government to link your IP address with your name, social security number, bank accounts and web surfing habits. IF we would enroll which we 99% won't, I'd do it on paper and mail it in-not that that would stop any snooping in the long run but it might make it a little harder for them.

 

[j's m]

If I go to the exchange for the plan I like, they ask under 49 or over 50. The under 49 price is 360.11. If I go to Amerihealth, that's the price for a 27 year old.

If I go to the exchange, the over 50 price is 613.70. Amerihealth's price for a 63 year old woman (me) is 1014.3.

They tried to fix it and made it worse by lying by the prices.

 

[mikek]

I don't know if y'all know this bit of information:
Many people signing up for health care in Florida through the Affordable Care Act have been shocked when they have to give proof of their credit score before they finish the process.

Anne Packham, one of many people licensed by the state to help people navigate the governments website, said on Tuesday that the credit check occurs so providers can make an educated decision about who to insure.

If someone is defaulting on all of their bills they may not want to have them as part of their health plan, said Packham, the lead Navigator in Florida.

Before Obamacare, this was routine with insurance companies. It surprises me that it will still be in effect. This will exclude even more people. I wonder if they'll be charged the tax if they apply and then are turned down.

Also, this is probably not news after the NSA, etc. but enrolling in Obamacare allows the government to link your IP address with your name, social security number, bank accounts and web surfing habits. IF we would enroll which we 99% won't, I'd do it on paper and mail it in-not that that would stop any snooping in the long run but it might make it a little harder for them.

source please- I'm no giant fan but i beleive this is wrong.

one- no human is has even been able to 'give proof of their credit score'- you can't. Only a business can buy your credit score.

second- all indications are that they only using experien to verify employment and possible other information (WHICH IS stupid since the IRS should have all that and they do link into the IRS for sure since they run the fines,er taxes, et ah fines/ er whatever we need to call them to get the bill passed and not strck down by the courts)

third- someone surely YEARS ago would have found the provision in the ACA that said they could now use credit ratings to rate you. They can't check if you drink, have cancer, or on medications already but somehow they allow a credit check- I dont buy it. In NJ i can get a rate from the insurers with just sex and age. I think federally they be allowed to "fine" you for smoking. But i think that is all.

If i'm wrong i would be surprised so a link to learn more would be much appreciated.

 

[j's m]

I don't know if y'all know this bit of information:
Many people signing up for health care in Florida through the Affordable Care Act have been shocked when they have to give proof of their credit score before they finish the process.

Anne Packham, one of many people licensed by the state to help people navigate the governments website, said on Tuesday that the credit check occurs so providers can make an educated decision about who to insure.

If someone is defaulting on all of their bills they may not want to have them as part of their health plan, said Packham, the lead Navigator in Florida.

Before Obamacare, this was routine with insurance companies. It surprises me that it will still be in effect. This will exclude even more people. I wonder if they'll be charged the tax if they apply and then are turned down.

Also, this is probably not news after the NSA, etc. but enrolling in Obamacare allows the government to link your IP address with your name, social security number, bank accounts and web surfing habits. IF we would enroll which we 99% won't, I'd do it on paper and mail it in-not that that would stop any snooping in the long run but it might make it a little harder for them.

Packham has retracted her statement:

"After receiving numerous emails about the story, Local 6 contacted Packham on Wednesday, and she said her statement was incorrect, adding that users do not need their credit scores to apply for the Affordable Care Act.

The embarrassing flap raises further serious questions about the capability of Obamacare navigators to provide accurate and trustworthy information about healthcare reform.

The navigators have access to sensitive personal data such as social security numbers and income, raising privacy concerns."

http://freebeacon.com/lead-florida-obamacare-navigator-does-not-understand-law/

 

[mikek]

http://freebeacon.com/lead-florida-obamacare-navigator-does-not-understand-law/

October 9, 2013 10:50 am

Lead Florida Obamacare Navigator Anne Packham has retracted earlier claims that Floridians must provide their credit score to apply for health insurance, WKMG reports:

A day after telling Local 6 that anyone signing up for the Affordable Care Act had to provide their credit score, the lead navigator in Florida said she was wrong.

 

[lauradis]

I don't know if y'all know this bit of information:
Many people signing up for health care in Florida through the Affordable Care Act have been shocked when they have to give proof of their credit score before they finish the process.

Anne Packham, one of many people licensed by the state to help people navigate the governments website, said on Tuesday that the credit check occurs so providers can make an educated decision about who to insure.

If someone is defaulting on all of their bills they may not want to have them as part of their health plan, said Packham, the lead Navigator in Florida.

Before Obamacare, this was routine with insurance companies. It surprises me that it will still be in effect. This will exclude even more people. I wonder if they'll be charged the tax if they apply and then are turned down.

Also, this is probably not news after the NSA, etc. but enrolling in Obamacare allows the government to link your IP address with your name, social security number, bank accounts and web surfing habits. IF we would enroll which we 99% won't, I'd do it on paper and mail it in-not that that would stop any snooping in the long run but it might make it a little harder for them.

Wonder if that will then push them into the private market for insurance at higher rates, because of unworthy credit?

So no insurance, but the feds still get there new tax and the poorest of the irresponsible non credit worthy get to pay for it. WOW

The kick in the balls, bad credit was from unpaid medical bills, because you didn't have insurance before ACA. Now you can't afford insurance because of ACA and non credit worthyness, because of unpaid medical bills.

Hope this new info is just more panic over new ACA

 

[lauradis]

federally they be allowed to "fine" you for smoking.

Let's see if I have ACA logic down

Smoking BAD
making over 400% BAD
Being over 50 BAD

Obesity Good
Being Sickly Good
Making under 94K year Good
Being under 49 Good

I'm sure there are more but ACA logic makes me want to smoke and drink

http://fitness.mercola.com/sites/fitness/archive/2012/08/03/obesity-surpasses-smoking.aspx

That's just one there are many many non american doctors saying smoking is on the decline while obesity cost more in health care.

 

[johde]

Let's see if I have ACA logic down

Smoking BAD
making over 400% BAD
Being over 50 BAD

Obesity Good
Being Sickly Good
Making under 94K year Good
Being under 49 Good

I'm sure there are more but ACA logic makes me want to smoke and drink

http://fitness.mercola.com/sites/fitness/archive/2012/08/03/obesity-surpasses-smoking.aspx

That's just one there are many many non american doctors saying smoking is on the decline while obesity cost more in health care.

If you make under 400% of the poverty level, your age thing go's wacky. For a given income, the second cheapest cost the tax payer the same amount of money. The 60 year old get's a bigger tax credit than the 20 year old. So at that level age doesn't matter. They can take that credit and purchase any plan they want.

I did a quick lookup on a local insurer around here comparing the premium I'd pay at my current 45 compared to me at 63 with my current income.

Silver plan we both pay about $120
Bronze plan 45 year old pay $60; 63 year old pays $0
Gold Plan 45 year $237; 63 year old $347

 

[lauradis]

If you make under 400% of the poverty level, your age thing go's wacky. For a given income, the second cheapest cost the tax payer the same amount of money. The 60 year old get's a bigger tax credit than the 20 year old. So at that level age doesn't matter. They can take that credit and purchase any plan they want.

I did a quick lookup on a local insurer around here comparing the premium I'd pay at my current 45 compared to me at 63 with my current income.

Silver plan we both pay about $120
Bronze plan 45 year old pay $60; 63 year old pays $0
Gold Plan 45 year $237; 63 year old $347

Age doesn't matter as much when your under 400% poverty level

But if your over 50 and over 400% you still in the bad camp.

You realize that over 40 age group till retirement are normally you highest earning years of your life.

Wonder what this is going to do to peoples ability to save for retirement?