ACA and The New Exchanges

[Nemont]

One can anticipate premiums to rise due to the health care exchanges. To what degree will vary dependent upon a number of factors, and subsidies incorporate another level of complexity. Recent news articles indicate some individuals might see premiums double under the ACA requirements . If you have some time, some interesting articles to read are:

Premiums Set to Rise

Health Insurance Sticker Shock

Health Care Spending

Policies will cost more, cover less

Not only that but due to the way the subsidy is figured you can have a 55 year old paying less out of pocket then a 25 year old same FPL and family situation. In addition you will have people that get no subsidy, they can't buy lower benefits off the exchange to manage their premiums and they will see an increase beyond their willingness or ability to pay.


It is an interesting time. We spent a couple of hours scenario building and the implications are almost too complex for a single person to understand and I think a lot of the rule writers simply are not able to see over the horizon at some unintended consequences.


Nemont

 

[dustinf]

Not only that but due to the way the subsidy is figured you can have a 55 year old paying less out of pocket then a 25 year old same FPL and family situation. In addition you will have people that get no subsidy, they can't buy lower benefits off the exchange to manage their premiums and they will see an increase beyond their willingness or ability to pay.


It is an interesting time. We spent a couple of hours scenario building and the implications are almost too complex for a single person to understand and I think a lot of the rule writers simply are not able to see over the horizon at some unintended consequences.


Nemont

It boggles my mind how idiotic health insurance has become. My wife was run over by a drunk driver and it cost us about $17,000 between copays and subrogation.

Hard to believe 60 years ago a doctor delivered my Mother in my Grandparent's house for a dozen eggs...

 

[cowboy]

Hard to believe 60 years ago a doctor delivered my Mother in my Grandparent's house for a dozen eggs...

You just hit the nail on the head. If you want "true medical reform" you have to go to the source of the problem, and that bowls down to what is being charged for what.

Doctors salaries are not the only problem. Ever look at a hospital bill and see what the charge is for individual items. When I was released the last time from a hospital I had a charge of 20 plus bucks for a small box of kleenix as an example. Never ordered them and never used them - tough chit.

This same visit I played a little game - I asked for a quote from my doctor before the procedure on what my bill would be. He and his staff looked at me like I had 3 ears - they had no idea.

Ever try and pay cash for an emergency visit upon leaving a hospital - can't be done in one of our hospitals in Billings. They don't know what the bill is going to be - sit back and open the surprise envelope at a later date.

I would bet that if eveyone in this country "got a quote" before having anything done medically, you'd be amazed at the cost savings. What else do we buy where we have no idea what the cost is going to be before we buy it - Very very little.

 

[jryoung]

"Cost" is an arbitrary term because that is what the provider bills the insurance company. But, it's more like a bartering game, start high, offer low and meet somewhere in the middle. Hospitals and providers lob a figure and some actuary determines how much to pay.

The result? Doctors are reimbursed pennies on the dollar and have to hire additional help to deal with billing issues. Because lower reimbursements are coming in, and costs are going up (additional help) they can only spend so long with patients and have to make it up on volume. That volume leads to poor service and greater risks. Because the care is poor, the patients have to come back (more costs) and risk goes up (higher malpractice premiums).

Are we any healthier? Nope? Did the ACA change anything? Nope

 

[sweetnectar]

I was revisiting this tread because my premium, just for me was $160/month and just went to $196 this month and in Jan I'm told it will go to $270(plan changes in Jan to cover obamacare guidelines...some dental care,sex changes, etc.) I currently use blue cross blue shield. I'm told from others their premiums are increasing as well. What are people doing? Any suggestions on what to do?

 

[Big Fin]

I was revisiting this tread because my premium, just for me was $160/month and just went to $196 this month and in Jan I'm told it will go to $270(plan changes in Jan to cover obamacare guidelines...some dental care,sex changes, etc.) I currently use blue cross blue shield. I'm told from others their premiums are increasing as well. What are people doing? Any suggestions on what to do?

By going to the exchange, my monthly premium will go down from $1,600 per month to $620 per month for me and my wife. Lower out of pocket and deductibles than the old policy. Both with BC/BS; no dental or vision. Crazy difference.

 

[BigRack]

Don't disagree with this but I would point out that what were doing prior to ACA was not sustainable either so I guess doing something was just a first step.


Nemont

What was not sustainable before Obamacare?

 

[BigRack]

The rules apply to all exchanges, except private Exchanges, remember in Montana doesn't run it's own exchange.

So the challenge is that if you are currently covered on your spouse's group plan and your spouses employer offers "affordable care" then you are eligible for an subsidy in the Exchange. You can still get coverage through the exchange but the subsidy that may be more expensive then the group plan and both may still be deemed, by you, to be outside your ability to pay the premium.

Counting Employee is another fun exercise that leaves one scratching your head.

Nemont

I think you need to revise this. It should read the spouse would not be eligible for the subsidy on the exchange.

 

[RobG]

I was revisiting this tread because my premium, just for me was $160/month and just went to $196 this month and in Jan I'm told it will go to $270(plan changes in Jan to cover obamacare guidelines...some dental care,sex changes, etc.) I currently use blue cross blue shield. I'm told from others their premiums are increasing as well. What are people doing? Any suggestions on what to do?

Mine are going down even without considering the tax credit. The insurance companies can no longer discriminate so basically if the insurance company formally "thought" you were high risk, your rates will go down.

Here is a calculator I found that will tell you the cost and the tax credit. http://kff.org/interactive/subsidy-calculator/

 

[kansasdad]

I fear one of the I intended consequences of the Affordable Care Act will be the uncoupling on medical and dental coverages. As Big Fin points out, his new exchange moderated plan drops dental and vision coverage. Many employer plans in the past have " thrown in" dental as an add-on, and as a result those standard plans have helped with basic diagnostic/preventive and restorative costs. A whole bunch of people are not going to think about this until they hit the front desk to check out and are asked to pony up their own dough, when they are used to having dental "insurance" covering their entire visits bill.

 

[Big Fin]

I fear one of the I intended consequences of the Affordable Care Act will be the uncoupling on medical and dental coverages. As Big Fin points out, his new exchange moderated plan drops dental and vision coverage. Many employer plans in the past have " thrown in" dental as an add-on, and as a result those standard plans have helped with basic diagnostic/preventive and restorative costs. A whole bunch of people are not going to think about this until they hit the front desk to check out and are asked to pony up their own dough, when they are used to having dental "insurance" covering their entire visits bill.

Just for clarity, my existing policy does not have vision or dental, and I will not have vision or dental in the exchange. I am accustomed to breaking out my wallet when I go to the dentist. Incentive to ration dental care and take good care of my teeth.

 

[exponentialpi]

Mine are going down even without considering the tax credit. The insurance companies can no longer discriminate so basically if the insurance company formally "thought" you were high risk, your rates will go down.

Here is a calculator I found that will tell you the cost and the tax credit. http://kff.org/interactive/subsidy-calculator/

And if you were low risk, rates go up. Reversion to the mean.

 

[sweetnectar]

Fin $1600 per month is greater than my house payment.

Using the calculator Rob G posted it looks like when I calculate my wife and 5 kids I am eligable for assistance big time. I'm not sure I feel the greatest about this. I feel guilty for being a taker as I had some pride that I was making enough yet at the same time I am greatful for the help. I'm not sure the system can handle it but I do hope to have increased income in the future and figure someday the table will turn.

As for dental coverage I got a letter from BC/BS making is sound like dental coverage was manditory. Anyone know if this is true.

 

[Dinkshooter]

I'm getting that sick feeling in my stomach as I read this post. I think it started with the word "subsidy."

Using the calculator Rob G posted it looks like when I calculate my wife and 5 kids I am eligable for assistance big time. I'm not sure I feel the greatest about this. I feel guilty for being a taker as I had some pride that I was making enough yet at the same time I am greatful for the help.

Hmmm looks like it is only a "subsidy" if the other guy takes it.

 

[Nemont]

What was not sustainable before Obamacare?

The system we had in place wasn't sustainable, that is just a fact.

Argue otherwise but the very same people who hate Obamacare are almost always the same once who b!tched the loudest about their premiums prior to Obamacare.

Nemont

 

[Nemont]

I think you need to revise this. It should read the spouse would not be eligible for the subsidy on the exchange.

That is correct but I made a typo but can't edit any longer.

Nemont

 

[Dinkshooter]

Just priced it myself.

Currently $1577 a month with dental. $3500/$7000 deductible.

Exchange $1594 a month with dental $500/$1000 deductible.

But pretty sure I will not qualify as currently my job pays 90% of my prems.

Still failing to see the sky falling on some of this stuff.

 

[Nemont]

Mine are going down even without considering the tax credit. The insurance companies can no longer discriminate so basically if the insurance company formally "thought" you were high risk, your rates will go down.

Here is a calculator I found that will tell you the cost and the tax credit. http://kff.org/interactive/subsidy-calculator/

Way too many variables to make a blanket statement like that. EVERYONE will be different

 

[Nemont]

By going to the exchange, my monthly premium will go down from $1,600 per month to $620 per month for me and my wife. Lower out of pocket and deductibles than the old policy. Both with BC/BS; no dental or vision. Crazy difference.

Big Fin,

I suspect that is the off exchange price because unless you are highly tax efficient your AGI is above the 400% of the FPL for you household size.

Nemont

PS: Everyone 19 years old and younger will have both dental and vision coverage whether off exchange or on exchange, doesn't matter whether it is group or individual either. Dental and vision for under 19 and under is consider essential health benefits.

 

[BigRack]

The system we had in place wasn't sustainable, that is just a fact.

Argue otherwise but the very same people who hate Obamacare are almost always the same once who b!tched the loudest about their premiums prior to Obamacare.

Nemont

I didn't say it was sustainable.

Health costs drive Insurance premiums and Obamacare has done nothing to lower health costs.